It is accepted that health care reforms and restructuring lead to the change of the tasks and competencies required by senior health care managers. This paper examined the major tasks that senior health executives performed and the most essential competencies required in the NSW public health sector in the 1990s following the introduction of major structural reforms. Diverse changes, restructuring and reforms introduced and implemented in different health care sectors led to changes in the tasks performed by health care managers, and consequently changes in the competencies required. What is known about the topic?The literature confirms that health reform affects senior health care managers’ acquisition and demonstration of new skills and knowledge to meet new job demands. What does this paper add?This paper provides a detailed description of the competencies required for senior health care managers in New South Wales in the 1990s after the introduction of the area health management model, the senior executive service and performance agreements. It confirms that restructuring and reform in the health care sector will lead to changes of the tasks performed by health care managers and, consequently, changes in the competencies required. What are the implications for practitioners?The competencies required by health care managers are affected by distinct management levels, diverse health care sectors and different contexts in which health care systems operate. The competencies identified for senior health executives in this study could guide educational programs for senior health managers in the future.