To read this content please select one of the options below:

Creating a sustainable model for stroke system change

Elizabeth Linkewich (North & East GTA Stroke Network, Sunnybrook Health Sciences Centre, Toronto, Canada)
Shelley Sharp (Stroke Services, CorHealth Ontario, Toronto, Canada)
Denyse Richardson (Toronto Rehab, University Health Network, Toronto, Canada)
Jocelyne McKellar (Toronto West Stroke Network, University Health Network, Toronto, Canada)

International Journal of Public Leadership

ISSN: 2056-4929

Article publication date: 30 April 2021

Issue publication date: 25 January 2022




The purpose of this paper is to develop an infrastructure and leadership capacity for a sustainable approach to collaborative change in a complex health-care system.


An infrastructure for system change and a mechanism to build capacity for change leadership was developed. This involved (1) using a community of a practice model to create a change community, (2) developing an iterative engagement and change process and (3) integrating collaborative change leadership skills and knowledge development within the process. Change leadership was evaluated using Wenger's phases of value creation.


A change community of 62 members across 19 organizations codeveloped a change process that aligns with Cooperrider's 4D Cycle. The change community demonstrated application of change leadership learnings throughout the change process.


A tailored approach was required to support sustainable transformational change in the Toronto stroke system. This novel methodology provides a framework for broader application to systems change in other complex systems that support both local and system-wide ownership of the work.



We would like to acknowledge Gail Avinoam, Jacqueline Willems and Cate Creede for their leadership and contributions to this work and providing input into the initial stages of the manuscript. We thank Sherry Darling and Sylvia Chan for their dedication and ongoing contribution to this work.

Declaration of interest: No potential conflict of interest was reported by the authors.


Linkewich, E., Sharp, S., Richardson, D. and McKellar, J. (2022), "Creating a sustainable model for stroke system change", International Journal of Public Leadership, Vol. 18 No. 1, pp. 46-56.



Emerald Publishing Limited

Copyright © 2021, Emerald Publishing Limited

Related articles