Who leads public healthcare today? A profile of Italy's general managers.

2. Operational management, with skills similar to those of a CEO, including responsibility for the budget and internal organization;

3. Strategic definition, i.e., the ability to orient the corporate mission over time and promote transformations consistent with public health objectives.

This triple role, often shared among multiple roles in private companies, places significant decision-making and political weight on general management, requiring managerial skills, institutional awareness, and a thorough understanding of the healthcare system.

The analysis conducted by the SDA Bocconi Oasi Observatory highlights that we are facing a turning point:

• A generational change is needed to avoid leadership gaps in the coming years;

• Greater gender equity is needed, both in terms of access to the register and in the actual probability of appointment;

• It is necessary to overcome territorial rigidity by promoting the circulation of skills between Regions;

• It is urgent to rethink the selection criteria, valorizing the company's results, transversal skills and the ability to guide "pachyderms" such as healthcare companies.

At the same time, it is necessary to strengthen the working conditions of general managers, especially in more unstable or peripheral contexts, where high turnover does not promote the quality of governance or the continuity of services.

The updated profile of the General Managers paints a precise yet complex picture: a mature, experienced, predominantly male management team, with limited mobility, exposed to local dynamics, and with little external access.

But the future of Italian public healthcare—between technological innovation, demographic transition, and economic sustainability—requires new forms of leadership. Leadership capable of acting beyond the confines of a single mandate, becoming a lever for the system: capable of engaging with the local community, but also with professional and scientific networks; capable of managing complexity with appropriate tools and a long-term vision.

For this to happen, it is necessary to invest in training, transparent selection processes, qualified mobility, and a valorization of the strategic role of the Directorate General (not just the DG, therefore) as a driver of change, and not just as an administrative garrison.

* SDA Bocconi