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A decisive factor in the difference between the success and failure of the development of practices and hospitals is the quality and number of suitable staff members, together with their motivation to devote their skills to the particular organization. Senior management is not required or paid to paint dramatic pictures of current and future problems, but to achieve success within given framework conditions (e. g. health funding, local circumstances, suitability of senior staff). Success must be measurable and verifiable within the dimensions of medical quality, service quality and economic viability - but also regarding staff loyalty and staff recruitment. This paper is intended to encourage critical reflection on structures and roles in the organization of hospitals and practices on the basis of knowledge and ideas gained from 25 years of senior management experience. The content of this article will apply only in part or not at all for a number of successful hospitals and practices. The aim of this paper is to increase that proportion.

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Leadership in the Tug of War Between What Is Desired, What Is Possible, and What Is Allowed – Knowledge and Ideas Gained from 25 Years of Senior Management Experience in Radiology