The role of mission leader appeared in Catholic health care in the 1980s. First filled by religious from sponsoring congregations, the presence of the mission leader assured that, as operational responsibility was transferred to lay leaders, the executive team of a system or facility included an "expert" in issues related to Catholic identity. 

In 1993, 95 percent of mission leaders were religious sisters or priests. In 2013, that percentage had dropped to about 44 percent. The current trend is moving strongly toward a mission role that is held by well-prepared lay leaders. Recognizing this trend early on, The Catholic Health Association (CHA), developed a competency model for mission leaders in 1999 that provided guidance to theological education programs for developing curricula for future mission leaders. 

Over time, the business of health care has become more multifaceted, as has the complexity of integrating Catholic mission and values into health care operations. This reality calls for a broader range of competencies for mission leaders that enable them to influence their organizations at every level and in every business decision. CHA again responded to this reality as it engaged in a collaborative and interactive process of evaluating the 1999 model and revising it to meet current needs. Starting in 2008, working with The Reid Group of Seattle, Wash., CHA engaged the ministry in a series of online surveys, personal interviews and focus groups to understand the challenges, needs and hopes of more than 200 CEOs, sponsors, mission leaders and others. That work was used to create the Mission Leadership Competency Model.