building a strategic plan umhs strategic planning and deployment april, 2013 masters series

Building a Strategic PlanUMHS Strategic Planning and Deployment

April, 2013

Masters Series

What is “Strategy?”What is a “Strategic Plan?”

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“Plans Are Useless;Planning is Indispensible” –

Dwight Eisenhower

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Why Strategic Planning and Deployment?

• Align people, processes and resources around common goals and actions

• Create a framework to prioritize effort and resources

• Create a system to monitor progress and adjust actions over time

• Strategic planning can happen at any level of an organization; it is not exclusively for executives

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Strategic Plan vs. Business Plan

• A strategic plan outlines where an organization is going and what actions it will take to get there in the context of its environment and capabilities

• A business plan is more detailed as to how a specific strategy will be implemented, and always includes− Projections related to revenue and operating expenses

(“business model” for margin generation)− Identification of capital investment− Quantification of return on investment− Assessment of risks and countermeasures− More detailed tactics for implementation

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Strategic Plans Answer 4 Basic Questions

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Where Are We Now? • Current State (SWOT)

Where Should We Bein the Future?

• Future State (SWOT)• Environmental Themes• Opportunities/Gap Analysis• Goals/Metrics

How Do We Get There? • Strategy Formation (prioritization, responsibility, timeline, barriers)

Are We Getting There? • Strategy Deployment & Metric Tracking

Where Are We Now: Current State

• The current state creates baseline understanding• The main components typically include strengths and

concerns. A traditional SWOT analysis is useful, primarily “SW”

• Data & information can be used to help inform the current state but the focus should not be exclusively on data (“analysis paralysis”)− Quantitative− Qualitative

• Lean tools may also be helpful

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Where Should We Be In The Future: “SWOT” Exercise

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Strengths Weaknesses

Opportunities Threats

Where Should We Be In The Future: “SWOT” Example (2007)

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Strengths Weaknesses

• US News and World Report honor roll hospital• Top 10 Medical School (USNWR)• Strong financial position and balance sheet• Leader in NIH funding to medical schools• Depth and breadth of resources afforded by

being part of the University

• Higher growth rates in government/self-pay payer segments

• High cost structure threatens patient care margin if value proposition cannot support premium pricing

• National competition for top faculty; salaries not matched to market in many specialties

Opportunities Threats• Honor roll designation offers opportunity to

leverage reputation at a regional/national level• More integrated hospital/faculty through

common ownership offers better coordination and planning across missions

• Recent NIH Clinical and Translational Science Award (CTSA) grant offers new and expanded patient care/clinical research synergies

• Continued economic difficulty in Michigan• Competitors moving aggressively and expanding

geographically to capture privately insured patients

• Competitors entering medical school space (e.g. Spectrum/MSU; Beaumont/Oakland University)

• Patient care margin pressure in government/self-pay and some private insurers

• Real declines in total NIH research funding due to federal budget pressures

• Medical education payment reductions

Where Should We Be In the Future: Mission/Vision

• Some choose to have an overarching statement of the preferred future, others choose to develop specific mission and vision statements

• Difference between mission & vision− Mission: Describes what business the organization is in− Vision: Describes where the organization is headed over

the long term or what it aspires to be− Missions stand the test of time, visions can change over

time

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• Goals are more specific statements of what an organization aspires to be

• “Goals Grid” a useful tool to articulate and prioritize goals

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Where Should We Be In the Future:Goals & Metrics

Preserve

Achieve

Eliminate

Avoid

Yes

No

Yes No

Have It?

Want It?

Current State/”SW”

Environmental Themes/”OT”

• Metrics measure whether goals are being achieved over time

• Good metrics are specific, measurable, attainable, and replicable over time (SMART)

• Metrics frequently have performance targets that the organization would like to achieve within a specified timeframe (e.g. 3 to 5 years)

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Attributes of Metrics

• What are key metrics to measure your project’s success?

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Metrics Exercise

• Once goals are established, strategies and tactics are developed

• Strategy versus tactic− Tactics are more specific actions that can be crafted as

projects with responsible people and timelines for implementation

− Strategies are a collection of tactics that are thematically similar

• Some get hung up on strategy/tactic nomenclature; use a more generic term “action” to describe what needs to be done to achieve goals

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How Do We Get There: Strategy

Strategy/Tactic Formation

• Strategies are best developed using an approach where actions are brainstormed, then grouped thematically into strategy statements

• Often by the point of strategy formation, groups have mentioned many actions that need to be taken usually by saying “we need to . . .;” this frequently comes up during SWOT

• Strategies/tactics should be written so that a responsible party can take them and act upon them

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Tool for Strategy/Tactic Formation

Brainstorming with Grouping• All members are given index cards and asked to take

30-45 minutes to brainstorm specific actions necessary to achieve goals

• Members asked to explain each of the actions they listed to the group

• After all actions have been shared eliminate duplicates, combine similar thoughts and group the actions by theme

• Themes can become strategy statements, the specific actions can become tactics

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Strategy Prioritization

• Once a list of strategies and their associated tactics has been developed, strategies need to be prioritized − Resources (time, capital, etc) are finite

• Examples of prioritization criteria− “Impact”: degree to which goal(s) are furthered− “Leverage”: one strategy can impact multiple goals− Dependencies: cannot do “y” until “x” is done first− Ease of implementation− Financial or other measure of return on investment

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Are We Getting There:Strategy Deployment

• The last, but very important, component is deployment

• Deployment includes a responsible party for each strategy/tactic and a target date for execution

• In some cases, potential barriers are identified up front and plans to address them are part of the strategic plan

• Deployment also includes a management infrastructure to assess progress over time

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Strategy Deployment as PDCA

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Strategic Planning &

DeploymentP

DA

C

P

DA

C

Strategic Planning &

Deployment

P

DA

C

“Plans Are Useless;Planning is Indispensible”

time

Discussion

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Confidential – Exempt from FOIAPreliminary And Advisory – For Internal Discussion Purposes Only

Not for Distribution

UMHS Strategic Plan

Preliminary and Advisory – For Internal Discussion Purposes Only

Confidential – Exempt from FOIA

UMHS Strategic Plan Timeline

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Sept 2009

July 2010

May 2011

July-Oct 2011

To Follow

Clinical, Research, Education committees launched to assesscurrent state, recommend goals/metrics, and identify strategies

Committee work integrated into a UMHS Strategic Plan; UMHS leadership prioritizes strategies for deployment teams, queuing others for future consideration

Deployment teams for strategies submit deliverables to UMHS leadership (ESG) that include recommended tactics, estimated resources and timelines

ESG evaluates deliverables and makes decisions on implementing strategies & tactics moving forward

Implementation, monitoring against goals, continued assessment of environment with adjustments as necessary

During this time, UMHS has considered or implemented many tactics congruent with the overall plan. Additionally, the goal and metric infrastructure to measure UMHS

performance has been continually refined.



Why Develop a Strategic Plan?

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• Create a roadmap that charts future direction and compels action in the changing environment

• Prioritize finite resources – people, money, time – to maximize return on investment

• Facilitate institutional alignment around common goals and strategies, along with ability to monitor performance and adjust over time

• Leverage strengths that come from a balanced and accomplished tripartite mission



Create the future of health care through discovery

Become the national leader in health care, health care reform,

biomedical innovation and education

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Driven by Our Vision


Confidential – Exempt from FOIA 25

UMHS in 2020 – Our “20-20 Vision”

• UMHS will be the location of research teams making historic discoveries

• The Michigan brand and quality will be seen throughout the region

• UMHS will be better known as a national referral center

• The nation will be looking to UMHS as the health system that has successfully addressed health care costs and disparities

• The educational experience we offer will be unparalleled and sought after by the brightest students

• UMHS will be providing the most advanced and timely personalized medicine available anywhere

• Health Systems around the globe will emulate UMHS



How Will We Get There?

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Innovation

Distinctive faculty

Ability to deal with anything

Superior quality



What Differentiates U-M?Bus. Eng. Law Medicine

(Research)Nursing Pharmacy Public

HealthSocial Work

Hospital

Cleveland Clinic - - - - - - - - 4

Duke 12 31 11 5 7 - - - 9

Harvard 2 18 2 1 - - 3 - 2, 8

Johns Hopkins - 26 - 3 1 - 1 - 1

Mayo Clinic - - - 26 - - - - 3

Stanford 1 2 3 5 - - - - 17

UCLA 14 14 16 13 21 - 10 10 5

UCSF - - - 5 4 1 - - 7

U-M 14 9 7 10 6 5 4 2 14

UPenn 3 22 7 2 1 - - 14 10

UPitt 85 - 71 14 7 19 11 14 12

Vanderbilt 28 37 16 15 15 - - - 14

Wash. U 20 49 18 4 - - - 1 11

27Source: USNWR Rankings



What Differentiates UMHS Among AMCs?

• Integrated StructureThe Health System’s academic entities and clinical delivery system are integrated and commonly owned by the University

• World Renowned Faculty Our distinguished faculty enable leadership in research, education and clinical care and advance innovation and complex problem solving

• Alignment with a Leading UniversityThe number of highly ranked, geographically concentrated schools associated with biomedical science and or health care delivery is unmatched

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Challenges & Threats

• Health Care Reform

• A more stringent regulatory environment

• Unfavorable state demographics

• Consolidation and integration of hospitals & physicians

• Increasing competition for patients, including threats to our referral base, which comprises 2/3 of our business

• Increasing competition for limited research dollars, top faculty and students

• Economic Reality: By the end of the decade, UMHS may be faced with a $100M-$200M annual “gap” in our clinical margin alone

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Confidential – Exempt from FOIA30

• Research and education investments are highly dependent on ability to generate clinical margins

• Clinical margins are dependent on distinguishing ourselves with robust research and education programs

Formula For Success

ClinicalMargin

(+)

Research(investment)

(-)

Biomedical & Medical

Education(investment)

(-)

Philanthropy (+)

Investment Income

(+)

Cash to Invest in

our Future



Positioning for Future Success: The UMHS Strategic Plan



UMHS Goals

• Create the ideal patient care experience

• Attain market leadership in key areas

• Generate margin for UMHS investment

• Translate knowledge into practices and policies that improve health and access to care

• Engage in groundbreaking discovery and innovative scientific collaboration

• Cultivate an interdisciplinary, continuous learning environment

• Promote diversity, cultural competency, and satisfaction among faculty, staff, and students



Clinical Programs• Michigan Market Leadership (Children

& Women’s, Cancer, Transplantation)• High-Complexity Patients• Destination Programs

Novel Delivery Models• Clinical Partnerships• ACO/Population Management

Ideal Patient Care ExperienceIntegrated Research• High-Potential Scientific Intersections• Discovery Research Into Clinic • Enabling Research Infrastructure• Build and Maintain Research Workforce

Basic ScienceNovel & Targeted

Diagnostics / Therapeutics

Clinical Delivery System

Future of Health Care

Translational Medicine

Enterprise-Wide Learning Architecture

Diversity/Health Equity

Institutional EnablersIntegrated Information Technology, Funds Flow/Faculty Effort, Payer Contracting

Our Strategic Platform










Research Strategies








Advancing the Research Enterprise

5 years – FY17

• Diversified research portfolio, rich blend of team and individual

• Coordinated, streamlined enterprise-wide infrastructure

• Strategy-driven cross-unit collaborations

• Ecosystem of entrepreneurialism

• Robust public-private partnerships

Today – FY12

• Heavy R01, individual investigator research portfolio

• Distributed infrastructure (PI/Department-based)

• Individual investigator-driven interdisciplinary collaborations

• Pockets of entrepreneurialism

• Budding public-private partnerships

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Right Mechanism

Discovery

Right Target

Translation

Right Therapy for the Right PatientPersonalized Medicine

Novel Targets Novel Therapies

Novel TherapyEffective Health Outcomes

• Improve treatment• Impact society • Define new health policies

Novel Mechanistic-based ResearchNovel Biomarkers& Targets

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Creating the future of

health care through

discovery

Research Enterprise Strategic Plan



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Research Board of Directors

E N A B L E R S

Research Enterprise Strategic Plan










Clinical Strategies








Health Care Leaders of the 21st Century

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UMHS will continue to be the referral center of choice, working with partners to:

• Keep local care local• Enhance local capabilities• Ensure that patients who need to leave their local

communities for care come to UMHS

Right Diagnosis

Right Treatment

Right Time

Right Place

Creating the future of

health care through

discovery



Clinical Partnerships – Market Prioritization Overview

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Tier A (Green)Strongly support UMHS' strategic goals

Tier B (Yellow)Offer some strategic goal support; evaluate opportunities as they present themselves

Tier C (Gray)Offer least degree of support for UMHS' strategic goals

Note: Evaluation of markets is relative to other Michigan markets



ACO / Population Management Strategies

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Key Tactics• Maintain status as a national leader in ACO operations

and policy• Participation in the CMS Pioneer ACO Model• Develop a statewide initiative (MiPCT) to coordinate care

for Medicare recipients• Develop plans for local and statewide Blue Cross

Organized Systems of Care (OSC)• Leverage market experience with potential partners

• Create a statewide ACO with selected physician organizations through POM and possibly Pennant



Oversight and Accountability

• EVPMA is responsible for ensuring the success of UMHS through execution of the Strategic Plan

• Executive Strategy Group (ESG) is responsible for oversight and monitoring progress to the plan:– Assigns accountable leads for strategies and continuously

monitors implementation– Identifies infrastructure support necessary for success– Removes implementation barriers as they arise– Monitors metrics regularly to assess organizational

progress against goals, adjusting strategies as necessary• All leaders will be responsible for facilitating progress

and implementation



Expectations of Leadership

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• Share your ideas for how we can improve the plan

• Ensure that all decisions advance our goals and strategies

• Communicate and talk about the plan

• Build consensus and alignment

• Own it!



Summary

• The UMHS Strategic Plan is our roadmap for strategic action and positions us well to respond to the changing environment.

• We must act decisively and assertively, but also be nimble.

• With proper execution, we will ensure our success for years to come.



Discussion

building a strategic plan umhs strategic planning and deployment april, 2013 masters series

Documents

strategic plans

strategic plan outlines

time strategic planning

current state swot

business plan

useless planning

traditional swot analysis

swot example