Building systemness for a more sustainable health system

Health services are facing increasing pressure to deliver better outcomes while managing rising demand, limited resources, and increasingly complex patient needs. As a result, there is growing recognition that improving care depends not only on the performance of individual organizations, but on how well the wider health system works together. Often referred to as systemness, this approach recognizes that better outcomes depend on organizations working as a coordinated system, with shared accountability for patients and consistent decision-making. This case study examines how a top 20 health system addressed the organizational complexity created through years of mergers, regionalization, and expansion, and how the principles of systemness helped create a more unified way of working.

The challenge

Our customer, one of the largest health systems in the United States, generating more than $15 billion in annual revenue and employing over 60,000 people, approached us with a significant organizational challenge. Following years of growth through mergers, regionalization, and expansion, the health system had developed considerable variation in leadership structures, governance, decision-making, operational standards, workforce models, and clinical service delivery. While these differences reflected the organization’s evolution, they also made it difficult to operate as a single, integrated system.

The challenge was not a lack of strategic ambition or direction. The organization had a clear vision of becoming “one” health system. The difficulty lay in translating that strategy into consistent action across a large, complex, and geographically dispersed organization. They needed an approach that would align leaders, standardize ways of working where appropriate, and strengthen their systemness without compromising the ability to meet local needs.

Our solution

Establishing a clear governance framework

We worked with executive leaders to define how decisions would be made across the enterprise. Governance structures were redesigned, decision rights were clarified, and responsibilities were clearly defined between enterprise, regional, and local teams. A new decision-making framework methodology was enacted and escalation pathways reduced ambiguity and provided a consistent foundation for decision-making across the health system.

Aligning leadership and accountability

To support consistent execution, we helped align leadership expectations, organizational structures, workforce models, and accountability mechanisms. Leaders developed a shared understanding of their roles and responsibilities while retaining the flexibility to respond to the needs of their regions and communities.

Embedding systemness in priority areas

Rather than implementing changes across the entire organization at once, the new operating model was introduced through priority operational and clinical domains. Common governance, enterprise guardrails, and standard ways of working were first embedded in these priority areas, allowing the organization to demonstrate early improvements before scaling the approach across the wider health system.

Supporting snterprise-wide adoption

The final stage focused on deploying and embedding these changes across the organization. Ongoing communication, governance, and regular review helped align enterprise priorities with workforce planning and operational decision-making, creating a more consistent way of working that accelerated strategic outcomes and supported long-term adoption.

Yet systemness is never truly complete; it is a journey that takes years to fully take shape. Organizations that embrace this ongoing evolution with resilience and openness to change will ultimately be the ones that endure and succeed.

The impact

The organization now has a clearer and more consistent approach to governance and decision-making across the enterprise, strengthening its ability to operate as one health system. Leaders have a better understanding of their roles and responsibilities, making it easier to work across organizational boundaries, collaborate more effectively, and deliver strategic priorities in a consistent way.

The impact went beyond better alignment. Many of the areas prioritized through this work had a significant financial impact and were closely tied to the organization’s growing portfolio of value-based contracts. Reducing duplication and creating shared ways of working helped bring enterprise, regional, clinical, and operational teams closer together. Changes of this scale are not always easy, but they are increasingly necessary as the health system looks to grow, strengthen performance, and deliver better outcomes for patients.

Ready to strengthen systemness across your organization? Learn how Inizio Ignite can help your health system build on the approaches demonstrated in this case study to drive measurable, lasting impact. Explore our Health Services capabilities