For a “healthier” strategy

Formulating and deploying strategy are recent subjects in Brazilian hospitals. Although they represent increasingly widespread and discussed concepts, we are still at an early stage of practical application and evolution. Some institutions already show greater maturity, it is true, but they are exceptions. Unfortunately, very few organizations in the health care sector have robust plans that are sustainable in the long term. And even these show enormous difficulties in deploying, implementing and monitoring strategy.

Over the past 15 years, we have directly supported the transformation of several hospitals and medical clinics in Brazil and abroad. And developing strategy management, from formulation to Daily Management, has been one of the most interesting and promising challenges. Revitalizing management may be one of the only viable paths for us to reach new levels of safety, quality and costs in health care. Resources will continue to be scarce, demand will continue to grow, and so will the prices of supplies.

If we are not capable of improving processes and drastically reducing waste, it will not be hard to predict the end of the story. Seeking to contribute in this direction, we have listed some characteristics that need to come together for strategy management to become more effective. These are fundamental elements that we have identified while helping organizations pursue new levels of performance.

A first point to highlight is that strategy management done the lean way truly places the patient at the center of care. Lean begins with a precise definition of who the customer is and what value is for them.  In other words, everything that is conceived, planned and executed must have as its sole and essential focus improving the delivery of value associated with the patient experience.

A second element consists of focusing management and directing teams' work on the daily identification and elimination of waste. Individuals and groups must be made aware of and trained to critically observe day-to-day work, seeking to identify and eliminate activities that consume time and resources but do not translate into value for the patient.

A third fundamental point: formulating, deploying and managing strategy, always seeking the legitimate and genuine engagement of people. They cannot be mere “targets”, but rather active and integrated participants throughout the different stages of the management process, from beginning to end. For this, we need to strengthen the culture of transparency and communication processes.

Hoshin kanri step by step

To put these elements into practice, hoshin kanri, one of the foundations of the lean way of managing strategy, seeks to align the organization's objectives with day-to-day decisions and work. The basic step-by-step process for thinking through and structuring this involves some critical stages.

First, work carefully on formulating the strategy, which must represent clearly and precisely what the institution's strategic orientation should be, its “true north”. Next, prioritize efforts, which means selecting the “drivers” of strategy deployment.

Then, work effectively on the deployment itself, that is, on defining the macro objectives and their implications for the entire organization. Next, work on detailing how to achieve the objectives in each of the selected processes. From there, it will be necessary to invest in communication, enabling negotiations and alignment with different levels of the organization and integrating capabilities and resources, both vertically and horizontally.

And when everything is at “full steam”, it will be essential to implement robust mechanisms to ensure the effective practice of Daily Management (GD), another lean method that consists, in short, of closely following the execution of routines and plans. In this stage, of monitoring and adjustment, a critical eye is needed to evaluate progress but, above all, imperfections, in order to understand problems and root causes and implement creative countermeasures to make corrections.

People at the center

Throughout this process, there is a basic premise: people must, in fact, come first. In this case, we are not referring to patients, but rather to employees, the health care professionals who provide and manage care. Formulating and deploying strategy are led by top management, but they need to involve the whole institution, covering the different hierarchical levels, so that there is full understanding and a sense of belonging. People need to see their respective roles within the strategic context, connecting individual purposes to the organization's needs.

Each person must know clearly and precisely what their contribution to the whole is. For this, it is necessary to communicate and align strategic objectives, considering everyone and at all levels, ensuring that employees, departments and functional areas clearly understand their specific challenges and the actions needed.

In this sense, individuals and teams need to have their performance associated with smart metrics, with established targets, which must be enhanced by fluid processes between departments, centered on the patient journey from beginning to end, and not on specific deliveries from isolated silos. In this way, we achieve employees who are more engaged and less overloaded.

For this, the lean system provides a series of methods and “tools”. For example, periodic review meetings, held with the support of visual management boards, with the definition and monitoring of key indicators. In addition to rapid improvement processes that can and should take place with the active involvement of all employees in identifying and eliminating waste.

Obviously, this is not something easy or even quick to do. Thinking through, formulating, deploying and managing strategy in a large hospital, for example, requires considerable effort and a lot of discipline. That is why the role of leadership tends to be decisive.

However, if everything is done carefully and efficiently, the results are worth it. Well-designed management processes make possible the much-desired performance improvements that are sustainable over time. If we are not capable of building consistent strategy management practices, we will hardly be able to ensure that improvements remain stable over time.

Without solid management routines, reduced waiting times may quickly start growing again. Waste of resources that had been eliminated can very easily become part of day-to-day reality again. Improvements in the quality of care and patient safety can be compromised by a simple change in the care or management team.

Formulating, deploying and monitoring strategy from a lean perspective are essential management processes for achieving coordinated and integrated care. They can ensure that patients receive care with agility, effectiveness and controlled costs throughout the different stages of care, from prevention through treatment and rehabilitation.