Many system design and process improvement strategies have allowed the health services sector to make incremental improvements. However, to achieve transformational change, there is often a need for a new and different strategic vision. Development of a transformational strategic vision and its implementation in professional-dominated services, like healthcare, has to be led by leaders with the technical expertise to chart out a new path, but with the flexibility to adjust the vision as it evolves. In implementing the new vision, leaders have to be cognisant of the need to bring about a cultural change within the organisation to support the new vision. This is likely to include the need to engage the heart and soul of the organisation and may require necessary changes in formal reporting structures, processes, systems, roles and relationships.