And what kind of health system would actually become possible if we did?
Healthcare has no shortage of metrics. Dashboards, KPIs, performance scorecards, quarterly reports —these are what make up the traditional language of accountability in our sector.
We track budgets, targets, compliance, and waiting times down to the decimal point.
But here’s the question: do these numbers truly capture what leadership in healthcare is meant to achieve?
Think about the leaders who left the deepest impression on you. Not the ones whose names appear in annual reports, but the ones who shaped the way you work, think, and care.
Chances are their impact was felt less in balance sheets and more in trust, culture, and human connection. Yet those dimensions rarely feature when we measure leadership success.
But what if they did?
The limits of the current scorecard
Healthcare leaders are under extraordinary pressure. Budgets are tight, demand is rising, and public scrutiny is relentless.
In such a climate, the way we measure leadership tends to reward short-term results: faster discharges, reduced waiting lists, lower costs. Important, yes. But they tell only part of the story.
When measures are dominated by operational and financial outcomes, they inadvertently shape behaviour. Healthcare leaders double down on activity that “counts” while the harder-to-measure dimensions —like staff wellbeing, culture, and long-term sustainability— often fade into the background.
It’s not because leaders don’t care. It’s because the system signals that these things matter less. And over time, we get the outcomes we measure.
Measuring what really matters
What would it look like if we expanded our definition of leadership success? Instead of asking only whether a hospital hit its targets, what if we also asked:
Did this leader strengthen trust?
Not just in a survey result, but in whether staff feel confident raising concerns, patients feel listened to, and boards feel they’re being told the truth.
Did they shape a culture of safety and learning?
Where mistakes are openly examined, ideas are welcomed, not shut down, and innovation is not punished.
Did they build sustainability into the system?
So that today’s solutions don’t just shift the burden forward for someone else to deal with tomorrow, but create resilience for the years ahead.
Did they support wellbeing?
Not only for patients, but for the workforce itself, because care cannot really be compassionate if the carers themselves are exhausted and burnt out.
It’s important to understand that these are not just “soft touchy-feely” measures. They are the leading indicators of whether our health system is producing what actually matters and whether it can endure.
The bottom line is that a hospital with high trust has lower turnover. A culture of learning and encouragement sees fewer repeat mistakes. A well-supported and psychological safe workforce delivers better patient outcomes.
In other words, the human side of leadership directly underpins, and in fact drives the clinical and financial side.
A different kind of accountability
If we measured leadership differently, the nature of accountability and what it means to be responsible for patient care would shift too.
Instead of a narrow focus on “did we hit the target”, boards and health executives would also be asking “did our leadership strengthen the system and its people?”
Healthcare leaders would be recognised not just for what they delivered, but how they delivered it. Short-term wins that damage trust or burn out staff would no longer be quietly tolerated. Instead, success would mean leaving the organisation stronger, more resilient, and more humane than before.
We’re not talking about discarding traditional metrics altogether. No health system can ignore financial discipline or operational efficiency.
But they need to be held in balance with relational and cultural measures. Because healthcare is not just any other corporate business.
Care and compassion are inherent expectations from the industry. And yet the outputs and outcomes we currently measure do not adequately consider this dimension of healthcare. The “success” of a healthcare organisation is regarded in the same way as any other “business”.
Without this critical balance, we risk building brittle systems that may meet today’s targets but will collapse tomorrow. And unsurprisingly, we already see this playing out across both public and private healthcare sectors in countless examples.
Why now?
The urgency of this shift could not be more great than it is now. Health systems around the world are at breaking point. Workforce shortages, rising chronic disease, aged care demand, post-pandemic fatigue — the list of pressures grows longer each year.
At the same time, leaders themselves are burning out. The role of a health executive today is arguably one of the most complex in any sector: balancing politics, funding, regulation, public trust, media scrutiny, and the sheer human burden of patient care.
In such an environment, the way we measure leadership determines where the energy and attention go.
If we measure only throughput and cost, leaders will spend most of their time chasing throughput and cost. The “human” aspects of healthcare leadership are relegated to the periphery as a “nice to have”.
But if we also measure culture, trust, and sustainability, leaders are incentivised and empowered to prioritise them.
Related
And the interesting paradox is that investing in the “human” side of leadership no longer becomes a distraction from performance —it becomes the foundation of it.
What becomes possible?
Imagine the real-life impact if we started measuring leadership differently.
A hospital CEO might be asked not only about elective surgery wait times, but also about the psychological safety of staff teams. A health board chair might look not only at financial risk but also at whether and how their health leaders are building trust with clinicians. Ministers might be briefed not only on NEAT targets, but also on indicators of staff retention and team morale.
The ripple effects could be profound:
- Leaders would feel they had permission to prioritise culture, not just throughput;
- Boards would reward long-term stewardship, not just quick fixes;
- Staff would see that their wellbeing is not just a slogan, but something leaders are genuinely accountable for.
We might even begin to attract and retain a different kind of health leader. Those who are motivated not only by managing complexity, but by building humane, sustainable systems of care. Just imagine the difference such an approach could make to our healthcare organisations and their cultures.
Rethinking the question
So perhaps the question isn’t only what if we measured health leadership differently, but what kind of health system would actually become possible if we did?
Would we see more leaders willing to invest in adequate staffing numbers, knowing it will count beyond just the financial expense? Would we finally rebalance our obsession with activity against our need for sustainability? Would we elevate the leaders who leave cultures stronger, people healthier, and systems more resilient —even if their names may never make headlines for hitting a target?
That, surely, is the kind of leadership healthcare needs to make the truest impact.
At the core of that type of leadership, is good healthcare governance: the ability to make sound, accountable decisions across complex systems. For health leaders and board directors who want to strengthen this capability, the AICD – AIHE Foundations of Directorship Health Variant program provides a practical grounding in governance — a skillset that is critical for ensuring your organisation leads, rather than lags, in the face of system stress. Register for the inaugural intake in October.
Dr Sidney Chandrasiri is the CEO of the Australian Institute of Health Executives.
This article was first published by the AIHE. Read the original here.