Organizational structure has evolved over the past several decades, with physicians assuming more or fewer leadership positions over time. Regardless of the role of physicians in health care organizational leadership, constant meaningful communication with the hospital, radiology group, or greater physician group administrative leadership is vital for any group of IR physicians to be successful. Understanding what is considered important to hospital administration and, in particular, being closely aligned with the C-suite leadership, is paramount to having successful communication with these stakeholders. Although each situation will obligatorily be unique, certain themes can be followed to optimize the working relationship between an interventional radiology service and organizational administration. This article provides guidelines and suggestions specifically in communicating with health care system leadership.