Distributed ISD projects are often typified by deepseated differences between team members from diverse organizational and professional backgrounds. Consequently, literature suggests that cohesion is crucial for aligning the efforts of a distributed ISD team; however, a competing body of literature also asserts that conflict is essential for capitalizing on diverse knowledge flows. Team leaders can therefore face a conundrum around how to balance the paradoxical need for both cohesion and conflict. In this paper, we develop a theoretical framework to analyze case study findings from the 'CDSS project', a distributed ISD project undertaken in an Intensive Care Unit (ICU). We find evidence that distributed ISD leaders must adopt a 'paradox mindset', one which embraces both cohesion and conflict. Based on these findings, we also put forward the concept of 'leadership intelligence' which describes the simultaneous enactment of a diverse set of leadership styles for balancing constructive cohesion and conflict.