Would you build a house without laying a foundation? The result would be four walls lacking any grounding and with little stability.

Similarly, it is impossible to build a highperforming organization without first constructing a strategy. Nonetheless, across all industries, less than 10 percent of strategic plans are executed and realized. How can this happen if the primary responsibility of management is to develop and execute strategies that will help the enterprise realize its vision and mission?

Look at your current organizational structure.
Assess your strategic initiatives and how you will execute your plans on the basis of the current decision-making structures and accountabilities.
Such an assessment will encompass an analysis of management requirements and should include a review of the following focal points:
Strategic plan.
Organizational control structure.
Management responsibilities.
Physician leadership.
An example of an organization that has employed this form-follows-function approach is St. Joseph Hospital.
Strategic Plan St. Joseph’s strategic plan includes three major initiatives:
Develop cancer, cardiac services, and neurosciences as distinctive, marketleading service lines.
Expand the outpatient strategy to include new facilities in two markets within St.
Joseph’s primary service area.
Significantly upgrade quality and patient safety throughout St. Joseph’s facilities.
These initiatives are fairly typical for metropolitan tertiary hospitals; what distinguishes highperforming organizations, however, is successful execution—and the structure that enables it.
Control Structure Control structures need to encompass patient care functions, patient care support functions, and administrative support functions. The way these functions are aligned varies dramatically between organizations and defines both culture and accountabilities within the hospital. At St.
Joseph Hospital, leadership responded to a change in the hospital’s strategic plans by also revising the control structure. The new, revised strategy shifted the hospital’s major spheres of organizational responsibility, prompting a leadership structure that was reflective of the institution’s goals:
An outpatient executive dedicated to the growth of outpatient centers, with line accountability for staff in the outpatient areas.
A service line dyad for each major program that links a clinical director with a physician leader. The dyad is accountable for service line development and profitability.
A clinical quality structure headed by the Chief Medical Officer with direct oversight and reporting from clinical quality and patient safety personnel.