Key Insights From Our 2022 Digital Structure and Governance Survey


Every other year, AVIA conducts its Digital Structure and Governance Survey to determine how health systems have organized to succeed in digital. We asked our Members and a number of other health systems about how they are set up to leverage digital. This included their practices and pitfalls in three key areas: digital strategy and oversight, digital resourcing with a focus on team structure and staffing, and digital execution and capability optimization. The survey allows us to better understand how health systems are organizing as things continue to change, so that we can continue to be a key partner.

Fifty health systems participated in the 2022 Digital Structure of Governance Surveyhere are some of the key insights and learnings.

Digital strategy and oversight

When we last conducted this survey in 2020, digitally enabling the consumer experience was the most common focus area for health systems and their teams. That hasn’t changed in the last two years, though now organizations have added virtual care as a primary focus and automation is emerging as a new focus area.

Similar to 2020, the majority of health systems reported that they had combined their digital and innovation teams. Most systems also reported that a distinction in leadership roles was still present between digital and innovation.

However, there was greater variability in the remainder of the responses in this section of our survey. Over 20 different executive and nonexecutive roles have accountability for digital across respondents; of respondents:

  • 37% position digital under a single executive team member
  • 32% spread ownership and responsibility across multiple executives
  • 31% take other approaches, such as ownership by a committee or nonexecutives

Interestingly, 40% of respondents do not budget specifically for digital teams. Our understanding is that these systems embed their digital resources in other teams, such as innovation and IT, so there is not a dedicated digital cost center.

Finally, fewer than 40% of systems have aligned their executive incentives to their system’s digital performance.

Digital resourcing: Structure and staffing

In 2020, digital team budgets were fairly modest, with a median of $2 million. Team sizes were also small, with a median of five full-time employees. The most commonly cited digital resources were program managers and project managers.

The number of dedicated resources is growing:

  • The number of systems with resources that are fully dedicated to digital rose from 46% in 2020 to 85% in 2022
  • More than 50% of respondents saw sizable resource and team growth over the last two years
  • 60% expect to grow their digital teams significantly over the next 12 to 18 months
  • 20% of respondents said they have teams of up to 15 full-time employees, while 30% reported teams of over 25 full-time employees

Digital execution and capability optimization

Digital resource and team responsibilities in 2020 included developing a digital strategy, sourcing and implementing third-party digital solutions, and managing vendor relationships. In 2022, these responsibilities remained consistent with 90% of responses; the remaining 10% included innovation functions and external diversification and commercialization functions.

Challenges to digital success

Health systems also appear to be aligned on the barriers that are most challenging to their success in the digital arena. The top challenges cited were culture, change management, and organizational readiness. This area offers the biggest opportunity for health systems to succeed with digital.

When asked to rate their effectiveness in a range of digital capabilities, respondents said they were ineffective or least effective in integrating data, measuring their progress and performance, and building workflows and processes to best leverage deployed solutions. In response to this need, AVIA developed the first of its kind digital health benchmarking initiative to help systems with measurement and comparing progress.

They rated their ability to work collaboratively across key groups, select digital solutions, and integrate solutions into core systems as highly effective.

In our view, this signifies that health systems have made remarkable progress toward developing their digital capacity. They’ve invested in creating strategies, adopting technology and engaging team members.

The next challenge is to develop the transformation capacity that will enable health systems to adopt and scale digital. In other words, hospitals have become good at “doing” digital; now they must tackle “being” digital.

The recipe for success in digital governance

While there’s no single “right” approach or model for digital governance, there are four clear steps that health systems should consider to succeed in digital transformation:

  • First, they must define and communicate what success looks like
  • Second, they must enable effective collaboration
  • Third, they must clearly describe digital ownership and accountability
  • And fourth, they must plan around known barriers

As your organization considers how to build your digital capabilities, you need a partner who can guide you around obstacles and set realistic milestones. If you’re ready to accelerate digital initiatives and start the transition from “doing” digital to “being” digital, get in touch.