This article studies the type of leadership that managers are currently exercising in the Catalan health system in Catalonia. A questionnaire (MQL-5X) was sent to 120 people occupying management positions in healthcare centers and hospitals as well as 14 others who also hold such positions in these healthcare centers andhospitals, were interviewed. The mixed methods research design attests that the Catalan health system is managed through a structure of simultaneous transformational and transactional leadership. However, the efficacy of this system is conditioned purely by the communicative competence that a manager may or may not possess, as the system itself makes no effort to encourage transformational leadership. Transformation leadership inspires positive change, conveys a clear vision and enhances morale, motivation and job performance. It galvanizes a team into changing their expectations and perceptions and motivates them to work towards common goals.