When organisations assume a single expert can handle multi-domain problems, they’re setting themselves up for expensive surprises. Today’s challenges sprawl across disciplines, defying professional boundaries and requiring coordinated effort where specialists integrate around shared infrastructure and standardised protocols.
This shift from individual mastery to orchestrated expertise isn’t just helpful. It’s essential.
From intricate surgical procedures to multi-billion-dollar developments, one specialist can’t cover all bases anymore. While surgical teams and development projects reveal the mechanics of orchestration, here’s the catch: successful orchestration depends heavily on context. Strategies need adaptation to specific institutional settings. Understanding why traditional individual expertise no longer cuts it requires examining how coordination demands have fundamentally shifted.
The Coordination Imperative
Individual experts used to be enough for domain-specific problems. That world’s gone. Today’s challenges span multiple specialist territories simultaneously, forcing a shift from sequential specialist contributions to concurrent integration. You can’t just pass the baton anymore.
Orchestration isn’t collaboration – it’s active integration of contributions around common frameworks instead of specialists working in parallel. Someone has to conduct the orchestra. This requires specific enabling conditions that go well beyond goodwill and good intentions.
Successful orchestration depends on shared infrastructure, like common platforms and equipment that let specialists access the same systems simultaneously. Standardised protocols reduce negotiation friction and enable consistent coordination. Of course, organisations love announcing they’re ‘collaborating’ while specialists still use incompatible systems. The real work? Synthesising specialist knowledge, not filing it in silos.
These enabling conditions become visible in high-stakes environments where real-time specialist integration determines outcomes. Surgical coordination provides a clear example of infrastructure dependence in action.
Surgical Coordination
High-volume surgical programmes face a coordination challenge: multiple specialists must work around complex procedures while maintaining consistent outcomes across thousands of cases annually. This isn’t about surgical skill alone. It calls for systematic coordination of anaesthetics, nursing, and rehabilitation expertise around shared technical platforms. One example of this infrastructure-dependent approach appears in Dr Timothy Steel’s minimally invasive spine programme at St Vincent’s Private and Public Hospitals, where he works on case selection and surgical planning while integrating expertise from multiple specialist domains.
The programme relies on shared equipment: Brainlab stereotactic navigation, operating microscopes, endoscopic tools, ultrasonic aspiration, and dedicated spine tables. A notable advancement at St Vincent’s Private is the introduction of the NuVasive Pulse digital surgery platform in September 2022, making it the first hospital in Australasia to offer this technology. The platform combines neuromonitoring, imaging, navigation, planning, and rod bending into a single workflow. This shared digital foundation enables coordination by providing specialists with common data streams and unified interfaces.
The complex cervical reconstruction pathway for atlantoaxial osteoarthritis reveals protocol standardisation in action. It includes preoperative CT/MRI planning, intraoperative navigation, and defined postoperative imaging to confirm fusion. Funny how ‘complex’ problems often call for ruthlessly simple protocols.
Standardisation creates a framework where multiple specialists coordinate their contributions through agreed decision points and technical sequences. Dr Steel has performed over 8,000 minimally invasive spine procedures since 1998. This sustained throughput highlights coordination dependence over individual surgical skill alone. High-frequency execution relies on anaesthetists, nurses, and rehabilitation specialists knowing their roles within standardised frameworks.
The programme’s reproducibility is demonstrated through a 6–12-month Spine Surgery Fellowship conducted in collaboration with St Vincent’s Private Hospital and Concord Hospital, where fellows assist across approximately 500 procedures annually. Look, it’s not just surgical skill multiplied by time. It’s coordination infrastructure that makes repetition possible through established frameworks. This systematic transfer of coordination frameworks through training reinforces that successful orchestration hinges on infrastructure investment and teachable protocols that create common technical ground for specialists to coordinate without constant real-time negotiation.
The same orchestration principles that underpin high-volume surgery also shape challenges when teams span cities and years.
Large-Scale Development
Large-scale development projects can’t rely on simple handoffs between specialists. You’re coordinating teams across months and years, not hours. Contributors work from different locations on components that must ultimately fit together perfectly. This creates cascading interdependencies where residential planning decisions impact retail infrastructure, which then influences hospitality planning and community space design.
Why do cascading interdependencies need dedicated integration leadership? Sequential handoffs simply can’t manage this level of complexity, requiring dedicated leadership focused on integration over domain execution.
Claire Johnston, who became CEO Americas at Lendlease in November 2022 after 26 years with the company, offers one example of this scaled coordination challenge. Her management of a US$15 billion development partnership with Google in the San Francisco Bay Area builds on her previous role as Managing Director of Google Development Ventures, demonstrating sustained institutional knowledge in development orchestration.
This project needs coordinating diverse teams of specialists across different sectors to develop up to 15 million square feet of residential, retail, hospitality, and community spaces. Johnston’s role involves establishing frameworks where urban planning decisions remain consistent with environmental assessments and align with engineering specifications and social policy requirements.
The scale creates cascading interdependencies among various domains. Active integration is required where specialists understand adjacent domains well enough to coordinate contributions proactively. Development orchestration at this scale asks for dedicated leadership focused on integration over domain execution.
Johnston’s coordination of Lendlease’s Google partnership reveals that modern large-scale development exceeds what sequential specialist handoffs can achieve. It requires sustained orchestration where integration itself becomes a distinct professional function separate from domain expertise.
Institutional Assembly
If integration is now a distinct professional function, some institutions are building the architecture for it before addressing specific problems. The Harvard Global Health Institute’s (HGHI) 2025–2026 Scholarly Working Groups show institutional orchestration design. Unlike operational examples, HGHI deliberately structures interdisciplinary coordination frameworks before directing them toward specific challenges.
Most organisations expect coordination to emerge from good intentions and shared coffee machines.
This acknowledges that complex problems routinely exceed individual specialist capacity, requiring organisations to invest in coordination architecture. Group 1, led by Satchit Balsari, Associate Professor of Emergency Medicine at Harvard Medical School, and Sharon Block, Professor of Practice at Harvard Law School, addresses worker protection under climate change by assessing the efficacy of heat adaptation measures globally. With 2.4 billion workers likely exposed to excessive heat, emergency medicine expertise must integrate with legal and policy frameworks to develop effective solutions.
Group 2, led by Wafaie W. Fawzi, Richard Saltonstall Professor of Population Sciences at Harvard T.H. Chan School of Public Health, tackles adolescent health challenges in Sub-Saharan Africa by focusing on nutrition, health, and education. This needs integrating epidemiological expertise with educational policy knowledge and nutritional science—distinct domains that rarely coordinate despite addressing overlapping populations.
The HGHI framework reveals that orchestration increasingly calls for deliberate organisational design. It focuses on assembling specialists around shared infrastructure and defined problems instead of expecting coordination to emerge organically from individual leaders.
Beyond group design, true integration depends on shared technical foundations—digital platforms that unite clinical and data domains.
Research Coordination
Coordination across clinical, data-science, and policy domains requires shared technical foundations that transcend individual institutional capabilities. Traumatic brain injury care and research, particularly for cases requiring sustained clinical intervention, face similar challenges as Harvard’s global health groups—specialists from clinical medicine, data science, and health policy must contribute to unified outcomes despite working from different methodological foundations. It’s a coordination Rubik’s cube, where every twist in one domain shifts outcomes in another.
One solution emerges from shared digital infrastructure. Professor Belinda Gabbe, Head of Pre-hospital, Emergency and Trauma Research at Monash University’s School of Public Health and Preventive Medicine and Chief Investigator of the Connect-TBI programme, states: “Connect-TBI will harness existing infrastructure and emerging digital health capabilities to establish a sustainable data foundation for moderate-severe traumatic brain injury (msTBI) care and research in Australia. This national asset will not only improve outcomes for patients but will reduce research waste, inform policy and resource allocation, and enable real-time quality improvement.” Her leadership demonstrates how infrastructure-enabled coordination addresses multi-domain challenges in traumatic brain injury care. The emphasis on infrastructure matters.
Stressing “harnessing existing infrastructure and emerging digital health capabilities” reinforces that coordination depends on shared technical platforms instead of persuading specialists to spontaneously collaborate. Institutions must build the ground on which coordination occurs. Digital platforms enable coordination at scale by providing common data foundations accessible across institutional boundaries. Without that foundation, you’re asking specialists to coordinate across incompatible systems.
Yet even robust platforms face limits when you try to duplicate them across contexts.
Scalability Challenges
Research on knowledge translation strategies in healthcare reveals orchestration limits. Reviewing implementation of coordinated care models highlights most knowledge translation strategies remain US-focused and hospital-based with limited evidence of effectiveness when transplanted to different settings. There’s an explicit warning against universal orchestration solutions; coordination models must adapt to local contexts instead of assuming frameworks scale automatically.
Context matters more than consultants admit. Consider a university hospital with research infrastructure that develops a coordination model—it fails when transplanted to community hospitals lacking that technical foundation. Solutions that worked brilliantly in one setting become expensive reminders that context actually matters, despite every consultant’s slide deck claiming otherwise. Geographic factors play a role too; models assuming certain regulatory frameworks or professional training standards encounter friction in jurisdictions with different structures. Cultural expectations about specialist autonomy and cross-domain communication vary significantly across settings, creating additional adaptation challenges.
Scalability challenges emerge from context-dependence across previous examples. Dr Steel’s surgical coordination relies on St Vincent’s infrastructure investment in navigation technology—elements not universally available. Johnston’s development orchestration builds on organisational capabilities not replicable elsewhere without substantial adaptation. HGHI working groups assume institutional capacity to recruit interdisciplinary faculty—resources unavailable to most organisations.
Orchestration offers powerful coordination mechanisms but resists standardisation. Each implementation needs tailoring to institutional capacity, regulatory environment, professional culture, and available infrastructure. The adaptation burden limits how quickly orchestration models spread and how reliably they function across different settings.
Integration Architecture
Modern complexity increasingly asks for orchestrated expertise where specialists coordinate around shared infrastructure and standardised protocols over working sequentially or in isolation. This shift is evident across sectors from surgical teams processing thousands of procedures annually to development partnerships managing billions in mixed-use infrastructure to academic institutions deliberately assembling interdisciplinary research frameworks.
Orchestration differs from collaboration through specificity—not just “working together” but coordinated execution around shared technical platforms like surgical navigation systems or digital health infrastructure, standardised protocols such as surgical pathways, and clear integration leadership. These elements enable specialists to contribute complementary knowledge toward unified outcomes instead of producing disconnected pieces for later assembly.
Organisations must invest in coordination architecture tailored to their contexts over importing universal models. Understanding that challenges exceed individual specialist capacity represents progress, but recognising the coordination imperative creates a meta-challenge. The conductor’s role itself becomes distinct expertise requiring training, frameworks, and institutional support. Modern complexity doesn’t just need better specialists—it calls for better integration of specialist contributions.
We’ve outgrown individual mastery, but mastering coordination? That’s the new frontier, and now is the moment to hone the conductor’s craft.
