Background: Since the beginning of health care system, it was normal that physicians should be in managerial positions. This approach is called clinical leadership and is defined when staff with medical background takes a leading post and influences strategic decisions and resource allocation. A change of organizational structures was brought through new public management (NPM) where management became a profession in itself and the responsibility for medical treatment was disconnected from management. Due to this, it was possible to take leading managerial positions for persons with non-medical background. Aim: The top management of the hospital Feldkirch in Austria gets examined how it has taken decisions and how important the professional background is. Special focus will be laid on the process of the outsourcing of the hospital's own sterilization into a public-private partnership. Methods: The study uses a literature review on the historical perspective of management structures in hospitals and on management/leadership key points, an expert interview and written materials (e.g. protocols, annual reports) to check and back up the findings of the interview. Conclusion: The managerial function are crucial for a successful project and it takes time to learn and develop the essential skills for management. When taking on a managerial position the professional background does not play a too important role. Little attention is given to nurses in managerial positions. The PPP was implemented due to the expertise, the problem sharing and responsibility of the partner while disadvantages like the distance, higher service costs and complexity of the tender were mitigated.