Sizing down: Why one health system executive created a strategy team "to be as small as reasonably possible"

As health systems expand into new regions, their moves are akin to a live version of the board game "Risk," in which players must occupy the most territory to win. Just like acquiring new territory in the board game, expanding a healthcare system requires careful strategy and planning. However, unlike "Risk," employees and bosses multiply as systems grow, and accountability can get muddled. Imagine playing a board game when an increasing number of people must decide each subsequent move.

One health system — Asheville, N.C.-based Mission Health — created a team to specifically oversee its growth, called the Strategic Growth and Business Development Division. We got in touch with the team's vice president, Jon Yeatman, to discuss how the team was chosen and how it manages strategy for a $1.4 billion system of six hospitals and more than 1,000 physicians. Mr. Yeatman explains the value of consciously staying small and how he puts together a strong band of uniquely talented individuals.

The Strategic Growth and Development Division consists of five to seven people. How did you determine the size of this team? How did the bandwidth of the leadership team affect the sizing?

Jon YeatmanThis team was created from scratch and our goal from the very beginning was to be as small as reasonably possible. We had that as a goal partly because nobody has the luxury of excess resources but, far more importantly, we had it as a goal because we knew that a purposefully constrained team would force the organization to focus only on the most important, impactful issues.

More specifically, for a team like ours, the appropriate size is really determined by four factors: scope of accountability for us, scope of accountability for others, skills and composition of the team members, and how external resources will be used. We worked very closely with the CEO, CFO and others to clearly delineate accountability. There are five areas for which we are accountable: overall strategy; mergers, acquisitions and divestitures; large/novel capital projects; service line growth; and innovation and consumerism.

We also hire, train and operate in a way that allows us to "do more with less." We hire bright, proactive individuals with complementary skills and an innate desire to "help" both clients and each other. In addition, we have designed training that is, and follow processes that are, based on the training at McKinsey & Company and The Advisory Board Company.

How did you build and develop the Strategic Growth and Business Development Division team?

Our team was essentially built from the ground up with the very important exception of a director who has essential skills, institutional knowledge and is a very good manager. Because we started from scratch, we spent a lot of time on selection. We have a very collaborative, open process and a fairly specific set of criteria that we're looking for.

We expect anyone joining the team to have a high baseline level of skills across the board, while also demonstrating a clear "spike" — at least one area where the individual is truly exceptional.

Our interview process is also designed to identify certain character traits. In particular, we are trying to find individuals who are proactive, confident, team-oriented, "helpers" and self-aware.

Complementary skill sets for a small team are essential. For example, on our team, we have an MBA that is quite good at finance, a law school graduate and former attorney, someone who has worked in e-commerce and so on. We would like to have someone with clinical training but haven't found the right person yet.

We also made the decision that prior healthcare experience is not necessary, especially at the junior level, and designed our training to accommodate someone who is new to the industry.

As Mission Health completes transactions and expands geographically, how does the Strategic Growth and Business Development Division adjust?

So far, we have been able to absorb most of the new additions to the system without changing our size. We welcome the new "client" and have a discussion about goals and priorities. We work with them to have those aligned as much as possible with existing goals and priorities, which creates a much higher likelihood of success.

With respect to geography itself, there is simply no substitute for personal interaction. So, while we certainly leverage video, phone and so on, we always make the time to establish a relationship face to face and to be physically present for discussions of real substance.

What have been your greatest achievements in this role?

One of my previous bosses — Ralph Muller, CEO of the University of Pennsylvania Health System — used to describe the importance of hiring with a saying along the lines of, "I will make one decision [to hire] and then that decision will make a thousand decisions."

That sentiment resonated with me deeply and resulted in the amount of time and thought I have given to curating the members of our team. I am thrilled with the members of this team — they are warm, talented and service-oriented, while maintaining very high standards and terrific work ethic.

I can hardly call this "my" greatest achievement though, because attracting that kind of individual actually gets easier with each hire who fits the mold. Candidates hear about our values and culture, and interviewees immediately pick up on it and are excited about becoming part of it, so the credit really goes to the first one or two people that joined the team and established our culture.

Has your viewpoint and leadership strategy evolved since you started this role 18 months ago?

Our view and leadership strategy is more a set of heuristics and guidelines than dogma. As such, they are specifically designed to change and evolve as the market changes, technology changes and payment changes — all of which are occurring. Like most, we are focusing more on network development and meeting the needs of consumers through easier access and more transparent pricing, while we focus less on things like new brick-and-mortar projects. This is a fun and energizing shift that is being broadly embraced at Mission.

We are quite lucky to have leadership that appreciates and empowers, in a fundamental way, both our customers and our employees. I think our strategy is that simple and that complex — establish the right "true north." Find the people that can get you there and then let them run: That is a powerful and fragile dynamic.


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