International Hospital Federation (IHF): Why Hospital Leaders Need to Understand Themselves

What does the IHF mean by self-awareness and continuous improvement?

A chief medical officer sees himself as fair and straightforward. He never raises his voice in meetings, yet makes decisions so quickly that some department heads have stopped raising objections. In the International Hospital Federation (IHF) leadership model, competency 2.A covers emotional intelligence and self-awareness; 2.B covers continuous improvement. This involves more than being able to name your feelings. Leaders need to understand how their needs, assumptions, habits and limitations affect the people around them. They also need to notice the gap between what they intended and how colleagues experienced the interaction. Someone may simply want to keep a meeting short, yet leave everyone with the impression that disagreement is unwelcome. That gap becomes easier to see when you stop defending your “leadership style” and look closely at what was said and how people responded.

Why do employees sometimes see a manager differently?

We do not always see ourselves as others see us. Leadership researchers study what they call self–other agreement: the extent to which a leader’s self-rating matches assessments from other people. A meta-analysis by Lee and Carpenter found that discrepancies depend, among other things, on how leadership is measured and who provides the rating. A manager may sincerely believe they encourage debate because they end meetings with “Any comments?” Staff, however, remember that the same manager interrupted a colleague and answered a concern impatiently just minutes earlier. Rather than debating whose judgement of the manager’s character is correct, look at the interaction. Did they allow time for an answer? Did they listen to a view that challenged their plan? Did they follow up on the concern? Self-awareness becomes useful when it changes behaviour other people can actually observe.

A personality profile does not assess leadership quality

Psychometric assessments can shed light on preferences, typical stress reactions, motivations and values. On their own, they cannot tell you whether someone is an effective department head. A highly conscientious leader may maintain excellent standards but sometimes micromanage. A decisive manager may respond quickly in a crisis yet leave too little room for discussion during a routine meeting. Someone who is sensitive to staff emotions may still struggle to enforce agreed boundaries. Traits do not dictate behaviour in every situation. The IHF model concerns capabilities demonstrated in a professional context. A personality profile is therefore best used as the start of a conversation: when do I react on autopilot, what puts me on the defensive and what would I like to do differently? The answers are most useful when tested against what happens in real conversations.

How do a manager’s emotions affect a conversation under pressure?

When time is tight, people tend to fall back on familiar reactions. A manager is dealing with several urgent requests when a colleague challenges a decision. If they experience the comment as a personal attack, their response may be sharper than they intended. Noticing rising irritation gives them a chance to pause, ask about the facts and then explain the limits of the decision clearly. Emotional intelligence includes understanding emotions and managing one’s own responses. It does not mean remaining serenely calm at all times or suppressing every feeling. Reviews involving nurse managers describe associations between emotional intelligence, individual characteristics and working conditions. They do not allow us to predict a particular manager’s effectiveness from one test score. The more useful question is whether that manager can use awareness of their emotions to listen and respond more thoughtfully.

IHF mentoring highlights the power of unwritten workplace rules

In 2026, the IHF developed its Mentoring Circles initiative with the American College of Healthcare Executives. Women leaders from different countries met in small groups to discuss experiences and professional challenges. Their conversations touched on unwritten rules that can be harder to navigate than an organisation chart. A new department head might know exactly what her responsibilities are, yet still feel unsure how directly she can disagree with a senior clinician. Talking with leaders whose experiences differ can help expose assumptions that usually go unexamined. What counts as respectful restraint in one hospital may be interpreted as a lack of initiative in another. Mentoring does not guarantee personal growth. It does, however, show one way self-awareness develops: through testing our own perspective against the experiences of other people.

Continuous improvement begins after the conversation ends

The IHF calls competency 2.B continuous improvement. Its practical value often becomes clear after a meeting, when a manager reflects on both the outcome and their own behaviour. If nobody raised any concerns again, complaining that “they never tell me anything” will not help. A better question is whether the manager’s previous responses have made speaking up feel pointless or risky. The next briefing offers a chance to try a different approach. They might ask everyone to name one possible risk, resist the urge to comment immediately and return to the issue a week later. Reflection without any change soon becomes an empty exercise. But one successful meeting is not proof of a new habit either. Development becomes visible when managers increasingly choose how to respond rather than relying on their automatic reactions, including in demanding situations.

The IHF sees self-awareness and continuous improvement as essential to hospital leadership. Understanding your tendencies can explain why you react as you do, but comparing your intentions with colleagues’ experiences reveals what may need to change. The best starting point is one observable behaviour you can try in your next conversation.

How Empatyzer helps turn self-awareness into better conversations

A department head notices that staff rarely raise concerns during briefings, although those issues are discussed privately afterwards. In Empatyzer, they review their profile, including their decision-making preferences, motivations and leadership style. They then describe a particular briefing to Em: what they said, how they responded to a question and what they learned later. They ask for several possible interpretations of their behaviour and help with a different way to open the next meeting. Em can suggest questions that invite staff to raise risks before a decision is made and ways to respond calmly to criticism. The department head chooses one goal: ask about concerns first, then explain their preferred solution. After several briefings, they return to Em to reflect on how the conversations have changed and whether staff are sharing more useful information. Micro-lessons provide regular reminders. That is how Empatyzer can support the self-awareness and continuous improvement described in the IHF model.