Compensation  ·  Retention  ·  Multi-site healthcare

No pay structure, and a raise conversation every day.

The client

A multi-site healthcare group.

A network of clinics operating across Canada and into California, employing several hundred people across clinical and support roles, grown largely through acquisition. Each practice had arrived with its own history, and pay had come with it.

The challenge

Pay decided one conversation at a time.

There was no compensation structure. Not a weak one, none. Pay had been set individually, at hire, by whoever was hiring, and had never been revisited systematically. The consequences had compounded quietly for years and were now arriving all at once.

People were leaving And the exit conversations kept landing on the same subject.
Raise requests every day With no framework to answer them, every request became a negotiation and every answer set a precedent.
Inequities surfacing between practices Acquisition meant people doing identical work on materially different pay, sitting in the same network and increasingly aware of it.
No basis for a yes or a no Leaders were making pay decisions on instinct and goodwill, which is unsustainable and, at scale, indefensible.
No annual cycle Nothing existed to review pay predictably, so the only way to get a raise was to ask, which rewarded the confident rather than the strong.
The approach

Build the structure, then build the rhythm that maintains it.

A pay structure that is published once and never maintained decays back into the same problem within two years. The structure and the annual cycle had to be built together, because the cycle is what keeps the structure honest.

Established a compensation philosophy first Where the organization wanted to sit against market and why. Without that, banding is just arithmetic and every exception becomes an argument.
Built the bands Roles grouped, benchmarked against market data, and banded so that every position had a defensible range rather than a number somebody remembered agreeing to.
Surfaced and addressed the inequities The gaps created by acquisition were identified and worked through deliberately, rather than left for someone to discover.
Built an annual review programme A predictable cycle covering performance and pay together, so that compensation became something the business ran rather than something that happened to it.
Trained the leaders to use it The structure only works if managers can explain it. They were taught the philosophy, the bands, and how to have the conversation.
The outcome

Pay became a system rather than a series of negotiations.

The most useful outcome is the one that is hardest to put a number against: leaders stopped improvising.

0 to 1Compensation structure

Built from nothing: philosophy, benchmarked bands for every role, and a defensible position for each employee.

AnnualReview cycle

A predictable performance and pay rhythm replaced ad hoc raise requests, so people no longer had to ask to be treated fairly.

NetworkConsistency across sites

Practices acquired at different times and on different terms were brought onto one structure.

At a glance

The engagement in short.

Client
A multi-site healthcare group, Canada and United States
Situation
No compensation structure, active retention losses, daily raise requests
Scope
Compensation philosophy, banding, equity review, annual review programme
Role
Vice President, People and Culture
Result
A maintained pay structure and an annual cycle to keep it current
Why this matters

Most pay problems are not pay problems. They are the absence of a decision that was never made.

Every raise request is a symptom

When someone asks for more money, the question underneath is usually whether the organization has any idea what they are worth. A structure answers that before it is asked, which is why the number of requests falls once one exists.

Acquisition creates pay debt

Every business bought brings its own pay history. Left alone, those differences do not fade, they surface, usually at the worst possible moment and usually through someone resigning.

The cycle matters more than the bands

Bands built once and never maintained are worse than none, because they create the appearance of fairness without the substance. The annual rhythm is what turns a document into a system.

Let's talk

Thirty minutes is usually enough to know if I can help.

You tell me what is going on. I tell you whether I can help, and if I cannot, who I think can. Both outcomes are useful.