Case Study: Building a Common Vision with Employed Physicians

Executive Summary

St. Claire Regional in Morehead, Kentucky employs over 75 physicians and other providers. As the group expanded, a physician leadership group was created with the objective of integrating the various practices and defining group direction. Significant progress was made, but had plateaued and progress slowed. HSG helped the physicians and executives define their shared vision for how the group would evolve over the next decade and the resulting strategic and operational priorities refocused and accelerated the group’s evolution.



The St. Claire Medical Group had disparate operational process, cultures, EHRs, and levels of accountability Leaders believed that variation needed to be reduced, and that the group needed to create a common strategic and operational focus. But they were unclear how to make that happen. The system CMO decided to seek outside advice. Starting with a couple of conversations with HSG consultants, the discussions expanded to include the system CEO and group COO. A plan was developed to accelerate progress.


How HSG Helped

The agreed-to approach was a consulting engagement designed to create a common vision for the group. That narrative vision outlined an aspirational description of how the group would function 10 years down the road. The proposed vision statement was developed by a steering committee consisting of 12 formal and informal physician leaders and four system executives, three of whom were the senior executives involved in the initial consulting discussions plus the executive with ownership of quality initiatives. In addition to the detailed vision, project deliverables included two other elements. First, an organizational structure recommendation that formalized enhanced roles for physician leadership and clear reporting relationships with dyads. Second, an outline of key strategic initiatives required to implement the vision.

The steering committee was asked to consider two primary questions in their deliberations:

  1. What did the group need to do to ensure success in a value-based purchasing market?
  2. How would the group need to function to make the doctors proud to be associated with it?

Our collaborative approach allowed the physicians to assume full ownership of the newly articulated vision. Our roadmap for developing a High-Performing Physician NetworkTM created a platform from which discussions could easily flow between executives and physicians.

A key final step was sharing the proposed vision and associated organizational structure with the entire physician group. The physician members of the steering committee delivered the presentation, took ownership for the content, and did a great job enthusiastically sharing their perspective on the vision.

The group then split to allow more intimate discussion and direct feedback. Each smaller group was facilitated by a physician member of the steering committee. During the breakout session reports that followed, most of the concerns and comments related to how the vision would be accomplished rather than what it should include. The consensus was that the outlined vision was desirable.

In addition, the executive group suggested four initial strategies to pursue, which the group at large considered to be a reasonable start.

The physician group also embraced the proposed organizational structure – even though it eliminated their traditional practice arrangements. The group applauded the identification of formal physician leadership positions within the group and, perhaps even more significantly, the newly expanded representation in the system’s senior leadership group – three additional physicians were added to the CEO’s major decision-making body.

Results and Impact

The actions taken by management in concert with physician leaders resulted in a number of positive outcomes. The actions:

  1. Accelerated the evolution of the group to meet the demands of value-based care by focusing discussion on essential strategies.
  2. Created precedence for even more collaborative interactions among the physicians and with Administration.
  3. Instilled a shared vision among the physician leaders, front line physicians, and executives.
  4. Provided a roadmap and a strengthened organizational infrastructure to propel the vision forward.
  5. Created a greater voice for physicians in both group and system operations, with a 300% increase in physician representation at the President’s Council.

While the bulk of the implementation and execution still lie ahead, both management and the physicians agree that the process set the stage for real progress. Each believes the engagement enhanced their ability to deliver results in a value-based care environment.


To learn more about building a common vision for your employed physicians, contact Terry McWilliams, M.D., Chief Clinical Consultant, at TMcWilliams@ or 502-614-4292