Edison Breakwater Strategies logoEdison BreakwaterStrategies
Practicing Independence

Chapter 1

Foundations of Independent Practice

Alignment — define your Independence Aim and inspect your foundation

90 minutes with your leadership team

Independence doesn't usually die in one dramatic moment. Instead, it erodes through a series of small, quiet compromises — signing contracts you didn't fully understand, letting toxic team dynamics slide because you're exhausted, or running yourself into the ground until your judgment fails.
— From the Operator's Chair

This chapter is your inspection. It is where you slow down and ask the hard questions about your operation, your culture, and your own resilience. Get your team involved. Take an honest, unflinching look at where you actually are. If your foundation is solid, you can build everything else on it. If it's weak, everything you try will eventually collapse.

Four core disciplines

  • Respect for People — their voices actually count in decisions, not just get heard
  • Continuous Improvement — confronting small problems before they metastasize
  • Value Stream Focus — mapping every step against the value it provides
  • Seeing Waste — duplicate data entry, unanswered calls, and lab backlogs are signals of system failure

How to run this session

Block 90 minutes. Read the Operator's Chair guidance aloud (5 min), answer KNOW IT individually and silently (15 min), discuss OWN IT as a group (40 min), assign DO IT actions with an owner and a date (20 min), then close with one takeaway and one commitment from each person (10 min).

Worksheets

A preview of the first worksheet is below. Members get every worksheet, plus saved answers and the 90-day action plan.

Worksheet 1.1

Define independence for your practice

Lesson:
Your Independence Aim
Purpose:
Create a clear, shared statement that defines why your practice chooses to remain independent.
Participants:
Leadership team, physician partners, practice manager, and anyone who influences strategic decisions.

Why this matters

Three years ago, a partner walked into my office, his frustration palpable. "We're independent, but I can't remember the last time that actually mattered." We lacked a shared, coherent definition of what independence truly meant. Our physicians would have said "clinical autonomy." Our practice manager would have emphasized "financial control." The front desk staff might have offered a shrug. All valid — but not aligned. Without alignment, when pressures mount, you are adrift. Every independent practice needs an Independence Aim: a one-sentence compass so specific an outsider could understand what makes you distinct. Consider the Midwest ASC group fracturing under hospital pressure. After two hours of honest conversation, they arrived at: "We exist to preserve community access to affordable, physician-led Plastic and Hand care in our ASC." That one sentence preserved $4 million in annual revenue, hundreds of jobs, and their ability to remain true to themselves.

Section 1

Know it

Answer individually before the group discussion — be honest, there are no wrong answers.

1.Why did you choose to work in an independent practice instead of a hospital-employed or corporate-owned setting?
2.What would you lose if your practice sold to a hospital system or private equity group tomorrow?
3.What's one decision you've made in the past year that you could NOT have made if you were employed by a larger organization?
4.On a scale of 1–5, how clearly can you articulate why your practice stays independent?
5.If a staff member asked, "Why don't we just sell to the hospital down the street?" what would you say?

Section 2

Own it

Discuss as a group — surface different perspectives and build a shared Independence Aim.

1.Discussion prompt 1: What themes showed up in everyone's answers? What did people say they'd lose if the practice sold? Where do we agree? Where do we disagree?
2.Discussion prompt 2: What would we lose that we can't get back? (Clinical autonomy? Speed of decision-making? Relationships with patients? Staff culture?)
3.Discussion prompt 3: Our Independence Aim, in one sentence. (This isn't a mission statement — it's the reason you're willing to do the hard work of ownership instead of selling.)

Role clarity — who will be responsible for:

Posting the Independence Aim where staff and partners can see it
Referencing it in leadership meetings when making strategic decisions
Revisiting it annually to make sure it still reflects reality

Section 3

Do it

This week and beyond — turn this into action.

Action 1: Post the Independence Aim where it's visible

  • Print it on a poster or document
  • Post it in the leadership meeting room
  • Post it in the break room or staff area
  • Post it anywhere strategic decisions are discussed

Action 2: Reference the Independence Aim in leadership decisions

  • At each leadership meeting, ask: 'Does this decision align with our Independence Aim?'
  • Document the decision and how it connects to the Aim
  • If a decision contradicts the Aim, discuss why and decide whether to proceed

Action 3: Review the Independence Aim annually

  • Schedule an annual review meeting with all partners
  • Ask: 'Does this still reflect why we chose independence?'
  • Update the Aim if circumstances have changed
  • Share the updated version with staff
Chapter 2