Consolidator Maturity Model Assessment

Pipeline EBITDA forecast *Shows the total EBITDA expected to be acquired from the leads that are in the business development pipeline. Ideally, it should be in the later stage of the business development process (Letter of Intent signed).*M&A: Lead to Close *Lead time, automatically collected and time-stamped from the time the prospect is registered in CRM to the time when the deal is closed.*Ops: Deal Close to Core Systems Integrated *Lead time is automatically collected and time-stamped between the time when a business was acquired to the time when all core systems/processes were implemented and the business entered into the “stabilization phase”.*Post-Acquisition Satisfaction *A formal post-acquisition assessment that determines the quality of change management processes at the level of the hospital. Post-Acquisition Satisfaction also determines the need for stabilization before implementation of new processes at the hospital level.*Finance: Total, Clinic Revenue, EBITDA (Top/Bottom Line) *Financial Metrics: Total Revenue, Hospital Revenue, Corporate EBITDA, Hospital EBITDA, AP, AR, COGS, OPEX, CAPEX, Corporate Overhead.*Close to VCP Function Integration Lead Time *Lead time of Deal Closing to all Value Creation Plan (VCP) Functions Integration*Cost of Delay *Can be determined through a prioritization process of any initiative in the organization. It is a part of Weighted Shortest Job First (WSJF) technique and is equal to Business Value+Time Criticality+Amount of Risk Mitigated+Opportunity for the business to advance within the Value Creation Plan.*Training Satisfaction/Effectiveness *After each training is conducted at the hospital level, a survey should be collected and quantified for the continuous improvement of the training process, as well as to establish the degree of burnout at the level of the hospital.*Department Performance Metrics --- *Each department that represents an item of the Value Creation Plan (VCP) should have a metric that is represented at all levels: Executive Balanced Scorecard, Departmental Dashboard, Regional Index and Hospital Metric.*All Visual Boards Lead TimesAll VCP Metrics at all Levels (FFP) *Each item on the Value Creation Plan (VCP) should have a metric or index (weighted combination of Metrics) that helps the entire organization understand the performance based on the Value Creation Plan (VCP).*System Liquidity *In Kanban systems, the rate and volume of predictable value creation.*Benchmarking Techniques (What is Normal for Us?) *There is no industry-specific benchmark on all the processes that are contributing to value creation. The Benchmark Development Technique is a data-driven process for each individual organization.*Strategy-Driven Data Goals Design, OKR *Quarterly planning should result in creation of key results based on the organizational objectives (OKR). These key results should be measurable and clearly understood within the success criteria of each goal.*Lead Time Distribution *Determines how much time is required for all the processes in the system to be completed and provides predictability of the time required to deliver value.*Capacity Allocation *Once the visual boards are created, the capacity of each phase is determined. The system has a predictable method of allocating capacity downstream towards incoming workload from the upstream.*Scientific Approach to Experiments: Build/Measure/Learn *Scientific Thinking is based on proving hypotheses. Every new idea in the organization should be designed as an experiment and go through a cycle in which there are clearly described outcomes, metrics are determined and results are measured until outcomes prove the hypothesis.*Flow Efficiency *Flow efficiency is a metric that shows how good a specific process is performed. It is calculated based on actual time spent (pure work time) on performing the activity versus Lead Time,which includes waiting for approvals, blockers, queues and/or other dependencies.*AI-based Predictive System *Once Machine Learning is incorporated into data analysis, metrics of the experiments can be simulated without wasting resources on the experiment itself. Experiments can be simulated on the existing organizational data model.*Cumulative Flow Diagram *Cumulative Flow Diagram is a tool that shows how well a specific process is performed in terms of managing queues, slack capacity, and bottlenecks in the workflow. It uses two axes: the timeline and the amount of work in a specific state of the workflow. This tool helps to effectively manage the flow, including Work In Progress (WIP) limits and/or scaling workforce.*

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Investor Pipeline *When managing investor relationships, there should be а system that provides the communication summaries, relationship cadence and outcome summaries. This process should be repeatable and visual.*Prospecting Pipeline *Once the hospitals are prospected, it is critical to systematize the business development process early, since the success of the Consolidator Arbitrage part of the Value Creation Plan (VCP) is dependent on the velocity of acquisition and integration of practices into the organization.*M&A: Prospecting/Due Diligence/Close *Acquisition Stream is a subsystem of the Value Creation Stream. It facilitates the Arbitrage Value Creation and requires discipline and visualization by both the Board of Directors, Executive Team and by Department Leads. The latter is important for the downstream management of the incoming upstream flow of businesses.*Ops: Core Integration *Core Processes are the first integration point in the post-acquisition process. They should live separately in a sub-system of the arbitrage part of the Value Creation Stream and should have a clear Definition of Ready (DoR) and Definition of Done (DoD).*Capacity Visualization *At this stage, all of the boards should have a capacity consideration for the Bottleneck Management Process.*Upstream & Downstream *Upstream refers to all the processes involved in prospecting, Due Diligence and Acquisition of the businesses with the Definition of Done (DoD) being “Deal Closed.” Downstream - are all the processes that follow the acquisition and their throughput is measured and predictable. The need to understand and measure the capacity of both Upstream and Downstream is part of the management of the entire Executive Value Stream’s ability to acquire, integrate and improve businesses. This is a critical step for acquisition goal-setting along with doing annual planning and raising capital towards those goals.*Pre-Integration/Integration Capacity Limits *Visualizing the capacity of the integration process is required to control the acquisition flow by the Business Development Team and is an important metric to be considered in Business Development (BD) Business Rhythm meetings.*Initiative Board --- *Most of the processes have to be developed in an early Maturity Level of the consolidation. Each process creation should have a place in a Quarterly Plan and be represented as an initiative with an owner, clear description of the problem, the solution and key results. These are Definition of Done (DoD) of this board and policies that should be explicit to all teams. All departmental initiatives should have similar phases.*Departmental Boards *Each department has two main processes - Initiative Creation and Change Management. The Initiative Board is shared with other departments and visible by all for accountability at the executive and cross-functional level. The Change Management Board is shared with regional managers for process implementation and may represent Centralized as well as Decentralized initiatives.*ROM Board *A Regional Operations Manager’s Board, also known as the “Change Management Board,” is a shared board with departments as well as being visible to the Executive Team. This board has hospitals on it, which undergo transformations according to the Value Creation Plan (VCP). This is a central board that allows Regional Managers to deploy new processes, identify and manage departments’ capacities, and execute cross-functional dependencies between departments.*Classes of Clinics *The visual board should have a clear indication of what transformation is available for change based on the Fitness Assessment. The hospital assessment should be conducted at the early stage of the Business Development and passed from Upstream to Downstream. A strategic filter plays a significant role in the identification of fitness of the business into Classes of Clinics that the consolidator is capable of improving.*Dependencies Throughout the System *Dependencies should be identified during several stages of the Value Creation Stream. There are two main classes of dependencies: 1. Initiative creation dependency - when one department is dependent on another while developing a new process (usually identified during Quarterly Planning) and 2. Process implementation dependency between departments or roles (should be considered while planning Change Management at the hospital level).*Workflow Progression Visualization *An indication of how long the hospital was in this phase. This practice can be used as a feedback loop to better understand the status of specific initiatives for early stage value streams, where workflow and classes of clinics are not well-defined yet or flow efficiency is low and/or lead times are not yet predictable.*VCP as a Subsystem of OperationsContinuous Improvement Board (Initiative Shiny Objects) *This board is very similar to the Initiative Board, but should be separate, as this is at a late stage of maturity. If it is considered earlier, then all Value Creation Plan items that are developed should be clearly separate from the Initiative Board.*Hospital Boards/Horizon Board (Strategic Shiny Objects) *Based upon McKinsey’s Three Horizons Framework, in the advanced stages of maturity, an organization can begin looking at other opportunities to explore, which are beyond the First and Second Horizon. For the most part, the Second and Third Horizons are the “shiny objects of the organization and are not recommended to be explored before the fourth level of maturity”.*

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