Articles

Leadership Equity Through a Full Lens

Healthcare systems are navigating a period defined by workforce shortages, clinician burnout, and shifting patient expectations. In cities like Chicago, these challenges are compounded by long-standing inequities in both health outcomes and leadership representation. Conventional leadership models, prioritizing productivity, financial outcomes, and operational control have proven insufficient in addressing these layered challenges. Emerging evidence suggests that leadership approaches grounded in relational trust, psychological safety, and workforce well-being are more effective in sustaining high-performing systems. The Care: Full Leadership Theory offers a redefinition: leadership not as authority or efficiency alone, but as the intentional practice of care, toward people, systems, and outcomes. Within this framework, equity becomes inseparable from leadership itself, as inequitable systems are often sustained by leadership models that fail to center human experience.

Theoretical Foundation: Care as Leadership Currency

At the core of Care: Full Leadership is a fundamental shift: care is the currency through which trust, engagement, and sustainable excellence are built. Leadership effectiveness is therefore measured not only by outcomes, but by the conditions created for people to thrive. This framework is operationalized through three interdependent precepts:

1.     Compassion as Strategy

Compassion is reframed as a strategic lever rather than a peripheral value. Leaders embed empathy into decision-making, recognizing that workforce engagement and patient experience are directly tied to leadership behavior.

2.     Human-Centered Decision-Making

Policies and operational decisions are evaluated based on their impact on people: clinicians, staff, patients, and communities, rather than efficiency alone.

3.     Healing the Healers

Leadership accountability extends to the well-being of the workforce. Addressing burnout, moral injury, and psychological safety becomes central to organizational sustainability.

Leadership Equity Through a Care: Full Lens 

Reframing Equity in Leadership 

Leadership equity has traditionally been measured through representation. While representation remains critical, recent literature emphasizes that equity must also encompass access to influence, decision-making authority, and supportive environments. According to Adesina et al. (2025), inequities in leadership are sustained not only by structural barriers but also by organizational cultures that marginalize certain voices and experiences. These dynamics are intensified for individuals navigating intersecting identities. The Care: Full Leadership framework expands this understanding by asserting that inequity persists where care is unevenly distributed.

Compassion as Strategy: Addressing Inequitable Leadership Pathways 

Traditional advancement pathways in healthcare leadership often rely on informal networks, sponsorship, and subjective evaluations mechanisms that can perpetuate inequity. Positioning compassion as strategy requires leaders to:

• Recognize and mitigate bias in promotion and evaluation processes
• Ensure equitable access to mentorship and sponsorship
• Evaluate leadership potential through inclusive and holistic criteria

Organizations incorporating structured, bias-aware leadership development processes can improve advancement outcomes for underrepresented groups. Compassion, in this context, is not passive; it is an active, strategic commitment to fairness, recognition, and opportunity.

Human-Centered Decision-Making: Redesigning Leadership Systems

Healthcare organizations frequently prioritize throughput, compliance, and cost containment, often at the expense of workforce experience. This dynamic disproportionately affects individuals in roles with less organizational power. Human-centered decision-making shifts this paradigm by:

• Integrating frontline perspectives into executive decisions
• Designing policies that account for differential impact across roles and identities
• Aligning operational goals with workforce well-being and patient dignity

Hill et al. (2025), found that leadership models incorporating participatory decision-making were associated with improved retention and engagement, particularly among historically marginalized groups.

In healthcare systems, where workforce diversity is high but leadership diversity remains limited, this approach offers a pathway to more equitable leadership ecosystems.

Healing the Healers: Equity in Workforce Experience

Burnout and moral injury are not experienced uniformly across the workforce.  Dzau et al. (2020) highlights that clinicians from underrepresented backgrounds often face additional stressors, including discrimination, isolation, and limited advancement opportunities. The “healing the healers” precept addresses these disparities by positioning workforce well-being as a leadership responsibility. Operationalizing this principle includes:

• Establishing psychologically safe environments where all staff can speak without fear
• Implementing structured peer support and debriefing practices
• Aligning incentives to reward supportive and inclusive leadership behaviors

Importantly, healing is both an individual and systemic process. Without addressing the organizational conditions that drive burnout, individual resilience efforts remain insufficient.

Implications for Executive Leadership

The integration of Care: Full Leadership into executive practice has several implications:

1. Redefining Leadership Metrics

Organizations must expand performance metrics to include:

• Workforce well-being and engagement
• Psychological safety
• Equity in advancement and leadership experience

2. Embedding Care into Governance

Boards and executive teams should:

• Hold leaders accountable for workforce outcomes
• Integrate care-based metrics into strategic planning
• Ensure transparency in leadership pathways

3. Aligning Incentives with Care

Compensation and recognition structures should reward:

• Compassionate leadership behaviors
• Team development and mentorship
• Contributions to equitable workplace environments

4. Scaling Human-Centered Systems

Leaders must redesign systems to ensure that care is embedded in:

• Decision-making processes
• Organizational culture
• Leadership development pipelines

The future of healthcare leadership depends on the ability to integrate equity with organizational strategy. The Care: Full Leadership Theory offers a necessary evolution, positioning care as the central currency through which trust, engagement, and sustainable performance are achieved. Advancing leadership equity requires more than increasing representation; it demands a reconfiguration of how leadership is defined, practiced, and evaluated. By embedding compassion as strategy, prioritizing human-centered decision-making, and committing to healing the healers, healthcare organizations can build leadership systems that are not only more equitable, but more effective. In this model, care is not an adjunct to leadership, it is its foundation.

Author: Jamia Thomas, MSN, NE-BC

References

Adesina, I., Joham, A. E., Hamad, N., Pincha Baduge, M. S. S., Garth, B., Nguyen, T. V., & Boyle, J. (2025). Intersectionality in healthcare leadership: A scoping review on the career experiences of racially and ethnically minoritized women health professionals. International Journal for Equity in Health, 24(1), 245.

Dzau, V. J., Kirch, D., & Nasca, T. (2020). Preventing a parallel pandemic: A national strategy to protect clinicians well-being. New England Journal of Medicine, 383(6), 513-515.

Hill, K. A., Austin, A. W., & Enders, F. T. (2025). Workforce interventions to improve representation in U.S. healthcare leadership. SAGE Journals, 12, 1-17. https://doi.org/10.1177/23821205251333034