by Shannon Stewart
Senior Consulting Director, Reliability and Management Systems

Hospitals and health systems are investing a lot of resources to thoughtfully and strategically plan how they will meet their communities’ needs in the future. They’re developing strategic plans that outline the path and steps needed to arrive at that future state. Embedding high-reliability principles—such as management systems that proactively engage employees—is essential to your hospital’s progress.  

To illustrate, consider the experience of Alex, the new CEO of a successful health system. Before Alex joined the organization, the strategy had been deployed in a top-down fashion—managed and driven by senior team members. And up to this point, this style had been fairly successful. The health system was financially stable and had quality care.

However, Alex noticed that revenue began to plateau and knew that upcoming regulatory changes could decrease revenue further. Alex and the board confirmed that the organization’s strategic plan and direction were still appropriate given the environment. Alex brought me in to evaluate what was missing. 

Though the organization had a strategic deployment plan, I found three specific areas where that plan was breaking down. Unfortunately, Alex’s problem is not unique and there are actions organizations can take to avoid them. 

Strategic and operational disconnect 

Mid-level leaders and their staff didn’t seem to understand the strategic direction of the system. The leadership team developed the strategic plan and invested in communication strategies to tell health system staff about the strategy. Even so, mid-level leaders developed goals for their staff that didn’t align with the strategy. 

I found that the mid-level leaders were told about the strategy but were never part of the deployment plan and therefore never really understood the strategic direction and how it applied to them and their staff. Because of that, the goals they created for their staff—though reasonable performance goals—didn’t align with the strategic plan. 

Without a robust process for guidance, coaching and communication between senior leadership and those responsible for strategy deployment, even a great plan will result in a lack of engagement and ownership across the organization, a missed opportunity to tap into the expertise of those closest to the processes and the misalignment of individual and team goals. 

Lack of innovation 

Many of the health system leaders at Alex’s organization seemed to be waiting for instructions on what to do next. Often, decisions that should be made by mid-level leaders were being brought to the senior team, taking up time that should be devoted to addressing system-level issues. 

The disconnect mentioned in the previous example can lead to slowed progress as senior leaders are unable to address system-level issues. Much like clinicians are encouraged to operate at the top of their license, in order for organizations to continue to innovate and move to higher levels of performance, staff at all levels should be fully engaged. 

That robust process for guidance, coaching and communication between senior leadership and those responsible for strategy deployment helps mid-level leaders and their staff feel comfortable and empowered to address obstacles with solutions. This creates a culture of innovation and collaboration. 

The drift 

Alex also noticed that the health system struggled to sustain the wins it achieved. “It feels like the organization is coasting instead of driving where we need to go,” Alex told me. When there was a crisis, the team went into action, working together to address the situation quickly and efficiently. However, when not in crisis mode, the team seemed to operate at a noticeably slower pace. 

When an organization seems to be “coasting” or “drifting” it may be the result of failing to monitor the processes that are not working, identify risks, adjust and sustain gains.  

Ensuring that a bi-directional flow of communication occurs—communicating the objectives of the strategy to the people doing the work and communicating the significant barriers to deployment to senior leadership—is crucial. 

During my time working with Alex, I was able to identify and address the areas where the health system’s strategic deployment system was breaking down. I helped Alex implement management systems across the organization to proactively engage the workforce in improvement and sustaining advancements.  

Since then, I’m pleased to share that the organization has accelerated its pace of change, engaged its employees to be problem solvers and created a new level of visibility and transparency in its plan. And you can, too, identify and address these common red flags; and even better, avoid them altogether. Strategy deployment assistance is one of the offerings available through Vizient’s high reliability organization solution. Feel free to reach out to me if I can be of assistance. 

In our next blog, my colleague will share how Alex was able to empower and support leaders to have an active role in the deployment of the system’s strategic plan. 

About the author: Shannon Stewart  has more than 25 years of health care experience and currently serves as a project lead for the Lean strategies department at NHRMC. On their Lean journey for more than seven years, the Lean strategies department is currently working to ensure that there is understanding and alignment of the organization’s strategic goals from the board of director level to the frontline staff personnel. 

Published: September 12, 2022