“It takes a village to raise a leader”

Women constitute most health workers, yet they hold proportionately fewer leadership positions. The literature is replete with normative advice to address gender specific barriers to women’s leadership; less attention is paid to the processes women undertake on their paths to leadership. We describe the leadership journeys of 23 women leaders in the health sector in Canada, guided by a multi-layered framework of barriers and enablers. A thematic analysis of 11 semi-structured interviews and 13 public presentations on leadership journeys was conducted, which applied a priori and emerging themes to segments of the transcripts using NVivo 12. Three key themes emerged: impetus for leadership journey, enablers to leadership development, and barriers to advancement. Women leaders reported a variety of reasons to embark on their leadership journey from their own desire to make a difference to being tapped on the shoulder by mentors and sponsors. Many of the barriers faced were specific to their intersectional identities where they often juggled the complex demands of gender role expectations, while maintaining personal and familial mental health and well-being. The multi-layered framework of important factors was validated and improved. Better understanding women’s leadership journeys needs to capture processual and structural dimensions.