Health care executives and boards no longer can lead with only one organization in mind. Value-based payment, along with a renewed emphasis on developing healthy communities, makes care coordination among community providers in multiple entities a necessity.

Today’s leaders need a transorganizational mindset. This mindset is a paradigm shift: Top leaders must understand connections and work among a network of different organizations and community stakeholders. Leaders must look beyond the health system boundaries to discover how community organizations and providers can work together to coordinate care and improve outcomes.

Complex strategies, such as value-based payment and population health, require leaders who are more than collaborators addressing individual issues. As transorganizational leaders, they must assume a collective responsibility to achieve mutual goals that improve quality and equity of health outcomes. The best executives and trustees are leading through relationships within and outside of their primary responsibility — they are conducting shared leadership.

For example, let’s look at the goal to improve health outcomes for a chronic disease, such as diabetes, for defined patient population groups. Achieving that goal requires building relationships across the continuum of care and beyond. The resulting structure may include networks of primary care and specialty physicians, nurse practitioners, outpatient services, clinical care units, community health clinics, urgent care centers and pharmacies. In addition, patients and at-risk community members need education and assistance with self-care and prevention practices. This work may involve alliances with schools, community groups, grocery stores, religious congregations and other community services.

Transorganizational Roots

Transorganizational is not a fad word or concept. Academic thought leaders such as Drs. Samuel A. Culbert, David Boje, Thomas G. Cummings and Kurt Motamedi began talking about planned change in networks of organizations a couple of decades ago. They suggested that change often involves more than one organization, which requires working among a network of organizations. This requirement has been true in health care for a long time.

A slower evolution among health care leaders is breaking out of silo thinking — that is, failing to include other entities in change efforts or share information outside of organizational boundaries. Silo thinking may persist because of the way health care administrators were taught leadership, with an emphasis on one organizational system.

Population health, value-based payment and building healthy communities all depend on working in many organizations and networks. Executives and board members need to become adaptive leaders who quickly develop a transorganizational mindset if they are to work effectively. A way of doing this is to “learn in action.”

Learning in Action

The path to change for many executives and trustees is learning from what they are already doing. Developing a transorganizational mindset need not be another scheduled task in an already demanding schedule. However, learning in moments of action is not always easy, because there are so many projects and initiatives in play at one time.

A simple way to reflect on performance and learn in action is to ask such questions as the following:

• What are we learning from our experiences of working with other organizations and the community?

• What are we learning about our leadership?

• What can we do differently that would make a significant difference?

• What should we keep doing that really matters to our stakeholders?

I suggest setting aside a few minutes during executive team and trustee meetings to ask questions like these. I recommend active listening to learn from everyone engaged in the conversation. It can be useful to document the key learning points so they can be recalled, as strategies are being implemented and future meetings unfold. This is an ongoing learning process that informs transorganizational work and the execution of mutual goals.

Shifting the Mindset

While learning plays a significant role in making the shift to transorganizational thinking, being aware of what a leader is thinking also can be helpful. With the collective good in mind — that is, the health of patients and the community — it is much easier to be a transorganizational thinker. This shifts a leader’s thinking from being merely a health care provider to being a community partner in improving quality of care and population health.

Taking on the role of community partner adds to the complexity of leadership. It is challenging to work with different organizations and to develop and implement strategies that improve health and health care. There are many viewpoints on care coordination and improving the equity of health outcomes.

Sometimes, there is a tendency to minimize the complexity. It can feel overwhelming and time-consuming to gain consensus on decisions. But when the complexity of viewpoints is not minimized, the ability to see interrelationships and interdependencies becomes clearer. In this way, the focus is on seeking common ground rather than differences.

The good of the patients and the community can serve as a core purpose for all partners. This clarity enables leaders to transcend the complexity. They see through it to gain a sense of the best way to achieve shared goals. With a core purpose in mind, leaders are able to determine the best approaches for sharing information and resources. Shifting to transorganizational thinking demands being purposeful in acting for the greater good of all those who are served.

Moving Forward

George Bernard Shaw effectively makes the case for changing mindsets: “Progress is impossible without change, and those who cannot change their minds cannot change anything.” The transorganizational mindset is a powerful way of thinking that can help executives and boards move the collective goals of health care and healthy communities forward. 

Diane L. Dixon, Ed.D. ( is a leadership and organizational development consultant. She is also a lecturer in health services administration at the University of Maryland School of Public Health in College Park.