The healthcare industry is known for constant and rapid change, highlighting the need for strong executive leadership. Within this industry, multihospital healthcare systems present particular executive leadership challenges due to their size and complexity, yet our understanding of how these executive-level health system leaders are developed has been extremely limited. The objective of this research was to study the establishment, organization, content, process, evaluation, and evolution of executive leadership development (ELD) programs in U.S. healthcare systems. Results of a national survey of health system CEOs, supplemented by interviews with multiple health system key informants, showed that ELD programs existed in around half of responding U.S. health systems and were especially prevalent among smaller systems. On average the programs were fairly new, with most having been established since 2003. ELD programs were reportedly valued by the health systems, as reflected by respondents' perceptions of program payoffs and sustained budgetary commitment. Specifically, ELD programs are believed to help further healthcare systems' strategic goals, initiate succession planning, and provide local development opportunities. In addition, the majority of program elements were reportedly worth the investment in improving executives' leadership skills and capabilities. Given the imperative to improve leadership capabilities in healthcare, ELD programs provide important opportunities to enable health systems to meet the challenges of a changing health services industry.