The 2026 edition of the DASP Network—SDA Bocconi’s community of General Managers and Executives of Italian Public Healthcare Organizations—was officially launched on campus. Titled “The Political Competencies of General Managers,” the event addressed a critical yet frequently misunderstood question: what does it mean for healthcare top management when “politics” shifts its codes, priorities, and time horizons? Which capabilities enable public managers to engage political counterparts in ways that advance institutional goals and safeguard organizational performance?

An inherent dimension of the role—not a distraction from it

Opening the session, Valeria D. Tozzi, Associate Professor of Practice, Director of the DASP Network and of the EMMAS Master, clarified the rationale behind the theme. Discussing the political competencies of General Managers and Executives of Italian Public Healthcare Organizations may appear controversial. In fact, it acknowledges a structural component of the role.

Interviews conducted with General Managers underscore the timeliness of the topic. While fully aware of the inherent “turbulence” of politics, many leaders still appear to expect behaviors and codes reminiscent of earlier institutional phases. Four structural considerations frame the debate.

First, the institutional dimension. Following the reform of the National Health Service (Legislative Decree 502/1992), the General Manager became the single-person governing authority of the healthcare organization—serving as the junction between political direction, the interpretation of population health needs, and accountability for managerial outcomes. Managerial autonomy does not operate in a vacuum; it unfolds within an institutional framework that shapes priorities and resource allocation. General Managers must therefore continuously build legitimacy and consensus around their strategic choices.

Second, public healthcare organizations function as political arenas. Like any complex enterprise, they host multiple interests, professional autonomies, and competing visions. Yet the healthcare setting presents distinctive features: clinicians, administrative bodies, local stakeholders, and scientific communities interact across multiple layers. These actors naturally triangulate through external influence networks. Managing such complexity requires negotiation skills, political acuity, and coalition-building capacity.

Third, environmental turbulence—absorbed and reframed by politics—creates cognitive distance between political and managerial narratives. Consider waiting lists: political discourse may emphasize expanding supply, whereas managerial reasoning often focuses on demand appropriateness. This divergence exemplifies the “dual narratives” generated by turbulence. Bridging them demands awareness and the capacity to foster authentic dialogue between distinct rationalities, aligning expectations within the broader ecosystem.

Finally, robustness. In a healthcare system under mounting pressure, preserving strategic coherence and public mission amidst turbulence depends decisively on the quality of the relationship between politics and management.

Turbulence as a structural feature

Antony Bertelli (Pennsylvania State University) argued that turbulence should not be viewed as an anomaly but as an intrinsic feature of representative democracies. Political competition, alternation in office, plural interests, and even contradiction are systemic characteristics.

Within this context, strategic leaders operate in a space of authorized discretion: discretion that is legitimate yet bounded by democratically sanctioned principles—legality, impartiality, accountability, transparency, and efficiency. High-quality management does not mechanically execute political directives; rather, it translates these foundational values into concrete choices. The General Manager thus emerges not as a technical executor but as a steward of democratic resilience, contributing to institutional stability through decisions aligned with shared principles.

What competencies for public healthcare leaders?

Raffaella Saporito, Associate Professor of Practice at SDA Bocconi, presented research insights drawn from a series of interviews with General Managers. A first risk identified is adopting a “nostalgic” posture—expecting politics to operate according to past codes and priorities. Such expectations generate misalignment. Effective leadership instead requires engaging politics as it manifests today, with its evolving language, pace, and consensus-building mechanisms.

Three competency domains stand out.

1. Qualified political communication. Leaders must curate truly relevant data, translate technical complexity into accessible messages, and respect decision-making timelines that extend beyond purely managerial logic. In contexts where institutional actors may lack deep knowledge of healthcare system mechanics, the ability to articulate managerial implications becomes critical. A pressing question arises: who explains to politics how the system works—and what managerial consequences policy choices entail?
2. Internal coalition-building. Strategic alignment across organizational components is essential. Without internal coherence, decisions weaken under external pressure.
3. Horizontal alliances. Collaboration across organizations and regions enables the development of shared technical proposals and facilitates political convergence on professional grounds. Networked leadership strengthens solution quality and enhances systemic robustness.

Bridging institutions and management

The roundtable, moderated by Valeria D. Tozzi, featured Massimo Annicchiarico (Veneto Region), Paolo Bordon (Liguria Region), Daniela Donetti (Umbria Region), Vito Montanaro (Puglia Region), and Emanuele Monti (Lombardy Regional Council).

A central theme emerged: trust as the relational infrastructure between political leadership and General Managers. Trust does not equate to contingent consensus; it is cultivated over time through continuous realignment of expectations between management and the multiple layers of political representation—from regional to local levels. This is not about personal rapport between individual politicians and managers, but about the trust capital the system as a whole is capable of generating.

Bilateral relationships are natural, yet they do not automatically create systemic coherence. Structured, recurring forums for dialogue function as institutional training grounds, strengthening the capacity to build shared representations of reality grounded in factual data. Regional directorates play a pivotal role in mediating between managers and political leadership, fostering stable practices and durable interaction models.

The overarching message is unequivocal: political competencies are not an accessory extension of the role of General Managers and Executives of Italian Public Healthcare Organizations; they are a constitutive element of governance. Exercising them means upholding the principles of sound public administration, making the link between values and decisions visible, and reinforcing the public healthcare system’s capacity to navigate turbulence without losing strategic direction.

The DASP Network 2026

In closing, Alessandro Furnari, Lecturer at SDA Bocconi and DASP Network Coordinator, outlined the thematic priorities for 2026 and introduced new formats to deepen organizational engagement in peer exchange and collective learning. The Network reaffirms its role as a structured platform for strategic leadership dialogue, designed to interpret sector transformation and develop shared analytical frameworks that transcend regional specificities.