Healthcare organizations are complex and their responsibilities broad, which results in many internal vertical and horizontal relationships and many external relationships. Peoples are all familiar with the standard organizational chart with its solid and dotted lines. We remember the solid lines, but we should not forget the dotted lines or those written in invisible ink. There are many books, articles, and consultants that provide guidance on working effectively with Boards. Learning these skills is important for the reader and the organization as the reader achieve senior leadership roles. Leaders also have robust data on the health of their community with information such as the Commonwealth Fund’s State Health Rankings, the Robert Wood Johnson Foundation’s County Health Rankings, and the CDC’s Small Area Life Expectancy Estimates. Healthcare leaders are gaining an understanding of the critical importance of the social determinants of health.