The key drivers for success of healthcare systems are a culture of performance
excellence, accountability for results and leadership execution. The lack of a uniform culture
across hospitals, the internal resistance to culture change and the absence of leadership
commitment all create barriers to the performance improvement (Yonek et al., 2010).
Similar findings in high-performing healthcare systems (Baker et al., 2008)
and transformational change in healthcare systems (Lukas et al., 2007) were produced.
The quality of the leadership execution is critical, especially when it has to enact the
trade-off between supporting consistency vs the capacity to innovate (Yonek et al., 2010).