Malloy & Co. Operating Partnerships — Fractional COO Services

The Health System
Operational Quality Assessment

25 indicators  ·  15 minutes  ·  An honest look at whether your operational infrastructure can sustain the performance your strategy demands

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0 / 25 answered

The gap between strategy and performance is almost always an operational infrastructure problem.

Most health systems have a clear strategy. Few have the operational infrastructure to reliably deliver on it. This assessment reveals where the gaps are — before they show up in margin reports, board conversations, or physician attrition.

Built from 30 years inside health systems, across four hurricanes, a pandemic, and dozens of service line transformations, these 25 indicators reflect what actually separates organizations that execute from those that don't.

Rating Scale
1 — StrongOperating well; a genuine organizational strength
2 — At RiskPresent but inconsistent; vulnerable under pressure
3 — Critical GapAbsent or broken; actively costing performance now

Section 1 — Accountability & Governance

Structure
High-performing health systems have unambiguous ownership of every critical metric. Operational drag almost always traces back to unclear accountability.
Every major initiative has a single named owner with defined milestones — not shared accountability distributed across a committee.CRITICAL
Accountability
Decision rights are clearly understood — people know what they can decide independently versus what requires escalation to leadership.
Decision Rights
Leadership meetings produce documented decisions and assigned follow-through — not just status updates that reset the next week.
Meeting Discipline
There is a functioning operating cadence — weekly and monthly rhythms that keep initiatives from losing momentum between leadership reviews.
Operating Cadence
Underperformance is addressed directly and quickly — there is no organizational tolerance for persistent unresolved performance gaps.
Performance Culture

Section 2 — Operational Efficiency

Performance
Operational efficiency determines whether your margins can support your strategy. The numbers in the dashboard rarely capture the full picture of where drag is concentrated.
Service line leaders have clear visibility into their contribution margin and understand the specific levers that drive it.CRITICAL
Margin Visibility
Throughput metrics — OR utilization, LOS, bed management — are tracked in real time and owned by identifiable leaders with authority to act.
Throughput
Staffing models are reviewed regularly against actual patient volumes — not carried forward from prior years with minimal adjustment.
Staffing Efficiency
Supply chain and purchased services spend is actively managed with defined targets, named accountability, and regular variance review.
Supply Chain
Your organization has reduced costs in the last 12 months without proportional reductions in quality, safety, or service line volume.
Cost Management

Section 3 — Physician Alignment & Engagement

Partnership
Physician alignment is not a nice-to-have. It is the mechanism through which volume, quality, and cultural performance are ultimately delivered.
Physicians in key service lines — surgical, CV, procedural — view leadership as operational partners, not obstacles to be worked around.CRITICAL
Physician Trust
Physician compensation models are aligned with current organizational performance priorities — not legacy structures that reward activity regardless of outcomes.
Compensation Alignment
There is a functioning joint operating committee or equivalent structure where physicians and administrative leaders resolve conflict and make decisions together.
Shared Governance
Physician engagement scores have improved or held steady in the last 12 months, and leadership understands the primary drivers of dissatisfaction.
Engagement Trend
Leadership can name the physicians whose alignment is critical to the next 12 months of performance — and has an active plan to maintain it.
Strategic Relationships

Section 4 — Quality & Safety Infrastructure

Clinical
Quality and safety infrastructure is only as strong as the organizational will to act on what it surfaces — and the systems that make that action possible.
Quality and safety data is reviewed at the executive leadership level — not just quality committees — and drives resource and priority decisions.CRITICAL
Executive Quality Ownership
Near-miss and adverse event reporting rates suggest a psychologically safe culture — not systematic underreporting driven by fear of consequences.
Safety Culture
Core quality measures — readmissions, HAIs, HCAHPS — are benchmarked against peer organizations, not just tracked against internal prior-year trends.
Benchmarking
Peer review and credentialing processes are functioning, timely, and not primarily defensive — they are genuinely improving practice.
Peer Review
Clinical and operational leadership are aligned on which quality gaps pose the greatest organizational risk — and there is a shared, resourced plan to close them.
Clinical-Ops Alignment

Section 5 — Strategic Execution

Momentum
Strategy execution is where most health systems lose margin, credibility, and talent. The gap between planning and delivery is where the COO earns their seat.
Your organization's top three strategic priorities are known — and measurably advancing — at every level of leadership, not just in board presentations.CRITICAL
Strategic Alignment
Capital projects are consistently delivered on time and within budget — or variances are surfaced early and managed proactively, not discovered at completion.
Capital Execution
Service line growth initiatives have produced measurable volume or margin improvement in the last 18 months — not just launch activity and planning documents.
Service Line Growth
The leadership team is energized by the organization's direction — not quietly managing burnout, disillusionment, or fatigue from repeated stalled initiatives.
Leadership Energy
If the CEO or COO stepped back for 30 days, the operational infrastructure would sustain performance — without degradation or leadership paralysis.CRITICAL
Organizational Resilience
Your Operational Quality Score
out of 75

Score Range

25 (Resilient)50 (At Risk)75 (Intervention Needed)

Section Breakdown

"She stabilized performance during a critical period. We achieved in months what we couldn't in years."
— Health System CEO

Operational Gaps Don't Close Themselves.

The health systems that close the gap between strategy and performance share one thing: they stopped trying to do it alone. Kelly Malloy embeds with health system executive teams as a Fractional COO — not to advise from a distance, but to install the operational infrastructure that makes performance measurable and sustainable.

Book a 20-Minute Discovery Call Download the PROPEL Framework
(941) 368-3945  ·  kelly.malloy@malloyoperatingpartnerships.com