How Much Does the Integral Organizational Nervous-System Diagnostic Cost?

Last updated: May 2026

IHS engagements are scoped per organization — there is no published fee schedule. The diagnostic typically runs 4-6 weeks and is principal-delivered by Thomas G. Goddard, JD, PhD, CCEP. Cost is determined by workforce cohort size, functions in scope, regulatory complexity, structural-review depth, and timeline. This guide explains every factor that drives cost, what the engagement includes, and why the cost of not engaging is the more consequential number for most healthcare leadership teams. This guide is not a fee schedule and is not a competitive bid comparison. It is a planning resource for leadership teams evaluating whether the diagnostic is the right next step.

Why IHS Does Not Publish Fixed Pricing

The diagnostic is principal-delivered. Every engagement is executed by Thomas G. Goddard, JD, PhD, CCEP — not by a team working against a standardized protocol. The scope is determined by the organization's actual workforce cohort, the number and complexity of functions in scope, the regulatory environment, and the depth of structural-document review required to connect survey and interview findings to the levers leadership controls.

A utilization-management team of 40 at a regional health plan is a categorically different engagement from a clinical-leadership tier of 200 at a hospital system carrying post-merger integration load. Fixed pricing would either underprice the complex engagement or overprice the focused one. Scope-based pricing produces accurate cost-to-value alignment for both.

What this cost guide IS: a substantive explanation of the scope variables that determine engagement cost, a description of the full deliverable set, and the workforce attrition and productivity data that establish the cost floor for inaction.

What this cost guide is NOT: a fee schedule, a published rate card, a competitive bid price, or a commitment to specific pricing. Those conversations happen in the discovery session.

Factors That Affect Diagnostic Cost

Each variable below adds fieldwork time, analytical depth, or principal time to the engagement. Engagements with multiple high-complexity variables carry larger scope; focused engagements with well-bounded cohorts carry smaller scope and faster delivery.

Factor Lower-Scope Signal Higher-Scope Signal
Workforce cohort size Single function or team (20-50 staff) Multi-function or whole-organization (200+ staff)
Number of functions in scope One function (e.g., utilization management only) Cross-functional (UM, prior auth, clinical, compliance, member services)
Regulatory complexity Single accreditor, stable regulatory environment Multiple accreditors, active CMS audit, pending state-mandate changes
Leadership cohort size 3-5 leaders (C-suite only) 10-15 leaders (C-suite plus department directors and medical leadership)
Structural-document depth Well-documented workflows; prior regulatory review available Undocumented workflows; no prior regulatory-burden review on file
Timeline and urgency Standard 4-6 week schedule Accelerated ahead of a regulatory deadline or board presentation
Existing survey infrastructure Active engagement survey; baseline data available to build on No prior workforce survey; full instrument administration from baseline

What the Engagement Includes

Regardless of scope tier, every engagement produces the same core deliverable set. The scope variables above determine the depth and breadth of each deliverable — not whether it is included.

  • Workforce Nervous-System Mapping Report (25-35 pages) — where chronic stress physiology, regulatory-burden friction, emotional toll, relational coherence, and silent attrition risk concentrate by unit, function, and role. Heat-mapped at the resolution the scope permits without compromising individual confidentiality.
  • Structural-Lever Recommendations Document — prioritized recommendations across workflow architecture, role design, escalation pathways, leadership cadence, governance protocols, and cross-functional coordination. Each recommendation names the signature it addresses, the evidence base, the realistic time-to-effect, and the leadership owner.
  • Leadership-Team Debrief and Recommendation Walk-Through — a 90-minute working session (in-person or video) walking the leadership team through the map, the priorities, and the recommended sequence. Structured for interrogation of the findings, not for passive presentation.
  • Optional follow-on scoping conversation — at the leadership team's election, a separate conversation about a bespoke implementation engagement. Not required; the diagnostic stands on its own deliverables.

The Cost of Not Engaging

The diagnostic is designed to address the structural conditions that drive workforce attrition, compliance-documentation drift, and operational degradation in U.S. healthcare. The cost of those conditions is documented and severe. For most healthcare leadership teams, the cost of inaction is the more consequential number.

  • RN replacement cost: $37,700 to $58,400 per nurse (NSI 2026 National Health Care Retention & RN Staffing Report). US hospital RN turnover stands at 17.6% in 2026. On a 100-RN unit, that is $664,000 to $1,027,840 in replacement costs per year — before agency premium and overtime.
  • Hospital revenue exposure: RN vacancy-driven capacity reduction generates estimated revenue losses of $262,900 to $535,900 per 100 RNs annually when unfilled shift productivity is included (NSI 2026).
  • Physician revenue at risk: The average physician generates $1.4 to $2.1 million in annual net revenue for a hospital system. A single departure in a high-demand specialty represents a revenue exposure that exceeds most focused diagnostic engagement fees within the first quarter of the vacancy.
  • Organizational factors drive 70% of burnout variance: Trockel et al. found that organizational factors account for approximately 70% of physician burnout variance (Trockel et al., JAMA Internal Medicine, 2018). The lever is structural, not individual. Individual wellness programs that leave organizational drivers intact produce documented rebound effects within 6-12 months.
  • Workforce in crisis across every segment: 55% of U.S. healthcare workers report considering leaving the field within twelve months (National Council on Behavioral Health, 2024). 45% of U.S. physicians report often or always feeling unable to provide the best possible care; 68% report moderate or severe distress as a result (PNHP 2026 Moral Injury in Medicine Report, 1,207 respondents).
  • Organizational interventions outperform individual ones: West et al.'s meta-analysis found that organizational-level interventions produce larger and more durable burnout reductions than individual-level programs (West et al., The Lancet, 2016). The diagnostic targets the organizational layer those interventions require to be effective.
  • Compliance-documentation drift: Workforce operating under sustained sympathetic activation produces documentation-vs-practice drift that concentrates in the exact records accreditation surveyors and CMS auditors review first. The cost of a URAC, NCQA, or CMS audit deficiency driven by workforce-load-induced documentation gaps compounds the attrition cost with regulatory exposure.

An organization that waits for a survey deficiency, a mass resignation event, or a board-level workforce crisis is paying the full cost of inaction before any diagnostic is commissioned. The diagnostic is designed to surface and address the structural drivers of these conditions while the leadership team still controls the levers.

How Engagements Are Structured

The diagnostic runs in three phases over 4-6 weeks. Scope variables determine depth within each phase, not whether a phase occurs. Every phase produces an intermediate artifact; the leadership-team debrief at the end of Phase 3 is the canonical delivery.

Weeks 1-2: Workforce Survey and Leader Interviews

A validated I/O psychology survey instrument is administered to the workforce cohort in scope, calibrated to the buyer's specific function set. In parallel, 60-90 minute structured leader interviews are conducted by the principal with each member of the leadership cohort. The interview protocol surfaces the autonomic, relational, cognitive, and meaning-source signal that survey instruments alone do not reach. Cohort size and the number of leaders in scope are the primary variables determining phase cost.

Weeks 3-4: Structural Document Review

The principal reviews the structural and operational documents that determine where regulatory-burden friction concentrates in the workforce: denial-cascade workflow mapping, intake-load analysis, escalation patterns, cross-functional handoff points, and governance documentation for the functions in scope. Regulatory complexity and the state of existing workflow documentation are the primary cost variables. Organizations with prior regulatory-burden assessments or well-documented workflows require less fieldwork time in this phase.

Weeks 5-6: Integration and Delivery

Survey data, leader interview synthesis, and structural review are integrated into the workforce nervous-system map. Deliverables are finalized. The 90-minute leadership-team debrief is scheduled and delivered. This phase is anchored by the principal's integration work and is relatively stable across scope tiers — the integration and delivery effort is bounded by the deliverable set rather than by cohort size.

Budget Planning by Phase

The following describes what to plan for at each phase. IHS does not publish dollar figures for any phase — cost is scoped per engagement. Contact IHS for a proposal calibrated to your organization's specific variables.

Phase 1 — Survey and Interview (Weeks 1-2)

  • Engagement letter executed; confidentiality terms and reporting thresholds documented
  • Workforce survey instrument calibrated to the function set in scope
  • Survey administration coordinated with the leadership team's preferred survey window
  • Leader interview schedule confirmed; 60-90 minutes per leader in scope
  • Primary cost driver: cohort size and number of leaders interviewed

Phase 2 — Structural Review (Weeks 3-4)

  • Regulatory-burden review across applicable CMS, state, and accreditor frameworks
  • Workflow documentation review: denial cascades, prior-authorization, intake-load, escalation pathways
  • Governance documentation reviewed for functions in scope
  • Primary cost driver: regulatory complexity and state of existing workflow documentation
  • Organizations with existing regulatory-burden assessments reduce phase cost

Phase 3 — Integration and Delivery (Weeks 5-6)

  • Workforce Nervous-System Mapping Report finalized (25-35 pages)
  • Structural-Lever Recommendations Document finalized with prioritized sequence
  • Leadership-Team Debrief and Recommendation Walk-Through (90 minutes, in-person or video)
  • Optional follow-on scoping conversation at leadership team's election
  • Cost relatively stable across scope tiers — driven by principal integration and delivery time

Frequently Asked Questions

Does IHS publish any pricing benchmarks for the diagnostic?

No. The diagnostic is principal-delivered by Thomas G. Goddard, JD, PhD, CCEP and scoped to each organization's specific workforce cohort, function set, regulatory environment, and structural complexity. A published benchmark would misrepresent the cost of a complex multi-function engagement and the cost of a focused single-team engagement with the same number. Contact IHS for a proposal calibrated to your organization.

How does this compare in cost to an engagement survey vendor like Press Ganey or Gallup?

Engagement survey vendors charge per respondent against normative databases. They produce climate scores — a valuable signal. They do not measure autonomic regulation, do not surface the emotional-toll and relational-coherence layers of the workforce, and do not connect findings to structural or regulatory-burden levers. The diagnostic is a different instrument operating at a different organizational level. The relevant comparison is not price-per-respondent — it is diagnostic depth, actionability, and the structural layer each instrument actually addresses.

Can the engagement be scoped for a single team or department?

Yes. The diagnostic scales from a single function — a utilization-management team, a prior-authorization unit, an intake operation — to a whole-organization assessment. A more focused scope produces a lower-cost engagement with faster turnaround. The deliverable set is the same at every scope tier; depth and breadth of each deliverable scale with scope.

What is the ROI case for a board-level budget presentation?

Three numbers anchor the board-level case: RN replacement cost of $37,700-$58,400 per nurse (NSI 2026); organizational factors accounting for approximately 70% of physician burnout variance (Trockel et al., JAMA Internal Medicine, 2018); and organizational interventions producing larger burnout reductions than individual-level programs (West et al., The Lancet, 2016). The diagnostic addresses the organizational layer where 70% of the variance lives. A single avoided RN departure recovers a material portion of a focused engagement's cost. Avoided regulatory deficiencies add to the return.

Does the diagnostic fee include the follow-on implementation engagement?

No. The diagnostic is a discrete engagement with its own deliverable set. Follow-on bespoke work — regulatory-burden organizational redesign, a clinician-leader cohort, a just-culture infrastructure build — is scoped and priced separately. The diagnostic is not a sales gate for follow-on work; it stands on its own deliverables.

How quickly can we receive a scoped proposal?

A scoped proposal typically follows within 5-7 business days of the discovery session. The discovery session establishes the workforce cohort, function set, regulatory context, and timeline — the variables that determine scope. Schedule the discovery session through the link below.

Is the diagnostic appropriate for PE-portfolio healthcare companies?

Yes. PE-portfolio healthcare platforms in the 0-90 day post-close window and the 18-36 month aftercare window are a primary use case. Workforce signal — autonomic load, relational coherence, attrition risk — is the leading indicator of integration trajectory. The diagnostic provides the structural map before that signal becomes a retention event or a compliance finding. Scope is typically calibrated to the platform company's leadership tier and the specific functions carrying the most post-close integration load.

Can the diagnostic be conducted entirely remotely?

Yes. The workforce survey is administered digitally. Leader interviews and the leadership-team debrief are conducted via video. In-person delivery is available and is the preferred format for the debrief; it is not required. Remote delivery does not reduce deliverable scope or analytical depth.

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