REVIEWED BY LAWRENCE D. PRYBIL, PhD, LFACHE
Health Care Strategy for Uncertain Times
Marian C. Jennings, Editor
Jossey-Bass/AHA Press, San Francisco
2000, 266 pp., $49.95 (hardcover)
The stated purpose of this book, written and edited by associates of Jennings
Ryan & Kolb, is to "...provide health care leaders with the tools to
reconceptualize and carry out strategic decision making in a new and unfamiliar
environment." Based on the experience of these consultants and their assessment
of organizational needs in the new millennium, the book takes a fresh look at
strategic planning and priority setting in health care institutions and systems.
A fundamental premise is that the pace of economic, environmental, and technological
change will not abate in the coming years and, therefore, those with leadership
responsibilities in health care organizations should consider new approaches
for charting the organization's strategic direction and priorities.
"Health Care Strategy for Uncertain Times" includes 10 conceptually
related chapters that can be viewed as a succinct essay on a key facet of strategic
thinking and planning. The text concludes with a compact list of "lessons
learned" from the authors' experience in advising and assisting clients.
The first chapter addresses the growing levels of uncertainty and risk in the
contemporary health care field and the implications of this reality for organizations
and their leadership teams. It identifies the differences between uncertainty
and risk, discusses key sources of uncertainty in the context of strategic planning,
and indicates the importance of good information in reducing uncertainty and
assessing risk.
Chapter 2 sets forth the premise that "...the fundamentals of strategic
planning are applicable to any business or industry" but also identifies
factors that uniquely influence planning in health care settings: extensive
restructuring during the 1990s, multiple constituent groups (stakeholders) who
hold divergent and often conflicting views on key matters, an "oligopsony"
market situation in which a relatively small number of purchasers (e.g., the
federal government) exercise extensive influence on the market, and the view
held by large segments of the American public that "...unrestricted access
to health care should be an inalienable right for all." This chapter also
reviews the history of health planning in America, including the growing involvement
of government in the 1970s and 1980s and the challenges associated with an increasingly
turbulent environment. The authors differentiate "strategic thinking"
from traditional planning, discuss the evolving roles of key participants in
an organizational planning process, and provide an overview of their own "strategy
cycle," which provides the basic framework for the remainder of the book.
Chapters 3 and 4 deal with the first phase of the authors' five-phase
strategy cycle — "assessing the environment and envisioning the future
through planning assumptions." In these chapters, the authors discuss both
the complexity and importance of these activities and describe specific tools
and techniques that can be helpful in conducting them. The authors believe that
many organizations devote insufficient efforts to environmental assessment,
both internal and external, and that thorough work in this realm provides the
foundation for future steps in the strategy cycle. The fourth chapter discusses
the concept of planning assumptions ("...informed guesses about the future")
that, in the authors' framework, constitutes a critical link between environmental
assessment and the subsequent identification of the organization's strategic
direction and strategies. Key market drivers in the health care field — from
demographics to technological advances — are reviewed and specific techniques
for developing planning assumptions are discussed.
The second phase in the authors' strategy cycle calls for organizational
leadership to focus on the residual uncertainties that remain after diligent
environmental assessment and the formulation of key planning assumptions. Chapter
5 discusses specific techniques that can be used, including scenario planning,
decision analysis, and game theory. Both the benefits and the limitations of
these techniques are discussed clearly. No panacea for eliminating uncertainty
in the contemporary health care environment is offered; however, the authors
believe these planning tools can "...help synthesize and weigh complex
and uncertain environmental factors" to assist decision makers in formulating
the organization's strategic direction and priorities.
The third phase in the strategy cycle involves the definition of the organization's
"strategic intent": that is, what the organization is today, where
it wants to go, and how it will get there. From the authors' perspective,
an organization's strategic intent includes three distinct but interrelated
components: its core etiology (its fundamental purpose, culture, and values),
its vision statement that describes "where the organization wants to go,"
and its "market stance," which spells out in concrete terms how the
organization intends to achieve its vision. The authors indicate that an organization's
strategic intent can take various forms, and they discuss several alternative
forms as well as the key steps that are involved in defining strategic intent.
Chapters 7 and 8 discuss the fourth phase of the strategy cycle — the formulation
of goals, strategies, and measures of success. The basic content of these two
chapters will be familiar to many readers and can be viewed as rather straightforward
"blocking and tackling" in strategic planning. Clearly stated goals,
crisp strategies, and meaningful measures of success, in many ways, are at the
heart of solid strategic planning. By the same token, of what value are goals
or strategies if resources are not available to make them happen? This issue — and
the growing importance of strong links between strategic and financial planning — are
discussed pragmatically in chapter 8. The authors conclude, and I concur, that
"Integrating financial and strategic planning has always been important,
but it takes on critical importance during times of uncertainty while financial
resources are dwindling."
Chapter 9 addresses the fifth phase of the strategy cycle (implementation)
and emphasizes the simple truth that strategic intent "...has value only
if it can be implemented successfully." How do some organizations and their
leadership teams execute plans and decisions expeditiously and effectively,
whereas others delay and stumble? The authors examine failed efforts to implement
change and spell out factors associated with success. In this chapter, the authors
draw on similar work by experts such as John Kotter. In itself, this chapter
is a succinct tour de force that should be distributed widely, read with
care, and provide a basis for dialogue within your leadership team.
Chapter 10, written by Ms. Jennings, summarizes key points from the preceding
chapters, highlights traditional planning techniques that, from her perspective,
remain valuable today and those she believes are no longer viable in this turbulent
environment. This chapter also summarizes the most important lessons that she
and her colleagues at Jennings Ryan & Kolb have learned about strategic
thinking and planning. These eight lessons are based on much experience, are
well-grounded, and could constitute a good starting point for leadership teams
who want to rethink their traditional planning approaches and cycles.
"Health Care Strategy for Uncertain Times" is a valuable contribution
to the field's knowledge base. Its conceptual framework is well thought
out, the content is based on broad experience in working with health care organizations,
and it is well-written. My background includes executive responsibility for
strategic planning in two large, multiunit health care systems, and I believe
this book has value for boards, senior executives, and planning staff. In the
health care field, we too often fail to learn from the experience of others
and, as a result, reinvent many wheels. Discussing this book as a leadership
team could be very useful as a starting point for reviewing and refining an
organization's strategic planning process. In addition, the book can be
valuable for students in financial management, health management and policy,
planning, and public health. These, and other, graduate students will benefit
from the experience and perspectives of Ms. Jennings and her colleagues.
Lawrence D. Prybil, PhD
Associate Dean and Professor
College of Public Health
The University of Iowa
Iowa City, IA