Summary
Health systems face urgent demands to change, yet many struggle to translate that urgency into action. An international analysis identified accessible communication, shared leadership responsibility, and the capacity to adapt and support innovation as priorities for closing that gap. For leaders, the practical insight is to build an organization in which people can contribute their expertise and take responsibility for putting change into practice.
The Leadership Challenge
A leadership team can agree that change is essential and still struggle to make it happen. New technology must fit established workflows. Employees need to understand how a proposed change serves patients and how it will affect their work. Questions emerge that the original plan did not anticipate.
A survey reported in NEJM Catalyst captured this gap. Among 100 CEOs of medium-sized and smaller hospitals across seven countries, 78% rated the need for change as high, but only 37% reported a high pace of change within their organizations. Recognizing the need for transformation had not consistently translated into rapid execution.
Getting to the source of the problem
Rachel Bonesteel and colleagues examined which leadership capabilities could help health systems respond to this challenge. Working with Future of Health, an international community of health leaders, they combined a literature review and expert discussions with the CEO survey, a scan of leadership profiles at 250 highly ranked hospitals, and organizational cases.
Their analysis challenged the assumption that one exceptional executive could supply all the expertise needed to lead change. It emphasized leadership teams with complementary knowledge and broader participation in decision-making. Published as a commentary, the article offered recommendations informed by these sources rather than a controlled test of their effects.
New Findings with Implications for Leading Change
The authors identified active, accessible communication as a central capability. At Cincinnati Children’s Hospital Medical Center, leaders connected daily work to longer-term goals through regular meetings and conversations with frontline staff. They treated resistance as useful information and committed to visible follow-up within two weeks of leadership rounding. The case illustrated how listening becomes more credible when employees can see what happens after they speak.
Shared responsibility also required changes in how decisions were made. At Karolinska University Hospital in Sweden, an earlier transition to value-based care had stalled amid staff dissatisfaction. Subsequent leaders simplified the organizational structure and shifted operational responsibility to departments. They also strengthened nursing representation and improved clinicians’ access to operational data. The case highlighted the organizational support needed to help people exercise judgment close to the work.
At Sheba Medical Center in Israel, the SPARC entrepreneurship program developed the capacity to turn clinical problems into potential solutions. Its 12-week program combined practical work with mentorship. Chiefs of services were encouraged to participate first and then support their teams’ involvement. This approach made senior leaders participants in developing innovation capability and helped build support for wider participation.
These cases illustrated ways to put the recommended capabilities into practice. They did not establish that any single approach independently caused better organizational performance.
What This Means for Leaders
Taken together, the cases suggest that leaders should examine how their organizations respond to employee knowledge. Asking for input is a starting point. Leaders also need to explain how concerns will reach decision makers and which decisions teams can make for themselves. Clear responsibilities and access to relevant information can help turn participation into action.
The article’s account of Sahlgrenska University Hospital offered a useful caution. Its Young Employees Forum brought early-career perspectives to senior management, but implementing proposals depended on management’s willingness to act. For practitioners, this highlights the importance of connecting opportunities to speak with a credible route to influence.
Leadership development should support that connection. The authors emphasized strategic assignments alongside formal programs and mentoring. A practical application is to give emerging leaders responsibility for a real organizational problem, support them as they consult affected colleagues, and review how they adapted their approach. Development then becomes part of the organization’s work of responding to change.
A Question for the Next Change Effort
For the next change effort, leaders can examine whether employees can see how their input shaped a decision and whether those responsible for acting have the authority and support to do so. That examination offers a concrete way to identify where an initiative needs stronger leadership capacity across the organization.
Access the full research paper here: Bonesteel, R., Rawal, P., Tabb, K., Opatrny, L., McBride, T., Hirsch, M., Brockmann, L., Zimlichman, E., McClellan, M., & Kahn, C. N., III. (2026). New leadership approaches for health system transformation in a time of rapid change. NEJM Catalyst Innovations in Care Delivery, 7(9), Article CAT260175. https://doi.org/10.1056/CAT.26.0175
