Case study
Improving Organizational Health & Capabilities


Because of this process, we have seen two major changes in the organization. 
One, we are now an organization of candor. Clear feedback and support lead to clear change. 
Two, we are a more decisive culture. Previously, we were only a culture of innovation. Today, we are still a culture of innovation – we still run lots of pilots – but now we are more decisive. We reach a decision point and make it. We don’t drag things out. Brutal honesty.
If a report isn’t being read? Stop writing it. Reclaim and repurpose the time.

If a pilot isn’t working? Shut it down.
And if a report is valuable? If a pilot is showing great results? Quickly make it part of the standard of care so that the benefit can spread.

– Christopher Arnold, MD, Senior Medical Director, WellMed Medical Group
Desire to impact others


Founded in 1990 as a single clinic, WellMed has grown into a leader in proactive, preventive care for older adults with over 645,000+ patients, 380,000+ Medicare Advantage patients, 7,500 sites and 18,000 providers’ offices in New Mexico, Texas and Florida. The growth has been particularly exponential since 2011, when it partnered with OptumCare™, one of the nation’s largest health and wellness companies.

Said Founder and CEO George M. Rapier III, MD, at TDE’s 2017 Deliberately Developmental Organization® (DDO®) Conference: “In the last two years, we’ve had growth basically tripling the size of the company. I’m absolutely convinced that without this methodology, and without this ability to communicate more openly, we would have stumbled all over ourselves… Instead, we survive. We thrive. We continue to grow.”

Dr. Rapier was initially coached regarding individual and organizational growth by Dr. Robert Kegan, one of TDE’s principals. Inspired by the process he experienced as well as the vision of creating a Deliberately Developmental Organization®, Dr. Rapier sought to spread developmental principles and practices across the rest of his company beginning in 2013. 

The decision could not have come at a better time: the exponential growth was weighing on the organization. “I, personally, was exhausted,” said Chief Information Officer Cindy Cornelius. “The IT department is like a company within a company. We correspond to the different departments. Finance requires a finance IT specialist. Doctors require software in their language… And as finance and medical and other teams’ work grows, so our work to create and automate support systems grows. As well, we were implementing new systems, new lines of business, acquiring new lines of business, become a service provider to a Fortune 100 company… our membership has gone from 50 clinics in 5 markets with a single payer to 250+ clinics in 14 markets with 12 different payers. The growth is and continues to be exponentially increasing and monumental.”

To harness growth and prevent employee fatigue, Dr. Rapier needed a system for helping people to get better at their jobs – and he needed it in place quickly.

Dr. Rapier hoped to increase his team’s:

  • Adaptability in the face of constant growth and change
  • Ability to communicate openly
  • Speed of decisioning
Plan for success


For more than six years, WellMed has been on a deliberate journey to increase human potential within the organization with TDE’s Dr. Kegan and Dr. Lahey, as well as consulting partners Otis Woodard and Pamela Duffett. For WellMed, it has been a cascading process of education. 

Developmental Cohort of 8 Executives Led by TDE => Early Evangelists Educated on Deliberately Developmental Organizations®

Smaller Cohort Trained by TDE as Group Facilitators => Believers Eager to Develop Colleagues as They Had Been Developed Themselves

Cohorts of 6-8 Next-Level Executives Led by TDE & Internal Group Facilitators Trained by TDE => High Potentials and Key Players Optimizing Performance

30+ Cohorts of 6-8 Team Members, Nearly All with Internal Group Facilitators => Working on Self-Improvement at Work with Coworkers Led by Colleagues

… And a waiting list of employees

“I am a different human being now, a different leader at WellMed, and a different wife, because of what this process helped me to untap and uncover,” said Cornelius. “I couldn’t spread it to my team fast enough.” 

Cornelius and other key leaders within the organization integrated deliberately developmental teachings and cohorts into their everyday work, recognizing that for the organization to do better, each of its “individual” parts needed to do better as well.

Raise up everyone

Developmental Sprints®

Developmental Sprints® to surface, address and change issues in individual performance, increase feelings of teamwork within the organization, and ensure resilience of the sales team longer term.

Shift desire to action

Building a Healthy Culture

Cohorts meet every other week for two hours. Prior to the meeting, each member leverages TDE’s proprietary template for describing and dissecting a situation. The process includes both situation- and business-specific questions integrated with questions that surface and challenge the assumptions and overarching mindset of the cohort member involved.

“The majority of situations, about 95%, are related to day-to-day business,” says Arnold. “They include a stressful meeting, manager-employee differences, trouble with a colleague, difficulties with a vendor, a negotiation that didn’t go as planned. The other 5% is personal.”

Within each cohort meeting, three people go through their situations with the team in-depth. The remaining present an expedited version of their situations and/or updates on past situations and new behaviors. The group’s role is to clarify and pressure test the situation, and review the member’s assumptions. Questions like, “Could this person be objecting because of…?” or “What was your reason for thinking this was their motivation?” are posed. Ultimately, the floor returns to the person who brought the situation to the group, who then speaks to how they can improve their thinking and behavior in similar situations in the future.

“When colleagues first join a cohort, there is a real psychological hesitancy about opening up,” says Arnold. “We’ve found it helpful to create cross-functional cohorts for first-timers. They need to learn that this isn’t about solving a problem for them. This is about changing how you see yourself and others within the situation. Once they’re comfortable with the format, we are able to group them by team or job function.”

It is in the team or job function cohorts where similar situations, and thus organizational solutions, become clearer. “We keep the cohort focused on the individual’s perceptions and behaviors, but if we see critical issues that need a solve – something that is a threat to the company or a problem that is common – or excellent best practices from which the company could benefit, then we bubble them up during the facilitators’ round table,” says Arnold, who also facilitates two cohorts. Issues are shared anonymously and “bubble up faster” than they would in another company.

Between meetings, Talking Partners (two members of a cohort group) hold each other accountable. Talking Partners check in with each other daily or weekly, and remind each other of what they told the group they would do. “Talking Partners are each other’s personal coach,” says Arnold. “They are your accountability partner, and a critical part of the process.”

Cornelius has taken the departmental specific cohorts vertically as well, incorporating members from OptumCare, WellMed’s parent company, as well as from companies it has acquired. “IT goes through, across and up-and-down an organization. Systems need to talk to each other. People need to talk to each other.”

See Positive change

Measuring Results

Of the 6,300 employees within WellMed, over 300 people or 5% of the organization have gone through the process. The cascade started at the top with company leaders now speaking the same language. New cohorts start regularly as additional internal facilitators are trained.

WellMed has seen incredible results from the work done:

  • Better equipped to cope with massive growth
  • More candid culture
  • Faster decisioning
  • Quicker surfacing of individual and organizational opportunities for improvement

“We have seen major, positive behavioral shifts in our leadership,” says Arnold. “Seeing the change in the COO, the CFO, your department head, your boss… it is inspirational. More candor. More comments. Better strategy. Better collaboration. You want to be part of it.”

For Cornelius, the difference between where she was “pre-Kegan” and where she is now is profound. “I still work on a freight train that isn’t stopping, but now I have perspective. I seek clarity. I elevate issues. I prioritize. I collaborate. More than anything, I have self-compassion and compassion for others. Because of this, I operate at a higher level today than I did before. And that is good for me, my team and the organization.”