Building a Strategic Plan
UMHS Strategic Planning and Deployment
April, 2013
Masters Series
What is “Strategy?”
What is a “Strategic Plan?”
1
“Plans Are Useless;
Planning is Indispensible” –
Dwight Eisenhower
2
Why Strategic Planning and Deployment?
• Align people, processes and resources around
common goals and actions
• Create a framework to prioritize effort and
resources
• Create a system to monitor progress and adjust
actions over time
• Strategic planning can happen at any level of an
organization; it is not exclusively for executives
3
Strategic Plan vs. Business Plan
• A strategic plan outlines where an organization is
going and what actions it will take to get there in the
context of its environment and capabilities
• A business plan is more detailed as to how a specific
strategy will be implemented, and always includes
− Projections related to revenue and operating expenses
(“business model” for margin generation)
− Identification of capital investment
− Quantification of return on investment
− Assessment of risks and countermeasures
− More detailed tactics for implementation
4
Strategic Plans Answer 4 Basic Questions
Where Are We Now?
• Current State (SWOT)
Where Should We Be
in the Future?
• Future State (SWOT)
• Environmental Themes
• Opportunities/Gap Analysis
• Goals/Metrics
How Do We Get There?
• Strategy Formation (prioritization,
responsibility, timeline, barriers)
Are We Getting There?
• Strategy Deployment & Metric
Tracking
5
Where Are We Now: Current State
• The current state creates baseline understanding
• The main components typically include strengths and
concerns. A traditional SWOT analysis is useful,
primarily “SW”
• Data & information can be used to help inform the
current state but the focus should not be exclusively
on data (“analysis paralysis”)
− Quantitative
− Qualitative
• Lean tools may also be helpful
6
Where Should We Be In The Future:
“SWOT” Exercise
Strengths
Weaknesses
Opportunities
Threats
7
Where Should We Be In The Future:
“SWOT” Example (2007)
Strengths
•
•
•
•
•
US News and World Report honor roll hospital
Top 10 Medical School (USNWR)
Strong financial position and balance sheet
Leader in NIH funding to medical schools
Depth and breadth of resources afforded by
being part of the University
Weaknesses
• Higher growth rates in government/self-pay payer
segments
• High cost structure threatens patient care margin if
value proposition cannot support premium pricing
• National competition for top faculty; salaries not
matched to market in many specialties
Opportunities
Threats
• Honor roll designation offers opportunity to
leverage reputation at a regional/national level
• More integrated hospital/faculty through
common ownership offers better coordination
and planning across missions
• Recent NIH Clinical and Translational Science
Award (CTSA) grant offers new and expanded
patient care/clinical research synergies
• Continued economic difficulty in Michigan
• Competitors moving aggressively and expanding
geographically to capture privately insured patients
• Competitors entering medical school space (e.g.
Spectrum/MSU; Beaumont/Oakland University)
• Patient care margin pressure in government/selfpay and some private insurers
• Real declines in total NIH research funding due to
federal budget pressures
• Medical education payment reductions
8
Where Should We Be In the Future:
Mission/Vision
• Some choose to have an overarching statement of
the preferred future, others choose to develop
specific mission and vision statements
• Difference between mission & vision
− Mission: Describes what business the organization is in
− Vision: Describes where the organization is headed over
the long term or what it aspires to be
− Missions stand the test of time, visions can change over
time
9
Where Should We Be In the Future:
Goals & Metrics
• Goals are more specific statements of what an
organization aspires to be
• “Goals Grid” a useful tool to articulate and prioritize
goals
Environmental Themes/”OT”
Yes
Preserve
Eliminate
Current State/”SW”
Have It?
No
Achieve
Avoid
Yes
No
Want It?
10
Attributes of Metrics
• Metrics measure whether goals are being achieved
over time
• Good metrics are specific, measurable, attainable,
and replicable over time (SMART)
• Metrics frequently have performance targets that the
organization would like to achieve within a
specified timeframe (e.g. 3 to 5 years)
11
Metrics Exercise
• What are key metrics to measure your project’s
success?
12
How Do We Get There: Strategy
• Once goals are established, strategies and tactics are
developed
• Strategy versus tactic
− Tactics are more specific actions that can be crafted as
projects with responsible people and timelines for
implementation
− Strategies are a collection of tactics that are thematically
similar
• Some get hung up on strategy/tactic nomenclature;
use a more generic term “action” to describe what
needs to be done to achieve goals
13
Strategy/Tactic Formation
• Strategies are best developed using an approach
where actions are brainstormed, then grouped
thematically into strategy statements
• Often by the point of strategy formation, groups
have mentioned many actions that need to be taken
usually by saying “we need to . . .;” this frequently
comes up during SWOT
• Strategies/tactics should be written so that a
responsible party can take them and act upon them
14
Tool for Strategy/Tactic Formation
Brainstorming with Grouping
• All members are given index cards and asked to take
30-45 minutes to brainstorm specific actions necessary
to achieve goals
• Members asked to explain each of the actions they
listed to the group
• After all actions have been shared eliminate duplicates,
combine similar thoughts and group the actions by
theme
• Themes can become strategy statements, the specific
actions can become tactics
15
Strategy Prioritization
• Once a list of strategies and their associated tactics
has been developed, strategies need to be
prioritized
− Resources (time, capital, etc) are finite
• Examples of prioritization criteria
−
−
−
−
−
“Impact”: degree to which goal(s) are furthered
“Leverage”: one strategy can impact multiple goals
Dependencies: cannot do “y” until “x” is done first
Ease of implementation
Financial or other measure of return on investment
16
Are We Getting There:
Strategy Deployment
• The last, but very important, component is
deployment
• Deployment includes a responsible party for each
strategy/tactic and a target date for execution
• In some cases, potential barriers are identified up
front and plans to address them are part of the
strategic plan
• Deployment also includes a management
infrastructure to assess progress over time
17
Strategy Deployment as PDCA
time
“Plans Are Useless;
Planning is Indispensible”
P
Strategic
Planning &
Deployment
P
Strategic
Planning &
Deployment
P
D
A
C
D
A
C
D
A
C
18
Discussion
19
UMHS Strategic Plan
Confidential – Exempt from FOIA
Preliminary And Advisory – For Internal Discussion Purposes Only
Not for Distribution
Preliminary and Advisory – For Internal Discussion Purposes Only
UMHS Strategic Plan Timeline
Sept 2009
Clinical, Research, Education committees launched to assess
current state, recommend goals/metrics, and identify strategies
July 2010
Committee work integrated into a UMHS Strategic Plan; UMHS
leadership prioritizes strategies for deployment teams, queuing
others for future consideration
May 2011
Deployment teams for strategies submit deliverables to UMHS
leadership (ESG) that include recommended tactics, estimated
resources and timelines
July-Oct 2011
To Follow
ESG evaluates deliverables and makes decisions on implementing
strategies & tactics moving forward
Implementation, monitoring against goals, continued
assessment of environment with adjustments as necessary
During this time, UMHS has considered or implemented many tactics congruent with
the overall plan. Additionally, the goal and metric infrastructure to measure UMHS
performance has been continually refined.
21
Confidential – Exempt from FOIA
Preliminary and Advisory – For Internal Discussion Purposes Only
Why Develop a Strategic Plan?
•
Create a roadmap that charts future direction and
compels action in the changing environment
•
Prioritize finite resources – people, money, time –
to maximize return on investment
•
Facilitate institutional alignment around common
goals and strategies, along with ability to monitor
performance and adjust over time
•
Leverage strengths that come from a balanced and
accomplished tripartite mission
22
Confidential – Exempt from FOIA
Preliminary and Advisory – For Internal Discussion Purposes Only
Driven by Our Vision
Create the future of health care
through discovery
Become the national leader in
health care, health care reform,
biomedical innovation
and education
Confidential – Exempt from FOIA
23
Preliminary and Advisory – For Internal Discussion Purposes Only
UMHS in 2020 – Our “20-20 Vision”
• UMHS will be the location of research teams making historic
discoveries
• The Michigan brand and quality will be seen throughout the region
• UMHS will be better known as a national referral center
• The nation will be looking to UMHS as the health system that has
successfully addressed health care costs and disparities
• The educational experience we offer will be unparalleled and sought
after by the brightest students
• UMHS will be providing the most advanced and timely personalized
medicine available anywhere
• Health Systems around the globe will emulate UMHS
Confidential – Exempt from FOIA
24
Preliminary and Advisory – For Internal Discussion Purposes Only
How Will We Get There?
Innovation
Distinctive faculty
Superior quality
Ability to deal
with anything
Confidential – Exempt from FOIA
25
Preliminary and Advisory – For Internal Discussion Purposes Only
What Differentiates U-M?
Bus.
Eng.
Law
Medicine
Nursing
Pharmacy
(Research)
Public
Health
Social
Work
Hospital
-
-
-
-
-
-
-
-
4
12
31
11
5
7
-
-
-
9
Harvard
2
18
2
1
-
-
3
-
2, 8
Johns Hopkins
-
26
-
3
1
-
1
-
1
Mayo Clinic
-
-
-
26
-
-
-
-
3
Stanford
1
2
3
5
-
-
-
-
17
UCLA
14
14
16
13
21
-
10
10
5
UCSF
-
-
-
5
4
1
-
-
7
U-M
14
9
7
10
6
5
4
2
14
3
22
7
2
1
-
-
14
10
UPitt
85
-
71
14
7
19
11
14
12
Vanderbilt
28
37
16
15
15
-
-
-
14
Wash. U
20
49
18
4
-
-
-
1
11
Cleveland Clinic
Duke
UPenn
Source: USNWR Rankings
Confidential – Exempt from FOIA
26
Preliminary and Advisory – For Internal Discussion Purposes Only
What Differentiates UMHS Among AMCs?
• Integrated Structure
The Health System’s academic entities and clinical delivery system
are integrated and commonly owned by the University
• World Renowned Faculty
Our distinguished faculty enable leadership in research, education
and clinical care and advance innovation and complex problem
solving
• Alignment with a Leading University
The number of highly ranked, geographically concentrated schools
associated with biomedical science and or health care delivery is
unmatched
Confidential – Exempt from FOIA27
Preliminary and Advisory – For Internal Discussion Purposes Only
Challenges & Threats
• Health Care Reform
• A more stringent regulatory environment
• Unfavorable state demographics
• Consolidation and integration of hospitals & physicians
• Increasing competition for patients, including threats to our
referral base, which comprises 2/3 of our business
• Increasing competition for limited research dollars, top faculty
and students
• Economic Reality: By the end of the decade, UMHS may be
faced with a $100M-$200M annual “gap” in our clinical margin
alone
Confidential – Exempt from FOIA
28
Preliminary and Advisory – For Internal Discussion Purposes Only
Formula For Success
Clinical
Margin
(+)
Research
(investment)
(-)
Biomedical &
Medical
Education
(investment)
(-)
Philanthropy
(+)
Investment
Income
(+)
Cash to
Invest in
our
Future
• Research and education investments are highly dependent
on ability to generate clinical margins
• Clinical margins are dependent on distinguishing ourselves
with robust research and education programs
29
Confidential – Exempt from FOIA
Preliminary and Advisory – For Internal Discussion Purposes Only
Positioning for Future Success:
The UMHS Strategic Plan
Confidential – Exempt from FOIA
30
Preliminary and Advisory – For Internal Discussion Purposes Only
UMHS Goals
• Create the ideal patient care experience
• Attain market leadership in key areas
• Generate margin for UMHS investment
• Translate knowledge into practices and policies that improve
health and access to care
• Engage in groundbreaking discovery and innovative scientific
collaboration
• Cultivate an interdisciplinary, continuous learning
environment
• Promote diversity, cultural competency, and satisfaction
among faculty, staff, and students
Confidential – Exempt from FOIA
31
Preliminary and Advisory – For Internal Discussion Purposes Only
Our Strategic Platform
Translational Medicine
Ideal Patient Care Experience
Integrated Research
• High-Potential Scientific Intersections
• Discovery Research Into Clinic
• Enabling Research Infrastructure
• Build and Maintain Research Workforce
Clinical Programs
• Michigan Market Leadership (Children
Novel Delivery Models
• Clinical Partnerships
• ACO/Population Management
& Women’s, Cancer, Transplantation)
• High-Complexity Patients
• Destination Programs
Enterprise-Wide Learning Architecture
Diversity/Health Equity
Institutional Enablers
Integrated Information Technology, Funds Flow/Faculty Effort, Payer Contracting
Confidential – Exempt from FOIA
32
Preliminary and Advisory – For Internal Discussion Purposes Only
Research Strategies
Translational Medicine
Basic Science
Novel & Targeted
Diagnostics /
Therapeutics
Clinical Delivery
System
Ideal Patient Care Experience
Integrated Research
• High-Potential Scientific Intersections
• Discovery Research Into Clinic
• Enabling Research Infrastructure
• Build and Maintain Research Workforce
Future of
Health Care
Clinical Programs
• Michigan Market Leadership (Children
Novel Delivery Models
• Clinical Partnerships
• ACO/Population Management
& Women’s, Cancer, Transplantation)
• High-Complexity Patients
• Destination Programs
Enterprise-Wide Learning Architecture
Diversity/Health Equity
Institutional Enablers
Integrated Information Technology, Funds Flow/Faculty Effort, Payer Contracting
Confidential – Exempt from FOIA
33
Preliminary and Advisory – For Internal Discussion Purposes Only
Advancing the Research Enterprise
Today – FY12
5 years – FY17
• Heavy R01, individual
investigator research portfolio
• Diversified research portfolio,
rich blend of team and individual
• Distributed infrastructure
(PI/Department-based)
• Coordinated, streamlined
enterprise-wide infrastructure
• Individual investigator-driven
interdisciplinary collaborations
• Strategy-driven cross-unit
collaborations
• Pockets of entrepreneurialism
• Ecosystem of entrepreneurialism
• Budding public-private
partnerships
• Robust public-private
partnerships
Confidential – Exempt from FOIA
34
Preliminary and Advisory – For Internal Discussion Purposes Only
Research Enterprise Strategic Plan
Right
Mechanism
Right
Target
Right Therapy
for the Right Patient
Discovery
Translation
Personalized Medicine
Novel Mechanisticbased Research
Novel Biomarkers
& Targets
Novel Targets
Novel Therapies
Novel Therapy
Effective Health
Outcomes
Creating the
future of
health care
through
discovery
• Improve treatment
• Impact society
• Define new health policies
Confidential – Exempt from FOIA
35
Preliminary and Advisory – For Internal Discussion Purposes Only
Research Enterprise Strategic Plan
E
N
A
B
L
E R S
Research Board of Directors
Confidential – Exempt from FOIA
36
Preliminary and Advisory – For Internal Discussion Purposes Only
Clinical Strategies
Translational Medicine
Ideal Patient Care Experience
Integrated Research
• High-Potential Scientific Intersections
• Discovery Research Into Clinic
• Enabling Research Infrastructure
• Build and Maintain Research Workforce
Clinical Programs
• Michigan Market Leadership (Children
Novel Delivery Models
• Clinical Partnerships
• ACO/Population Management
& Women’s, Cancer, Transplantation)
• High-Complexity Patients
• Destination Programs
Enterprise-Wide Learning Architecture
Diversity/Health Equity
Institutional Enablers
Integrated Information Technology, Funds Flow/Faculty Effort, Payer Contracting
Confidential – Exempt from FOIA
37
Preliminary and Advisory – For Internal Discussion Purposes Only
Health Care Leaders of the 21st Century
Right
Diagnosis
Right
Treatment
Right
Time
Right
Place
Creating the
future of
health care
through
discovery
UMHS will continue to be the referral center of choice, working
with partners to:
• Keep local care local
• Enhance local capabilities
• Ensure that patients who need to leave their local
communities for care come to UMHS
Confidential – Exempt from FOIA
38
Preliminary and Advisory – For Internal Discussion Purposes Only
Clinical Partnerships –
Market Prioritization Overview
Tier A (Green)
Strongly support UMHS'
strategic goals
Tier B
Offer some strategic goal
support; evaluate
opportunities as they present
themselves
Tier C (Gray)
Note: Evaluation of markets is
relative to other Michigan markets
Offer least degree of support
for UMHS' strategic goals
Confidential – Exempt from FOIA
39
Preliminary and Advisory – For Internal Discussion Purposes Only
ACO / Population Management Strategies
Key Tactics
• Maintain status as a national leader in ACO operations
and policy
• Participation in the CMS Pioneer ACO Model
• Develop a statewide initiative (MiPCT) to coordinate care
for Medicare recipients
• Develop plans for local and statewide Blue Cross
Organized Systems of Care (OSC)
• Leverage market experience with potential partners
• Create a statewide ACO with selected physician
organizations through POM and possibly Pennant
Confidential – Exempt from FOIA
40
Preliminary and Advisory – For Internal Discussion Purposes Only
Oversight and Accountability
• EVPMA is responsible for ensuring the success of UMHS
through execution of the Strategic Plan
• Executive Strategy Group (ESG) is responsible for
oversight and monitoring progress to the plan:
–
–
–
–
•
Assigns accountable leads for strategies and continuously
monitors implementation
Identifies infrastructure support necessary for success
Removes implementation barriers as they arise
Monitors metrics regularly to assess organizational
progress against goals, adjusting strategies as necessary
All leaders will be responsible for facilitating progress
and implementation
Confidential – Exempt from FOIA
41
Preliminary and Advisory – For Internal Discussion Purposes Only
Expectations of Leadership
• Share your ideas for how we can improve the plan
• Ensure that all decisions advance our goals and
strategies
• Communicate and talk about the plan
• Build consensus and alignment
• Own it!
Confidential – Exempt from FOIA
42
Preliminary and Advisory – For Internal Discussion Purposes Only
Summary
• The UMHS Strategic Plan is our roadmap for
strategic action and positions us well to respond
to the changing environment.
• We must act decisively and assertively, but also
be nimble.
• With proper execution, we will ensure our
success for years to come.
Confidential – Exempt from FOIA
43
Preliminary and Advisory – For Internal Discussion Purposes Only
Discussion
Confidential – Exempt from FOIA
44