Week 16. Effective Implementation of Strategic Plan

business model innovation

population health management, shift from volume to value, risk-sharing, value-based contracting, accountable care

categories of review and update process

- communication and expectation - management and leadership - context

challenges of implementation

- lack of energy and focus - lack of management - disconnect from operations - lack of resources

areas of future emphasis for healthcare strategic planners

1. Be nimble to exceed the rate of change 2. Tell stories 3. Integrate and cocreate 4. Erase the boundaries of business 5. Generate data-driven insight

External environmental assessment to address business model innovation

- Arrangements between competing providers and payers that can shift market share - New alignment models among providers in the market affecting relationships between physicians, health systems, and other provider organizations, and the ways in which these models are shifting referral relationships - Emergence of nontraditional competitors, particularly those who engage patients earlier in the care process and could steer referrals away - Impact of Medicare payment models, which can add critical mass to population health initiatives - Payer-provider innovations that over time may extend from more advanced markets to the local market

external communication idea

- Create summary document for marketing materials and media distribution - Post succinct and clear outline of strategic plan on website - Create presentation with a review of strategic plan for CEO to give to community groups - Schedule appearances before various community constituencies (e.g., church groups, chamber of commerce)

implementation planning to address business model innovation

- Determining what skills will be obtained through training, recruitment, and partnering with other entities - Specifying where revised role descriptions, performance review criteria, incentives, and progress tracking are required and who will be responsible for each of these - Defining accountability processes specific to the innovation - Identifying what education the board of directors may need to oversee these value-based business models, particularly where risk contracting or insurance is involved - Specifying where independent physicians need to be engaged (e.g., independent physicians are typically involved in CINs as both participants and in governance) and how that will be achieved

roles of leaders in the future strategic planning

- Diagnostician - Segmenter - Disrupter - Team Coach - Salesperson - Inquisitor - Antenna - Accelerator

effect of clinical and technological innovation

- Enhancing the organization's ability to deliver better value - Strengthening differentiation and positioning - Increasing the pace of the evolution of the care delivery model - Shifting the location of care delivery - Changing the provider team and its roles - Affecting the ability of the organization to remain independent

why innovation is often poorly addressed?

- Fear that a particular innovation is just a fad - Sectorwide attitude of risk aversion and insularity, combined with the viewpoint that healthcare is so unusual that changes that affect other fields are irrelevant - Overconfidence in expert knowledge, to the exclusion of the customer's viewpoint - Need to focus limited resources (people, time, funds) on resolving immediate challenges (e.g., maximizing fee-for-service revenue, reducing costs, strengthening physician alignment, forming strategic alliances)

dimensions of balanced scorecard

- Financial. Financial performance and management of resources (including intangible resources such as workforce capability and supplier relations) - Internal business processes. Cost, quality, efficiency, and other characteristics of goods and services - Customer. Measures of satisfaction, market share, and competitive position - Learning and growth. Measures of the ability ro respond to changes in technology, customer attitudes, and economic environment

reasons fro regular progress review

- To shine the spotlight on the ongoing importance of implementation to the organization's success - To encourage and motivate individuals and teams involved in implementing action plans through visibility, recognition, and praise - To make sure that appropriate progress is being made and that priorities stay on track - To discuss and resolve problems and internal obstacles to progress, particularly those that require interdisciplinary intervention - To allow reallocation of valuable resources to the areas that most need them

questions identifying how much of an update is called for

- Have we made sufficient progress toward each of our strategic goals in the past year as measured by our performance on year r objectives? - Are there recent or pending developments (internally or externally) that have or will have a major impact on organizational direction and priorities? - Do current goals and metrics still reflect our most important strategic aims? - Do major initiatives still represent the key ways we will pursue our goals?

Internal environmental assessment to address business model innovation

- How far primary care physicians have come from a focus on "sick patient visits" to one based on keeping patients well-including those who don't come into the office - How effective primary care physicians and those monitoring chronic conditions are at keeping patients out of the emergency department - How effective patient transitions between units in the hospital and from the hospital to other care delivery sites (e.g., patient home or nursing facility) are, and the quality of related communications and monitoring (because transitions create patient vulnerability) - How ready information technology (IT) and other infrastructure services are to support care and quality management = How effectively the organization uses its electronic health records and data systems to support care management - Whether the organization is positioned to measure and report key metrics such as quality of care, patient outcomes, patient satisfaction, and physician performance - How well clinicians keep patients engaged

new strategic planner

- Planners as strategy finders. - Planners as analysts. - Planners as catalysts.

fostering implementation success

- Understand that plan execution starts during the preplanning. - Consider execution while formulating strategy. - Choose execution leaders wisely. - Mobilize the team and communicate. - Mark the implementation phase in a formal, celebratory way. - Drive the plan down into the organization. - Watch out far the warning signs of execution failure. - Communicate, communicate, communicate. - Have a monitoring system in place. - Consider moving from strategic planning to strategic

path-breaking planning process

- Systematic, ongoing internal and external data gathering leads to the use of knowledge management practices. - Innovation and creativity are prized - Strategic planning is more bottom-up than top-down. - Evolving, flexible, and continuously improving strategic planning processes help organizations adapt more readily. - Dynamic strategic planning has replaced static planning.

organizational direction to address business model innovation

- What degree of financial risk does the organization want to accept for patient care? - Is the organization interested in incorporating both provider and payer roles? - In what parts of the continuum of care does the organization intend to have a role (e.g., wellness, ambulatory care, acute care, post-acute care)? - Is the organization in the business of caring for the sick or improving or maintaining population health-or both? - Must the organization own all aspects of the care in which it is involved, or is it willing to enter into strategic relationships with others to provide components of that care?

strategy formulation to address business model innovation

- Whether market share can be increased or leakage reduced sufficiently to offset volume reductions from managing utilization - How much volume would likely be lost if the organization does not pursue new business models as patients are steered to more efficient providers ( opportunity cost) - Whether investing in a CIN or other model can be more cost-effective than hospital employment to engage independent physicians - What start-up investment and financial reserves are required, and what the range of financial burden might be

Internal communication idea

- communicate directly with frontline employees as often as possible to ensure buy-in of strategic initiatives - Train executives and managers to convey strategic initiatives and core values in a consistent manner - Articulate accountability so that staff members have a clear understanding of responsibilities - Reinforce strategic initiatives through symbolic representation, such as posters or signs - Use multiple networks: town hall meetings, employee newsletters, intranet postings, webcasts/podcasts - Consider producing a video with staff at all levels explaining the plan

tips of key contributor to success in strategic planning

- embrace contradictions - embrace complexity - explain simply - look outward - when in doubt, disrupt

traps that leaders may have

- single-color palette - managing instead of leading - planning the unplannable - rigidity

communication process

1. Audiences that need to be addressed - senior management and boards - Their subordinates - Other employees 2. How to frame the message for each audience - Tailor information to their jobs and positions. - Take into account the information that they need to carry out their part in the plan. - Be sensitive to their need to know proprietary information or planned strategies. 3. The best method of communicating the plan - Develop scripts and visual aids for each major target audience so that a uniform message is conveyed. - Have a senior manager, preferably a member of the planning team, present the plan to each target group. - Leave time for employees (and others) to ask questions and get answers, preferably in small groups facilitated by managers who are also recording issues.

4 step process to create effective implementation plan

1. For each strategic goal, appoint one or more executive champions from the senior management team to draft the year 1 implementation plan. 2. Each team reviews its respective draft goal statement, objectives, and major initiatives for clarity, alignment, and completeness. 3. Each team identifies a set of proposed projects and tactics to be undertaken during year 1 of implementation. 4. Senior management reviews all draft implementation plans to ensure internal alignment with appropriate prioritization and allocation of resources.

benefits of balanced scorecard

1. It aligns the organization around a more market-oriented, customer-focused strategy. 2. It facilitates, monitors, and assesses the implementation of the strategy. 3. It provides a communication and collaboration mechanism. 4. It assigns accountability for performance at all levels of the organization. 5. It provides continual feedback on the strategy and promotes adjustments in response to marketplace and regulatory changes.

develop a detailed year 1 implementation plan for the new strategic plan

1. Prepare and submit the proposed strategic plan to the board of directors far review and approval. 2. Roll out the new strategic plan to internal and external audiences. 3. Establish systems for monitoring and reporting progress. 4. Update the strategic plan on a regular basis, no less than annually.

board review and approval process

1. Prepare the draft strategic plan document and presentation materials 2. Obtain a resolution by the strategic planning committee recommending board approval of the plan 3. Provide an opportunity for medical staff review and input (for hospitals and health systems) 4. Hold formal and informal work sessions with the board to review and discuss the proposed strategic plan 5. Board votes to adopt the strategic plan

7 deadly sis that doom effective strategy implementation

1. The strategy is lacking in terms of rigor, insight, vision, ambition, or practicality. 2. People are not sure how the strategy is to be implemented. 3. The strategy is communicated on a need-to-know basis. 4. Some or all aspects of strategy implementation lack a specific person in charge. 5. Strategic leaders send mixed signals by dropping out of sight when implementation begins. 6. Unforeseen obstacles to implementation occur. 7. Strategy becomes all-consuming, and details of day-to-day operations are lost or neglected.

fundamental qualities of good strategy

1. Will your strategy beat the market? 2. Does your strategy tap into a true source of advantage? 3. Is your strategy granular about where to compete? 4. Does your strategy put you ahead of trends? 5. Does your strategy rest on privileged insights? 6. Does your strategy embrace uncertainty? 7. Does your strategy balance commitment and flexibility? 8. Is your strategy contaminated by bias? 9. Is there conviction to act on your strategy? 10. Have you translated your strategy into an action plan?

relationship between strategy and implementation

MISSION, VISION, AND VALUES OVERALL STRATEGY (3-5 YEARS) Strategic goals: what do we intend to accomplish? Objectives: How will we measure success? Major Initiatives: What types of activities will be required? Implementation Plan: What specific actions will we take in year 1?