Building Execution into
Strategy
How St. Vincent’s Health Services
Effectively Adapted to Changing
Times
The opinions expressed are those of the presenter and do not necessarily state or reflect the views of SHSMD or the AHA. © 2016 Society for Healthcare Strategy & Market Development
Situation
• 25-year collaborative
relationship with a large
primary care practice that
had “grown up” at St.
Vincent’s
• “Good news/bad news”
• What’s the risk?
Problem
In 2014, group sold to
hospital’s competitor
creating potential for
undersized primary
care and ambulatory
network
Key Strategic Challenges and Strategies
Key Challenge
Strategy
Initiative
A. Primary Care Network
Undersized
ambulatory and
physician network
to support assets
and manage
populations
Development
Secure Local
Market and
Prepare for
Population Health
1. Unified Physician
Platform/Local
CIN/Primary Care
Institute
2. Anchor group
partnership
B. Retail/Consumer Focus
Primary Care Institute
• Primary Care Institute (PCI) created in 2014
• Convened a multi-disciplinary team:
–
–
–
–
–
–
Strategic Planning
Physician Enterprise
Real Estate
IT
Behavioral
ACO
- Finance
- Marketing
- Design & Construction
- Nursing
- Community PCPs
From the data emerged a
vision
Rigor to Execute
• Primary Care & Ambulatory Network
Strategy
A. Strategic Intent: Creating a Primary Care Institute
B. Modes of Growing Primary Care Capacity
C. Approach to Geographic Areas of the Market
Implementation
• Primary Care Institute Implementation
A. Scope of Work
B. Management Structure
C. Committee Charters and Membership
D. PCI Steering Committee Agendas
Modes of Growth
Group A:
Provider Recruitment
Group B:
Long-Term Provider
Pipeline
Group C:
New Access Points &
Clinical Services
Group D:
Engaging Healthcare
Consumers
Prioritized each of the modes within the groups
Primary Care Institute Implementation: “First and Second Moves”
= First Move
Workstream
A. Provider Recruitment
MSG Recruitment
PHO Recruitment
Recruitment into Indep. Practices
B. Long Term Pipeline
Quinnipiac SOM
FHC Preceptors
C. New Clinical Services
Diabetes Center of Excellence
Investments in Geriatrics
SNF Partnership
FQHC Partnership
D. New Access Points
Urgent Care – Billing Model & New Sites
Investments in current MSG sites
Fairview Site
Stratford
APRNs/PAs
Retail Partnership
inQuickER
Healthgrades
eVisits and Telemedicine
= Second Wave
Executive Lead
Accountable Implementer
Gleckler/Schek
Scifo/Willey/Flavell
Gleckler/Schek
Gleckler/Raskauskas
Hunt
Flavell
Gleckler/Schek
Schek
Fogel
Schek
Fogel
Schek
Fogel
Schek
Fogel
Schek
Fogel
Schek
Fogel
Schek/Raskauskas
Fogel / Hunt
Schek
Fogel/Hoey
Gleckler/Schek/Auger
Gleckler/Schek
Scifo/Willey
Gleckler/Schek
Brown/Willey
Scifo/Willey
Auger/Schek
Scifo/Willey
Auger/Schek
Gleckler/Schek
Scifo/Willey/Fogel
Auger
Willey/Scifo
Auger
Marker
Auger
Auger
Status
Work Underway
Work Underway
Work Underway
Work Plan Developed
Work Plan Developed
Work Plan Developed
Work Underway
Not started
Exploratory Phase
Work Underway
Not started
Work Underway
Work Underway
Not started
Work Underway
Work Underway
Work Underway
Not started
11
Key Success Factors
•
•
•
•
•
•
•
Defining intent (secure the core)
Creating case across organization
Securing alignment on priority
Capital
Interdisciplinary team
Priorities (moves, milestones, check-ins)
Strategy leaders and operational leaders
working in tandem
“No worthwhile
strategy can be
planned without taking
into account the
organization’s ability to
execute it.”
Larry Bossidy
Execution, 2002
Hurdles, Method, Tools
BUILDING EXECUTION INTO
STRATEGY
Building Execution into Strategy
• How to ensure a well-designed strategy
converts into effective implementation
• Hurdles: Why we hate to change
• Overcoming the Hurdles: Fair Process, Trust
and Commitment, Voluntary Cooperation
First, you
must
have the right
strategy.
Blue Ocean Strategy
17
What do you need to thrive in
changing times?
• A real strategy
• A well-defined, integrated,
cohesive approach
• A clear, simple story
What’s
your
hook?
Blue Ocean Strategy
18
All strategies ask…
• Which customers or markets?
• What distinguishes us?
• What value proposition?
• Why key processes give us
competitive advantage?
• What are the human, technological
or organizational enablers of the
strategy?
Blue Ocean Strategy
19
Red Ocean Strategies are bloody!
• To win you must grab a bigger
share of the market.
• Very Competitive.
• It’s a zero-sum game!
• One wins, the other loses.
Blue Ocean Strategy
20
Blue Ocean Strategy is…
“…A way to make the
competition irrelevant by
creating a leap in value for
both the company and its
customers.”
Blue Ocean Strategy
21
Why are they so hard to
implement?
Ask your leadership
The brain
hates
change!!
Change creates
pain in the brain!
Blue Ocean Strategy
23
Comfort of the Herd--Culture
24
Birds of a Feather Flock Together
Power Of Habits
• We love to think that we
are full of “free will.”
• But, we really are driven
by our habits.
But, You Need To Change
In All of History …
• The Seven Basic Plots
– Overcoming the Monster
– Rags to Riches
– The Quest
– Voyage and Return
– Comedy
– Tragedy
– Rebirth
• But thousands of ways of telling the story.
Dianne Had a Great
Story
• St. Vincent’s was the fallen hero that
needed a Rebirth.
• With the data in hand, they went after it
with great struggle, obstacles, hurdles
and hope that they could quickly tackle
the well-established competitor, who
used to be their best buddies.
• Against great odds they overcame the
monster and restored the patients to
their rightful home at SVMC.
Ok, so you have a great strategy and it has become a wonderful
inspiring story. Now what?
HOW TO EXECUTE A GREAT
STRATEGY?
Strategy Faces Hurdles
• The Cognitive Hurdle: Waking employees up to the
need for a strategic shift.
• The Resource Hurdle: It is assumed that the greater
the shift in strategy, the greater the resources it
requires for execution.
• The Motivational Hurdle: How do you motivate key
players to move fast and tenaciously to carry out a
break from the status quo?
• The Political Hurdle: As one manager put it, “In our
organization you get shot down before you stand
up.”
Overcoming Hurdles
• It is only when all the members of an
organization are motivated to support a
strategy, for better or worse, that a company
has a chance to stand apart as a great
executor.
• That means your strategy needs a strategy!
To Execute on a Strategy
•
•
•
•
Minimize risks.
Inspire trust and commitment.
Inspire their voluntary cooperation.
Build execution into strategy from the start.
Must Build Engagement
Reach into “Fair Process.”
Fair process is key variable between successful
strategic implementations and those that fail.
Power of Fair Process
Based on research
– People care as much about the justice of the
process as they do about the outcome itself.
– Satisfaction with the outcome and
commitment to it rise when procedural
fairness is exercised.
How Do You Do Fair Process?
• Begin with building strategy into people’s
buy-in up front.
• Engage the team in the strategy-making
process.
• People trust that a level-playing field exists.
Inspire them to
cooperate
voluntarily in
executing the
resulting strategic
decisions.
Voluntary Cooperation
• More than mechanical execution.
• Don’t want people to do only what it takes
to get by.
• Going beyond the call of duty.
• Go beyond their own abilities, even
subordinating own self-interests—to
execute resulting strategies.
Three “E” Principles
• Engagement
• Explanation
• Expectation Clarity
Why Does it Matter
• People emotionally seek recognition of their value.
• Not as employees but as people who want to be
treated with full respect and dignity and appreciated
for their individual worth.
Ignore Fair Process and they will..
•
•
•
•
•
Feel intellectual indignation.
Not share ideas and expertise.
Hoard their best thinking and creativity.
Undermine and Sabotage the process.
Not trust the strategic decisions being made.
Good Strategy Execution
• Is based largely on motivating-people.
• Requires you to overcome organizational
hurdles.
• And win trust with fair process.
• Demands a holistic approach to formulating
the execution of the strategy.
Glassdoor, 2013 research of 2000 employees
What did they do?
How did St. Vincent’s convert a
great strategy into a winning
execution?
Timing
This was a crisis.
No need to wait for a crisis to implement a
strategy really well.
Reflecting Back on the Process
• Engagement
– The WHO (Interdisciplinary Group)
• Explanation
– The WHY (Build a New Network)
• Expectation Clarity
– The WHAT (Results of the Work Together)
Progress Report
PCI = Launching Pad & Landing Pad
• 4 new urgent care centers, total 8, all with
online scheduling capability
• New PCPs in the market
• E-visits launched in 2016
• Multiple service line initiatives
• Joint ventures
Special Needs - 13
Primary Care
Urgent Care
Specialty
Cardiology
Questions
Thank You!
Dianne J. Auger, Senior Vice President,
Chief Strategy Officer
St. Vincent’s Medical Center
[email protected]
www.stvincents.org
Andrea J. Simon PhD, President and CEO
Corporate Anthropologist
Simon Associates Management Consultants
[email protected]
www.simonassociates.net
@simonandi
Facebook.com/simonassociatesmanagementconsultants
Blue Ocean Strategy
54