The CEO Experience in Victorian Public Hospitals: Challenges and strategies for leadership stability

Leadership stability is increasingly recognised as critical to hospital performance and reform continuity, yet CEO turnover in healthcare is among the highest globally. In Victoria, where public hospitals operate under devolved governance but central accountability, leadership disruption risks slowing reform and weakening system confidence. This study explored what attracts, retains and develops Victorian public hospital Chief Executive Officers (CEOs), beginning with an appreciative inquiry into what helps them succeed. Sixteen CEOs, representing 21% of the cohort across metropolitan, regional and rural services, participated in confidential interviews in late 2024. A brief pulse survey in March 2025 provided additional context during early implementation of Local Health Service Networks (LHSNs). Analysis identified five recurring tensions shaping the CEO experience: performance expectations without structured onboarding; departmental relationships characterised by reactive engagement; governance that can enable or destabilise; leadership development confined to silos rather than system-wide; and reform ambitions that outstrip local capacity. Addressing these five system-level tensions through structured onboarding, trust-based relationships, governance capability, coordinated leadership pathways and realistic workload settings would strengthen leadership stability, reform delivery, retention and system performance.