Our Sector Yearns for Better Leadership - and That Gives Me Hope

Something happened recently that stopped me in my tracks.

My book, Leading Above the Line, has now reached over 5,000 leaders.

When I wrote it, I expected it to land with a relatively small audience of people already interested in leadership development. I did not expect to now be ordering another 1000 books on top of the 5000 already printed over the past 5 years. And what has surprised me even more is that the book has found its way well beyond healthcare, into education, government and corporate settings.

This isn't a story about a book, though. It's a story about what 5,000 copies tells us about the state of leadership in our sector right now.

The gap no one talks about enough

Here is a tension I see constantly: we are a sector built on evidence-based practice. We train for years to develop clinical and technical expertise. We are regulated, accredited and held to high evidence-based standards of care. And yet, when it comes to how we lead people, I hear of many practices that are the antithesis of what the evidence says.

Think about it. How many years did we spend in formal training to do clinical or technical work? Now compare that to the formal training we received to lead a team, manage performance, give feedback, or create psychological safety.

For most leaders I work with, the contrast is staggering.

Research confirms this pattern across healthcare systems globally. A 2024 study published in BMC Health Services Research found that university education has scarcely provided health professionals with adequate management competencies, and that management training programs have become essential to prepare professionals for the leadership demands they face (Giovanelli et al., 2024).

The gap between clinical expertise and leadership capability is not a personal failing.

It reflects how our systems have traditionally trained clinicians for technical excellence without equipping them for the managerial and organisational responsibilities they are later expected to carry.

The cost of leaving this unaddressed

When leaders are underprepared, it doesn't just affect them. It ripples outward. Teams lose psychological safety. Supervision becomes performative rather than developmental. Feedback focuses on what people are doing wrong rather than what you want to see. The weight of constant urgency replaces the space for reflection, and talented clinicians disengage or leave.

I have seen brilliant clinical experts promoted into leadership roles and left to figure it out through trial and error. Some do remarkably well. Many carry an invisible burden of self-doubt, wondering why leading people feels so much harder than the clinical work they trained for.

Does this resonate with you?

What 5,000 leaders are telling us

What I have learned from the conversations, emails and training rooms over the past few years is this: leaders across our sector are actively seeking something different. They want to move from managing crises to creating the conditions for their teams to thrive. They want to lead from grounded clarity, not reactive exhaustion.

The hunger is real, and it is not limited to one discipline or setting. Leaders in community health, hospitals, schools, government departments and corporate environments are all grappling with the same core questions:

• How do I lead myself well enough to lead others?

• How do I help my team deliver high clinical standards of care in this chronically underfunded context?

• How do I build a culture of learning rather than blame?

• How do I create psychological safety when the system around me feels unsafe?

• How do I sustain myself while giving so much to others?

These are not soft questions. They are the sharp edge of what determines whether a team thrives or merely survives.

Leadership is a lifelong practice

If there is one thing I would invite you to sit with from this newsletter, it is this: leadership is not a destination you arrive at when you get the title. It is a practice, much like clinical practice, that requires ongoing learning, reflection and skill development.

John Dewey said, "We do not learn from experience. We learn from reflecting on experience." This is as true for leadership as it is for clinical work. Yet how many of us create deliberate space to reflect on how we are leading, not just what we are delivering?

Here are some questions worth considering:

• When did you last invest in your own leadership development with the same rigour you would apply to clinical training?

• What leadership behaviours are you modelling that you would want your team to mirror?

• Where might you be operating on autopilot, relying on instinct rather than evidence-based leadership practice?

• If your team described your leadership style honestly, what would they say?

The invitation

Five thousand copies didn't change a single workplace. People did. People who picked up a framework and started asking themselves harder questions. People who chose curiosity over defensiveness, and learning over proving.

Our sector yearns for better leadership, and that yearning is not a sign of failure. It is a sign of readiness. The question is: What will you do with yours?

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