St. Nicholas Health System is an integrated health delivery organization comprising St. Nicholas Medical Center, Suburban Western Health Center, Suburban East Health Center, St. Nicholas Employed Physician Practice, St. Nicholas HMO, and St. Nicholas Home Care and Durable Medical Equipment Corporation. The health system operates in a highly competitive city of 2.5 million residents. 

Headed by CEO Serena Parris, the leadership group has 25 members, including the executive vice president and chief operations officer (EVP/COO), several system senior vice presidents, assorted system vice presidents, and the site administrators from each business unit. The senior team meets weekly to discuss tactical and strategic operations as well as ongoing projects (if time allows, which is rare). 

The site administrators do not feel they are part of the executive team, given that they report to the COO and not to the CEO, and that most of the discussions relate to the system rather than the individual business units. In fact, at St. Nicholas, much of the work is accomplished through interactions between the vice presidents or executive directors and administrators or middle managers. Because Serena is a hands-off leader, she has given her EVP/COO freedom to make ongoing operations decisions. The EVP/COO gives the site administrators much autonomy to run their own facilities. 

Serena depends heavily on only three executives on the team—the EVP/COO, the senior vice president of medical affairs, and the chief financial officer. The rest of the 25-member team is aware that Serena has frequent daily communications with these three executives. 

Questions 

1. What are the strengths of this team? Its weaknesses? 

2. Do the site administrators belong to this group? Explain your answer. 

3. What message does Serena send to her team by relying so much on three team members over everyone else? 

4. If you were a consultant, what advice would you offer Serena to strengthen the team?