CEO Nick Astwick on claiming back New Zealand’s lost healthspan
Nick Astwick, CEO of Southern Cross, believes leadership is defined by three core traits: intentionality, reflection, and self-awareness. He argues that effective CEOs focus on making consistently good decisions rather than waiting for perfect ones, especially in uncertain environments. His leadership philosophy centres on separating self-worth from business outcomes, enabling objective decision-making. In healthcare, he emphasises that culture must align directly with strategy, particularly when serving people in vulnerable moments. Ultimately, he defines the CEO’s role as holding two responsibilities simultaneously: defining reality clearly and providing hope through decisive action.
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The need-to-know:
Good decisions matter more than perfect decisions. Waiting for complete information slows organisations; consistent good decisions compound into the right outcomes over time.
Culture is what leadership actually cares about. Teams align not to stated values, but to observed priorities—misalignment destroys trust instantly.
Relevance, not efficiency, is the real competitive battleground. Growth comes from staying meaningful to customers, not just optimising internal performance.
Let’s go a little further
Nick Astwick leads Southern Cross with a clear and grounded belief: leadership is not an abstract concept. It is a daily discipline shaped by how decisions are made, how people are treated, and how reality is confronted.
His perspective was not formed in theory. It was shaped through experience, particularly the realisation that leadership is far harder than it appears from the outside. Early in his career, he conflated leadership with management. Over time, that distinction sharpened. Management focuses on execution. Leadership focuses on direction, people, and context.
At the centre of his philosophy are three traits.
The first is intentionality. Strong leaders are deliberate. They understand where they are going and act with purpose. This is not about speed for its own sake. It is about clarity of direction and commitment to action.
The second is reflection. Leadership requires continuous learning in motion. Decisions rarely unfold as expected. The ability to pause, assess, and adapt becomes a competitive advantage. Reflection is not occasional. It is constant, often happening in small, immediate moments after key interactions.
The third is self-awareness. Astwick is explicit that this required development. Understanding strengths, limitations, and emotional responses allows leaders to operate with greater authenticity and effectiveness. Without this, decision-making becomes reactive and inconsistent.
These traits become most visible under pressure.
During COVID, Southern Cross faced the same uncertainty as every healthcare organisation, compounded by the vulnerability of the people they serve. The leadership response focused on three priorities: protecting employees, restoring safe access to healthcare, and acting in the best interests of members. This included returning value when services were inaccessible. For Astwick, these moments define a brand more than any period of stability.
Underlying this is a critical mental model: the difference between good and right decisions.
Many leaders aim for certainty. They delay action, seeking the “right” answer. Astwick rejects this. In complex environments, perfect information does not exist. The responsibility of leadership is to make good decisions with the information available. Over time, a pattern of good decisions produces the right outcomes more often than not.
This requires a culture that supports decisiveness. Debate is encouraged. Disagreement is necessary. But alignment must follow quickly. Once a decision is made, the organisation moves together.
Culture, in this context, is not abstract. Astwick defines it simply: culture is what leadership cares about. Employees observe behaviour, not statements. If leadership claims to prioritise customer experience but rewards short-term profit, the organisation will follow profit. Alignment between strategy and what leaders visibly prioritise is non-negotiable.
In healthcare, this alignment carries additional weight. Patients engage with the system during moments of vulnerability. The expectation of care, speed, and integrity is higher. Culture must reflect that reality.
This leads to a broader strategic focus: relevance.
Astwick argues that most organisations are not competing on functional excellence alone. They are competing to remain relevant. In insurance, this challenge is particularly visible. Half of customers see value only when they claim. The task, therefore, is to shift from being a transactional provider to a continuous health partner.
Relevance drives growth more reliably than efficiency. It sustains customer relationships, extends tenure, and builds advocacy. Profit becomes an outcome, not the objective.
Partnerships play a central role in achieving this. No organisation can deliver everything required alone. Astwick views partnerships as fundamental to modern business models, particularly when scaling or addressing capability gaps. However, they must be intentional, strategically aligned, and built on mutual value. Poorly defined partnerships fail quickly.
Ultimately, his leadership model returns to a simple but demanding standard.
The CEO must define reality and give hope.
Defining reality means seeing clearly what others see and naming it without distortion. Giving hope means demonstrating a credible path forward through action, not rhetoric.
Holding both simultaneously is the work.
Question for you
Where might your organisation be avoiding reality in order to preserve comfort, and what would change if you addressed it directly?
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