Test changes and prepare receiving sites for adoption
A health system operating-model redesign needs a method for testing changes in daily work and deciding how they should be adopted elsewhere. A successful pilot does not automatically produce a workable enterprise model. Leaders need to understand what produced the result, which conditions must be preserved, and what each receiving site will have to adapt.
“A successful pilot does not automatically produce a workable enterprise model.”
The implementation sequence should reflect the change's dependencies and risks. Moving too quickly can overwhelm teams or conceal unresolved role conflicts; moving too slowly can prolong a costly or ineffective process. Define what evidence is needed for the next decision and who can act on it. That gives the C-suite a more useful basis for setting pace than a commitment to either rapid rollout or indefinite piloting.
Translate structural changes into operating decisions
A new organization chart can clarify authority, but the redesign must also explain what changes for a charge nurse, a service-line director, or a regional finance leader. Specify the decisions, handoffs, and information flows that will differ. Check whether the proposed structure gives those people the authority and support required to carry out the new responsibilities.
Shared services, regional teams, and service-line co-management are options for addressing duplicated work or fragmented accountability. Compare them with the problem being solved and the coordination they require. Name the owner of each outcome and establish how local needs will be handled. A pilot can help participants examine a proposed arrangement, but it should be selected to test meaningful uncertainties rather than merely demonstrate the design under favorable conditions.
Choose the scope of implementation deliberately. Some changes can be tested in one unit; others require a coordinated transition because the old and new arrangements cannot operate together. In either case, define roles, preparation, support, and a route for reporting problems. Use regular communication at the level where decisions occur, with a way for frontline feedback to change the implementation plan.
Design the test and the decision to expand it
For example, a system could test a standing clinical, finance, and operations group responsible for throughput across selected emergency departments. The test would need defined decision rights, baseline measures, and feedback from the affected teams. Assess whether the group resolves delays, duplicates existing authority, or adds meetings without changing the work. The Institute for Healthcare Improvement's guidance on spreading changes emphasizes that receiving teams also need to test and adapt a change in their own context.
Select measures that reflect the redesign's intended effect, such as throughput, expense, patient safety, or workforce stability. Include unintended effects on related services and the cost of implementation. Establish definitions and reporting periods before launch, and review results alongside changes in volume, patient mix, and other initiatives. A favorable trend can justify further testing without proving that the redesign caused the entire improvement.
For a shared-service proposal, specify the work to be pooled, the service standards, and the local responsibilities that remain. A clinical resource pool, IT support team, or revenue integrity function will have different competency, technology, and access requirements. Assess whether the infrastructure supports reliable coordination. Smaller or rural systems may find a narrower service or regional partnership more feasible, but each option still needs a cost, governance, and delivery assessment.
Prepare receiving sites to use the model
A pilot can stall after a sponsor leaves or when another facility lacks the conditions that supported it. Preserve the decision record, implementation materials, and lessons from the test. Assign a receiving-site owner and provide access to the pilot team. Identify the practices that must remain consistent and the elements that can be adapted, then evaluate the local version before assuming the original results will recur.
Review committees and councils as part of the redesign. State which decisions stay local, which require enterprise approval, and where urgent matters go. Remove or revise overlapping responsibilities where appropriate. A new multidisciplinary group is useful when it has a defined decision to make and the necessary authority; otherwise, it can add delay to an already complex process.
“Reputation or a recognizable structure does not establish fit.”
When borrowing another system's model, compare community needs, payer mix, clinical footprint, scale, and available skills. Ask which features solved that system's problem and whether the same problem exists locally. Adopt the relevant principles, then test the specific arrangement. Reputation or a recognizable structure does not establish fit.
Make the next implementation decision explicit
For the next redesign phase, record the operating change, the accountable owner, and the evidence needed to expand, modify, or stop it. Agree on handoffs between pilot teams, receiving sites, and executive sponsors. Fund the support needed for adoption and maintain a route for resolving local conflicts. Review the resulting economic, clinical, and workforce effects together rather than declare completion when the reporting lines change.
“A useful redesign process leaves the system with more than a tested idea.”
A useful redesign process leaves the system with more than a tested idea. It establishes how leaders will decide where the model fits, prepare the next site, and respond if the results differ. That responsibility continues after the pilot ends.
Connex convenes health system operating executives in Trusted Peer Groups to compare what a pilot established and what receiving sites needed before adopting the change. Those accounts can help leaders identify what a local test should examine and what support expansion may require.
