HEALTHCARE | ACADEMIC PHYSICIAN GROUP | ORGANIZATIONAL REALIGNMENT | ROLE CLARITY
The Structure Was the Strategy
When your strategic plan can’t succeed because your organization isn’t built to execute it
Is this your situation?
This engagement may resonate if your organization is experiencing any of the following:
Your organization has a compelling strategic direction but the structure, resources, and reporting relationships haven’t changed to support it
Leaders are working hard but focused on roles and priorities different from the new strategic goals
The operating model that got your organization to where it is today is now one of the biggest obstacles to where you need to go
You have a brilliant strategic plan but aren’t sure whether the organization has the budget, the capability, or the accountability structure to execute it
The Strategic Dilemma
The vision was aligned. The operating model was not.
During its strategic planning process, a large academic physician group within a major university-affiliated hospital system discovered a critical gap. The new department head's vision was aligned with the members' aspirations (he had their buy-in), but the current operating model was not built to support it.
As the planning discussions progressed, it became undeniable that the operating model lagged behind the group's growth and complexity. Over the past 10 years, the department expanded significantly. New divisions were added, the number of members in the department doubled, and, as a result, clinical care demands, its research mission, and teaching responsibilities all grew. The pace and scope of their growth increased friction between physician members and the administrative staff hired to support them. Siloed decision-making and accountability gaps were now fully exposed.
A strategic plan built on top of this operating model would fail. Before implementation could begin, the structure itself had to become part of the strategy.
What Made It Hard
Restructuring a complex organization while it was still running
Organizational realignment in a clinical environment carries risks that don't exist in most organizational contexts. Every administrative function supports physicians who are simultaneously delivering patient care, teaching residents, and conducting research. Disruption to support structures could have immediate consequences for patient care capacity and for physician well-being.
The realignment also had to navigate the political realities of a large, established institution. Divisional and program leaders had developed ways of working that suited their individual needs, not the department's collective goals. Silos had become factions. Changing the structure meant changing who had authority, who had resources, and who was accountable to whom.
The budget was the third constraint. Every structural change required investment. The department needed to make a credible financial case for each change and integrate those investments into a four-year budget that could be defended to practice group members, the university, and the hospital.
THE BUDGET INSIGHT THAT CHANGED THE ENGAGEMENT
Rather than assuming the money would be found after the plan was approved, Focused Momentum led the department through building a budget alongside the plan — integrating resource requirements from each of the five strategic initiative teams into a single, defensible four-year financial commitment. “Cecilia forced us to consider budgetary requirements and led us through a process of developing a multi-year strategic budget,” said the department’s director of strategy. “That was a real value add.”
The engagement and our approach
Realigning the organization — then using Role Clarity to make it stick
The turning point in the Strategy Creation session led directly to priorities in the Plan Development phase. Focused Momentum guided five strategic initiative teams through four months of building aligned plans. These plans were then integrated into one coherent departmental strategic plan. Organizational realignment followed that integrated plan — and Focused Momentum’s Role Clarity process made the new structure functional.
Five strategic initiative teams build the plan
Each of the five strategic initiative teams developed a plan for their area. They identified new priorities, the structural changes, resource requirements, and accountability mechanisms needed to deliver on the department's goals. These five plans were integrated into a single departmental direction with a unified budget.
Structural realignment tied directly to strategic goals
Every structural change was anchored in specific strategic objectives. Overall, the Department’s administrative staff doubled as a result of the specific gaps each initiative team documented. New departmental support offices were established to build the required dedicated new capabilities. Nothing was added without a strategic rationale and a budget line.
Role Clarity: making the new structure functional
With individual area plans integrated, it was clear what additional staffing and shifts in responsibilities were required to execute them. The current structure, from the leadership team through the administrative teams, had to change.
Focused Momentum applied its proprietary Role Clarity process — a management discipline in which each functional area defines its strategic role, outlines who will do what, and clarifies how to align with other areas on shared accountability – to this challenge.
The Role Clarity structure and process translated the new strategic plan into explicit functional ownership, ensuring that the goals, resources, and accountability were aligned. By working through each position, this process ensured that gaps and shifts were identified and transitional plans were agreed upon, so that those working in the organization could not revert to old patterns.
Leadership forums realigned to fit a new management cadence
Meetings, reporting structures, and decision-making forums were redesigned to reflect the new organizational structure and the Role Clarity agreements. Each forum was aligned with a specific set of strategic priorities and functional accountabilities, ensuring the plan remained the anchor of organizational decision-making throughout implementation.
THE ROLE CLARITY PROCESS: INPUTS AND OUTPUTS
Focused Momentum’s Role Clarity Process is a strategic plan implementation process that takes four inputs: financial goals, performance metrics, strategic initiatives, and organizational structure to produce five outputs for each functional area:
• Critical Result Areas: the name of the core result a function/position owns or contributes to
• Metrics: the goals that define success for each result area
• Methods and Role: the specific role this function or position plays in each process or method employed to achieve results
• Priorities: current obligations and new strategic priorities that must be delivered within a specific timeframe
• Time/Attention: how functions or individuals allocate their time/attention to deliver on each critical result area
Applied across the department’s new functional offices and administrative areas, this process created the accountability structure the strategic plan required.
The Result
A structure aligned to strategy — and the resources to execute it
ADMINISTRATIVE CAPACITY
Administrative support doubled; departmental leaders were given budgets to hire the professionals needed to deliver on their portion of the strategic plan
RESEARCH INFRASTRUCTURE
A dedicated staff team was established with dedicated resources and expanded granting capabilities, targeted at five research priority areas
TEACHING MISSION
Educational program resources were centralized, eliminating duplicated teaching support resources and optimizing the Department's academic mission
QUALITY AND SAFETY
A staff group was formed to coordinate quality improvement initiatives and share best practices across divisions
MEMBER SUPPORT
A specialized staff lead was hired to enhance faculty career development and physician wellness — a direct response to burnout identified in the assessment
EDIAB STRATEGY
A comprehensive Equity, Diversity, Inclusion, Accessibility, and Belonging strategy was developed and integrated into the departmental plan to ensure unity and culture thrivedPrior to this planning effort, management resembled a game of Whack-a-Mole. The strategic plan implementation broke down historical silos and realigned the organization and its resources to its goals.
With a clear strategic plan and budget allocated over four years, each leader and team had a charter and the resources to act on it. Accountability increased because it was now built into the structure — and made explicit through Role Clarity — rather than assumed.
The organization that emerged was not just better planned. It was better built.
What this means for you
The strategic principle behind this result
Strategic plans fail most often not because the strategy was wrong, but because the organization wasn't structured to deliver it. The vision was clear. The people were bought in. But the reporting relationships, resource allocations, and accountability mechanisms were still calibrated to the organization's previous priorities.
The sequence matters: strategy informs structure, not the other way around. When restructuring follows from a strategic plan, every structural change has a rationale, a budget, and a measurable goal attached to it. And when Role Clarity follows restructuring, the new structure becomes functional rather than theoretical.
If your organization has a strategic plan but hasn't examined whether its structure is built to execute it — or whether your leaders actually know what they own and how they work together — those are the missing steps between a plan that inspires and a plan that delivers.
Recognize your situation in this story?
Let's talk about what a strategic planning engagement with Focused Momentum would look like for your organization.