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.”