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In the years before its dramatic rise on the back of GLP-1 therapies, Novo Nordisk was best known for disciplined execution, a strong focus on diabetes and a long record of home-grown innovation. It met its targets with near predictable consistency, supported by stable structures and deeply embedded ways of working. Yet technological change, scientific uncertainty and increasing market pressures challenged whether a model built on reliability and internal self-sufficiency could keep pace. This case examines how Marcus Schindler, an externally hired leader who would later become the company's Chief Scientific Officer, attempted to future-proof Novo Nordisk's research and development organization. Rather than relying on incremental improvements, he introduced ambitious aspirations, pushed teams to experiment beyond their comfort zones, normalized failure as a source of learning and tested new organizational structures alongside the existing core. As students follow these choices, the case exposes a set of concrete leadership dilemmas: How fast should a leader push change in a stable, successful organization? How do you gain credibility as an outsider without full consensus? How do you balance accountability and psychological safety? And how do you allocate attention between short-term execution and long-term renewal? The dilemma becomes sharper as Novo Nordisk's GLP-1 therapies deliver extraordinary commercial success, shifting focus toward operational execution and raising questions about whether exploration risks being crowded out by exploitation. A deeper leadership question also emerges: How does a leader stay true to a long-term vision when runaway success pulls attention toward the here and now? This case challenges readers to think critically about leading change in high-performing organizations, driving transformational innovation, managing competing time horizons, and making leadership choices when success itself becomes the biggest constraint.