Advancing Strategic Planning
Alexander, Kathryn, Frontiers of Health Services Management
THE VALUE OF STRATEGIC PLANNING is derived from its ability to bring an organization's leaders and stakeholders together to formulate strategic direction in view of environmental uncertainty. The process should focus leadership's attention on developing consensus about the future and successfully positioning the organization for sustainable competitive advantage in that future. Frankly, considering the level of uncertainty in today's healthcare environment, I can't imagine working in a healthcare organization that doesn't have a strategic plan to guide, motivate, and challenge it.
Over the past 25 years of being involved in strategic planning in healthcare organizations, I have witnessed and introduced numerous improvements in both process and product. For a long time now, thankfully, I have not heard anyone question the need for strategic planning.
But, as Alan Zuckerman points out in his article, the fact that sound but basic planning practices are now widely used still leaves "healthcare strategic planning quite far behind the state of the art outside of healthcare." Zuckerman has been at the forefront of the industry's thinking about strategic planning for more than a decade, and he continues to raise provocative questions that prompt us as practitioners to improve our work and our organizations. He points to a key issue-that many in our industry have traditionally considered healthcare "different" from other industries, thus warranting a somewhat different planning approach, process, and products. The result has been that we seek out and adopt best practices almost entirely from other healthcare organizations.
Are we at a point in the evolution of healthcare in the United States when we need to push beyond this comfort zone? Our pace of change certainly rivals that in other industries; we operate within a system that many consider "broken"; and sustaining competitive advantage more than ever requires strategic vision, organizational agility, and innovation. How do we need to advance our strategic planning practices accordingly?
I agree with Zuckerman that implementing his list often best practices in healthcare strategic planning "will place any organization in the top tier of healthcare organizations practicing strategic planning nationally." But four practices on the list, arguably the most critical, have proven extremely difficult to implement in the organizations for which I've worked over the years.
1. Establish a unique, far-reaching vision. This is intimately connected to another item on the list, "differentiate from competition." Objectively identifying our organization's differentiating characteristics (in juxtaposition to competitors), strengths, and weaknesses in order to develop a unique, long-range vision is not easy. I still sometimes hear complaints at planning retreats about spending time on visioning. Even more difficult is keeping the vision alive and relevant to engage employees who typically work within a short-term, operations frame of reference every day.
2. Develop focused, dear strategies. Making trade-offs, identifying what to "stop doing," and limiting the focus of work historically have not been strengths of most healthcare organizations. As most mission statements articulate, the healthcare organization exists to provide care to all who need it. Beyond this challenge, how does an organization assess whether it has developed the "best" strategies to address critical issues? We need not only a process by which we periodically evaluate the effectiveness of strategies-giving them enough time to "work," but allowing adjustments and avoiding potentially negative consequences-but more importantly, a culture that allows flexibility and withstands, perhaps even thrives, on change.
3. Structure effective participation. Clinical leadership needs to be integrally involved in every organization's strategic planning process. Although not frequently cited as a strong physician interest or competency, strategic planning cannot drive an organization to success without real partnering with physicians on process, critical issues, vision, and strategy development. …