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In this paper, we describe the robust governance structures and processes underpinning the development of the first International Evidence-Based Guideline for the Assessment and Management Polycystic Ovary Syndrome (2018). The guideline was an outcome of the Centre of Research Excellence for Polycystic Ovary Syndrome, and an example of a transformative, strategic research initiative to impact delivery model. The governance structure supported and delivered critical ethical and regulatory outcomes, including: broad and diverse representation across health professional and consumer groups and exceeded regulatory standards; adherence to rigorous knowledge creation processes; and compliance with the standards for guidelines set by the approval body, the Australian National Health and Medical Research Council (NHMRC). Well-articulated and appropriately implemented governance structures that meet the complex nature of contemporary research and translation activities are essential to enable distributed leadership and to deliver key outcomes.