4 Ways to Refocus Your Strategic Planning

Think back to 2008. A huge recession was upon us, brought about by a series of events for which healthcare shouldered no blame. But like the rest of us whose lives were turned upside down by the event, healthcare was suffering.

Low patient volumes, a locked up debt market and a suddenly overstaffed workforce (based on substantially reduced inpatient volumes) were only a few of the major problems confronting senior leaders in healthcare.

The emphasis then was on the now, and many senior leaders told us in our annual HealthLeaders Media Industry Survey that they were forgoing strategic planning for the time being. This step seemed a prudent one, as many of the assumptions senior leaders once used to build a successful long-term strategy seemed not to apply anymore. At least, there were more pressing problems to solve.

But it's not a smart move to continue to lag in strategic planning. If you cut back on strategic planning via layoffs or by moving employees to other tasks to focus on immediate concerns, now's the time to rebuild, if you haven't already done so. Big changes are coming not only to the reimbursement system, but also in the ways healthcare organizations must evolve to change their care delivery methods. You can't make those moves without a well-thought-out, deliberate plan.

I thought I would revisit this topic in an attempt to learn how one of the best organizations seeks to ready itself for the future, and that led me to Danville, PA-based Geisinger Health System, which stakes its reputation as an innovator in being able to spot trends and improve the health of the communities they serve.

Of course, while much of that reputation depends on the quality of the clinical care delivered at Geisinger, we've already seen that patients can't necessarily distinguish between a good and a poor clinical experience. They certainly are much more adept, however, at distinguishing between healthcare providers that waste their time versus those that don't and between systems that are convenient versus difficult to deal with.

At Geisinger, much of the work in determining access points and the necessary investment in those access points is done through the strategic planning team.

Thomas Charles, Geisinger's vice president of strategic planning, says there are four basic components to the system's strategic planning efforts:

1. The market: This is what most people think about when they think about strategic planning. It involves the surveying of the external environment and your facility's place in it. Geisinger strives to be the glue that ties together a patchwork quilt of healthcare options for the community, says Charles, and to do that, it must try to work in concert with physician groups, allied healthcare providers, and even other acute care hospitals to make sure that patients can access quality care close to home. It may serve as some comfort to learn that even a multidimensional, nationally known health system can't do it on its own.
   
   "Because of our integrated structure, we can offer a full continuum in many communities," Charles says. "But expanding that to include our partners as well is important because we see that as a fundamental mindset in terms of providing care to populations."
   
   Geisinger is active in 31 counties, with a hospital in Wilkes Barre, the flagship medical center in Danville, and large ambulatory facilities in State College. "Those are our three hubs but we have partners in a broad geography," Charles says. "Because of how dispersed we are, we interface with a lot of other providers."

For example, Geisinger, says Jackie Paul, senior vice president of strategy and business development, works on program development together with a couple of institutions which in the past could have been considered strong competitors. But now, "our specialists go there and work in their institution to work on procedures," she says. "Those are planned together based on their need, and where we have the capacity to help, we do."

2. Quality: Geisinger is focusing on quality care as the movement toward paying for quality accelerates, says Charles.

"This movement toward paying for outcomes to population health management to figuring out ways to deliver care that is high value and convenient are fundamental themes driving our evolution going forward," he says.

A big challenge to quality care is represented in clinician workforce-related trends -- especially with physicians and mid-level practitioners, he says. Across the country, substantial numbers of physicians are late in their careers. Geisinger's strategy on quality reflects the fact that demand for care will continue to increase, which means it may be provided in different settings by people other than physicians.

Also, like other systems, Geisinger is dealing with retirements as well as the new entrants into that part of the workforce who have different (read, less frenetic) perspectives on professional life and personal life balance. All this is a fancy way of saying that today's physicians don't want to be tied to their offices for 60-70 hours a week.

3. Innovation: In this case, the need for innovation stretches to customer service. "If we want to try to keep the care close to home for the patient, how do we work with our community partners, those physicians that are non-Geisinger and community hospitals that are non-Geisinger?" asks Paul, rhetorically. She says her guiding principle is keeping in mind what's best for the patient.
   
   In every part of Geisinger's service area, there are widely different types of care that need to be given for such a wide range of population, she says.
   
   "You can have urgent care centers, community practice sites, acute care, e-visits, and some combination of telehealth, and that's where our group is working with rest of our institution," she says. "What are our strengths in this location? What should it look like? Does it have enough primary care? Does it have enough of a variety of specialists? This kind of planning requires filling in gaps.
   
   "What care is not being delivered that might benefit the patient?" she says. "This is not just about shifting settings."
4. Legacy: This concept might be the most difficult to grasp, as it is the most long-term in nature, says Charles.
   
   "The approach we use as a governing principle is what's in the best interest of the patient and then try to tailor care delivery in way that gets right resources to the patient in best way," he says.
   
   At Geisinger Medical Center in Danville, it makes sense to focus on the highly complex procedures, says Paul. Less complex procedures might make sense for community hospitals or urgent care sites that may or may not have any ownership structure with Geisinger. In the end, say Geisinger's strategic planners, their goal is to support the legacy of the institution as being one focused on the quality of care received by its service area rather than as a big, dominant medical center that simply seeks the most profitable services and leaves scraps for competitors.

So what about results? In the past year alone, Geisinger has recruited more than 120 physicians, and has recently developed the following key programs:

·        Brain tumor institute

·        Epilepsy monitoring unit (linked to its nationally known program for surgical treatment for intractable epilepsy)

·        Expansion of its largest outpatient campus, to include the addition of an ambulatory surgery center, and 54 more physicians over the next five years

"It's not like strategic planning is the reason Geisinger is such an outstanding health system," Paul says. "We're a piece that has smart innovative people involved who are trying to help apply a little strategy, planning, and discipline to make sure all these great things are integrated and we're able to leverage it all so we can change the face of healthcare."

Scott Davis, vice president of consulting and business development with Geisinger, works closely with Charles and Paul in formulating and executing the health system's strategic plan.

"Our process is proactive, evolving not as a static document that sits on a shelf," he says. "We have a constant and tremendous level of assessment and filtering processes to synthesize all that's going on in the market regionally and nationally to provide guidance to our leaders. That keeps care local, nonthreatening, benefits community providers, and aligns us for what we do best, which is quaternary care."