Execution is everything!

1. Execution is everything! Converting Plans into Action James A. Rice, Ph.D., FACHE

2. Building Blocks for Execution: What have we learned about the key factors that help increase the chances for a culture driven toward excellent implementation; to convert great plans to actions that yield great results? Results Require Execution not Just Great Plans

3. Engagement. Execution. Results. Conversion is about driving from left to right

4. How to convert plans to action to results? • Self-defeating teams to self-directed teams • Ossified organizations to optimized organizations • Crumbling communities to celebrated communities • Stagnant culture to star culture Results Require Execution not Just Great Plans

5. How to convert “Fritz” the individual from • Naysayer to soothsayer? • Wet blanket to electric blanket? • Obstacle or oracle? • Change choker to change champion? • Exasperated to ecstatic? Results Require Execution not Just Great Plans

6. Pillars of Performance Building our future on solid pillars of: Service, Quality, Growth, Finance & People

7. 5 Performance Pillars support efforts to achieve an organization’s vision Our Vision 2010 Our strategy requires synergistic work among all of our five pillars; work that is grounded on and built from our commitment to our mission, values and principles Finance Growth Quality Service People Principled Passion Values Guided Mission Based Results Require Execution not Just Great Plans

8. Our Vision 2010 We intend to be the market’s premier provider system recognized as a seamless & integrated system that delivers outstanding and progressive health care services Our Mission is to assure a lifetime continuum of health care services for the people of our region Mission Based Results Require Execution not Just Great Plans

9. positioning statements from our leaders. “Making a positive difference in lives and living” “Our Community. Our Future.” “Our people serving neighbors and friends” “A proud heritage. A bright future.” “Modern curing. Old fashioned caring” Results Require Execution not Just Great Plans

10. Our Values and Principles Guide Our Work in the 5 Pillars as We Drive Toward Our Vision Our Vision 2010 P ersonal Customer Services R esponsiveness and Teamwork I ndividualized Care D edication & Commitment E xceeding Expectations of Quality Principled Passion: W orking as a Team, Shared Responsibility E mployee Knowledge and Skills C ompassion A ccountability and Leadership R espect, Integrity and Diversity E xperience and Innovation Values Guided: Mission Based Results Require Execution not Just Great Plans

11. How can we enhance plan execution? More measurable targets, clearer accountabilities, more results celebrations, more pay for performance

12. Vision 2010 Pillar What is our goal Our New, Board level, Strategic & Financial Plan is built up from a “Results Hierarchy” of a major goal for each pillar; a strategy to achieve the goal; and three major sub-strategies as key to implement the strategy. Matrix workplans and budgets are then developed and followed for each of the system’s operating units and managers How measured How accomplished Lead Strategy Sub-strategies Lead Manager Matrix Connections & Support Across Our System Workplans and Budgets of Each Unit Workplans and Budgets of Each Unit Workplans and Budgets of Each Unit Results Require Execution not Just Great Plans

13. Our “Results Hierarchy” Vision 2010 Finance Growth Quality Service People What What What What What Top 100 US Hospital Systems 97% Patient Satisfaction Top Area Employer “A” Credit Rating 5% More Market Share How How How How How Operate Performance Driven Processes Expand Role in ED & Chronic Diseases Recognize & Reward Service Excellence Nurture a Culture of Respect & Value Put the Patient First Center for Patients & Visitors Earn Physician Pride & Loyalty Earn Employee Pride & Loyalty Celebrate People Stories Often Invest in Specialty Centers Focus on Cash Smart Care Management Processes Build Philanthropy Recruit Physicians Active Marketing Blame Free Work 24/7 Education Evidence Based Medicine Assess Moments of Truth Transparent Reporting • Each unit leader asks and answers 2 questions: • How can our unit/team best contribute to the achievement of our “Results Hierarchy”? • How can I best earn the work & enthusiasm of my followers to best accomplish my monthly & annual workplans and budgets? Action Plans & Budgets for Each Division, Department or Unit Principled Passion Values Guided Mission Based Results Require Execution not Just Great Plans

14. Pillar strategy developments The following pages outline the board level definition of what we hope to accomplish, and how, over the next five years within each of the five pillars. Management will be developing specific workplans for each of the strategies and sub-strategies during the Spring

15. Common Obstacles to Execution? 1. The problem is poorly defined & lacks ownership 2. Unclear statement of strategic direction & not owned • lack description of desired future state • lack statement of desired outcomes • lack measurable performance targets, results, objectives 3. Alternate scenarios not formulated/modeled 4. Lack accountable party to lead implementation 5. Grand vision not bolted to day-to-day work nor resources 6. Incomplete plan to implement the strategy 7. Implementation resources undefined or out of balance: time, talent, treasure, technology 8. Lack advanced identification of where it could go wrong 9. Lack contingency plan(s) for alternate realities 10. Lack performance monitoring & incentives for recognition/reward Results Require Execution not Just Great Plans

16. Plans People Process Project management Pride Passion Praise Parking Pay teams Pay Individuals Profits Pride Promotions Plaques Pats Pizza Prizes Promises (hope) Promises (commitment) Promises (interpersonal) 2020 Powerful concepts to assist in effective conversion:Hindsight. Foresight. Insight. Develop worksheet for teams to define how to apply each in your unique setting and situation Results Require Execution not Just Great Plans

17. The Generic Model 10 10 10 10 10 Probability Of Implementation Leader/ Follower Balance Clear Accountability Managed Obstacles Contingency Plans Good Idea E.S.E. 500 What is ESE ….? Results Require Execution not Just Great Plans

18. Effective Stakeholder Engagement (ESE) • What is it? • What gets in the way of doing it well? • How and when to do it? Power Planning Partnerships The Power of The Babushkas Effective Stakeholder Engagement Results Require Execution not Just Great Plans

19. Toolkit for High EQtm … • Town Hall Forums • Project Management Software • Gantt Charts • P.E.R.T. Charts • Sticky Walls/Post-It Pads • Colored Dots • Opinion Polling Systems • Babushka Brainstorming • Fax Net and Email Net • Flip charts/transparencies • Visioning Exercises • Newspaper article/headline • Scenario Building • Idea Factory • Charrette Process/Room/Web • Computer assisted modeling • Field Trips • WBS • Issue Papers • ORT Aikido Exercises • Strategy Maps Others you would add? Results Require Execution not Just Great Plans

20. Aikido Action Planning • Definition: Tool to use quick definition of obstacles to get a job done to a positive advantage …to define a practical action plan for results that have a greater chance to actually be implemented! • Rationale for this tool? • Recognizes human tendency to think first of what can go wrong, or what would get in way of successful achievement of a defined goal; • Enables group to dump baggage of negative insights that can block their creativity for new ideas of how to accomplish something ( a little catharsis frees the soul and opens the mind); • Offers a legitimate role for the curmudgeon to offer negative comments about likely potholes in road that you would want to fix anyway • Allows fast group engagement so they feel more ownership of the process results, i.e. increase chance for execution to occur. Results Require Execution not Just Great Plans

21. Aikido Action Planning Technique: • Step 1: fast brainstorm of everything group can think of that would frustrate achieving the job at hand(obstacles to goal); • Step 2: group prioritizes to the top 3-5 obstacles based on their judgment about the relative importance and likelihood of the obstacle (use simple or complex voting to save time) • Step 3: assign each one of the top obstacles to a small group and ask them to quickly define the top 3-5 practical ways to remove, reduce or work-around the obstacle; • Step 4: ask full group to listen to small group reports, and then list all the actions that could be taken to attack the top obstacles, add added ideas that are stimulated by this discussion; • Step 5: group prioritizes the long list of possible actions into the top 3-5 actions regardless of obstacle they are associated with… this list becomes the core of your overall action plan to accomplish the original job or goal.. It will be about 85% of a great plan… further discussion or work by experts could add ideas for the rest of the 15% success that you may want • Step 6: Write of the Action Plan with timetable and accountabilities and get it done and celebrate your success in small steps along the journey of implementation Results Require Execution not Just Great Plans

22. Engagement Worksheets can help: • Situation analyses • Capacity to implement • Clarity of what is to be implemented: • what • when • why • by whom • resources needed Results Require Execution not Just Great Plans

23. A Cyclical Model Phase 1 Planning To Plan Phase 2 Values Audit Phase 3 Implementation Considerations Environmental Scanning Mission Formulation Phase 4 Strategic Business Modeling Phase 5 Implementation Considerations Performance Audit Environmental Scanning Phase 7 Phase 6 Contingency Planning Gap Analysis Phase 8 Integrating Functional Plans Implementation Considerations Environmental Scanning Phase 9 Implementation Results Require Execution not Just Great Plans

24. Worksheets for ImplementingStrategic & Business Plans

25. What is strategic & business planning? • a structured process conducted in a formal way by a group/team of leaders to answer four deceptively simple questions… • Where are we today? • Where should we be going tomorrow? • How shall we get there? • Are we getting there? • Written answers = The Plan • The Process more important than The Plan But, implementation, monitoring and refined actions for measurable results are the keys to success Results Require Execution not Just Great Plans

26. Why do planning? • guide to policy development • guide to policy implementation • process for team building and culture enhancement, i.e better morale • greater chance for increased performance of the enterprise… • better patient care and care outcomes • more organizational stability • better financial vitality Results Require Execution not Just Great Plans

27. Obstacles to good planning? • lack of vision or commitment from the top? • Unforgiving operation environment? • Lack of time? • Lack of information? • Lack of motivation or skill from participants? • Lack of incentives to participate fully? • Others? Results Require Execution not Just Great Plans

28. How to do good strategy development? • review experiences of others • design and follow a sensible “process roadmap” • link to MBO, assign accountabilities, integrate with budgeting & embrace performance recognition • remember two proverbs… • life by the yard is hard, but life by the inch is a cinch; • don’t do nothin’, cuz ya can’t do everything. • Jump in, get started and refine it next year Results Require Execution not Just Great Plans

29. Strategy Development Process Situation Analysis Phase: Assemble facts on Environment & Operations Conduct S.W.O.T. Analysis Identify Priority Issues & Challenges Where are we now? Goal Formulation Phase: Where should we be going? Define Directions: Mission/Vision Goals & Objectives Explore Alternate Ways of Dealing with Issues Strategy Formulation Phase: How should we get there? Develop Strategies to Achieve Results Define Resource Needs for Each Strategy Establish Budgets: Capital & Operating Evaluation & Control Phase: Are we getting there? Ongoing Performance Evaluation of Units & Managers Establish M.I.S. to Gather & Display Data by Objectives & Budget Adjust Performance and/or Objectives Results Require Execution not Just Great Plans

30. Environmental Scanning Worksheet For Brainstormed List of Key Trends Possible Implications of Trend: Major Trend: General Comments on Trend: Results Require Execution not Just Great Plans

31. Organizational Culture & Vitality Challenges : Issue: Issue: Issue: Issue: Issue: Actions: Actions: Actions: Actions: Actions: A Worksheet for Strategic Thinking Results Require Execution not Just Great Plans

32. Situation Analysis Worksheet: SWOT Analysis Strengths to Build on: Weaknesses to Overcome: Opportunities to Pursue: Threats to Guard Against: Results Require Execution not Just Great Plans

33. Self Assessment Against Priority Indicators of Success: Holding Our Own Indicators of Success: General Comments: Winning Losing 1. 2. 3. 4. 5. Overall Conclusion on Our Performance in Market: Results Require Execution not Just Great Plans

34. Actions We Should Start, Stop and/or Continue We should start..... We should continue..... We should stop..... Results Require Execution not Just Great Plans

35. Implications Wheel for Action Planning Implication: Implication: Potential Action/Strategy: Implication: Implication: Implication: Implication: Implication: Results Require Execution not Just Great Plans

36. Prioritizing Strategies and Tactics for Success Goal: Evaluation/Screening Criteria: Cost to Start: Cost to Run: Political Costs: Degree Goal Achieved Total Score Possible Actions/Strategies: 1 2 3 4 5 Results Require Execution not Just Great Plans

37. Action Plan Worksheet for Each Major Objective or Strategy Manager: Date: Objective or Strategy: Page: Dates: Start Lead Person Major Tactics/Actions: General Comments: Finish 1. 2. 3. 4. 5. Results Require Execution not Just Great Plans

38. Group Work High EQtm Actions to convert: 1. Fritz; 2. Teams; 3. Organizations; 4. Communities