Culture and strategy often are regarded as "soft" elements of organizational leadership, yet nothing is more vital. An incorrect strategy or resistant culture often become discernible only when an organization is on the rocks. How can leaders inculcate the right strategy and culture in their organizations? An axiom holds that "culture eats strategy," which is a barrier to enacting change in a changing healthcare industry. Strategy is about setting priorities and allocating resources. As resources tighten, priorities for most healthcare organizations today are changing. Organizational culture is defined as a set of shared mental assumptions that guide interpretation and behavior. Healthcare leaders speak of a culture of safety, a culture of wellness, or a patient-centered culture. Often, however, culture proves resistant to change. Top executives must point the way, but ultimately culture and strategy are about leading people to a desired new state. Leaders must build trust that they are heading in the right direction.