The primary research focus is an exploration and investigation of executive leadership perceptions of their decision making activities within hospital organizations throughout two states: Michigan and Kentucky. Ethically, transformational and transactional executive leaders (Burns, 1978; Bass, 1999a, 1999b) may entrust stakeholder integrity with effective and efficient teamwork (Srivastra, 1988). For example, during collaborative communication processes (Wiio, 1978), leaders can facilitate stakeholder teams in contributing to strategic planning (O’Shannassy, 2003). Furthermore, leaders may empower and delegate (Spreitzer & Quinn, 2001) these stakeholders to accept accountability. The secondary research focus includes exploration of what leadership activities impact hospital organizations encountering systemic change. Survivability can depend upon a successful transformation from leadership change management (Nadler & Nadler, 1998; Ackerman-Anderson & Anderson, 2001a; Anderson & Ackerman-Anderson, 2001b) toward stakeholder knowledge creation within a learning organization (Montouri, 2000). Positive results from the aforementioned activities, therefore, may enrich quality improvement initiatives (Leonard & McAdam, 2002, 2003). The presence of power and political activities (Provan, 1989, 1991), however, can evolve from financial challenges. Lastly, this comprehensive analysis of integrated leadership activities with organizational survivability supports a mixed methodology triangulation approach (Miles & Huberman, 1994; Tashakkori & Teddlie, 1998; Creswell, 2003) to discover a new grounded theory (Strauss & Corbin, 1998) toward a real theory of healthcare transformation.