Strategic Planning Toolkit - WordPress.com · strategic planning. The information in this toolkit...

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Strategic Planning Toolkit

Creating a framework for change


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Table of Contents Introduction ............................................................................................................. 3

Overview ................................................................................................................ 3

Who should use this toolkit? ............................................................................ 4

Tools ........................................................................................................................... 4

Roadmap/Workflow ........................................................................................... 4

Templates .............................................................................................................. 5

Preparatory Work for a Strategic Planning Process ............................... 5

S.W.O.T. Analysis .............................................................................................. 9

Gap Analysis ..................................................................................................... 13

Prioritization Table ......................................................................................... 17

Detailed Action Plan ...................................................................................... 20

Internal Assessment ...................................................................................... 23

Measurements of Success ............................................................................ 26

Case Studies/Examples ................................................................................... 28

Links to Evidence and Resources .................................................................... 30


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Introduction A strategy is an overall approach, based on an understanding of the broader context in which you function, your own strengths and weaknesses and the problem you are attempting to address. A strategy gives you a framework within which to work; it clarifies what you are trying to achieve and the approach you intend to use. Strategic planning is the overall planning that facilitates the effective management of a process. Strategic planning takes you outside the day-to-day activities of your organization or project. It provides you with the big picture of what you are doing and where you are going. Strategic planning gives you clarity about what you want to achieve and how to go about achieving it, rather than a plan of action for day-to-day operations. Strategic planning enables you to answer the following questions:

Who are we? What capacity do we have/what can we do? What problems are we addressing? What difference do we want to make? Which critical issues must we respond to? Where should we allocate our resources? What should our priorities be?

Once these questions are answered, it is possible to answer the following:

What should our immediate objective be? How should we organize ourselves to achieve this objective? Who will do what when? How do we know we have been successful?

Strategic planning is hard to do well. Often when done it leads to lengthy, jargon-filled documents that gather dust on office shelves. They are rarely the living documents that help give meaningful direction to decisions. The aim of this toolkit is to demystify the term strategic planning, to highlight principles for how to do it well and to identify some useful tools to use to make strategic planning become more meaningful and achievable. Overview This toolkit provides a model for guiding an organization through a strategic planning process. It covers the background issues that need to inform or direct the strategic planning process, the resources needed to address those issues, the strategic actions that must be taken by the organization, and finally, it defines what it would mean if the actions were to succeed. It is this strategic framework that gives the activities coherence and direction. We have included practical tools that can be used at any point during a strategic planning process.


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Strategic planning is at the core of the work of an organization. Without a strategic framework it is hard to determine where you really are and how you will get to where is you would like to be in the future. This toolkit offers you a way to complete detailed strategic planning. You can replicate the method in any organization or practice that wishes to embark upon the journey of strategic planning. This document will be a helpful guide for a practice or organization that wishes to make a significant impact.

Who should use this toolkit? This toolkit will help you if you have had only limited experience in planning or in strategic planning. The information in this toolkit is beneficial for those who have not been involved in running an organization, on the planning side of the work or the individuals that realize how important strategic planning is versus just developing strategies. If strategic planning is new, or fairly new to you, then you should find this toolkit useful. You will find this toolkit useful when:

You need to plan strategically as well as operationally You need some ideas to help you create a strategic planning process You begin the planning for a new project or improvement plan You feel you need to review you’re the direction of your practice or

organization

Tools Roadmap/Workflow This toolkit provides health care systems and/or practice leaders and teams with the tools needed for strategic planning. Below is an outline of how and when a practice team could use specific tools.

1) Complete the Preparatory Work at least annually, amongst organizational leaders or teams to insure accuracy of information.

2) After completing the prep work, if your practice is in a period of transition, with many blanks to prep work questions or external challenges and demands, complete the SWOT analysis as a first step towards practice transformation.

a. Once your practice’s QI team completes the SWOT analysis, spend another QI team meeting to complete the Gap analysis. Take the list from the Opportunities and Weaknesses (O&W) columns to fill in the “current status” of the gap analysis, using the gap analysis as a framework for identifying your current state vs. the best practice state.

OR


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b. After completing the prep work, if your practice has not seen great changes and developed a clear vision, move on to the Internal Assessment. The internal assessment is specifically for QI teams to determine their internal work and not identify external barriers and threats to their PCMH transformation journey.

3) When the practice QI team has finished their assessments or analysis, it is essential to spend time completing the prioritization table. The prioritization table allows the practice to identify implementation items based on ease of implementation and impact.

4) Use the information gathered for all analyses, assessments and priorities to begin creating a detailed action plan. The detailed action plan should include SMART goals. As always, the QI teams should develop a mechanism for ongoing monitoring of the action plan for progress.

5) Finally, no strategic planning work is complete without a measurement of success. Develop the measurement of success with the implementation of each tool using SMART goals and share the measurements with all employees. Incorporate all measurements into the strategic planning tools created above.

Please remember that not every organization has the same needs. Implementation should not be viewed as rigid, but rather fluid and flexible to the needs of the practice. Write down all of the tools used in this guide and place the written copies in a location that is easy to access for the entire practice, whether that is in the break room on large posters or on a shared drive of the practice’s computer system. QI teams are encouraged to share progress and barriers to strategic planning with the rest of the practice to promote transparency. Templates

Preparatory Work for a Strategic Planning Process This questionnaire will help participants in a strategic planning process to prepare themselves so they can make a useful contribution to the process. Thinking about our organization or practice:

1. What has happened in the past three years in the external environment that could affect our work as an organization/practice? _______________________________________________________________

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2. What are the challenges and threats facing us as an organization/practice in our external environment? _______________________________________________________________

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3. What are the opportunities we should be taking advantage of in the environment in order to:

a. Make us more sustainable as an organization/practice? b. Help us achieve our vision?

_______________________________________________________________

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4. What information do you have that you think is important to share with others in the strategic planning? _______________________________________________________________

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5. What are the important strengths of our organization/practice?

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6. What weaknesses are preventing our organization/practice from achieving its

vision? _______________________________________________________________

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7. Do you think we are clear about our vision, values and mission? Make some notes

about what you think our vision, values and mission are. ______________________________________________________________________

______________________________________________________________________

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______________________________________________________________________

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8. What challenges have we failed to meet in the past two to three years and why have

we failed to meet them? _______________________________________________________________

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9. What challenges have we met well in the past two to three years and what helped us

to meet them? _______________________________________________________________

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10. What is the most important outcome that you would like to see emerging from this

strategic planning process? Why do you think it is so important? _______________________________________________________________

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Practical Application Consider involving team members with a variety of longevity experience within the organization from 2-25+ years. This will provide your practice with more detail and a comprehensive understanding of your current state. Facilitate this activity as a brainstorm and then prioritize the most important to answer the questions above.


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S.W.O.T. Analysis The Strengths, Weaknesses, Opportunities and Threat (SWOT) analysis helps organizations assess issues within and outside the organization. A SWOT analysis is an organized list used for strategic decision making. Consider answering the following discussion questions in the PCMH categories of patient-centered care, team-based approach, integrated and coordinated care, access, self-management support, population and care management. SWOT Defined: Strengths: Characteristics of the business or project that give it an advantage over

others Weaknesses: Characteristics that place the business at a disadvantage Opportunities: Elements that the project could use to its advantage Threats: Elements in the environment that could cause trouble for the

business Discussion Questions and SWOT Diagram Development (45-60 min)

1. What are the current strengths at the practice? What are the current limitations at the practice?

2. What is the one thing your organization did best last year? What do you need to replicate that success?

3. What goal did your team not see accomplishment on last year? What is the single most important thing you can do to prevent the same thing from happening next year?

4. Thinking back on your PCMH transformation thus far what did you struggle the most to accomplish? Has this process been sustained? What still needs to be accomplished?

S.W.O.T. SWOT Diagram: Answering the questions above identify areas of strengths, weakness, opportunity and threats matrix of the current state of PCMH transformation at your practice. Internal – Things that the practice can control; patient feedback, processes, resources, job satisfaction, etc. External – Things you cannot control but impacted and be impacted by; system priorities, healthcare reform, the medical neighborhood, patient population, etc.


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Practical Application As a silent brainstorm/group discussion (45-60 min) complete all four quadrants of the SWOT analysis. List 3-5 key priority areas for QI teams to develop project work around. These priority areas should not only be important to the practice’s patient population, but energizing work that will positively affect your and other’s job satisfaction.

Strengths Weaknesses

Opportunities Threats


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S.W.O.T. Analysis Reflection After completing the SWOT Analysis with your team, use this page to record action items and next steps as well as reflect upon the tool’s execution with your team.

1. List the key priority areas around which the team can develop project work: a. _________________________________________________

_________________________________________________

b. _________________________________________________

_________________________________________________

c. _________________________________________________

_________________________________________________

d. _________________________________________________

_________________________________________________

e. _________________________________________________

_________________________________________________

2. Action Items and Next Steps

Action/Next Step Assigned to Completion Goal Date

Completion Date


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3. Success and challenges using the SWOT analysis

4. Reflect upon lessons learned

5. Additional Research


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Gap Analysis

What is this tool? The purpose of the gap analysis is to provide project teams with a format in which to do the following:

Compare the best practices with the processes currently in place in your organization

Determine the “gaps” between your organization’s practices and the identified best practices

Select the best practices you will implement in your organization Who is the target audiences? The QI Team lead will be the primary individual to prepare this written gap analysis, but the entire Quality Improvement team should be engaged in performing the gap analysis. How can the tool help you? Upon completion of the gap analysis, project teams will have the following:

An understanding of the differences between current practice and best practice An assessment of the barriers that need to be addressed before successful

implementation of best practices How does this tool relate to others? Information from the S.W.O.T. analysis, weaknesses and opportunities will provide the areas of focus to be examined in the analysis. The best practice elements defined in the Best Practice Strategies section can be used to map out the detailed Action Plan for the QI Team. Practical Application With your practice’s QI team, spend 45-60 minutes completing the gap analysis tool, following the instructions below:

1. List the expected evidence-based best practice in the “Best Practice” column

2. In the “Best Practice Strategies” column, list all the steps associated with the best practice process

3. In the column labeled “Status”, document your organization’s practices and describe how they differ from each best practice element. Be specific and include information such as policies, protocols, guidelines, and staffing

4. Use the “Barriers” column to identify barriers that may hinder successful implementation of each best practice strategy. Consider systems, procedures, policies, people, equipment, etc.

5. Indicate in the “Implement” column whether your organization will implement the best practice strategy. If not, explain why

6. Repeat steps 2-4 for each best practice


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Project: Practice: Individual Completing this Form:

Best Practice Best Practice

Strategies Status Barriers

Implement (Yes or No)


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Gap Analysis Reflection After completing the Gap Analysis with your team, use this page to record action items and next steps as well as reflect upon the tool’s execution with your team.

1. What was your team’s reaction to the number of or types of gaps identified?

2. How will your team work to prioritize and address gaps?



Completion Date


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4. Success and challenges using the gap analysis




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Hig

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Prioritization Table Practical Application Take the “current status” list from the Gap Analysis and/or the “ignoring” or “dreams” lists from the internal assessment and put each item on a sticky note. Place the items within a quadrant based on ease of implementation or impact. Consider the practice’s priorities minimally over a 12-month time period, including items that have yet to begin.

Implement Challenge If the task has high benefit and has low effort to implement, list here:

If the task has high benefit and has higheffort to implement, list here:

Possible Kibosh If the task has low benefit and has low effort to implement, list here:

If the task has low benefit and has higheffort to implement, list here:

Low Effort High


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Prioritization Table Reflection

After completing the Prioritization Table with your team, use this page to record action items and next steps as well as reflect upon the tool’s execution with your team.

1. How does your team plan to address the high priority items?

2. What was the reaction to items in the “Kibosh” quadrant?



Completion Date


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4. Success and challenges using the prioritization table




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Detailed Action Plan

Day-to-day activities being planned out is called an action plan. Without a strategic framework, you don’t know where you are going or why you are going there! Without an action plan, it is likely that the strategic plan will remain a grand dream that is not put into action. This tool aims to help you do detailed, useful action planning and takes the QI Team through a process that could be replicated for various projects or across a system. Useful action planning, located within a clear strategic framework, helps your improvement team to make a significant impact. Action planning is the process that guides the day-to-day activities of an organization or practice. It is the process of operationalizing your strategic objectives. Most action plans consist of the following elements:

Expected results, a statement of what must be achieved by the strategic planning process

What to do, a spelling out of the steps that have to be followed to reach this objective

Deadline information, some kind of time schedule for when each step must take place and how long it is likely to take

Accountability structure, a clarification of who will be responsible for making sure that each step is successfully completed (who)

Monitoring in the context of action planning is the ongoing assessment of how an organization or project is performing against its action plans. Monitoring in the action plan context addresses questions such as:

Are objectives being achieved within the timeframes set?

Are resources being efficiently and effectively used?

Are we doing what we said we would do and if not, why?

Are individuals meeting their objectives?

Monitoring should be an internal function. It should be done continuously, which helps those in leadership positions determine whether the organization or practice is implementing its action plan effectively and efficiently. It helps them learn from mistakes and it helps management or leadership take corrective action when necessary.

Practical Application Using your QI team’s information from the prioritization table, begin with the items listed in the “implement” section. Each implement item should be its own focus area of the detailed action plan. Be certain every focus area is specific, measurable, achievable, realistic and time bound (SMART) with a person assigned to do a specific task by a specific date.


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Action Plan Reflection

After completing the Detailed Action Plan with your team, use this page to record action items and next steps as well as reflect upon the tool’s execution with your team.

1. Success and challenges using the action plan




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Internal Assessment

Most, if not all organizations or practices undergoing PCMH transformation have multiple priorities they are working on. How do practices know if they are duplicating work and if their day to day actions match the practice’s strategic plan? An internal assessment is required for practices to get a pulse of what they are working on and reprioritize work as necessary.

Practical Application Similar to the SWOT Analysis, as a silent brainstorm/group discussion (45-60 min) complete all four quadrants of the internal assessment.

Proud Burdens

Ignoring Dreams


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Internal Assessment Reflection

After completing the internal assessment with your team, use this page to record action items and next steps as well as reflect upon the tool’s execution with your team.

1. What activities, outcomes or work is the practice currently proud of?

2. What are the burdens experienced by the practice? How do the burdens differ from practice team members?

3. What priorities or work is the practice ignoring that needs to be done?


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4. What dreams or work would the practice like to accomplish in the next 6-12

months?




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Measurements of Success Most, if not all organizations or practices undergoing PCMH transformation have goals of some kind. Often missing in these goals are the measures of success. What will tell us that we accomplished these goals and that it made any difference? Measures of success are the criteria that we believe show the impact of our work. The measures may be quantifiable or qualitative, but they are observable in some way. Without data on what is being accomplished by our deliberate actions, we have little or no foundation for decision-making or improvement. Without data, anyone’s opinion is as good as anyone else’s. “Common knowledge” is notoriously unreliable for decision-making. Measures of success should tell us the following about whether our goals:

achieved the results we expected

produced results we didn’t want or expect

should be changed

should continue (or not)

should be measured in other ways The measures themselves should reflect the purpose, mission, and hopes of the organization or practice. A strategic plan needs measures of success. Without knowing in advance what “success” looks like, it is very difficult to implement any plan. Some plans have measures of success for the whole plan as well as for individual goals within the plan. Establishing measures of success is hypothesis testing. We think that if we do A, then B will happen. We assume there is a cause-and-effect relationship. Establishing measures and then comparing what happened to what you thought would happen is a reality-check on your hypothesis. The resulting data can beg the question, “If this isn’t working like we thought it would, how we should change it, or should we even continue?” The act of identifying measures of success and collecting the data creates a common language and set of shared expectations within a working group. When QI teams begin talking in concrete, measurable terms about success, it becomes very quickly apparent whether or not people are thinking in the same terms. Practical Application Using quantitative and qualitative measures from multiple perspectives including staff, provider and patients, develop measures of success. Write them down, create a plan for monitoring progress towards measures, share measures with the entire practice and celebrate achievements!


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Measuring Success

A strategic plan and internal practice assessments can only be successfully if there is a clear measurement of success. Use the table below to determine measurements of success. Be certain to complete both the internal and external perspectives section.

1) Complete the internal perspective section by asking the entire practice staff how they know they have achieved “success.” These should be SMART goals and can use quantitative data such as clinical quality measures, decreased cycle times and more efficient processes within the practice.

2) Complete the external perspective section by asking patients and the community what successes they would like to see in the practice. Using patient experience surveys, patient advisory boards or focus groups, ask patients what activities and outcomes would need to occur for the patients to score the practice higher in various topic areas.

Internal Perspective

Where must we excel?

External Perspective

How do patients and the community view

us?


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Case Studies/Examples Primary care practices are faced with numerous competing priorities in the current health system. They are faced with trying to balance administrative activities while also providing comprehensive and quality care to patients. Practices are using patient-centered medical home recognition programs as a framework for transformation. For many of these practices after they have applied and been recognized they are faced with a decision point. As the quality improvement coach at one practice, the need was identified for strategic planning to focus efforts on activities that will improve care built off the work they have already done, and concentrate on future action toward areas the practice could effect. To introduce strategic planning, we worked with the practice to identify a multi-disciplinary team that included representation from each role at the practice and both formal and informal leaders. We chose to use the SWOT analysis tool for this strategic planning exercise. Each team member personally answered each of the following questions individually and then reported their answers to the rest of the group:

1. What are the current strengths at the practice? What are the current limitations at the practice?

2. What is the one thing your organization did best last year? What do you need to replicate that success?

3. What goal did your team not see accomplishment in last year? What is the single most important thing you can do to prevent the same thing from happening next year?

4. Thinking back on the NCQA application process, what did you struggle the most to accomplish? Has this process been sustained? What still needs to be accomplished?

For each answer the team decided in which SWOT quadrant it belonged, with a primary focus on the things that the practice can control: patient feedback, processes, resources, and job satisfaction vs. the things the practice cannot control, but can impact and be impacted by: system priorities, healthcare reform, the medical neighborhood, and patient population.

Once the SWOT matrix was completed the practice used a consensus voting method to decide their five top priority areas to work on over the next year. These activities were only chosen from the strengths and weakness categories however, they did use the opportunities and threats to drive the conversation toward the best choices. Each role at the practice was given a different colored voting dot; providers and practice leadership outnumbered the staff that were represented. As voting concluded, it was identified that the staff had focused their votes toward patient follow-up on self-management support goals and the sustainability of the self-management support structure at the practice. Although the votes were less than other areas, it was clear it was important for staff and it was chosen as a top priority area.


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Top 5 chosen during Strategic Planning meeting: Population management strategy, evaluation metric, ruler across diseases, patient

dashboard (12 votes) Transitions of care from ED and hospital setting, safe transitions (10 votes) Engage CTAs in team based care, restructure overall team-based care model on pt.

flow (7 votes) Process for providing community resources to patients (6 votes) Follow-up on SMS goals, sustainability of SMS (6 votes)

With the priority areas now determined, the practice had a path for the year to follow. At the conclusion of the strategic planning session, project leaders were identified and tasked to present their topic at the next all staff meeting, find team members, and develop objectives to complete these large tasks in more manageable changes that could be rolled out over time. This activity gave the practice an owned direction that they could support and fulfill.


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Links to Evidence and Resources "How to design an effective content toolkit | Content Strategy Inc." 16 Aug. 2017, www.contentstrategyinc.com/how-to-design-an-effective-content-toolkit/ Sa, C., & Tamtik, M. (2012). Strategic planning for academic research a Canadian perspective. Higher Education Management and Policy, 24(1). Retrieved from http://www.keepeek.com/Digital-Asset-Management/oecd/education/strategic-planning-for-academic-research_hemp-24-5k9bdtj6b0r6#page1 “Section 6: Toolkit Guidance.” AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care, U.S. HHS: Agency for Healthcare Research and Quality, 15 Feb. 2013, www.ahrq.gov/research/publications/pubcomguide/pcguide6.html. Sliverstein, R. (2010). Make SWOT Analysis Part of Your Year End Review. Phoenix Business Journal. Retrieved from http://www.bizjournals.com/phoenix/blog/business/2010/12/make-swot-analysis-part-of-your.html?page=all

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