A health system growing faster than its leadership capacity.

A large regional integrated health system in active growth: one that has acquired multiple other health systems and regional hospitals in recent years, each bringing its own culture, leadership history, and organizational identity into an enterprise still working out how to function as one. The growth was strategic. The integration was hard.

Budget pressures compounded the complexity. Cuts to management layers that had provided stability and continuity arrived at exactly the moment those layers were most needed, when leaders were being asked to hold teams that didn’t yet feel like theirs, in a system that didn’t yet feel coherent. Mid-level managers were absorbing the loss of longtime leaders they’d oriented their professional identity around. Others were stepping into expanded roles they hadn’t anticipated. And senior executives were running into blockers — patterns in their own leadership and in the ecosystem around them — that the organization’s rapid growth had finally made impossible to work around.

The organization needed coaching. What it needed more specifically was coaching at every level simultaneously, because in a system this size, moving this fast, the leaders at each level were becoming each other’s constraints.

Bryan is currently working with multiple leaders across the organization simultaneously: each at a different level, each with a different growth edge, each coaching arc designed from a diagnostic assessment of where that leader actually is rather than where their title suggests they should be.

Mid-level managers

navigating the loss of a longtime leader and the destabilizing effect that loss had on their own sense of professional identity and direction. The coaching work here focused on differentiation: helping these leaders understand what was theirs to carry and what belonged to the transition, developing the self-awareness to notice when they were operating from loss rather than leadership, and building the relational skills to hold their teams through a disorientation that mirrored their own.

Leaders in new and expanded roles

facing the complexity gap that promotions reliably produce: the moment when what worked at the previous level stops working and the skills required at the new level haven’t been built yet. The coaching focused on skill development specific to that gap: decision-making at greater scope, navigating stakeholder ecosystems they hadn’t previously had to manage, and the executive presence required when the room changes and the old version of you no longer fits it.

Leaders navigating acquisition integration, managers whose teams now included people from acquired organizations, carrying different cultural norms, different loyalties, and different assumptions about how leadership is supposed to work. The coaching here focused on building the relational and systems-reading skills to lead a team that doesn’t yet share a common framework, and the presence to earn trust across a cultural seam rather than assume it comes with the org chart.

Senior executives

working on the patterns keeping them locked inside their current operating range: blockers that looked like organizational problems but were partly patterns in their own leadership that the organization’s complexity had finally made visible. The coaching used the Lectical Leadership Decision Making Assessment as the primary developmental instrument: mapping where each executive’s reasoning was, identifying the specific growth edges, and building a practice arc around the real constraint rather than the comfortable story about it.

Across all cohorts

Two things were consistent. First, the skill-building frame: the explicit premise that leadership is a craft that can be developed deliberately, not a fixed trait you either have or don’t. For leaders who had been told their whole careers that they were good leaders, being invited to actually build skill rather than perform it was clarifying in ways they hadn’t expected. Second, the Designed Team Alliance, an ORSC-grounded instrument for surfacing what’s actually operating in a team system. The important distinction: leaders weren’t coached on their teams. They were coached to use the DTA with their own teams, to surface tensions, name dynamics, and facilitate honest team conversations that previously required an outside voice to initiate.

At the close of the engagement, progress will be assessed against the developmental baselines established at intake: LDMA re-assessment where applicable, stakeholder interviews with direct reports and managers, and behavioral observation across the arc. The question at every close is the same: can the leader point to something specific that changed? Can the people around them?

We’ll update this case when the engagement wraps.