Strategic planning or long-range planning is a critically important activity for every organization, regardless of size. Even a small practice of two or three physicians can benefit from the development of a documented road map with mile posts for where the organization is going, why it is headed in that direction and how it is going to attain the objective.
For every practice setting, planning should be an ongoing agenda item with dedicated time for the identification, discussion, decisions and assignment of responsibility for each initiative.

Timing

The timing for the planning session will be dictated by the agenda and the governing body’s willingness to devote sufficient time to the session. At a minimum, a formal planning session will normally be about three hours– again dictated by the agenda, number of attendees and the group’s tolerance for time. While some sessions are a couple of hours, other sessions may involve the whole day. Larger organizations often devote an entire weekend to the planning activity.

Planning Session

At the annual planning session, attendance is normally limited to members of the governing body and the administrator. Some organizations invite all stakeholders to the session but this can become unwieldy with too large a group at the table to move efficiently through the agenda in the allotted time.

The planning session should be a separate, dedicated event rather than an agenda item at the monthly meeting of the governing body. Planning requires dedicated focus and should incorporate a number of set events both before and after the actual session.

Pre-Planning Questionnaire

In order to build an agenda for the planning session, it is a good idea to develop a pre-planning questionnaire and circulate it to all stakeholders for completion. Questions should include those topics that warrant discussion and decision by the practice/group/center. Some examples might include:

What specialties/services should be added? Should any be eliminated?

Are you satisfied with the level of clinical support staffing? Administrative support staffing?

What improvements in the day-to-day operations of the organization require action?

How effective is management?

Is the governing body doing a good job? If not, what changes would you suggest?

Is there a succession plan for the leadership of the organization?

Is there adequate space/staffing/equipment for your practice?

As an owner, are you satisfied with the return on your investment?

Agenda

The responses to these types of questions, coupled with issues brought to the attention of management by others (including those issues driven by legislative action in your state or national law, as well as requirements from payers) will serve to set the agenda. Also, a review of governing body minutes for the past year will allow the group to review “what has happened” and the current status of unfinished initiatives – all needing discussion/decisions at this year’s planning session.

After the agenda is set, management should be charged with researching the topics so that information critical to decision making is available, including data analysis, market information, trending and cost impact of various alternatives. Management is responsible for providing decision makers with all the information they need to make informed decisions.

A sample agenda would be:
Call to Order
Review of last year’s session/minutes
Items for discussion
A B C D E
Actions – decisions on discussion items
Appointment of Action Agenda (Approved Initiatives) Responsible Party

Last Year’s Session

If there was a planning session last year, the results of that session should be reviewed with explanations as to the status of various actions, and an update on the degree of success with each approved initiative. In fact, the minutes of the previous session serve as the key report card, allowing the group to assess where there were accomplishments, and when a particular approved action did not reach completion; and if so, an analysis of why not.

Using a Facilitator

While the use of an outside facilitator is always a positive move because he/she has no vested interest
or historical baggage and can maintain objectivity in the conversation – there is an expense involved which some organizations may not wish to incur. In that case, a stakeholder should be identified to lead the session. The key to an efficient session is the ability of the leader to be objective and not dominate the discussions another advantage of using an outside facilitator, is his/her role as a time keeper to assure completion of all agenda items. He or she also has the responsibility of managing the conversations to allow all participants to be heard while preventing any individual(s) from dominating the discussion.

Action Agenda

After all subjects have been reviewed, it is recommended that an individual be assigned to take responsibility for each approved action. (This should be someone who has fire in the belly for the initiative and will champion it.) The champion will shepherd the initiative through to completion and report the current status at governing body session. This individual should be a physician, and NOT the administrator, although the administrator and other members of management provide administrative support to the champion.

The approved initiatives resulting from the planning session decisions should form the basis of an action agenda for the organization, with regular reporting of the status of the initiatives at governing body meetings during the year. In addition to listing the responsible party for each action item, a due date for the first report on the initiative should be identified.

In summary, strategic planning is a fundamental management tenet as well as a responsible course of action for every organization. The requirement for planning is incorporated in the Standards and Elements of the Accreditation Association for Ambulatory Health Care. Surveyors will be interested to view the planning method that the organization undertakes the process, the documentation (minutes of the planning session), the periodic reporting of action items, and details of the organization’s planning activity.