Provider-based healthcare delivery is one of the most rewarding and meaningful professional endeavors. Successfully meeting the mission of delivering high quality care with excellent outcomes to patients, delivering outstanding patient satisfaction, addressing provider burn-out, and recruiting and retaining staff, all while managing to thin margins is incredibly complicated.

Current State

Healthcare systems are en-masse revisiting strategic plans since the initial COVID-19 surges, as there are many ongoing issues that need attention through the pandemic and eventual endemic phases:

Staffing Management

Inpatient RN shortages cannot be understated, as health systems are increasingly limited by staff rather than beds[i]. Staff management, retention, and innovative care models will need to be a dedicated area of focus for the medium-term future until nursing schools can provide a steady supply of replacement staff[ii].

Digital Enablement & Innovation

Many health systems saw a hundreds-fold increase in their telehealth adoption rates during the pandemic[iii]. Although this is stabilizing, it is important to dedicate capital to meet consumers using more digital vehicles[iv]. The infrastructure necessary to effectively deliver on digital enablement can be expensive and time consuming as technologists, providers, and patients need to work together to deliver on this promise[v].

Population Health and the shift to ambulatory

Many factors are driving the need to prioritize investment and innovation in the ambulatory setting[vi]. Two primary forces include: 1) the shift in reimbursement favoring a lower cost ambulatory setting (e.g. ambulatory surgery centers) and 2) population health strategies making it possible to intervene with patients in the ambulatory setting before they need an inpatient encounter. Ambulatory management can be wide-ranging and complex in scope: network adequacy by specialty, provider productivity, referral and leakage management, capital outlay for ambulatory surgery centers or micro-hospital expansions, and so on.

Business Continuity in a COVID-19 environment

Initial shocks to supply chain and inpatient capacity from the pandemic have been mitigated, but on-going surge preparedness will be important in optimizing the trade-off between caring for COVID-19 patients and having capacity for surgical cases. This will require stronger supply chain and bed management mechanisms (post-acute care, transfers, etc.) to flex effectively and minimize financial impact[vii].

Reducing health care disparities

Data has shown that underserved populations tend to be hit harder by certain diseases[viii]. COVID-19 outcomes have unfortunately also reflected a disproportionate impact on underserved and minority populations[ix]. Most organizations have dedicated diversity equity and inclusion departments to partner with the community and clinicians to improve clinical outcomes, but each approach needs to be tailored for the community being impacted and the specific disease. This is also an undertaking that will require resources, enhanced community engagement, and broad coordination across the organization.

Managing increased competition while maintaining margin performance

COVID-19 paused many growth campaigns, but competition for patients did not stop. Health systems are facing increased competition from national players establishing themselves in local markets or negotiating directly with employers[x][xi]. There is an increased need to highlight differentiation from the competition with the existing consumer base and simultaneously expand into new geographies and markets. Without the associated increased revenue from growth, it will be a challenge to fund and deliver on any of the previously mentioned areas (ambulatory, capacity management, health care disparities, etc.).

Having Strategic Planning & Deployment Confidence

Even in the best of times, managing these high priority efforts while running the day-to-day operations of a health system is a monumental task. All these initiatives, sometimes numbering in the hundreds, need to be managed simultaneously and executives need peace of mind to know that these efforts are progressing against goals effectively. The worry about implementation success is well founded: a survey study of executives by “The Economist” and the “Project Management Institute” (PMI) showed that[1]:

Only 56% of strategic initiatives had been successful over a 3-year retrospective
Half (52%) of the completed strategic initiatives showed poor or fair results

When asked for the main reason why these efforts failed, the most common response from executives was a lack of leadership endorsement and support, especially at the C-suite level. Often there is little formal coordination, governance, and accountability across the various stakeholders (e.g. finance, strategy, operational owners). The ability to execute strategic efforts is dependent on managing a formal multidisciplinary Enterprise Planning Lifecycle (EPL).

The Enterprise Planning Lifecycle Approach

It is important to have key elements in place to simultaneously deliver on all the priority activities across the enterprise:

Strong centralized governance with C-suite participation that increases executive awareness (KPIs and statuses) and drives accountability through report-outs and operational subcommittees
Coordination across multiple departments to make sure that strategic plans inform operational deployment and have the reporting mechanism in place to allow for timely interventions

If interested on how to establish an EPL and effectively plan and deploy against your strategic objectives, we would encourage you to read the four-part Forum Solutions series:

Forum Solutions is a management consulting company dedicated to crafting and delivering transformational outcomes for our clients, our colleagues, and our community. With our help, clients become more agile, resilient, and connected, bringing great ideas to fruition with brilliant results. From start-ups to the Fortune 50, business leaders rely on Forum Solutions to help them form and realize their strategies. Our company is a certified Woman Owned Business that believes in developing and growing our colleagues, company, and region in a socially conscious way.

[1]https://www.pmi.org/learning/thought-leadership/series/pmo/c-suite-failing-strategiy-lessons

[i]https://www.advisory.com/daily-briefing/2021/08/25/nurse-shortage

[ii]https://www.aacnnursing.org/news-information/fact-sheets/nursing-shortage

[iii]https://consultqd.clevelandclinic.org/cleveland-clinics-digital-health-playbook/

[iv]https://www.beckershospitalreview.com/digital-transformation/where-13-health-systems-are-investing-their-innovation-dollars-this-year.html

[v]https://newsnetwork.mayoclinic.org/discussion/entering-the-digital-front-door-to-a-better-health-care-experience/

[vi]https://www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/walking-out-of-the-hospital-the-continued-rise-of-ambulatory-care-and-how-to-take-advantage-of-it

[vii]https://www.beckershospitalreview.com/patient-flow/8-hospitals-postponing-elective-procedures-amid-covid-19-resurgence.html

[viii]https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/

[ix]https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-ethnicity.html

[x]https://www.fiercehealthcare.com/hospitals/tenet-commits-nearly-1-5b-to-secure-ownership-92-more-surgcenter-ascs

[xi]https://www.fiercehealthcare.com/payer/industry-voices-health-systems-and-rise-direct-contracting