The leadership challenges of maintaining such an organisation are formidable. A key one has been the past reluctance of indigenous Aboriginal and Torres strait islanders to engage with the mainstream health system itself, including hospitals and General Practitioner clinics. The creation of Institute for Urban Indigenous Health (IUIH) was also based on the potential for development of 'new' models of delivery, and new business models to decrease dependency on grant funding from government by moving to a social enterprise model and becoming more community controlled. Integral to maintaining the harmony and synergy of the four indigenous bodies who make up the IUIH, has been the concept of 'family' which is deeply embedded in indigenous culture. Leadership in the very uncertain environment of indigenous health also requires considerable negotiating skills since managing the interface with governments and other stakeholders is crucial to the survival of the organisation.