In fast-moving biotech and pharma organizations, misalignment between functions—R&D, regulatory, clinical operations, and commercial—creates a hidden tax on clinical timelines and threatens patient access to lifesaving therapies. In this Clinical Leader article, ProjectNext Leadership co-CEO Molly Rosen and colleagues Fred Kohler and Kristen Chester argue that effective clinical leadership requires "lateral agility"—the ability to lead across silos by translating functional risk, building relational capital, and managing conflict as a core leadership skill. They provide practical recommendations for clinical development leaders to move from siloed thinking to enterprise-wide collaboration.