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As the complexity of change efforts increases in healthcare organizations, the demands on leadership increase, as well. This study examines the experience of the leaders who implemented the Emergency Department Patient Navigation (EDPN) program at Presbyterian Healthcare Services (PHS). Utilizing a case study methodology to interview 12 participants, open-ended questions captured in-depth descriptions of what participants learned as they led a successful change effort. Findings emerged in three categories: Personal Shift to Agreement, Success Factors, and Leadership Characteristics. Personal Shift to Agreement was used to describe the difference between the prior state and the end state. Terms used to describe what caused the shift include trust, leadership, communication and a focus on the patient. What emerged as significant factors supporting the success of the program are the use of an enterprise approach, leader modeling, the importance of making difficult decisions, the navigator role, and physician involvement. Key Leadership Characteristics identified by participants as important to have demonstrated personally were adaptability, innovation, and collaboration. Analysis demonstrates that the program was led utilizing effective change methodology, thus creating transformational changes in patient care, and in transformation in the personal leadership of several participants (Kotter 1996). The role of the physicians in development of the program demonstrated effective use of the social networks, specifically as Opinion Leaders (Rogers, 2002). Effective use of Distributed Cognition (Hutchins, 1995) to develop the solutions allowed the team to create an environment that brought the strength of the enterprise to bear on the national problem of wait times in an Emergency Department (ED).