A Framework for Successful Leadership in Health Care

Posted by Katie Moriarty on April 17, 2017

While Sister Ursula shakes up priorities at Nonnatus House, Modern Day Midwife Katie Moriarty looks at what leaders do today to make positive changes.

Editor’s Note: The opinions expressed in this blog post are solely those of the author.

Spoiler Alert: This post discusses events in Call the Midwife Season 6 Episode 3

“Each life is a journey defined by the turns we take and the words we choose or which fate chooses for us. Some travel geographically – trading home for home and one language for another. But we all move from youth to maturity, childhood to parenthood as if we were traversing continents. For worlds shift and the kind that alters safe passage cannot be bought and we have no holy passport to protect us …. And so we venture forward – fragile maps in hand, flying out banners of courage and of hope.”

Episode 3 deals with the ramifications of the push to move women and birth from their homes within their community with their midwives to a medicalized approach within general hospitals. Sister Ursula continues with her 20 minute per client time limit or the midwives face ramifications. Unfortunately, there was a negative outcome which was far from what she had intended. Phyllis Crane explains that the shortened time allows only seeing a patient within the framework of a symptom; however, there is a larger context within community or district based care.

This Modern Day Midwife would like to blog about a white paper written by the Institute of Healthcare Improvement (IHI). The white paper explores high-impact leadership style that embraces qualities that attempt to focus on what we term Triple Aim results. Triple Aim results look to improve care, improve the health of the population, and reduce costs. This is exactly what the Nonnatus house nurses and midwives were engaged in trying to accomplish. Their new leadership (Sister Ursula) only focused on cost with leaving the value base behind.

The Institute for Healthcare Improvement (IHI) is a leading innovator in health and health care improvement worldwide. They seek out innovative models of care, and spread or disseminate proven best practices. IHI is dedicated in optimizing health care delivery systems, driving the Triple Aim for populations, realizing person- and family-centered care, and building improvement capability.

This particular white paper presents three interdependent dimensions of leadership that when combined together define high-impact leadership within health care. The three dimensions are:

  1. New Mental Models for leaders as they redesign care delivery systems to compete on value, rather than on volume, and deliver Triple Aim results for the populations they serve.
  2. High-Impact Leadership Behaviors that when they are aligned with the mental models can accelerate cultural change and support efforts to achieve Triple Aim results.
  3. IHI High-Impact Leadership Framework which serves as a guide where leaders need to focus efforts and resources in order to drive improvement and innovation.

High-impact leadership requires leaders to adopt four new mental models which are individuals and families are partners in their care; we need to compete on value, with continuous reduction in operating cost; the need to reorganize services to align with new payment systems; and lastly that everyone should be focused on improving things. New mental models help to promote innovation.

For high-impact leadership behaviors there are five critical behaviors which are intended to be open ended. The behaviors are being person-centered (be consistently person-centered in word and deed), having front line engagement (be a regular, authentic presence at the front line and a visible champion of improvement), having relentless focus (remain focused on the vision and strategy), being transparent (require transparency about results, progress, aims, and defects), and to think and collaborate across boundaries.

Lastly, the IHI high-impact leadership framework has six domains that leaders are to focus their efforts to drive improvement and lead innovation to achieve Triple Aim results. The six domains are:

  1. The focus should be driven by persons and by the community
  2. Create vision and build will
  3. Develop capability
  4. Deliver results
  5. Shape culture
  6. Engage across boundaries

I found this paper stimulating as it engages everyone to achieve success with the mental models focusing on how we think about challenges and solutions—the leadership behaviors focus on what leaders do to make a difference—and the framework helps leaders see where they should focus their efforts. Take a look here to read more about the Institute for Healthcare Improvement.

“Sometimes there is no map for the road we find ourselves upon …. Lies ahead uncharted, unfurling into mist. We are all traveling through one another’s countries but it is no matter if we meet as strangers for we can join forces and learn to love and where there is friendship and affection THERE is the place we can all call home.”

Image - KatieMoriarty.jpgKatie Moriarty, PhD, CNM, CAFCI, FACNM, RN is a professor on faculty at Frontier Nursing University and a Certified Nurse-Midwife with WSUPG CNM Service at Hutzel Women’s Hospital in Detroit, Michigan. Katie serves on the Board of Directors for the American College of Nurse-Midwives as the Region IV Representative. Previously she was the Associate Director of the Nurse-Midwifery Education Program at the University of Michigan.
Read More About Katie | Read All Posts by Katie


Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. IHI White Paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2013.