Saint Francis Healthcare System is located in Cape Girardeau, MO and is anchored by the 307-bed Saint Francis Medical Center. They were number three in consumer preference in a two-hospital community in 1999 with an ADC of 124. After 16 years of aggressive strategic action and effective leadership, the organization has grown to be one of the biggest players in its market, with tertiary services that serve the five-state region, an ADC of over 200, and a home county market share of 56 percent.


In 1998, Saint Francis had only 32 percent of their home county market share. The hospital had services and facilities befitting a community hospital. The challenge was to produce growth that would sustain the organization and allow it to build excellent regional services that could compete with those in St. Louis and Memphis.


HSG completed a number of projects to help management define and implement their strategic growth plans. Those included completion of the strategic plans in 2002, 2008, 2011, and 2014. We also worked with management on physician manpower planning, strategies for a JV surgery center, development of satellite outpatient facilities and managed care issues.

In the strategic plans the focus was:

  1. Enhancing name recognition and top-of-the-mind awareness through aggressive and well-coordinated marketing efforts
  2. Aligning employee engagement to improve patient and physician satisfaction through a unique Service Quality Award
  3. Growing the number and quality of physicians employed by or aligned with the medical center
  4. Expanding regional referrals through aggressive referral management programs and responsiveness
  5. Expanding facilities to include all private rooms and facility homes for key services including Orthopedic, Heart, Cancer, Women’s, Level III NICU and Neuroscience service lines.
  6. Aggressive expansion of relationships with primary care physicians throughout the region, with employment of significant groups over time and development of supporting outpatient facilities.
  7. Collaboration and partnerships with other providers to help achieve mutual goals.
  8. Patient satisfaction with results that consistently were in the 90th percentile.
  9. Physician satisfaction that consistently ranked in the 95th percentile.
  10. Employee satisfaction measured at the 95th percentile, recognized by Modern Healthcare 6 years in a row for Best Places to Work in Healthcare


The key to the organization’s success and its ability to remain independent has been its financial success. In the last five years, net operating margin has varied from a low of 2.9% to a high of 9.7%. All, after providing 50% of any excess operating margin over 3% to employees through the Service Quality Award program. Remarkably, the organization has 440 days’ cash on hand.

That cash situation also allows the organization to invest in new physicians and resources to improve care quality. For example, they added a relationship with the Cleveland Clinic and M.D. Anderson to improve the quality of their cardiac and cancer services. All of these efforts have led to the organization being a great resource and making a sustainable difference in Cape Girardeau and the five-state area they serve.

To discuss strategic planning services for your organization, contact David Miller, Managing Partner, at dmiller@HSGadvisors.com or (502) 814-1188.

David W. Miller

Founder, Board Member