Background: There are many health and economic disparities present in border regions of countries. Addressing those disparities in a collaborative manner in the border region is paramount. Leading such border collaborative organizations successfully requires a certain leadership approach. Objective: This research sought to explore what cross border health collaborative leadership approaches were deemed important by current cross border leaders and actors performing cross border work in the US-Mexico and Ireland-Northern Ireland border regions. Methods: A forty statement (8 categories), Likert type quantitative survey was developed with the goal of exploring the importance of leadership themes and or actions in developing and coordinating cross border health collaboratives. The cross border setting (n=159) included the border regions of the Republic of Ireland (IRE), Northern Ireland (NIRE), Mexico (MX) and the United States (U.S.). An exploratory factor analysis was utilized in this endeavor. Results: Upon completion of the exploratory factor analysis the survey instrument was reduced to five categories and 20 statements. The five leadership themes/categories (with Cronbach Alpha measure) that were identified were Communicate to Engage the Collaborative (.77), Steer the Collaborative (.74), Understand the Members of the Collaborative (.69), Manage the Collaborative (.71) and Strategic Relationship Building for the Collaborative .59). The respondents from both border regions agreed on important leadership approaches needed to lead and develop a border health collaborative. Conclusions: An initial/preliminary 20 statement survey instrument was developed with adequate construct validity as well as internal reliability to assist in the exploration of what leadership approaches are important in developing cross border health collaboratives. The findings from this study align with recently published cross-border toolkits from Europe and the US-Mexico border region that describe the manner in which cross-border leaders and actors should proceed in developing and coordinating projects and cross-border collaboratives.