RT Journal Article SR Electronic T1 Transformational leadership capabilities for medical leaders JF BMJ Leader FD BMJ Publishing Group Ltd SP leader-2017-000041 DO 10.1136/leader-2017-000041 A1 David Rooke YR 2018 UL http://bmjleader.bmj.com/content/early/2018/01/23/leader-2017-000041.abstract AB Background/aim This paper summarises and extends information presented at the Lilly Lecture 2017. It is based on the author’s experience and research in working to develop senior leaders in many sectors over the last 30 years. The aim is to provide practical, usable insights into an aspect of leadership capability that is often overlooked in order to enable greater effectiveness in leaders.Methods The paper draws on the author’s own experience, of the research of Harthill and other organisations working with the concepts that have been labelled constructivist development or more lately ‘vertical’ development.Results Research, both qualitative and quantitative, points to the need for leaders to develop the meaning-making capacities to deal with increased levels of complexity and ambiguity. Fewer than 5% of leaders across multisectors are seen to develop these capacities.Conclusion Leaders within the National Health Service are particularly challenged by complex and ambiguous contexts. They need to extend their leadership capacities to be able to lead effectively in such contexts. Leaders today are not being supported to develop these capacities and more needs to be done. There are actions that individuals as well as organisations can take to support this development.