Maine Health Leadership Retreat 3-6-09

1. Maine HealthLeadership Retreat3-6-09 Applied Strategic Thinking Fitzpatrick Consulting

2. Culture, in turn, is Governed by a Few Key Simple CULTURE Rules Together They Produce RESULTS How Organizations Succeed CUSTOMER REQUIREMENTS ORGANIZATIONAL PURPOSE Structures Systems Processes Information Resources Leadership Professionalism/Respect Communication Commitment Teamwork Customer-centered Care Organizational Design Organizational Behavior CULTURE The Interaction of Design And Behavior Produces PDL Access Productivity Internal Alignment Satisfaction INTERMEDIATE RESULTS Market Share Profit Margin Customer Loyalty Horizontal Growth ULTIMATE RESULTS Fitzpatrick Consulting

3. Strategic Evolution Organization is Capable of Adjusting Strategy to Changing Market Forces Organization Knows They are Achieving the Strategy Customers Perceive a Difference Everyone’s Actions Are In Alignment with Strategy Everyone Knows His/Her Role in Achieving the Strategy Everyone in the Organization Understands the Strategy Have a Strategy Fitzpatrick Consulting

4. Clinical Improvement: Quality and safety System and Clinical Integration Coordination of care Learning Patient satisfaction, experience and service Technology Information management, reporting and performance outcome and process metrics People Access for care Efficiency, cost, utilization and reliability PCP/SPC relationships Engaging community MD’s Advocacy, policy and lobbying Developing partnerships Community health, prevention and wellness New business opportunities and growth Disease and care management; Population health Practice management and process improvement Innovation Credentialing Leadership Communication (up and down) Transparency Reimbursement, risk sharing, contracts, P4P Developing Strategic Focus Fitzpatrick Consulting

5. Applied Strategy • What do we mean by the term “Strategy”? • What are some of the “Elements” of Strategic Thinking? • How do we translate Vision into Strategy? • Given Maine Health’s overarching strategy… • Exercise: Can you say what your strategy is? Fitzpatrick Consulting

6. Activity • Work in small groups to develop a “Strategy Statement” (35 words or less) that medical leaders at your level are intent on accomplishing on behalf of Maine Health • Share in the large group for discussion and feedback Fitzpatrick Consulting

7. STRATEGIC PLANNING DEFINITIONS VISION VISION IS THE ORGANIZATIONS COMPOSITE “LINE OF SIGHT” INTO ITS FUTURE • Products and services • People/skill sets • Geographic markets and segments • Customers • Competitors • Suppliers • Research and development • Facilities GOAL • DEFINED AREAS OF EFFORT THAT SUPPORT THE VISION. A GOAL IS A HIGHER LEVEL CONCEPT THAN AN OBJECTIVE OBJECTIVE • FOCUSED, MEASURABLE OUTCOMES WITH TIMEFRAMES THAT SUPPORT GOALS STRATEGY • A PLAN OF ACTION INTENDED TO ACCOMPLISH GOALS AND OBJECTIVES TACTIC • COORDINATED ACTIVITES THAT SUPPORT STRATEGY Fitzpatrick Consulting

8. What is Strategic Planning? • Environmental and competitive assessment • Emerging trends (Local, regional, national) • Key customer’s “interests” • Data analysis and synthesis (SWOT) • Identify strategic opportunities and prioritize • Evaluate criteria for prioritization • Best/worst case scenario’s (best choice) • Business Case • Customer value assessment • Cost to deliver (time and $$) Fitzpatrick Consulting

9. The Strategic Mindset In Leadership: • Has a clear sense of desired outcomes before acting. Develops a plan capable of delivering outcomes that will add significant value to a state of affairs • Scopes outwards to capture the larger context, to see how the pieces fit together • Is adaptive to realities and flexible in choice of tactics. Recognizes that once action begins the "game board" is fluid offering both new threats and new opportunities • Where possible, tries to achieve multiple objectives through singular actions • Plans a couple of steps ahead. It is said that Napoleon could conceive of seven steps ahead, each one with its potential counteractions by opponents • Anticipates opponent's actions and mentally rehearses next responses should those contingencies arise Fitzpatrick Consulting

10. Holds resources in reserve should their need arise • Forms alliances with opponents of his opponents • Learns opponent's strengths and weaknesses • Is aggressive in pursuing goals and ready to move on to the next • Does not rest on old glories • Taps diverse points of view in planning • Assures that everyone knows their roles and are equipped with the resources to contribute • Maintains a state of readiness. Stays alert and ready • Monitors activities in the operating environment • Uses "what if" speculation to stretch thinking in the direction of opportunities and possibilities Fitzpatrick Consulting

11. Has a good sense of what may be possible to achieve in the prevailing state of "politics." The art of what's possible • Studies the logic of the opponent's tactics with an eye toward determining what their ultimate end purposes may be • Makes use of trial balloons. Feints actions to test reactions • Usually prefers taking the offensive • Patient, with a good sense of timing • Acts decisively when the time to act has come • Is able to scrap or alter plans when information indicates actions are not attaining their intended results • Doesn't signal punches. (Unless in the form of a ploy.) • Knows what can be conceded or lost and what is essential to retain, preserve, gain • Doesn't bluff when the stakes are critical Fitzpatrick Consulting

12. Seeks and exploits opponent's weaknesses, oversights and mistakes • Maintains forward momentum • Uses surprise to advantage • Uses speed to advantage • Has the discipline to remain composed when the unexpected occurs • Tries to capitalize on crises or change, turn them to advantage • Stays future-focused • Invents both sequential and parallel actions to accomplish goals • Picks battles that can be won and avoids those that cannot be won. (At least not at an acceptable cost.) • Supplements actions with those of others (allies, partners, joint ventures.)  Fitzpatrick Consulting

13. Elements of Our “Charter” Fitzpatrick Consulting

14. Your Improvement InitiativeStages of ChangeProchaska and DiClemente Maintenance Make the Change “Stick” Resolve associated problems (unintended consequences) Identify potential for relapse: mitigate Action Implement Change – use skills tools, etc. Small Tests of Change Problem-Solve “Just DO it!” Relapse Whoops! “This didn’t work!!!” Don’t Panic! Use as “lesson” Return to contemplation… Preparation Course of Action for Change What’s Needed – skills, tools, resources “HOW do we … “ Contemplation Reason for Change What’s in it for ME? “We CAN …” Pre-contemplation Awareness of Problem/Opportunity to Change Concern/Doubt in Current State “We SHOULD … “

15. Your Improvement Initiative Innovation / Adoption Curve Rogers Late Majority Early Majority Early Adopters Laggards

16. Your Improvement Initiative Perspectives that Support the Change Business Process Redesign Role Optimization Advanced Access Performance Dashboard: Metrics/Quality Human Cultural Assessment/Development Leadership Patient Experience Teamwork Work-Life Balance

17. Your Improvement Initiative Template for Change Challenges / Barriers Benefits How to Leverage How to Mitigate