Healthcare is increasingly organized in network in which organizations across domains collaborate to address healthcare’s grand challenges. Leadership often emerges as one of the determinants of network effectiveness, but the turnover of members and leaders is high. It is therefore crucial to understand how such leadership transitions unfold. We explored this by following a network prior and during a leadership transition, performing 46 hours of observations, collecting documents, and performing 34 interviews with network representatives. Our results show that an unexpected leadership transition can take a long time affect the dynamics such as trust between network members and the network composition. Additionally, the results show that a lead-organization can be established based on both organizational characteristics as well as individual characteristics. In case of the latter, the governance structure of the network may be less stable in case of a transition. Many covert conversations as well as decision-making processes seemed to occur outside of formal network meetings, showing that the influence of formal leaders, though they lack formal hierarchy, may be larger than previous research suggests in the form of nudging and leveraging. We urge that networks should therefore consciously design their governance and leadership structure in a way that diminishes the effects of an unexpected transition, such as dual leadership from two organizations. Furthermore, we argue researchers studying networks should acknowledge the fact that many dynamics in networks may not be directly observable and consider this when interpreting their results and designing their research.
