Holding the Complexity: Dr. Hasan Sheikh on Adaptive Leadership in Substance Use Care

As a guest speaker in Harvard Online’s Adaptive Leadership course, Dr. Sheikh brings these complexities into focus—from his work in a busy emergency department to his role shaping substance use care across Ontario.

From the Emergency Department to Provincial Leadership

Dr. Hasan Sheikh is an emergency and addiction medicine physician at Toronto’s University Health Network (UHN), where he serves as the first Medical Lead for Substance Use Services. He is also the Provincial Clinical Lead for Substance Use Disorders at Ontario Health’s Mental Health and Addictions Centre of Excellence. 

Beyond hospital walls, he has been a visible advocate for practical, evidence‑based tools like naloxone distribution, arguing that failing to get overdose‑reversal kits into the hands of people who use drugs, their families, and frontline providers was contributing to preventable deaths. (vancouver.citynews.ca) 

Underpinning this clinical and policy work is training in public administration from the Harvard Kennedy School, where he focused on leadership and systems change in public health.

Technical vs. Adaptive Work in Substance Use Care

Dr. Sheikh’s story shows how a single ER doctor can help to change a system and lays out a crucial distinction that sits at the heart of the Adaptive Leadership course: the difference between technical and adaptive challenges.

On the technical side, if someone with opioid use disorder stops using opioids, there are clear tools:

• Evidence‑based medications
• Standardized protocols
• Systematic ways to relieve withdrawal and taper physical dependence over time

These are critical, and they can be taught, measured, and implemented through guidelines and training—what adaptive leadership would call technical work.

But then there’s everything those protocols can’t touch. “That’s not going to be the full solution to help people who use substances,” Dr. Sheikh explains. The bigger work involves:

• Confronting stigma and moral judgments that still shape care
• Redesigning services so people aren’t repeatedly revolving in and out of the Emergency Department without getting the help they need 
• Challenging long‑standing assumptions among clinicians, policymakers, and the public about what addiction is and who “deserves” care

These challenges require system changes where people strongly disagree on the best path forward. These are adaptive challenges—problems that require shifts in beliefs, relationships, and ways of working, not just new protocols.

Being “Happily Uncomfortable”

One of the most powerful leadership lessons Dr. Sheikh offers is what happens when you actively surface different perspectives in this space.

“One of the things I’ve noticed in doing this adaptive work and surfacing these different perspectives,” he says, “is that the perspective that I hold gets challenged every day that I do this work.”

Instead of resisting that, he has learned “to be kind of happily uncomfortable with that.” To sit with feedback, even when it disrupts his own certainties. What allows him to inhabit that tension, he says, is a grounded confidence that he is “doing things for the right reasons” and keeping “the person at the center” of the work.

This is classic adaptive leadership: inviting dissent instead of shutting it down, treating discomfort as data about the system, and staying open to being wrong.

A Long, Non‑Linear Road

Another theme he emphasizes is time. “The road for this type of work is long,” he reflects. “It takes time. You never know when you’re gonna get agreement, when you’re not, when your interventions are gonna work and when they’re not.”

He describes the frustration of feeling like you’re going backwards, having the same conversations, running into the same resistance. But instead of framing that as failure, he reframes it as diagnosis. If you’re stuck, it “just means that there are perspectives that you haven’t elicited, that you haven’t addressed, and more work that you need to do.”

Why His Story Matters for Adaptive Leadership Learners

Harvard Online’s Adaptive Leadership course is built for people working on problems exactly like this: issues that are technically solvable in pieces, but fundamentally adaptive in their roots.

Through Dr. Sheikh’s story, course participants can:

• See the technical/adaptive distinction in action in a high‑stakes, real‑world domain
• Explore how to lead change when your own perspective is continually challenged
• Learn what it looks like to keep people with lived experience at the center of system redesign
• Grapple with the emotional reality of long, non‑linear change efforts

Watch the clip with Dr. Sheikh below, then explore how the Adaptive Leadership frameworks can help you in your own context—whether you’re working in health care, public policy, nonprofits, or any field where the challenges are complex, contested, and human at their core.