Delegation Case Study: Large Healthcare

A quick story about Decision-Rights in a Large Healthcare Org

In 2019, my team and I collaborated with the senior leadership of a large healthcare organization grappling with a perceived innovation deficit within the depths of their expansive workforce. The CEO had initiated a program for mid-level leaders to propose alternatives to the operating model, but the path forward was unclear.

Our diagnosis revealed an unexpected issue: the problem was not with the strategy, staff or structure, but in decision dysfunction at the upper levels of the organization. Senior leaders' disputes over roles and responsibilities were preventing good ideas from getting to the market in a reasonable time.

In an exercise reviewing the past year's senior leadership meeting agendas, we found that 65% of the items, which ranged from high-level vision to minute budget approvals, shouldn’t have even made it to the meeting.

Why was the next level below the LT inappropriately escalating items? Because their decisions made in mid-level forums would tend to get shot down by a leader in a different part of an organization that didn’t agree with one aspect or another in the proposed approach.

Why use the designated decision forums when those forums don’t really have any sticking power? We may as well just send it up to the leaders and let them sort it our amongst themselves.

No wonder the organization struggled with accountability and empowerment.

This is fundamentally a distribution of authority problem. Are the right people in this organization doing enough of the right work? At what pace layer of the organization is the integration happening? Are norms around shared decision-making helping different parts of the organization work better together?