Case Study – Urban Hospital

New Hospital Conquers 3 Major Transformations in 3 Years

The Challenge

A new hospital with the latest equipment and top staff was an exciting contribution to the community. Nevertheless, in the first couple years, problems began to surface.

  • Throughput was low and costs were high
  • Patient satisfaction and morale were dropping
  • Engagement program for 900, only yielded 12 ideas
  • Had just lost a major source of patients and revenue
  • From top to bottom – leaders were stuck in thinking they were fine and others were the problem

By Month 3

  • Established a new leadership culture and level of performance that enabled the organization to rapidly respond to continually changing internal and external demands year after year

By Year 1 –Managers Transformed from Siloed Victims to Cross-Functional Business Leaders

  • 30-day readmission went from 4/5 to 1/5 (leading practice for the system)
  • Quality scores and patient safety improved (now top 10% nationwide)
  • Successfully implemented an electronic system for transitioning patients
  • Patient experience and physician engagement scores soared

In Year 2 – Responded to a 45% Growth in Patient Demand in Just 90 Days

  • Captured a new health plan, increasing demand and boosting revenue by 45%
  • Patient experience scores improved by 20% year over year
  • Achieved 21% income margin and year over year numbers improved
  • Now hospital represents 40% of the net income for the system of 14 hospitals

In Year 3 – Rallied to Address New Financial and System Demands in Only 3 Months

  • Leveraging their updated Strategic B STATE Roadmap and culture, they rallied and engaged people at all levels to address the financial and system demands
  • Changed from a distributed to a centralized approach to care
  • Lowered expense ratio from 33% to 25%, addressing a need to reduce costs
  • Exceeded profit goal by $1M after projecting a loss just a few months earlier

By the end of the first working session

  • The Senior Leadership Team was energized, unified, speaking with one voice, and working off of the same picture and priorities

Within 18 weeks

  • Middle Managers were now working together to surface issues and resolve problems, rather than pushing them to the SLT or pointing fingers at each other
  • Employee engagement was transformed – people felt recognized and connected and understood the hospital direction and initiatives


Prior to considering a B STATE Approach, traditional town halls, team-building, leadership training, action campaigns, and engagement efforts were not getting any traction. It was clear to the CEO that they needed breakthroughs in both results and behaviors – and they needed them quickly.

Key to Success

Instead of focusing on and prioritizing all the issues, the Senior Leadership Team (SLT) used the Breakthrough Leadership Team System to develop a future picture of success and a B STATE Strategy Execution Roadmap to drive them to their future picture. This instantly unified the SLT, creating immediate traction as an organization.

B STATE Strategic Execution Roadmap

1) Leveraged External Drivers to Unify the Senior Leadership Team (SLT)

Establishing their own B STATE Strategy Execution Roadmap, the SLT created a shared Picture of Future success and a new set of leadership “habits” to drive change. By identifying their external business drivers, the SLT instantly unified around a new Mindset, new Collective Habits of Execution, and Shared Priorities.

2) Facilitated a Department Manager Role Change as a Senior Team

The SLT then identified and communicated 7 critical shifts in the role of department (middle) managers. Using the Breakthrough Leadership Team System, they provided forums, support, and time for the department managers to “pick up the reigns” in leading priority initiatives and resolving day-to-day issues as a team, taking shared ownership and accountability for success.

3) Implemented a B STATE Communication and Proactive Recovery System

Standing meetings were completely reworked. A management forum was created for the department managers to share ownership and accountability for implementing top priorities. At the same time, leaders held daily “huddles” to surface and address any operational or patient throughput issues utilizing a B STATE Proactive Recovery System to respond and adjust quickly as a team.

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