Progress Over Process

What happens with your team at the snap count?

Jason Kelce, the legendary Philadelphia Eagles center, once said, “Leadership is taking accountability yourself and holding others to the same standard, regardless of what’s going on.”

This ethos, forged in the high-stakes trenches of professional football, is highly relevant to today’s health systems, where achieving operational goals requires more than talent or effort. It requires collective, cross-functional accountability to shared outcomes.

When Kelce snapped the ball, 10 other men sprang into motion, each with a defined role, each responsible for executing the play in tight formation. Timing, coordination, and trust were non-negotiable. No one on the offensive line operated in isolation. If one lineman missed a cue, the play broke down regardless of how flawlessly the others executed their assignments.

Health systems must adopt the same principle

Far too often, even well-designed improvement efforts aimed at reducing heart failure readmissions, lowering avoidable ED visits, and improving length of stay fail to meaningfully improve performance across the field. These efforts don’t fall short because the play was wrong or the team lacked skill. They fail because teams lack shared accountability. Instead, they are aligned with different reporting lines, separate incentive structures, and multiple, sometimes competing, definitions of success.

This misalignment breeds disjointed execution. Care managers operate toward clinical goals. Finance focuses on cost. Technology emphasizes system stability. Each group may be excellent at “their part,” but without shared ownership of a common metric and commitment to moving the ball together, the team stalls in the red zone. Progress is replaced by process. And no one celebrates a well-run play that fails to deliver the outcome.

It is time for a reset

In football, the offensive line doesn’t get the spotlight—but it determines whether the offense succeeds. The same is true of the operational “trenches” in healthcare. Success comes not from siloed excellence, but from interdependent execution. Everyone from discharge planners to pharmacists to revenue cycle managers must move in unison. They must see the same scorecard, understand the shared goal, and feel a clear sense of accountability not only for their individual roles but also for the collective outcome.

That means redefining how accountability is structured. In too many health systems, accountability still follows traditional hierarchies and departmental silos. But patients don’t experience care that way, and neither should the teams who serve them. A hospital readmission is not solely the responsibility of the inpatient team. Nor can ED utilization be owned just by the emergency department. These are system outcomes, and they demand system teams with system-level accountability.

The case for common metrics

To foster this accountability, health systems must rally their teams around clear, meaningful, and measurable goals that transcend organizational charts. Everyone who touches a shared workflow should understand the same outcome metric and be expected to act in its service.

In the context of heart failure readmissions, for instance, this might mean a cross-disciplinary team jointly owning a 30-day readmission rate goal. Success isn’t measured in whether the discharge summary was sent or whether a post-discharge call was logged. It’s defined by whether the patient was hospitalized. The team owns that outcome, and each member’s role must be understood in service of that result.

Achieving this level of accountability is not a project. It is a leadership mindset. Leaders must do more than convene multi-disciplinary workgroups or align on strategy. They must actively dismantle reporting-line silos that obstruct execution.

They must clarify “who owns the ball” on each critical outcome. And they must reward the quiet, collaborative, and consistent operational plays that move the system toward its goals—even if no one’s name gets called in the end zone celebration.

Jason Kelce understood his blocking assignments and shared accountability with the other offensive linemen to move the ball downfield. Failure to move in unison at the snap count meant a penalty, a tackle for a loss, or a quarterback flat on his back.

Four questions for health system leaders

To assess whether your teams are truly aligned around shared outcomes, leaders should ask:

1. Is there a single, clearly defined metric that this team is collectively accountable for, regardless of functional role or reporting line? If success is defined differently across departments, true collaboration will always be elusive.
2. Do team members understand how their individual contributions influence that shared metric, and are they empowered to act on it? Alignment without empowerment creates passive execution.
3. Is accountability structured around achieving outcomes or completing processes? Executing the play matters far less than moving the ball down the field.
4. Who has ultimate ownership to call the play, review the progress, and coach for improvement? Ambiguity in authority creates a diffusion of responsibility and leads to underperformance.

Health systems will not win the future of care delivery through isolated excellence. The teams that succeed will be those that align deeply, act collectively, and are accountable to each other, not just their vertical reporting line.

Talent and tools matter. But execution, like in football, happens in the trenches—where trust, timing, and shared goals determine the outcome. To make progress that matters, healthcare leaders must build teams where accountability runs across the line, not just up and down it.