The principle of ‘mission command’ is founded on the clear expression of intent by commanders and the freedom of subordinates to act to achieve that intent.4 The concept is hierarchical but decentralised: people are briefed on the intentions of their commanders two levels higher in the hierarchy. Subordinates are told what to achieve, not what to do. Such a mode of working is not alien to the NHS. Clinical teams are naturally hierarchical, but great responsibility is delegated to even very junior medical staff. Good leaders will act to ‘flatten the hierarchy’, preventing it from being a barrier to initiative or open communication.5 When in doubt, military and medical staff can fall back on the more-or-less implicit intent of their superiors. However, this approach is much less familiar in non-clinical aspects of NHS leadership. It is common for authority to be tightly held, for decisions to require ratification at high level and for budgets to be centralised. This approach may be appropriate when the pace of institutional change is slow, the appetite for risk is small and the control of money is paramount. We no longer live in that environment. Is it time to emphasise a mission command approach to NHS leadership?