We experienced this a lot and still today it definitively remains a big challenge. The first thing we put in place 3 years ago with the arrival of our new CEO was to build a ‘tactical plan’ aligned with our new strategy. He asked me to build such a plan… I didn’t had really a clear way to proceed, so I follow this different steps:
1) I started with interviews and sessions with every person at the C-level based on some key questions: based on our new strategy where do you wanna be with your departement within the next 5 years? Based on this what actions/projects/initiatives do we need to work on next year ? Who is accountable and responsible for each action? Which team will work on that? Which ressources do you need (budget, people, material, machines, hardware, …) ? What is the timeframe ? Are there some prerequisites ? Are there some interdependencies with other projects or teams?
Remark: the first time I did this, it was more top down from C-level. Now we do this every year and it’s much more bottom up since a lot of people know the approach much more better and understand where we wanna go.
2) I collected all this input and put this in a excel spreadsheet. I made a kind of Template we now use every year.
3) I did several workshops with the executive committee to review all together all the list of projects. Big discussion around all those projects: are those strategic ones, or more departemental ones ? Do we really need this? Is this really a priority next year? And we came to kind of commitment on what we wanna do all together. Also the link with budget was criticial and helped to do a kind of cross check if we foresee all resources needed to be able to realize our ambitions.
4) We presented this detailed plan to our managers (physicians and non physicians) to get them on board and still adapt the plan where needed. It was key to have also their support in this exercice and to move forward
5) We get this tactical plan validated by our Audit Committee and our Board.
The key thing here is that we know all projects we all are working on, we know the priorities and so we make much more links. This helped us a lot to avoid that kind of silo working method. The key challenge remains when a new Director arrive, or a new staff member which don’t know this method, of way of working. But here again communication and coaching remains crucial.
We recently change the full compensation model of our physicians. Some context information: we merged 2 hospitals in 2000, but there was no real merging of the physician Financial associations. Since 1st of January we change this, meaning forcing (of course after long negotiation run between board and medical counsil) all physicians from 1 specialty to merge financially, coming from both hospital sites. In addition we change the complete perception model:
From the revenus from the medical acts from a specific medical specialty we withdraw:
– a % for central billing (to cover our billing costs, processes, teams, …) –> Remark: this amount is the same for all physicians in the hospital group
– a % for our medical investment fund (to buy all medical devices) –> Remark: this amount is the same for all physicians in the hospital group
– a % for a Quality fund to support qualitative projects/initiatives –> Remark: this amount is the same for all physicians in the hospital group
– a X% which is specific for each specialty –> objective here is to cover the direct and indirect cost of the medical specialty
– or + a Y% which is for the solidarity mecanism between specialities which are better or less paid depending on the price list per medical act
+ a Z % which is a sort of bonus if quality indicators are fulfilled
For specialties, for example like neurology they have a positive Y%, so they benefit from other speciality solidarity.
On top of that we guarantee a minimum compensation fee.
By having this model in place you stimulate work, growth but definitvely quality –> multidisciplinary work, quality indicators, …
Some steps I would go through:
1) First question: what is your organization’s strategy? What are the key pillars and goals to reach? What’s your mission?
2) Second question then: what’s your key objectives from your chronic disease strategic plan? Again what’s your mission ?
3) Analyze which link you can set up between the hospital’s strategy and your chronic disease plan. There should be an alignment, a continuity.
4) Then define cleary the scope of your chronic disease strategic plan:which disease(s) do you wanna cover ? Define the timeframe of your strategic plan. Do you wanna go for a pilot/project roll out mode ? Or a big bang approach with all together? What are your key drivers (quality, cost reduction, growth, patient volume increase, …) ?
5) Who are the key actors to realize that strategic plan ? Who do you need to involve/have on board to move forward?
6) I would conduct some AS IS sessions to gather a clear inventory on what’s done today to manage chronic diseases in your institution and then define the gaps between the AS IS situation and where you wanna be tomorrow after realizing your strategic plan (TO BE situation). By identifying those gaps you will be able to define a clear action plan and put some priorities. Those actions car cover different areas: resources from a people perspective, but also infrastructure, technology, innovation, process changes, …
7) Based on this analyzis I would write down a strategic plan (for 3 to 5 years) + a tactical plan (annuel or bi-annual plan with concrete actions)
8) I would validate that plan with all key players/stakeholders to have upfront agreement on the plan and the actions you’re gonna conduct all together
9) Once you get the validation: communicate, communicate, communicate
I recognize the challenge. We have a well balanced system in place, but you always need to put it back on track on regular basis. Here some elements on how a right mix between managers and physicians is put in place in our organization:
– Our board is composed by a mix of physicians and non physicians –> this allows to also always have at least a medical perspective/points of view in the management décisions taken
– Our Chief Medical Officer is part of the executive committee and reports to our CEO
– Our Medical Counsel is composed by 16 physicians (= kind of medical union)
– Our organization (moving to matrix structure) is composed by medical clusters. A physician is leading every cluster together with a nurse leader and a performance manager
2) Build a strategic and tractical plan together
The executive committee developed a detailed strategic plan based on a clear strategy map. We built it top down + bottom up. Every one in the organization (employees, physicians, non physicians, …) know our strategic plan. Based on this we ask every medical service lead to build his own medical tactical plan –> so we have an alignement between the hospital strategy and the teams stratégies/actions.
3) Presence at leadership meetings
We quaterly organize a management meeting (non physicians managers) where some representative physicians are present to be aware about the information, the problems discussed, performance review, …). And also some non physicians ans executive committee assist to the quaterly medical leadership meetings.