Aligning Strategic Plans with Operational Objectives

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Aligning Strategic Plans with Operational Objectives

Healthcare Organization and Management · Chapter 8: Strategic Planning and Decision-Making in HealthcareSection 8.6 · lesson 53 of 1059 min · free with a free account

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In this lesson

Turning strategy into daily work through execution systems and honest reviews.

  • Identify the five systems a strategy needs in order to execute
  • Use a strategy map to locate the broken link in a causal chain
  • Explain the uses and limits of the balanced scorecard
  • Diagnose initiative overload and reports that hide bad news

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Transcript

Everything said in the video, section by section (1,241 words). Read along, or search it.

Opening Case

Green Reports, Unchanged Transfers

A year ago, Larkfield set out to cut avoidable ED visits from the town's nursing homes, with an in-reach team of nurse practitioners. Today the numbers are in. ED transfers from the homes haven't fallen. Odder still, every monthly report on the program was green. Helen Wu, the chief executive, asks the hard question: was the strategy wrong?

Execution Systems

Five Systems a Strategy Needs

Execution is the set of arrangements through which a strategy becomes daily behavior. It isn't a phase after planning. It's a set of systems that must exist for a plan to do anything. There are five. Clear priorities, few enough to hold in mind during an ordinary decision. Committed resources. And accountable owners, with authority to match. Measurement that shows whether it's working while there's still time to act. And a review rhythm: the right things, at the right intervals, with the right people. Miss any one, and the strategy won't execute. The missing one usually shows up within an hour of asking.

Strategy Maps

Checking the Bottom Link First

Priya Nair, the chief nursing officer, lays out the strategy as a map. Robert Kaplan and David Norton popularized strategy maps: a chain of causes and effects. Capability: three nurse practitioners hired. Process: every home visited weekly. Service change: residents reviewed before they deteriorate. Outcome: fewer ED transfers. Read down, the map lists requirements. Read up, it gives reasons. And each link can be checked early, on its own. So they check the bottom link. Only one practitioner was ever hired. The visits never happened at scale. The strategy wasn't wrong. Recruitment failed, and nobody measured it.

Balanced Scorecard

Four Perspectives and Three Limits

Many hospitals track strategy on a balanced scorecard, introduced by Kaplan and Norton in nineteen ninety-two. It holds several perspectives together, not finances alone. The original four were financial, customer, internal process, and learning and growth. Hospitals often rename them financial, patient, process and quality, and workforce. Three limits come with it. Scorecards grow: one with forty indicators has stopped being a scorecard. The causal links between perspectives are assumed, so it can be all green while the chain is broken. And it reports where you are, not where you're heading, unless it includes leading indicators. Larkfield's had none for hiring.

Quick Check

Counselors Hired, Smokers Not Counseled

Quick check. Another hospital's strategy map: hire two tobacco counselors, counsel every admitted smoker, more quit attempts, fewer readmissions. Six months in, both counselors are hired, but only thirty percent of smokers are counseled. Which link failed? Pause, and decide. Counseling every smoker. The capability link held: the counselors exist. The process link broke, so nothing above it can work yet. Fewer readmissions is tempting, because that's the number the board watches. But it's the result of the chain. Measuring only the top would hide where it broke.

Cascading Measures

Limiting Distortion on the Way Down

Strategic measures must reach departments to have any effect, and distortion creeps in on the way. Three practices limit it. Cascade the objective, and let the department propose the measure. It knows which measure would capture the goal, and which would be gamed. Pair every cascaded measure with a balancing measure, so the local version can't be met by pushing a problem elsewhere. And check bottom against top: read a department's measure, and ask which strategic objective it serves. It takes minutes, and finds most distortion.

Review Rhythm

Monthly, Quarterly, and Annual Reviews

Execution also needs a cadence, matched to what's reviewed. Monthly reviews check delivery and leading indicators: are the posts filled, are the visits happening? Owners and the executive lead attend. Quarterly reviews ask whether the strategy is working: are the middle measures moving, has an assumption failed, should anything stop? The executive team attends, with the owners. Annual reviews ask whether the strategy is still right, given what's changed outside. That one involves the board. Larkfield's monthly report tracked transfers, a slow outcome, and never asked whether the posts were filled.

Reallocation

Stopping Work to Fund Priorities

The fix needs money for two more nurse practitioners. That's the hardest execution step: moving resources from something that works to something that matters more. It means stopping. Organizations add priorities easily, and stop things almost never. So each new priority is funded from the margins of everything else, until nothing has enough. Three things make stopping possible. Name the funding source when the priority is set. Have the body that set the priority decide what stops, not each department. And state the consequence honestly, because a stopped service has patients and staff attached. Helen's team pauses a patient-portal redesign to fund the posts, and says so.

Initiative Overload

Counting Changes Per Department

There's another reason the visits stalled. Initiative overload: more changes running at once than managers can absorb. The signs: managers can't name the priorities, initiatives are quietly dropped without a decision, staff say change just happens to them, and a problem gets its third solution. The limit is management attention, not money, and it doesn't stretch. A department can absorb only a few big changes at once. Ellen Murphy's unit, 4 South, was running nine. The remedy is arithmetic: count the initiatives touching each department, then stop or defer until the number is deliverable.

Middle Managers

What Translators of Strategy Need

Strategy is decided above middle managers and delivered below them. They translate intent into operations, absorb the clash between strategy and reality, and decide daily which instruction gets attention. To do it, they need a few priorities, so trade-offs are deliberate. The authority for local decisions. Enough context to judge something new. And time. An organization that gives them none of that, then blames middle-manager resistance, has misdiagnosed its own design.

Hidden Bad News

Why Every Report Stayed Green

And the green reports? Nkechi knew by month three that hiring had stalled. So why report green? Because the last manager who reported a program off track got a demand for a recovery plan, due within a week, and had her judgment questioned in front of her peers. A review where nothing is ever off track isn't a sign of a well-run organization. It means bad news has a cost people have learned to avoid. Redesigning the report template won't help. It just produces green reports in a new format. The cause is what happened the last time someone reported a problem.

Quick Check

Three Directors, Three Different Priorities

Quick check. Asked separately what the hospital must get right this year, three directors at another hospital each give a different answer. Which execution failure is this? Pause, and decide. Unclear priorities. If three leaders can't name the same few, nobody below them can trade off deliberately. Cut the list, state the order, and ask again in a month. An absent owner is tempting, since nobody seems in charge. But that pattern shows up as questions bouncing between departments, not as different lists. Asking three managers the same question separately is the cheapest execution audit there is.

Case Resolved

Rewarding the Early Red Report

Back to Helen's question. The strategy wasn't wrong. Execution failed, at the bottom link, and the reviews hid it. So Helen changes three things. Every report must name one thing going badly, or it's sent back. Recovery planning moves to a separate meeting. And she says an early red report will be treated as good management, then proves it the first time one arrives. She warns the board: the next few reviews will look much worse. That's the sign it's working.

Key Takeaways

Execute, Measure, and Hear Bad News

To recap. Execution rests on five systems: priorities, resources, owners with authority, timely measures, and a review rhythm. Map the strategy as a chain, and check the bottom link early. Scorecards need few measures, and leading indicators, not just results. Stop things to fund new priorities, and count the initiatives each department carries. And make bad news cheap to report, or you'll never hear it.

About Healthcare Organization and Management at UPI Study

Healthcare Organization and Management (Health 302) is a self-paced online course of 105 video lessons in 18 chapters, from health systems and the law to ethics, leadership, teams, strategy, informatics, finance, quality, human resources, marketing and evidence-based practice. It carries a NCCRS credit recommendation for 3 semester credits.

Every lesson transcript is free on pages like this one, and the videos are free with a free UPI Study account. Enrolling adds a practice quiz after each lesson, the graded work and final exam that earn the credit, lifetime access, and an official transcript on completion. UPI Study has helped over 130,000 students with college credits. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

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Why students take Healthcare Organization and Management with UPI Study

How hospitals and clinics are runHealthcare Organization and Management covers how care organizations are led and run: health law and ethics, leadership and teams, strategic planning, health informatics, budgets, quality improvement, staffing and marketing. It is a core course in healthcare administration and health management degrees.
Credit at a fraction of the priceThe same 3 credits can cost $750 or more at a US college. Here it is one payment, self-paced, with lifetime access.
Finish your degree soonerTransfer credits reduce the courses you still owe, so you can graduate earlier or lighten a heavy semester.
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Study on your own scheduleNo start dates, no deadlines. Watch the lessons, practice, and take the final when you are ready.
130,000+students helped with college creditsACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Where the credit goes

Universities that work with NCCRS

Healthcare Organization and Management carries a NCCRS credit recommendation. These universities work with NCCRS; some are UPI Study's signed partners. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.

Thomas Edison State UniversityThomas Edison State UniversitySigned partnerUniversity of the PeopleUniversity of the PeopleSigned partnerCharter Oak State CollegeCharter Oak State CollegeSigned partnerStrayer UniversityStrayer UniversitySigned partnerColumbia Southern UniversityColumbia Southern UniversitySigned partnerIndiana TechIndiana TechSigned partnerPenn StatePenn StateWorks with NCCRSSouthern New Hampshire UniversitySouthern New Hampshire UniversityWorks with NCCRSSUNYSUNYWorks with NCCRS +many more cooperating universitiesFind my college →

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FAQ

Questions students ask us

About Aligning Strategic Plans with Operational Objectives

What is a strategy map in healthcare management?
A strategy map, popularized by Robert Kaplan and David Norton, lays out a strategy as a chain of causes and effects, from capability to process to service change to outcome. Read downward, it lists requirements; read upward, it gives reasons. Because each link can be checked early and on its own, it shows where a strategy broke, such as needed staff never being hired.
What are the four perspectives of the balanced scorecard?
The balanced scorecard, introduced by Kaplan and Norton in 1992, originally used financial, customer, internal process, and learning and growth perspectives. Hospitals often rename them financial, patient, process and quality, and workforce. Its limits are that scorecards tend to grow too large, the causal links between perspectives are assumed, and it reports current position unless it includes leading indicators.
What is initiative overload in a healthcare organization?
Initiative overload means running more changes at once than managers can absorb. Signs include managers who cannot name the priorities, initiatives dropped quietly without a decision, staff who say change just happens to them, and problems that receive a third solution. The limit is management attention, not money, so the remedy is counting the initiatives touching each department and stopping or deferring some.
Why do project status reports stay green when a program is failing?
Reports stay green when reporting bad news carries a cost people have learned to avoid, such as an immediate demand for a recovery plan or public questioning of a manager's judgment. Redesigning the template does not fix it. Leaders change it by treating an early red report as good management, separating recovery planning from status review, and proving that response the first time bad news arrives.

About the Healthcare Organization and Management course

How many college credits is Healthcare Organization and Management?
Healthcare Organization and Management (Health 302) carries a NCCRS credit recommendation for 3 semester credits. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities.
How much does Healthcare Organization and Management cost and what is included?
$250, paid once, with lifetime access: all 105 video lessons, a practice quiz after each, the graded work and final exam, and an official transcript when you finish. Students who want several courses choose UPI Study PRO instead.
Which universities accept UPI Study credits?
UPI Study has signed partner agreements with universities such as Thomas Edison State University, University of the People and Charter Oak State College, and works with universities such as Penn State, SNHU and SUNY. ACE and NCCRS have over 2,100 cooperating colleges that will consider accepting credits; the final decision is with the universities. Use "Find my college" on this page to check yours.
How long does Healthcare Organization and Management take?
It is self-paced with no deadlines. The 105 lessons total about 17 hours of video; most students add reading and practice time and finish in a few weeks to a few months, on their own schedule.
How are the exams done?
Quizzes and assignments are online in the course. The final exam is taken online with proctoring; a person on the UPI Study team checks assignments, usually within two days.
How do my credits reach my college?
When the course shows 100% complete, request the official transcript from your dashboard. It is sent to the college you name, and you can send it to more than one. Check your college first with "Find my college" on this page, or ask Athena.

Ready for the full course? Earn 3 credits in Healthcare Organization and Management.

105 video lessons, a quiz after each one, and the graded work that earns the credit. Recommended for credit by NCCRS.

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