There will always be exceptional people in healthcare. The more difficult task is placing their capability where it can have the greatest effect.
Healthcare spends considerable effort developing leaders after appointment. We should be asking harder questions before appointment.
When a healthcare leader struggles, attention usually turns quickly to the individual.
Were they strategic enough? Did they communicate effectively? Could they manage conflict? Did they build trust? Did they adapt quickly enough?
These are reasonable questions, but sometimes they are being asked too late. Because some leadership failures do not begin after appointment – they begin with the appointment itself.
Healthcare has become highly sophisticated at assessing professional achievement. We examine clinical reputation, qualifications, technical expertise, operational results, organisational knowledge and professional standing.
What we are often less disciplined about is determining whether those achievements predict success in the particular leadership role that now needs to be filled.
That distinction matters.
A person can be highly capable and still be poorly matched to a role. And in healthcare, the cost of that mismatch rarely remains confined to the individual.
The problem with promoting for past performance
There is a familiar pattern in healthcare – an exceptional clinician becomes the clinical director; a highly regarded manager moves into an executive role. The person who consistently solves the hardest problems is given responsibility for an entire team.
The logic appears sound: reward strong performance with greater responsibility. But leadership roles are not simply larger versions of the jobs that came before them. They often require an entirely different set of capabilities.
The clinician whose success has depended on personally making the right decision may now need to create conditions in which dozens of other people can make good decisions without them.
The manager who has succeeded through close operational control may move into an executive role where influence matters more than authority.
The expert who has built a career by having the answer may suddenly need to lead situations in which there is no obvious answer at all.
This is why the transition from expert to leader should not be regarded simply as career progression. It is a change in the nature of the work.
Success increasingly depends on the ability to:
- influence without relying on positional authority;
- manage disagreement and conflict;
- develop capability in others;
- operate through ambiguity and complexity;
- make decisions with incomplete information;
- create psychological safety;
- delegate judgement rather than simply delegate tasks, and
- recognise when being the expert in the room is no longer the leader’s most valuable contribution.
The mistake is not appointing talented people, it is assuming that talent transfers automatically between fundamentally different roles.
The more useful question is not ‘who is best?’
Leadership recruitment often asks some version of: Who is our strongest candidate?
But that question is incomplete. The strongest candidate for what?
A leader who is highly effective in a stable, technically complex service may not be the person required to repair a fractured culture.
A decisive turnaround leader may be exactly what an organisation needs during crisis, but less suited to a period requiring consensus-building and leadership development.
A highly collaborative leader may excel in one environment and struggle in another where difficult structural decisions cannot be deferred.
Leadership capability does not exist independently of context. The better question is: who is best equipped for what this role requires now?
That small change in wording produces a very different appointment process.
Related
The AIHE capability-first leadership appointment decision tree
A capability-first approach begins with the work that needs to be done, not with the person waiting for promotion.
1. Start with the role
Before discussing candidates, define the leadership challenge. Ask: What must be different because this person has occupied this role for the next two to three years?
Is the organisation trying to:
- stabilise an underperforming service?
- rebuild trust or culture?
- deliver transformation?
- improve clinical governance?
- strengthen financial performance?
- develop a stronger leadership team?
- manage significant workforce risk?
- integrate previously disconnected services?
- lead through uncertainty or major reform?
If the answer is unclear, candidate selection is already premature.
2. Identify the capabilities the challenge requires
Once the purpose of the role is clear, translate it into observable leadership capabilities.
For example:
If the challenge is cultural repair, look for evidence of trust-building, difficult conversations, listening, accountability and psychological safety.
If the challenge is transformation, look for strategic thinking, influence, ambiguity tolerance, stakeholder alignment and execution.
If the challenge is operational stabilisation, decision-making, prioritisation, performance management and disciplined delivery may matter more.
The capability profile should emerge from the problem the organisation needs solved, not from the CV of the preferred candidate.
3. Look for evidence, not reputation
This is where many appointment processes become vulnerable.
A candidate may be widely respected – they may have an impressive title, they may be clinically outstanding, they may have worked in the organisation for many years.
None of those things should be confused with evidence that they can perform the leadership work required.
Ask instead: Where has this person demonstrated these capabilities before? Not: “Do we think they could do it?” But: “What have they actually done that gives us confidence they can?”
Appointment becomes considerably more rigorous when organisations shift from leadership potential by reputation to leadership capability by evidence.
4. Test the person against the context
Even demonstrated capability is not enough on its own. The context matters.
Consider:
- the maturity of the team;
- the degree of organisational trust;
- stakeholder complexity;
- financial and workforce pressures;
- the political environment;
- the pace of change required;
- the level of clinical risk;
- the authority attached to the position; and
- the organisation’s appetite for disruption.
Then ask: Will this person’s leadership approach work here, now? The same behaviour that creates success in one environment can create difficulty in another.
5. Separate development gaps from fundamental mismatch
No candidate will meet every requirement perfectly. The important question is whether a gap can reasonably be developed.
There is a significant difference between “this person needs greater exposure to finance”, and “this role requires someone who can lead through conflict, and this person consistently avoids difficult conversations”.
The first may be a development need. The second may represent a fundamental mismatch between the person and the work. Good leadership development should stretch capability.
It should not be expected to compensate indefinitely for poor role fit.
6. Make the appointment for the future, not as a reward for the past
The final question should therefore be: Does the evidence suggest this person is the strongest match for what the organisation needs this role to achieve next?
If yes, appoint. If the answer is uncertain, develop further or widen the field. If the answer is no, do not allow seniority, loyalty, reputation or past performance to turn a recognition decision into an appointment decision.
Because promotion and recognition are not the same thing.
The warning signs of a poor leadership match
A mismatch is not always immediately obvious. Often it appears gradually. The leader begins making more decisions personally. Decisions travel upwards rather than being made closer to the work. Capable team members begin waiting for approval. Difficult conversations accumulate. The leader becomes increasingly busy. Operational problems continue despite enormous personal effort.
Eventually, an uncomfortable pattern appears: the individual is working harder while the system is performing worse.
At that point, organisations frequently respond with coaching, mentoring, resilience training or additional leadership development. Sometimes that is entirely appropriate. But leaders and boards should also be willing to ask a more uncomfortable question: Are we trying to develop our way out of an appointment problem?
Healthcare needs more than leadership development
Leadership development remains essential. But development alone cannot compensate for poor selection. The stronger system is one in which healthcare organisations become equally sophisticated at selecting, then appointing, then developing, then supporting, then evaluating leaders.
That starts with changing the purpose of leadership recruitment.
A senior appointment should not primarily recognise what someone has achieved. It should represent a carefully considered prediction about what they are capable of achieving next.
That requires organisations to stop beginning with: “Who deserves the opportunity?” and begin with: “What does the role require, and who has the strongest evidence that they can deliver it?”
There will always be exceptional people in healthcare. The more difficult task is placing their capability where it can have the greatest effect. Because sometimes someone really is the right person.
Just not for this role.
Dr Sidney Chandrasiri is the CEO of the Australian Institute of Health Executives.
This article was first published on the AIHE website. Read the original article here.