Leadership & Culture in Transformation at Inova Health

In this exclusive interview for the American Journal of Healthcare Strategy, Marna Borieux, DHA, MBA, VP and Administrator, Primary Care Service Line at Inova Health, shares an insider’s perspective on building organizational culture, operationalizing “systemness,” and leading with intention. Her story offers actionable insights for executives, emerging leaders, and anyone interested in the mechanics of true healthcare transformation.

Why Leadership & Culture Are the New Imperatives

Why do leadership and culture matter now, more than ever, in healthcare? In a word: volatility. The last five years have exposed the vulnerabilities of even the most advanced health systems. As Marna puts it, “I always consider leadership a continuous learning cycle, so don’t stop learning, right? Put yourself in the spaces and the positions and in front of the people that you can learn from, whether that is… books, taking formal classes… it matters.” Inova Health—Northern Virginia’s premier system, caring for 1-2 million patients annually across a vast network—has thrived by refusing to treat leadership and culture as afterthoughts.

Today, executives are expected to be both stewards of financial health and architects of workplace experience. At Inova, 25,000 team members participate in a “Drive to Excellence,” a strategic push that fuses vision, accountability, and culture into everyday action. In a time when many organizations are struggling to recover their footing post-pandemic, Inova’s story is an instructive contrast.

Marna Borieux: An Unconventional Path to Executive Leadership

What shaped Marna Borieux’s leadership journey, and why did she pursue advanced education? Marna’s ascent—from project manager at Cleveland Clinic to VP at Inova—wasn’t a straight line. “I tend to describe my career path as more squiggly than linear,” she explains. After a decade at Cleveland Clinic, including senior director roles, Marna sought a new challenge: “I was looking to upskill what I was currently doing in the healthcare setting… The DHA program at MUSC… aligned more with the goals that I was looking for. I was not necessarily looking to go into academia full-time. I was looking to upskill what I was currently doing in the healthcare setting.”

Key decision points:

• Considered PhD, DrPH, and DHA programs
• Chose the DHA at Medical University of South Carolina (MUSC) for its practical, applied orientation
• Managed the transition from Cleveland Clinic to Inova during her doctorate—amid the COVID-19 pandemic

This focus on continuous learning reflects what Marna sees as essential for every leader. “No matter what level you get to in the organization, if [learning] stops, then you… slip into the wrong side of leadership.” Her experience is a case study in intentionality—balancing education, professional growth, and family life while seizing the right opportunities.

The Power of Intentional Career Moves—and the Role of Mentors

How did Marna choose her next step, and what role did mentorship play? Major career moves are rarely comfortable, especially when it means leaving a role where you’ve built trust and credibility. For Marna, the catalyst was a mentor she respected: “Great leadership matters… it depends on who’s asking, what is the opportunity, and how does it fit into your personal goals.” When a former Cleveland Clinic leader recruited her to Inova, Marna recognized the rare alignment of values, culture, and mission.

She emphasizes looking for these leadership traits:

• Empathy and emotional intelligence
• True collaboration and “one team” mentality
• Servant leadership: recognition of people as individuals, not just roles

“For me, what I looked for in a leader was one that really, um, demonstrated, um, empathy… collaboration… someone who recognized my work but recognized me as a person.” The lesson: The right mentor clarifies clarify excellence can look like and offer a model to emulate. For leaders at any stage, this means actively seeking out those whose values and actions align with your own aspirations.

Inside Inova: Transformation in the Face of Uncertainty

What was happening at Inova when Marna joined, and how did new leadership catalyze transformation? Marna arrived at Inova during a period of sweeping change: “Anytime you have new leadership within an organization, there’s bound to be transformation.” Not only was the executive cabinet almost entirely new, but the organization was also in the midst of redefining its mission, vision, and values. This was the dawn of Inova’s Drive to Excellence, a system-wide journey to embed cultural and operational transformation at every level.

Key elements of Inova’s transformation:

1. Systemness: Breaking down silos, operating as one unified system rather than disconnected sites
2. Seamlessness: Creating frictionless patient experiences across care settings
3. Stewardship: Prioritizing resource management, financial responsibility, and sustainable margin improvement

Naming the transformation mattered: “Naming it makes it real… we had a cultural integration council that was made of leaders and team members from across the organization.” This collective, collaborative approach anchored the process and ensured buy-in from all corners of the system.

COVID-19: Acceleration, Not Disruption

How did the pandemic impact Inova’s transformation—and what can other systems learn from this? While COVID-19 upended operations for most U.S. health systems, Marna reports it was, paradoxically, a catalyst for progress at Inova. “For us, we found that it accelerated it more than anything else… all of a sudden we now have a system command center. We have our teams from all over the system coming together to figure out these big hairy challenges.”

This real-world stress test advanced Inova’s journey from a federated collection of hospitals to a genuinely integrated system. Concrete changes included:

• Launching a system transfer center for coordinated, timely patient movement
• Accelerating technology adoption and workflow redesign
• Fostering interdepartmental collaboration out of necessity

The result? A more cohesive system, better prepared for future crises, with a culture of agility and collective problem-solving.

Sustaining Transformation: Operating Rhythms and Cultural Investment

How does Inova sustain change and ensure results don’t unravel as leaders move on? Marna is clear: “Getting the right people matters… we’ve been intentional about creating what I like to call our operating rhythm.” This means more than just meetings—it’s about building a structure where candid discussion, accountability, and transparency are regular, protected features of organizational life.

Inova’s Operating Rhythm includes:

• Regular operating reviews with system leadership
• Executive team meetings for discourse and decision-making
• Cabinet meetings with the CEO for strategic alignment
• Built-in cadence for leadership forums and story-sharing

These mechanisms create built-in accountability and ongoing cultural reinforcement. “If it’s a hard thing to talk about, let’s talk about it… if we don’t, we might miss an opportunity to truly come up with the right solutions.”

Culture, Joy, and Purpose: Anchoring the Human Side

How did Inova focus on culture, joy, and purpose amid uncertainty? Transformation isn’t purely technical. Marna’s team “never stopped working on our culture. When times got the hardest, that’s when we leaned in further to the culture.” During the pandemic, Inova doubled down on purpose and joy—making time for reflection, recognition, and the sharing of positive stories. They embedded these values into leadership forums, rounding practices, and even operational reviews.

• Recognizing teams for exceptional work, not just outcomes
• Encouraging purpose-driven reflection: “Why am I in this thing called healthcare to start with?”
• Emphasizing joy at work as a protective factor against burnout

This approach paid off. While other systems struggled with persistent workforce dissatisfaction, Inova’s team weathered the storm, and their performance metrics reflected this resilience.

Financial Stewardship Without the Fear Factor

How did Inova tackle margin improvement without triggering fear or layoffs? For many, “margin improvement” is synonymous with staff cuts and morale erosion. Not so at Inova. As Marna explains, “Margin improvement is something that every one of our leaders look at on a regular basis… but we never stop working on our culture, whether that is to help continue developing our leaders, to equip them as they are working with our frontline teams, or it is telling the stories of our frontline teams to recognize the amazing work they’re doing.”

Rather than using cost-cutting as a blunt instrument, Inova’s approach is to:

• Set management action plans for efficiency and effectiveness in each area
• Foster transparency around tough topics
• Maintain investment in leadership development and culture, even during fiscal tightening

This dual focus—discipline with humanity—has positioned Inova for continued growth and stability.

Marna’s Advice: How to Become (and Stay) a Great Leader

What practical steps can leaders take to develop themselves and their teams? Marna’s central advice: Never stop learning and don’t go it alone.

• “I always consider leadership a continuous learning cycle, so don’t stop learning, right?”
• Seek mentors who embody the traits you aspire to—“a lot of us learn how to lead from other great leaders or just from other leaders.”
• Get comfortable with feedback, vulnerability, and iteration
• Create or seek out spaces that challenge your assumptions

Her actionable tips:

1. Define what kind of leader you want to be—and find role models who embody those attributes
2. Ask for feedback and create space for vulnerability (“Where do I have the opportunity to develop myself further?”)
3. Surround yourself with the right people, resources, and tools
4. Accept that the journey is continuous and non-linear—leadership isn’t a static destination

Conclusion: Leadership as a Continuous, Cultural Commitment

In the high-stakes, high-change world of U.S. healthcare, Inova Health’s story demonstrates that leadership and culture are not “soft” add-ons—they are hard-edged, strategic differentiators. As Marna Borieux’s journey shows, success comes from intentionally cultivating your skills, seeking out great mentors, embedding accountability and transparency, and never losing sight of the human core—purpose and joy. For every leader facing daunting change, her words are a reminder: “We are all on this continuous learning journey together.”