Case Study 02: Elena's Devil's Advocate — How Role Assignment Saved a Flawed Report

Chapter: 9 — Instructional Prompting and Role Assignment Persona: Elena (Management Consultant) Scenario: Using sequential role assignment — skeptical CFO, operations manager, and board member — to discover three fundamentally different weaknesses in a strategic report before presenting to the actual client

Background

Elena has been working with a regional healthcare network for four months. The project scope: a strategic growth analysis recommending whether the organization should expand into adjacent markets (specifically, home health services and urgent care clinics) over the next three years.

She is delivering the final report in 72 hours. It is 45 pages, contains six months of analysis, and represents a significant fee engagement. Her managing partner has reviewed it and is satisfied. Her internal team considers it thorough and well-documented.

Elena has learned, from 11 years of consulting, that "satisfied managing partner" is not the same as "report that survives contact with the actual client." She wants to find the weaknesses before the client does.

Her approach: run the report through three distinct stakeholder roles — each representing a different type of decision-maker at the client organization who will read and potentially challenge the report.

Designing the Three Roles

Elena thinks carefully about who will be in the room when this report is presented. She has met all three people. She knows their professional backgrounds, their primary concerns, and their previous objections to other consulting work.

Role 1: The Skeptical CFO

You are Margaret Chen, CFO of Meridian Health Network, a 2,400-bed regional
healthcare system with $2.1B in annual revenue. You have been CFO for 8 years.

Your primary concerns in any strategic growth analysis:
- Capital allocation risk: you are protective of the balance sheet and skeptical
  of projections that rely on optimistic assumptions
- Revenue recognition timing: you have seen too many analyses that front-load
  benefits and back-load costs
- Sensitivity analysis: you want to see what happens when key assumptions are wrong
- Integration costs: you believe consultants systematically underestimate the cost
  and disruption of adding new service lines

You have a specific sensitivity about home health services — your organization
tried to enter this market in 2018 and failed, at significant cost. You are not
opposed to considering it again, but you will scrutinize those projections
especially carefully.

Your communication style: direct, evidence-demanding, not hostile but completely
willing to table a discussion until the analysis is more rigorous.

Read the following strategic report. Produce:
1. Your three most significant financial concerns — the assumptions or projections
   you would challenge immediately in the room
2. The one analysis you believe is missing that would be required before you could
   support this recommendation
3. Two questions you would ask in the first five minutes of the presentation

Role 2: The Operations Director

You are David Okonkwo, Chief Operating Officer of Meridian Health Network. You
have been with the organization for 14 years, the last 6 as COO. You came up
through hospital operations.

Your primary concerns in any strategic growth analysis:
- Implementation feasibility: you have seen strategies that look brilliant on paper
  fail because the organization did not have the operational capacity to execute them
- Workforce: any new service line requires new staff, and your region has a nurse
  shortage and an administrative talent pipeline problem you consider severely
  underestimated by most analyses
- Systems integration: your EHR (Epic) is in a multi-year upgrade cycle; any new
  service line would need to be evaluated against that implementation timeline
- Change management: your organization is in the middle of a post-COVID recovery
  that has left frontline staff stretched; you are protective of their capacity

You are supportive of strategic growth in principle but you have learned to be the
person who asks "but who is going to do this?"

Read the following strategic report. Produce:
1. Three operational concerns not adequately addressed in the report
2. The specific implementation assumption you believe is most dangerously optimistic
3. One recommendation that would make this report actionable rather than theoretical

Role 3: The Board Member

You are James Whitfield, Chair of the Meridian Health Network Board of Trustees.
You served as CEO of a large regional health system for 12 years before retiring
to board work. You now sit on three healthcare system boards.

Your primary concerns in any strategic growth analysis presented to a board:
- Strategic coherence: does this recommendation fit with the organization's stated
  mission and 5-year strategic plan, or is it an opportunistic pivot?
- Competitive positioning: you want to understand the competitive dynamics, not
  just the market opportunity
- Risk disclosure: as a board member you are concerned about governance risk —
  you want to know what you are authorizing and what could go wrong
- Precedent: you have seen organizations fail by diversifying before core
  operations were fully stabilized

You are experienced enough to ask the question that sounds simple but isn't:
"Why should we be the ones to do this?"

Read the following strategic report. Produce:
1. Two strategic coherence questions — places where the recommendation either
   conflicts with or is inadequately anchored to the organization's stated mission
2. The question you would ask the CEO that would determine whether you supported
   taking this to a board vote
3. Your honest assessment: is this report ready to present to a board? Why or why not?

Running the Reviews

Elena spent 90 minutes running the report through all three roles. Each session produced specific, distinct findings.

Margaret Chen's Review (CFO)

Concern 1 — Home health revenue projections: "The home health market entry projection assumes 18-month ramp to profitability. The 2018 failure at this organization took 36 months to reach profitability projections that were never met. This analysis does not reference that failure, explain what has changed, or provide a sensitivity analysis for a 36-month ramp scenario. Before this presentation, I need to see a scenario analysis that shows us three ramp timelines: 18 months (base case), 30 months (moderate case), 48 months (conservative case), and the capital implications of each."

Concern 2 — Cost of capital: "The report uses a WACC of 5.8%. With current interest rates and our organization's current debt load, I calculate this to be more like 7.1%. At 7.1%, two of the three strategic options in this report no longer clear our investment hurdle rate. Either defend the 5.8% figure or recalculate all three options at 7.1%."

Concern 3 — Capital allocation: "The report recommends pursuing both the urgent care and home health expansions simultaneously. These two initiatives together represent approximately $180M in capital investment over 36 months. The report does not analyze what this means for our other capital priorities — our facilities modernization program and our IT infrastructure upgrade. Is this a trade-off? If so, it needs to be stated explicitly."

Missing analysis: A waterfall chart showing the order of capital deployment across all three growth options and the existing capital program, with clear priority logic.

Two questions for the room: (1) "What happened in 2018, and why is this time different?" (2) "What does your sensitivity analysis look like at a 7.1% cost of capital?"

Elena's reaction when she saw this output: "The 7.1% WACC issue is real. I used 5.8% based on historical data — I did not update it for the current rate environment. That is a significant error that would have been caught immediately."

She recalculates immediately. The CFO's concern is correct: at the current rate environment, the home health standalone option no longer clears the hurdle rate. This changes the report's recommendation.

This finding alone justified the entire exercise.

David Okonkwo's Review (COO)

Operational Concern 1 — Epic timeline: "The report's implementation timeline places home health services launch in Q3 next year. Our Epic upgrade is in Q2-Q4 of next year. No organization successfully launches a major new service line in the middle of a system-wide EHR upgrade. This timeline either needs to be pushed 12 months or the implementation assumption needs to account for our upgrade timeline explicitly."

Operational Concern 2 — Nursing staff assumptions: "The workforce section assumes we can hire 47 home health nurses within 18 months at current market rates. Our current nursing vacancy rate is 14.3% in acute care — we have not been able to fill acute care positions for 22 months. The assumption that we will successfully hire home health nursing in a market where we are already failing to fill our existing acute care positions needs to be explained, or this is a meaningless projection."

Operational Concern 3 — Change management: "The report contains no change management budget or plan. We are currently asking frontline staff to absorb COVID catch-up patient volumes, an ongoing EHR upgrade, and a recent merger integration. The section on 'operational readiness' is two paragraphs. Change management in a parallel service line launch of this scale is typically a six-figure line item and 12-18 months of active effort. The report reads as if implementation happens automatically."

Most dangerously optimistic assumption: 18-month profitability timeline for home health, given the labor availability constraints described above.

Recommendation for actionability: Add a 90-day readiness assessment section that specifies: the five organizational capabilities that must exist before launch, how those capabilities will be measured, and who owns the readiness check.

Elena's reaction: "The Epic upgrade conflict is a legitimate oversight. I knew the upgrade was happening but did not check the specific timeline against our proposed implementation window. This needs to be fixed before the presentation."

The workforce section she considered adequate. After the COO review, she recognizes it as the most important operational risk in the report — and the least well-analyzed section.

James Whitfield's Review (Board Chair)

Strategic Coherence Question 1: "The organization's 5-year plan, as stated on page 3 of this report, prioritizes 'deepening clinical excellence and regional market leadership in acute care.' The home health market entry represents a fundamentally different business model — dispersed delivery, different workforce, different economics, different regulatory environment. The report does not explain why this recommendation is consistent with the stated strategy. Either the recommendation should explicitly argue for a strategic pivot, or it should be anchored more specifically to how home health services reinforce acute care market leadership."

Strategic Coherence Question 2: "The urgent care clinic recommendation is presented as growth, but the report's own competitive analysis on page 22 shows that the two largest urgent care operators in this market have national networks and significantly lower cost structures. The report recommends we compete with them. Why? What competitive advantage does Meridian have in urgent care that would allow us to compete profitably against national chains with 4x our scale?"

Question for the CEO: "What is the core strategic thesis here — are we diversifying for financial resilience, or are we growing because we can, or is there a specific capability we want to build that requires being in these markets? Until I understand the answer, I cannot evaluate whether the recommendation is right."

Board-readiness assessment: "This report is not ready for a board vote. It contains a significant financial assumption that appears to need revision (cost of capital), an operational timeline that conflicts with a known internal constraint (EHR upgrade), and a strategic logic gap that is significant enough to potentially change the recommendation. I would recommend a three-week revision before this goes to the board."

Elena's reaction to the board member review: "The 'why us in urgent care?' question is the one I was most afraid someone would ask and had not fully answered. I have data on the market opportunity. I do not have a compelling answer to why we, specifically, would win in a market where national chains have structural cost advantages."

What the Three Reviews Found — and Did Not Overlap

Elena maps the findings and notes where different roles found different things:

The critical insight: there was almost no overlap. Each role found an entirely different category of problem. If Elena had run only the CFO review, she would have fixed the financial modeling but shipped a report with an implementation timeline that conflicted with the EHR upgrade and no answer to the competitive advantage question. If she had run only the COO review, she would have fixed the operational issues but shipped a report with a WACC calculation error that the CFO would have caught in the first five minutes.

The three roles were not redundant. They were complementary.

The Report After Revision

Elena spent the following day revising the report based on the three sets of findings:

1. Updated WACC from 5.8% to 7.1% — this changed the recommendation. The home health standalone option was removed from the shortlist. The revised recommendation was urgent care only in year one, with home health contingent on a 2-year readiness assessment.

2. Revised implementation timeline for urgent care to begin 14 months after the Epic upgrade completion — this pushed the recommendation back by 9 months but made it operationally feasible.

3. Rewrote the workforce section — expanded from 2 paragraphs to a full section including a detailed hiring analysis, a vacancy rate comparison, and a recommendation to begin workforce partnerships with nursing schools before any capital deployment.

4. Added competitive advantage analysis for the urgent care recommendation — shifting the argument from "market opportunity exists" to "Meridian's existing patient relationships and brand recognition in this market create a specific advantage in retention that national chains cannot replicate."

5. Added a strategic coherence bridge explicitly connecting the recommendation to the stated 5-year plan — framing urgent care as an acute care feeder network, not a diversification strategy.

The revised report received this response from the actual CFO at the presentation: "This is thorough. I have one question about the workforce assumptions in year two, but overall this is the most rigorous growth analysis we have received." The board voted to approve the strategic direction three weeks later.

The Efficiency Argument

Without the role review: - Report delivered as originally drafted - CFO catches the WACC error in the presentation room - COO raises the Epic conflict — Elena has no response prepared - Board chair asks the competitive advantage question — Elena has no compelling answer - Presentation deferred, engagement extended by 4-6 weeks to revise, reputation for rigor takes a hit

With the role review: - 90-minute investment in role assignment sessions - 6-hour revision day - Report delivers clean, all findings addressed, client confidence high - Engagement closes on schedule, strong reference client secured

The 7.5 hours invested in the role review and revision was not a time cost — it was a risk mitigation mechanism that protected a $180,000 engagement and a long-term client relationship.

The Principle Behind the Practice

The fundamental insight of this case study: different stakeholders in any important review carry different categorical concerns. A CFO's financial modeling concerns are not the same category as a COO's operational feasibility concerns, which are not the same category as a board member's strategic coherence concerns.

When you review your own work, you tend to review it from one perspective — usually the perspective most similar to your own expertise and the one you have been inhabiting during the work. You have been thinking like a consultant; you review it like a consultant. But it will be read and evaluated by people who think like a CFO, a COO, and a board chair.

Role assignment gives you the mechanism to temporarily exit your own perspective and evaluate from angles that are genuinely different from your own. When the roles are specific and well-designed — grounded in real knowledge of the actual people who will read the work — the feedback is not generic and not overlapping.

The output of a well-executed role assignment exercise is not a list of problems. It is a map of the specific vulnerabilities in your work, organized by the stakeholder most likely to raise each one.