Historically our department, in a large academic medical center, had relatively little physician leadership and clinical operations were controlled by non-physician administrators and managers. As new, eager physician leaders have joined our program to effect change, there is tension in clarity of roles. Would love to have input on methods to support effective, positive, nimble, collaborative physician-administrator dyad leadership to support high quality, patient centered care. Am looking for concrete evidence-based methods that have demonstrated success at other large medical centers (beyond “encourage everyone to get along with each other” and “go on a retreat!”) What are best methods to move away from separate organizational structures where one side is administrators/managers and the other side is physicians? Our “functional” organizational structure has led to the two groups having challenges implementing rapid change. It is not clear when there are disagreements who has the final authority to make decisions. The leadership structure and roles are not completely clear. Big decisions seem to pile up at the top and the two groups can tend to maximize their own goals rather than that of the total organization.