Strategic Planning for Larger Groups

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

Is bigger better? To cope with external threats and challenges, many healthcare organizations have answered this question with a resounding “yes!” Hospitals, healthcare systems and managed care organizations have pursued enormous consolidation to strengthen themselves in the marketplace.

As an organization grows, internal challenges always arise. Yes, it would be great if an anesthesiology group can stay small and control its own destiny, but that appears to be less and less of a possibility given, once again, the external threats anesthesiology groups now face.

One challenge for larger anesthesiology groups is to get “the herd roughly moving west.” Physicians’ independent nature is such that getting a large group of physicians to agree on a unified strategic direction is a significant challenge for group leadership. The best performing groups conduct periodic strategic planning efforts to map out their strategic direction. I believe that as the world gets a better handle on Covid-19, it is time for many groups to develop or reconsider their future.

However, once a group grows to a certain size (say 35-40) it becomes increasingly difficult to conduct a planning retreat that meets the following desires:

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

The problem is group process—with so many people in the room, it is nearly impossible to have the complete debate and discussion among all group members. What often happens is that five or six individuals debate the issues while everyone else watches. Many such meetings end up with a vague idea of what the agreed upon plan is.

If your group has to have all the physicians in the room, these problems can be mitigated by:

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

However, we have utilized the following approach to large group strategic planning efforts that balances the desire for involvement with the ability to have beneficial in-depth discussion on the issues.

Through this process groups are trying to satisfy the reasonable members of the group. A “reasonable” group member wants to have input into the planning process, but recognizes they won’t always get exactly what they want.

An “unreasonable” group member expects the group to do exactly what they want and either torture the other members to get what they want, or go so far as to sabotage group decisions. I wish that there was another alternative, but the only ways to deal with “unreasonable” group members is to either ignore them or ask them to join other groups where there behavior is tolerated.

So here is a set of steps that a larger anesthesiology group can follow to conduct their strategic planning effort.

Step 1: Survey/Interviews

Typically all physicians are surveyed to obtain their input on:

• Strengths and weaknesses of the group.
• Opportunities and threats the group faces.
• How they would like to see the group evolve.
• The issues that should be addressed during the planning process.

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

Step 2: “Board+” Retreat

A sub-set 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 less. The meeting typically lasts a day or two, with a day and a half being the most common. This group develops what we call the “draft” plan for the group. At this meeting the attendees:

• Develop or update the group’s mission statement, vision statement and values statement. These are “high-level, big picture” statements that should be used to guide subsequent decision-making.
• Review environmental opportunities and threats the group faces.
• Discuss internal strengths and weaknesses of the group.
• Create clear goals and objectives.
• Work to resolve key issues facing the group

What are the key issues to be discussed? That depends, of course, on the circumstances of each group. We find that groups often discuss:

• Market area to serve – expansion
• Goals for size of group
• Recruitment
• Affiliation with others
• Governance
• Workload and compensation
• Call
• Operations

Subsequent to the retreat, a “draft” plan is developed that is a written summery 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 input and 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 at the retreat. Instead the larger group is asked to answer 3 questions:

1. What plans or objectives are you most pleased with?
2. What changes/improvements would you suggest to the plan?
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 who was at the retreat at each table. You also should try to spread out the “nay-sayers” so they don’t get negative momentum going.

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 full group meeting and decide whether or not the “draft” plan should be adjusted. The final plan is then adopted by the Board.

If the Board does not have the authority to adopt the final plan, it can recommend the plan for adoption at the next Shareholder meeting.

This process balances the need for input, in-depth discussion and decision-making.

For more than 25 years, Will Latham, MBA has worked with medical groups to help them make decisions, resolve conflict and move forward. 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 more than 135 medical practices representing over 1,300 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 healthcare conferences. He can be reached at WLatham@LathamConsulting.com.