You have a strategy. How do you rate your organization’s execution of that strategy on a 1-10 scale? For most, it is not high – or as high as they would like. Closing the strategy-implementation (aka, the knowing-doing or what-how) gap is the leadership Achilles heel of any business, but especially for hospitals, a business recognized by Drucker as the most complex organization to lead. Given that his observation pre-dated some of today’s larger and more evolved and blended academic-community healthcare systems, the complexity he referred to then has only increased. Across industries, the results of studies consistently identify unsuccessful execution for the vast majority of strategies; and the results of CEO surveys cite execution as the biggest current challenge, but reasons for such failure and concern vary widely. A sampling of HBR articles on the topic cite too much of an internal focus, poor CEO preparation in both strategy AND execution, “a people problem.” 

Perhaps the most common trait about healthcare system strategies is the perception of their authors that their strategy is unique. As JP Morgan Healthcare Industry Conference observers noted, most health system strategies look alike. What is unique is the execution – the How. Notes Rosabeth Moss Kanter, “When a strategy looks brilliant, it’s because of the quality of execution” (Smart Leaders Focus on Execution First and Strategy Second, HBR, 11, 2017). Because transformation is a journey and one size does not fit all, it is more apt to say there are no integrated healthcare systems, but many integrating systems. For healthcare systems to evolve and execute well, they need an operating model that will help them ‘discipline the change process.’ They need to have a way that is lived by all. 

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