We have seen some of our large healthcare clients face a common challenge in executing their enterprise-level transformation efforts: How to maintain enterprise-wide alignment while empowering local teams to execute with speed and ownership?
Leaning too far towards centralized control can slow decision-making and dampen innovation. Leaning too far toward local autonomy can lead to inconsistency, fragmented processes, and diluted results. In our experience, successful transformation leaders strike a deliberate balance—one where strategy and governance are centralized, but execution is decentralized and owned by the teams closest to the work.
Centralized Considerations – creating consistency and a single version of the “truth”
Activities that should remain at the enterprise level to ensure alignment and clarity:
- Strategic goals, OKRs, and performance metrics
- Enterprise value targets
- Reporting standards and financial tracking
- Governance, risk management, and decision escalation
- Enterprise-wide data definitions and regulatory guardrails
Decentralized Considerations – creating momentum and “fueling” ownership
Execution belongs with local leaders who understand workflows, constraints, and adoption dynamics:
- Day-to-day process redesign
- Local communication and change adoption
- Root cause identification and issue escalation
- Quick-cycle testing and iterative improvement.
Our “Guardrails + Playbooks” Approach – creating alignment without stifling flexibility
A practical operating method for large, complex organizations:
- Guardrails: Non-negotiables (KPIs, compliance, financial standards)
- Playbooks: Templates, best practices, and workflows that local teams can adapt
The Role of a Transformation Operating System
A well-designed transformation structure keeps both sides in balance. Typical components include:
- A central Transformation Office (TMO) for governance and reporting
- Local transformation leads embedded in markets, practices, or business units
- Cross-functional workstreams (clinical, digital, operations, revenue cycle)
- A regular cadence of accountability
The goal: organization-wide clarity, faster decisions, and consistent execution.
The Leadership Imperative
Balancing control and autonomy ultimately comes down to leadership behaviors:
- Communicate direction clearly
- Empower teams to own execution
- Remove barriers quickly
- Build trust through transparency
- Celebrate progress early and often
We have observed that the best transformation programs are not “top-down” or “bottom-up”—they are aligned, connected, and co-led across every level of the organization.
To learn more about how we help our payer, provider, and health system clients assess the variability in corporate vs. local requirements and execution capabilities in their transformation initiatives, visit us at www.sunstonemanagementadvisors.com.
