Response: Why C-Suite Collaboration Fails and How Hospitals Can Finally Close the Execution Gap

By Jimmy Lepper, Co-Founder, Empactful Advisors

Kristin Kuchno’s insightful piece on the “critical glue” for C-suite collaboration highlights a truth every hospital leader knows intimately: no amount of individual talent can compensate for a leadership team that is misaligned, siloed, or operating without a shared execution rhythm.

The executives quoted, including Ashley Vertuno, Bob Adams, Travis Andersen, Alan Kumar, MD, and Gil Peri, are absolutely right: alignment, transparency, culture, and shared decision-making are foundational. But as we’ve learned working with health systems across the country, even teams who believe they are aligned often struggle to convert alignment into measurable performance gains.

That gap between aspiration and execution is where most hospitals leave margin, workforce capacity, patient access, and operational efficiency untapped.

At Empactful Advisors, we exist to close that gap.

The Missing Ingredient: Turning Collaboration Into Repeatable Execution

Hospitals achieve breakthrough performance not when executives simply “row in the same direction,” but when the leadership team is equipped with the tools, cadence, and decision-making discipline to turn that collaboration into quarter-over-quarter results.

We don’t settle for incremental gains - incremental is not enough in today’s reality. We help leadership teams cut through the noise, eliminate decision churn, and focus on the small number of metrics that matter most. We find time and again that this enables them to deliver significant step-change improvement, even in long-stagnant areas like throughput, cost productivity, access, or service line margin.

Executives often know what they want to improve. They rarely have a structure that aligns the full leadership system around how to drive that improvement in a sustained, coordinated way.

That is the missing “glue.”

Culture Isn’t Soft – It’s the Hardest Operational System in the Hospital

Several leaders in the article correctly highlight culture as the connective tissue of high-performing teams. We take it further: culture is not a slogan or a retreat; it is a deliberately built operating system.

Real cultural transformation requires activating three elements simultaneously:

• Mindset - shifting how leaders think about accountability, priorities, and possibility

• Behavior - building new leadership habits, meeting cadences, and decision norms

• Business execution - embedding those expectations into KPIs, dashboards, sprints, and performance management

When hospitals activate all three, culture becomes a catalyst not a constraint. It’s also how we counter a reality many systems face today. I don’t believe that hospitals don’t have a capability gap. They have an activation gap.

The Power of “Seemingly Impossible” Goals

One theme we see across our most successful client engagements echoes what these leaders shared: growth demands more than incremental improvement. It requires the courage to set bold, clear outcomes, and the discipline to pursue them with a unified leadership system.

Too often, hospitals anchor improvement efforts in what feels realistic instead of what is required. We challenge leadership teams to identify areas where progress has stalled and commit to meaningful, step-change gains. It unlocks creativity, accelerates decision-making, and engages teams far more deeply than incrementalism ever could.

When employees feel seen, valued, and included in that ambition, they don’t comply; they champion execution.

Why C-Suite Collaboration Breaks Down and How to Fix It

In our experience, collaboration fractures most often because:

• Leaders are aligned on vision but not on priorities

• Meetings surface issues but don’t drive decisions

• KPIs are too broad, too numerous, or too disconnected from behavior

• Execution is delegated rather than co-owned

• Culture is acknowledged, but not operationalized

The article spotlights systems that are already working to close these gaps. What we bring is the structure that ensures those efforts produce durable, systemwide impact.

Our work with hospital C-suites focuses on embedding a repeatable execution engine – one that:

• Uncovers hidden margins and untapped capacity

• Creates alignment around a small number of strategic outcomes

• Strengthens collaboration through transparency and shared decision-making

• Builds leadership rhythms that accelerate progress

• Embeds cultural change into daily operations, not just messaging

When leaders take off their “individual hats,” as Gil Peri described, and operate as one executive body with shared ownership for results, transformation becomes not only possible, but predictable.

The Path Forward

The executives quoted in Becker’s are modeling the right instincts: transparency, shared goals, consistent rhythms. But the next frontier for high-performing systems is not more collaboration; it’s collaboration engineered for performance.

At Empactful Advisors, we help organizations move from alignment to acceleration, from aspiration to activation, and from incremental gains to breakthrough results.

Because strategy matters. People matter. But execution is where lives change and where leaders leave their legacy. If your system is ready to turn collaboration into sustained performance, we’re here to help.

If your system is ready to move from alignment to acceleration, let's talk.