What our 2025 diagnostic data reveals about the real challenge facing life science leadership teams
We analysed the diagnostic data from the leadership work Open Water delivered with every life science client in 2025.
Across launch teams, newly formed senior leadership teams, and functions working through restructure in pharma and biotech, eight themes appeared repeatedly:
→ Overwhelm
→ Change fatigue
→ Culture tension
→ Alignment gaps
→ Cross-functional breakdown
→ Leadership confidence under pressure
→ Commercial pressure
→ Communication friction
Left unresolved, these create friction – slowing decisions, diluting accountability, and eroding momentum – ultimately constraining performance at the precise moment it is needed.
These themes reflect what leaders are experiencing day-to-day – though not every team is dealing with all eight – however a pattern becomes visible when those experiences are viewed together.
On the surface, these can look like separate problems needing separate responses. A closer look suggests that many of the visible issues sit downstream of a deeper problem: leadership teams that appear aligned but have not reached the level of shared clarity and cohesion required to make priorities stick, decisions hold, and collaboration work under pressure.
You see this clearly in launch environments. Ahead of a first product launch, leaders may be navigating unfamiliar market access dynamics, thinner clinical data than competitors, limited launch experience, and intense commercial pressure. Those pressures are real – but they are not usually what determines the outcome.
What matters is whether the organisation is ready to execute around the therapy: aligned on priorities, clear on decisions, and able to work as one system under pressure. When that readiness is missing, misalignment, drift and friction quickly take hold – slowing momentum at the exact moment it needs to build.
The data from our diagnostic interviews shows that leadership misalignment is rarely visible as open disagreement.
Its symptoms include:
→ Decisions that don't stick
Agreements made in meetings are revisited or unravel later, as leaders act on different interpretations of what was agreed.
→ Priorities that compete rather than align
Goals differ across functions or regions, and everything feels justifiable, creating resource tension and slowing trade-offs.
→ Strategy that isn't consistently understood
Direction exists, but signals are not fully shared or interpreted in the same way, leading teams to pursue different outcomes with equal conviction.
→ Unclear roles and decision ownership
Particularly during periods of change, ambiguity around responsibilities and decision rights leads to delay, duplication, or unnecessary escalation.
→ Cross-functional friction that feels personal
Tension between functions increases, often framed as capability or commitment issues – when, in reality, teams are working from different assumptions.
In our interviews, leaders describing cross-functional breakdown were not usually describing a communication gap. They were describing teams that had seemed aligned in the room, only to discover later that the alignment was not deep enough to deliver in execution.
Harvard Business Review's July 2026 article, The False Alignment Trap, describes the gap between leadership teams believing they have reached agreement and having actually reached it. The risk is that the gap remains hidden until it shows up later as drift, delay and rework – often at the point when execution should be accelerating.
The triggers we have seen in the past 12 months are not always related to AI. They range from new commercial structures and leadership transitions to first-in-market launches, mergers and major restructures. The context changes – but the pattern is consistent: more is being asked of leadership teams than they have explicitly aligned on how to deliver. And it is in that gap that alignment becomes the problem beneath the problem.
That pattern is particularly visible during moments of post-merger integration.
We saw this clearly in our own client work when a specialist biopharma acquired a niche player and needed to bring together its Complement and Coagulation business units.
The transaction logic made sense, and the strategic opportunity was clear. But the leadership teams on both sides had spent years operating as what one executive later described as "lone wolves" – individually capable – but not yet structured to align around one shared agenda.
The work was not about adding more process. It was about helping the combined leadership team agree how they would work together, make decisions together, and build trust across what was now, on paper, formally one organisation. Within weeks, 250 leaders moved from parallel decision-making to a single identity, with a strong sense of belonging, a unified vision and a collaborative ethos.
The complexity had not disappeared. What changed was that the leadership team had answered the questions that mattered before the cracks widened. Within weeks of concluding the transformation journey, the VP said, "Nobody is mentioning or referring to the old legacy organisation or using the name of the legacy company anymore. People have completely embraced the identity of the new organisation."
If "communication gaps" are treated as the root problem, the response is often a workshop on better meetings. If "cross-functional breakdown" is treated as the root problem, the response is often a new escalation route.
While these may be useful, neither will hold if the underlying issue is misalignment – a lack of shared clarity on priorities, decision-making and how the team operates under pressure.
Our diagnostic interviews consistently reveal the effects of overwhelm, role transition and change fatigue. But when each issue is treated separately, leadership attention becomes fragmented. The more useful question is: what sits underneath them? In many cases, the answer is alignment and cohesion.
Open Water Co-Founder, Ben Shoshan, explains the approach.
"The shift happens when you take people out of their day-to-day context so they're not operating as simply human functions, and you give them the opportunity to actually be human beings, together. It's critical to give people space to be vulnerable and share personal stories – that's what allows us to build meaningful trust.
By focusing only on process, or strategy, or any of the other organisational systemic issues – we're looking at the symptom, rather than the cause. If on the other hand, humans are allowed to bond, and align around common purpose and common values, in a meaningful personal way, they will act in a more collaborative, supportive way in order to achieve their desired outcome and purpose."
By analysing our diagnostic interviews and the results we've achieved working with leaders, we have a much clearer view of what many life science leadership teams are really dealing with beneath the visible issues.
In a sector where launch windows are unforgiving and cross-functional interdependence is the operating model, the cost of discovering misalignment late is not measured only in "difficult meetings." It is measured in lost momentum, slower decisions, weakened trust and, ultimately, putting launch success at risk.
And most leadership teams will face that test at every strategic inflection – through the next launch, the next restructure, or the next wave of AI-enabled change.
Because when alignment is made explicit early, performance is no longer constrained by issues that should have been resolved upstream.
References
2025 Life Science Leader Diagnostic Interviews, Open Water
What Launch Success Now Depends On, Open Water Whitepaper, May 2026
The False Alignment Trap, Harvard Business Review, July–August 2026
Specialists in the human side of change, we partner with leading life science organisations to deliver deep change and cultural transformation.