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Exploring the Networking of Academic Health Science Leaders: How and Why Do They Do It?

Lieff, Susan J. MD, MEd, MMan; Baker, Lindsay MEd; Poost-Foroosh, Laya PhD; Castellani, Brian PhD; Hafferty, Frederic W. PhD; Ng, Stella L. PhD

Author Information
doi: 10.1097/ACM.0000000000003177


Effective leadership inspires and coordinates the efforts of individuals and teams toward the fulfillment of collective goals and organizational mandates. In the academic health sciences, current conceptions of leadership revolve around the individual.1 For example, scholarly work has focused on the needs, competencies, and mental models of academic leaders, helping to guide recruitment efforts and inform performance feedback and leadership development.2–9

However, within the broader field of leadership science, we are seeing a shift away from leadership as an individual experience toward leadership as a shared and collective process, which occurs within continually changing social systems.10 Emerging theories capture leadership as a relational phenomenon, situated in specific contexts and involving patterns of relationships among different sets of people that develop over time.11,12 In their discussion of contemporary paradigms of leadership, Lieff and Yammarino note, “These paradigms apply well to the academic health sciences context and their utility needs to be explored and discussed within current academic leadership practice.”1

Alongside these evolving conceptions is a growing interest in the use of social network analysis as a way to explore the relational dimensions of leadership practice. Social networks within institutions are composed of a set of social actors (e.g., department heads, faculty, staff) and the various types of relationships that define their interactions. When viewed as a whole, a social network can reveal nonobvious patterns of interaction that can be highly useful when exploring relational aspects of leadership.13,14

From a social network perspective, leadership involves appreciating global patterns of relations and more specifically, particular ties (connections between individuals) that connect people, to more effectively manage these connections relative to a specific goal, such as instituting an organizational change.15 The extent to which leaders engage in networking activities internally (within the organization) and externally (beyond organizational boundaries) influences individual and group effectiveness as well as organizational survival and growth.14,16–18 Social networks proffer many benefits, including reciprocity between connections, increased flow of diverse information, access to resources, and enhanced understanding of organizational practices.14,19,20 The structure of a leader’s network connections is highly relevant to the leader’s success. In fact, leaders who bridge diverse or disconnected groups are often more effective at implementing significant reforms, while those with cohesive networks are better at instituting minor changes.21,22 Whereas social network analysis has focused largely on the structure and span of leaders’ networks, additional work is needed to elucidate the specific activities and processes engaged when leaders network.

In the business world, Ibarra and Hunter described 3 forms of networking: operational, personal, and strategic.16 However, leadership relational processes are highly situational.10 If we are going to train leaders to be successful within the academic health science context, we must understand the relational, network-based activities of their leadership work within that context—the purpose of the current study. As a first step, we ask, how do leaders engage in networking activities in the academic health science context?


Study design

There exist a variety of approaches for studying networks, including highly computational approaches that are more appropriate for studying quantitative details of networks, such as structure, density, or span.12,13 However, we were interested in understanding the processes at work during leaders’ networking activities. Therefore, we employed a constructivist grounded theory approach and used qualitative social network analysis methods as the elicitation process during semistructured interviews.23–25 Our research team engaged in reflexivity throughout this study, encouraging dialogue during data collection and analysis and continually questioning our own assumptions, the research process, and the developing findings. The research team consisted of an experienced academic health sciences leader and leadership scholar (S.J.L.) and 3 qualitative researchers (L.P.-F., L.B., S.L.N.), 2 of whom (L.P.-F., S.L.N.) are health professionals. All members of the team have experience as educators in the health sciences. This study was approved and monitored by the University of Toronto Office of Research Ethics.


Using purposive and convenience sampling, participants were recruited from the New and Evolving Leaders (NEAL) program at the Centre for Faculty Development at St. Michael’s Hospital, University of Toronto. NEAL aims to develop the capabilities of academic leaders in the Health Science System and consists of three 4-day modules over the course of 9 months, with coaching and web-based distance learning between the modules. Participants are both formal (individuals with official titles) and informal leaders, with faculty appointments in Faculties of Health Sciences or Medicine, locally or beyond, who have been in a faculty position for at least 3 years. For our study, we spoke with 24 academic health science leaders, 16 women and 8 men, who were enrolled in this program from September 2014 until May 2015. They included faculty from medicine, rehabilitation sciences, kinesiology, pharmacy, and basic sciences; 18 were also clinicians. Their ranks included 8 full, 8 associate, and 7 assistant professors and 1 senior lecturer. Although we did not focus on how long they had been in their current roles, few were new to their positions. Those in formal roles included associate and vice deans, chairpersons of university departments, education and research leaders within university departments and university-affiliated hospitals, and heads of clinical departments within university-affiliated hospitals.

Data collection

Initial interviews were conducted in person in September and October 2014, lasted 60 to 90 minutes, and were digitally recorded and transcribed verbatim. To elicit conversations about networks, we drew upon qualitative social network analysis methods,23,24 asking participants to engage in a network mapping exercise during the interview. This mapping approach aimed to capture the participants’ perspectives of their social networks26 and explore the content and dynamics of their networks and networking activities.24 Using participant-generated visuals as an elicitation method during interviews has become increasingly common in qualitative research, including in health professions research.27–29

The network map template included 3 concentric circles (representing the participant’s academic unit, organization, and field or system) and 4 quadrants (representing level of importance of the relationship to them). Positioning themselves in the center of the map, participants were asked to identify who they connect with or who supports them in their academic leadership role, to write the names of these people on their map (nodes) and then draw their connections (ties) with them and among each other as they discussed the nature of each relationship (e.g., why they were important) and the directionality(ies) of the connection. Interviews used a loose topic guide (Supplemental Digital Appendix 1 at to help the interviewer cover key matters of interest and prioritized a dynamic elicitation approach based on network maps. That is, the interviewer asked some general questions about networks and networking but mostly worked from the participant-generated map to elicit understandings and explanations of nodes, ties, and activities related to them. For example, Figure 1 represents a simulated participant-generated network map. In reference to this map, the interviewer may ask, “So I notice you’ve indicated a couple of individuals here (J and G) who are close to you in terms of their work context and very important to your work. Can you please tell me a bit more about that?”

Figure 1:
Participant-generated network map. Simulated example of a network map drawn by one of 24 academic health science leader subjects in a study to explore the networking activities of academic health science leaders at the University of Toronto, conducted between September 2014 and June 2015. Map drawings were used as interview elicitation devices to explore how academic health science leaders network and why. The horizontal axis refers to the academic context of the participant. Quadrants reflect the degree of importance of the relationship. Gray ovals containing letters represent individuals with whom participants have relationships. Unidirectional arrows represent participant-generated relationships. Bidirectional arrows represent reciprocal connections.

Nine participants were theoretically sampled—meaning they were sampled to elaborate and refine our emerging theory25—and thus participated in a second interview. The second interviews were conducted in May and June 2015. At the follow-up interviews, participants used a pen with a different color of ink from the first interview to indicate changes in their networks. Again, the interviewer used the map as an elicitation approach to prompt explanations: “Let’s go back to the people who have shifted. Walk me through why you have moved your department chair into a quadrant representing more importance.” The general topic guide used for the second interview was developed on the basis of our ongoing analysis (see Supplemental Digital Appendix 1 at

Data analysis

Data analysis of interview transcripts occurred alongside and informed data collection. The data were analyzed using Dedoose Version 8.0.35 (2018) for managing qualitative and mixed method research data (SocioCultural Research Consultants, Los Angeles, California). Consistent with a constructivist grounded theory approach, our analysis involved a constant comparative process and was both inductive and increasingly deductive as analysis went on. Two researchers (L.P.-F. and S.L.N.) carefully read and coded the interview transcripts inductively and developed preliminary categories. They paid particular attention to the character and quality of ties and reasons and approaches for initiating, maintaining, or pursuing them. The entire research team met frequently to discuss and refine the developing categories to enhance rigor and relate the developing theory to extant theory (e.g., Ibarra and Hunter’s model). In our late stages of analysis, we reviewed the complete dataset with the goal of identifying and expanding on the relationships between categories, with attention paid to identifying key networking activities.

Given the use of network maps to elicit our 2 sets of interviews, it would be challenging for a reader to take away meaningful insight from a traditional format of presenting excerpted quotations from our interviews without hearing and seeing the connection to the maps. Thus, we decided to represent our data not through excerpts but rather through representative vignettes of networking activities.30–32 As Lingard et al33 note, “a story’s power resides not in its generalizability, but in its resonance, its ability to transport readers to their own … moments and to produce a sense of déjà vu that signals shared social experience and prompts deep reflection.”


We found that academic health science leaders engaged in 4 distinct categories of networking activities: role bound, project based, goal/vision informed, and opportunity driven. These networking activities were influenced by participants’ conception of their role, related outcomes, and perceived leadership work context. In Table 1, we present the representative stories illuminating each category of networking activities in our dataset. We recommend reading these stories alongside the findings described below. The names in the table are not the actual names of the participants or the people in their networks.

Table 1 - Representative Stories to Illustrate Leadership Networking Activities of 24 Academic Leaders From the New and Evolving Academic Leaders Program, University of Toronto, 2014–2015
Networking activity Representative story
Role bound Samuel (Participant 24)a is a recently appointed department chief; he views his role (much to his chagrin) as “putting out fires.” He has a sense of agency in his role; he is trusted to make decisions within his scope. He describes a thoughtful decision to appoint a colleague, Sara, as deputy chief because of her innate leadership qualities and her ability to quickly “get it.” Sara helps him perform his most immediate role, putting fires out, well. In his initial interview, Samuel rarely talks about goal- or vision-informed networking activities. His networking activities revolve around his most immediate duties and “putting out fires.”
We recognized that Samuel had only recently begun in his new chief role, which may be why he tended toward practical, task-oriented networking activities in his first interview. When we interviewed him again later, after he had been in his role for more than a year, he had begun to engage in more future-thinking activities, networking with an eye to succession planning.
Project based Joanna (Participant 3, Interview 1 of 2) has worked to connect people from her past role with new people, who together can support a specific project: the development of a new curriculum. She articulates why she reconnected with a former colleague (for specific expertise) and why she chose her new team for this project. Factors such as expertise, compatible personalities, and shared vision influenced her choices. She also selected people who seemed “on equal footing” to minimize power differentials. She felt that for this particular project, with its focus on getting the curriculum up and running, these factors were of high priority.
John (Participant 7) has dedicated efforts to connecting with a colleague, Paul. John has known Paul as an acquaintance for many years. When John identifies the need to fill a specific role under his purview, he thinks of Paul, reaches out, and hires him into the role of program director. Because of the importance of this role, John’s networking activities do not end there. Quite the contrary, as he continues to support Paul in his new program director role through frequent meetings. While Paul “technically” reports to John, John very much views Paul as a vital part of his network; he relies upon him and supports Paul to fulfill this specific role.
Goal/vision informed Suzanne (Participant 23) has a vision for improved collaboration and clearer shared goals among members of her clinical discipline across the many teaching hospitals in the city. She has thus set a goal of not only connecting with many leaders across these different organizations herself but also having them connect with one another. She accomplishes this goal by reaching out to each leader by phone, making a personal connection herself, then engaging in activities to foster connections among them. She does so by creating newsletters for them to increase their awareness of one another, organizing events at which they can meet, and putting in place structures (including funding) that will enable them to come together productively toward common goals. Suzanne speaks about how she has come to engage in these vision- and goal-related networking activities through a mix of trial-and-error, gut feelings, and now that she is enrolled in the current leadership program, leadership theory.
Opportunity driven Tom (Participant 9) deliberately networks with a hospital executive, Sherri, who has demonstrated some support of and interest in his research. He has known of her for many years but interacted with her minimally at first. Given his broad view of his scope of work, he has had the foresight to build a collegial relationship with her despite her lack of direct oversight over him and his role. While Tom focuses on research and Sherri focuses on patient care, given her high-level leadership position in the organization, her engagement matters to Tom. So, Tom cultivates a positive relationship despite having no specific, immediate, and direct “need” to do so.
At her follow-up interview, Joanna (Participant 3, Interview 2 of 2) speaks more of opportunity-driven networking activities. She recounts a meeting, by chance, at a national medical education conference. At a reception, she finds herself noting the name tag of Sam. She recognizes this name; Sam, she has heard, is very adept at improving motivation of faculty in relation to competency-based medical education (CBME) initiatives. This is something Joanna has been struggling to do with her team. After a heartening conversation, Joanna spontaneously invites Sam to a future retreat with her team (with no planned date!). She notes that she believes that now her team and Sam will interact, that the interaction will be helpful in carrying out the CBME vision, and that this networking activity was not planned but that the connection was driven by Joanna’s recognition of an opportunity relative to a need.
aThe names in the stories are not the actual names of the participants or the people in their networks.

Role-bound activities

Participants framed role-bound networking activities as those required for their day-to-day work and shaped and constrained by participants’ understanding of their formal job description, their position within the organizational structure, and the leadership style of their superiors. Participants’ job descriptions often outlined expectations of engagement in specific activities, such as leading group and individual meetings, to accomplish prescribed work and achieve relevant outcomes. Whether these networking activities were with colleagues, learners, or administrative staff, they were understood to be mandated and essential to fulfilling one’s role. For example, one participant, in pointing to some very important, within-unit relationships on his map, reported:

These are the people I rely on, on a day-to-day basis, to get things done. These are the 3 key people in the unit that help me run it. (Participant 7)

Typically these leadership roles were described in the context of a hierarchical organizational structure such as a department or division. Participants reported to others higher up in the organizational structure and at the same time were accountable for the behavior and effectiveness of individuals reporting to them. Ties were required with these direct reports to ensure expected communication and oversight. Even within these required relationships, participants would manage the strength of their ties; for example, many participants spoke of minimizing the frequency of their interactions within relationships they did not particularly enjoy. Alternatively, they increased their contact and amount of communication with individuals when needed to enhance information flow or gain or provide support.

The degree to which participants controlled their ties within role-bound networking activities varied with superiors’ leadership styles. In contexts in which their superiors operated using a more top-down, directive leadership style, participants often initially limited themselves to relationships that were inherited or to which they were directed. By contrast, in situations in which superiors afforded greater autonomy over their team’s work and decision making, participants felt more agency to choose and develop relationships that they felt were essential for role-effectiveness. For this study, we defined autonomy as the capacity to decide for oneself and pursue a course of action (self-directedness) and agency as the capacity to act independently and to make one’s own free choices (initiative).

Project-based activities

Rather than being defined by a formal job description, project-based networking activities revolved around completing a specific project or fulfilling a portfolio’s needs. Participants would take on a project (voluntarily or otherwise) and identify with whom they needed to connect to see that project to fruition. They would then network to engage appropriate individuals for the project’s leadership or related other roles. Project-based activities required a contextual awareness beyond one’s unit because taking on a new project necessitates familiarity with the system surrounding the tasks at hand. This broadening of the work context enabled identification of relevant individuals. One participant, for example, in describing a committee she formed, commented on engaging people for their unique knowledge or skills:

Because of her expertise, I invited her to sit on my committee, along with X from Department Y. We’re pretty well on an equal footing. But she knows a lot more about theory and that type of thing. (Participant 3)

Relative to role-bound activities, participants perceived a greater sense of agency and autonomy with project-based networking activities. They could more actively and purposefully choose with whom to connect and why. However, their sense of agency and autonomy was not static; this sense shifted depending on contextual factors (i.e., power relations within a project team or departmental resources). We saw participants’ sense of agency and autonomy grow when contextual factors afforded growth. Constraints on this autonomy were imposed by timelines and requirements of the project or portfolio. As such, relationships that are developed as a result of project needs may have an expiry date, usually achievement of the project outcomes or term.

Goal/vision-informed activities

Goal- or vision-informed networking activities involved deliberate engagement of others by participants to facilitate the vision of the organization, their own vision, or a specific academic goal. Participants looked beyond their local unit or organization to include relationships that could help inform, support, or engage in their vision or goals. This quote illustrates well a desire to connect around common goals and vision as the motivation for forging the indicated relationship:

I think in hindsight we had a common interest and common goal moving forward. We were interested in moving the same things forward in supporting the fellows and residents in the same way. (Participant 12)

Participants connected with others for a variety of reasons, including the individual’s content or systems knowledge or their unique network and ties. They felt autonomous and had a sense of agency within the boundaries of what they perceived to be a larger context that was deemed relevant for this work and typically were not constrained by their formal network or job.

Opportunity-driven activities

Opportunity-driven activities focused on developing or maintaining relationships when participants perceived potential for future opportunities. These opportunities were not identified or defined in any specific way; these relationships were considered potentially valuable without any specific agenda. Participants who engaged in these activities had a very broad sense of their context and looked well beyond their unit or organization to the system at large. As a result, their potential to influence or be influenced was much greater because they saw opportunities where someone with a narrower sense of context might not. Participants felt unconstrained in their ability to network opportunistically in ways that were spontaneous (e.g., meeting someone at a conference and pursuing that relationship) or deliberate (e.g., connecting with people in similar roles elsewhere or with a funding agency). In this example, one participant, while pointing on his map to some important people outside his organization, described meeting someone at conferences without any specific goal in mind:

Yeah, there are few that are important outside. I see X a lot at different meetings. He’s very highly regarded in the field that I work in. Actually, I just saw him yesterday. The day before we were at a meeting in China. I think maybe he helped me to promote the type of work that I do. (Participant 6)

How perceptions of roles and work context influence networking activities

As illustrated in our stories and networking descriptions, networking activities of participants are strongly influenced by their sense of autonomy and agency. This sense of autonomy and agency was shaped and constrained by how participants conceptualized their leadership role as well as how they perceived their work context.

When academic leaders take on a leadership position, they first conceptualize the nature of the role and then determine what they need to do to be effective. This conceptualization of their role can minimally be defined by the job description, where one exists. However, there is also an opportunity for the leaders to impose their own views about what is meaningful or essential for the job beyond and within what is prescribed. This step further elaborates their understanding of the role and, in turn, what is required to achieve success.

Perception of work context refers to what participants perceive to be of value or relevant to the work at hand or potential work in the future. Expanding their perception of their work boundaries to include perceived relevant areas confers added benefit through identification of potential relationships that can provide information, exchange, challenge, and support. Although participants may have awareness of a broader context, they do not necessarily consider the extent to which it may be relevant to their leadership role and work thereof. Which aspects of their context are considered relevant can be influenced by several elements, such as their superior’s leadership style and expectations, job description, new project demands, environmental changes, or their own priorities at that time. These relevant aspects of their context for the role become the participants’ perceived boundaries or scope of practice. This perception, in turn, affects their sense of autonomy (self-directedness) and the degree to which they exercise agency (initiative).

Participants’ conception of their role and perception of work context were found to be fluid and flexible, resulting in network maps that were complex, dynamic, and changing over time. The changes expanded on a continuum from day-to-day, task-oriented activities toward longer-term, strategy- or vision-oriented activities, depending on their role focus and perception of relevant context at that time. When this view is expanded, thoughtful and purposeful networking activities are also expanded (see Figure 2). For example, perception of a greater work context results in deliberately developing more relationships to expand their network outward and vice versa. One type of network can also change to another type of network. For example, a leader may strategically develop a relationship that later may shift to become beneficial to a shared project or other initiative. In contrast, a task-specific contact may become useful in enabling the achievement of a specific vision or goal.

Figure 2:
Leadership networking activities of 24 academic health science leaders from a study conducted at the University of Toronto from September 2014 to June 2015. Horizontal axis represents degree to which participants experienced a sense of autonomy and agency in the initiation of their relationships. Vertical axis represents degree to which participants perceived the breadth of the conception of their leadership role and perception of their work context. Graph and shaded area under the graph indicate the 4 types of networking activities that emerged from the qualitative data and their relationship to autonomy and agency and role conception and perception of work context of participants.


The purpose of this study was to advance understanding of networking activities in the academic health science leadership context. Our findings particularly resonate with and build upon 2 sets of extant theory, one from business leadership and one from psychology.

First, our findings align with and further develop Ibarra and Hunter’s model for how new business leaders create and use networks.16 Their model highlights 3 forms of networking: operational, personal, and strategic. Operational networking helps leaders manage current internal responsibilities with the goal of meeting assigned objectives and coordinating people and their work, and it is typically prescribed by job and organizational structure. Personal networking boosts leaders’ personal career development. Strategic networking involves engaging with others within and beyond the organization to marshal information, support, or resources in service of developing and implementing organizational strategy and goals. Ibarra and Hunter note that while many business leaders are adept at operational or personal networking, they must learn to strategically network to be effective.

In our study, role-bound networking was most aligned with operational networking. Notably, this form of networking was constrained by participants’ perception of the requirements or prescription of their job. These ties are essential and independent of the people who occupy the leadership position.34 In contrast, project-based networking, while still related to a task and therefore still aligned with Ibarra and Hunter’s operational networking, was not constrained in this way. Rather, participants were able to define the scope of what was needed relationally, and they networked both within and beyond their organization to meet the project’s needs.

Similar to Ibarra and Hunter’s strategic networking, our participants engaged in goal- or vision-informed networking to define and enact the future activities of the organization. However, they also engaged in opportunity-driven networking, which was future oriented and often serendipitous. In contrast to Ibarra and Hunter’s findings, these behaviors were intended as an investment in future possibilities, and many were unplanned and emergent. Unlike in Ibarra and Hunter’s model, personal networking did not appear as a discrete domain for our participants. When it did occur, it emerged from an existing connection for another purpose. To relate our findings to theirs, we have mapped our findings onto Ibarra and Hunter’s model (see Supplemental Digital Appendix 2 at

Our findings also relate to psychological theories of leadership that focus on how mental structures or patterns of thought (schemas) influence the network relationships leaders initiate, maintain, or modify.15 These schemas represent how a leader makes sense of his or her work context, its boundaries, and the relationships within.35 Internal schemas such as prizing the organization, believing in relational influence, and valuing a pragmatic approach to the work of leadership drive networking agency in newly promoted business managers.36 Similarly, our participants’ agency could be interpreted as influenced by their schemas of the boundaries of the relevant work context and the degree to which certain relationships within that context could serve the organization’s needs. In a professional law firm setting, individual agency in networking reflected the perceived constraints and opportunities of the social structure.37 Individuals’ social position influenced their experience of power and hence networking agency. Our findings linked conception of role to perception of a bounded autonomy, which influenced agency. Our participants networked beyond their role requirements because they felt empowered to do so for a specific purpose. Only direct constraint by a superior could diminish their agency. Perhaps this empowerment occurs because social constructions of hierarchy and power are experienced differently in the academic health science context than in a law firm. Indeed, in the law firm study, the authors did question whether their findings would be replicated in a context “where professional networking is intended to benefit a third party.”37(p728) Agency is also influenced by availability of resources.38 Leaders initiate network relationships because of a perception that their current relationships can’t provide access to needed resources. This resource evaluation may influence the expanded perception of the relevant work context for networking agency that we found.

For any academic leader, there are multiple and changing agendas that must be addressed, from keeping the organization running, to visioning the future, to adapting to emergent demands. Our findings illuminate that leaders’ perceptions of these different agendas and their context influence with whom and how they develop or maintain relationships. Academic leaders must appreciate the importance, necessity, and fluidity of these network relationships to support their work and balance the competing demands of their various roles.


Networking is essential for effective leadership22 because addressing organizational and strategic issues involves relational and not just analytical tasks.16 Our study supports that this relational work is just as relevant for academic health science leaders as any other leader. Our study further illuminates 4 specific types of networking: role-bound, project-based, goal/vision-informed, and opportunity-driven networking. Additionally, the agency and nature of the networking was strongly influenced by the academic leader’s role conception and perception of relevant work context. Our study did not engage common quantitative social network analysis approaches; more research along these lines in our academic health science context may be useful as we build from and relate to growing bodies of such work in other fields.

Next steps

Future work in academic health science leadership could look at the perspectives of others and perhaps engage data collection methods such as focus groups to capture some relational interpretations of leaders’ networking activities. We also suggest additional work more deliberately focusing on how power relations affect networking in academic medicine, in general, and different departments or disciplines, more specifically, building on the work of Casciaro et al in law firms.37 The complex links between formal job descriptions, perceived work contexts, agency, and networking activities require further exploration. In the interim, however, leadership development programs should ensure that participants appreciate the importance of networking and the relationship between their mental models and the diversity of networking options available to them. When leadership development programs strive to support leaders in thinking beyond current job structures, these leaders can in turn reshape job structures for others. Nonetheless, this ironically remains an individual-focused approach to advancing a collective endeavor.


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