The benefits of good organisational skills in a leader will be enhanced performance of the workforce. We are facing many new organisational challenges in healthcare. Establishing and promoting clinical governance, involving the public and patients in meaningful ways, changing skill mix, adopting new models of working, working in truly integrated teams with alternative providers, and encouraging patients to self care, require us all to have an understanding of the current context and culture as well as a willingness to change. An effective leader will be able to steer a course around and through these challenges leading to successful implementation of service improvements.