Leading the Organization You Inherited

CEOs are held accountable for systems they didn’t choose.

In a recent conversation with an FQHC CEO, this came up more directly than I’ve heard it before.

Most organizations aren’t designed.
They evolve.

Over time, decisions layer on top of each other:

Workflows built for a different scale
Staffing models shaped by past constraints
Processes no one would design today, but no one has fully reworked

And then a new CEO steps in.

Accountable for performance

Without having chosen the system producing it

What looks like underperformance is often misalignment inside the system itself

Not one problem

But a set of decisions that no longer fit together

The work isn’t starting from scratch

It’s deciding what to keep
what to challenge
and what to rebuild

While the organization is still running

Most people underestimate how much of leadership is reworking inherited systems

not creating new ones

Where are you working around a system that probably needs to be rethought?