There are various interpretations of business agility in several methodologies. We will focus on the agility specific to small business consolidation.
Considering that the time of private equity is short (3-5 year window), consolidation has to grow by rapidly developing and implementing various processes that will maximise the value of each business before a recapitalization event.
This is achieved by creating a sustainable mechanism of developing an idea, converting it into a business case, and developing the tool for either increasing the top line or expanding the margin and then applying it to all the hospitals in the network.
This is achieved by having a well-defined Initiative Development Value Stream.


  • Respect for the People Who Do the Work. Agile leadership empowers front-line staff to make their own decisions, which gives the feeling of being in control when dealing with problems at work. Allow autonomy while performing the tasks that people are passionate about and have mastery in execution. 
  • Unity of Purpose. Team culture is a value creation tool. Put your people first and the profits will follow. Only teams united around one purpose and who share the core values will get on board with the new organization. Core values must be defined and regularly practiced. Cultural assessment is as important as pre-acquisition financial and legal due diligence.
  • Set Clear Goals to Drive Measurable Results. What gets measured, gets done. Building a quantitatively managed organization allows for predictability and sustainable growth. The frontline staff productivity and overall organizational success must be visualized and represent a direct connection with organizational strategy. Extra effort must be recognized.
  • Manage and Scale Processes, Not People. Make the processes visual and policies explicit. Every person should have a job function that they own, policies that direct them, and a system that automates this process. If something goes wrong, look back at the process, policies, and training provided first. Burnout is a result of poor leadership, not bad employees.
  • Leadership Should Motivate, Not Govern. Create the right context for employee self-actualization and recognize the breadth of talent across the organization. Allow creativity to guide people’s motivation. 
  • Nurture a Continuous Improvement Culture. Let people create their own solutions to the problems they’re accountable for. Only a shared responsibility environment and the culture of candid feedback allow for exponential workflow development. Managing the health of the work environment should be an ongoing process.


For an organization with such a short lifetime to maximize its invested capital, organizational agility is the key instrument that has to be developed and managed from the Inception Level of Maturity. If not developed early, the initiatives are created only at the HQ level, deployed top-down, and training is rarely established. This ultimately leads to resource allocation towards the projects that never reach entire platform penetration and have no metrics to support the effect.

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


The organizations that lack agility at the level of the new initiative creation will have a significant downstream effect on the well-being of the front line staff. The processes that are developed without a consistent framework will stress out the people who are responsible for the implementation and will affect Regional Managers, hospital managers and will influence these burnout triggers: Lack of control, value conflict, insufficient reward, work overload, unfairness, and breakdown of the community.


These models have significant advantages because they are unfettered by historical processes. They can dedicate the time to incubating the original processes within the organization, while developing the process of initiative creation.