How far along is your system on the journey to full/true systemness?
Instructions: For each statement below, rate your organization on a scale of 1-4.
- 1 — Not yet: This is not on our radar or in early discussion only
- 2 — In progress: We’ve started but have significant ground to cover
- 3 — Mostly there: We’re doing this well but there are gaps
- 4 — Fully realized: This is embedded in how we operate
1. Our system has a single, overarching governance structure that guides decisions across all sites and facilities.
1 2 3 4
2. Individual facilities do not make major operational or clinical decisions independently of system leadership.
1 2 3 4
3. When priorities conflict between the system and a facility, there is a clear and trusted process for resolution.
1 2 3 4
4. Clinical protocols and care pathways are standardized across all facilities.
1 2 3 4
5. Our system actively monitors and addresses variation in care delivery across sites.
1 2 3 4
6. All facilities track the same core metrics and use agreed-upon definitions for how they are measured.
1 2 3 4
7. There is transparency across facilities about performance data and outcomes.
1 2 3 4
8. There is a culture of trust and collaboration between system leadership and facility-level leadership.
1 2 3 4
9. Resources — people, budget, and tools — are allocated at the system level based on where they are needed most.
1 2 3 4
10. A patient who receives care at multiple facilities in our system experiences a consistent standard of care regardless of location.
1 2 3 4
Scoring your results
Add up your ratings across all 10 statements.
- 10-19 — Federation: Your system is largely operating as a collection of independent facilities. Most decisions, processes, and priorities are still running at the local level. Recognizing where you are is the first and most important step.
- 20-29 — Progressing: You’ve made real progress. Some attributes of systemness are taking hold, but meaningful gaps remain. The opportunity is in identifying where to focus next and building the connective tissue between what’s working and what isn’t.
- 30-40 — Advancing: Your system is operating with a high degree of integration across most areas. The work now is about sustainability — closing remaining gaps, embedding what’s working, and building the leadership capacity to maintain momentum.
Want to talk through your results and how we could help?
