So You Think You’re Strategic?

That's why Tersigni pushed to extend Ascension's strategic planning time frame from three years to 15 years. Today, its plan extends to the year 2020. Having a truly long-term plan is key to Ascension's ability to take new ideas, pilot test them, and then implement them across the system. "We have 65 major hospitals and more than 200 delivery sites in 20 states and the District of Columbia. To move large-scale change through an organization of our type does take time," says John Doyle, Ascension's chief strategy officer.

It means tough choices
Making strategic thinking a part of the decision-making process might be easy if leaders had only one or two decisions to make. But every hospital leader has numerous ideas and competing priorities from multiple sources. How do leaders pick which ones to emphasize?

Strategy is about making choices, says David Strand, Cleveland Clinic's chief emerging business officer. And although some leaders might think strategy is all about selecting what ideas make business sense, eliminating ideas can be equally important.

Strand was brought to Cleveland Clinic to make sure growth strategy—and choices—are clear. To this end, he's created a process for ensuring strategy happens continuously. When an idea comes in, Strand and a small group of the organization's leaders evaluate it to determine whether the idea is worth taking to the next phase, in which due diligence is done. The most viable ideas are eventually brought to the growth board, a group chaired by Strand that includes several Cleveland Clinic executives, including the CEO, CFO, chief of staff, and head of marketing.

Once approved by the growth board, ideas are reviewed by people with a variety of expertise including product development, clinical factors, market intelligence, financial planning, and marketing to evaluate it from different vantage points. Through this process, a long list of ideas is reduced to just the most viable ones. "If you have a hundred opportunities that you look at, you might pick one or two that you pursue—not 20," Strand says.

It needs a champion
Strategy should be a continuous process, and therefore a focus of the entire executive team. But it's often not. "A great new idea isn't always great news to people who are already very busy. You've got to build a coalition of people around getting something launched," says James McCaughey, chief strategy officer at Lucile Packard Children's Hospital in Palo Alto, CA.