Contents
EDITORIAL
Moving into the second quarter of the 21st century
Abraham (Rami) Rudnick, MD, PhD
This winter 2026 issue of the Canadian Journal of Physician Leadership (CJPL) starts with a research article on vicarious trauma of hospital leaders, an important and under-addressed matter. Another article in our Health Economics series shows us how to organize data to improve decision-making. Rural leaders will learn how collaborative care can include specialists under conditions of enduring scarcity when reading the current article in the Rural Leadership section.
RESEARCH
Vicarious trauma among hospital leaders following secondary disclosures: a qualitative study
Astha Patel, BHSc, Simrat Soni, MSc, and Michael Miletin, MD, MSc
Background: The findings of root-cause analyses of critical patient safety incidents are revealed to patients and families via “secondary disclosure” (SD). This process is often emotionally challenging. Although studies have demonstrated the psychological toll of patient safety incidents on frontline health care workers, the impact on physician and non-physician administrators who participate in SD meetings remains unexplored.
HEALTH ECONOMICS
Removing a negative does not always add a positive: how decision analysis can probably help you
Jeffrey S. Hoch, PhD, and Carolyn S. Dewa, MPH, PhD
In this seventh article in the health economics series, we introduce decision analysis to provide leaders with insights when making strategic decisions amidst uncertainty. The additional clarity offered by decision analysis can improve decision-making by organizing evidence to allow better interpretation of the data. A hallmark of decision analysis is a model structure that illustrates what is known (e.g., strategies and types of outcomes) and what is unknown (e.g., a certain future). Results from this type of research help leaders understand what their options are and how to think optimally when making decisions under uncertainty.
RURAL HEALTH LEADERSHIP
Collaborative care in rural health: receiving specialist expertise under constraint
Giuseppe Guaiana, MD, PhD
Rural health systems operate under persistent constraints related to geography, workforce scale, and service redundancy. As a response, collaboration between family physicians and specialists is best understood not only as a discrete intervention but also as an organizing principle for rural health system design. Evidence from collaborative care models, continuity-of-care research, and specialist access initiatives, such as provider-to-provider consultation systems, is relevant to rural contexts. The literature suggests that structured collaboration can strengthen primary care capacity, support continuity, and extend specialist expertise beyond episodic referral-based models.
CSPL COACHES
LEADERSHIP EDUCATION AND TRAINING
Health-promoting leadership as a core competency across the physician leadership education spectrum
Victor Do, MD
Physicians are increasingly expected to lead teams, programs, and health care systems in contexts marked by growing clinical complexity, workforce distress, and persistent inequities. In response, physician leadership education has expanded across the education and career continuum; yet, well-being is often addressed as a parallel concern rather than as a core leadership responsibility. This article advances health-promoting leadership as a framework for understanding how leadership practices shape the conditions for health within medical learning and working environments.
CSPL COACHES
COACHING CORNER
What is Coaching?
Ellen Tsai, MD, MHSc (Bioethics)
Coaching Corner is a collaboration between the Canadian Physician Coaches Network and the Canadian Society of Physician Leaders to highlight the value of coaching for physician leaders, including how they may effectively use coaching skills in their own interactions. In this first article of the series, we begin the journey of a physician leader as they explore how non-directive coaching differs from other resources that can support them in navigating the challenges of their new leadership role.
VIEWPOINT
Otroversion and physician leadership: clinical reflections on independence, authority, and ethical action in medicine
Rami Kaminski, MD
Physician leadership is commonly understood through models emphasizing collaboration, visibility, and group engagement. Although these qualities are often essential, they do not encompass the full range of leadership orientations observed in clinical practice. In this article, I introduce otroversion as a clinically observed personality orientation characterized by resistance to group rituals, norms, and the pressure to conform, with low intrinsic need for group belonging and reliance on internal reference points.
CSPL COACHES
VIEWPOINT
What great teams sound like: reflections on leadership, listening, and performance in health care
Aaron Smith, MD
Contemporary leadership literature increasingly emphasizes the role of teams in delivering performance under conditions of complexity and uncertainty. However, discussions at the point of health system delivery often continue to focus on individual actors rather than on how they function as teams. Leadership scholars have long used music as a metaphor to describe how groups coordinate, adapt, and perform collectively. Drawing on this tradition, and on lived experience playing in a musical group, this viewpoint explores music as a practical lens for understanding what enables effective teamwork in health care.
VIEWPOINT
Leading with integrity: the role of values-based leadership in health system transformation
Alexandre Ngoc Nguyen Teichmann, MD
As health systems become increasingly complex, values-based leadership (VBL) can serve as a guiding framework for ethical and effective decision-making. VBL offers a framework in which leaders align decisions, behaviours, and organizational actions with core ethical principles, including integrity, compassion, and authenticity. This article briefly examines the evolution of value-based health care and the emergence of VBL, to then explore its significance for today’s physician leaders and outline strategies to cultivate this competency in future leaders.
CSPL COACHES
VIEWPOINT
Leadership lessons: decisiveness, listening, and the future of Canadian health care
Ibraheem Almani, MD
Leadership in health care requires decisiveness, active listening, and the ability to balance oversight with empowerment. Insights from the literature and a conversation in 2025 with Dr. Janet Pope, professor of medicine at the University of Western Ontario and former division head of rheumatology at St. Joseph’s Health Care, provide a broad viewpoint on physician leadership in Canada. This article highlights decisiveness as disciplined speed, listening as a foundation of psychological safety, and the ability to zoom in or out as circumstances require.
BOOK REVIEW
The Science of Happiness Workbook: 10 Practices for a Meaningful Life
Kira M. Newman, Jill Suttie, Shuka Kalantari, Norton Professional Books, 2025; Reviewed by Johny Van Aerde, MD, PhD
The Science of Happiness Workbook is a practical, evidence-based guide from the Greater Good Science Center (GGSC) at the University of California, Berkeley. It offers short and actionable daily exercises to develop habits for building happiness and meaning. The 160-page self-help book, based on studies and courses generated at GGSC,1 doesn’t just make promises, it also delivers results by turning research into action in a positive yet realistic way.
