While delivering outstanding care, this nationally renowned integrated delivery network faced increasing financial challenges and had struggled to find root causes. Numerof diagnosed the issues and helped to change the culture, improve clinical-administrative alignment, and address critical gaps in capabilities, processes, and accountabilities.


  • This nationally renowned integrated delivery network was widely lauded for its outstanding focus on quality, but was struggling financially.
  • Under significant reimbursement, regulatory, and competitive pressure, and aware of symptoms like low levels of employee engagement, senior leadership knew that change was needed but sought help determining underlying issues and addressing them.


  • In a situation assessment, Numerof identified critical gaps in culture and infrastructure that threatened the organization’s ability to maintain its reputation for industry-leading care – and its financial viability.
  • To maintain course toward ambitious cost reduction goals without sacrificing quality, a major cultural shift was needed and critical strategic, financial, and operational leadership capabilities had to be developed. Essential processes and systems for managing variation in cost and quality were also required, especially as key senior management team members transitioned out of the system.
  • We engaged senior leadership to establish a common understanding of external forces, clarify goals, ensure alignment with organizational strategy, and define the competencies required for success, many of which were not developed currently in the organization.
  • Through a highly participative process, we designed, achieved consensus on, and implemented job charters that defined key roles, responsibilities, accountabilities, and decision-making authority.
  • To integrate the new tools in a sustainable manner across the organization, Numerof defined performance management processes integrated with the job charters and developed and mapped curricula in support of capability development.


  • Numerof’s work closed the gap between existing capabilities and those needed for success in the evolving environment, resulting in greater strategic linkage between institutional goals, patient care staff, and supporting infrastructure.
    The tools developed provide the basis for understanding roles and responsibilities as well as systematic and structured hiring, training, development, performance management, and succession planning.
  • The organization subsequently engaged Numerof to help close specific gaps and develop essential capabilities.