by Stephanie Sargent, MHA, RN, CPPS
Senior Consulting Director, Reliability and Management Systems
In a previous blog, my colleague Shannon Stewart, Vizient senior consulting director, Reliability and Management Systems, shared the story of Alex, the new CEO of a successful health system who inherited a top-down approach for strategic deployment—one that was managed and driven by senior team members. In this model, organizations may initially experience gains (and Alex's did), but without full alignment within all levels of an organization, good management systems and a robust review process, sustained goal achievement is unlikely.
In a subsequent strategy deployment, Alex leveraged a management method that produced enterprise-wide alignment of goals, initiatives, metrics, transparency and bi-directional communication, driving the breakthrough goals and operational outcomes he was seeking.
Here's how Alex was able to apply key tools and techniques of "Hoshin Kanri"—the Japanese strategic planning method also known as policy management—to facilitate strategy execution, create and sustain engagement of all stakeholders and develop review processes that create visibility, transparency and accountability.
In the previous blog, Alex described a disconnect among leaders at all levels, of the organization's vision and the strategic directives. Without a unified understanding of the organization's strategic goals and a system to create alignment, projects and initiatives are chartered and resourced with little-to-no connection with, nor impact on, an organization's overall objectives. It's like a rowboat of employees with no heading coordinates, no compass, no rudder, in rough seas. Some have oars, some not. Some with oars are rowing, some are not. Some are rowing forward, and some are rowing backwards. Where will this rowboat land ashore? No one knows!
Effective strategy deployment begins with ensuring adequate cross-functional resourcing. In a whitepaper Next-Generation Strategic Planning: New Challenges, New Approaches, Sg2 describes, "To guard against misalignment, healthcare strategy teams must be positioned to bring together functions of the health system that interact infrequently. Collaboration with finance helps ensure adequate resources. Ties to marketing reduce the risk of planned failure due to poorly communicated strategy. Sufficient accountability and monitoring necessitate links to operational and service line leaders."
For effective strategy deployment, getting all stakeholders to engage in the development of work at their level that is directly tied to and supports strategic goals is key to strategy execution.
In Hoshin Kanri there is a process known as catchball. Catchball is so named because it involves the communication and exchange of strategy from top down to bottom up across the enterprise. All levels of the organization have a stake in the strategy because they were involved in the development and provided the opportunity to influence the final plan.
Here's an example: the board of directors approved several goals for the organization's strategic plan. Many organizations' strategic plans are categorized by pillars, with several goals and initiatives per pillar. Each pillar is assigned to a senior leader (or champion). The pillar champion "tosses" to the leader at the next level what that leader must do by proposing a set of targets. In turn, this leader "receives the toss" (or set of targets) and responds to the pillar champion with how they propose to hit those targets. After an agreed-to project plan is developed, the leader then "tosses" to the next level leader what that individual must do by proposing a set of targets. This process repeats from tactical teams to operational teams and finally to action teams at the frontline, culminating with a cohesive set of projects that align with and directly support the initiative.
Though the catchball process requires planning, resourcing and engagement, the benefits are worth the investment by:
- Creation of dialogue across all levels of the organization on how the strategy can be practically applied
- Shared ownership being achieved when top-level strategies are adapted at each level based on how each level can contribute to the top-level strategy
- Development and management of leading and lagging indicators that are individualized at each level but linked to the top-level targets. This creates a line of sight across the organization about what is not working.
Management systems support continuous improvement with visual management tools, standard work and management accountability. Typically, scorecards, dashboards or huddle boards are mechanisms by which leaders review status updates on projects with team leaders. If performance is not meeting the targets, an immediate plan is made by assigning a team member to determine the causes and readjust as needed to reach resolution.
It is everyone's job to know what's going on with the health of the initiative in real time. In a robust management system, problems are discovered and solved quickly. A no-blame culture ensures that problem-solving is focused on process-based contributors to the problem.
After the implementation of initiatives, the greatest peril of strategy deployment is drift or "coasting"—where initial gains are not sustained. The backbone of accountability is creating leadership standard work of regular review meetings that focus on measures of process improvement.
A robust reviews process includes use of dashboards where review of metrics objectives creates visibility into performance.
According to Sg2, "A set of metrics should be devised and incorporated into a dashboard or scorecard to simplify ongoing monitoring." Good dashboards:
- Are easy to view and interpret (i.e., use of a color system such as red, yellow, green - to indicate status)
- Display clear owners delineated for each task (both operational accountability and implementation oversight)
- Utilize most up-to-date data sources, including claims data or internal EMR
- Limit metrics to a key view so as not to become overwhelming
As leadership standard work becomes engrained within the fabric of the organization, the daily, monthly, quarterly and yearly reviews become muscle memory and the culture of the organization. The culture of continuous improvement within the organization and a shared mental model of the organization's vision becomes "the way we do things here".
With a new understanding of strategy deployment Alex was able to achieve and sustain his organization's breakthrough goals. Use of Hoshin Kanri provided the tools and methods to create alignment of improvement projects that directly served to achieve pillar targets. Hoshin Kanri, established as a business operating system, creates a consistent standard and sustainable framework for organizations to achieve clinical, operational, and financial goals and achieve performance excellence.
Strategy Deployment assistance is one of the offerings available through Vizient Safe and Reliable Healthcare. Feel free to reach out to me if I can be of assistance.
About the author
Stephanie Sargent, MHA, RN, CPPS, brings over 27 years of experience in the health care industry. Stephanie's areas of expertise and professional skills include Lean; Six Sigma; patient safety; risk management; quality control and quality assurance; and systemwide application of continuous improvement principles to drive excellence, resilience and high reliability. At the Medical University of South Carolina, Stephanie's professional experience includes outcomes management, performance improvement and patient safety program management. Prior to joining Vizient, Stephanie was the vice president of product development and quality and, most recently, chief clinical and quality officer at SE Healthcare, a healthcare management consulting firm specializing in quality improvement, risk reduction and clinician burnout prevention. During her time with SE Healthcare, as project lead, she was instrumental in the strategic planning, development and successful launch of two innovative solution offerings. Stephanie received her master's degree in health administration from the Medical University of South Carolina and a bachelor's degree in psychology from Clemson University. Stephanie is a registered nurse, a Certified Professional in Patient Safety™ and a Just Culture certified trainer.