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This paper aims to examine the benefits and challenges of enacting cross‐sector alliances as a strategy to meet the health leadership capacity and capability requirements to effect improvements in health service delivery.

The findings originate from two case studies of cross‐sector alliances in Canada.

Value generated by strategic alliances in health with organisations from public, private and civil sectors is accrued at the inter‐organisational, organisational, group and individual level. Obstacles related to mindsets, operations and governance guiding the partnerships were identified which further an understanding of the advantages and constraints for using cross‐sector alliances as a strategy for large‐scale health leadership development.

Future research could investigate whether other factors influence the overall success of using an alliance strategy which may lead to a more comprehensive understanding of large‐scale health leadership initiatives. Given the universal health care context of this study, the results should be examined for their generalisability to other contexts.

The results urge decision‐makers to develop the mental models, behaviours and processes that support the use of cross‐sector alliances to achieve practical benefits gained through large‐systems health leadership development that may otherwise be unattainable.

This paper responds to the needs of executives by investigating alliances among health, education, business and government as a strategic driver for building the health leadership capacity and capability needed for implementing health reform.