Author: Tony Mira
So many anesthesia groups are so busy meeting the service requirements of the facilities they serve that they often fail to take a step back to consider just why they feel so overwhelmed and what they can do about it. Strategic planning can prove to be an invaluable business tool.
There is a tendency to think of strategic planning in today’s medical group environment as something limited to overpaid management consultants who are trying to impress their clients with the value of a SWOT analysis. While it is true that most anesthesia practices do not hold regular strategic planning sessions or formally commit time to the future of the practice, such activities can nevertheless be significant to the survival and viability of the practice.
Above and Below
An MGMA speaker once articulated an intriguing concept when he explained that we all have what he referred to as below-the-line activities and above-the-line activities. Below-the-line activities are all the things we need to accomplish to get through the day. For anesthesia providers, these would include managing the day’s cases, completing pre-op assessments for the next day’s cases and responding to any other clinical or administrative crises that might arise. Above-the-line activities pertain to those things we do to plan for the future. Groups that conduct regular business planning sessions typically focus on this kind of activity, which might include practice expansion opportunities, ways to improve profitability or consideration of new lines of business.
The speaker’s contention was that businesses that maximize their above-the-line activities end up being more profitable and more successful over time. By analogy, this concept definitely applies to today’s business leaders. Elon Musk, Warren Buffet and Bill Gates pride themselves on their ability to envision and pursue ideas that others have yet to think about.
No Substitute for Strategy
The fact is that most anesthesia practices are exclusively focused on their core mission: consistently providing quality anesthesia care to the patients scheduled by the facility. Especially in the current environment where so many practices are short-staffed, the idea of devoting valuable clinical time to strategic planning seems like the ultimate luxury. Nothing could be further from the truth. The very fact that so many providers feel trapped in an environment over which they have no control is exactly why they need to take time to step back, take time to assess how their current situation evolved and explore alternatives. A concept that haunts so many groups is the notion of scope creep. What once seemed reasonable now seems overwhelming. Strategic planners love to repeat the mantra that we either determine our own destiny or someone else will determine it for us.
Over the past ten years, too many anesthesia practices have simply ceased to exist because the management of the group could not envision a way to keep the group viable. Some were simply taken over by the facility, which made them employed providers. Others were victims of an RFP process that they failed to understand and master. Still others—and maybe these were the smart ones—decided to either sell out or merge with a larger entity. No matter what path a practice took, though, someone ultimately had to figure out how to provide the necessary anesthesia services.
Parts of the Plan
Strategic planning can be thought of like a three-act play. If all three elements are incorporated, the group has a better shot at achieving financial health and future growth. These three “acts” can be summarized as follows:
- Identify the Current Situation. The group’s leadership must provide a clear and compelling picture of the practices’ current situation so that members come to agree on the problems they must face and address. Individual members may have diverse objectives and agendas, and this can lead to challenges. However, a good facilitator can often lead divergent factions to common agreement—at least as it concerns the core objectives. Suffice it to say that groups that cannot agree on the problem will never agree on the solution.
- Consider All the Options. There are always options to address clearly defined problems. The problem is that we often tend to shoot down potential options based on pre-conceived notions or sacred cows. Strategic brain-storming needs to include all options and evaluate them from a variety of perspectives. Too often, anesthesia practices focus only on their immediate needs and objectives. Part of the challenge is that hospitals are complex systems with a variety of stakeholders, each with slightly different objectives. More often than not, successful options involve enrolling multiple stakeholders. This is what is referred to as out-of-the-box thinking and is an aspect of strategic planning that consultants may be better qualified to guide the practice through. One thing we can safely say is that successful practices have built solid partnerships not only with administration but with the other key departments with which they must interact and on whom they depend.
- Assess the Aftermath. Mohandas Gandhi used to say that actions express priorities. When we facilitate strategic planning sessions, we remind clients that no matter how upbeat and enthusiastic they may be at the end of the day’s session, the only way to truly evaluate the session is to look back after six months to identify what changed as a result of the day’s discussion. Good plans have no value if they cannot be implemented. In other words, what happens after the strategic planning process is much more important than what happens during it.
It is often said that of the five phases of an anesthetic—preparation, induction, maintenance, emergence and recovery—the preparation phase is the most important. The more you can know about a case in advance, the more you can anticipate and plan for any potential complications. Obviously, there are always unforeseen complications, but experienced practitioners know how to minimize their impact. Why should it be any different in the overall management of the practice?
We strongly recommend that strategic and business planning become a regular and integral part of your practice management. It can be a formal activity, such as a strategic planning retreat, or a regular business meeting agenda item.