There are five distinct levels of a traditional consolidation business:

  1. The Board
  2. Executive
  3. Department
  4. Regional
  5. Hospital

The focus of the Consolidator Operating Framework (COF) is to articulate the connection between the levels and to connect them using metrics, business rhythm and feedback loops.

The levels of the organization develop with the progression through the Levels of Maturity. Starting with the executive and founders, this team shares roles that carry strategic importance and their success is measured in execution of the initiatives which are the Key Results of the board-directed objectives. As the organization develops, the founders team extends vertically into the departmental Level of the organization.

One important aspect of the consolidation – Operations are in charge of coordination at each as it cascades through the system: COO to VP of Operations to Regional Managers to Hospital Managers

Executive Level
Is represented by CEO, COO, CFO, CIO, CDO sometimes Legal and CMO (C-suite)

Department Level
Is represented by the basic business functions specific to the value creation as outlined in the Value Creation Plan (VCP):
Basic Business Functions:

  • Finance
  • M&A
  • Marketing
  • HR
  • Legal

Functions Specific to Value Creation Plan (VCP):

  • Hospital-Level Marketing
  • Procurement/Inventory Management
  • Facilities Management
  • Medical Operations
  • IT
  • Recruiting
  • Learning
  • Support
  • Integrations
  • Analytics/Data Science

The focus of the departmental level is on two main processes: 1. Development of the new Initiatives within the Initiative Value Stream and 2. Deploy the processes to the hospitals in partnership with the VP of Operations or Regional Management.
Departmental level is separated in two levels in the 3rd-4th Levels of Maturity: The Director Level, which is responsible for new initiatives and functional Change Agents, who are the Project Managers that hold the competency of the particular processes of their department. They implement these processes at the level of the hospital in partnership with Hospital Management and Regional Manager as Program Managers/Coordinators.

The Regional Level is represented by the VP of Ops and Regional managers.
As the organization reaches the level when departmental heads are not able to manage priorities at the level of the hospital, the VP of Operations is required to become a Program Manager of multiple initiatives. The VP of Operations acts as a “guardian” for the hospitals, helping them to deploy one project at a time and is a critical instrument in order to have a continuous improvement culture without burnout at the hospital level.

As the organization is progressing towards levels 3-4, the VP of Operations is expanding the team vertically by hiring Regional Managers. Regional Managers are managing hospital Capacity and work with the functional Change Agents at the level of the department to deploy projects to functional leads within the hospital.

The Hospital Level
This level is represented by the hospital manager and various functional leads that carry out the hospital functions and support continuous improvement culture at the level of the hospital. One person at the hospital can carry several functional lead competencies, but careful capacity management at the level of the hospital should be considered as well as the career ladder — reflecting commensurable compensation based on the roles fulfilled.


Not having an organizational structure defined in the first or second levels of Consolidation Maturity carries the risk of spontaneously hiring of “just good people” without having an impermeable structure and talent pipeline in place, as well as ability to delegate responsibilities at the time of the excess capacity by the founders team.

Connected Processes

  • Knowledge Accumulation
  • Core Processes Implementation
  • Strategic Filter
  • Prioritization (WSJF)
  • Talent Acquisition
  • Pre- and Post-Acquisition Assessments
  • Training
  • Quarterly Goals/Rock Planning
  • Recruiting at the Hospital Level
  • Implementation of VCP Processes
  • Change Management
  • Data-driven Change Management
  • Data-Driven VCP Initiative Process
  • Horizon 2 Experiments
  • Horizon 3 Experiments


One of the most common reasons for burnout is front line employees’ uncertainty about their job descriptions, lack of clear reporting structure. and lack of clear goal setting. Without a well-defined organizational structure, the goal setting is practically impossible and this may lead to the following burnout triggers: Lack of control, insufficient reward, work overload, unfairness, and breakdown of the community.


The de-novo and franchise models are in the same boat with the other types of consolidation. The organizational design clarity should come at the inception level and change only the names in the chart, but not the chart structure itself.