The dominant system-level strategic priorities facing Ontario hospitals were elicited and validated. Researchers employed a multi-stage survey and focus group process to solicit the opinions of senior hospital managers and other healthcare stakeholders. Four shared, system-level priorities emerged: (i) improved clinical and staff recruitment; (ii) stronger inter-hospital partnership and vertical integration along the continuum of care; (iii) improved patient safety; and (iv) the implementation of decision support systems. A subsequent CEO validation survey showed strong endorsement of these system priorities. The authors conclude that a survey, focus group, and validation process can reveal shared system priorities and can highlight emergent organizational strategies designed to resolve them. This process, in which a hospital learns of the priorities facing other hospitals in a system, is a potentially useful managerial tool to promote "strategic synapse"-whereby management can adjust internal organizational strategy and local scorecards to align with shared system priorities.