Question

• The CEO of your hospital asks you to outline a strategic plan for improvement in delivery of nursing services. What information would you gather and who, if any, would you involve in the process?

Answer 1

A strategic plan is a tool that moves your practice toward a goal you have set. However, the definition of a strategic plan differs among different people, according to management consultant Teri Guidi, MBA. Guidi, chief executive officer of Oncology Management Consulting in Philadelphia, Pennsylvania, points out that although there is “no wrong idea” of what a strategic plan encompasses, people often do have misconceptions about it. “Some expect a strategic plan to be precise—it's not. Some think that it will take you forward forever—it won't. The biggest mistake people make is already having the end result in mind when they start.”

Why Do It?

Of all the compelling reasons for your group to engage in strategic planning, perhaps the most critical is the speed at which forces in your environment are changing. “Physicians who try to keep practicing as they have in the last five years will be at a disadvantage,” says Dawn Holcombe, MBA, president of DGH Consulting in South Windsor, Connecticut. “The world swirling around oncologists is changing, and things they may not even know about will affect their practice.”

Engaging in the process of strategic planning has benefits in addition to the plan that comes out of it. For starters, having everyone in the same room fosters collegiality and creates a milieu in which you can focus on the direction of your practice, away from patient care and other duties. In addition, the process promotes the open and creative exchange of ideas, including putting disagreements on the table and working out effective solutions.

Short- and Long-Term Planning

Establishing the direction of your practice and identifying overarching goals provide the foundation for strategic planning, whether short or long term. In the field of health care today, a long-term plan will likely address no more than the next 3 years. After the strategic course is determined in the initial planning session, the group should meet at least annually. During these sessions, the partners should revisit the practice goals, update the environmental assessment with new data, and identify strategies needed to address issues that will arise within the next 12 months. For example, as the retirement of one or more partners approaches, a succession plan may need to be developed (as described in related article on page 136). Meanwhile, growth in patient volume may call for recruitment strategies for both physicians and midlevel providers.

Scheduling a Strategic Planning Session: Who, When, and Where

Just as there is no one way to define strategic planning, there is no single way of doing it. Examples and guidelines are presented here that you may draw on to implement a process that makes sense for your practice.

The decision makers of the practice should be the ones who conduct strategic planning. If your practice is so large that including all partners could make a meeting unwieldy, it might make sense to have a smaller group, such as the executive board, do the planning. In addition to shareholders, you may want physician associates and key managers to participate. Inclusion of individuals who are not partners, at least for some parts of the meeting, may also have advantages. This can foster buy-in to the strategic direction, thereby contributing to the success of the resulting action plan. The oncology group at the Toledo Clinic, a large multispecialty center in Toledo, Ohio, found it beneficial to include the executive director of the clinic. By participating, the director gained valuable insight into the special administrative and practice needs of oncology.

Setting aside at least one day for strategic planning is recommended, especially if this is the first time your group has undertaken it. Distribute an agenda ahead of time, and use a moderator to keep the meeting on track. The location should be comfortable and private. The participants must be able to focus solely on strategic planning, without interruption, so arrange to have patient-related calls covered. Members of the Toledo Clinic used a consultant to guide them through strategic planning, and the consultant facilitated a one-day retreat at a country club. The meeting began around 9 am, after physician rounds, and the nurse practitioners of the group provided patient coverage. Other oncology groups may have conference space available in their office. A half-day meeting can be adequate for groups that have been doing strategic planning for many years.

Starting Point: Mission and Values

Developing a mission statement for your practice—a statement of its basic purpose—is the first step of strategic planning and provides the foundation for the entire process. You may think that putting your mission in writing is a bureaucratic waste of time, but in fact, determining how to articulate your mission is a productive experience. It sets the stage for later prioritization, and the process compels the shareholders to reflect on and express the purpose of the practice. Is providing high-quality care to patients with cancer your entire mission? What about research? Does your practice have a mission to serve the community through education? Answering questions such as these helps spell out the core mission of the group.

Once you succinctly define the mission of your organization, you should develop value statements expressing your core beliefs regarding issues such as patient care, interaction with the community, and how members of the practice work together. In the framework of a traditional strategic plan, the mission statement is concisely expressed in not more than one or two sentences, with value statements articulated separately. However, some organizations combine the mission and values into a narrative of one or more paragraphs. The format used is inconsequential; most important is that your group express the enduring elements of your practice, which will form the foundation on which the practice direction and strategies are expounded.

For a practice that is hospital based or part of a larger organization, the mission and values of the group should be consistent with those of the larger organization. Your group may want to state its own distinct mission or simply adopt that of the larger organization, as did the group of nine oncologists affiliated with the Toledo Clinic. “In practices like ours, which are within a larger organization, it's important to support the larger organization's mission,” says Peggy Barton, group manager. “It could lead to confusion if the broad organization and the practice are going in different directions.”

SWOT Analysis

The SWOT analysis—an assessment of the strengths, weaknesses, opportunities, and threats of your practice—is a staple of strategic planning. This analysis uses a mix of quantitative and qualitative information, most of which should be gathered and analyzed before the planning meeting. The process for gathering information and performing a SWOT analysis varies greatly, and there is no single correct method. The size of the group, the frequency of strategic planning meetings, and how fast changes are taking place both nationally and locally are all significant factors affecting the process.

Internal Assessment: Strengths and Weaknesses

In identifying internal strengths and weaknesses, include hard data such as the number of new consults, cost of drugs per full-time-equivalent physician, and financial reports. It is useful to benchmark aspects of the quality and efficiency of the practice against data on other oncology practices (Sources for Benchmarking Data provides references for locating this information).

If possible, investigate the perceptions of individuals outside the practice—patients, hospital administrators, and referring physicians, for example. A consultant naturally has an advantage in gathering candid assessments from such individuals, unless an anonymous survey is used. How others view the practice can be critical to performing an accurate SWOT analysis, as demonstrated in an experience reported by consultant Guidi. In one practice that had rather long wait times, the physicians believed that the patients did not mind, because “they know that when it's their turn, they'll get just as much attention as the patient before.” But the patients interviewed by Guidi cited long wait times as a top complaint and said they would mention it to others considering the practice for treatment.

Gather qualitative information and opinions from physicians and staff. What do they see as the top issues facing the practice, and what do they consider to be the strengths and weaknesses of the practice? These perspectives can be provided during the meeting, but it is useful to collect information ahead of time, so a larger group can be polled, and anonymity can be assured. Holcombe distributes a questionnaire to solicit information from each physician and also interviews key individuals. Her summary is then reviewed and discussed during the strategic planning retreat.