HEALTHCARE · ACADEMIC / PHYSICIAN GROUP · HIGHER EDUCATION · SUBSIDIARY / DIVISION STRATEGY
The Weight of the Vision
When the weight of what you’ve taken on is larger than you understood when you said yes
Is this your situation?
This engagement may resonate if your organization is experiencing any of the following:
You have just stepped into a significant leadership role and quickly realized your past experience did not fully prepare you for its scope and complexity
Your organization has the ambition and the people to achieve a compelling vision but no structured process to translate that vision into a plan everyone can execute
The gap between where the organization is today and where it needs to be is larger than you understood when you accepted the role
You are trying to lead transformation while still delivering on your core mission and the two demands are pulling in opposite directions
The Strategic Dilemma
A transformational vision. No roadmap. No margin for error.
A large academic physician group within a major university-affiliated hospital system was still recovering from the demands of the pandemic when it appointed a new department chair. He was selected over other candidates for his strong and comprehensive vision to transform the department — a vision that would have challenged even the most experienced leaders.
Within months of his appointment, he conducted listening sessions across all seventeen specialty divisions in the department. What he heard confirmed both the scale of the opportunity and the scale of the challenge. His past experience had not fully prepared him for the complexity of what he was now responsible for: more than 620 physicians, a three-part mission of patient care, teaching, and research, a complex governance structure, and a workforce still navigating the aftereffects of a global pandemic.
The gap between where the department was and where he wanted it to go in just six years was larger than he had understood. Every initiative would require structural change and meaningful investment. He needed expert guidance — and a consulting partner who would not be intimidated by the complexity or the people.
It takes a certain personality to be able to navigate strong A-type personalities that are associated with physicians. And we felt and were correct in believing Cecilia could do that.
— Tracy Serafini, Director of Strategy and Communications, large academic physician group
What Made It Hard
Leading transformation while delivering patient care — simultaneously
The complexity of this engagement was unlike most strategic planning environments. The client group operated across seventeen subspecialty medical divisions within one of the country’s most prestigious university-affiliated hospitals, with dual accountability to both the hospital and the university.
Physician wellness was a high priority throughout the engagement. The pandemic was fading but not behind them, and many physicians were at the breaking point. While there was broad agreement that change was needed, participating in a planning process while managing full clinical, teaching, and research commitments was a genuine hardship. Every session, every review cycle, every decision required working within the rhythm of patient care first.
Early on it became clear that the department’s current operating model had not evolved with its growth and complexity. The gap was not just strategic — it was structural, operational, and cultural, and all of it needed to be addressed together.
WHAT THIS ENGAGEMENT REQUIRED FROM A CONSULTING PARTNER
The department’s director of strategy described the selection process: they needed someone who could grasp a highly complex medical environment quickly, communicate in its language, respect the primacy of patient care, work at the pace the organization could sustain, and navigate the strong personalities of a physician leadership group with confidence and directness. Focused Momentum was selected for all of those reasons.
The engagement and our approach
A Strategy Summit® designed for an environment unlike any other
Focused Momentum was engaged to lead a full Strategy Summit®, customized for the department’s unique governance structure, stakeholder complexity, and the demands of a clinical environment. The engagement ran in two phases: a nine-month strategic planning process followed by three years of implementation support.
Strategic assessment across seventeen divisions
The assessment phase engaged leadership across all seventeen specialty divisions, capturing the full range of perspectives on the department’s current state, its aspirations, and the gaps between the two. Stakeholder engagement was designed around clinical schedules — shorter, targeted sessions that could be completed without disrupting patient care commitments.
45-person Strategy Creation session
In June 2022, Focused Momentum facilitated a 45-person Strategy Creation session — the largest and most complex group planning session of the engagement. The session produced the critical insight that would shape everything that followed: the department’s vision and member aspirations were aligned, but the operating model and budget were not.
Five strategic initiative teams, four months, one integrated plan
Each core aspect of the department’s operations required its own strategic plan. Focused Momentum guided five strategic initiative teams through a four-month process of building individual plans that were then integrated into a single, coherent departmental direction with a realistic four-year budget.
Three years of implementation support
Recognizing that the scale of transformation required sustained guidance, Focused Momentum extended the engagement to support implementation across three years — including organizational realignment, Role Clarity, Strategic Alignment Planning, ongoing strategic oversight, and business planning for outpatient clinic expansion.
The Result
A department transformed — mission, structure, and capability aligned
ORGANIZATIONAL MANAGEMENT
Roles, responsibilities, resources, and reporting structure aligned with strategic plan goals, strengthening culture and departmental visibility
ADMINISTRATIVE CAPACITY
Administrative support doubled so core areas had the professional resources needed to serve physician members and deliver on the department’s three-part mission
PATIENT ACCESS
New division launched with 61 physician members; a new outpatient clinic model was designed and launched to optimize hospital resources and reduce patient wait times
RESEARCH SUPPORT
Office of Research Support established; internal grant programs expanded targeting mid-career, quality, safety, education, and translational research
TEACHING MISSION
Educational resources centralized and teaching support optimized to reduce duplication and improve execution of the academic mission
PHYSICIAN WELLNESS
Office of Member Support launched to increase support capacity, enhance faculty career development, and foster physician well-beingCecilia recognized early on that things won’t move as quickly as they do in the business world, because a physician will always prioritize patient care. Moving the needle takes time — and with that comes patience.
— Tracy Serafini, Director of Strategy and Communications, large academic physician group
Prior to this planning effort, management resembled a game of Whack-a-Mole more than management discipline. Decisions changed based on who was loudest or latest to get the department head’s attention. Accountability was rare. Silos created factions. The strategic plan broke down those silos and realigned the organization — its structure, its budget, and its leadership — to its goals.
What this means for you
The strategic principle behind this result
A clear vision is required to evolve any organization. But a great vision is not attainable without planning rigor, patience, and the faith that you are on the right path even when the status quo makes it harder than it needs to be.
The leader in this engagement was selected for his vision. What he needed was a process that could translate that vision into a plan his organization could execute — one rigorous enough to survive the complexity of the environment and flexible enough to work within the pace of clinical life.
If you are a new leader who has just taken the measure of what you have inherited, and the gap between where you are and where you need to go feels larger than you expected, that is not a reason to hesitate. It is a reason to plan.
Recognize your situation in this story?
Let's talk about what a strategic planning engagement with Focused Momentum would look like for your organization.