In the 21st century, healthcare executives are facing changes of unprecedented magnitude in virtually every area, affecting their ability to compete. That hindrance brings with it a greater need for rapid and effective organizational change and improvement. Yet changes in the U.S. healthcare delivery system have historically been criticized as slow and less than effective in responding to the changes necessary for rapid performance improvement. To that end, the purpose of this applied research study was to help healthcare executives better understand the barriers to effective organizational change and improvement from the perspective of frontline leaders. Focus groups were conducted with 167 frontline leaders from four community hospitals to explore why hospital change efforts fail. Participants representing 11 different functional areas, including all facets of hospital operations, were asked to identify the primary causes of failure of a recent change initiative at their hospital. A content analysis of the focus group data identified 10 primary barriers to successful hospital change, some of which are ineffective implementation planning and overly aggressive timelines, failure to create project buy-in and ownership, ineffective leadership and lack of trust in upper management, unrealistic improvement plans, and communication breakdowns. Leadership lessons and recommendations based on the research findings are provided.