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Health systems are delivered by highly committed and skilled health professionals overwhelmingly driven by compassion. Unfortunately many have to work in environments where leadership cultures are antithetical to that compassion. Broadly speaking the prevailing leadership culture in New Zealand’s health system is managerialism which involves decision-making through a very narrow lens that is management rather than clinically and patient-centred driven. Within district health boards (DHBs) this can be alleviated by the closer proximity between senior managers and health professionals and largely overcome where there is sufficient oxygen to enable genuine engagement between them. The more distributed the engagement at all levels the more clinically and fiscally effective it is.

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