October 15, 2026

Research on women CEOs of Ontario hospitals led in partnership between Proximity Institute and Ivey Business School is challenging stereotypical views of leadership.  

“What emerged in this study is the surprising utility of communal leadership behaviours for women in the Ontario hospital CEO role,” says Dr. Ryan Miller who led the research for his PhD dissertation published in 2025. “People often think of leadership as highly agentic, meaning that it is most often correlated to traits and behaviors such as assertion, confidence, and tactful aggression.” 

Communal leadership, however, is an approach that focuses on collaboration, relationship-building, and empathy. Behaviours associated with this emphasize demonstrating vulnerability, nurturing growing talent, and creating psychological safety. “Given the high relational demands of Ontario hospital leadership, these behaviours are very well suited,” says Dr. Miller.  

Half of Ontario hospital CEOs are women 

For the past several years, women have accounted for more than half of Ontario hospital CEOs – gender proportionate representation at the most senior level of leadership that remains rare in many other sectors. This trend, coupled with post-pandemic research examining the advancement of women leaders during periods of crisis (known as the “Glass Cliff”), and reinforced by the experiences of women hospital CEOs themselves, prompted Proximity to explore women’s leadership more deeply. 

“How did women CEOs rise to the role? What motivated them to pursue the CEO position? And what barriers and enablers did they encounter along the way? These were key questions we were looking to understand through our partnership with Ivey,” says Christine Mitchell, Director, Strategic Research who co-led the project alongside Claire Hefferon Payne, Manager, Leadership Programs. With research interests closely aligned and a personal connection through his wife’s experience as a Registered Nurse in Ontario, Dr. Miller was drawn to exploring the topic alongside Proximity. 

Forty-three women CEOs of Ontario hospitals were interviewed as part of the study, representing 69% of the total at the time. Interview questions centred on the behaviours that contributed to their career advancement, especially advancing to the CEO role. Ten Ontario hospital Board Chairs involved in their appointments were also interviewed. 

Challenging leadership stereotypes 

Results challenged much of the existing scholarly work and widespread preconceptions on how leaders ‘should lead’. 

First, communal leadership behaviours proved to be critical to women’s career advancement. For example, when time came to make necessary yet unpopular decisions, the resulting backlash was mitigated by the consistent use of communal behaviours. “Importantly, this didn’t stem from a calculated enactment of different leadership behaviours,” says Dr. Miller. For the Ontario hospital sector, the findings illustrate “a natural fit story of how these communal behaviours contribute to positive outcomes for strategic choices.” The two approaches are not set in opposition to one another; finding the right balance between communal and agentic behaviours is key. 

Second, value-congruence emerged as a key commonality amongst participants. “They really focused on their organic fit for the role of Ontario hospital CEO. They wanted to solve problems. They wanted to be helpful. They were only willing to pursue the role if it would result in better patient and system outcomes, which is different from the status-seeking motivations you might expect in executive leadership.”  

Dr. Miller also notes the self-reinforcing nature of this communal ascent. Many of the participants indicated that they look for communal leadership behaviours when identifying top talent within their own teams, “which hopefully suggests that our idea of an effective leader is broadening beyond long-held stereotypes,” he says. 

An integrated approach 

“Don’t use a brick if a feather will do,” is Dr. Miller’s takeaway for Ontario hospital leaders. 

Using both communal and agentic behaviours, knowing how and when to apply them, and eventually integrating them were key milestones in the growth of the leaders studied. Further, placing value in communal behaviours and not defaulting to the preconceived, agentic views of leadership is critical to understanding how leaders continuously evolve and thrive.   

Complete findings can be found within Dr. Miller’s PhD Dissertation, supervised by Dr. Martha Maznevski and Dr. Alison Konrad: Communion then Agency: Women’s Ascension to the Hospital CEO Role