First it is worthwhile to discuss what is the role of the Regional Operations Manager (ROM).
Historically, the Regional Manager is seen as a person controlling the hospitals in their region and having discussions with Hospital administration about their productivity. There is no better way to create a conflict in this type of framework.

The Consolidator Operating Framework (COF) suggests that a Regional Operations Manager (ROM) is a person who is continuously seeking solutions based on the metrics that are available to both the Hospital Management Team as well as Regional Manager (Hospital Scorecard) and works with the team on creating Action Plans that will combat these issues.

The Regional Operations Manager (ROM) acts as an advisor for problems in a hospital.. But in order to devise a solution for each issue, there should be a team that helps the Regional Operations Manager (ROM) when the issues exceed their competencies. And that’s why they always work in partnership with the Functional Change Agents from each department. This is an example of how Regional Manager may solve the issue:

Example: The Hospital Scorecard shows a decrease in revenue and when further investigated, there is a more than the customary drop in appointments compared to the previous year. The Regional Operations Manager (ROM) as well as the Hospital Management Team assess this issue prior to the Level 10 (L10) meeting and Hospital Manager creates an agenda item for discussion.
At the Level 10 (L10) meeting, the issue is discussed and it is determined that the capacity at the hospital level did not change, but the fill rate has dropped over the past three weeks. The Regional Operations Manager (ROM) suggests deploying several campaigns that may be suggested by the marketing team. This is documented in the Action Plan.
The Regional Operations Manager (ROM) conducts a separate meeting with the Marketing Change Agent in their region and receives advice to send a dental campaign to all the customers that have not had dental cleaning done for their pets in the last two years or longer.
Upon participation in several L10 meetings with the Hospital Teams in the region, the Regional Operations Manager (ROM) realizes that this is a common issue, and decides to create an Action Plan at the regional level partnering with the Marketing Change Agent.
This is now a tool that they will apply together to all hospitals centrally, meaning that this does not require hospital involvement. Therefore, the campaign could be rolled out simultaneously at many hospitals, but with respect to the Marketing Team capacity.
The Regional Manager and Hospital Management teams can now continue monitoring the metric that was assigned to this issue and consider the action plan completed when the metric is corrected. Until that point, this Action Plan is discussed at every L10 until full resolution.


Without a well-articulated process of Regional Process Management, there is no hope for Value Creation through Margin Expansion.

Connected Processes

  • Knowledge Accumulation
  • Strategic Filter
  • Prioritization (WSJF)
  • Training
  • Quarterly Goals/Rock Planning
  • Recruiting at the Hospital Level
  • Implementation of VCP Processes
  • Capacity Reservation Process
  • Change Management
  • Data-Driven Change Management
  • Data-Driven VCP Initiative Process


Proper Regional Management structure and process are the most important elements that need to be executed properly if there is a plan to create additional Value through Margin Expansion. The most common burnout issue in any type of consolidation is no clear explanation about why the process is being deployed, and no empowerment through joint decision making on how to resolve issues; they all look top-down. These are the most common burnout triggers that are observed in the hospitals without his process: Lack of control, value conflict, work overload, unfairness, and breakdown of the community.


Once the organization grows to the level when Regional Management should be involved, the VP of Operations needs to start expanding the team by adding Regional Operations Managers (ROM). The process of management by region is very similar to a classic consolidation by acquisition, but the metrics of success will vary.