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

2. Results Require Execution not Just Great Plans 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?

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

4. Results Require Execution not Just Great Plans 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

5. 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?

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

7. Results Require Execution not Just Great Plans 7 5 Performance Pillars support efforts to achieve an organizations vision Values Guided Principled Passion Mission Based FinanceGrowthQualityServicePeople 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

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

9. 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

10. Results Require Execution not Just Great Plans 10 Our Vision 2010 Mission Based Values Guided: Principled Passion: Our Values and Principles Guide Our Work in the 5 Pillars as We Drive Toward Our Vision P ersonal Customer Services R esponsiveness and Teamwork I ndividualized Care D edication & Commitment E xceeding Expectations of Quality 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

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

12. Results Require Execution not Just Great Plans 12 Vision 2010 Pillar 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 systems operating units and managers How accomplished How measured Lead Strategy Sub-strategies Lead Manager Workplans and Budgets of Each Unit Matrix Connections & Support Across Our System What is our goal

13. Results Require Execution not Just Great Plans 13 Vision 2010 FinanceGrowthQualityServicePeople Action Plans & Budgets for Each Division, Department or Unit Each unit leader asks and answers 2 questions: 1.How can our unit/team best contribute to the achievement of our Results Hierarchy? 2.How can I best earn the work & enthusiasm of my followers to best accomplish my monthly & annual workplans and budgets? Our Results Hierarchy Values Guided Principled Passion Mission Based Operate Performance Driven Processes Expand Role in ED & Chronic Diseases Put the Patient First Recognize & Reward Service Excellence Nurture a Culture of Respect & Value What How What How What How What How What How A Credit Rating5% More Market Share Top 100 US Hospital Systems 97% Patient Satisfaction Top Area Employer Focus on Cash Smart Care Management Processes Build Philanthropy Recruit Physicians Invest in Specialty Centers Active Marketing Blame Free Work 24/7 Education Evidence Based Medicine Assess Moments of Truth Center for Patients & Visitors Transparent Reporting Earn Physician Pride & Loyalty Earn Employee Pride & Loyalty Celebrate People Stories Often

14. 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. Results Require Execution not Just Great Plans 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

16. Results Require Execution not Just Great Plans 16 2020 Powerful concepts to assist in effective conversion: Hindsight. Foresight. Insight. 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) Develop worksheet for teams to define how to apply each in your unique setting and situation

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

18. 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? The Power of The Babushkas Power Planning Partnerships Effective Stakeholder Engagement

19. Results Require Execution not Just Great Plans 19 Toolkit for High EQ tm … 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 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 Others you would add?

20. 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.

21. 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

22. 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

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

24. 24 Worksheets for Implementing Strategic & Business Plans

25. Results Require Execution not Just Great 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

26. 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

27. 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?

28. 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; dont do nothin, cuz ya cant do everything. Jump in, get started and refine it next year

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

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

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

32. 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:

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

34. 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.....

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

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

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

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