Over the past 10 years, large integrated healthcare systems, multi-national pharmaceutical companies and biotechs, and healthcare retailers, among others have undertaken ambitious growth through mergers and acquisitions (M&A), expanding their footprint to serve broader customers across geographic regions. While M&A can enable scale, efficiency, and greater care coordination, many companies are struggling to realize the full value of integration due to persistent leadership, cultural, operational, and change management challenges.

Given our experience working with leaders across the health ecosystem, we share the most frequently cited challenges that executives face in navigating growth and consolidation simultaneously—and propose key questions, challenges, and opportunities for leaders to consider amid growth.  Lastly, we provide strategic leadership development approaches that can enable organizations to thrive through the complexity.

Core Challenges Facing Health Ecosystem Leaders

1. Cultural Integration and Alignment

M&A brings together organizations with distinct identities, values, and legacy cultures. Leaders must harmonize those differences into a unified vision while maintaining local pride and community identity. Without intentional cultural integration, employee engagement, physician alignment, and organizational cohesion suffer.

Key Questions for Leaders:

• How do we honor legacy identities while creating a shared culture?
• How can leaders role-model new norms and behaviors organization-wide?

As organizations expand, governance becomes more layered, often leading to unclear decision rights, misalignment between corporate and regional leadership, and slowed innovation.

Key Challenges:

• Balancing centralized vs. decentralized authority
• Navigating ambiguity in dual-reporting or dyad models
• Ensuring speed without sacrificing alignment

Newly acquired or affiliated entities often lack standardized leadership expectations, competencies, and development opportunities. This creates variability in leadership effectiveness across the enterprise.

Opportunity:

• Deploy leadership assessments and tailored development plans to upskill leaders at all levels
• Implement a system-wide leadership competency model that reflects strategic goals

M&A activity can spark insecurity, change fatigue, and increased attrition among high-potential talent—especially if communications and transition planning are weak.

Implications:

• Loss of institutional knowledge and innovation drivers
• Increased costs related to recruitment, onboarding, and productivity loss

Response:

• Invest in coaching and targeted engagement for emerging and high-potential leaders
• Establish clear career pathways and visibility into future roles

Financial and operational efficiencies are a major driver of M&A—but many organizations face slow progress in integrating core systems like revenue cycle, supply chain, R&D initiatives, and EMRs. Leaders often lack experience managing this scale of transformation.

What’s Needed:

• Scalable change management and communication strategies
• Cross-functional leadership development that promotes system thinking and collaboration

AI and digital transformation offer huge promise, but leaders face pushback from teams fearful of job disruption or workflow overload. Integration of new tools requires new leadership capabilities around technology adoption, empathy, and data-informed decision-making.

Strategic Recommendations

To meet these challenges head-on, health ecosystem leaders must prioritize leadership development as a critical enabler of integration success. Recommended approaches include:

1. Develop a Unified Leadership Competency Framework
   • Co-create with input from clinical, administrative, academic, and operational leaders
   • Align competencies to strategic priorities: innovation, equity, resilience, efficiency
2. Invest in Targeted Coaching and Cohort-Based Development
   • Focus on system-level leaders, regional executives, and dyads
   • Use coaching to support retention and role transitions
3. Accelerate Change Management Capabilities
   • Train senior and mid-level leaders in leading through ambiguity and transformation
   • Embed change champions across the enterprise
4. Leverage Assessments to Identify Leadership Bench Strength
   • Use 360 feedback and psychometric tools to inform succession planning
   • Create development pathways to close gaps
5. Build Leadership Communities Across Regions
   • Facilitate cross-system learning exchanges
   • Use leadership academies to build a sense of shared identity and alignment

Conclusion

Growth and consolidation across the health ecosystem are inevitable and essential for sustainability, but without strong, aligned leadership, the strategic benefits of integration are lost. Now is the time to invest in leadership as the cornerstone of transformation. Leadership development is not a luxury—it is an imperative.

Interested in learning more about TLD Group's leadership development solutions? Reach out to work with TLD Group today!