A challenge that just keeps grinding on me year after year, seemingly more so in healthcare than other sectors that I talk with, is the struggle that senior executives have with selection of the critical few strategic initiatives. It is not my intention to pound on the healthcare executives; I just have more questions than I have answers.
How many number one priorities is any organization, regardless of size (staff, revenues, geography, etc), realistically capable of executing to in any given year? My thinking is that it’s a limited number regardless of corporate size; i.e. a bigger company doesn’t warrant more initiatives.
What are the organizational system drivers that 1) create the unrealistic demand across the enterprise and 2) prevent a critical focus on the vital few? My thinking is that there are many: not understanding customer requirements, compensation & promotion models, annual budgets, silo’d accountabilities, fear of competition, short-term perspectives, lack of understanding of actual capacity, disconnection from front line work…to mention a few.
So what’s the problem? The inability to narrow the focus of critical work, results in unwarranted demands and stress on the organization and it’s people, fundamentally creating chaos. The only “reasonable” action by the senior team is to then prioritize the long list of “have to’s” which doesn’t eliminate anything, just ranks order the importance. The result? Strategy by Starvation: allocation and overburden of resources until you simply run out of them and/or burn them out. All remaining “important work” on the list starves away.
So what’s the target condition? Strategy by Subtraction. Respectful and ruthless elimination of non-critical initiative from “the list”.
What’s the hypothesis on how to achieve Strategy by Subtraction? Still working on this one but here’s what I have so far: First, we need to get to the bottom of the iceberg and talk about principles, philosophies, and core mental models. Second, we need to borrow a concept from Pascal Dennis and determine “true north” for the company. Third, and not until the other work is done, we pull in a few supportive methodologies from lean, such as Hoshin Kanri for execution.
Like I said, still working on this one…