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Structure of health-care dyad leadership: an organization’s experience

Anurag Saxena (College of Medicine, University of Saskatchewan, Saskatoon, Canada)
Maura Davies (Maura Davies Healthcare Consulting Inc, Halifax, Canada and Saskatoon Health Region, Saskatoon City Hospital, Saskatoon, Canada)
Don Philippon (School of Public Health, University of Alberta, Edmonton, Canada)

Leadership in Health Services

ISSN: 1751-1879

Article publication date: 23 April 2018

Issue publication date: 17 May 2018




This study aims to explore the structural aspects (roles, responsibilities and reporting) of dyad leadership in one health-care organization (HCO).


The perceptions of 32 leaders (17 physician leaders and 15 dyad co-leaders) in formal leadership positions (six first-level with formal authority limited to teams or divisions, 23 middle-level with wider departmental or program responsibility and three senior-level with institution-wide authority) were obtained through focus groups and surveys. In addition, five senior leaders were interviewed. Descriptive statistics was used for quantitative data, and qualitative data were analyzed for themes by coding and categorization.


There are a large number of shared responsibilities in the hybrid model, as most activities in HCOs bridge administrative and professional spheres. These span the leadership (e.g. global performance and quality improvement) and management (e.g. human resources, budgets and education delivery) domains. The individual responsibilities, except for staff and physician engagement are in the management domain (e.g. operations and patient care). Both partners are responsible for joint decision-making, projecting a united front and joint reporting through a quadrat format. The mutual relationship and joint accountability are key characteristics and are critical to addressing potential conflicts and contradictions and achieving coherence.

Practical implications

Clarity of role will assist development of standardized job descriptions and required competencies, recruitment and leadership development.


This is an original empirical study presenting an integrated view of dyad leaders and senior leadership, meaningful expansion of shared responsibilities including academic functions and developing mutual relationship and emphasizing the central role of stability generating management functions.



This is a self-funded study. There is no conflict of interest to report. The ethics approval for this study was obtained from the University of Saskatchewan Ethics Committee’s Behavioral Board of Ethics and from the SHR. The authors would like to acknowledge the assistance of SHR in conducting this study.


Saxena, A., Davies, M. and Philippon, D. (2018), "Structure of health-care dyad leadership: an organization’s experience", Leadership in Health Services, Vol. 31 No. 2, pp. 238-253.



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