Hope Is Not a Strategy: How to Create Your Strategic Business Plan

Will Latham, MBA
President, Latham Consulting Group, Inc., Chattanooga, TN

In the previous issue of The Communiqué (“Hope Is Not a Strategy: A Primer for Anesthesia Groups on Strategic Planning,” Fall 2016) we described the need for strategic planning and described the overall process. This process includes:

1. Developing mission and vision statements for the group.
2. Identifying internal strengths and weaknesses and external opportunities and threats.
3. Discussing key issues.
4. Developing objectives and strategies.
5. Creating action plans to implement those strategies.

Let’s now turn to the “nuts and bolts” of how your anesthesia group can conduct a successful strategic planning process.

Retreat vs. Series of Meetings

Anesthesia group strategic planning meetings provide an opportunity for the physicians to discuss key issues and develop plans for the group.

The meeting process typically comes in one of two forms: (1) a retreat; or (2) a series of meetings.

We believe that a retreat approach is the preferable process for the following reasons:

• With a series of meetings, you will chew up a lot of time reorienting everyone to what you are doing and what has been decided.
• Often, the attendee mix changes from meeting to meeting, the result being that the group zig-zags in its decision making.
• Typically, groups conduct these meetings in the evening, which is when the physicians also tend to be tired or stressed. The result is that discussions often turn to the same subjects discussed at the group’s regular meetings.

A strategic planning retreat might last one to two days, depending on the issues to be addressed and the time the physicians are willing to give to the process.

Preparing for the Retreat

It is essential to use the time spent at a retreat in the most efficient and effective manner possible. Why? 

• Most managers and group leaders know that it’s hard to pull all the physicians together. When you have them together, you want to make the most of it.
• The most expensive part of the process is the time at the retreat. If you multiply the number of people in the room by an hourly rate for an eight-hour day, you end up with a large number. For example, if you have 20 people in the room, eight hours at an hourly rate of $300 would cost $48,000.

Retreat time needs to be structured to be as efficient and effective as possible. That’s why preparation is key. Preparation involves considering the following:

1. Who will be the participants?
2. What will be the timing of the meeting? 
3. Who will serve as the retreat facilitator?
4. What data/information will be needed for the meeting?
5. What are the key issues?
6. What is the agenda?
7. What other arrangements are needed?

We will cover the first two items—participants and timing—in this article and the remaining preparation steps in future articles.

Participants

Who should attend the anesthesia group’s strategic planning retreat? Typically, attendees should include all shareholder physicians and the group’s manager. Depending on your group’s situation, you might also consider:

• Shareholder-track physicians
• Employed physicians
• Selected mid-level providers
• The group’s CPA
• Other advisors

Typically, we recommend the following:

• The group should limit the number of attendees, especially those who are more likely to be "observers" (such as members of the administrative team beyond the manager, employed physicians or mid-level providers). You want the physicians to have a free and open discussion about the issues. Sometimes physicians "clam up" if too many non-shareholders are in the room.
• If you include non-shareholder physicians, you might want to consider having a "shareholder-only" segment.

Timing

You will need to agree on the timing of the meeting—both when will it be held and how long the retreat will last.

Most anesthesia groups conduct their retreats over a weekend. If the group plans to allocate one and one-half days to the process, often, it allocates a full day on Saturday and a half-day on Sunday.

The group should pick a time when most, if not all, of the physicians can be present. However, every group has some who are more involved and vocal than others. The timing should be planned to make sure these engaged physicians attend. If you try to avoid the "nay-sayers," they will use that as an excuse to resist implementing the plan.

Logic would say the retreat should be held in the fall so that once it is complete, management can develop the annual business plan and budget, and implementation can begin in January. However, we find that most groups conduct their retreats on weekends in January through April to avoid holding the retreat on weekends during nicer weather.

Agenda

Once the preceding steps have been taken it is time to put together the meeting agenda. Your agenda might look like this if you are conducting a one and one-half or two-day retreat.

Saturday

• Meeting goals and ground rules
• Decision making
• Interview feedback:
  
  
  • Internal analysis - strengths and weaknesse
  • Environmental analysis - opportunities and threats
• Mission and vision statement
• Discuss key strategic issues

Sunday

• Discuss key strategic issues, continued
• Next steps in strategic planning process
• Summary

As you can see, the retreat includes some introductory work related to meeting goals, ground rules and decisions; feedback from the interviews; and the work of defining the mission and vision and discussion of key strategic issues.

Other Arrangements

You also need to make some detailed arrangements about where the meeting will be held. We typically recommend a meeting room at a hotel. Hotels are usually set up to host meetings and can provide meal services. Meeting at the hospital is typically a bad idea as hospital meeting rooms are not conducive to a group meeting, and many hospitals don’t offer food service on weekends when meetings are typically held.

Some groups hold their retreats out of town and use meals and evenings to build camaraderie. While this is can be a good idea, some physicians are resistant to traveling. You will need to determine your group’s willingness to travel.

If you do decide to hold the meeting out of town, we suggest that you do not make it a “family outing.” Family outings have two downsides: (1) reduced time for camaraderie-building and physician-to-physician interaction; and (2) increased anxiety among some physicians to complete the retreat work as fast as possible to spend time with their families.

You will also need to make a final decision as to how long you will meet. As noted earlier, the length of the meeting depends on two things:

1. The issues to be covered
2. The amount of time the physicians are willing to give to the planning process

If they are only willing to give one day, you will need to prioritize your key issue list to make sure the most important issues are covered. You will also need to make sure the meeting room is set up in the way you like (we typically suggest a U-shaped table set-up) and has flipcharts available to record discussion points and decisions, and that you arrange for any needed handouts.

Communication About the Retreat

The last task in preparing for your retreat is developing a memo and sending it and the agenda to the participants. The memo package should: 

• Describe strategic planning and tell why it is important.
• Discuss the goals of the retreat.
• Include details of the retreat (where and when).
• Include the agenda.
• Include important background information related to specific issues (cost benefit analysis, etc.).
• Include articles about the future of healthcare. Underline or highlight the important passages.

Strategic Planning for Larger Groups

Once a group grows to a certain size (e.g., 25-30) it becomes increasingly difficult to conduct a planning retreat that meets the following criteria:

1. All physicians attend the retreat.
2. There is an in-depth and complete discussion of the important issues.

The problem is group processes. With 50 people in the room, it is nearly impossible to have a complete debate and discussion that includes all members. What often happens is that five or six individuals debate the issues while everyone else watches.

If you must have all of the physicians in the room, these problems can be mitigated by:

1. Using the retreat as an information- sharing only meeting 
2. Using subgroups to discuss issues
3. Using a rigorous process to discuss and debate motions that were developed prior to the retreat

We have used the following approach for large group strategic planning efforts that balance the desire for involvement with the ability to have beneficial in-depth discussion on the issues.

Step 1: Survey/Interviews

Typically, all physicians are surveyed to obtain their input on:

• Group strengths and weaknesses
• Opportunities and threats the group faces
• How group members would like to see the group evolve
• The issues that should be addressed during the planning process
• Other questions that the group would like to ask

In addition to the surveys, we typically conduct individual interviews with those who will attend the “Board+” Retreat (discussed below).

Step 2: “Board+” Retreat

A subset of the group then meets to discuss key issues and develop plans for the group. Typically this group is composed of the board and other key leaders. It is best to keep this group to 15 or fewer. The meeting typically lasts one to two days, with one and one-half days being the most common. This group develops what we call the “draft” plan for the group. At this meeting the attendees:

1. Develop or update the group’s mission/vision 
2. Review environmental opportunities and threats
3. Discuss internal strengths and weaknesses
4. Create clear goals and objectives
5. Work to resolve key issues facing the group

Subsequent to the retreat, a draft plan is developed that is a written summary of the conclusions reached at the retreat.

Step 3: Full Group Meeting

Following the Board+ Retreat, a meeting of all physicians is conducted and the results of the planning retreat presented. At this time, all physicians will be able to give their feedback about the results of the planning process.

This step is usually completed at an evening dinner meeting. It is important to note that the goal of this step is not to re-do the work of the retreat. Instead, the larger group is asked three questions:

1. What plans or objectives are you most pleased with? 
2. What changes/improvements to the plan would you suggest? 
3. What key issues were not adequately addressed in the draft plan?

Operationally, the physicians sit at small tables of six or so, with at least one person at each table who attended the retreat. You should try to spread out the “nay-sayers” to prevent negative momentum.

Once again, this meeting is to allow the shareholders to have one more chance to provide input into the planning process.

Step 4: Board Adoption

At a board meeting the board members review the results from the full group meeting and decide whether the draft plan should be adjusted. The final plan is then adopted by the board. This process balances the need for input, in-depth discussion and decisionmaking.

Will Latham, MBA is President of Latham Consulting Group, Inc., which helps medical group physicians make decisions, resolve conflict and move forward. For more than 25 years Mr. Latham has assisted medical groups in the areas of strategy and planning, governance and organizational effectiveness, and mergers, alliances and networks. During this time he has facilitated over 900 meetings or retreats for medical groups; helped hundreds of medical groups develop strategic plans to guide their growth and development; helped over 130 medical groups improve their governance systems and change their compensation plans; and advised and facilitated the mergers of over 120 medical practices representing over 1,200 physicians. Mr. Latham has an MBA from the University of North Carolina in Charlotte. He is a frequent speaker at local, state, national and specialty-specific healthcare conferences. Mr. Latham can be reached at (704) 365- 8889 or wlatham@lathamconsulting.com.