The importance of strategic planning at your office

Stephen A. Dickens, J.D., M.A.Ed, FACMPE, vice president of medical practice services at State Volunteer Mutual Insurance Company

Strategic planning is one of those terms that can make physicians’ eyes glaze over. Between payer rule changes, staffing shortages and stubborn inflation, many practices feel lucky just to make it through the week, let alone carve out time to chart a three-year vision. Yet failure to look ahead can be fatal, says Stephen A. Dickens, J.D., M.A.Ed, FACMPE, vice president of medical practice services at State Volunteer Mutual Insurance Company.

Dickens has spent decades walking physician groups through the nuts and bolts of setting priorities, assigning accountability and keeping momentum alive when enthusiasm wanes. In this interview with Medical Economics, he explains how to turn a daunting concept into a manageable checklist: Begin with honest data on internal and external pressures, rank the issues that threaten your mission, and appoint a champion to keep the plan moving. His message: Spend the time now or pay a higher price later, down the road for everyone.

Medical Economics: Strategic planning can often sound like a big, abstract idea. How do you help practices make strategic planning feel real and actionable, especially when they're facing things such as policy changes, staffing issues, or financial pressures?

Stephen A. Dickens, J.D., M.A.Ed, FACMPE: Many groups see strategic planning as some big, hairy monster and something that is overwhelming. And strategic planning really is just a process. It begins with collecting data. What are the internal and external factors affecting the organization? As we're talking here today, [examples include] policy changes and tariffs or those kinds of external changes. Talking about staffing changes, that's more internal.

The key players, whether they are the group's lead physicians, its board, or maybe all the physicians, depending on the group size and its administrative team, need to sit down and say, “OK, what are the biggest issues facing us?” And then prioritize.

That's where a lot of groups get lost. They come up with this big list of things that they need to do, that they need to get done and they get lost because it's so overwhelming. You can't do everything all at once. It’s just not realistic. So, what I like for them to do is prioritize: What are the things that are going to make the biggest difference, and what are the resources we can allocate to those? Once they've done that, somebody has to be accountable. Somebody has to be in charge of keeping the process moving. From there, everyone has to understand why the group is doing what it’s doing.

Medical Economics: What are some signs that practices should be resetting their strategy?

Stephen A. Dickens, J.D., M.A.Ed, FACMPE: If they're not actively talking about the plan, then either we've not done a good job of communicating the why of it and what it is that we need to do. If people are acting like this isn't going to make a difference, they become lackluster about it. That's the time to push the reset button. If people no longer understand what we're doing or why we're doing it, then we've lost something there. And those are essential elements.

I would encourage practices to watch for changes in attitude, such as canceled meetings [in which] we're supposed to be talking about this. They never really get around to it on the agenda or they don't put it on the agenda. “Oh, well, it really doesn't make any difference.” That lackadaisical lack of attention is indicative that there's a problem.

Medical Economics: How do you make the case for carving out time to think long term when the day-to-day feels so overwhelming?

Stephen A. Dickens, J.D., M.A.Ed, FACMPE: Making the case is as simple as [asking], “Do you want to continue to be in practice?” Or “Do you want to continue to provide quality patient care?” It's about understanding the necessary evils. We all have to do a lot of things that we don't like to do to get the result we want. It’s about making the connection that they don't have time not to make the time. And the problem is not going to go away.

We all have the same number of hours in the day, and it usually is about priorities and keeping your practice open, keeping your patients cared for, keeping your staff engaged. Those all need attention. Those all need focus. And it's about the leaders, the physician leaders, the administrative leaders understanding that just getting through the day doesn't deal with any of those things because time goes so quickly: A day turns into a week, turns into a month, and you've let what might have been something you could have dealt with now snowball into something that you can't deal with.

Medical Economics: From your experience working with practices over the years, do you have an example when strategic planning made a real difference?

Stephen A. Dickens, J.D., M.A.Ed, FACMPE: Oh, I do have a story. I've done a number of strategic planning meetings over the years, and I always like to meet with the key players before the meeting. And that is the lead physician, at a minimum, and the practice executive, always at least those two. I typically, depending on the size of the group, like to [include] a couple of other physicians. I always want to know who they think is supportive of what they think. Also, I want to know who they think doesn't agree with them, so I can get the other side of it. I like to go into it knowing what all of those different views are. There are generally some physician surveys, or I'll also do physician interviews.

I remember this one group, a number of years ago, that I went into that had several offices. I talked to a couple people, and we did the surveys and got the data back. And what showed in the data was that one of the locations in the practice was not very happy; the staff comments, the physician comments and the administrative comments all seemed to direct [their unhappiness] toward a particular physician.

I see all that and think, OK, well, this ought to be interesting when we get into the meeting because I share all the data. It's anonymous, but I just throw it all out there. Let's attack the elephant in the room.

We're going through all of this, and we're having this conversation and [this doctor’s] feelings are getting hurt. They finally just kind of got this pensive, reflective look on their face, put their head in their hands and finally looked up and said, “Oh my gosh, I'm the problem.”

Everything changed at that moment because they realized what was being said was true. It wasn't that they were a horrible clinician; it was how they were coming across. It created an opportunity for this physician to embark on some leadership training.

Everything that comes out of strategic planning doesn't have to be big things such as building a new building, buying a new [electronic health record]. It can be about identifying the simplest of things such as a process that doesn't work. People aren't happy with the compensation formula, i.e., we have a problem we haven't addressed. I've always thought back to that moment that changed that doctor's life, and it changed that practice for the better.