Current pressures on public health systems have led to increased emphasis on restructuring, which is seen as a potential solution to crises of accessibility, quality, and funding. Leadership is an important factor in the success or failure of these initiatives. Despite its importance, health leadership evades easy articulation, and its study requires a thoughtful methodological approach. We used a modified Delphi method in a Participatory Action Research (PAR) project on health leadership in Canada. Little has been written about the combination of Delphi method with PAR. We offer a rationale for the combination and describe its usefulness in researching the role of leadership in a restructuring initiative in “real time” with the participation of health system decision makers. Recommendations are provided to researchers wishing to use the Delphi method qualitatively (i.e., without statistical consensus) in a PAR framework while protecting the confidentiality of participants who work at different levels of authority. We propose a modification of Kaiser's (2009) post-interview confidentiality form to address power differentials between participants and to enhance confidentiality in the PAR process.
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