What to assess, what to protect, what to decide fast — and how to build authority without destroying culture
Hamza Asumah, MD, MBA, MPH
The Honeymoon Period Is Shorter Than You Think
Research published in Harvard Business Review in January 2025 is direct on the point: the honeymoon period for new healthcare executives is well and truly over within the first few months. After six months, the window for establishing credibility, reshaping culture, and building leadership momentum has narrowed significantly. Most African healthcare executives — whether stepping into a new clinic group, a hospital executive role, or a diaspora-return leadership position — do not have a structured playbook for this transition. They arrive with credentials, good intentions, and no systematic framework.
The consequences are predictable. Either they move too fast, disrupting existing relationships and institutional knowledge before understanding the system they have entered. Or they move too slowly, signaling indecision to a team that was watching for direction. Both extremes damage the one asset a new leader cannot afford to lose in the opening months: trust.
The First 90 Days framework, pioneered by leadership expert Michael Watkins and taught at IMD Business School, offers a rigorous transition methodology that has been applied by thousands of executives across industries globally. But it requires significant adaptation for the African healthcare context — where authority is relational rather than purely hierarchical, where institutional memory often lives in informal networks rather than documented systems, and where the gap between formal organizational charts and actual power dynamics can be significant.
| 40% | of senior healthcare leaders globally underperform in their first year due to inadequate transition planning — a number that rises in under-resourced contexts (Harvard Business Review, 2025) |
Understanding the Terrain Before You Move: The STARS Assessment
Before any action, a new healthcare leader must correctly diagnose what kind of situation they have entered. Michael Watkins’ STARS framework — Start-Up, Turnaround, Accelerated Growth, Realignment, and Sustaining Success — is the most practically useful diagnostic tool available.
In African private healthcare, the Turnaround and Realignment categories are by far the most common entry conditions. Turnaround describes a business that is in trouble and knows it: cash flow problems, staff turnover, quality failures, or declining patient volumes. Realignment describes a business that is in trouble but does not yet know it: complacent, operationally stuck, culturally resistant to change, and often led by founders or long-tenured managers who mistake familiarity for stability.
The diagnostic determines everything. A leader entering a turnaround situation can move faster, make harder decisions sooner, and justify disruption because the stakes are visible. A leader entering a realignment must build a compelling case for change before implementing it — because the organization does not yet feel the urgency. Misidentifying which situation you are in is one of the most common and costly mistakes a new African healthcare executive can make.
The 30-60-90 Day Framework: African Healthcare Edition
Days 1 to 30: Listen, Map, and Diagnose
In the first month, your primary job is intelligence gathering. Meet every key stakeholder — clinical leads, administrative managers, front-line staff, board members, major suppliers, and payer contacts. Not to perform competence. To understand the actual state of the organization beneath the formal narrative. Ask the same five questions in every conversation: What is working well that I should protect? What is broken that I need to fix? What has been tried before that did not work? What does this organization need most from its leadership right now? And what should I know that nobody has told me yet?
In parallel, conduct a rapid financial and operational diagnostic. Examine the last twelve months of financial statements. Identify the top three revenue drivers and the top three cost centers. Understand the payer mix and collection performance. Review staffing ratios and turnover rates by department. Map the organizational structure against the informal influence networks that actually make decisions. By day 30, you should have a clear picture of the business’s real condition versus its official narrative.
Days 31 to 60: Build Relationships and Secure Early Wins
The second month is about converting intelligence into credibility. Identify two to three early wins — specific, visible improvements that demonstrate competence and signal your leadership direction without requiring organizational transformation. An early win could be resolving a longstanding procurement problem, redesigning a patient intake process that was causing complaints, or implementing a simple reporting mechanism that gives the team data they have been operating without. Early wins are not about proving you are the smartest person in the room. They are about demonstrating that you can identify problems and execute solutions.
This is also the period for strategic relationship building. In African organizational contexts, <authority without relationship is authority without execution. Your ability to move the organization will depend on the quality of relationships you build in this phase — with your direct reports, your board, your key clinical staff, and your most influential informal leaders. Invest disproportionately in these relationships before you need them.
Days 61 to 90: Set Direction and Build Accountability
By the end of the first three months, the organization should know three things: where you are taking them, what you expect of them, and how you will measure progress. This requires publishing a clear strategic direction statement — not a lengthy strategic plan, but a concise articulation of the two or three priorities that will define the next twelve months. It requires implementing a performance management cadence: regular team meetings, defined key performance indicators, and accountability mechanisms that create clarity without creating fear.
The most effective African healthcare leaders I have observed in this phase combine strategic clarity with relational warmth. They set standards firmly while making clear that the purpose of accountability is organizational health, not personal judgment. This combination — high expectations delivered with genuine care for the people responsible for meeting them — is the behavioral signature of transformational healthcare leadership.
“The first 90 days do not determine your entire tenure. But they determine the conditions under which the rest of your tenure will be fought — or celebrated.”
The AHAG Advisory Perspective
Executive transitions are one of the highest-leverage intervention points in a healthcare organization. AHAG provides structured leadership transition support for incoming healthcare executives across Africa and the diaspora — combining the First 90 Days methodology with deep contextual knowledge of African healthcare organizational dynamics.
Dr. Hamza Asumah 
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