Regionalization has been a major policy experiment in Canadian healthcare. Objectives attached to this policy were ambitious and somewhat unrealistic. Regional health authorities have shown that they can play a useful role in implementing healthcare reform. However, their legitimacy is difficult to sustain, and they need to renew their roles in order to remain a valuable asset in the improvement of healthcare delivery. A model of leadership for RHAs based on content and process dimensions is proposed to support the development of their role in improving the delivery of care. RHAs need to depart from a too distant mode of managing healthcare and support more healthcare organizations in their search for innovative ideas and organizing models and strategies. By adopting such an approach to their roles, it is expected that RHAs will further contribute to the improvement of healthcare and consequently will gain legitimacy to develop more autonomous policies with regard to broad ideals such as democratization and health improvement.

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