Maine Hospital Association, Strategic Planning Roles & Responsibilities of the Board

Strategic Planning- Roles & Responsibilities Within the Process

1. Content & Focus Of Strategic Planning

_______'s strategic planning process should demonstrate a thoughtful and systematic review and analysis of key environmental trends, organizational performance indicators, and strategic options. It should also be grounded in a periodic review of the organization's mission and the long-term vision that guides strategic decision-making. Key stakeholders should be engaged in the planning process in a manner that helps them understand both the environmental context for the organization's strategy as well as the rationale for each strategic initiative. Most importantly, it should be designed in such a manner as to ensure that the key stakeholders within the organization are aligned with one another related to future strategic directions.

2. Roles & Responsibilities Of Key Stakeholders In Strategic Decision Making

The following should be accepted as the formal definition of the roles and responsibilities of the various stakeholder groups within the organization's strategic decision-making process:

a. CEO & Senior Management

The President/CEO is the individual within the organization who is ultimately responsible for the development and implementation of the overall Strategic Plan. The CEO and Senior Management will be responsible for providing active leadership within the strategic planning process in the following manner:

Monitor environmental trends and assess their implications for the organization and its medical staff.
Play a lead role in recommending system-wide strategic objectives including growth and financial performance targets.

- Organize and analyze quantitative and qualitative data; draft documents for committee and board review.

Conduct appropriate business analysis of current organizational performance as well as opportunities and threats to programs and services provided by the organization and its medical staff.
Help identify and evaluate options for action; formulate recommendations to be reviewed by various Board committees including the Strategic Planning Committee, the Physician Advisory Committee, ad hoc task forces and by the full Board.
Provide appropriate opportunity for involvement of both board members and physicians in major strategic decisions before those decisions are finalized.
Ensure that the Board's policies related to physician participation in strategic planning and strategic decision-making are adhered to; and work with medical staff leadership to address problems that develop.
Actively pursue possibilities and evaluate new opportunities for fulfilling the organization's vision and strategic objectives.
Do whatever is required to successfully implement the Strategic Plan and achieve approved organizational goals and objectives.

b. Members of Medical Staff

In an effort to engage physicians, who are active members of medical staff, as active partners in the development of the local integrated delivery system, physicians will be encouraged to participate in strategic decision making in the manner outlined below. Additionally, the medical staff agrees to:

Participate in governance, including board and board committee membership, in order to help ensure that physician perspectives are adequately represented in governance decision-making.
Actively participate in committees, task forces, and other forms of group meetings in order to provide physician input into major strategic decisions.
Offer advice and counsel, in a timely manner, related to strategic matters in order to help improve the expected outcomes.
Provide active leadership related to strategic matters that directly impact the ability of physicians to practice medicine and maintain economically successful medical practices.
Explore opportunities for collaboration with that will benefit individual physician practices, the organization, and the community-at-large.
Fulfill board and committee responsibilities in a manner that is consistent with defined conflict-of-interest and confidentiality policies of the Board.

c. Board of Directors

The Board of Directors has the ultimate responsibility for approving the organization's strategic plan and the related business plans required to support successful implementation. As the Board fulfills this responsibility it will:

Ensure that the organization's strategic plan is responsive to and consistent with the organization's mission and value statement and that it is sufficient to ensure future success and viability.
Ensure that there has been sufficient review and evaluation of key environmental trends, organizational performance, opportunities and threats, strategic options, and recommended actions.
Offer advice and counsel related to strategic matters in order to help improve the expected outcomes.
Actively utilize committees, task forces, and other forms of group meetings to encourage stakeholder input into major strategic decisions.
Encourage physician and management participation in the governance process in an appropriate manner in order to achieve increased support for board decisions and encourage increased collaboration among all parties.
React to and test the analysis and recommendations of management and physicians related to strategic matters.
Ensure that the interests of the community-at-large, as well as the interests of the physician community (as a key component of the larger community), are addressed as the organization strives to fulfill its mission.
Monitor the implementation of the organization's strategic plan; while providing support for and holding participating managers and physicians accountable for achieving agreed-upon results.

3. Engagement Of Physicians In Strategic Decision Making

A variety of mechanisms and techniques should be used to engage physicians and other key stakeholders (board members and senior managers) in the process of strategic decision making in a manner that will help increase the likelihood that they will have a strong sense of ownership for and a ready willingness to support the final decisions related to strategic direction as well as the efforts to implement each strategic initiative. The mechanisms and techniques include the following:

a. The Board of Directors: The Board of Directors must approve the final strategic plan and monitor its implementation. Physician membership (approximately 30% of the total membership) on the Board of Directors should be sufficient to ensure that physician perspectives will be addressed within the strategic planning process. Additionally, the process for strategic decision making should ensure that all board members fully understand what is being proposed, participate in the formulation of the proposed strategy, have an opportunity to carefully examine the various options and test the thinking behind what is being proposed, and appreciate the risks involved in both action and non-action.

b. Strategic Planning Committee Of The Board: The Strategic Planning Committee of the Board should ensure that the organization has a strategic plan in place that defines a long-range vision, concrete strategic performance measures, and a current strategy that is sufficient to ensure fulfillment of the organization's mission and long-term financial viability. This committee should be composed of roughly 4-5 percent lay board members, 4-5 physicians, and several executive managers in order to ensure that both the interests of the community-at-large and the interest of the physician community are appropriately represented. The CEO, other designated members of senior management will participate as voting members and provide support for the work of the committee. The committee should meet approximately six times per year to review the current strategy of the organization (more frequently when there is a formal process in place to update the strategic plan), to test its resiliency in relationship to the current and future trends within the healthcare environment, and to ensure that all elements of the strategy have sufficient support from the key stakeholders. As a committee of the Board, its role is to make recommendations to the Board, not to make independent decisions or take independent action. As referenced above, the President/CEO should be providing proactive leadership within the work of the Strategic Planning Committee.

c. Physician Advisory Committee: The Physician Advisory Committee should be responsible for providing advice and counsel regarding the formulation of strategic direction related to clinical services and other initiatives that impact medical practice. The membership of this committee should include a broad representation of various specialties within the medical staff and an appropriate representation of senior management (to be determined with the President/CEO) as voting members. It should oversee the process by which individual strategic initiatives impacting medical practice are shaped and implemented, including the utilization of 'ad hoc' task forces on an as-needed basis to ensure strong stakeholder support for politically sensitive initiatives. This committee should also ensure that the Board of Directors, the Board's Strategic Planning Committee, and the general Medical Staff are fully informed regarding the progress related to implementing various elements of the organization's strategic framework impacting clinical services. While this committee is established as a standing committee of the Board of Directors, it will generally report directly to the Strategic Planning Committee of the Board. On occasion, it may report directly to the Board in order to ensure timely communication of critical issues.

d. Ad Hoc Task Forces: Ad Hoc Task Forces should be actively utilized to provide substantive in-depth physician input into major strategic initiatives. While the Strategic Planning Committee may function as a committee-of-the-whole for certain initiatives, 'ad hoc' committees should commonly be used to address specific elements of the strategy that are expected to impact either the delivery of care by physicians or the economic success of individual physician practices. While ad-hoc task forces report directly to the Physician Advisory Committee, on occasion they may make presentations at Board, Strategic Planning Committee, or Medical Staff meetings in order to ensure that all parties are well informed and have the opportunity to provide the task forces with advice and counsel.

e. Opportunities For Broad-based Stakeholder Input: Interviews, focus groups, printed surveys, and other techniques should be utilized to get in-depth input from various stakeholders (physicians, board members, and managers). The findings from these activities should be shared with board members and physicians in a timely manner. Additionally, retreats, open meetings, and other forms of gatherings should be used to provide appropriate education for all parties, to share findings, to verify conclusions, and to test recommendations.

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The Bristol Group