Strategy by Starvation

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…


8 thoughts on “Strategy by Starvation

  1. Susie here…also participating in strategic deployment this week and already several conversations about expanding quality goals and strategies while we have not met the ones we have which makes your blog a perfect reminder of how hard this is and yet how ineffective if we try to “do it all” and do nothing well.

  2. Karl,
    Some of other ideas about why:
    1. The strategic demands on most health care organizations, or the threat of future market changes, has never been higher.
    2. This, along with a lack of belief that operational excellence is a strategic issue/opportunity,
    3. Combined with a fundamental lack of understanding of our own operations and how to effect improvement.

    These three factors combine to create an environment in which health care executives are launching a 1,000 ships and hoping for the best.

    1. James, Nice adds. Your #1 concerns me even more as the implication might be an even greater increase in “ships launched” over the next couple of years. Reflecting on #2 & #3, the countermeasures are to then 1) consistently demonstrate improvements in cost/quality/service through daily improvement, standards, standard work, etc. and 2) be relentless in getting executives into the gemba in a consistent and meaningful way. Appreciate the reflections James. – Karl

  3. Great post Karl. I agree that the ability to say “No” is the greatest strategic thinking an organization can do (but it is often the hardest). The thing that makes it so tough is that generally the pet projects are pretty good for customers and the company.

    I have been reflecting on organizational system drivers to why limiting projects to the critical few is so difficult. I think one aspect is that there is not really much of a TEAM amoungst executives. In my experience, it is usually a group of people playing nice together but competing over resources all the time. Jamie Flinchbaugh’s “Hitchiker’s Guide To Lean” discusses how standard work can only succeed if there is good teamwork because someone has to choose the team decision versus how they think they can do it better. I think this is a common problem with exec teams.

    1. Brian, Thanks for the additional reflections. Now you have me thinking about the critical components of teams and how to create and leverage at the exec level. Thinking that I need to re-read “The Five Dysfunctions of a Team” by Patrick Lencioni. Next weeks read. Thanks, Karl

  4. Hi Karl. I want to know when you run across a hc company that has actually practiced strategy by subtraction. It sounds heavenly and I would like to see it in action. I think your list of system drivers is probably about right, in addition to a lot of fear and uncertainty about what the future will bring, so a lot of bets are being hedged. Not an easy list to overcome. And I do agree, that expecting Hoshin Kanri to solve all the problems, will lead only to disappointment.

    1. Laura, Thank you for the additional thinking on this one; appreciate the addition of “fear and uncertainty” about the future – key factors. Will definitely keep you posted as I continue my learning’s. Thanks, Karl

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