Strategic Planning: The GPS for Medical Practices and Other Healthcare Organizations

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Strategic Planning: The GPS for Medical Practices and Other Healthcare Organizations

Have you ever tried to navigate an unknown or slightly known territory without a map or GPS?  Well, I have and it was a big mistake! Following an hour of non-value-add (NVA) time in driving around, the wasted gas and getting to my destination late, I made two commitments to myself: 1) my next car would definitely have an in-built navigation system and 2) I will never part with my phone again!

A medical practice without a strategic plan is like someone heading out without one’s GPS.  Strategic planning is the best travel tool to get you to your destination using the most efficient path with the added benefit of avoiding a route with an accident, and the choice to control toll expense.

For many medical practices, strategic planning is not a systematic or consistent business activity though it should be.  Many strategic decisions are made out of sudden external pressures, internal pain- and breaking points (often financial), and random interest in the latest industry fad or trend.  While some of these initiatives may work, no organization should subject the sustainability and viability of its existence to the odds of success akin to that of a spinning wheel game.  Brainstorming ideas, no matter how wild, is a good exercise.  However, the selection and development of those ideas should be informed by the many factors that affect the organization before resources (i.e. money, time and people) are directed towards their advancement.

Understanding strategic planning is important in order to appreciate its necessity and application.  Strategy is the art of devising or employing plans toward a goal or objective.  “Strategic planning is an organizational management activity that is used to set priorities, focus energy and resources, strengthen operations, ensure that employees and other stakeholders are working toward common goals, establish agreement around intended outcomes/results, and assess and adjust the organization’s direction in response to a changing environment. It is a disciplined effort that produces fundamental decisions and actions that shape and guide what an organization is, who it serves, what it does, and why it does it, with a focus on the future.”

There are two major categories of strategic planning:

• Red ocean strategic planning is a protectionist methodology of planning in which an organization is competing in bloody red shark-infested waters of a defined market with defined competitors by incremental improvements or augmentation to the existing business. Horizontal integration of organizations is an example of this.
• Blue ocean strategic planning involves breaking out of the bloody red ocean of competition into relatively uncontested and calmer waters to do something new often in reaction to emerging possibilities in the market.

No strategic plan is viable without the following fundamentals:

• Alignment with the mission, vision, and values of the organization
• Directed towards a clear and defined set of objectives
• The basic purpose serves to sustain and grow the organization
• The plan should reflect buy-in from all key stakeholders
• The plan should have an executive level of sponsorship or ownership, and be incorporated into the operational level of accountability.

Management of the strategic plan is necessary to ensure accountability. To do so effectively, the plan should:

• Reflect an order of priority – keeping in mind the resource intensity and payoff value of each component.
• Reference an execution (operational) plan which includes the KPI- key performance indicators; specific, measurable, attainable, realistic and timely (SMART) goals; robust action items, and a timeline-driven task list.
• Highlight the critical risk and success factors.

In addition to getting an expert to help facilitate strategic planning sessions efficiently, there are many tools that are available to aid successful planning.

• Data analysis – gathering and organization of information about quality measures, volume, market share, service/product line, payer, competition, capacity, local, regional, state and national trends within and outside the healthcare industry etc.
• SWOT analysis – an examination of the organization’s Strengths, Weaknesses, Opportunities for growth and Threats from the external environment.
• PESTEL analysis – an external scan of the Political, Economic, Social, Technological, Environmental and Legal/regulatory environments.
• Force Field analysis – identification of the driving or hindering forces (underpinnings) attributed to the SWOT analysis-derived information.
• Financial analysis – assessment of the organization’s financial health and need based on information contained in the organization’s balance sheet, budget, proformas, as well as cost-benefit analysis, make or buy analysis and the evaluation of access to funds or the capital market.
• Software – many software programs such as ClearPoint Strategy, i-nexus, Envisio, Cascade Strategy etc. are useful facilitative applications that help with both the planning and accountability part of the process.

It is also important to not be misguided by misconceptions about the strategic planning process. It can be done at any time in the life cycle of the practice or organization or business, and it can be conducted at any time in the year. It should reflect a multi-year timeline typically about 3-5 years and be subject to constant review and reevaluation. It should serve as a nimble living document that’s adaptable to the changes from the internal and external factors that informed the plan in the first place.

I bet that you could start your strategic planning exercise as soon as possible simply by conducting a visualization exercise and conduct what is known as a gap analysis.  Hold a roundtable with your staff and ask each to envision the practice or organization that they want to see in the foreseeable future (visualization).  Then the team should be challenged to list the gaps or reasons preventing the attainment of that vision (gap analysis).  Use the information to segue into the other aforementioned tools and continue the strategic planning process.  

Oyinkansola Ogunrinde is the Founder and Chief Practice Transformation Officer of FUNMI Healthcare Consulting, LLC, a consultancy specializing in the management of physician practice and ambulatory services (www.funmihc.com).

References:

Harrison, J.P., Essentials of Strategic Planning in Healthcare. Washington, DC: AUPHA and HAP, 2016. Print.

Kim, W.C., and Mauborgne, R. Blue Ocean Strategy. Boston: Harvard Business School, 2005. Print.

Merriam-Webster, https://www.merriam-webster.com.  Accessed 05 February 2019.

Balanced Score Card Institute, https://www.balancedscorecard.org  Accessed 05 February 2019.

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Clinician Burnout: A Watershed Moment?

Photo by JOHN TOWNER on Unsplash

Physician burnout is not only bad for physicians; it is bad for the rest of the care team, quality of care, patient safety, patient experience, your bottom line and the organization as a whole.

Flying high, there I was again on a flight. However, before take-off, I heard the same line that we’ve all heard a million times over: “Should the cabin lose pressure, oxygen masks will drop from the overhead area.  Please place the mask over your own mouth and nose before assisting others.” It never gets old.

How can clinicians take care of others, if they are burned-out?  Approximately 30 to 50 percent of all clinicians are affected by burnout according to a number of sources.  The challenges in healthcare are not going away, at least not anytime soon.  As such, clinicians must personally find ways to relieve the stress and prevent burnout.  They don’t need to be told about the importance of social and leisure activities outside of work, however, they must learn to put the oxygen mask on first.  These activities should be systematic and if needed, be scheduled rather than taking a “let’s see how this week goes” approach.  As a bonus, this action has the added benefit of erasing that occasional cognitive dissonance some clinicians may feel when advising patients about stress-reduction.

Physicians rank too many bureaucratic tasks; spending too many hours at work; lack of respect from administrators and employers; and increasing computerization of practice atop the list of culprits for burnout.  According to a number of studies, there are big differences between the percent of CEOs, CMOs and COOs, who said they felt that they sufficiently understood the causes of burnout and the percent of the same groups who say that they are sufficiently addressing the problem-reflecting a considerable solution gap.

Understanding the data gives us insight about where to begin.

1) Surveys: Administering surveys that elicit, with some level of specificity, the reasons for burnout is a great starting point.

2) Champions:  Forming a task force or selecting a point person (in the cases of smaller organizations and physician practices) to champion the data analysis, and holding true to the Pareto principle, to identify the relative fewer issues that are usually causing most of the problems.  The same task force or a new committee (one that reflects the workplace diversity – personnel levels, departments, clinical and non-clinical disciplines, and social demographics) or the entire team (for smaller organizations and physician practices) can work on possible solutions.  It is good to assign an executive sponsor to the group in order to give its existence – credibility, its function – accountability and its recommendations – a priority with senior leaders.

Needless to say, understanding the numbers is not enough. The data should be used to inform targeted solutions. Based on the information uncovered, the instruments to facilitate effective and sustainable change could take many forms based on the culture, size, resource, and leadership commitment of an organization.

Change should be infrastructural such as those made to the culture (i.e. blame vs. no blame, teamwork orientation and leadership responsiveness etc.), systems, policies, and processes that allow for a less stressful and more fulfilling workplace.  It should also be person-centered to include solutions like employee welfare assistance programs, stress-reducing work models, training, counseling, therapeutic and well-care health services, professional development and coaching programs.

The solutions would need to be dynamic enough to address the 3 key dimensions of burnout as indicated by Christina Maslach, PhD, a professor of psychology at California, Berkeley who has studied the subject for over three decades:

1) Emotional exhaustion: Feeling fatigued at work or due to work.

2) Cynicism: Developing an indifference or even hostility towards others.

3) Inefficacy: Feeling under-accomplished, ineffective or un-impactful at work.

Many tools are available to help organizations regardless of size and resource to begin to address the issue of burnout.  These include physician survey tools like the Mayo Clinic-developed Physician Well-Being Index (PWBI) or Maslach Burnout Inventory (MBI);  professional organization guidelines like the Institute of Healthcare Improvement (IHI) framework for a healthy healthcare workforce;  training programs and workshops to combat burnout such as those facilitated by the National Academy of Medicine and the American Nursing Association; and many evidence-based interventions like Schwarz rounds, and a myriad of mental health and well-being services.

I bet if you implemented the following recommendation, you’d begin to see improvements especially for items that are considered to be low hanging fruits.  Take an identified problem and then ask “why” until you can no longer provide an answer to the question. Review the “response(s)” to the last “why” for possible change, and if indicated, address the issue with the specific brainstormed solution(s). If no change is indicated, go to the preceding “why” and corresponding “response(s),” and repeat the exercise. This is a Lean-Six Sigma tool known as “5 Whys” and it’s akin to conducting a root cause analysis exercise (RCA).

Oyinkansola Ogunrinde is the Founder and Chief Practice Transformation Officer of FUNMI Healthcare Consulting, LLC, a consultancy specializing in the management of physician practice and ambulatory services (www.funmihc.com).

References:

George, M., Rowlands, D., Price, M., and Maxey, J. The Lean Six Sigma Pocket Toolbook. NewYork: McGraw-Hill, 2005. Print.

Norton, J., West, P., Gee, P., Krusie K., Boissy, A., Rehm, S., Williams, M., Putnam, T., and King, N. “Fighting the Fire of Burnout in Healthcare” Frontiers of Health Services Management, vol. 35, no. 2, Winter 2018.

Peckham, C. “National Physician Burnout & Depression Report 2018” Medscape, January 17, 2018, http://www.medscape.com. Accessed 12 December 2018 and “Physician Lifestyle & Happiness Report 2018” Medscape, January 10, 2018, http://www.medscape.com.   Accessed 12 December 2018.

Thew, Jennifer. “Beating Clinician Burnout” HealthLeaders Media, April 2017, 11-21.

Van Dyke, Maggie, “Battling Clinician Burnout: Fighting the Epidemic from Within” Healthcare Executive, January/February 2019, 10-19.

The Practice Management Bookie: Intro

As we begin the new year, I am optimistic and excited about all that healthcare will bring.  To remain viable, one must boldly meet the challenge. I hope that I can be of assistance to physician practices and ambulatory outpatient centers; joining you all in partnership as you take on this monumental task whatever it looks like specifically for your enterprise.  In addition to the full complement of consulting services ( i.e. project planning & oversight, project implementation, retained advisory resource, and interim administrative management) that FUNMI Healthcare already provides,  a thought leadership blog: “The Practice Management Bookie” will be introduced this year.  The Monthly 2nd Thursdays – release blog will provide a high-level, yet insightful and actionable 5-10 minute-read information that is pertinent to physician practice and outpatient or ambulatory center management.  I bet that you will find the content highly valuable and useful for the transformation of your organization. Stay tuned!

About FUNMI Healthcare Consulting Blog

The Practice Management Bookie Blog: Topics Coming in 2019 

Physician and Clinician Burnout

Strategic Planning for Physician Practices

Managing Physician Practice Staff Performance

Value Based Programs: MIPS and APM

Budgeting and Cost Management for Physician Practice

Revenue Cycle Management for Physician Practice

Patient Experience

Practice Transformation: Telemedicine, NP & PA Utilization, Care-coordination etc.

Using Lean Six-sigma for Process Improvement in your Physician Practice

Regulatory: Fraud/Abuse/Compliance/Stark Laws  

On the horizon: Direct Primary Care, Medical Marijuana, Community Partnerships etc.

Opening/Starting Your Medical Practice

“Transforming the delivery of healthcare through effective & efficient operational management, financial management and growth strategies in a targeted and pragmatic way that results in foundational, substantive and sustainable solutions for medical practices and outpatient centers”