This chapter explores systemic leadership in physical healthcare, where the body is central and interoception and embodiment provide unique insights. Good leadership directly impacts patient care. Drawing on my experiences of working within services that address the psychological needs of people with physical health conditions, I suggest the importance of reflexively shifting between perspectives—metaphorically moving between the “dancefloor” of frontline experience, the “balcony” of oversight, and wider contexts, much like playing improvisational jazz. Ideas from systemic work as well as systems-psychodynamics, and group relations theory inform this approach, with tools like drawing the organisation in the mind, to help surface hidden dynamics. Attention to embodiment extends leadership conversations, acknowledging how bodily awareness influences the way we take up our roles when leading and following. Ultimately, systemic leadership is not just a set of behaviours but an orientation—curious, reflexive, relational, and embodied—towards creating effective, equitable, joined-up healthcare systems.