ACHE Message Boards

Week 6

My comments for Week 5 outlined a proposal for development of our new plan.  My colleagues have given additional contributions for the exercise.  I would therefore limit my comments for this week to the issue of the participation of physicians in the planning process.

Background

Over the last twenty years there have been significant changes in the composition and practice of the physician team employed in the public system.  Considerable investment has been dedicated to the preparation and development of generalist and specialist, the creation of new posts and change in contractual arrangements. The system has experienced challenges with the changing of the guard from the older physician specialists mentoring types to an increasing number of physician specialist with private sector interest , in addition to employment in the public sector.   

The private sector investment by the physicians compete in several sectors with services offered by the PHA and in some instances they also provide diagnostic and treatment modalities not available in the public sector. In such cases the PHA currently contract these services from the private sector partners.

Issue

The competing interest and ineffective management of the physician pool reduces the quality of the engagement of physicians in strategic non clinical exercises.

Proposal

Mechanism to improve the participation of physicians in strategic and leadership functions will enhance the quality of care.

Challenges

1. The physicians expect to be treated as “special” and do not see themselves as a particpants in general staff  large group meetings.  They expect to be addressed directly in fora convened especially for them.
2. Participation of physicians in the formal clinical committees varies.
3. Determination and/or agreement on representative/s to serve on administrative committees.

Approach

1. Meet with physician executives of all the institutions
1. elaborate on objectives of strategic planning exercise;
2.  request them to identify a core representative group of all physicians at each institutions who will function as the physician working group to canvas contributions from the wider body
3. provide guidelines to physician workgroup on process and deliverables
4. assign a liaison to the group from the  membership of the Strategic Planning Committee core group
5. establish deadlines for information to be developed and organize discussions, formulate recommendations with the institutional Medical Advisory Committee
6. present and discuss recommendations with the Executive Management Committees of each institutions
7. Medical Chief of Staff of each institution presents institutional recommendations to the Medical Affairs Committee of the Board
2.  Involvement of Medical Affairs Committee of the Board
1. review strategic directions for the plan
2. analyse input from institutions in the context of the strategic direction and the objections
3. identifies representative group of physician to liaise with the Strategic Planning Committee core group
4. provide guidance and recommendations to the Strategic Planning Committee
3. Strategic Planning Committee
1. prepares plan with the contributions from all the stakeholders
2. implement the communication strategy  to provide feedback
3. establish a process for review, updating and monitoring

Comments on Course

This was my first online exercise and my expectations were that we would have received more didactic instructions” on the how to. However I must say I found the process useful as it presented more opportunity for the individual to find or propose the solution based on the guidance from the reference material and the responses from Alan.

The approach placed the participant in the role of being ones own consultant and I believe sensitized more to the need to better define the scope of work for consultants and emphasized need to assume ownership of the process 

Things to do better.

1. I support the comments of the other colleagues re the format for internet communication
2. Alan, I would have liked to review the case studies prepared in your book – despite the fact that through the program we had live cases from our colleagues

In reviewing the process we've been following so far - I think we do a good job of obtaining inout and engaging the key stakeholders. The one area that we as consultants are sometimes constrained in is 'time'. I think we do have opportunity to improve our process in gaining a broader perspective fromt the stakeholders and engaging members that may differ in their ideas.

I second what DFrench mentioned - it would be wonderful to get ideas and learn from non-healthcare organizations. (i.e. case studies).

I agree with what has been written thus far by the other participants, namely that "true" participation is key by the stakeholders.  Although it's impossible to engage 26000+ people in a strategic planning process, however, having enough of the key stakeholders is crucial for, not only success, but also for acquiring the ideas and approaches for success.  No one has all the answers, we must rely on those who support us to

Regional leadership is currently creating the regional plan based off the system plan right now and it will be passed on to the administrators within a month.  Our new administrator is planning on having an off-site strategic planning session with all directors and managers participating.  I believe that this is a step in the right direction from our previoius administration and their top-down approach. 

Changes, given the new leadership at both the corporate and local level, time will tell.

I believe that overall the text was helpful and insightful.  As others have said, this format is difficult especially for topics that lend themselves to great interaction and discussion.  

1)      The executive and senior management were involved in the strategic planning process from the onset.  The clinical members of the executive management team along with the line staff met to walk through the site and determined that further physical adjustments were necessary to achieve the desired outcome.  This caused us to realize that the line staff should have been included from the onset because they would have had a better appreciation for budgetary constraints and other environmental limitations, which may have led to “buy-in” by all the stakeholders.  

2)      Other changes that I would like to incorporate in the planning process include the following:

a)      Have the units/departments determine and present their needs as part of the new planning culture

b)      Create more autonomy and accountability at the unit/departmental level

c)      Create a culture in which the employees are fully engaged in the planning activities

3)      The information provided in this course was beneficial, as it was a refresher to the textbook approach to strategic planning.  However, there is very little guidance on how to deal practically with team members that are not “…willing to put aside their own self-interest for the sake of the group (p. 101),” and how to obtain “buy-in” at all levels of the organization. 

Wow!  Thanks for all the feedback.  It's clear that we've covered the basics and maybe then some more, but there's a thirst for more breadth and depth in a number of areas:  participatory techniques and dealing with thorny situations that arise, implementation approaches, more penetrating environmental assessment incorporating risks and uncertainties and lessons about competitive approaches from outside of health care, more "how-to's", etc.  As I revise and extend the course, your feedback will be very helpful to the next generation of participants.  Glad to see that all of you apparently found this course beneficial, too.

For those who haven't weighed in yet on this last module, I'm heading out of town for about a week and may have limited computer access.  I'll be sure to check in next Thursday when I return to see if there are any additional postings.

Thanks very much to all of you who participated in this course!

Alan

For this course, I reviewed our process of strategic planning over the last year.  In the future, I think two things can be improved upon:

1.  More collaboration among mid-level management including a retreat.  Understanding overall prioirities and those outside of your direct area could create more buy-in.

2.  We need more review and dissemenation of the plan among employees and Board members.

We tend to update the plan monthly, adjusting goals, budgets and strategy based on current needs and new and/or unexpected projects.  We need to have a broader long-term plan instead of only 1-2 years as we tend to get bogged down in smaller projects without see the big picture.  We also need to have a retreat of mid-level and senior management to better define the process.

The book was informative with a lot of common sense information. It helped me to sees the steps drawn up with a map to follow so that others can follow along when the process is ongoing.

 

Jennifer

Thanks, Jennifer.  Just checking back in after a week on the road.  Glad you found the course and book useful and have a few good ideas you can implement as you move forward.  Good luck!

Alan