Turning around an Academic Health System by Reshaping Culture and Improving Performance

Academic health systems - particularly those serving underserved states - carry a unique responsibility to advance patient care, education, and research while operating under significant financial, workforce, and regulatory constraints. This article describes the transformation of OU Health and the University of Oklahoma College of Medicine, Oklahoma's only academic health system, emerging from a period of clinical, financial, and cultural distress as a more unified, mission-driven enterprise demonstrating early signs of recovery and performance improvement. Following a costly divestiture from a for-profit management structure and the disruption of the coronavirus disease 2019 pandemic, OU Health undertook a comprehensive turnaround strategy anchored in three interdependent pillars: creating a shared vision, leading with safety as a foundational priority, and aligning leadership and accountability across the enterprise. Through structured change management, a systemwide learning map engagement of nearly 10,000 employees, redefined safety governance grounded in learning health system principles, and explicit expectations for leadership behavior, the organization achieved measurable early improvements, including reductions in hospital-acquired infections and mortality alongside stabilization of financial performance. The authors present a replicable framework for academic and nonacademic health systems navigating large-scale transformation, emphasizing culture and safety as prerequisites for sustainable operational and financial recovery.