Most healthcare organizations don’t have a strategy problem.
They have an absorption problem. And it’s costing them real change.
Strategies are clear. Investments are real. Leadership is aligned. And yet, somewhere between the sponsors and the people doing the work, the change doesn’t land. The organization wasn’t built to absorb change at that pace.
There’s a question I’ve started asking before we talk about timelines or launch dates:
Before we talk about how fast you need to move, are you actually built to move that fast right now?
It gives people pause. Not because there isn’t an answer — but because the question hasn’t been asked. And the gap between not asking it and not knowing the answer is exactly where many change efforts quietly break down.
Speed gets most of the attention. Readiness determines what sticks.
Our first article in this series (“Lead like a cheetah”) introduced how to lead at speed. The second (“Disciplined acceleration in healthcare transformation”) explored when to accelerate. This one answers a more fundamental question: what makes speed possible in the first place?
Speed is a product of design, not just drive
The cheetah is built for speed in ways that are easy to admire and easy to misread.
Its spine flexes like a coiled spring, extending stride length far beyond what leg length alone would allow. Its heart is three times larger relative to body size than most mammals, and its respiratory rate can jump from 60 to 150 breaths per minute during a chase, engineered to flood muscles with oxygen during short, extreme bursts of exertion. Its claws are semi-retractable, functioning more like cleats than the fully retractable claws of other large cats. Even its tear-mark facial markings may reduce solar glare during daytime hunts.
None of this is accidental. Every structural feature exists to support one thing: the ability to move with explosive precision when the moment demands it.
But here’s what the cheetah teaches that a speed highlight reel doesn’t: after a sprint, its core body temperature spikes so dramatically that it must rest, sometimes twenty to thirty minutes, before it can eat the prey it just caught. It isn’t resting because it’s weak. It’s resting because its design requires recovery. The sprint is only possible because recovery is part of the system.
The speed isn’t separate from the fitness; it’s a consequence of it.
Many organizations do the opposite: they announce the sprint and skip the question of whether the system was designed to handle it.
Readiness is structural, not emotional
Readiness is one of the most misused words in change. It’s often labeled a sentiment, as in, “Is the team ready?” when change fitness is actually a structural condition. It’s either there or it isn’t. When it isn’t, momentum doesn’t just slow. It consumes itself.
In practical terms: if leaders can’t clearly explain the change, teams won’t execute it.
Organizational fitness for change shows up in concrete signals:
- Leaders at every level can say why the change is happening, not just what it is.
- Roles are clear enough that people know what the change means for their real, daily work, not just for the strategy map.
- Trust in leadership is high enough that when something hard is asked of people, they believe the ask is genuine and that support will follow.
- There’s enough slack in the system that people can learn while still delivering.
These aren’t soft signals. They’re the load-bearing structures of any successful change.
When these conditions are absent, something predictable happens: the initiative launches, communication goes out, leaders speak with a slide deck and good intentions, and the organization goes quiet. And quiet in change work gets misread as alignment, until the adoption numbers come in, rework begins, and someone says six months later, “We implemented it. It just never really stuck.”
When willingness and readiness get confused
A health system was midway through a major transformation. The strategy was sound. The investment was significant. The executive team was genuinely aligned. By nearly every traditional measure, the change effort was well-managed.
And then the adoption data came back.
Utilization of the new model was spotty. Workarounds had proliferated, defeating the purpose of the investment. Leadership was frustrated. The people had shown up for training, asked questions, and said in surveys that they understood the change.
What they hadn’t said, because they hadn’t been asked, was whether they felt equipped to carry it out. Whether leaders had the language to answer their teams’ questions. Whether the volume of concurrent change had left any real capacity to absorb this one.
People don’t have infinite capacity to stretch.
They were willing. They weren’t equipped. In change, those two things aren’t the same.
Cheetahs rest up to twelve hours a day. They don’t hunt at night — not because they don’t need to eat, but because their eyes are built for daylight and the dark belongs to larger, stronger predators. They don’t hunt when overheated. They spend time on elevated ground scanning terrain before committing to a chase. That deliberate preparation isn’t weakness. It’s what makes the sprint possible when it matters.
When the plan fails, readiness holds
In 1914, Ernest Shackleton set out to lead the first land crossing of Antarctica. Before his ship, the Endurance, ever reached the continent, it became trapped in packed ice and was slowly crushed. The expedition’s original mission was over before it began.
What followed is one of the most remarkable survival stories in history. Shackleton and his crew spent nearly two years stranded on drifting ice, in lifeboats, and eventually marooned on a remote island.
Yet not a single life was lost.
They survived because of what Shackleton had built into the crew before the mission began. He prioritized psychological resilience, optimism, and adaptability over technical skill — with people who could absorb the unexpected, not just execute the plan.
For healthcare, the parallel is direct: the clinical operations leader who can carry a difficult message without losing the room, the revenue cycle manager who can answer questions without hedging, the supervisor who can keep progress when the plan shifts.
That kind of readiness doesn’t first appear on launch. When the initiative hits friction, and it will, those with genuine change fitness will adapt.
The plan failed. The readiness held. The preparation made adaptation possible.
Five things fit healthcare organizations do differently
Organizational change fitness goes beyond training events or communication campaigns. It reflects a set of conditions leaders build deliberately ahead of the sprint, so when the moment comes to move, the system can respond.
These aren’t optional. They’re the conditions that determine whether change works, and build on each other. Equip leaders first, and they can carry the message. Make tradeoffs visible, and people can focus. Build in recovery, and the system stays in motion. Measure the right things, and you can see where fitness is breaking down. Treat activation as a lasting capability, and you stop starting over every time.
Here’s what this looks like in practice for change-ready organizations:
- They invest in leader readiness before launch. The middle layer of directors, managers, and leads determines whether change is real. If those leaders aren’t equipped to answer the basic questions their teams will ask, no communication strategy compensates for it. Fit organizations equip leaders to carry the message before the message goes out.
- They make tradeoffs visible. Every new initiative competes with the existing load. What’s being retired? What’s being deprioritized? Naming it doesn’t solve it, but pretending it isn’t there is one of the fastest routes to eroding trust.
- They build recovery into the design. Sprint capacity isn’t unlimited, and recovery isn’t a failure of commitment; it’s what makes the next sprint possible. Organizations that compress every timeline and stack initiatives eventually discover that their workforce is in a kind of sustained low-grade overload that looks like engagement on a survey and feels like exhaustion in the hallway.
- They measure readiness, not just launch status. The question isn’t whether it went live. It’s whether the people responsible for sustaining it have what they need. Those are different questions, and fit organizations ask the second one.
- They treat activation as a capability, not a task. This compounds over time. When the ability to mobilize people around change is treated the same way any other capability is treated — resourced, practiced, measured, and improved — each change builds upon the last one instead of starting again from zero.
What high-performing teams understand about readiness
In sports, the difference between teams that sustain performance over a season and those that peak early and fade is rarely raw talent. It’s conditioning: the capacity to perform under load, recover quickly, and maintain execution quality as fatigue builds.
Teams that overtrain early see injuries, burnout, and declining performance when the games matter most. Teams that build fitness intelligently, with periodization, recovery protocols, and attention to cumulative load, tend to peak when it counts.
The New Zealand All Blacks rugby program, one of the most consistently successful teams in professional sports history, has long attributed part of their sustained dominance to a culture they describe as “better people make better All Blacks.” The fitness they build isn’t just physical, it’s psychological, relational, and systemic. Players are expected to manage their own readiness, communicate honestly about capacity, and support the people around them. The system works because everyone in it is built to absorb pressure, not just perform under it.
The clinical operations director who can hold a room when the rollout hits complications. The revenue cycle VP who can give their team honest context when the timeline shifts. The change champion who has enough support structure behind them to actually champion something.
That’s what change fitness looks like in practice. Not as a concept, but as a person who was prepared before the pressure arrived.
Why readiness matters more now
Healthcare has always required leaders to manage complexity. But the nature of that complexity has shifted in ways that raise the stakes considerably for change fitness.
AI integration into clinical and administrative workflows is compressing decision cycles and raising expectations for speed the workforce hasn’t yet been built to absorb. Regulatory pressure continues to increase. Workforce strain, the accumulated effect of years of disruption, turnover, and sustained demand, has reduced the slack that once gave organizations room to absorb new initiatives without breaking stride.
You can’t outrun a readiness deficit
You can only delay the reckoning with it.
In this environment, launching a change effort without assessing readiness isn’t bold. It’s expensive, both in the direct costs of failed adoption and rework, and in the trust cost: the erosion of confidence in leadership that happens when people are asked to carry something they weren’t equipped to carry.
Trust, once eroded, is slow to rebuild. Slower, almost always, than the cost of investing in readiness before the sprint.
An activation capacity diagnostic can provide a structured way to evaluate whether the organization is genuinely built to absorb what leadership is about to ask of it, before the sprint begins. The organizations that do this work ahead of launch don’t just move faster. They move in a way that sticks.
The question to ask before the next sprint
In 2026, the pressure to move won’t ease. The market isn’t slowing down. Board expectations aren’t softening. The pace of technological change isn’t relenting. Sustainable speed, the kind that drives real adoption, real behavior change, and real outcomes, isn’t about moving harder. It’s about moving from a position of readiness.
Ambitious timelines alone won’t carry organizations through this moment. What matters is having the change fitness built, and in place, to absorb what those timelines demand. That’s the advantage.
That’s the concept at the center of this article and the series it belongs to. Not just speed. Not just strategy. Activation readiness: the structural condition that determines whether the human system can receive what leadership is asking it to carry.
The leaders who navigate this environment most effectively are the ones who ask a different question before the next initiative launches. Not just: “Are we ready to announce this?” But: “Are we actually built to absorb it — and if not, what needs to change before we do?” Those are different questions. And the space between them is where transformation either takes root or fails.
A cheetah’s adrenal system recovers fully within about thirty minutes of a sprint, resetting for the next hunt. That recovery isn’t passive. It’s purposeful. The same discipline that drives the sprint governs the recovery. Both are part of the design.
Reflection: Where’s your organization right now? Is it genuinely fit for the change you’re asking people to carry? And if the honest answer is not yet, what would it take to build that readiness before the sprint begins?
Leading change at the Speed of Now requires more than urgency. It requires change fitness. And the discipline to build it before you need it.
Not just fast. Fit first. Then flexible.
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