\ua9 The Author(s) 2022. Transforming health systems is a complex, messy business with no quick or simple solutions. Countries struggle to make it happen with policy failure often the result. Reporting on a World Health Organization Europe project aimed at understanding how health system transformation can succeed, the paper draws on three European country case studies to offer insights and lessons for policymakers elsewhere engaged in similar efforts. Critical to success in implementation is the adoption of a receptive context for change. Building on the policy capacity literature, it emphasizes the importance of environmental pressure, the quality and coherence of policy, leadership style, supportive organizational culture, and managerial-health profession relations
