The authors' purpose of this article was to explore the experience of hospitals with transformational change. Transformational change is defined as radical change introduced by visionary leaders at the level of the organization. Using reengineering as an example, this article examined transformational change, and questioned what it means for hospitals. The authors argue that transformational change has been illusive because it has, at best, offered new solutions to a century-old question: How can hospitals be made more business-like?