Strategic Planning and
Execution
Barry Arbuckle, PhD
President and Chief Executive Officer
MemorialCare Health System
Becker’s Hospital Review
May 16, 2014
“It’s interesting how many organizations do
strategic planning and yet how little value is
considered to be delivered as a result. ”
– Does the process produce a plan that's "real?"
– Does the plan really work for the organization?
– How to know if the plan was deployed…well?
Automotive Industry
Environment Effects on Sales
• 2000-10 Decade
– Employee wages/benefits/pensions
– Emission Standards
• Oil Prices
– 2006 - $62.36
– 2008 - $91.35
• Hummer Sales
– 2006 - 71,524
– 2008 - 9,046
In Process
UC Irvine Health
Partnership
Seven Deadly Sins
Lacks rigor, insight, vision, ambition
or practicality
People not sure how the strategy is
to be implemented
Strategy communicated on a
“need to know”
Some or all aspects lack a specific
person in charge
Strategic leaders send mixed
signals by dropping out of sight
Unforeseen obstacles occur, and
not prepared to overcome them
Strategy all-consuming, details of
day-to-day are neglected
Corboy, O’Corribui, 1999
Strategic Planning
• Both inward and outward focused
• Longer-term, then reel back in
– 3 - 5 years ---> 1
• Involves evaluating and prioritizing among
opportunities to:
– Create superior value for customers
– Differentiating the organization from competitors
– Enhancing the organization’s ability to anticipate
and proactively adapt to pending environmental
change
– Purposeful resource allocation
MemorialCare’s Standard Work
Strategic Planning Cycle
1.Identify a Vision: Share It
• Environmental Assessment
Scenario Analysis
• SWOT
• Financial performance targets
• Operational performance targets
(quality, satisfaction, efficiency)
• Facility, equipment, staffing needs
1
2
5. Update Strategies and
Tactics as Necessary
Mission
Values
Culture
5
Goals
Objectives
Strategies
2. Set a Course of Action
• Leadership Retreat
• Outcomes
• Implementation Plan
•
•
•
•
•
•
•
Balanced
Scorecard
Corrective action and
contingency plans
Updated financial
projections
4.
Measure and
Monitor Results
Performance Reporting:
• Financial
• Operational (outcomes, quality, etc.)
• Organizational learning
• External customers (satisfaction)
4
Financial projections
Capital formation plan
Medical staff plan
Facility master plan
update
Foundation plan
Resource
Allocation
3
3. Implement
• Operations Enhancement
• Leadership Training
• Physician Alignment
• Accountability
• Communication Plan
8 Keys to Success
1. Building a timeline that allows for advanced
education and study
2. Creating a system-wide prioritization process
3. Developing cascading entity planning (Lean
Management System)
4. Linking to the 10-year Financial plan and
budgeting process
5. Incorporation of Kata principles for detailed
initiative planning
6. Use of “90-day cycle thinking” to communicate
system-wide on key progress and next steps
7. Deep Dives for “gnarly issues” and consensus
building
8. Creating linkages into system-wide strategic
marketing for our patients, physicians and staff
1. Building a
Timeline
• Standard
Schedule
– Published, no
surprises
• Example: MemorialCare
– MHS BOD Strategy Retreat - Nov
– Sr. Executive Group Retreat -Jan
– Strategy Committee - Jan
• High level initiatives reviewed & endorsed
• To full Board for approval in January
– Feb-Mar
• Staff development of initiative detail
• Syncing to financial and capital plans
• Campus retreats/development of aligned
local plans
– Apr
• Final version/detail for full Board approval –
Strategy Committee, MHS Board, campus
Boards
– May-Jun
• Finance plan for full Board approval
• Strategic Plan disseminated
– Jul 
• Tracking initiated for each initiative
• Quarterly Strategy Close
MHS Strategy Retreats
History of Action
Affiliations & Alliances • 2013: UCI Health
• 2013: Ambulatory growth
(2012)
Population Health
(2011-12)
• 2013: Roadmap, Seaside
• 2012: Explore Knox Keene
Debt Issuance
(2010)
• 2012: Refinanced debt
• 2011: Researched options
Mergers &
Acquisitions (2008-9)
• 2011: Acquired CHLB
• 2010: Hospital evaluations
• 2009: Roadmap
• 2012: Added IPA
• 2011: Seeded MCMG
• 2008-10: Roadmap
Medical Foundation
(2007, 2009)
2. Creating SystemWide Prioritization
• SWOT
2. Creating SystemWide Prioritization
• SWOT
• Retreat Flow/Culture
– Learning/study/fun!
– Starting Pyramid discussion
– Clarifying and narrowing
• World Café
• Top 5
• Multi-voting, debrief
• Red Dot discussion
– Re-draft, review
The Rules of Dots
• Can’t get more
• No begging, borrowing or otherwise
coercing
• Yours to use or not use
• Colors
–  Green – have to do in next year
–  Yellow – good to do but multi-year or later
–  Red – advise against (or don’t understand)
3. Developing the
Cascading Plan
• Standard Framework - Pyramids
SystemWide
Entity
Key
Processes
• MHS system-wide plan
• Owned by all
• Medical Centers, Medical Foundation,
Health Plan
• Specific focus
• Cascade
• Departments, Key Teams
Definition of Our Terms
• Strategic 5-Year Vision
– A vivid mental image of our future state (years out)
• 3-Year Strategy
– A systematic plan of action that will result in steady movement
toward our desired future state
• Fiscal Year (FY) Initiative
– An act which originates or begins movement toward the
desired future state
• FY Activity
– A very specific action aimed at achieving specific and
measurable “what by when” goals and defining related capital
and operating requirements
• System-Wide
– Initiative that is intended to be deployed across the system,
generally initiated by distributed function leader / executive
• Entity
– Initiative that is intended to be deployed at a campus or other
entity according to their own specific needs
Result
Cascade Example
Putting In the Detail
Focus Area Vision
FY Initiative
What Success Looks Like
Accountable
Planned Activities to Meet Initiative
Target by (incremental deadline
Qtr)
Goal /
Measure
Financial Plan Linkage
4. Linking to 10Year Finance Plan
• 10-Year Plan & Budgeting Process
– Bounding Measures (EBIDA, Operating Margin, cash)
– Detailed Strategic Plan Tracker, answers:
• What Success looks like?
• Who is Accountable?
• Which are the key supporting Activities
• What is the Timeline, Measure, Financial Plan linkage?
Focus Area Vision
FY 13 Initiative
What Success Looks Like
Accountable
Planned Activities to Meet Initiative
Target
Goal/Measures
Completion
Financial Plan Linkage
Explanation of Status, Planning Steps
Market Differentiation & Growth
FIVE-YEAR VISION FOR THIS FOCUS AREA:
MemorialCare will maintain the top position in our communities for market share, financial strength, and brand awareness.
THREE-YEAR STRATEGY FOR THIS FOCUS AREA:
Establish MemorialCare Health System as a market leader with recognized centers of excellence through 1) strategic growth and development of key service lines in each market and 2) effective consumer marketing to the communities we serve.
System-wide focus areas:
D. Explore
 We have identified
regionalized services regionalization opportunities,
completed assessments, and
initiated work to accomplish key
service design changes as
approved
K. Testman,
M. Schafer,
CEOs
(B. James,
C. Capaldi,
W.Dorcheste
rH. Folli)
1) Initiate system leadership Strategy Deep Dive(s) to oversee
regionalization opportunities and identify where further study
warranted (services, COE, ancillary)
2) Engage external unbiased expertise where deemed helpful to
analyze our opportunity/benefit analysis of options (regionalization
/ centralization / partnership / sell or contract)
3) Activate plans for regionalized Imaging and ASC strategy as each
approved
4) Initiate analysis/planning for regionalized aspects of Laboratory
services, and activate as approved (inpatient, Outreach)
5) Analyze opportunities within Centers of Excellence (oncology,
cardiology, other) and make recommendations for next steps
6) If we decide to regionalize, identify resource to oversee
FYE
Completion of
opportunity
assessment,
activation of
approved path
ROI based
ASC $8.0M in FY 13, $2.0M
in FY 14
Imaging $10M in FY 13
1FQ 2FQ 3FQ 4FQ
5. Incorporating
Kata
• Coaching Kata – behavior
or pattern
1. What is the target condition?
2. What is the actual condition now?
3. What obstacles are preventing you
from reaching the target condition?
• And which are you addressing now?
4. What is your next step?
5. When can we go and see what we
have learned from taking that step?
Making Sure We Stay
on Track
• Monitoring
– Ongoing assessment – status, on-track or address
• Bi-weekly Strategy Cabinet (Council), monthly Exec
• Quarterly system-wide roll-up, campus also
• Quarterly – Deep Dives (topical)
– Board receives semi-annual report at mid-year, end
of year, as well as key reports on initiatives and
tactics
• Our Strategy Committee of the Board reviews quarterly
– Their charter calls for anything > $5M, strategic risk vs benefit,
or “just cause we want their input”
– Visibility Board
6. Use of 90-Day
Cycles
Tactic implemented, work
completed, no further action
required (some multi-year,
incorporated in to next FY)
Tactic initiated, work in
progress, status on track for
expected timeframe or
target goal as of this report
Tactic initiated, work in
progress, status not on track
for expected timeframe or
target goal as of this report
Tactic not initiated per
expected timeframe
Tactic evaluated,
determined not to pursue
Tactic initiation deferred, not
yet due as of this report
Sample Report
Ex: FY’14 2FQ Close Review
Market Diff and Growth
Initiative (PG)
Status / Key Updates 2FQ
 Achieve
same store
growth and
membership
acquisition
(TB, CC, MS)
•
•
•
•
•
•
•
Next 3FQ Focus
Onboarded new VP Clinical
Integration & Business
Development (Capaldi)
MHVI clinical integration team
launched (report to S. Close)
Pursue direct to employer
(DTE) opportunities- targets
identified, outreach begun
•
Ensure MHVI work group
targets are met according to
timeline/plan. Determine
approach/timeline for next one
•
Sales team training approach
developed, training held Dec
for 90 staff across the system,
opportunity to cross-sell
Open enrollment plan &
strategy group implemented
Wave Imaging centers deal
closed for 5 centers with
SimonMed, reporting to MCMF,
integration with Next Gen EMR
Lab Outreach evaluation
completed, Deep Dive held,
workstreams launched
•
Host Deep Dive for DTE,
continue to pursue, continue
dialogue with additional
targeted employers
Advance sales team strategy
and measurement tools
Tracking impact of enrollment
campaign
Monitor impact of SimonMed
Evaluate further SCA-Surgery
Center opportunities
Activating Lab Outreach
recommendations
Advance vertical integration
plan – update analysis,
activate prioritized plans for
vertical services (buy/partner)
BD VAT re-initiated, meetings
scheduled for the rest of the FY
to ensure progress
•
•
•
•
•
•
7. Deep Dives,
Gnarly Issues
• Consideration of strategic need
• Taking a time out - shorter retreat
– Focused topic – ex. Population Health roadmap,
shared PHO contracting strategy, employing
specialists, Proton Beam…
– Focused invitees
– Focused agenda
• Report out linked back in to overarching plan
8. Linking to the
Plan
• Communicating 7 times, 7 ways
–
–
–
–
–
System-wide webcasts, videos and publications
Manager and staff evaluations
Long term comp objectives
Staff User-Friendly plan
Available on intranet
Designing a
Strategic Planning Framework
+

• What makes this work?
– Plans key
implementation steps
– Accountability clear
– Monitoring progress
– It’s… Standard Work
8 Keys to Success
1. Building a timeline that allows for advanced
education and study
2. Creating a system-wide prioritization process
3. Developing cascading entity planning (Lean
Management System)
4. Linking to the 10-year Financial plan and
budgeting process
5. Incorporation of Kata principles for detailed
initiative planning
6. Use of “90-day cycle thinking” to communicate
system-wide on key progress and next steps
7. Deep Dives for “gnarly issues” and consensus
building
8. Creating linkages into system-wide strategic
marketing for our patients, physicians and staff
Encouraging Creativity
Innovation is a GOOD thing!