[This paper is a commentary on Describing the Essential Elements of a Professional Practice Structure by Sue Mathews and Sara Lankshear.]

The leadership challenges identified by Mathews and the members of the Professional Practice Network of Ontario (PPNO) will not come as a surprise to anyone in a leadership role in healthcare today.

Much has been written about leadership gaps and the challenges for healthcare leaders in building quality practice environments. The sources of the current challenges have been attributed to the "shattered covenant" between leaders and workers arising from an era of downsizing and a resulting loss of trust in leaders (Noer 1993). Porter-O'Grady (2003) states that the role of the leader in the new world is to create congruence by "assuring a sustainable future for the organization" while at the same time "advancing the value and viability of those whose efforts lead to organizational success." He also notes that during periods of significant transition the complexity, time limits and intensity of the work of change are impossible for an individual leader to address alone.