HealthDNA™ technical whitepaper
HealthDNA™ Executive Team Alignment
Does the executive team actually agree, or only believe it does?
- Reporting level
- Aggregate only, minimum 5 respondents
- Audience
- The C-suite and the senior director group of a hospital, health system or service line
- Structure
- 8 dimensions × 5 items = 40 items
- Overall index
- Executive Alignment Index
- Response scale
- 5-point Likert; the fifth item in every dimension is reverse-scored
- Score range
- Dimension 5-25 · total 40-200
1. Construct and design
HealthDNA™ Executive Team Alignment is built on the shared HealthDNA™ framework: 8 dimensions, five items each, with one reverse-scored anchor per dimension to reduce straight-line responding. Every item is written in behavioral, observable language for clinical and laboratory settings, so respondents rate conditions and behaviors rather than abstractions.
Audience: hospital and health system executive teams. Voice: candid, board-room adult, never scolding. Report at team level only. The most important output is dispersion: where executives answered the same question very differently. Use enterprise language: strategic priorities, decision rights, capital trade-offs, cascade and message discipline, speed from discussion to decision, follow-through on commitments, conflict handled at the top rather than pushed down.
2. Dimensions
Shared Strategic Priorities
PRIOWhether executives, asked separately, name the same organizational priorities.
When strong
Every executive names the same top three priorities in the same order.
When low
Have each executive write the top three alone and work the differences in the room.
Operational risk
Different priorities at the top become competing initiatives four levels down.
Coaching move
Publish the top three on one page and open every executive meeting against it.
Decision Rights Clarity
RIGHTSWhether it is clear which seat owns which decision, without negotiation each time.
When strong
Decisions land with a known owner and do not bounce.
When low
Write the decision rights for the five areas that keep coming back to the table.
Operational risk
Unclear ownership turns every decision into a meeting and every meeting into a delay.
Coaching move
For each recurring decision, name the owner, the consulted parties and the deadline.
Cross-Functional Accountability
ACCTWhether executives hold each other to commitments rather than routing it through the CEO.
When strong
Executives raise a peer's miss directly and it is received as normal.
When low
Agree that peer-to-peer challenge is expected, then model it once in the room.
Operational risk
Accountability that only flows through the CEO does not scale and breeds side conversations.
Coaching move
End each meeting by reading the commitments aloud with owners and dates.
Capital & Resource Trade-off Discipline
TRADEWhether the team can choose between competing worthwhile requests on a shared basis.
When strong
Requests are judged on a shared framework, not on who argued hardest.
When low
Agree the criteria for capital and position requests before the next cycle opens.
Operational risk
Trade-offs made by influence rather than criteria damage trust and misallocate capital.
Coaching move
Score the next three capital requests against written criteria in the room.
Speed of Decision
SPEEDHow long it takes this team to move from a raised issue to a decision people can act on.
When strong
Issues get decided in one or two passes and stay decided.
When low
Set a decision deadline for every item raised and record it in the minutes.
Operational risk
Slow decisions cost more than imperfect ones and teach the organization to stop asking.
Coaching move
Track the age of open executive decisions on a visible list.
Conflict Handling at the Top
CONFWhether disagreement is worked in the room or displaced onto the layers below.
When strong
Hard disagreements get named directly and closed at executive level.
When low
Take the disagreement everyone is avoiding and put it on the next agenda by name.
Operational risk
Executive conflict pushed downward becomes departmental warfare nobody can resolve.
Coaching move
Ask, at the end of each meeting, what was not said that should have been.
Message Discipline Downward
CASCWhether the organization hears the same message from every executive.
When strong
Directors can repeat the priorities back in the same words.
When low
Write the cascade in one paragraph and have every executive use it unchanged.
Operational risk
Different words from different executives read as disagreement, whatever was intended.
Coaching move
Test the cascade by asking three directors to state the priorities cold.
Follow-Through on Commitments
FOLLOWWhether executive commitments are closed on time and misses are reported honestly.
When strong
Commitments are tracked and misses are surfaced by the owner, not discovered.
When low
Keep one commitment list with dates and read it at every meeting.
Operational risk
An executive team that does not close its own commitments cannot ask anyone else to.
Coaching move
Report your own overdue commitment first, in the room, before anyone raises it.
3. Scoring and banding
Each item scores 1-5, with reverse-scored items inverted before summing. A dimension raw score runs 5-25 and is banded as At Risk (5-10), Developing (11-15), Solid (16-20) or Strong (21-25). The total across all 8 dimensions runs 40-200 and is converted to a percentage of scale to place the respondent or group into an overall Executive Alignment Index tier.
| Tier | Threshold | Interpretation |
|---|---|---|
| Aligned | 78% of scale and above | This team agrees on the priorities and on who decides what. |
| Broadly Aligned | 60% of scale and above | Agreement on direction, with real disagreement on trade-offs and speed. |
| Divided | 40% of scale and above | Executives are working from different versions of the plan. |
| Fragmented | 0% of scale and above | The organization is receiving conflicting direction from the top. |
4. Reporting and the 90-day plan
Every report pairs the Executive Alignment Index with a dimension breakdown, the three highest and three lowest dimensions and a phased action plan. The plan is deliberately short so a leader can act inside one quarter.
Days 1-30
Name the disagreement out loud
- Have each executive write the top three organizational priorities alone, then compare the lists in the room.
- Take the dimension with the widest spread and spend one full meeting on it.
- Write down which decisions belong to which seat.
Days 31-60
Decide and record
- Close the two largest open disagreements with a written decision and a named owner.
- Agree the cascade: one message, one set of words, every leadership forum.
- Set a standing rule for how a decision gets reopened, and how it does not.
Days 61-90
Prove it downstream
- Ask directors to state the top three priorities and compare their answers with yours.
- Review every executive commitment made this quarter and report the misses.
- Re-run this instrument and compare the spread, not the average.
5. Privacy model
- No protected health information is collected at any point.
- Results are reported at group level only. A report unlocks only once at least 5 people in that group have responded and individual responses are never shown back to the employer.
- Demographic capture is optional and deliberately coarse, so no combination of fields re-identifies a respondent.
- Free-text comments are never attributed to a named respondent.
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