Methodology

Every engagement runs on a charter.

Before AHA does anything inside a practice, both sides agree — in writing — on three things: what authority we hold, what is in scope, and what conditions end the engagement. Turnaround work fails on ambiguity. The charter removes it.

The Engagement Charter

Authority, scope, and exit — settled before day one.

Authority

Which operational decisions AHA makes, which the owners keep, and which require both. Temporary authority is what makes an operator effective — and written boundaries are what make temporary authority safe. Clinical decisions always remain with physicians.

Scope

What the engagement covers, and — just as deliberately — what it does not. Bounded scope is how urgency stays productive instead of spreading into an engagement without edges.

Exit conditions

What must be true for the engagement to end: which systems are installed, which roles are filled and performing, which numbers are stable. Exit is defined at the start, when everyone is clear-eyed — not negotiated at the end.

Why it keeps us honest

If we hold authority and the practice doesn’t stabilize, there is no one else to point at. The charter makes our accountability enforceable rather than rhetorical. That is the arrangement working as intended.

Phase Structure

Diagnose. Stabilize. Install. Exit.

Engagements move through four phases. The pace varies with the practice’s condition; the sequence doesn’t.

Diagnose

Facts before plans.

A structured assessment of the practice’s cash position, operations, and governance — built from the practice’s own data and the people who run it. Reported results and operating reality are not always the same thing: a reported loss can be an operating problem, an accounting issue, a timing distortion, or all three — and the plan depends on which. So the assessment reconciles what the reports say against what the bank, the schedule, and the billing system actually did. The output is a shared, written understanding of what is actually wrong, the order it must be addressed in, and what stability will look like for this practice.

Phase ends when: Owners and AHA agree on the diagnosis, and the charter reflects it.

Stabilize

Stop the deterioration.

Cash brought under visibility and control. Critical operational failures triaged. Stalled decisions made. Stabilization favors reversible speed over elegant design — the practice needs a floor before it needs an architecture.

Phase ends when: The practice is no longer losing ground — and the numbers say so, not just the mood.

Install

Make it durable.

The management rhythm, reporting, role structure, and governance practices the practice will run itself: a cash instrument the owners read weekly, revenue-cycle reporting that reconciles the billing system against the bank, schedules built on actual procedure times, and management routines with named owners. People are trained into the systems, not just handed them. This phase converts the recovery from an event into a capability.

Phase ends when: The practice runs its own operating rhythm with AHA observing, not driving.

Exit

Leave deliberately.

Authority transfers back on schedule and our involvement tapers by plan. The engagement ends as chartered — with the option of Ongoing Maintenance if the practice wants a periodic outside check on its own numbers.

Phase ends when: The exit conditions written into the charter are met. That is what “done” means.

A Note on Specifics

The charter’s details are set per engagement.

Each charter’s specific terms — decision rights, thresholds, timelines, and commercial arrangements — are set with each practice, in private, where they belong. We publish the structure rather than the template because the discipline is the point: no AHA engagement begins without one.

All four service lines run under this structure. A maintenance relationship gets a lighter charter than a turnaround — but it gets one.

See the four service lines

Start with a diagnosis, not a commitment.

A first conversation obligates nothing. If a structured assessment makes sense, we’ll say so. If it doesn’t, we’ll say that too.

Start a conversation

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