"In some cases, we've pulled back in some of our programmatic efforts around building the continuum. We've had a couple of partnerships where their capacity looked to be positive, but once we started operation, the expectations were not being met, so we've had to discontinue lines of service that we've started."
Pressed for examples of areas that still need a lot of work, Hawthorne concedes that some of its efforts around integrating best clinical practices with independent physicians continue to be challenging.
"We haven't given up but in this area, it's a bit of the Wild West mentality," he says. "Aligning with physicians when there's no real major economic hurt going on with them … it's so difficult to persuade them to look at a future state of healthcare that's dramatically different. Yet we'll continue to try to align with independents through clinical integration."
He cautions fellow health system leaders to lead with an element of patience in terms of recasting the business model for the future, but he stresses the value of deliberate and ongoing strategic planning.
"You have to have a vision for the future. It may not be clear, but always look forward to opportunities," he says. "It's better to model the change than to have someone tell you how to change. Have courage to create opportunities."