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Setting Your Strategic Goals in Motion: A How-To Guide for Anesthesia Groups

I find the great thing in this world is not so much where we stand, as in what direction we are moving: to reach the port of heaven, we must sail sometimes with the wind and sometimes against it—but we must sail, and not drift, nor lie at anchor. — Oliver Wendell Holmes

In earlier Communiqué articles ("Hope is Not a Strategy: A Primer for Anesthesia Groups on Strategic Planning," fall 2016 and "Hope Is Not a Strategy: How to Create Your Strategic Business Plan," winter 2017) we discussed the reasons for developing a strategic plan and how to create one. But if you develop the plan and declare victory, you only get half of the benefit from the process.

Top-performing anesthesia groups take several steps after holding their planning retreats to develop a strategic plan. We encourage your group to consider doing the same.

1. Document Your Planning Efforts

The work done and decisions made at the retreat should be documented in a written report. It doesn't have to be fancy; just document the decisions made at the retreat.

It is important to do so for the following reasons:

  • Confirm agreements:The report should be sent to all participants, and they should be asked to confirm that it represents the decisions made at the retreat.
  • Communicate to those who did not attend: Several members of the group may have been unable to attend the retreat. The report can help communicate to them what happened at the retreat and the decisions the group reached.
  • Monitor activities: As will be discussed below, the report should be used as a tool to help monitor the group's progress.
2. Develop Detailed Action Plans

Another important step after the retreat is to develop detailed action plans. During the retreat, the attendees should have identified projects or initiatives, assigned responsibility for implementing the projects and initiatives, and set general dates for completion (or dates for status reports).

However, those responsible for these various projects should develop detailed action plans that specify:

  • What will be done? What steps will be taken?
  • Who will do it?
  • What will the costs be?
  • What will the benefits be?
  • When will it be completed?

Here are some guidelines to consider when creating action plans.

  • Establish the specific goal of the plan. Why is it being done?
  • Identify who has overall responsibility for the plan.
  • List the steps to be performed to complete the plan.
  • Indicate the date each step should be completed.
  • Develop and include all added manpower and expenses the plan will require.
  • Develop and include quantitative and qualitative results expected from the plan.
3. Set Up a Monitoring Process

To derive the most value from a planning process, ongoing monitoring is needed to assess how well the group is meeting the goals of the plan. There are two reasons to do so:

  1. Monitoring performance can help keep the group on track.
  2. Some physicians complain "we met and decided, but then didn't do anything." Monitoring helps connect the work done at the retreat to the various initiatives' implementation.

It's best to assign an overall coordinator for this monitoring effort. We believe assigning it to a physician is best, but it could fall to the manager. It is often best if the group president performs this function.

Periodically, the coordinator should collect updates on the various initiatives. On a regular basis—perhaps quarterly—the group should review the plan to see how well it is performing. Some groups hold an evening dinner meeting to review the update.

4. Empower Your Board

Plans come to nothing if they are not implemented. One of the key responsibilities of any group's governance team is to move the group toward achieving its strategic goals. Medical groups move forward by discussing issues, making decisions and setting policy.

If your group has established a board or executive committee, typically that governance body makes decisions or sets policy within its level of authority. "Authority" involves what the board can do without having to go to a higher authority, such as the shareholders.

Authority typically involves:

  • Who can you hire or fire?
  • How much money can be spent?
  • What contracts can you enter into?
  • What strategic issues can you decide?
  • How far can the board go in dealing with disruptive issues?

Medical group governing boards often get mired down while addressing important group issues or trying to make decisions. They also have a tendency to micromanage rather than govern.

Here are some ways to overcome these challenges.

Send it to Committee

We have found that the best medical group boards use their committees to process information prior to the board addressing an item. When an item is raised at the board level, the first step is often to send it to a committee to:

  • Define the scope of the issue
  • Gather needed data
  • Analyze the data
  • Recommend a solution

Once the committee has developed a solution or recommendation, this information should be presented to the board. However, the board must be extremely careful not to redo the work of the committee. If the board feels the committee has not completed the assignment, it should be sent back to the committee for further work.

In addition, the board should make every effort to accept the committee's recommendation. Why? If the board always rejects the committees' recommendations or re-does the work, the committees will reach the conclusion that their thoughts are not being considered and stop doing the work.

Avoid Micromanagement by Setting Policy

As a board tries to do its work, it's often tempted to move from governance/oversight to organization micromanagement. The best way to avoid this problem is to focus the board on setting policy rather than on making decisions.

A policy is a statement that guides and constrains the subsequent decision making. The goal of setting policy is to try to specify the ends rather than the means.

In setting policy, the board should identify what is to be accomplished, and a range of acceptable and unacceptable means for achieving the objectives. This could include a set of directives for how the group will operate in the future, or instructions to management on implementation.

To help the board avoid micromanagement, it's often helpful to remind them that they don't have to (and shouldn't) make every decision. The board has options, which include:

  • Requesting proposals and recommendations from management prior to making a decision. Example: we need to avoid problem X. Management: develop a set of alternative methods to achieve this end.
  • Delegating decision-making authority with constraints. Example: we need to avoid problem X. Management: develop a set of alternative methods to achieve this end that costs less than $50,000.
  • Delegating decisions with exceptions. Example: we need to avoid problem X. Management: develop a set of alternative methods to achieve this end, but it must be a process solution rather than a technology solution.
  • Retaining authority and making decisions itself.

The best boards spend most of their time setting policy and always ask, "Is this something that management should decide once we've provided guidelines?"

5. Revisit the Plan

The world is not a static place. Your strategic plan should not be static either. The most effective groups update their strategic plans on a regular basis, either yearly or every other year.

Naturally, a significant internal or external change should trigger a review and re-discussion of the group's plans. For example, if the group loses a significant contract or portion of business, it may need to meet and develop plans to regain its footing.

Groups should consider these areas periodically.

  • The group's recruitment plans should be updated at least annually. Someone once said that "Recruitment is like roller skating. Sometimes you go where you want to go and sometimes you go where the damn things take you." People may leave, retirements may take place and new service demands may arise.
  • The group's compensation plan (or time/money balance) should be looked at approximately every other year. Some groups discuss their compensation (or time/ money/vacation) at every meeting, thereby reducing the time to discuss important strategic issues. Many groups agree that they will only discuss changing the current system once a year or once every other year unless 40 percent of group members sign a document requesting a review.
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