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Leadership in healthcare plays a pivotal role in shaping patient outcomes, enhancing staff experiences and optimising the overall effectiveness of the healthcare system. However, structural reforms often overlook the interconnected nature of healthcare components. This oversight has eroded collaboration, engagement, relationships and the principle of localism. The persistent belief that ongoing structural reform is necessary to resolve quality issues is a misconception. Instead, structural reform generates the breakdown of established relationships and collaborations, frequently leading to unintended and unpredictable consequences. 1 We propose that clinical leaders, through broad engagement across multiple layers, are uniquely positioned to develop a deeper understanding of these complex challenges and drive meaningful improvements.