Strategic Planning - Aligning Resources and Capabilities for Competitiveness

This article was written by Brendan L. Ashby, MBA, MPH, MCHES, FACHE, Dean of Health Sciences and Service Programs, Saint Paul College for the “Networking News” monthly newsletter. The Network Technical Assistance Project is funded by the Federal Office of Rural Health Policy, Health Resources and Services Administration, U.S. Department of Health and Human Services through a contract to Rural Health Innovations, LLC, a subsidiary of the National Rural Health Resource Center.

Having been involved in the development and leadership of rural based healthcare networks in Minnesota and health workforce training in post-secondary academic institutions has shown me the importance of strategic planning. As network leaders, our charge is to assess the viability of the current or emerging network, gauge if the network is tactically positioned to meet its goals and objectives, and identify which strategic concerns and challenges warrant immediate leadership attention. However, as important as strategic planning is, I have found it useful to adopt a mindset of strategic process that involves strategic thinking, acting, and learning that are just as important if not more important than any approach to strategic planning. To help foster that mindset of strategic process, I want to share two of the tools that have helped my stakeholders and me-the Business Model Canvas and Strategy Change Cycle.

Business Model Canvas

When I was preparing for strategic planning sessions with my network, I wanted a novel approach and a colleague of mine suggested I try to develop business model canvases. The Business Model Canvas is a strategic tool developed by Alexander Osterwalder and Yves Pigneur as a way to visually capture and describe a network's business model. I have had great success when using the business model canvas, especially when engaging reticent stakeholders that might have limited experience in any type of strategy planning or experts who appreciate the pragmatic framework. This unpretentious but powerful tool can demonstrate what is happening within a network and its value proposition in nine key areas:

• Key activities: What are the most important activities that your network does or is planning to do?
• Key resources: What resources are necessary for the network and its stakeholders to experience success?
• Key partners: Identify all of your network's critical partners such as hospitals, clinics, vendors, community-based organizations, academic partners, insurance companies, and other stakeholder groups.
• Value proposition: What makes your network the best value for your stakeholders? Why would a patient, customer, or partner organization participate in your network's services?
• Costs: How many resources and types of resources does your network need to be sustainable and successful?
• Customer relationships: How does your network establish and maintain relationships with your customer segments? On a one-to-one relationship, mass market, or niche? What are the costs of those relationships?
• Customers: Who are your customers? Think beyond the healthcare partners, funders, or health consumers. 
• Revenue: How do you bring money into your network? Through grants, training, services, shared savings? What else?
• Channels: How do you communicate with your stakeholders? Face to face meetings? Social media? Web conferencing? Printed materials? Think about all of the channels that your network currently uses or could use. 

Using the business model canvas helps network participants to discover areas of strength, minimize network weaknesses, and potentially discover opportunities for additional funding and increasing services (businessmodelgeneration.com). For example, the business model canvas was an instrumental tool used in my former palliative care network to develop new relationships with other likeminded rural based healthcare systems across nine counties in northern Minnesota that resulted in increasing interdisciplinary training for health providers involved in palliative care, growing patient participation, and improving patient education.The business model canvas is an effective, interesting, and enjoyable method for network participants to begin to review their efforts from diverse perspectives.

Strategy Change Cycle                     

The Strategy Change Cycle developed by John M. Bryson can assist network leaders to figure out what the challenges are and provides ten steps to work through the strategic planning process. The strategy cycle will help network leaders think about your stakeholders and who needs to be part of the discussion; what details does the network leadership need and if you are missing any information; how you are going to implement this strategy process; if this is realistic; and lastly how can we create the highest enduring value for the people that your network serves. 

The ten steps are as follows:

1. First your network leaders have to agree on the strategic planning process
2. Identify the network's mandates
3. Review and gain understanding on the network's mission and vision
4. Conduct a SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis
5. Discover the strategic issues facing the network
6. Frame tactics to address the challenges
7. Review and approve the strategic plan
8. Reaffirm alignment with the network's vision
9. Foster a successful implementation process
10. Revaluate strategies and the strategic planning process

The final steps of using both the Business Model Canvas and Strategy Change Cyclewill occur when your network reassess your identified strategies and remember to be agile, change when necessary, and make corrections as needed. You need to constantly be thinking strategically.  Remember, this is a process and not a one-time project. If you keep that in mind then you will be successful.

Strategic Planning Resources

• Aim for Impact and Sustainability: Strategic Planning, National Rural Health Resource Center
• Baldrige Excellence Framework: Health Care, Baldrige Performance Excellence Program
• Business Model Canvas, Business Model Generation
• Integrating the Strategic Plan, Logic Model, and Workplan, Evaluation Research Team
• Strategic Planning Basics, Balanced Scorecard Institute
• Strategic Planning Process Outline, Center for Rural Health University of North Dakota School of Medicine and Health Sciences 
• Strategic Planning That Leaves you Smiling, Studer Group (webinar recorded 10/13/2014)
• Strategic Planning That Works: Integrating Strategy with Performance, American College of Healthcare Executives (webinar series ACHE members: $530, Non-members: $605)  

Data Reporting: Not Just “Because I Said So”

By, Margo Kulseth, former Information Specialist

As a kid, our parents made us do things we did not want to do. “Get off the couch and go outside” or “turn off that TV” or “don’t put so much sugar on your cereal” are a few examples from my childhood. When I asked why, my dad often responded with “because I said so.” That did not seem like a valid reason, but because I was the kid and he was Dad, I had no choice, so I begrudgingly complied.

Do I have a problem with authority? I don’t think so. Who among us likes to be forced to do something without a reasonable explanation? Daniel Goleman, author of Leadership that Gets Results published in Harvard Business Review, would call this the coercive leadership style, and in general, it is not the most effective long-term.

With our country’s health care system evolving from a volume-based model to one that is value-based, the ability to demonstrate the value of our health care services is becoming increasingly important. This is commonly accomplished by collecting, reporting and analyzing data and then interpreting that data to identify and improve on target areas. Therefore this process has been incorporated into various requirements for health care providers, which can feel like an imposition on staff time and resources that are already bursting at the seams. Have you ever questioned why all this data is necessary and felt like the answer from an authority figure was “because I said so"?

Recently, I wrote a blog post from the funder’s perspective called “Walk A Mile in your Funder’s Shoes.” Making sense of this confusing world often boils down to imagining ourselves in someone else’s shoes. The numbers in our data spreadsheets represent human lives. In health care, providing recommended care 99% of the time is not good enough. What if that 1% remaining was you, your spouse, parent or child?

Another authority figure from my youth was my 9^th grade English teacher, the late Mr. Larry Schloer. He always used to tell us “close only counts in horseshoes and hand grenades.” While he was usually referring to a spelling test, this is another example of wisdom from my youth that can be applied to the goals of data analysis in health care.

Until 100 percent of our critical access hospitals are reporting on 100 percent of the quality measures 100 percent of the time and achieving 100 percent of recommended care for 100 percent of the patients, there is still work to be done. Does that sound daunting? As we like to say here in Minnesota, you betcha! But is it necessary? Is it worth it? You betcha!

Most everything we do in health care, including tracking data, has a much higher purpose than “because I said so.” Even when we are tired, stressed, burned out or overworked, we must never forget…”every patient matters.” I challenge you to repeat those three little words to yourself whenever the spreadsheets full of numbers bear down on you and your already full schedule. Those numbers represent people, the very same people most of us got into the field of healthcare to help. Let’s work together toward a better health care system, one that clearly demonstrates “every patient matters.”