Europe has set demanding ambitions for its health systems. They are expected to become more resilient, digital, integrated, sustainable and people-centred while responding to population ageing, chronic disease, workforce shortages and financial pressure. Yet these ambitions will not be delivered by legislation, funding or technology alone.
Management is the implementation capacity of a health system
It turns policy into operating models, investment into services, data into decisions and professional expertise into coordinated care. My position is that the European Union and its Member States should recognise management capacity as a strategic component of the health workforce and a necessary investment in the future of European healthcare.
The invisible infrastructure of health systems
Management is often most visible when something fails: a waiting list grows, a workforce crisis deepens, a digital programme underperforms or a hospital cannot maintain services during disruption. When organisations function well, the management work behind them can disappear from view.
That work is not an additional administrative layer around healthcare. It includes deciding how resources are allocated, how teams are organised, how patient pathways connect, how risks are controlled, how quality is measured and how organisations remain accountable to the populations they serve.
Allocation
Determining how limited financial, human and technological resources are used responsibly.
Organisation
Designing teams, responsibilities, working conditions and professional relationships.
Coordination
Connecting patient pathways, services, institutions and levels of care.
Accountability
Measuring quality, controlling risks and remaining accountable for results.
A new policy may define what should change, but managers must determine how it can work within real services. A new technology may be clinically promising, but organisations must procure it responsibly, redesign workflows, prepare professionals, protect data and evaluate whether it creates value.
An integrated-care strategy may establish the objective, but leaders must create shared governance, clarify responsibilities and overcome boundaries between hospitals, primary care, community services and social support.
Management quality affects clinical quality, workforce experience, financial sustainability and public trust.
Clinical expertise remains the foundation of healthcare, but it cannot compensate indefinitely for weak coordination, unclear accountability or poor implementation.
Europe’s shared pressures are management challenges
Healthcare delivery remains primarily a national responsibility, but European health systems face many of the same pressures: demographic change, the growing burden of chronic disease, workforce shortages, unequal access, technological disruption and the need for greater resilience.[1]
The estimated shortage of doctors, nurses and midwives in the European Union in 2022. More than one third of doctors and one quarter of nurses were aged over 55 and expected to retire in the following years.[2]
Management cannot replace the professionals Europe needs. It does, however, influence whether available capacity is used responsibly. Working conditions, team design, professional autonomy, skill mix, rostering, wellbeing, leadership culture and unnecessary administrative burden all affect recruitment, retention and productivity.
Digital transformation
Turning promising initiatives into safe, routine and scalable practice requires decisions about procurement, interoperability, workflows, training, cybersecurity, governance and accountability.
Integrated care
Connecting hospitals, primary care, long-term care, home care and community services requires shared objectives, information flows, financing arrangements and working relationships.
Resilience
Resilience is built through everyday decisions about supply chains, workforce flexibility, communication, infrastructure, data and continuity of operations.
Environmental sustainability
Sustainability becomes real through investment choices, procurement, energy management, clinical and operational redesign and the capacity to measure progress.
These are not separate technical agendas. They are management agendas that meet inside the same organisations.
Management capacity should become a European priority
The European Union complements national health policies by supporting health-system modernisation, digitalisation, resilience and cooperation.[3]
A stronger European approach to management capacity would respect national diversity while creating added value in areas where health systems can learn and act together.
Make management and implementation capacity visible
European programmes supporting digital health, workforce transformation, preparedness, integrated care or sustainability should include resources for organisational redesign, leadership development and implementation, not only for technology, infrastructure or technical guidance.
Create stronger development pathways for managers
Development pathways should cover governance, finance, operations, workforce, data, digital transformation, quality, ethics, resilience, sustainability and collaboration across care settings.
Involve managers earlier in policy design
Those responsible for implementation can identify operational barriers, unintended consequences and resource requirements before they become failures. Their contribution should not begin only after strategic decisions have already been made.
Strengthen the evidence base for management practice
Health systems need better ways to study implementation, compare organisational approaches and distinguish between initiatives that merely appear innovative and those that improve access, quality, workforce experience, efficiency or outcomes.
Different national systems will retain different professional and institutional arrangements. European cooperation can nevertheless support shared competencies, leadership development and mutual learning.
The World Health Organization describes strong health-system governance as requiring strategic policy frameworks combined with oversight, coalition-building, regulation, system design and accountability.[4]
These are not abstract institutional functions. They require organisations and leaders with the capacity to perform them.
WHO Europe’s vision for hospital transformation also identifies effective leadership and governance as essential conditions for more integrated, resilient, digital and sustainable hospitals.[5]
This recognition should be reflected in investment, policy dialogue and health-workforce planning.
Building a European community of management practice
Europe already has substantial management knowledge, but much of it remains within individual organisations or countries. A pathway redesign, workforce model, crisis response or digital implementation may generate valuable lessons without ever becoming visible to managers elsewhere.
Professional associations have an important role in changing this. They can connect national experience, provide trusted spaces for comparison and help translate operational lessons into European policy dialogue.
The objective is not one universal management model
European health systems are too diverse for that. The objective should be to understand which principles are transferable, which conditions enable success and which implementation barriers repeatedly prevent progress.
This also requires space for different voices: senior executives, operational managers, emerging leaders, nursing and clinical managers, researchers, policy experts and professionals working across integrated health systems.
Europe’s management conversation will be stronger when it reflects different systems, generations, territories and professional backgrounds.
From ambition to organisational capability
The European Health Union will ultimately depend on what health organisations can deliver.
Regulations can establish standards. Funding can create opportunities. Technology can provide new capabilities. But people must organise services, lead teams, manage trade-offs and remain accountable for results.
Health management should therefore be recognised not as overhead, but as infrastructure: the organisational capacity that allows clinical knowledge, public investment and European policy to produce value for patients and communities.
Europe needs more health professionals.
It also needs organisations capable of enabling those professionals to succeed.
A stronger Europe for health requires stronger health systems. Stronger health systems require stronger management.
References and source notes
- European Commission — Health systems coordination. Identifies the shared pressures affecting European health systems, including demographic change, chronic disease, technology, workforce shortages, unequal distribution of professionals and health inequalities.
- OECD and European Commission — Health at a Glance: Europe 2024. Reports an estimated EU shortage of approximately 1.2 million doctors, nurses and midwives in 2022 and highlights the ageing of both the population and the health workforce.
- European Commission — EU health policy overview. Clarifies that national governments retain primary responsibility for organising and delivering health services, while EU action supports modernisation, digitalisation, resilience and cooperation.
- World Health Organization Regional Office for Europe — Health systems governance. Defines health-system governance through strategic frameworks, oversight, coalition-building, regulation, system design and accountability.
- World Health Organization Regional Office for Europe — Shaping the Vision: Strategic Hospital Transformation within the WHO European Region Health System. Identifies quality leadership, governance and effective management as central to hospital transformation, integration, resilience, digitalisation and sustainability.
Professional experience. Independent perspectives. European dialogue.
Contributing to Europe’s healthcare management conversation.