As individuals advance within an AHC, they may often head into a phase where they begin taking on both formally identified leadership roles. This leads to two types of formal leadership: role-based leadership and complexity-based leadership.
Role-Based Leadership. This category of leaders work within the boundaries and mandate of their title. Role-based leaders, sometimes described as formal leadership, often define themselves in relation to other groups via their role. One example is a department chair. This type of leader displays high interpersonal mutuality, a term coined by Kegan to explain how an individual engages with others on a transactional level due to their perceptions of themselves. As a role-based leader identifies with their position they begin to see how to engage with other groups in a mutually beneficial manner. For example, the department chair may be protective of colleagues within the department, preventing another service unit from making unreasonable demands on their time. Those who see themselves exclusively as role-based leaders have an achievement orientation for their team to stand out, defining their own success via the team.  However, this stance may result in challenges when interactions with other groups necessitate coalitions that diminish the leader’s profile. Organizations that force linear and hierarchical accounting or reporting structures may inherently force individuals into role-based leadership stances. Role-based leadership structures confine the role, influence, and accountability of the leader. As well, the creativity and responsiveness of a leader may be stifled by the hierarchical processes of role-based leadership within the complex environment of AHCs.
Complexity-Based Leadership. In the LEADS+ framework, complexity-based leaders look beyond a singular identity to wrestle with and reconcile their multiple roles. Complexity-based leadership acknowledges that people can be “leading from every seat,”47 but also that collective and distributed leadership can be far more advantageous in complex environments.51 These individuals self-author their leadership roles by engaging others across the AHC, identifying issues that cross programs and departments and achieve results via non-competitive wins for multiple groups (including their own). For example, a vice-president of innovation and research integrates their role as a clinician, hospital administrator and university professor to identify an opportunity for the AHC to compete for new governmental funding.  Developing a proposal requires a coalition of various knowledge users that the complexity-based leader connects via their diverse professional network. This leader implements a strategy to pursue innovation funding that leverages common and intersecting needs across the programs and institutions within the AHC
Complexity-based leaders leverage shared commonalities and alignment of values to break down silos and build effective coalitions between traditionally disparate groups. Typically, this type of leader emerges from previously held formal role-based leadership positions. However, complexity-based leaders may also be outside of formal hierarchical structures; they are not limited by titles. Knowledge of organizational structures and processes allows complexity-based leaders to identify non-linear systems outside of regular reporting structures or AHC divisions. Complexity-based leaders tackle big goals beyond the immediate accountability of any one unit, helping the AHC to become less fragile.