What is strategy and why does it actually matter?
Strategy must be the most misunderstood word that we come across as we work melding managerial skills with clinical skills for the best outcome for patients and clinical teams. I frequently observe that the clinicians spend many hours understanding specific definitions of concepts so that they can both wrestle with them and communicate with colleagues precisely what they mean. This discipline doesn’t seem to carryover when they are discussing matters on how they organise themselves for success. I’m a big believer that we are both facilitated and hindered by language in that once I have a label for a concept, I can conceptually visualise the problems that I’m wrestling with, conversely if not, I can’t.
The technical definition of strategy is “the direction and scope of an organisation over the long term which achieves advantage for the organisation through its configuration of resources within a changing environment and to fulfil stakeholder expectations”. (Johnson and Scholes).
On the face of it, this has nothing to do with medical practice in the United Kingdom but let’s just analyse those concepts.
“Direction and scope”. This is about what the teams are actually going to do. This is perhaps easier to get into under the concept of what the team is not going to do. We have worked with many teams and we frequently start by acknowledging that different individuals, or when working with differing teams within networks, have differing aspirations for the magnitude of change. It’s much easier to discuss that upfront rather than get into a situation that we frequently find ourselves, where people are “saying yes and doing no”. Clearly the teams and networks are buffeted by the storm forces unleashed by NHS England. It is a perfectly acceptable strategy (known as strategic fit) to decide to maximise the opportunities and minimise the threats posed. Once you have decided this (strategy) you then need to decide exactly who is going to do what and when (the implementation plan).
“Advantage for the organisation”. It is so tempting to think that this is pulled from the school of business which is all about competition. I put it to you that within the intensely political organisation that is the National Health Service anybody who thinks that they are not jostling and competing for resources has missed the learning from what happened to general practice over the previous 10 years.
“Configurations of resources”. These are the decisions about who is going to do what. In a service industry this means then how are we going to spend our money. We see that many practices do their financial planning by listening to a report by financial accountants about what happened last year. What I can absolutely assure you that you cannot change what happened last year. The need is to make proactive decisions about what happens next year.
“Changing environment”. It is a hackneyed phrase that “generals always fight the last war” but it’s an inevitable consequence of analysing retrospective data and making decisions based on this. The strategy is the decision on what we going to do in the future. If we can make a reasonable assumption that the future is different from the past (remote consultations anyone?) then it is important to make a stab at estimating what the future is going to be.
Sometimes when facilitating strategy sessions we lose some medical staff here. As scientists they want to “know” things, and predictions are difficult, especially about the future. This is another way where strategy differs from planning. The strategy is a hypothesis; we move forward, we gather data, and we change our thinking when the evidence changes.
Still this can be unsatisfactory for some, so I put it to you that there are three options:
- You can do things that are likely to be successful.
- You can do things that are unlikely to be successful.
- You can do nothing at all.
Surely the wise team will choose to do things that are more likely to be successful? Sometimes the default position can be option three and certainly I’ve been known to challenge a group with:
“I have heard two things about you. Firstly, you don’t like the way things are. Secondly, you don’t want to change anything “
“Fulfil stakeholder expectations”. I have managed to avoid the word “vision” in this blog but “stakeholder” seems to have crept in. This is just a shorthand way of saying that for organisations to succeed they have to succeed in the eyes of key individuals and organisations. One of the stressors currently driving in general practice is that the strategies (albeit reactive and implicit) do not work for the senior doctors, with the consequential disastrous exodus.
So, when put into the context of our working lives I put it to you that organisations and teams that have clear and healthy (and shared and agreed) strategy are happier places to work.
Dr Richard More, CEO Xytal