Administration and Leadership

Leading Transformations: Lessons Learned from Academic Medical Center CEOs

Chatfield JS, Longenecker CO, Fink LS, et al. Ten CEO imperatives for healthcare transformation: Lessons from top-performing academic medical centers. J Healthc Manag. 2017;62(6):371–383. doi: 10.1097/JHM-D-16-00003


Healthcare is transforming at an unprecedented rate from a delivery model that’s based on volume to one that’s based on value. This is creating disruptions and change in healthcare as systems adjust to perform in the value-based model.

The way in which EMS is delivered and our role in healthcare is beginning to change. Initiatives such as the EMS Agenda 2050, National EMS Scope of Practice Model Revision Project and various other activities within our professional associations are working to transform our industry in one way or another.

This means the value of EMS is being discussed. In the article, “Ten CEO imperatives for healthcare transformation: Lessons from top-performing academic medical centers,” the authors summarized imperatives and lessons learned by CEOs while transforming their academic medical centers and serves as a timely resource for EMS.


In the article, the following 10 imperatives are discussed:

  1. Build Your Team Around a Shared Vision
  2. Construct the Pillars of Strategy Development and Execution at Every Level of the Organization
  3. Healthcare is the Ultimate Team Sport
  4. Foster a High-Reliability Learning Organization
  5. Align Your People with a Shared Language and a Common Toolkit for Change
  6. Healthcare Transformation Requires Continuous and Effective 360-Degree Communication and Accountability
  7. Translate Big Picture Goals in Meaningful Ways to Employees at All Levels
  8. Transparency Is A Prerequisite to Successful Transformation
  9. There Is No Single Organizational Structure that Yields Success
  10. Translate Success


Building your team around a shared vision requires a willingness to engage in dialogue, to listen, and to understand. A vision for the future requires that it’s known and understood by all.

A shared vision requires: comprehensive education, meaningful data, proactive engagement, transparency, communicating the back story and intensive communication. All of this is focused on how the change moves the organization toward the shared vision all the way through the front lines.

Foundational to leadership through organizational change is creditability. Leaders must model the behavior and change that they’re asking others to support. Individual behaviors must reflect the organization’s values and guiding principles, which shouldn’t only be modeled, but demand from everyone.

Healthcare is a team sport and the more open the process, the more likely of obtaining consensus on a shared vision. Everyone needs to be aligned from the front line on back.

This starts with engaging in a planning process that involves all relevant leadership across all organizational units. It’s best to use a leadership model that engages the organization rather than just the internal power hierarchy.

Culture matters and should pursue consistent excellence in quality and safety across all service lines and units. Such a culture encourages and supports: continuous employee learning, critical thinking, embracing mistakes as opportunities, valuing employee contributions, disseminating knowledge throughout the organization, and incorporating new knowledge into everyday activities.

Such a respectful culture can be described as a no-blame with trust, honesty, and self-respect that prevails in allowing for mistakes to be learning and growth opportunities that enrich the organization and its members.

Effective communication is critical for leading through change. It’s making sure that all leaders are communicating with a single voice aligned to a shared vision and communicated through a shared language.

Everyone needs to be able to articulate in unison the organizational goals and how those goals work towards the shared vision. Just as this requires some level of accountability to the performance measures of the goals, simple acts of acknowledgement can be powerful forms of communicating progress towards achieving a goal.

Everyday activities and organizational goals ought to be connected, clearly communicated and visualized. Leaders need to be able to translate how each group, unit and individual contributes to the strategy. In this context, transparency is required and should communicate progress toward a goal, and the measures should be open for all to see.

This should create an open and honest culture where trust is prevalent and where pride and morale increases.

Success comes from teamwork, transparency and the consistent application of an approach. Teamwork is supported by cross-pollination and collaboration among service lines and units.

The way organizational change is engaged will vary, but consistency to the chosen approach is supported. Creating early awareness and anticipation about a change is strongly supported. Do not pilot an initiative alone, instead involve and engage individuals throughout process. Together define success and translate how ideas and best practices will be transplanted.


The imperatives and lessons discussed in this article are timely in our EMS profession and can be viewed by EMS leaders as a toolkit for proactive change.

As a profession, we’ve had the advantage of acting as spectators in the evolving healthcare environment. For EMS leaders, this should create a clearer view of our future and the need to proactively apply true quality improvement processes in our operations with developed benchmarks that can be applied across the industry and utilized in a value-based system.

Utilizing the imperatives presented as well as applying the lessons learned should be viewed as an opportunity to not repeat the same mistakes as others. Engaging in a proactive process allows us EMS leaders to retain more control through transformational change when compared to engaging in a reactive process.

This article offers EMS leaders valuable advice in an area where the previous experiences of others places us at the advantage, if only we’re willing to pay attention.