This chapter discusses the governance as it relates to healthcare transformation and describes the difference in corporate governance and transformation governance. It explores the responsibilities of governance versus leadership. The chapter describes how a Transformation Management Office (TMO) can play an integral role in the transition from volume to value. New governance structures must be put in place to recognize the impact, balance decisions, and ensure proper management of investments in transformational initiatives. Initially, transformation activities may be limited, and depending on the size of the organization, the overlap in membership and focus will vary. An Enterprise TMO is defined as the central point of coordination for all transformation programs and projects. The central task of the TMO is to orchestrate the complex, often disruptive, change typically needed to achieve breakthrough value in transformation. Governance, decision-making, and supporting structures are critical to the success of transformation initiatives.