Leaders are responsible for building the organization’s ability to carry change through. They must understand what the change requires, determine how the organization will respond, and address the conditions that enable people to do the work.
Here, “leaders” refers to people responsible for directing implementation, supervising the work, or making decisions about the resources and organizational support a change requires. These roles exist at different organizational levels and carry different responsibilities and degrees of authority (Damschroder et al., 2022; Williams et al., 2024).
That responsibility applies whether change begins with an internal opportunity or an external demand. An organization may choose to expand a service or act on a team’s proposal for a better way to work. It may also need to respond to a new requirement or a shift in demand it did not anticipate. The time available to prepare will differ, as will the choices available.
The source of change shapes the response
Determining the response begins with understanding both the source of change and the conditions within the organization. The updated Consolidated Framework for Implementation Research brings these influences into view, including policy, financing, organizational structures, and the people carrying out the work (Damschroder et al., 2022). In practice, this means examining how an external demand or internal opportunity will affect the work people are expected to perform.
The distinction becomes practical when leaders consider their discretion: the choices they are authorized to make about how to respond. These may concern timing, scope, approach, or resources. A requirement to standardize practice across locations may fix the obligation and deadline while leaving choices about local workflows and implementation support. Those accountable for implementation need to identify which decisions fall within their authority and which require approval elsewhere. An internally chosen service expansion may allow more freedom over timing and scope, while still requiring an operating model that supports it.
Identifying these choices helps establish who must decide what. For a mandated change, that may mean deciding how to meet an obligation within a fixed deadline. For an internal initiative, it may mean deciding whether to proceed, where to begin, or what to test first.
Translate the need into organizational direction
Those decisions become organizational direction when people understand what is expected to change and why. People need clarity about how decisions will be made, where uncertainty remains, and which elements are required. That explanation must distinguish the requirements of the change from preferences introduced in its name.
That distinction matters when an external obligation becomes the explanation for every internal decision. It also matters when an internally chosen initiative is presented as if its design were inevitable. Some elements may be fixed; others reflect leadership choices. Making those choices visible allows informed participation and makes accountability for the chosen response explicit.
The response leaders choose must also be tested against the organization’s ability to deliver it. This requires ground truth: an understanding of how the work is currently performed and which conditions will support or obstruct the response. The question is, “Do the people accountable for the outcome have the authority, resources, and capability required to produce it?” (Batiste, 2026a, “From Ground Truth to Informed Action” section, question 4). A mandate does not confer those conditions. They must determine what is already in place and what they need to strengthen or build.
For the organization introducing a standardized practice, that inquiry could reveal that local leaders cannot authorize necessary workflow changes or that technology cannot support required documentation. For the service expansion, it could reveal that the proposal assumes expertise or staffing that has not yet been secured. Ground truth brings those constraints into the decision while there is still time to address them.
Build the capacity to carry out change
Once those constraints are visible, leaders must decide how to address them. The organization may need to resolve competing priorities, change how functions coordinate, or develop capabilities it has not previously required. Clear direction becomes actionable when those decisions establish the means to carry it out.
Responsibility for these decisions must be matched to the authority of the role. Those directing implementation can identify needs and coordinate the work within their remit. Decisions about what the organization will take on, which priorities it must adjust, and where to commit additional resources require the involvement of people authorized to make them. Executive sponsorship must include resolving conditions beyond the implementation team’s authority.
The judgment of readiness needs to be revisited as the work develops. A systematic review of 47 healthcare studies of changes in practices, policies, and programs found substantial variation in how readiness was defined and assessed; most studies measured it only once (Caci et al., 2025). An assessment made before implementation cannot be assumed to describe what people will encounter throughout the change.
As implementation reveals new demands, leaders need ways to hear about them and authority to respond. An expanding service may attract a different mix of patients than expected. A required practice may expose a dependency the initial plan missed. Each development is reason to reconsider whether the resources and arrangements established at the outset remain sufficient.
Lead through the transition
Responding to those developments can require immediate decisions to protect continuity or meet an obligation. Those responsible for these decisions also need to examine what the response requires of people and whether that effort can be sustained.
Meeting the initial deadline can conceal how much effort the organization required to get there. A rollout may stay on schedule because a manager personally resolves every exception or a small group repeatedly bridges gaps between departments. Leaders therefore need to examine “what, and whom, that performance depends on” (Batiste, 2026b, “Recognize the work. Reduce the dependency.” section, para. 4). During change, that distinction helps reveal whether new organizational capability is taking hold or whether familiar people are absorbing new demands.
The judgment and flexibility of those people deserve recognition. Their contribution also provides evidence about what the transition still requires. Repeated exceptions may point to unclear decision authority. Reliance on one person may reveal knowledge that needs to be shared. Leaders are responsible for using that information to strengthen routine operations, so the organization’s response becomes something its people can sustain.
Strengthening the support around people is part of this leadership work. In a study of 21 youth mental health clinics, adding leadership development and organizational strategy support to training and technical assistance improved leadership behaviors and staff perceptions of support for a new clinical practice. The analysis linked improvements in that support to more consistent delivery of the practice (Williams et al., 2024). The findings concern one practice and a combined strategy, but reinforce the importance of developing leaders and the organizational support around implementation.
Providing that support requires decisions in daily operations. When the work reveals a barrier, those with authority to act need to decide whether to revise the design, strengthen support, change the sequence, or reconsider the approach. An internally chosen expansion may need to proceed more slowly. A mandatory change may require resources to be redirected to meet the deadline. Monitoring progress becomes useful when it informs those decisions.
Build an organization that can move through change
These decisions continue to matter after the rollout is complete. The question remains whether the organization can perform under the changed conditions, recognize emerging difficulties, and adapt without relying indefinitely on exceptional effort.
The Batiste Model™ brings this ongoing responsibility into view through its connected dimensions of Truth, Structure, and Capability. Truth concerns the accuracy of the organization’s understanding of the situation. Structure concerns how the organization supports the response. Capability concerns whether its people can carry the work forward. Examining these dimensions together helps identify what needs attention as conditions change.
Whether change begins with an internal opportunity or an external demand, leadership remains accountable for connecting what the organization is expected to do with its ability to do it.
References
- Batiste, Q. (2026a, October). Before the next solution: Why healthcare transformation begins with ground truth. Batiste Advisory Group. https://batisteag.com/insights/before-the-next-solution
- Batiste, Q. (2026b, October 22). The invisible work of leadership. Batiste Advisory Group. https://batisteag.com/insights/the-invisible-work-of-leadership
- Caci, L., Nyantakyi, E., Blum, K., Sonpar, A., Schultes, M.-T., Albers, B., & Clack, L. (2025). Organizational readiness for change: A systematic review of the healthcare literature. Implementation Research and Practice, 6. https://doi.org/10.1177/26334895251334536
- Damschroder, L. J., Reardon, C. M., Opra Widerquist, M. A., & Lowery, J. (2022). The updated Consolidated Framework for Implementation Research based on user feedback. Implementation Science, 17, Article 75. https://doi.org/10.1186/s13012-022-01245-0
- Williams, N. J., Ehrhart, M. G., Aarons, G. A., Esp, S., Sklar, M., Carandang, K., Vega, N. R., Brookman-Frazee, L., & Marcus, S. C. (2024). Improving measurement-based care implementation in youth mental health through organizational leadership and climate: A mechanistic analysis within a randomized trial. Implementation Science, 19, Article 29. https://doi.org/10.1186/s13012-024-01356-w