A Decade Later: Why Ecosystem Leadership Still Matters

When Bob Sachs and Tracy Duberman first wrote From Competition to Collaboration, we were responding to a healthcare system locked in silos. Our goal was to challenge leaders to think beyond organizational boundaries—to see themselves not just as executives of their own institutions, but as stewards of the broader health ecosystem.

We introduced the Health Ecosystem Leadership Model (HELM™) as a guide for navigating that shift. HELM was designed to help leaders envision the future, align diverse stakeholders, manage across boundaries, and mobilize collective action. It was a call to lead differently—through curiosity, collaboration, and purpose.

Nearly ten years later, the need for that type of leadership is even more urgent. The U.S. still spends more per capita on healthcare than any other nation yet lags in outcomes. Meanwhile, today’s leaders face mounting complexity: policy whiplash, public distrust, workforce burnout, and pressure to do more with less.

What’s Working — and What’s Not

We’re not starting from scratch. There are bright spots. Community-based coalitions, cross-sector equity initiatives, and partnerships with tech and public health organizations are making real progress—particularly at the local level.

But nationally, momentum is uneven. The post-pandemic period saw many organizations revert to transactional thinking—focused on efficiency and immediate gains rather than long-term transformation. We see turf wars, siloed priorities, and short-term solutions that don’t address the root challenges.

A 2025 study in The Journal of Public Administration and Theory, highlighted in Stanford Social Innovation Review, reinforces why some efforts succeed while others stall. The most effective cross-sector partnerships, it found, are rooted in trust, community engagement, shared learning, and data-informed decision making—all key tenets of HELM.

These findings reaffirm our belief: collaboration is not just a tactic. It’s a leadership strategy.

HELM in Today’s Context

HELM remains as relevant now as it was when we first introduced it. But what’s evolved is our understanding of what makes it work.

Process alone doesn’t drive transformation. Mindset does.

HELM leaders don’t lead with certainty—they lead with curiosity. They seek out diverse perspectives, listen deeply, and explore solutions in partnership with others. They manage ambiguity while keeping a clear eye on shared goals. And they understand that the journey to alignment is often nonlinear—but still worth the effort.

In today’s environment, where disruption is constant and priorities often compete, traditional leadership models fall short. HELM leaders are equipped to navigate complexity with agility, humility, and purpose.

Collaboration Starts Inside the Walls

It’s tempting to think of collaboration as something that only happens between organizations. But it’s just as critical within them.

Whether aligning clinicians and administrators, bridging departments, or working across geographies, internal collaboration demands the same skillset: trust-building, systems thinking, and influence without authority.

One of us previously led enterprise-wide leadership efforts across a national health system. Sometimes those initiatives succeeded, and sometimes they didn’t. The difference often came down to whether local leaders felt connected to the mission—or whether they were protecting their own turf.

What we’ve learned is this: organizations that invest in collaborative leadership at every level are better prepared to partner across the ecosystem. Internal alignment strengthens external impact.

And while leadership development is often one of the first things cut in a down market, we’d argue the opposite: in times of disruption, leadership development isn’t a luxury. It’s essential.

From Partnerships to Transformation

Healthcare today is full of partnerships—between hospitals and tech firms, payers and community orgs, providers and retailers. But many of these are transactional, designed to meet a narrow or immediate goal.

Transformative partnerships are different. They grow out of mutual trust, shared learning, and deep listening. They take time. They require leaders to let go of control and co-create something new. And they often lead to outcomes no single organization could have achieved alone.

This kind of work is not fast, and it’s not easy. But it’s the path to innovation, sustainability, and greater impact.

It Starts at the Top

Senior leaders don’t need to manage every partnership directly—but they do need to create the conditions for collaboration to thrive.

That means modeling collaborative behaviors, prioritizing time for relationship-building, and aligning incentives with the organization’s mission. It also means embedding collaboration into the culture—through how leaders are selected, how teams are supported, and how success is measured.

Culture isn’t defined by posters or taglines. It’s reflected in how people are hired, how they’re developed, and how decisions get made. If collaboration is a value, it has to show up in everyday leadership—not just in strategy documents.

If We Wrote a New Chapter Today...

We’d call it: Collaboration as Strategy: Leading in a Time of Fracture.

Because this moment doesn’t just call for alignment—it calls for creation. Leaders can’t wait for conditions to be perfect. They must start small, build trust, test new approaches, and focus on shared outcomes.

To those stuck in a transactional role:
Pause. Reconnect with your purpose. Invite others into the conversation. Begin again—this time, together.

Why We’re Still Hopeful

Despite the headwinds, we remain optimistic.

We see promising initiatives emerging from the ground up. We see leaders stepping into new roles focused on equity and partnership. And we see a generation of rising professionals who believe that healthcare should be both data-informed and deeply human.

HELM leadership isn’t a trend. It’s a mindset—and a movement. One that meets this moment with clarity, courage, and connection.

Because the future of healthcare is collaborative. And that future starts now.

Is your organization ready to lead through connection, not control? Let’s explore how TLD Group can support you in cultivating collaborative leaders who drive impact across the health ecosystem.