E-Paper
Leadership development is not a training; it is systems design
This article is authored by Dr Ayesha Chaudhary, country director, WomenLift Health India.
Prefer HTon Google
Historically, leadership development in health has been built around individual competency; assessing the leaders’ strengths and gaps, building their skills, confidence, communication, emotional intelligence and sending them back to their unchanged institution. These individual focused interventions are simple to design, deliver and measure. They are critical, but they assume that better-equipped individuals will, on their own, change the systems they work in. However, changes that last long and beyond the lifetime of a leader, need re-imagination at the systems design level.
A recent 2021 systematic review and meta-synthesis of multi-sector evidence on organisational interventions on advancing women in health care leadership indicated that leadership development works only as part of wider institutional change, not a stand-alone intervention. It highlights that leaders revert to old ways of doing things once back in their unchanged institutions.
Reimagined leadership development keeps individual competencies as its foundation and builds a new capacity on top of them; systems design; deliberately redesigning how health systems work, within institutions and across the sector. It enables a leader to spot the components within the ecosystem, map their inter-connections and dependencies and enable seamless exchange between them, to result in a whole that is greater than the sum of its parts. It enables the leader to bring in the ‘whole of ecosystem’ approach in action.
For women, leadership development has responded by asking them to adapt, build more confidence, negotiate harder and find a mentor. It has produced remarkable women leaders, who succeeded despite the system rather than because of it. It has not changed the system they returned to. In fact, health systems were not designed to exclude women. But they were designed without them in mind, which often has the same effect.
Reimagined leadership development changes the question. Instead of asking how women can fit the system, it asks how the system can be redesigned. A leader trained in systems design learns to see these assumptions as design choices, and design choices can be changed to redesign new institutions that are conducive. For example, systems re-design within an institutional context specifically, works on five interlocking components of people, policy, practise, place and culture. Leaders with an ecosystem mindset can see the people beyond just their work, such that people can bring their full self to work. They can rewrite policies such as promotion criteria to value impact over career breaks. They can design deliberate practises to enable formal mentoring and sponsorship circles. They can build a safe, decent working place that integrates caregiving support. They can model and drive a culture where both ambition and care co-exist. Such an interaction of the institutional components makes it a healthy and exceptional workplace. So, with re-imagines leadership development, leaders not just grow individually, but also reshape the institution to enable others to grow alongside including both men and women. The effect compounds. Every system a woman leader redesigns becomes an easier path for the next woman to walk. Over time, the exception becomes the pipeline. This is not work for women alone. Every leader trained in systems design, women and men, shares responsibility for building institutions where women can lead. We have spent decades teaching women to lead in systems built without them. It is time to teach leaders to build systems with women in mind.
Systems design for an individual leader equips the leader to drive change beyond themselves. The individual remains the point of learning; the system becomes the point of impact. In WomenLift Health’s 2025 leadership development evaluation report, 67% of its Global Fellows reported contributing to an institutional policy or practise change. Two years after the programme, 90% were still using or sharing what they learned. These results are self-reported, but they point to what becomes possible when leadership development is designed for systems change rather than individual polish.
It is time government and philanthropic funders treat leadership development as part of health systems investment, built into national and state health strategies, workforce plans and budgets, not left to stand-alone training projects run by others. Leadership is infrastructure too. It belongs inside every country’s health strategy, workforce plan and budget, as a permanent investment rather than a periodic intervention. It must be measured not just in individual, but in the system to see if it is still in place five years on. Good infrastructure outlives the leaders who build it, and so does change built into a system. A redesigned institution keeps working after the leader moves on. Like any infrastructure, leadership also connects. In health, research, innovation, policy and delivery each depend on leaders who can see the whole system and redesign the spaces in between.
Therefore, leadership development is important for everything we do but it is not an answer by itself. Leadership should be kept in perspective, as a part of the answer, as a component along with science, politics, economics, sociology, and so on. All these need to work together in addition to policy, regulation, governance and extant best practises. Growth is a complex phenomenon that requires global events to come together with good leadership and create enough human choices for shaping the future. Countries such as India must create both social and capital wealth, and good leadership plays an important role in both. Let us re-imagine leadership development: From individual competency to systems change in health.
(The views expressed are personal)
This article is authored by Dr Ayesha Chaudhary, country director, WomenLift Health India.
