As a class guest speaker last week for healthcare professionals studying for their Masters in Public Health, I was struck by the difference in opinion between the authors of the class readings on strategic planning and the physicians’ attitudes.  The readings talked about the steps in the strategic planning process and the time-tested nature of strategic planning in many organizations throughout the world.

The physicians in the class felt that strategic planning produced binders that sit on the shelf and that rarely involve out-of-the-box thinking, because they are written by people who work together daily and think alike.  Physicians complained that when they are asked to participate, it is often to bless the plan rather than to contribute to its development in a meaningful way.

The class came together on the need for timely implementation, which can be challenging when physicians look upon long-term planning as several weeks in advance and hospital leaders view it as several years in advance.  When discussing a model for timely implementation, physicians recalled from their residencies the process of daily patient rounds, in which a task list was compiled that contained the task, the deadline, and the individual responsible for getting it done.  As the authors of Crucial Confrontations  wrote, “There is no we in accountability.” 

In the minds of the physicians in the class, committees diffuse responsibility and blur the distinction between discussion and action in the desire to obtain consensus.  Chunking the steps of a long-term process into actionable steps can help if the steps involve outcomes, such as consistently decreasing operating room turn-around time between cases, rather than process measures, such as forming a committee to study a problem.  Transparency and keeping promises are key to overcoming physician skepticism and building trust and respect.

I wonder if another limitation to strategic planning is that the timeframe that it presumes is rapidly shrinking.  Eisenhardt and Sull (”Strategy as Simple Rules.” Harvard Business Review Reprint R0101G, 2001) wrote that in complex environments, strategy should be simplified to seize fleeting opportunities. The rules that they recommended included:

• Jump into the confusion
• Keep moving
• Finish strong
• Build on success
• Learn from mistakes

Creating a safe environment for learning, as discussed in A Vision, may be our only sustainable competitive advantage.  What do you think about the current role for strategic planning:

• Is strategic planning an activity that we should pursue in 21st-century healthcare organizations
• If so, should the process stay the same
• How should we deal with short-term priorities and fleeting opportunities
• Where is the strategic planning process working
• In what ways does the process need to be tweaked for healthcare

As always, I welcome your thoughts

Kenneth H. Cohn
http://healthcarecollaboration.com