The health care industry is recognizing the importance of political skill among its professionals. To address this need, a longitudinal study investigates how the political skill of health care leaders (N = 555) evolves and impacts unit performance. Utilizing cross-lagged panel through a three-wave study, measurement equivalence and analysis of variance, we found political skill to influence performance differently over time, across professions, and at the dimension level. Interestingly, political skill did not just influence next year’s political skill levels in health care leaders, but also showed a strong positive influence on the unit’s performance. Similar lagged overall effects were found for both clinical and nonclinical leaders with the caveat that political skills dimensions can evolve differently. For instance, networking ability is underdeveloped and likely to decrease over time for clinical leaders. In summary, future theories and applications consider the temporal elements, the dimensionality of political skill, and the differences in leaders’ occupational interests. We discuss further implications and future research.