Know Your Destination: What is Systemness?
With all the turmoil in healthcare today, it seems impossible to chart a path forward. Facing reimbursement cuts and a hostile regulatory environment, however, healthcare organizations must transform their operations to meet this new reality.
We believe the destination for this transformational journey must be systemness—a cohesive, integrated state characterized by an entire organization working together toward a common vision, achieving collective outcomes, and committing to a culture of continuous improvement. The journey to systemness demands performance transformation—a new mindset driving improvements in operational models.
Systemness is the alignment and integration of all components of a healthcare system to work as a single cohesive unit. It requires an unwavering commitment to creating and maintaining a seamless patient- and family-centered experience that delivers high quality care across all settings. Systemness brings a coordinated and efficient approach to fragmented care delivery through integrated care coordination, harmonized systems and processes, and a culture of collaboration between caregivers and administration.
Liz Carlton, Senior Vice President of Quality, Safety, and Operational Integration at The University of Kansas Health System, has been a key leader in the organization’s integration with two local community hospitals. The acquisitions and subsequent integrations spurred a journey to systemness for her organization.
“For The University of Kansas Health System, we determined that systemness would mean providing a consistent patient experience across all locations and care settings,” Carlton says. “This is foundational to our mission and vision, which are centered around people and patients.”
Similarly, Carolyn Wilson, former Chief Operating Officer at Beaumont Health in Michigan and M Health Fairview in Minnesota, believes that “setting a clear and aspirational goal for your target outcome is pivotal to making progress, and having a clearly defined destination allows for stakeholder alignment on the desired outcome.”
Challenges exist, of course—siloed workflows, data fragmentation, and misaligned incentives all impede progress. With a defined destination in mind, however, these barriers can be addressed systematically.
To find your organization’s road forward, start with the end in mind:
- What would it mean for our organization to achieve systemness?
- What measures of success will we track to remain focused on our destination?
Make Your Packing List: Documenting Current State
After choosing your destination, you prepare for your trip by packing your bags. Similarly, you prepare for your journey to systemness by documenting your organization’s current state. This involves taking inventory and examining existing resource utilization, processes, systems, technologies, and capabilities. Current state documentation is your organization’s “packing list,” including strengths and opportunities for improvement. This assessment should cover not only historical performance on specified measures but also organizational culture, technology infrastructure, and patient engagement strategies.
As you assess current state performance, you should take note of gaps and redundancies. This information will be essential to inform a gap analysis in the next phase. Just as forgetting an essential item can derail a trip, missing a critical element in your current state analysis can lead to setbacks and inefficiency in your transformation efforts.
As a former COO for two multi-billion-dollar health systems, Wilson has experience leading transformation. Regarding the “packing list” for the journey, she says, “Highlighting your current outcomes with actual data gives everyone a common understanding of current state. Reaching alignment on the baseline for key outcomes provides valuable intel for what changes are needed to move forward. Reviewing key data outcomes also provides impetus for what key measures and outcomes will be used to propel the team forward and allow you to measure your success in making changes.”
Carlton shares her perspective from her organization’s integration of two community hospitals into the health system:
“On the road to systemness, integration planning is not a ‘plug-and-play’ process. It requires dedicated time to understand current state and presents an opportunity to optimize processes and workflows across the organization during the integration. One thing we uncovered quickly was the value of embracing the talent and treasures of each entity while protecting against dilution of the uniqueness that is necessary when you’re bringing together hospitals of different sizes and resources.”
Before taking to the road, review your packing list one last time:
- Do we have a complete and honest picture of our organization’s current state?
- Do we have gaps that require a closer look?
Being thorough in this phase pays dividends later, smoothing the road to your systemness destination.
Build Your Itinerary: Getting from Current State to Future State
With your assessment bags packed, you’re ready to develop the route to take you from your current state to systemness. Creating your itinerary begins with a gap analysis comparing your current performance to your desired future state. This analysis will help you identify the key initiatives and milestones that will drive transformation, creating a step-by-step itinerary that gets you from your current state to your desired future state.
Your transformation itinerary should include:
- Reasonable timelines
- Assigned responsibilities
- Prioritized initiatives
- Identification of necessary resources
- Specific success metrics
As you build your itinerary, be realistic. Just as you wouldn’t expect to visit multiple cities in a single day, you won’t achieve organizational change overnight. And just as travelers account for unexpected delays or detours, your transformation roadmap should allow for adjustments, ongoing evaluation, and recalibration.
Wilson emphasized the importance of a flexible itinerary. “We’ve all experienced dramatic shifts in healthcare—from pandemics to changing payer behaviors to consumerization,” she says. “Factors causing further shifts that we don’t always predict or know will continue to influence our journey to systemness. Therefore, flexibility and adaptability are necessary while keeping your endpoint clear.”
A successful transformation itinerary is more than just a task list. It’s a comprehensive plan that aligns all aspects of the organization and directly addresses stakeholder engagement and buy-in, resource allocation, and continuous monitoring to ensure progress. Set the tone at the top, with leaders consistently communicating cultural change to support sustainable and continuous improvement. Prioritize initiatives that deliver the greatest impact, and sequence them in a way that builds momentum.
The pursuit of systemness is something that happens within your organization, not something that’s done to it, and buy-in from front-line staff as well as leadership is essential.
As you finalize your itinerary, ask yourself:
- Are our objectives and vision clear?
- Is our plan comprehensive yet adaptable?
- What cultural changes are needed to support sustainable change?
- Are our milestones realistic, and have individuals been assigned responsibility to achieve those milestones?
- Have we anticipated potential obstacles?
With a solid itinerary in hand, you’re equipped to embark on the next stage of your transformation journey.
Take Flight: Operationalizing Your Systemness Implementation Plan
The moment has arrived when strategies and tactics meet execution, and the success of your transformation efforts hinges on how well this transition is managed. Like any journey, the first steps are critical in setting the tone for what follows.
Operationalizing your systemness plan involves mobilizing teams, deploying resources, and executing the initiatives outlined in your itinerary in a timely manner. Communication is key during this phase. Just like airlines communicate flight status, your teams will look to you to ensure everyone involved understands the plan, their roles, and the timeline. An effective implementation requires committed leadership, effective project management, accountability mechanisms, and continuous monitoring of performance against collective goals and the organization’s vision. Every member of your organization must understand, embrace, and be engaged in the transformation process, always keeping the destination in mind.
Carlton shares her thoughts on implementation. “This work is rooted in a commitment to continuous improvement and a culture that upholds accountability for ongoing improvement efforts,” she says. “While systemness is the ultimate goal, we believe it is something we must actively and continuously strive toward.”
Inevitable challenges—whether they are resource constraints, resistance to change, or unforeseen circumstances—can be navigated successfully by leveraging your organization’s culture of continuous improvement and the strong foundation you’ve built during planning phases.
As your transformation takes flight, ask yourself:
- Are our teams prepared for the journey ahead?
- Is our communication strategy clear and effective?
- Are we ready to adapt as circumstances change?
By addressing these questions, you can reach your destination of systemness.
Consider a Tour Guide: PYA’s Performance Transformation Team
As you consider the journey to systemness, engaging a trusted third-party partner can be helpful to provide objectivity, structure, and tools to drive meaningful progress. PYA’s Performance Transformation team has decades of experience leading and serving healthcare organizations across the country. Grounded in that experience, we are passionate about developing partnerships that help our clients accelerate their transformation journey, navigate change effectively, and avoid common pitfalls.
Our team emphasizes a cultural commitment to continuous improvement that boldly reimagines healthcare organizations for long-term improvement and growth. We believe in an approach rooted in experience and expertise across financial, strategic, and operational disciplines, which align to advance patient outcomes and financial sustainability.
PYA brings a collaborative team of experts with industry experience and a proven track record of breaking down silos to evaluate, assess, and identify optimization opportunities across the continuum of care. We then partner with you to take a patient-centered approach to identifying and implementing transformational strategies.