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The Fewer, the Better

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When Beebe Medical Center in Lewes, Del., was surveyed for a state quality award a few years ago, hospital leaders took one particular piece of feedback to heart: Get focused. The 135-staffed-bed coastal facility had added so many goals to its strategic plan that administrators could hardly find the forest for the trees. In addition to business goals, the list included The Joint Commission’s national patient safety goals and a host of other minutiae. “It’s easy to get distracted, because there are so many things to be concerned about,” says Jeffrey M. Fried, president and chief executive officer. “But if we want all of our departments and everybody in the organization to be on the same page with us, we can’t give them a plan that’s got 57 goals.”

Beebe’s leadership made a conscious decision to de-clutter the hospital’s strategic focus by prioritizing and narrowing goals down to a “vital few”—safety, quality, customer satisfaction, financial performance and access to care. But Beebe is not alone in its efforts to clarify its mission. “Gradually, healthcare leaders’ strategic goal-setting is becoming sharper,” says Alan Zuckerman, president of the Philadelphia-based consulting firm Health Strategies & Solutions, Inc. As targets decrease in number, he says, they become more measurable and more far-reaching—two must-have traits for any effective healthcare organizational goal.

Leaders of healthcare organizations in need of a strategic overhaul will find that winnowing the scope of their plan may cause growing pains as some popular initiatives garner less attention. But the resulting clarity can go a long way toward putting adequate resources in place and establishing the measurability and accountability that are necessary for vision to become reality.

The narrow way

So when you’re slicing 57 goals down to a handful, how do you determine what lands on the cutting room floor? For 70-hospital Catholic Health Initiatives, much of the decision hinges on simplicity. The Denver-based system’s four main goals—people, quality, stewardship (changed from “performance” in 2006) and growth—are broad concepts that are easily grasped. “The four goals have resonated across the system,” says John DiCola, senior vice president of strategy and business development. “People get that they are our areas of focus, and that’s given us greater organizational focus.” The core goals are supported by 14 more specific objectives that clarify how each goal is defined.

When good ideas abound, the challenge for senior management is to pinpoint which ones will have the most traction for advancing strategy, says DiCola. Leadership must also learn to say “no” and take things off the table. One tough decision for CHI in 2006 was to remove technology from its list of main goals—a decision Beebe made as well. Technology was elevated in status a few years ago at CHI to emphasize the importance of investing in information, says DiCola. But despite valid arguments on both sides of the issue, technology eventually came to be seen as an enabler for the other goals. “We didn’t want information to take on a life of its own apart from the other core strategies,” he says.

Part of the challenge of minimizing goals is maintaining accountability. Assigning responsibility to individuals is crucial, says Zuckerman. “It’s hard to know exactly who’s responsible when you delegate something to a committee,” he says. Remember, too, that accountability follows measurability. Bad goals often start with verbs, Zuckerman says. “If you have a goal that says ‘improve quality,’ the question is ‘How much?’ If it’s improved at all, the goal has been accomplished.”

Many organizations turn to incentive programs to encourage leaders and employees to do their part toward meeting targets, but without clearly defined parameters, incentives are meaningless. At one point, Beebe’s employee incentive program took on the form of an entitlement program. “For a couple of years, an incentive was paid regardless of how well we hit our goals,” says Fried. When one year passed with no goals being fulfilled, the leadership team got employees’ attention by paying out no year-end incentives. Now the hospital’s goals are clearly tied to performance in the minds of employees.

Making it happen

As an organization crafts its plan, two things should be considered: who will be involved in determining goals and whether those individuals are prepared for the task. “As many people as necessary—not as possible—should be at the table when developing the organization’s strategy,” says Brian K. McDonald, president of the Jackson Harbor Group consulting firm in Green Bay, Wis.

CHI uses several levels of conversation for goal formation. A planning committee of three board members and individuals from outside the organization serves as the core group, which expands into a steering committee by adding 20 to 25 executives from the system’s regions before the board votes on the final version.

To maximize engagement in the process, put some effort into laying the ground work for participation. “Send participants review information that is as provocative as possible without being impractical,” says McDonald. Then, give them time to take it all in, even if that means opting for a retreat setting. “Leaders are busy running operations and carrying out more tactical activities, and when you ask them to step back and think about the future, it takes a little time to engage them in strategic discussion,” he says.

McDonald also recommends seeking input in advance from key employees not directly involved in the decision-making process, then sending preliminary information from strategy meetings back to the broader management ranks for feedback. Early inclusion can expedite culture change efforts around goals later on. “Without a conscious alignment of everyone’s efforts,” says McDonald, “people just keep doing what they have always been doing.”

Kara Olsen is a staff writer with HealthLeaders magazine and managing editor of HealthLeaders Online News. She may be reached at kolsen@healthleadersmedia.com.



Five Goal-Setting Rules of Thumb

1. Don’t blindly adopt system plans as your own. Use it as a framework, but build time into the process for individual hospitals to adjust the strategies for execution in the local market, says Brian K. McDonald, president of the Jackson Harbor Group in Green Bay, Wis.

2. Avoid short-term goals. “Anything you can resolve in a year or 18 months is probably operational and doesn’t belong in a strategic plan,” says Alan Zuckerman, founding partner and director of Philadelphia’s Health Strategies & Solutions, Inc.

3. Plan with your destination in mind. Predicting what an organization will look like in 10 years is a challenge, but don’t get hung up on details that can be honed as you move forward, says John DiCola, senior vice president of strategy and business development for Catholic Health Initiatives in Denver.

4. Do some scenario planning. Topping the list of possible future goals is addressing consumerism. “Considering that high probability, organizations ought to explore the related opportunities and threats,” says McDonald. Looking to other industries’ responses can help.

5. Don’t neglect strategy for the sake of tactics. Even if you’re financially struggling and can barely see the way through the next month, ignoring the bigger picture can only harm the business in the long run.

—Kara Olsen