Making strategy real
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Making strategy real. Bryan N. Becker, MD, MMM Becker’s Annual Hospital Review Meeting May 16, 2014. Objectives. Review Case Study Understand Structural challenges contemporary AHC/healthcare environment Approach to strategy

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Making strategy real

Making strategy real

Bryan N. Becker, MD, MMM

Becker’s Annual Hospital Review Meeting

May 16, 2014



  • Review Case Study

  • Understand Structural challenges contemporary AHC/healthcare environment

  • Approach to strategy

  • Steps to making strategy engaging for staff and part of their work

Case study

Case Study

  • Modest-sized academic health center

  • Low performer standard quality, outcome, efficiency, satisfaction, financial metrics

  • Over-reliance on single payer

  • Poor physician alignment

  • Multiple, repetitive leadership transitions

  • Mission supported in words, not action

Case study cont

Case Study cont.

  • Strategy

    • Minimal strategic planning

    • None of the traditional strategic planning tools—stop at SWOT

  • Organization challenged with

    • Prioritizing

    • Implementation and Execution

    • Cessation of failing activities

Organizational turbulence take a non traditional approach

Organizational turbulenceTake a Non-traditional approach

  • Acknowledge organizational challenges

  • Build strategy using various resources

  • Leverage mission



Desired future state

Revenue and income

Present state




  • How do you move strategy forward in an unsettled organization? YOU CAN’T AFFORD TO STAND STILL

  • How do you move strategy forward acknowledging the disconnect between structure and activity?

  • How do you move strategy forward acknowledging the need to communicate across the structure?

    “I have no problems, just opportunities.”

    Former IU football coach Terry Hoeppner

I mplementing strategic intent essential for operational reality



Unfulfilled vision


No vision





Power of Strategy




Power of Delivery Method

Implementing strategic intent essential for operational reality

Turning Vision into Reality

A powerful business strategy needs to be matched by a powerful delivery mechanism in order to turn vision into reality

  • Tools to develop an appropriate organizational strategy for change are well proven

  • Many businesses fail to deliver the strategy they develop

  • Usually fundamental business management process is at fault – the bridge between strategy and operation is not functioning

  • Various models exist to ensure the machinery between strategy and operational engine are effective:

    • Mintzberg’s three step operation

    • Balanced scorecard

    • Business management process.

To exploit an organization’s capability and potential, the power of its strategy needs to be matched by the power of its delivery mechanism and pace of implementation.

Source: Alan Meeking, Business Strategy Review, Winter 1994.

Leverage mission

Leverage Mission

  • Take mission and align strategy around it

  • Affordable Care Act

    • Newly eligible in Primary Service Area

    • Expand insurance coverage (Marketplace)

    • Expand Medicaid

      New “market”, New competencies, Mission-aligned

Making strategy real

Traditional Structure

Making strategy real

Network of activity



  • Level set mid-management

  • Common communication venue—Leadership Development Programs

  • Focus on behaviors first—UI CARE

  • Set a common platform

  • Communicate everywhere--email, forums, newsletters, video, gallery, social media

People strategists and executors

People: Strategists and Executors

  • Find Strategists

    • See it, articulate it to make it work

    • Painful to integrate execution planning, more painful to see strategy fail

    • Sounding smart is overrated

    • I am just as responsible for execution as the executor is

  • Find Executors and Implementers

    • Need to be involved in the strategy process early

    • Relevant and valuable to the strategy process

    • Know the “whys” behind the strategy

    • I am just as responsible for strategy as the strategist

  • Chasing the Chasm Between Strategy and Execution, HBR Blog Network, Doug Sundheim 08/22/2013

Strategy as a choice cascade

Strategy as a Choice Cascade

  • Explain the choice that has been made and rationale for it

  • Explicitly identify next downstream choice

  • Assist in making downstream choice as needed

  • Commit to revisiting and modifying the choice based on downstream feedback

Making strategy real

Value WorkgroupsAlign withOrganizational Goals Circle = Intervention expected to improve MetricStar = Metric most likely to improve from interventionArrow = Intervention may present risk to this metric

Access the frontlines

Access the frontlines

  • Dialogue with frontline workforce

  • Bring Data to them

  • Corroborate and Validate impressions

  • Seek out and Challenge the Obvious

Iterative, defining

Ideas and dialogue

Align and leverage mission to deliver straightforward message around strategy

Financial success

Financial Success

Our daily work

Our Wired environment

More patients & Their convenience


Count the green boxes

Count the green boxes

  • Use lessons from building virtual teams and stay local

  • 18 months ago

    • 2 green boxes

  • 12 months ago

    • 5 green boxes


Lessons learned

Lessons Learned

  • Focus on the Wildly Important

  • Act on Lead Measures

  • Keep a Compelling Scorecard

  • Create a Cadence of Accountability

  • Strategy without Execution is Hallucination

    Karl Moore 05/31/2012

“Try not. Do or Do not. There is no try.”

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