In this episode, host Ken Segel talks with Donise Musheno, Vice President of Perioperative Services at Lancaster General Hospital (Penn Medicine), about leading large scale operational transformation through trust, culture, and systems thinking. When she began, her team faced a 30% instrument defect rate and 9% case delays, issues that undermined efficiency and morale. By focusing first on relationships and trust, then simplifying priorities around quality and efficiency, Donise helped her team achieve dramatic improvements: defects dropped to 4% and delays to less than 0.2%. She emphasizes real time problem solving, transparent data, and empowering frontline leaders to test and learn quickly. The conversation highlights how building culture first enables sustainable excellence, turning crisis into collaboration and measurable, lasting results.