Three levels of operating responsibility.
Aava structures every engagement around one of three levels of operating responsibility — Optimize, Transform, and Operate. The levels describe scope and accountability, not a required sequence: clients may enter at any level, and a mandate can deepen as the organization’s needs and Aava’s role evolve.
Optimize
Defined Initiatives
A focused mandate to assess, design, implement, or correct a specific operational priority.
- A specific function is underperforming and ownership wants it diagnosed and corrected
- A survey, audit, payer action, or licensure deadline requires focused expert execution
- A new program, market, system, or capability must be designed and implemented
- Ownership wants an independent operating assessment before a larger decision
- Revenue-cycle assessment and denial-recovery program
- Survey preparation or corrective-action remediation
- Operational and financial assessment of an acquisition target
- Design and launch of a new clinical program
- KPI, dashboard, and reporting build
Authority is scoped to the initiative: Aava leads the mandate, directs the workstream, and makes the operating recommendations, while implementation decisions that extend beyond the initiative remain with ownership and management. Where the mandate includes implementation, the required execution authority is defined in the engagement charter.
Typically measured in weeks to several months, defined by the mandate's end state rather than the calendar.
- The initiative's plan, execution, and delivery to the agreed end state
- Honest findings — including the ones that are unwelcome
- Implementation of agreed changes where the charter includes it
- Transfer of documentation, tools, and knowledge at close
- A sponsoring executive with the authority to decide
- Access to the people, data, and systems within scope
- Timely decisions at the charter's defined decision points
- Ownership of policies and choices that exceed the mandate
A defined reporting rhythm for the initiative — typically weekly progress against plan, findings as they emerge, and a closing deliverable with results, remaining risks, and recommended next steps.
Transform
Department Management
Direct operational responsibility for a department or core operating function, with defined authority, reporting, and performance accountability.
- A core function chronically underperforms and specialized management is unavailable internally
- Recruiting permanent functional leadership has failed, stalled, or would take too long
- Ownership wants a function professionalized before scaling it — or before a transaction
- A first initiative with Aava has proven value and ownership wants continuing operating depth
- Revenue cycle operated end to end under performance accountability
- Compliance and quality run as a continuous-readiness function
- HR and recruiting managed through a chronic-vacancy period
- Business development and referral operations under pipeline accountability
Aava carries defined operating authority inside the function's charter: staffing and workflow decisions, day-to-day management, spending within agreed thresholds, and vendor and process changes within scope. Decisions that cross the charter's perimeter escalate to ownership through an agreed path.
Ongoing engagements, typically structured in annual terms with defined review points; many begin with a stabilization phase and continue on demonstrated performance.
- The function's daily operation, staffing, and quality standards
- Embedded leadership and supervision within the department
- The function's KPIs, improvement agenda, and delivered results
- Transparent reporting and immediate escalation of material issues
- The charter: scope, authority thresholds, and escalation rules
- Enterprise decisions the function depends on but does not control
- Cooperation of adjacent departments at the defined interfaces
- Engagement in the scheduled performance reviews
A fixed monthly reporting package for the function — KPIs against chartered targets, variances with causes and actions, service-level performance, and the improvement agenda's status — plus scheduled operating reviews with ownership.
Operate
Enterprise Management
End-to-end management of the organization under centralized executive accountability.
- Owners are stepping back from daily management without a successor in place
- Investors hold a healthcare asset without an operating team of their own
- The enterprise requires a sustained, multi-function rebuild under one leadership
- An acquired or de novo organization needs complete operating leadership from day one
- Complete management of a facility for owners exiting daily operations
- Operating leadership of an investor-held platform through its hold period
- Enterprise management through a multi-year turnaround and rebuild
- Management of a newly opened facility from day one through stabilization
Aava exercises enterprise operating authority under a management agreement: executive leadership, operations, finance, people, compliance, technology, and growth, within defined limits and reserved ownership powers. Governance boundaries — what management decides, what the board or ownership decides — are explicit and observed.
Multi-year engagements structured around the mandate: stabilization and rebuild phases, continuing management, and defined transition or renewal points.
- Executive leadership and every operating function of the enterprise
- Financial stewardship: cash, controls, reporting, and plan performance
- Regulatory standing, workforce stability, and clinical reliability
- The complete governance reporting relationship with ownership
- Governance: reserved powers, capital decisions, and policy direction
- Timely decisions on matters the agreement reserves to ownership
- Capital and resources agreed in the operating plan
- Engagement in board-level reviews and the annual planning cycle
Full governance reporting: a complete monthly package of financial statements, enterprise KPIs, compliance status, risk items, and management commentary; structured quarterly reviews; and immediate escalation of anything material. Ownership should never be surprised by its own organization.
Tell us what needs to change.
Whether it is a single department or an entire enterprise, we will tell you plainly what we would operate, how, and what it would take.