Box 1: What is the LEADS in a Caring Environment framework?    The LEADS in a Caring Environment Capabilities Framework is a framework that identifies the leadership capabilities needed to effectively lead and manage in the context of Canadian healthcare. What makes the framework unique from other competency/capability frameworks is that the LEADS framework is built on the foundation of CARING – caring for patients, for staff, for providers and for the health of the population. The LEADS in a Caring Environment framework represents the key skills, behaviours, abilities and knowledge required to lead in all healthcare sectors and in all levels of the health system. The framework is made of five key domains: Lead Self, Engage Others, Achieve Results, Develop Coalitions and Systems Transformation, and within each domain there are four key capabilities describing what effective leadership looks like. The framework is designed to show the interplay between leadership and management as both are equally needed to lead effectively in the healthcare sector and is designed to be relevant to all roles in healthcare, be it academic, clinical or administrative. In addition, it represents a ‘distributed leadership’ approach to defining leadership  - that is, it outlines that any  individual —regardless of where they sit in the healthcare system and/or regardless of what  role/title an individual may have — they can lead from where they are. Everyone can play a role in transforming healthcare and the LEADS framework is a model that can be leveraged to enable effective leadership in healthcare.  
 
Box 2: Kegan's Human Development Model (including the Orders of Consciousness) The Kegan Human Development model is a framework that reinforced identity formation as a complex phenomenon that is shaped through experiences. The number and breadth of experiences enables individuals to have and learn how to objectively use these perspectives. Challenges bring about changes in the perspectives that an individual has and their ability to use these in combination to navigate the world around them. The perspectives are first-order or second-order (imperial, incorporative, impulsive), third-order (interpersonal), fourth-order (institutional), and fifth-order (inter-individual). The first- and second-order stages involve a focus on self without acknowledgement of the wants or needs of others. The third-order stage involves an awareness of the needs of self and others. The fourth-order stage involves an acceptance of aspects of self, others, and systems that were formerly rejected, due to the development of self-authorship. The fifth-order stage involves systems-level thinking and the recognition of multiple selves in self and others. This framework conceptualizes human development as an incremental progression through an increasingly complex view of self, others and systems. It is worth noting that not everyone achieves all orders of consciousness.  
We engaged in multiple rounds of discussions via videoconferencing with memo-generation and collaborative conceptual development using cloud-based, real-time interactive documents. Each session lasted approximately one-hour.