Change and reform in the healthcare system, and policy determination to reduce costs has now necessitated a rethink and more innovation for this sector. Leadership needs to strengthen professionals who have the dual responsibility for ensuring the quality and effectiveness of healthcare and this requires new organisational forms beyond the traditional hierarchical structures. Drawing upon strategic management and leadership discourse to underpin the study into sustainable and high performing healthcare systems, we present seven key lessons (propositions) from a mixed-methods study of a city-wide collaboratives in Leeds, UK. Our study suggested that the sustainability of such collaboratives, requires a more effective structure that could be local city-wide collaborative in contrast to national/regional collaboratives. However, there are also several unknowns in such novel organisational structures. The study also finds that both an energetic strategic leader and promotion of professional learning cultures are vital for the sustainability of such collaboratives.