Strategic planning: Physicians needed

In the era of value-based purchasing, including physicians in the development of strategy has never been more crucial. Your system’s future will depend on the ability of your physicians and related providers to deliver better, more effective care and manage to quality metrics. In the longer term, they must deliver reliable outcomes and lower costs. Physicians are in an excellent position to identify how to deliver that value.

If you are not already engaging doctors to gain their understanding of the market’s trajectory and their insights into how to respond, you have a problem. If you are not jointly building strategic initiatives, you risk falling short in an increasingly challenging market.

Physicians desire a high level of inclusion in the strategic direction of the organization. They want to be integrated into the decision-making process and to receive feedback on their ideas. They are deeply invested in delivering better care to patients and shaping their work environment in positive ways.

Engaging physicians in the strategic planning process is a foundational element of building an effective strategy. Perhaps more important, by engendering support for the plan, it will facilitate its implementation.

Best practices

From the vantage of hundreds of planning projects, and with a strong belief that physicians must help drive strategy development, my colleagues and I agree that there are a number of best practices that you should consider for your health system or hospital.

Engage physicians directly in the strategic planning leadership through broad physician representation on the steering committee. We recommend a committee of up to 13 individuals, including five to seven physicians. This representation creates a process to capture the knowledge of physician leaders. It also creates a reality filter, helping ensure recommendations that can be implemented. Physicians are not prone to remaining silent if they believe an initiative is ill-conceived or under-resourced. Finally, physician inclusion gives you advocates among the medical staff to accelerate acceptance of the plan’s initiatives.

Engage more physicians in the planning (and implementation) process through a physician strategy steering committee. This larger group of physicians can advise on all issues directly affecting physicians and provide useful insights. The physician members also have time to get deeper into tactics, such as the placement of physicians, details of specialties needed and physician alignment efforts that should be pursued. The role of this group is to make recommendations to the steering committee. This level of inclusion can further enhance acceptance of the strategic plan.

Board member attendance at physician meetings is helpful as well. It has three benefits: It ensures the board and its steering committee better understand the physician perspective, it gives physicians a greater feeling of having a voice, and it helps the board understand physician perspectives if there is conflict with the direction advocated by the board.

Determine which physicians to include in strategy development. Who should be involved in the steering committees is always a key question. Clearly, formal medical staff leaders require consideration, but informal leaders are more important. This is especially true if the informal leaders have a grasp of the bigger picture and are patient and willing to commit the time. Specialty diversity is key as well, with strong representation from hospital-based groups and primary care a useful consideration. Hospital-based groups add value because they better understand hospital operations. The primary care providers understand the crucial flow of patients.

Another relevant factor is the division between private and employed physicians. Most hospitals strive to bridge this gap and focus on getting these cohorts to function as one. At times, however, the strategy cannot be implemented because private physician agendas diverge from those of the hospital. Having private doctors at the table will facilitate making tough decisions, especially if the physicians are not directly involved in a controversy and can thus be impartial. If your hospital must work around private physicians to achieve success, they will better understand (even if they don't accept) the conclusions.

Focus on the employed physician network strategy as a requirement in the planning process, and make sure the committee is tying the physician group and system strategies together. For most health systems, long-term success is closely tied to the evolution of the employed physician network. The network is the venue for most new recruitment and locus of the primary care strategy. It also represents the best chance for transforming practice patterns and care coordination. Increasingly, it is also the locus of the organization’s strategy for risk products, as these physicians tend to better understand the requirements to improve care processes. Ensuring participation of the group's physician leadership in the development of its vision, strategic priorities and supporting actions is time well-spent.

Recognize the planning process as a great opportunity to educate physicians. In addition to the inclusive behaviors outlined above, a strategic planning best practice is to involve an even broader group of physicians in a kickoff retreat. The retreat should focus on two types of education: national trends in health care that are relevant to your organization and organization-specific performance challenges (versus goals) that should be considered in setting strategic priorities. In addition to informing physicians, this approach helps ensure a shared perspective as the organization embarks on the planning process. It also provides context to the changes and why the organization must change.

Consider whether strong outside facilitation can add value when discussing difficult issues with physicians. Dysfunctions that sabotage organizational success are hard to confront under the best of circumstances but can be more skillfully surfaced by the right moderator.

Keep the medical executive committee and other formal medical staff structures in the loop. While these physician leaders are not primarily the decision-makers, keeping them updated can help avoid controversies and potentially improve the plan. Two or three updates to the MEC during the planning process are generally adequate, and if they are delivered by a physician deeply engaged in the process, even better.

View service line planning as a great venue for physician inclusion, as it directly affects the practices of your physicians. This involvement should be a particular focus for services prioritized in the strategic plan. Growing the care capabilities of the service, institutionalizing best practices, building bundled payment strategies and improving the ability to produce reliable results are all issues that require physician attention. And, as an ongoing matter, a strategy to consider should involve the inclusion of physician leaders in service line leadership dyads.

Don’t ignore other opportunities for physician involvement in this process. Not all physicians will be included in formal discussions, but input through interviews, online surveys and focus groups is valuable. It adds credibility to an analysis and helps reinforce your knowledge of common physician perceptions.

Remember that the best strategies are supported by great implementation, and including physicians in planning sets the stage for their help in driving implementation. Three great practices are worthy of replication. One good approach is to involve physicians in quarterly strategic plan updates to the board and have them participate in presentations on progress. Another excellent use of physicians' insights is to have them provide leadership on technology and equipment decisions. And, at a service-line level, participation in a dyad management structure adds great value to the implementation process.

Ensuring physician leadership in building the strategic plan is step one. Physicians' involvement will pay massive dividends as they understand the rationale for the plan, support it with their peers and engage in its implementation. Given the high stakes of strategic decisions and the growing complexities of implementation, it is easy to see why you should be committed to physician inclusion at this level.

David W. Miller ( is managing partner of HSG in Louisville, Ky.