What Military Leadership Teaches About Health System Transformation: Lessons from New Zealand with Dr. Lloyd McCann

Welcome to Episode 9 of the Ardexia Podcast where we speak to leaders, clinicians and advocates for better healthcare. This week, we talk to Dr. Lloyd McCann, Chief Executive Officer of Tamaki Health in New Zealand, a fellow of the Royal Australasian College of Medical Administrators and Health Informatics New Zealand, and a former reconnaissance officer in the New Zealand Army.

Most organizations struggle to achieve even 50% adoption rates for new technology. Tamaki Health achieved 90% adoption for AI scribes. This is unheard of as most adoption stalls at 20% or less.

Dr. McCann served on the expert panel that reviewed New Zealand's health and disability system from 2018 to 2020, completed fellowships at Oxford University Hospitals in emergency medicine and performance improvement, and previously served as global medical director for Harris Corporation Healthcare Solutions. His military background provides unusual perspective on healthcare transformation.

The conversation revealed what separates successful digital health implementations from expensive failures: empowered leadership, granular execution plans, unsexy infrastructure, and demonstrating tangible clinician value.

Bureaucracies Can Innovate With Good Leadership

We use "bureaucracy" as shorthand for slow, inflexible, resistant to change. Lloyd's military experience challenges that assumption.

"We often talk about bureaucracies as entities unable to be agile, innovative, effectively manage change. Armies around the world are big bureaucracies. My experience through the New Zealand Army was actually one where good leadership drove a lot of innovation and managed change very effectively."

Whether organizations innovate depends on leadership, not inherent structure.

Lloyd's experience across the New Zealand public health system and the NHS reinforced this: "Through empowered and enabled leadership and having a good plan, you can drive effective change and transformation and innovation."

The key phrase: empowered and enabled leadership. Not just having leaders, but creating conditions where they can actually lead.

An 80% Plan Delivered On Time Beats a Perfect Plan Delivered Late

Military training emphasizes planning and execution in ways healthcare rarely does.

"We're very good in health at developing strategies and defining the problem state. And then in some instances actually coming up with a plan, but we don't get granular enough. We don't take people on the journey enough in terms of understanding how that gets implemented."

Healthcare produces detailed problem analyses, comprehensive solution frameworks, and ambitious transformation visions. Then implementation stalls because we haven't done the unglamorous work of step one, step two, step three, step four.

"An 80% plan delivered on time is much more effective than a 100% plan delivered late."

You need a good plan, not a perfect plan. Then you need to act.

Decentralization Enables Innovation

The New Zealand Army adopted decentralized leadership early.

"Part of the training and ethos was any person in the field needs to have a good understanding of the mission, the purpose, and the why so that they're able to make good decisions in the moment without necessarily referring back to their chain of command."

Top-down mandates can force initial adoption, but sustained use requires people understanding why something matters and having autonomy to adapt it to their context.

Lloyd's startup experience reinforced this: "You need a plan, you need leadership engaged. And then you need a bottom-up build so that you execute something everybody buys into, but also has understanding of not only the why, but the granularity of the steps to implement."

You can't shortcut this. Healthcare is a complex adaptive system. Leading it requires operating at multiple levels simultaneously.

What Reviewing an Entire Health System Reveals

From 2018 to 2020, Lloyd served on the expert panel reviewing New Zealand's health and disability system.

His first observation: healthcare systems aren't designed. They evolve through decisions, accidents, serendipity, funding changes, and individual actors responding to those signals.

"The notion of considering, how do we design for consumer centeredness? How do we design for equity? How do we design for optimized clinician experience? How do we design for technology enablement? That's just something we haven't done."

Healthcare systems have pockets of deliberate design, pilots that demonstrate what works, but lack ability to scale those successes systemwide. The curse of pilotitis.

Translation from Policy to Practice

The review recommended a regional approach. Instead, New Zealand created a national organization with significant centralization, similar to the NHS model.

The reasoning was sound: consistency in service delivery, more consistent funding decisions, ability to drive change from the center in a country of just over 5 million people.

What actually happened: "That's just slowed decision making, funding isn't getting to where it needs to get to. And so we've now pivoted back to a more devolved and decentralized structure."

"From a system design perspective, we know that if you can devolve decision making as close to the clinical front line as possible, you're probably more likely to achieve better outcomes."

New Zealand tried one approach, learned from experience, and adjusted. That willingness to pivot based on evidence matters more than getting initial structure perfect.

The Digital Infrastructure That Enables Innovation

New Zealand has a national health identifier. Every person, including temporary visitors, has a unique NHI number tagged to their health records.

Tamaki Health, with 52 clinics serving 350,000 enrolled patients, runs a single instance of their practice management system across the entire network.

"We're able to aggregate patient data and information, analyze and interpret that in terms of who is at risk of what. But also this creates a foundation for technological innovation because we've got that single instance."

This infrastructure enabled automation that saved tens of thousands of hours in back office processes. It enabled patient-facing interventions that drove immunization rates up in at-risk populations, increased HPV screening, and improved cardiovascular disease risk screening.

The automation handles mundane tasks: recalls, identifying at-risk populations, prompting human operators. It takes those tasks off clinician workload so things actually happen in a timely manner.

This is the unsexy infrastructure work that determines whether digital health innovations scale or die in pilot purgatory.

Achieving 90% Adoption Rates

Tamaki Health achieved 90% adoption rates for AI scribes. That's unheard of in healthcare technology.

The answer started with organizational DNA.

"There is something unique about the DNA from a Tamaki perspective where people are bought into the why behind the reason to look at these technologies and adopt these approaches to transform the way we deliver care."

But understanding why isn't enough. Tamaki demonstrated tangible benefits for clinicians, not just patients.

"We've been able to demonstrate to our teams that there's quite a bit in this for me as a clinician or as an administrator, and that the benefit has been tangible."

Technology that only benefits patients or administrators but adds burden to clinicians gets resisted. Technology that delivers value clinicians personally experience gets adopted.

Tamaki's telehealth teams use the AI scribe. They're leveraging it to drive efficiencies in clinician workflows around generating referrals and patient clinic notes. They're building toward an AI clinical companion that acts as another care team member.

The progression matters: start with something that works and people actually use, then build on that foundation.

The Bottom Line for Digital Health Implementation

Several principles emerge:

Bureaucracies can innovate with empowered leadership. Size and established processes don't prevent change. Leadership that creates conditions for innovation does.

Execution beats perfect planning. An 80% plan delivered on time is more effective than a 100% plan delivered late. You need granular implementation steps, not just strategy documents.

Decentralize decision-making. Top-down mandates force initial adoption. Sustained use requires people understanding why and having autonomy to adapt.

Infrastructure enables innovation. National health identifiers, single instance EHR systems, automated workflows determine whether innovations scale.

Demonstrate clinician value. Show tangible benefits for the people doing the work, not just patients or administrators.

Be willing to pivot. Learning and adaptation matter more than getting initial structure perfect.

Tamaki Health achieved 90% adoption rates by balancing patient benefit with tangible clinician benefit, building unsexy infrastructure, empowering leadership, and creating granular execution plans.

This is what sustainable healthcare transformation actually looks like.

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Learn more about Dr. Lloyd McCann's work: LinkedIn | Tamaki Health

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Ready to transform your healthcare innovation approach? Contact Ardexia to discuss how we can help you move from pilot to sustainable adoption.

Related Resources

Episode 8: Why Healthcare Design Starts with Stories, Not Solutions

Article: 95% of Adoption Fails

Dr. Aditi Joshi is the CEO of Ardexia and host of the Ardexia podcast. She's an emergency physician who has built multiple digital health programs across three continents and specializes in turning failed digital health implementations into measurable clinical and financial success.