And yet the Chair has a nagging feeling that something is off.

That feeling is usually right. In our experience, the most important leadership issues in healthcare are rarely the ones a standard performance review is built to find.

Why November 2026 raises the stakes

Australian health leaders are working through a very different funding environment. The new National Health Reform Agreement addendum, announced in February, commits the Commonwealth to an additional $25 billion for public hospitals over five years, with state and territory funding envelopes still being settled through bilateral agreements. More money brings more scrutiny, more reform expectations and more public accountability for how it is used.

At the same time, the sector is carrying workforce strain, hospital access pressure, ongoing aged care reform and the first full year under the new Aged Care Act. Executives are being asked to lead through all of it at once.

In that environment, a review that only asks "did they hit the numbers?" is not enough.

Where reviews go wrong

1. They measure outputs, not leadership. Financial result, activity targets and accreditation outcomes matter. But they are lagging indicators. They tell you what happened, not how it was achieved or what it cost the team.
2. They rely on the executive's own story. Self-assessment and a one-way presentation to the Board create a polished narrative. The real picture sits with the people who work around that executive: direct reports, clinical leaders, and partners across the system.
3. They avoid the uncomfortable questions. Is the senior team still intact? Are your best clinicians still engaged? Is the executive building successors, or becoming the single point of failure? Chairs often sense these issues but don't feel there is a safe forum to raise them.
4. They ignore fit with the next chapter. The leader who was right for a turnaround may not be right for a period of growth, consolidation or reform delivery. A review looking backward will never ask that question.

What a stronger review looks at

• Trust and culture: What do clinicians, managers and the broader workforce say when the executive isn't in the room?
• Decision quality under pressure: Not just the decision, but how it was made, who was consulted, and how it was communicated.
• Team strength: Retention, capability and bench depth below the executive.
• Stakeholder relationships: Government, regulators, unions, medical leadership and community.
• Forward readiness: Whether the executive's strengths match the next three years, not just the last twelve months.

Boards that do this well treat the review as a two-way conversation, not a verdict. They gather independent input, name risks early and agree on a support plan, whether that is coaching, a change in scope or, occasionally, a succession conversation held on their own terms rather than in a crisis.

The cost of getting it wrong

Research into Australian hospital CEO turnover has found that leaders leaving is costly, both financially and in organisational stability, with flow-on effects for patient care. Notably, researchers point to boards actively supporting their CEO, and investing in culture and leadership development, as one of the best protections. A review that surfaces issues early is part of that support.

Is your review telling you the whole story?

At Predictus Search, we work with Boards and Chairs across the sectors that shape people's lives. We know what strong executive capability looks like, and what it takes for it to hold up under pressure.

If you suspect your executive review is missing something, let's talk. Contact Predictus Search for a confidential conversation about how to assess leadership in a way that protects your people, your performance and your future.