This study examined the impact of top management characteristics on strategic change in public hospitals in Indonesia, focusing on the mediating role of performance measurement system (PMS) design. Questionnaires were distributed to 157 top managers from Indonesian regional public hospitals undergoing reform. The findings indicate that younger, short-tenured top managers with business administration backgrounds are likelier to lead the strategic change, specifically the shift from a defender to a prospector strategy. Additionally, PMS design partially mediates the relationship between top managers' age, educational background, and strategic change. However, no significant mediation effect of PMS design was observed in the relationship between top managers' tenure and strategic change. These results suggest that healthcare organizations should consider their top managers' characteristics when planning and implementing strategic change. The role of PMS design in facilitating strategic change should also be carefully evaluated, especially when considering younger and less-tenured top managers as change leaders.