MAKING STRATEGY REAL
Bryan N. Becker, MD, MMMBecker’s Annual Hospital Review MeetingMay 16, 2014
Objectives• Review Case Study• Understand Structural challenges contemporary
AHC/healthcare environment• Approach to strategy• Steps to making strategy engaging for staff and part of
their work
Case Study• Modest-sized academic health center• Low performer standard quality, outcome, efficiency,
satisfaction, financial metrics• Over-reliance on single payer• Poor physician alignment• Multiple, repetitive leadership transitions• Mission supported in words, not action
Case Study cont.• Strategy
• Minimal strategic planning• None of the traditional strategic planning tools—stop at SWOT
• Organization challenged with• Prioritizing• Implementation and Execution• Cessation of failing activities
Organizational turbulenceTake a Non-traditional approach
• Acknowledge organizational challenges
• Build strategy using various resources
• Leverage mission
Strategy
Value
Revenue and income
Present state
Desired future state
Opportunities• How do you move strategy forward in an unsettled
organization? YOU CAN’T AFFORD TO STAND STILL• How do you move strategy forward acknowledging the
disconnect between structure and activity?• How do you move strategy forward acknowledging the
need to communicate across the structure?
“I have no problems, just opportunities.”Former IU football coach Terry Hoeppner
Implementing strategic intent essential for operational reality
• Tools to develop an appropriate organizational strategy for change are well proven
• Many businesses fail to deliver the strategy they develop
• Usually fundamental business management process is at fault – the bridge between strategy and operation is not functioning
• Various models exist to ensure the machinery between strategy and operational engine are effective:
• Mintzberg’s three step operation• Balanced scorecard• Business management process.
STRATEGIC IMPLEMENTATION
Unfulfilled vision
Challengingvision
No vision
Pedestrianvision
High
HighLowLow
Power of Delivery MethodPo
wer
of S
trat
egy
Pace
Turning Vision into RealityA powerful business strategy needs to be matched by a powerful delivery mechanism in order to turn vision into reality
Source: Alan Meeking, Business Strategy Review, Winter 1994.
To exploit an organization’s capability and potential, the power of its strategy needs to be matched by the power of its delivery mechanism and pace of implementation.
Strategy OperationalEngine
Leverage Mission• Take mission and align strategy around it• Affordable Care Act
• Newly eligible in Primary Service Area• Expand insurance coverage (Marketplace)• Expand Medicaid
New “market”, New competencies, Mission-aligned
Traditional Structure
Network of activity
Communication• Level set mid-management• Common communication venue—Leadership
Development Programs• Focus on behaviors first—UI CARE• Set a common platform• Communicate everywhere--email, forums, newsletters,
video, gallery, social media
People: Strategists and Executors
• Find Strategists• See it, articulate it to make it work• Painful to integrate execution planning, more painful to see strategy fail• Sounding smart is overrated• I am just as responsible for execution as the executor is
• Find Executors and Implementers• Need to be involved in the strategy process early• Relevant and valuable to the strategy process• Know the “whys” behind the strategy• I am just as responsible for strategy as the strategist
• Chasing the Chasm Between Strategy and Execution, HBR Blog Network, Doug Sundheim 08/22/2013
• Explain the choice that has been made and rationale for it• Explicitly identify next downstream choice• Assist in making downstream choice as needed• Commit to revisiting and modifying the choice based on
downstream feedback
Strategy as a Choice Cascade
Value WorkgroupsAlign with Organizational Goals
Circle = Intervention expected to improve Metric
Star = Metric most likely to improve from intervention
Arrow = Intervention may present risk to this metric
Value Workgrou
p
Measurement (Pre-
intervention)
Measurement (Post-interventio
n)
Contact for Data
UI Health Scorecard Domain and Goal
Our Daily Work
Focus Group conducted with staff on unit (8W) by Eve Martinez-Soto
Focus Group conducted with staff on unit (8W) by Eve Martinez-Soto
David Loffing/Eve Martinez-Soto
PEOPLE, FINANCIAL HEALTH, CUSTOMER, INTERNAL PROCESS and TECHNOLOGY, QUALITY and OUTCOMES
More Patients & Their
Convenience
Days Until Next Available Appointment
Visit Volume
Days Until Next Available Appointment
Visit Volume
See Kay Soto for reports
PEOPLE, FINANCIAL HEALTH, CUSTOMER
Financial Success
Point of Service Cash Collections/Total Net Patient Revenue (by clinic)
Point of Service Cash Collections/Total Net Patient Revenue(by clinic)
Diane Ruiz,Caryn Riley
PEOPLE, FINANCIAL HEALTH, LEARNING and RESEARCH, CUSTOMER, INTERNAL PROCESS and TECHNOLOGY
Our Wired Environment
End user survey (pre-intervention) created and available via Survey Monkey
End user survey (post-intervention) created and available via Survey Monkey
John Schreier PEOPLE, FINANCIAL HEALTH, CUSTOMER, INTERNAL PROCESS and TECHNOLOGY, QUALITY and OUTCOMES
People
TBD – {Potentially Employee Engagement Scores)
TBD – {Potentially Employee Engagement Scores)
Teresa Oliszewicz, Mary Jo Smith
PEOPLE, FINANCIAL HEALTH, CUSTOMER, INTERNAL PROCESS and TECHNOLOGY
Access the frontlines• Dialogue with frontline workforce• Bring Data to them• Corroborate and Validate impressions• Seek out and Challenge the Obvious
Ideas and dialogue
Iterative, defining
Align and leverage mission to deliver straightforward message around strategy
OUR DAILY WORK
PEOPLE
Financial Success
OUR WIRED ENVIRONMENT
MORE PATIENTS & THEIR CONVENIENCE
Count the green boxes• Use lessons from
building virtual teams and stay local
• 18 months ago• 2 green boxes
• 12 months ago• 5 green boxes
Today
Lessons Learned• Focus on the Wildly
Important• Act on Lead
Measures• Keep a Compelling
Scorecard• Create a Cadence of
Accountability• Strategy without
Execution is Hallucination
Karl Moore www.Forbes.com 05/31/2012 “Try not. Do or Do not. There is no try.”