Aligning Health System Organization with Shifting Market Demands


Tidelands Health [Tidelands] is an integrated community health system located in coastal South Carolina, serving the region that spans from Charleston County to Myrtle Beach.  Comprised of two mid-sized hospital campuses, 298 inpatient beds, and 50+ ambulatory sites, Tidelands and its regional physician network – Tidelands Health Group [THG] – see an average of over 500,000 patient encounters, annually.

In recent years, the U.S. Census Bureau recognized Tidelands’ primary service area as one of the fastest-growing metropolitan areas in America.  To accommodate the needs of this booming market, THG invested heavily in expanding its provider base – evolving rapidly from a small group of independent physician practices to a 215 provider, 30+ sub-specialty ambulatory network.

This accelerated growth in Tidelands ambulatory business and prompted a shift in the system’s strategic focus.  With nearly 80% of all patient encounters now arising from its physician network, ambulatory experience and patient choice became central to the organization’s market capture strategy and top imperatives for system leadership.


The Challenge

Although Tidelands had adopted a new Ambulatory focus, internally, the organization retained its legacy, hospital-centric structure.  While this structure had historically allowed for meaningful leadership accountability across Tidelands’ inpatient business, it impeded transparency and hindered leadership’s ability to drive desired outcomes from the burgeoning ambulatory enterprise.

In this legacy structure, ambulatory care was housed wholly within the purview of a single VP, with all physicians reporting to him and their individual practices all having a direct reporting line to single Director. Despite being aligned with a larger health system – where system utilities [e.g. finance, IT, supply chain] were centralized and managed horizontally across the inpatient environment – day-to-day clinic operations and outpatient business functions remained decentralized and were managed vertically within the individual practices.

As the ambulatory enterprise grew, this structure became too flat to effectively manage.  The Tidelands leaders who were accountable for system utilities [e.g. Chief Financial Officer, Chief Operating Officer, etc.] had no mechanism or ability to meaningfully impact performance in the outpatient network. As a result, the health system began to experience misaligned processes and products, duplicative roles and work efforts, and missed opportunities to realize material economies of scale.


The Approach

Tidelands engaged Knowledge Capital Group [KCG] to facilitate the development of a new organizational model to mitigate these challenges.  The goals of this new model were to better align and unify the hospitals with the THG physician network, realize efficiencies across the ambulatory enterprise, and establish a scalable foundation for future organizational growth and expansion.

After conducting a thorough assessment of legacy processes, systems, leadership structures, and health system needs, KCG collaborated with Tidelands leaders to develop a solution that addressed two key focus areas:

1. Clinical Delivery Framework

KCG worked with Tidelands leadership to develop a clinical delivery framework that organized both inpatient and ambulatory network providers into clinical Service Lines – referred to as Specialty Business Units [SBU].  These SBUs were defined around care pathways, rather than practice of origin, with each having a named Medical Director who would be responsible for clinical delivery.

Furthermore, each Medical Director now reports to a single, accountable physician leader, [Chief Physician Executive (CPE)] whose purview spanned both the inpatient and ambulatory settings.  With aspects of clinical quality and patient safety aligned under a single physician leader, the CPE was empowered to align incentives, drive clinical metrics, implement evidence-based protocols, and stimulate the sharing of best practices and clinical innovations across the health system.

2. Aligned & Integrated Operations

To support the new Clinical Delivery Framework, and to create a scalable platform for operational efficiencies and consistent service delivery, ambulatory operations were extracted from the individual physician practices and realigned under the purview of the corresponding health system leader [e.g. Chief Financial Officer, Chief Operating Officer, Chief Information Officer, etc.].

To further support this operational integration, each SBU was assigned an Administrative Director [AD] who served as the dyad-partner of the SBU Medical Director.  In this role the AD oversees day-to-day operations of the SBU and is ultimately accountable for patient access, practice operations, financial management, and effective utilization of system utilities.



Benefits of such large-scale organizational change often take time – months and sometimes years – to be quantified and categorized.  And while Tidelands is still in its early stages of its organizational restructuring, Gayle Resetar, COO, offered the following as observable impacts:

  • “The entire process of reimaging how Tidelands and THG could be more aligned created a platform for how other, large-scale change projects are managed.”
  • “The SBU structure and its dyad leadership model has driven transparency and a heightened sense of accountability throughout the enterprise.  It has also provided us with a platform to facilitate provider performance dialog.” 
  • “Aligning hospital-based and ambulatory providers under a singular clinical leader has helped create a more cohesive patient and provider experience across the continuum, regardless of care setting, clinical specialty or geographic location.”
  • “The consolidation of ambulatory and hospital Finance functions has enabled us to get our hands around payer and provider contracts and enabled our CFO to have a greater level of control over both expenses management and revenue cycle performance.”
  • “While still early in the process, integration of ambulatory operations into the greater Tidelands system has increased operational efficiencies, reduced delivery variation and reduced supply chain spend.  Anecdotally, we saved ~$27,000 in the first month.”
  • “Provider engagement improved by 17% for those physicians within two-years of their start date.”