Most healthcare organizations have a strategic plan. Some have robust plans that are built with careful consideration of strengths and weaknesses of the organization. Fewer health systems have plans that drive significant improvement within their organization.

What are some keys to unlocking a strategic plan to drive significant improvement?


In our work life, just as in our home life, it is much easier to control those things that are within our “sphere of influence.”  We often see organizations that carefully craft their strategies and take them no further than the executive team. While the top levels of any organization control the development of strategies and goals, they are typically not the ones executing on the tactics that support those strategies. Along with crafting the strategies, the executive team also has responsibility for communicating and resourcing the elements of the strategy. However, when it comes to daily work, most strategies are related to activities that occur many organizational levels away from the executive team—at the frontlines. Unfortunately, many frontline workers cannot easily communicate the key strategies of the organization or, more importantly, how their daily activity supports (or hinders) those strategies. Organizations often fall short of their annual goals and objectives, only to get frustrated and reset the clock at the beginning of each year, hence the need for Strategy Deployment, or Hoshin Kanri.

The textbook definition of Strategy Deployment includes a management process by which the strategic plan is cascaded down into an organization by linking tactics, metrics, and improvement at all levels. There is an important facet of this management principal that I referenced above as the sphere of influence. It is much easier to change things for which we can control the outcome. By linking strategies with supporting tactics and linking operations to those tactics, the organization becomes aligned around necessary improvements. However, each level of the organization is only capable of controlling activities within their sphere of influence.

Let’s look at an example that includes a hospital that wants to improve its Length of Stay (LOS). The executive team sets a strategy to improve the LOS. The need for this strategy can be to improve patient satisfaction, improve finances, or increase access to healthcare services. However, the executive team doesn’t directly control how long patients stay in the facility. They can encourage a nursing manager to improve LOS, and the manager may communicate at a staff meeting that the team needs to improve, but the manager may not have direct control over those activities that impact when a patient discharges. The frontline staff is more closely involved in the day-to-day activities that impact how quickly a patient discharges from the hospital. The improvements are focused on where the work actually occurs. As an added benefit, frontline staff gains the understanding that the work they do makes a difference in the bigger picture. In addition, senior leaders gain an understanding of the role they play in the process. In the LOS example, the frontline staff may need help with changes to the hospitalist standard work. However, the frontline staff cannot control that work. Frontline staff may need the Chief Medical Officer to coach the Hospitalists into a new way of behavior. Now the CMO understands that their role in the LOS reduction program is to coach and monitor the standard work of the hospitalists.

A key point here is that the improvement cascaded down to the daily work at the frontline level, but also cascaded back up the organization to allow each level to clearly understand how they can impact the needed improvements.

Even in this simplified example, it is clear that many other lean principles play an important role in the foundation of a Strategy Deployment system. Lean principles such as management systems, problem solving, leader standard work, and visual controls are necessary elements to create a culture of learning necessary for success.


Tom Stoffel, Principal at HPPToday’s blog was written by Tom Stoffel, Principal at HPP.

Tom brings more than 15 years of continuous improvement experience in the healthcare industry. He oversees all Lean demonstration and development engagements for HPP. Before joining HPP, Tom served as President of Transformation Group, Inc. He developed TGI Healing Healthcare, a brand of Lean Healthcare training tools designed to make lasting improvements. Tom helps healthcare organizations make lasting improvements through development of improvement systems. He has led healthcare organizations in both the development of high-level Lean Strategies down to hands-on implementation of Lean in a clinical setting. Tom has developed an excellent working knowledge of Lean practices and principles by working with a diverse client base of all sizes and prominence. Tom earned a Bachelor of Science in Engineering from the University of Michigan in Ann Arbor, Michigan and has achieved the levels of Certified Lean Specialist from the Business Improvement Group and the National Institute of Standards and Technology (NIST), along with being an ASQ Certified Quality Engineer.  His training background includes Lean, Quality, and Leadership Training, as well as serving as an Adjunct Faculty Member at Waubonsee Community College in Sugar Grove, Illinois.

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