In Indian River County, more than a decade of mistrust, suspicion and public controversy fed local headlines and the six o’clock news. This history colored interactions between the Indian River County Hospital District Board (IRCHD) and the Board of Indian River Medical Center (IRMC), creating a strained working relationship as the two entities struggled to share governance of the hospital.

Located in Vero Beach, Florida, IRMC was a 285-bed acute care facility with $230M in annual net patient service revenue. IRMC earned robust philanthropic support and hosted cardiac and cancer centers of excellence. However, the organization faced some notable challenges including constrained cash flow, increasing competition, and significant capital investment needs to upgrade and replace an aging facility. Considering the community’s history of conflict, overlapping governance responsibilities, and a poor working relationship between the IRMC and IRCHD Boards, the chances of bringing the parties together to create a shared strategic vision for IRMC seemed slim.



IRCHD owns and leases the hospital facility to the Indian River Hospital Board, d/b/a Indian River Medical Center Inc (IRMC). In 2017, Marybeth Cunningham was the new Chair of the IRCHD Board and Wayne Hockmeyer was the chair of the IRMC Board. As successful and pragmatic business leaders, both Marybeth and Wayne understood that IRMC was at a key decision point and that the status quo was untenable. The challenge was to forge consensus with a fractious governance model.

A significant complication in bringing the Boards together for deliberations was Florida’s Sunshine Law, which requires public access to meetings of boards, commissions and other governing bodies of state and local governmental agencies or authorities. While IRCHD was subject to full compliance with the Sunshine Law, IRMC, as a private non-profit, was exempt. To enable a collaborative process, each Board would need to adhere to the Sunshine requirements that applied to IRCHD as a public body. Wayne and Marybeth believed that a public joint process was essential to craft a consensus around a shared vision for IRMC. These decisions were momentous. As Wayne notes, “It was critical given the history that we have a joint process so that stakeholders saw the same information and participated in the same discussions and that the process was open and witnessed by members of the community.”

Stroudwater performed a deep analytical dive into the market opportunities across the group’s specialties, examining areas where increased patient access would increase market share and geographic areas where focused efforts would improve market share. Further, we did a detailed work-flow analysis to identify areas of operational improvement given a very thin management bench spread across a large geography. Most importantly, Stroudwater engaged with physician leadership to enable them to take ownership of the process knowing that the key to change would be physician leadership. We identified bright spots amongst the physician leadership of practices that should be replicated across other locations and specialties to improve.



The Boards formed a Joint Committee (the “Committee”) composed of 7 members from the IRCHD, IRMC and Indian River Medical Center Foundation (IRMCF) Boards. This step created a shared venue for leaders of these organizations to work collaboratively on the future of IRMC. Once the Committee membership and commitment to a shared process had been set, the decision to hire Stroudwater as an outside adviser was made. As Marybeth notes, “We wanted an adviser who would bring experience, be objective and not have any preconceived notions.”

Stroudwater’s mandate throughout this process was to bring the two Boards together around a shared and informed vision for IRMC’s next steps. The Joint Committee reviewed and discussed quantitative and qualitative data including stakeholder interviews, an analysis of the regional market, a financial analysis of IRMC, and state and national healthcare dynamics. Using this data, a set of Strategic Objectives were developed to guide the Committee’s deliberations on alternative strategic options; these Strategic Objectives formed the common fact base from which Committee Members could make an informed recommendation for a strategic option for the hospital. At its final meeting, the members of the Committee made a unanimous recommendation to explore partnership opportunities for IRMC.



Despite more than a decade of conflict, mistrust and controversy, the Board leaders at IRCHD and IRMC achieved stakeholder buy-in and launched a process that led to consensus around a shared vision for healthcare delivery in Indian River County and an engaged and supportive community. The key components of the process included:

  • A collaborative approach embraced by both Board Chairs
  • A shared venue for discussion between leadership of the governing bodies and other stakeholders,
  • A common fact base to provide insight and inform decision making
  • A single, experienced advisor to facilitate discussions
  • An effective communication and public engagement strategy that reflected regulatory constraints, the needs of stakeholders, and the need to address the legacy of prior controversies and mistrust

Three years later, Indian River is over a year into a successful partnership with Cleveland Clinic. The partnership brought outstanding clinical and operational resources and a commitment to invest $250 million into IRMC. The IRCHD, IRMC and IRMCF Boards and surrounding community are pleased with the outcome. Wayne notes, “I think you would be hard pressed to find anyone unhappy with the outcome. Being so public throughout the process was uncomfortable at times, but it paid off for us. Public confidence in IRMC’s care has improved. And employees and providers have rallied around Cleveland Clinic’s patient first culture. I am thrilled that the Boards and stakeholders were able to overcome lots of history to do the right thing for the community.”