At a time when healthcare systems are under unprecedented pressure, effective leadership and management have never been more important. Yet they are often among the first functions to be questioned when organisations face financial constraints or political scrutiny.
This paradox formed the basis of the recent WHLNet & ISQua Broadcast, Why Do Leadership and Management Matter in Healthcare? What Do They Actually Contribute?. The session brought together international experts Dr Vijay Agarwal (India) and Dr Laura Desveaux (Canada) to explore the role leadership and management play in delivering safe, high-quality, sustainable healthcare.
A paradox at the heart of healthcare
Opening the session, moderator Prof Anurag Saxena (Canada) highlighted a familiar tension experienced across health systems worldwide. Public discourse often characterises healthcare managers as bureaucratic “paper-pushers” whose work diverts resources from frontline care. At the same time, healthcare organisations are being asked to respond to growing demand, workforce shortages, financial pressures and rapid technological change—challenges that require increasingly sophisticated leadership and management.
The discussion centred on two questions:
- Why do leadership and management matter in healthcare, and what do they actually contribute?
- If they are so important, why are they so often portrayed as unnecessary or even harmful?
Rather than defending leadership and management uncritically, the speakers acknowledged that poor design and delivery of these functions can create unnecessary administrative burden, undermine trust and stifle innovation. However, they argued that effective leadership and management are essential to building organisations capable of consistently delivering high-quality care.
Leadership becomes visible when systems fail
Dr Vijay Agarwal opened the discussion with a powerful observation:
“When healthcare goes well, leadership is invisible. When healthcare goes wrong, everybody suddenly discovers administration—and blames it for everything.”
He argued that modern healthcare is a complex adaptive system, not a simple machine. Success depends not on individual effort alone but on the ability of entire organisations to coordinate care, learn from experience and continuously improve.
Leadership, he suggested, creates the conditions that allow clinicians to deliver excellent care by:
- establishing a clear vision and organisational purpose;
- creating cultures of safety, learning and accountability;
- enabling collaboration across professional and organisational boundaries;
- investing in people, capability and continuous improvement; and
- ensuring that decisions are guided by evidence and patient needs.
Rather than viewing management as administration removed from patient care, Dr Agarwal described it as the infrastructure that makes high-quality care possible.
Beyond the leadership versus management debate
One of the recurring themes throughout the broadcast was the false distinction often drawn between leadership and management. Both are tools of administration: the process of “dispensing, giving, or applying something” to the delivery of health services.
Leadership is frequently associated with vision and inspiration, while management is portrayed as bureaucracy and control. The speakers challenged this simplistic narrative.
In practice, effective healthcare leaders must also manage people, resources and systems, while effective managers must provide leadership by supporting teams, navigating complexity and enabling change. High-performing organisations require both capabilities working together.
Building organisational capacity
Drawing on Canadian experience, Dr Laura Desveaux explored how leadership contributes to organisational capacity rather than simply organisational hierarchy.
She emphasised that today’s healthcare challenges—including digital transformation, workforce sustainability and integrated models of care—cannot be addressed through technical expertise alone. Organisations need leaders who can build relationships, foster trust, engage clinicians and patients, and support teams through continual change. During the questions and answers component of the program, Laura emphasized that the true challenge of leadership is for people to ‘understand who they are’—i.e., the hard work of introspection–which differentiates it from mastering the outward work of logistics management.
“It’s not an either or”, she stated. “There’s context. There are times when you need people to step in, manage, steer more actively. But if you have that in the absence of creating the conditions for autonomy and success…(leadership)…you’re not going to have…high performance”. Leadership is less about exercising positional authority and more about creating the conditions in which improvement becomes possible.
Why leadership is often misunderstood
The panel also reflected on why leadership and management continue to receive criticism despite their importance.
Several factors contribute to this perception. Leadership and management work:
- often happens behind the scenes and becomes visible only during times of crisis;
- can become disconnected from frontline care if they are poorly designed;
- is often, in public and political debates focused on reducing their costs without recognising the value these roles provide; and
- often prevents problems before they occur, making its contribution difficult to measure.
The speakers stressed that the solution is not simply “more” but “better” leadership and management that remain closely connected to patients, clinicians and organisational purpose.
An engaging global conversation
Participants contributed throughout the session via live polling, discussion and questions, highlighting that these challenges are shared across diverse healthcare systems.
Despite differences in national contexts, there was broad agreement that healthcare organisations need leadership and management that is evidence-informed, collaborative and focused on enabling high-quality care. As healthcare continues to evolve, leadership and management should be recognised not as competing with clinical care, but as essential partners in creating the systems that allow clinicians to succeed.
The broadcast concluded with a clear message: effective leadership and management are not optional extras. They are fundamental capabilities that help healthcare organisations navigate complexity, support their workforce and continuously improve care for patients and communities.
If you missed the live session, a recording is available through ISQua’s resource library – https://login.isqua.org/resources/whlnet-and-isqua-broadcast-why-do-leadership-and-management-matter-in-healthcare-what-do-they-actually-contribute. Please note that you must log in as an ISQua Guest or Member to access.
