Mind to Function

Written by Wieteke Idzerda, Occupational Therapist, CRT Therapist

Healthcare leadership in Aotearoa New Zealand is evolving rapidly. It sits at the intersection of system reform, growing population needs, workforce pressures, and an increasing commitment to equity—particularly for Māori and underserved communities. Within this shifting landscape, emerging leaders are being asked not just to manage services, but to reshape them.

This is not leadership as hierarchy. It is leadership as influence, courage, and presence. One of my earlier OT supervisors, always said in the face of anything difficult, have courage. That has stuck with me and I often have to lean on this to get through challenging times.

A System in Transition: Why Leadership Matters Now

Healthcare in Aotearoa is undergoing significant reform, with a stronger focus on equity, integration, and Te Tiriti o Waitangi. Alongside this, demand is rising—driven by ageing populations, chronic conditions, and widening health inequities (Ministry of Health, 2022).

In practice, this looks like:

– More complex clients
– Faster decision-making
– Greater accountability

It shows up in everyday actions: speaking up, questioning, advocating.

Modern healthcare leadership is increasingly understood as relational and distributed, rather than hierarchical (West et al., 2015). This shift is essential in a system that depends on collaboration across professions and communities.

What is Important in Emerging Leadership?

In Aotearoa, leadership is not neutral—it is deeply cultural, relational, and values-driven.

Equity and Te Tiriti o Waitangi
Leadership must actively address inequities for Māori and other underserved populations. This requires more than intention—it requires action, partnership, and reflection (Came et al., 2020).

There have been times where I have had to pause and ask myself: Whose voice is missing here? That question alone can shift practice.

Systems Thinking
Leaders must understand how services connect. Decisions made in one space ripple across the system.

Relational Practice
Trust, humility, and connection matter. Leadership is often less about having answers, and more about creating space for others. Listen, encourage and build up. 

Workforce Wellbeing
There is no sustainable system without a supported workforce. Burnout is not an individual failure—it is a system signal (West et al., 2015).

The Unique Contribution of Allied Health Leadership

Allied health professionals bring something distinct to leadership.

Through an occupational therapy lens, frameworks like the Model of Human Occupation (MOHO) emphasise volition, habituation, and performance capacity (Kielhofner, 2008). These concepts do not just apply to clients—they apply to teams and systems.

– Volition: What motivates our workforce?
– Habituation: What patterns are we reinforcing?
– Performance capacity: Are we enabling people to function at their best?

I often find myself drawing on this lens in leadership spaces—seeing not just tasks, but people in context.

Allied health perspectives are inherently:

– Holistic
– Function-focused
– Collaborative

Yet, leadership spaces have not always reflected this diversity. Strengthening allied health leadership is critical for a system that aims to be person-centred and equitable (Stokes & Moore, 2021).

Perceived Challenges to Overcome

Emerging leaders are navigating a number of tensions:

Workforce Pressure
Short staffing, especially in rural and community settings, creates constant compromise (Ministry of Health, 2022).

System Complexity
Reform brings opportunity—but also uncertainty.

Professional Identity
Many clinicians hesitate to identify as leaders. I have felt this too—that quiet questioning of “Am I ready?” or “Is this my place?”.

Equity vs Reality
We are called to lead equity-focused change within systems that are still catching up.

These tensions are not barriers to leadership—they are the environment in which leadership is forged. Where we can be creative and innovative. Where we can lead change and show what can be done.

The Courage to Make Difficult Decisions

Some of the hardest leadership moments are the quiet ones.

Having to repriortise my day, meaning that I have to change not only my day but someone else’s.
Challenging a colleague when something does not feel right.
Saying no, when yes would be easier.

I remember a moment where I had to advocate strongly for a client’s access to services, knowing it would create tension within the team. It would have been easier to stay quiet. But leadership, in that moment, meant discomfort.

Ethical decision-making in healthcare often involves navigating competing values, rather than clear right or wrong answers (Beauchamp & Childress, 2019).

Avoiding difficult decisions does not protect people—it risks harm.

Backing Yourself as a Leader

Backing yourself is not about confidence all the time—it is about commitment to your values, even when confidence wavers.

There are still moments where I second-guess decisions after the fact. That does not disappear. What changes is the willingness to act anyway.

Leadership identity develops over time, through experience, reflection, and support (Stokes & Moore, 2021). It grows in small moments:

– Speaking up in a meeting
– Trying something new
– Reflecting honestly on what did not go well (and be willing to learn from it)

You do not “arrive” as a leader—you become one.

Sitting with Discomfort

Discomfort is a constant companion in leadership.

– When change is resisted
– When conversations are hard
– When outcomes are uncertain

In Aotearoa, culturally safe practice requires us to sit with discomfort—particularly when engaging with perspectives that challenge our own (Came et al., 2020).

I have learned that discomfort is not something to fix quickly. Dan Carter (a legendary All Black) often spoke about “leaning in” to pressure and discomfort rather than avoiding of it is key. I often reflect on this but sometimes, the most important thing is to stay present:

– To listen
– To reflect
– To not rush resolution

This is not easy work. But it is necessary work.

A Way Forward

Emerging leadership in Aotearoa healthcare is grounded in:

– Equity
– Relationships
– Courage
– Reflection

It is not about having all the answers. It is about showing up—especially when things are complex.

You can feel uncertain, and still lead.
You can feel uncomfortable, and still do what is right.

In a system under pressure, leadership is no longer a position—it is a practice.

And increasingly, it belongs to those who are willing to step forward, speak up, and stay present when it matters most.

Disclaimer: All views are my own and are not attributed to my employer or other organisations I’m affiliated with.

References

Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.

Came, H., O’Sullivan, D., & McCreanor, T. (2020). Introducing critical Tiriti policy analysis through a retrospective review of the New Zealand Primary Health Care Strategy. Ethnicities, 20(3), 434–456. https://doi.org/10.1177/1468796819896466

Kielhofner, G. (2008). Model of human occupation: Theory and application (4th ed.). Lippincott Williams & Wilkins.

Ministry of Health. (2022). New Zealand health system reforms. https://www.health.govt.nz

Stokes, T., & Moore, A. (2021). The future of allied health leadership in Aotearoa New Zealand: A literature review. Auckland University of Technology.

West, M., Eckert, R., Steward, K., & Pasmore, B. (2015). Developing collective leadership for healthcare. The King’s Fund. https://www.kingsfund.org.uk