In our review of the prior literature (both from within and outside of health care), we noted that there was a paucity of frameworks that mapped the developmental journey of leaders. There were many papers that told the story of individual leaders’29–32, how senior individuals might mentor junior leaders33, or health care systems’ developmental pathways journeys throughout a career.34–36 However, most of these frameworks do not explicitly articulate the asymmetric growth of a leader across multiple roles nor stratify their progression via acquisition of more complex leadership capabilities (e.g., within themselves, in relation to small teams, with regards to other organisations and groups, and finally in achieving systems changes or results). For instance, Heifetz’s adaptive leadership approach suggests that a given leader should change and adapt to their context37, but assumes that a leader is at a specific stage within variable contexts and does not provide the insight about how a leader’s roles change over time.
Meanwhile, the meta-leadership framework (developed by McNulty, Marcus and their other colleagues from Harvard)38–40  speaks to the need for leaders who can bridge multiple worlds and work together, especially in times of crisis. The meta-leadership framework was first developed from studying various emergency situations (e.g., Boston Marathon Bombing) and is highly resonant with our complexity-based leadership phenotype. However, meta-leadership does not speak to the versatility of an individual to switch between various types of engagement or leadership and followership in varying contexts, nor does it compare meta-leadership with other stages of development that a leader might encounter on their professional development journey.
Numerous other leadership frameworks have multiple levels (e.g. Collins’ Good to Great five leaders levels41) or loosely describe various stages a leader may experience though their lives (e.g. Joiner & Joseph’s Leadership Agility42), but few models tend to pull together the various aspects of development into a model that expects a health care leader to variably manifest capabilities in different contexts.