Systemness self-assessment

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

Operations

1. We have focused on creating economies of scale through centralized business functions like procurement/supply chain, revenue cycle, HR, marketing, managed care contracting, finance and accounting, etc.

1 2 3 4

2. All facilities track the same core metrics and use agreed-upon measurement definitions, and there is a single source of truth for KPIs.

1 2 3 4

3. There is a single, consolidated EHR used across all inpatient locations, or strong data interoperability.

1 2 3 4

4. Our employees across the system are aligned to a single, system-level culture and set of core values, and our workforce strategies focus on cultivating engagement in support of system-level priorities.

1 2 3 4

Clinical/care delivery

5. Clinical protocols and care pathways are standardized across all facilities.

1 2 3 4

6. Our system actively monitors and addresses variation in care delivery across sites.

1 2 3 4

7. We have optimized referral management across the system to improve access to appointments and load-balance across all available locations.

1 2 3 4

8. A patient who receives care at multiple facilities in our system experiences a consistent standard of care regardless of location.

1 2 3 4

Leadership, governance, and strategy:

9. Service lines are rationalized across the system.

1 2 3 4

10. Capital allocation decisions are made at the system level.

1 2 3 4

11. The leadership team’s incentives are aligned to promote overall system-level performance vs. individual location-level performance.

1 2 3 4

12. Clinician leaders are prominently embedded in system-level decision-making structures.

1 2 3 4

13. There is a clearly articulated division of authority between system, regional, and local structures, and everyone is clear on what decisions can be and are made at each level.

1 2 3 4

Scoring your results

Add up your ratings across all 13 statements.

13-25 — 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.

26-38 — 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.

39+ — 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?

Systemness self-assessment