The report into care at Mid Staffordshire NHS Foundation Trust called for strong leadership in nursing and the government’s response acknowledged the importance of senior managers gaining front line experience of the NHS. This article discusses the background to the need for visible leadership and the advantages and disadvantages of different approaches to engaging with the front line. Lessons from other industries are considered and a spectrum of engagement activities relevant to health care suggested. Senior leaders’ visits to the front line have brought identified benefits for staff but there is little proof of patient benefits, so more research needs to be commissioned to generate evidence of effectiveness.