Leadership challenges in hospitals around the world (insights from the YEL Alumni)

Date:  21 December 2023

An article produced by members of the IHF’s Young Executive Leaders Alumni network.


Hospitals are some of the most complex organizations in the world. But despite funding, language, and cultural differences, challenges faced by hospital leaders around the globe are often the same. Common difficulties such as funding gaps, system fragmentation, communication failures, and health human resources issues impact the daily work of hospital leaders and call for efforts to find local solutions to global problems. Being a healthcare leader requires preparation and resilience – much like qualifications for areas with very specific approaches, protocols, and policies in other sectors of society. In addition to hard skills (like financial analysis), soft skills (like emotional intelligence) are needed, and must be particular to the environment and performance profile of the organization.

The World Health Organization, through its global strategy on health human resources entitled Workforce 2030, is clear in stating that health and development goals in the coming decades will only be achieved through motivated and trained health professionals. According to this document, a “simple” prescription for healthcare managers is to: (1) focus on clinician wellbeing, (2) ensure complete and well-adjusted teams, and (3) recruit well. A robust workforce of motivated, engaged and committed healthcare professionals is essential for a sustainable healthcare system and integral to tackling leadership challenges like those outlined above. Here is a consolidated list of simple takeaways for healthcare leaders anywhere in the world.

  • Where possible, ensure that healthcare payers, in addition to the clinical delivery team, are invested in positive patient outcomes and experience.
  • Be open to innovative solutions for closing funding gaps.
  • Consider the entirety of the patient journey.
  • Look to global leaders to learn about value-based healthcare (VBHC), and consider implementing VBHC in your health system.
  • Allow more time for study and development.
  • Invest in communications training at both frontline and leadership level.
  • Undertake ongoing training, paying particular attention to the development of soft skills, in addition to knowledge updates.
  • Consider realistic long-term labour market availability, strategize internal upskilling, and consider building sustainable training pathways via vocational programming.
  • Prioritize succession planning and consider uncoupling performance management and career mapping.

Leadership in the hospital sector is extremely challenging and requires increasingly competent professionals to work in this setting. Globally, hospitals have more in common than they have differences. And so it is useful to compare perspectives and share lessons across borders. From funding challenges to system fragmentation, personnel gaps to communication problems, health executives around the globe can support one another as each works towards the same goal – helping people achieve better health. In this article, we discuss common health sector challenges and provide reflections to help leaders and professionals working in hospitals attain a global view of these scenarios. Spanning Europe, Africa, North and South America – these ideas are described through the perspective of members of the IHF’s Young Executive Leaders Alumni network.

Inadequate health sector funding

In many parts of the world, health systems struggle to match resources to the care that is needed. Countries in southern parts of Africa indicate that most governments have struggled to allocate adequate resources towards health. Data from the World Bank’s World Development Indicators shows that during the period 2011‒2015, the Southern Africa Development Community (SADC)’s total health expenditure as a percentage of gross domestic product (GDP) was around 6.4%, compared to 15% committed in an Abuja Declaration in 2001. As some African countries fare better than others, this presents a healthcare accessibility challenge in the region, which in turn causes hospital leaders to initiate moves to compensate for the public funding gap.

In some cases, private healthcare players seek to find ways of bridging the funding gap. For example, Africa has seen the introduction of public–private partnerships (PPPs), which allow fundraising from private sources (or even other developmental finance institutions) to complement government budgets.

In some areas, there has been marked proliferation of private healthcare players – growth that is aimed at making up for the lack of public system capacity. However, there is still a system gap; that of the payer. If individuals do not have the capacity to finance their own treatment, the problem of the undersized system persists.  Many private hospitals have started to collaborate one way or another with private healthcare funders or insurance companies. This collaboration has in some cases presented an ethical leadership dilemma for hospital leaders due to conflicting objectives of the parties – the hospital aims to treat people to their satisfaction with good quality results, while the healthcare funder (who may be in the controlling seat), is endeavouring to pay as little as possible in claims. The balancing act of leading in a changing system requires great analytical skills, tact, and emotional intelligence.  It has become imperative for leaders to push a deliberate relationship management strategy and justify patient experience as an agenda for all stakeholders.

Healthcare industry fragmentation

Fragmentation is another common problem. The fragmented structure of the healthcare sector in many countries has left serious leadership responsibilities on healthcare leaders of tomorrow if they are to deliver effectively on patient and carers’ experience. In countries like Zimbabwe, hospitals, clinician-led diagnostic services (like pathology and radiology), and healthcare funders operate as entirely different entities. While all of them claim to be looking out for the best interests of the patient, no one is deliberately responsible for the holistic patient experience. This fragmentation has resulted in high cost to the patient, often adverse patient experience, and an inefficient overall system (with duplication of effort and uncoordinated processes).

To combat fragmentation, it has become important for hospital leaders to be deliberate about mapping patient journeys and placing all services delivered to the patient in one care pathway (even if component ownership is different). In some organizations, global billing has been introduced successfully – this is the practice of costing end-to-end patient services. It can result in a more coordinated effort when serving the patient, as well as thoughtful consideration of whether the total bill is fair for the patient.

In laggard markets where access to healthcare is an issue, there is an opportunity for healthcare leaders to apply the basics of value-based healthcare. In this approach, payments are based on actual value delivered (or patient outcomes), as opposed to a standard fee dispensed for specific services rendered. Hospital leaders should invest more time considering how to make value-based healthcare a reality – in the interest of treating patients fairly, promoting quality outcomes, and finding efficiencies in a stretched system. Significant strides have been made in this area in Australia and parts of Europe. The Australian Centre for Value-Based Healthcare and the VBHC Centre Europe have been instrumental in driving this agenda and could be looked at as lead agencies on this important topic.

Failures in communication

Another significant challenge in hospital leadership is the lack of widescale standardization and protocols enabling effective professional communication. As is evident in Brazil, different geographical locations, diverse areas, and distinct educational programmes give rise to unique sets of professional terms. Additionally, communication acumen varies greatly among professionals conducting administrative versus care activities on health units.

Upon hire, healthcare teams should undertake mandatory communications training. Communications onboarding programmes could be aimed at developing a common language, building culture, and improving interpersonal relationships. Its result would be higher quality, standard processes that positively impact team dynamic, as well as patient safety.

Leaders are fundamental to this change: being the example of good communication and contributing to the alignment and standardization of processes across areas can transform hospital teams. When there is a failure in communication by the strategic or tactical levels of a health organization, it negatively impacts all hospital activities. This can result in oscillation in both staff and patient satisfaction; therefore, investing in strategies to strengthen the communication skills of leadership throughout the hospital hierarchy is, in turn, an investment in great management.

Health human resources shortage

The global health human resources shortage is well documented by the World Health Organization and has reached unprecedented levels. Hospital leaders all over the world now find themselves in a situation where they simply cannot deliver enough care because of this crisis. While the shortage was predicted on the basis of population growth years ago, because of the added stress of the COVID-19 pandemic, many health professionals have considered leaving or indeed have left the profession, leaving untenable gaps within their organizations. Consequently, countries that can afford to have begun poaching carers from countries that can afford less. One can argue that this is a short-term solution to a long-term problem (not to mention globally inequitable). Hospital leaders all over the world must think of more sustainable ways of ensuring the supply of healthcare professionals in their own countries is more deliberately managed.

Sponsoring training in some of the critical professional skills (for example, intensive care nursing or operating theatre support) is one idea. In this model, hospital institutions themselves would front the cost of micro-upskilling base-level trained staff to attract, retain, and grow talent internally. Healthcare leaders today should also consider developing entirely new funding partnerships with vocational training schools that can directly increase the pool of much-needed clinical health resources.

Lack of succession planning

Related to the health human resources crisis is the problem of poor succession planning. This problem is not new; organizations all over the globe have long cited succession planning as a thorn – particularly in healthcare. Hospitals are so busy with day-to-day urgencies that proactive human resources planning is often put on the back burner. It makes sense – if you think about medical training, clinicians are explicitly taught to deal with the most important, most vulnerable cases first. Triage is core to how hospitals operate; it is a notion that is woven into the fabric of our identities. And so, thinking long-term about individuals’ career trajectories and retirement plans feels like less of a burning platform than the sick patients at our door.

This is true for both frontline roles and executive leadership strata. In his 2006 article entitled View from the Top: CEO Perspectives on executive development and succession planning practices in healthcare organizations, Kevin Groves quoted “Healthcare CEOs are too pressed by the day-to-day challenges and financial pressures of running their organizations to invest time in sorely needed development of future leaders”. Station aside, failure to cope with predictable attrition is detrimental to any institution.

While this is a longstanding difficulty, lack of adequate succession planning is hurting hospitals a lot more today. With an ageing population and a limited labour market (from which to replace retirees and career changers), today’s health human resources crunch is a real problem that poses serious safety risks to patients (Ghafoor et al, 2021). During and following the COVID-19 pandemic, many hospitals offered incentives for soon-to-retire staff to stay on a little longer. Others used incentive schemes to bring talent back from other areas. Those programmes were short-term solutions that will soon cease to help and it is imperative that hospital leaders think critically about removing barriers to undertaking proper succession planning.

Here is one idea: often, organizations utilize employee performance appraisals to have conversations about succession. In some Canadian institutions, human resources advisors recommend uncoupling these two topics. Not only can the rigidity of a current-performance conversation stifle the creativity that inspires mapping longer-term career trajectories, but the inherent confidentiality of a performance appraisal can also hinder the robust data capture needed in succession planning. Beyond that, many organizations struggle to get through performance appraisal cycles more often than every 3–5 years, which simply does not enable adequate workforce planning. Leaders today should try to implement more frequent, nimble, and informal succession planning touchpoints with direct reports. Leveraging their strong internal communication skills (acquired through the training noted above!), leaders should be able to create a safe environment for transparent career planning.

Summary of considerations for healthcare leaders

Hospitals worldwide grapple with complex challenges that profoundly impact the roles of their leaders. These challenges require tailored solutions for the healthcare sector. Leading health units demands extensive preparation due to the unique protocols, policies, and soft skills required for effective communication. Despite the importance of succession planning, hospitals often prioritize immediate concerns over long-term HR strategies, impacting both frontline and executive roles. The ageing population and limited labour market intensify this concern, underscoring the need for innovative approaches.

Inadequate healthcare funding poses another hurdle, particularly in regions like southern Africa. Insufficient government resources lead to accessibility issues, compelling hospital leaders to seek public–private partnerships and innovative funding methods. The fragmented nature of the healthcare industry in some countries complicates the patient experience. Coordinated structures bridging different services are increasingly crucial, as are value-based healthcare models and ethical leadership to balance patient care and cost considerations.

The global shortage of healthcare professionals hampers effective healthcare delivery, and has worsened through post-pandemic attrition. Leaders must address this by investing in training critical professionals and collaborating with training schools. The World Health Organization reminds leaders of the importance of motivated, trained healthcare professionals for achieving global health and development goals.

In navigating these challenges, health managers should prioritize clinician wellbeing, comprehensive teams, and recruitment, while embracing ongoing training and technology. Engaging and committed healthcare professionals can make a significant impact on patient care and organizational success. Ultimately, these difficulties underscore the need for competent leadership in hospitals, fostering global collaboration, and innovative solutions for quality healthcare delivery.




Produced by members of the IHF's YEL Alumni network.

Agir – Health Management, Innovation and Results Association, Brazil

J. Antônio Cirino

Director of Education and Development
2024 Steering Committee co-chair and Young Executive Leaders 2021

As well as compliance, a practising communicologist, quality manager, professor and health researcher.

Searchmore Chaparadza

Baines Intercare Medical Centre, Zimbabwe

Searchmore Chaparadza

Managing Director
Young Executive Leaders 2022

IHF Member: Baines Intercare Medical Centre, Zimbabwe. Pioneering groundbreaking services and the founder of a healthcare-centred consultancy firm project.


Centro Hospitalar do Médio Ave, EPE, Portugal

Dr Luis Andrade Moniz

Executive Director
Young Executive Leaders 2022

IHF Member: Portuguese Association of Hospital Managers. Member of the board of directors since 2016, in charge of HR, patient management and legal.

Taylor Johansen

Children’s Hospital of Eastern Ontario (CHEO), Canada

Taylor Johansen

Director, Neurodevelopmental Health

Taylor is CHEO Director in Child Development and Community Services and Head of the department of Autism. She is a YEL Alumni (2021).

Written by:

Karen Cabuyao

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