'With the little wisdom, insight and maturity that I hope I have developed with age and experience, I am able to confess that some inter-organisational relationships suffered as I pursued system-wide strategic change'

June is conference season for many managers and so it was off to the NHS Confederation in East London and then to the European Health Management Association conference in the contrasting vibrancy of Lyon, France's second biggest city.

I am often surprised, but know I shouldn't be, that the leadership agenda for healthcare managers across Europe is very similar. Only the political and local contexts are different. Resource management, developing effective personal leadership, reforming delivery systems, positively engaging clinicians, breaking free of the yoke of organisational bureaucracy - these all feature across Europe..

But back to London, where I have two interrelated memories from the confederation event. First, David Cameron and his reference to partnership development. Nothing new here, I know, but I cannot recall the last time health policy was presented with quite the same emphasis on the importance of interpersonal working. We often forget that system-wide working starts with developing personal relationships. In our inter-organisational working we endeavour to choose the people we prefer to do business with while selecting out those we would rather not have to work with.

My second memory is of David Nicholson's first confederation conference speech. And what a speech it was! Clear messages simply presented, but above all passionate. Passion, along with vision, is an important leadership attribute for securing follower support and at last the NHS has a leader who espouses genuine passion. He too talked about the importance of partnerships.

At this point, I can hear a number of my former NHS colleagues saying, but hang on, how come Goodwin is suddenly emphasising the importance of partnership working when his own chief executive record in this area was mixed? They are right, of course, my record was mixed. And with the little wisdom, insight and maturity that I hope I have developed with age and experience, I am able to confess that some inter-organisational relationships suffered as I pursued system-wide strategic change across organisations for the greater good of the health system.

But my experience has shown me that there can be a tension between investing in developing effective inter-organisational relationships and pursuing strategic decision-making. Sometimes, it doesn't matter how much effort is made in relationship building because when push comes to shove and a decision has to be made, there are likely to be some players who eschew supporting an emerging new strategic picture. In this case, the choice is between tackling the resistance head on or not pursuing the change at all.

And is this not the rub? Managers can develop their relationship-building skills as much as they like but unless they are equally good at assessing risk and taking decisions, then surely all their personal skills development adds up to nought?