STRATEGY

An Innovative Approach to Strategic Planning: Building From the Middle Out

At large health systems like Penn State Health, strategic planning typically starts with the board of directors, who communicate their vision to the C-suite who then funnel directives to the staff at large.  However, in the aftermath of the COVID-19 pandemic, leaders at the five-hospital health system (which includes an academic medical center and Children’s Hospital along with four community hospitals) wanted to “reframe” that process to engage local stakeholders in planning decisions that affected their work directly.

According to Vince Gallucci, vice president of strategy and marketing for Penn State Health, the goal was to take a “middle-out” (as opposed to a “top-down”) approach. This started with identifying the people who would ultimately execute on the plans and engaging them in their development. Executive leadership would then vet the plans, which were called “playbooks,” explains Jerry Griffin, Penn State Health’s director of consumer insights and digital engagement. The playbooks would essentially set the strategic priorities for each individual group—in some cases, locations; in others, service lines—within the health system and outline how they would be addressed.  

“We wanted to build a plan, a strategic set of imperatives and priorities, where we would have direction from the board but also go directly to the sources, if you will, and start strategic planning work with the folks at a local level,” Gallucci says. “The most important thing we were able to do from the middle out was identify the deployment of people who were going to execute on the plans, and then roll them back in to our executive leadership.” 

Gallucci and Griffin will be speaking about this topic at SHSMD Connections 2023. To learn more about the SHSMD annual conference in Chicago, Sept. 10-12, visit SHSMD.org.  

Why Planning Is Vital 

In any industry, every organization needs to have a strong strategic planning process in place.

“I saw in the past that if you don’t have that clear strategic plan, it could lead to confusion, inefficiencies and missed opportunities as you try to grow your business,” says Griffin, who came to Penn State Health from the for-profit sector.  “That’s why I think it’s imperative that everyone is aligned and on the same page, especially as hospitals and health systems grow.” 

Griffin cautions however, that to ensure success, the planning process needs to be as strong as the plan itself. Even systems that develop comprehensive and ambitious strategic plans can see them fail for several reasons, including that they neglected to establish how new initiatives would ultimately be implemented. 

In most cases, this is because these organizations make the fatal mistake of failing to engage all relevant stakeholders in the development of the plan, as these front-line staff will likely have the most direct experience with how new initiatives will be put in place. 

“If you don’t engage front-line staff and keep them engaged—and if you don’t get input from those key stakeholders—you may not have a strong plan,” Griffin notes. 

The middle-out approach mitigates this latter potential pitfall by engaging front-line staff in the planning process from the beginning. 

Engaging Front-Line Staff in the Process

The playbook development process means that local stakeholders are aligned with the plan for their facility and feel engaged and heard throughout its development. 

“It’s imperative that everyone is aligned and on the same page, especially as hospitals and health systems grow,” Griffin explains. “We’re a five-hospital system but, as we grow, we want to make sure all the hospitals are following that same true north.” 

Each playbook includes an introduction, which explains the plan and the general mission behind it, as well as a framework for the plan—a list of the priority strategies, each aligned with specific goals—and a set of metrics designed to measure successful plan implementation. 

According to Gallucci and Griffinl the playbooks incorporate ideas as well as feedback received from local stakeholders and front-line workers. For example, one playbook focuses specifically on diversity, equality and inclusion (DEI), while others focus on individual health-system service lines. 

“We reframed a little bit of what a traditional strategic planning process would be with data analytics and so on, and hours and hours of work of studying data and metrics,” Gallucci adds. “We still did that, but that was probably the minority of the work that we did. We really wanted to get closer to the priorities across our regional and our academic hospitals and, ultimately, what’s happening within departments.” 

In a reference to the athletics program at Penn State’s flagship campus in State College, Gallucci and Griffin refer to the initiative as their “Big Ten” of playbooks, meaning they have 10 playbooks in place that represent plans for human resources, DEI programs, individual medical groups, leadership and operations. 

Since launching the initiative, they now have 11 playbooks completed, with another five or six in the works and other divisions within the health system requesting to get involved in the process. This is significant, given that strategic planning is often viewed with dread, Gallucci says. 

“We are now very busy doing the work that people once would respond to with, ‘Ugh, strategic plan. How long will this take?’” Gallucci adds.

How the Playbook Looks 

The playbooks developed at Penn State Health essentially all follow the same format. Typically, an introductory section describes the work done within the division or service line from the perspective of those doing the work. Then, the document outlines a framework for instituting new initiatives, including delegation of tasks and leadership roles. 

Next, the playbook establishes a set of priorities for the division or service line. This process may start with a long list that’s narrowed down during discussion, with input from the entire staff. 

In subsequent working sessions, led by Gallucci and Griffin, the stakeholders discuss “breakthrough strategies,” which Penn State Health describes as initiatives designed to make the system stand out. 

“Essentially,” Gallucci explains, “what would be unique and different? For most, that’s a challenging effort. Are these priorities aligned with the strategies? And are those breakthrough strategies driving our goals forward?”  

To date, the process of building an integrated system strategy from the middle out has been well received by the health system. In general, across the health system, there’s more focus on what’s critical for professionals to move forward within their area of the organization. There has also been greater engagement among health-system staff. 

“It’s been a great experience for the organization,” Griffin notes. “As we’ve gone through this process, we’ve really started to gain some engagement. I think there’s been a culture change in our organization as we start focusing on this approach, because they start to see the value of engaging. We’ve received a lot of participation engagement with the different groups that we’ve met.” 

Image credit: Geralt/Pixabay