Is Leadership—not Policy or Grand Design—the Primary Lever for Changing Complex Systems?

Format: Round Table Discussion

Complex systems such as health care are often addressed through rational, comprehensive reform plans designed by experts and implemented through national political decision-making. This approach repeatedly fails. There is no single authority capable of implementing an “integral” plan; political systems are increasingly polarized and fragmented; and decision-making and change cycles are misaligned with the long time horizons such reforms require. As a result, political solutions tend to address problems that are already many years old by the time implementation can even begin.

This round table challenges the assumption that system-wide change primarily depends on national planning and policy design—an assumption rooted in the executive myth that comprehensive analysis and perfect design at national level are first necessary to steer complex systems. Instead, building on insights from our book Make Health Care My Care, we explore a leadership-centered approach that starts from the ongoing work of those already leading change in health care: the leadership of clinicians, managers, frontline innovators, and patients.

The discussion focuses on how political and national institutions can shift from rational system designers to practical enablers by aligning incentives, resources, and legitimacy with leadership where change actually occurs.