Pitfalls and Mitigation Strategies for Dyad Leadership Practice and Implementation in Healthcare.

Dyad leadership (co-leadership between a physician and another clinical, eg, nurse or an administrative leader) is being increasingly adopted in healthcare to leverage diverse competencies required and achieve coherence between administrative and clinical governance. The challenges and success strategies of this model have been described. However, the organizations and leaders struggle with its implementation and actual practice. The purpose of this paper is to describe the pitfalls and suggest mitigation strategies for the practice and implementation of dyad leadership model. The insights were derived through inductive thematic analysis and constant comparison of the "text" that included a narrative review of extant peer-reviewed (PUBMED, MEDLINE, CINAHL, PsychInfo, Scopus) and grey literature on dyad leadership (2000-2025), interdisciplinary perspectives on relevant theories, findings through research in a health region (2010-2011), and reflections on experiences in a dyad leadership role. The pitfalls at the individual and dyad partner level include a lack of "shared" leadership literacy, suboptimal relational dynamics (spurious harmony, not switching switch leader-follower roles, and not allowing time for the relationship to mature), and ineffective collaboration (unresolved role ambiguity, lack of information sharing, ineffective decision-making, and counterproductive actions). At the organizational level the pitfalls are lack of organizational preparation and non-strategic implementation, lack of support for and accountability of dyad leaders, and not selecting the right people for dyad leadership roles. Mitigation involves becoming adept at the required behavioral complexity relying on a deeper understanding of shared leadership, nurturing a mutually valued relationship aimed at collective identity, and leveraging collective efficacy, inter-dependencies, complementary strengths, and positive effects of psychological ownership and territoriality. Strategic organizational implementation includes criteria-based selection, appropriate support and clear accountability mechanisms, and monitoring leaders' behaviors and effectiveness of the model. Navigating these pitfalls would help agency and well-being, fulfilled relationships and effective collaborative work to utilize the full potential of the dyad leadership model.