Basics of Strategic Planning: For inpatient settings

Introduction

Strategic planning is an ongoing process where you prioritize your organization’s operations to align with the organization’s value. Strategic planning may take the form of prioritization, resource allocation, and process refinement. Strategic planning must always be backed by solid data and collaborative efforts from all affected areas of the organization.

In Healthcare, as defined by Dr. Porter, value is health outcomes achieved per dollar spent. At a high level, strategic plans for HSO’s must always follow the key value - trying to achieve the optimal health outcomes with the least net cost to the patient.

Understanding the Inpatient Setting

The inpatient setting, commonly referred to as hospital care, is care that patients receive when in the hospital. Generally, patients are only admitted to the hospital when their condition is severe or have other life-threatening conditions. Inpatient facilities have access to, generally speaking, a wider range of specialists than would be collocated in outpatient settings. Organizational strategy at large may determine what kind of non-life-threatening patients are directed to the inpatient setting due to factors such as outpatient surgical center availability. The majority of inpatient’s enter through a referral or via the emergency department.

There are a variety of challenges presented for inpatient care, starting with the complexity and severity of illness, overcrowding, and emergency department dysfunction. Organizationally speaking, staffing, particularly nurse staffing, patient engagement, compliance, and quality of care are major concerns for inpatient settings.

The Strategic Planning Process

Below is the AJHCS Strategic Planning Process, developed specifically for hospitals, as a fork of the United States Governments strategic planning process.

Step 1: Enviornmental Analysis

The environmental analysis for HSO’s can be complex and must be tailored to the organization’s needs. At the most basic level, an environmental analysis considers both the external factors and how much these external factors impact the organization. It also is crucial to consider potential strategies to counteract these impacts or synergies to use them in your favor while performing this analysis.

For inpatient facilities, here are some examples of environmental factors:

• Population demographics
• Geographical Location
• Severe Weather events
• Local healthcare infrastructures
• Insurance Coverage Patterns
• Transportation and accessibility
• Public health policies and resources
• Socioeconomic factors

To conduct this analysis, you must gather data from government reports, health department statistics, academic studies, and industry reports; you then must align this data with your internal data, taking note of potential trends and impacts from environmental conditions.

Examining the demographic and socioeconomic factors of your patients and aligning this with outcomes is a powerful tool that can greatly improve your quality of care.

Once you have collected data, conduct a SWOT analysis with a collaborative team. Engage stakeholders, such as hospital staff, local health authorities, community leaders, and patients in the SWOT analysis and to help develop strategic priorities.

Step 2: Situational Analysis

The situational analysis shifts its lens inward, offering a deep dive into the organization's inherent capabilities, processes, and culture. Unlike the environmental analysis, which scans the external landscape for opportunities, threats, and trends that impact the organization from the outside, the internal situational analysis concentrates on evaluating the organization's core internal aspects. This introspective approach aims to uncover strengths to be leveraged and weaknesses to be addressed, thereby enhancing operational efficiency and healthcare delivery.

For inpatient facilities, key internal factors to examine in a situational analysis include:

• Operational Efficiency: Analysis of workflows, patient throughput, and resource utilization to identify bottlenecks and areas for improvement.
• Clinical Quality and Safety: Evaluation of patient care standards, treatment outcomes, and adherence to safety protocols.
• Human Resources: Assessment of staffing levels, qualifications, training programs, employee satisfaction, and retention strategies.
• Technology and Infrastructure: Review of the current state of medical equipment, IT systems, and facility conditions to determine their adequacy for patient care and operational needs.
• Financial Health: Examination of revenue streams, cost management, investment in healthcare technologies, and financial planning to ensure sustainability.
• Organizational Culture and Leadership: Analysis of leadership practices, decision-making processes, and the organizational culture's alignment with the mission and values.

Step 3: Strategic Vision

Now that you know where you are you have to consider where you want to be. This can be one of the most crucial parts of the strategic planning process because it will essentially determine where the organization will position its resources and efforts.

It’s essential to utilize collaborative decision making, such as sticky note voting, whiteboarding, brainwriting, etc. with a wide variety of individuals from all involved departments. This point cannot be stressed enough: all stakeholders must be involved in this process. This includes any applicable groups, not limited to: physicians, maintenance staff, IT staff, Nurses, technicians, and most importantly, it should always include patients.

Some guidelines you can have before your brainstorming session are to keep things realistic but not too realistic. You need goals for your teams to shoot for, but not goals that feel either too easy or too out of reach. It’s also important that everyone involved in the strategic vision is aligned on the organization’s guiding principles and mission.

When conducting strategy planning, start by allowing patients to express their goals, objectives, and ideas before clinical and administrative leaders. Patients may have unexpected ideas or priorities, so it’s vital that Clinical and Administrative leaders strive for adaptability throughout the process.

Step 4: Metrics

Metrics help you track your progress along the timeline to your desired outcome. The first step in developing metrics is to look back at your strategic goals and your mission. Some metrics might align with your strategic goals but may come at too high of a cost to your mission or values, in that case, these metrics should not be used. Only utilize metrics which are in line with your organizational vision and that help provide actual data.

A popular saying among productivity management professionals is that “Not Everything that counts can be counted” - a prime example of this is Microsoft Teams Activity status, which when monitored, actually decreases employee productivity.

Due to performance evaluations and other pressures, it may be tempting to choose metrics which can show progress even when it isn’t clear there is any. Try to resist this approach. Instead, only choose metrics that are highly relevant and specific. For example, Hospital Readmission vs. Number of Daily hospital visitors. Clearly, one of these offers little meaning, although it is still used at some institutions to provide insight into resource allocation, even in areas unrelated to visitors.

Step 5: Timeline

The creation of the timeline is another area where flexibility is required. In the healthcare setting, it is likely that there are compliance requirements that will dictate the timeline for your strategic planning project, however, it’s vital to remember not to “ruin” an otherwise excellent initiative, just because it doesn’t fit into an externally imposed deadline.

For example, if it would take 24 months to reduce hospital readmissions by 12% but the deadline is in 12 months. Don’t try to fit the project into 12 months.

Similarly, use metrics to identify ways in which process could be completed faster or in different orders to maximize both efficiency and patient care.

Step 6: Implementation

The final and perhaps most critical step in the AJHCS Strategic Planning Process is the implementation phase. This stage transforms strategic plans into actionable initiatives, bringing the vision and goals established in earlier steps to life. Implementation requires meticulous planning, effective communication, and robust management to ensure that strategies are executed efficiently and achieve the desired outcomes.

Key Implementation Strategies:

• Action Plan Development: Begin by breaking down strategic goals into specific, actionable tasks. Assign clear responsibilities, deadlines, and resources for each task. Action plans should be detailed, yet flexible enough to adapt to unforeseen challenges or opportunities.
• Stakeholder Engagement: Continue to involve stakeholders throughout the implementation process. Regular communication with hospital staff, patients, community leaders, and other partners ensures buy-in and allows for the collection of feedback to refine strategies as necessary.
• Resource Allocation: Ensure that the necessary resources—whether financial, human, or technological—are allocated to support the initiatives. Prioritize projects based on strategic importance and resource availability, and be prepared to reallocate resources as priorities shift.
• Training and Development: Equip your team with the skills and knowledge they need to implement the plan effectively. This may involve training programs, workshops, or hiring new talent to fill gaps in expertise.
• Monitoring and Adaptation: Establish a system for monitoring progress towards strategic goals. Use the metrics developed in Step 4 to track performance, and be prepared to make adjustments to the plan as needed. Regular review meetings can help identify issues early and keep the implementation on track.
• Communication: Maintain open lines of communication across the organization. Regular updates on the progress of implementation, successes, and challenges help keep everyone aligned and engaged. Transparent communication fosters a culture of trust and collaboration.
• Celebrating Milestones: Recognize and celebrate achievements along the way. Acknowledging milestones boosts morale and motivates the team to continue working towards the strategic goals.

Implementation is an ongoing process that doesn't end once initial actions are taken. It requires continuous evaluation, learning, and adjustment to respond to the dynamic healthcare environment. Successful implementation hinges on the organization's ability to execute with discipline, adapt to change, and maintain a steadfast focus on its strategic vision. By effectively managing this step, hospitals can realize their strategic objectives, improve patient care, and enhance operational efficiency, setting a solid foundation for long-term success.

Case Studies

Best-In-Class Onboarding Sparks Improved Retention and Performance | Healthcare Strategy Consultants (tillerhewitt.com)

Christus St. Michael Health System engaged Tiller-Hewitt HealthCare Strategies LLC to develop a program aimed at enhancing partnerships, recruitment, onboarding, integration, and retention of top providers. The strategy involved a comprehensive stakeholder engagement, leading to the launch of a formalized hospitalist onboarding, navigation, and mentorship program. Results showed improved recruitment, retention, operational performance, and a significant reduction in turnover. The initiative also led to CHRISTUS St. Michael being recognized as one of the nation's top hospitals by IBM Watson Health.