Which structure fits this organization?
Healthcare has evolved from a relatively simple professional service into one of the most complex forms of human collaboration, yet most provider organizations continue to be structured primarily around professional disciplines — Medicine, Surgery, Nursing, Radiology, Laboratory, Pharmacy. This discipline-based architecture protects professional standards, education, and credentialing, but it does not correspond to the way patients actually experience care. Patients do not encounter departments; they travel a journey across them.
This instrument turns that argument into a decision. It works at four levels — a department, a clinical programme, a hospital or a multi-site network — and at each of them twenty-one questions test the unit against the three design forces, the six design dimensions and the Quadruple Aim, then return the combination of structural and coordinating mechanisms that fits its context — with the reasoning, the alternatives and the trade-offs stated in full. It answers one question: which combination of organizational mechanisms best enables this organization to achieve its strategic, clinical, operational and patient-centered objectives?
Cardiac care, arranged five ways. In Model 1 cardiology is a division inside Physicians, and the cardiac work is spread across five departments that each answer for their own profession — which is why no box in that panel owns the patient. Models 2 and 3 gather the same people and equipment, first under a cardiac programme running alongside the departments, then under a single Cardiac Administration with its own budget and outcome set. Model 5 changes the unit of organization altogether: not a department, not even a service, but one condition — heart failure — carried by a dedicated team from prevention to long-term follow-up. Model 4 is the one that changes the denominator rather than extending the same axis. A service line is answerable for the people who present to it; a population unit is answerable for a register, including the people who never attend — which is why its money follows heads rather than cases, and why falling activity with stable outcomes counts as success rather than as a crisis. The models are not mutually exclusive; mature organizations sit at different points for different services.
Identify the unit under assessment
Every field here is optional — you can start scoring straight away. The unit of analysis sets the level the instrument scores at, and the rest appears on the report header. The names you type stay in this browser and are never sent anywhere. When you generate the report, the scores are recorded — without any name, organization or note — so the instrument can be improved.
Answers are judgements about the organization, not measurements. The instrument is most reliable when completed by a small group — an executive lead, a clinical lead and one assessor from outside the service — answering independently and then reconciling differences. Starting an assessment always opens a blank instrument; the worked example is illustrative and never carries into your answers.