Hope Is Not a Strategy

As the changes in healthcare accelerate, many radiology groups are operating without an agreed upon plan to cope with external pressures and improve the performance of their organization. It appears that, for many groups, hope is their strategy.

As radiology group leaders know, the lack of an agreed-upon plan for the future can cripple the organization’s ability to survive and thrive. “Agreed upon” are they key words. While individual members of the group or some member of the group’s leadership might have a plan in mind, the fact that it has not been discussed will limit success in implementation.

Most successful groups conduct periodic strategic planning processes to harness the power of the group. Nonetheless, many groups avoid developing plans. They think monthly meetings should suffice; prefer to avoid the inevitable conflicts that arise; or recoil at anything that sounds like a kum ba yah session. 

The decisions that radiology groups face today are significant and have long-range implications. They involve issues such as whether or not the group will stay independent, who the group will align with, which sites of service to pursue, what technology to invest in, the addition of new services and a host of others.

Decisions related to each of these issues require substantial resources and lead times. Often, the decisions are interrelated. For example, the decision to add new sites of service can be directly impacted by the group’s ability to recruit.

Therefore, the best performing groups conduct periodic strategic planning efforts. Strategic planning includes four major tasks: developing mission and vision statements for the group; performing regular internal strengths and weaknesses and external opportunities and threats (SWOT) analysis; discussing key issues; and developing objectives, strategies and action plans.

Mission and vision

We know that some of you will gag at the thought of developing mission and vision statements for your group. Maybe you have spent a whole weekend developing a mission statement for a hospital you work with and come up with, “We serve patients.”  Maybe your group has tried in the past, but the result was so ethereal that individuals don’t see the connection between these statements and the real world.

Mission and vision statements serve hard-core business purposes by helping the group to properly allocate and utilize resources. They serve as a guide when setting strategy and making decisions. The best-performing groups always ask whether a proposed initiative is part of the mission or taking the practice toward its vision.

A mission statement defines the group’s purpose and reason for being. It addresses who the group wishes to serve (geographic area, types of patients, health systems); customer (e.g. patients, referral sources, health systems) needs the group wants to satisfy; physician and staff needs that need to be satisfied; core values and requirements for being a member of the group; and guiding principles and policies.

A vision statement addresses where a group is headed, looking out three to five years.  It attempts to define the group’s preferred future, the services and specialties it intends to offer; the geographic region it would like to serve; the target number of clients; the ideal size of the group; the type of relations it will have with others; and whether or not it will remain an independent group.

SWOT, issues, action

Once a group’s mission and vision statements have been developed, it is time to identify the important issues that need to be addressed in the planning process. The first step in that effort is a SWOT analysis.

Most planning efforts use this information to develop plans to fix significant weaknesses, pursue key opportunities, avoid significant threats and leverage group strengths. By analyzing the SWOT, the group can identify the key issues that need to be addressed in the next steps of the planning process.

The key issues to be addressed in the planning process are different for every group, because the results of the SWOT analysis are different for every group. Radiology groups, however, commonly need to address relationship issues, such as whether the goal is to remain independent and with whom the group should consider affiliating (other groups, hospitals). Geographic coverage and size and recruitment issues also often need to be addressed. Internal issues that often need attention include governance model, compensation system, call and operations.

The final step in the strategic planning process is to set objectives, establish strategies and develop action plans. Objectives describe realistic situations you would like to see come about and that align with your group’s mission and vision. Strategies are the major decisions, policies or action programs employed to meet your objectives. Actions plans address what will be done, who will do it, costs, benefits and a target completion date.

Too big to retreat

Most small- and mid-sized radiology groups utilize a planning retreat process to develop their strategic plans with all shareholders participating. Once a group reaches a certain size (30 or more), however, it becomes increasingly difficult to conduct a planning retreat in which all physicians participate, and at which all important issues are discussed completely and in depth.

It is nearly impossible to have the complete debate and discussion among all members with more than 30 people in the room. What often happens is five to six individuals debate while everyone else watches.

In the case of a larger group, we have found the following, step-wise approach balances the desire for involvement with the ability to have beneficial in-depth discussion on the issues.

Step 1. All physicians are surveyed or interviewed to obtain their input on the SWOT and the issues they believe should be addressed in the planning process.

Step 2. A sub-set of the group, including the board and a limited number of designated partners, then meets to conduct the strategic planning steps noted above and create a “draft” plan. This group typically is composed of the board and other key leaders. It is best to limit this group to 15 or fewer participants.

Step 3. Following the retreat, a meeting of all physicians is conducted and the “draft” plan is presented.  This meeting gives those who did not attend the retreat the opportunity to provide feedback about the results of the planning process.  It is important to note that the goal of this step is not to re-do the work at the retreat. 

Instead the larger group is asked three questions: What did you like about the plan? What did you dislike? What wasn’t considered that should have been?

Step 4. At a later date, the board members review the feedback from the full group meeting and decide whether or not the “draft” plan should be adjusted. The final plan is then adopted by the board.