guest post by Jeff McKune

Andrew touched on the central point of strategy when he said that it is "where you want to be." As with solving any problem, understanding the problem is the first step. Understanding where a hospital wants to be in the future is the first step in strategy development. There is a strategy development methodology known as complex adaptive systems that overcomes some of the shortcomings to other approaches. None would question that the healthcare industry is dynamic, with players and variables changing so quickly that adapting a static approach to strategy development is, for all practical purposes, hopeless. Perhaps those more static methodologies, and the resulting frustrations, are one of the reasons why senior leadership often reverts to a more operationally focused "what do we need today" approach.

In brief, the complex adaptive systems methodology starts simply with a series of scenarios. Write several brief scenarios about aspects of healthcare in the future - just a few paragraphs for each is sufficient. Base each scenario on your current knowledge as well as trends that you see. Where will healthcare be in five or ten years? Write in the present tense, placing yourself in the new world of healthcare as if it actually existed. Select two or three of the most compelling scenarios as the seeds of your strategy. From here, the strategy development is a series of straightforward but thoughtful steps.

* Identify the stakeholders in your scenarios. What skills and capabilities do they have? How will your organization relate to them?
* The keystone organization is that organization through which other services will flow. It is the cornerstone of the socioeconomic business system - the healthcare environment in which you operate. What skills, capabilities, equipment, and other resources will you need to be that keystone organization in your scenario? Do you have the right people? This will hopefully lead to another entirely separate discussion on strategic human resources management.
* Decide how you will acquire the skills, capabilities, resources, equipment, and people that you will need. This is much more than "we need a 64 slice CT scanner". This is acquisition with intent and a clear view of where the acquisitions will place you in your future scenario.
* The plan for acquiring what you will need becomes an action plan that is the basis for your implementation plan for your strategy. Implementation is where so many organizations fall short, so developing project plans and milestones is crucial.

At least once a year, revisit your scenarios. What has changed? How have the complexities of your system reshaped your scenario? Simply restate your scenario and reiterate through the steps once again. What you learned from the previous effort and your new perspectives will sharpen your next strategic plan. This is the advantage to the complex adaptive systems approach.

When your entire organization is focused on making your hospital successful five or ten years in the future, it is much more difficult for other organizations to compete or deflect you from your target. It is like playing chess with someone who can think ten moves ahead of you - you don't stand a chance.

Jeff is Director of the Ambulatory Surgery Unit at Phelps County Regional Medical Center