Designing and delivering managerial training for the turnaround of a National Health System. Lessons and reflections from research evidence and field work in the Romanian NHS

Contemporary scholarships in leadership and management increasingly emphasizes the centrality of competent leaders and professionals in enhancing performance at both organizational and system levels, particularly within public health systems facing growing demands for sustainability and reform. Despite initial efforts across various National Health Systems (NHSs) to strengthen managerial capabilities, progress remains constrained by structural path-dependencies and professional bureaucracies. This study investigates the design and implementation of a large-scale, competency-based managerial training program within the Romanian NHS, developed between 2023 and 2024 with the support of the Ministry of Health and the World Health Organization. The intervention followed a multi-phase approach, including a comprehensive literature review and a national needs assessment involving 1200 stakeholders through semistructured interviews and online surveys. A Training-of-Trainers (ToT) scheme was delivered to 150 selected participants by academic experts from Italy, Spain, and Portugal. These trainers subsequently facilitated system-wide training activities, reaching up to 5000 clinical leaders and managers across the country. Findings underscore the strategic relevance of tailored training initiatives in advancing competence-based human resource management. Common training needs identified include leadership, strategic planning, ethics, change management, and systems thinking. The Romanian experience offers transferable insights for designing context-sensitive training programs capable of fostering system-wide organizational transformation in other transitioning health systems.