Wednesday, January 9, 2008

Future Planning

I recently returned from three days in New Orleans with the CHRISTUS Health Futures Task Force II. Part of the purpose of this group is to reflect on the importance of and various types of planning which must occur in a health care system that is undertaking a Journey to Excellence.

After reflecting with this group, it is clear that planning for health care fits into three major categories: short-term, mid-term and long-term. It was reassuring to me that CHRISTUS has incorporated all three into its toolbox, and I would like to discuss them with you.

Short Term is the planning that one must do in a complex organization when an unexpected crisis occurs. It requires the leadership team to assemble an appropriate, knowledgeable group of individuals who can quickly and clearly express what the crisis is, but more importantly, develop rapid solutions for addressing the crisis and creating normalcy as quickly as possible. A key illustration of this kind of crisis would be a major quality-of-care case which received local and even national notoriety. Like the Tylenol poisoning which gained national attention, these occur unexpectedly and must be dealt with in an expeditious and transparent manner.

The hurricanes, which recently closed five of our hospitals, was certainly a crisis and created outcomes that far exceeded what we anticipated in our disaster planning. As the electricity and air conditioning were quickly terminated along with all our fresh water supply, the action plans to care for critically ill patients in rooms reaching 102 degrees required the ultimate and best short-term planning. Fortunately we were successful, and reopened all five hospitals within a week.

Mid-term planning is a much more common type of planning, which in our organization is represented by three-year rolling strategic planning. We are now beginning our 10th cycle of this planning as we enter our 10th year as CHRISTUS Health.

Three-year rolling planning means that the plan year that we are in, such as this year (FY 08), has in reality been looked at twice before. It was the “third year out” in 2006, and therefore we did our best to identify what the “quicksand” areas in 2008 might be. By quicksand, I mean we predicted things that could occur, but they were “soft” in many spots. They could have created instability if they occurred, and in some instances, would have caused the “sand to shift.” Therefore, what we expected needed to be redefined as we moved into the second year.

I call the second year out the “wet cement year” because it’s much firmer than quicksand and much more clearly delineated, but if in fact something changes or occurs that isn’t correct--like someone walking on the cement--it is still in the state that you can smooth it over and resurface it.

Then we move into the plan year (which is currently 2008), where we add the final catalytic agent and the year becomes hard cement. It is the plan in this year that the budget is designed around and for which the capital allocations are made.

I still periodically hear leaders say that you can’t plan for more than a year in health care. I acknowledge that some of the planning will be crisis planning, and that the three years in the mid-term planning process are very different (quicksand, wet cement and hard cement). However, because three-year rolling planning will always keep three years in front of you, the advantage of this methodology is that by the time the year becomes your plan year, you have reviewed it at least twice before in your planning cycle and have few, if any, surprises.

The final planning is the long-term planning, or “future planning.” We are doing this for the second time in the 10-year history of CHRISTUS.

Future planning is done through various methodologies that aren’t as concrete as three-year rolling planning, but provides an opportunity to develop recommendations which--if reviewed on an annual basis and appropriately incorporated into the three-year rolling planning process--will often create strategies which are on the cutting edge and set the pace for health care innovations. Because this process is so important and unique, I will commit one or two future blog posts solely to the future planning process and keep you appraised particularly on the evolution of Futures Task Force II, which will be an 18-month process with the task force’s recommendations being reported during our 10th anniversary in February of 2009.

Before I close, however, I’d also like to connect the dot to the post I did on creating vision for an organization and how you become a “visionary.” Actually, visioning is really in a sense a very distant planning process, which begins to set the framework for what might occur, around which more definitive planning should be done. For me, visionary planning is done predominately for 10 years and beyond. This gives you the framework for future planning (which usually looks at 8 to 10 years in the future) and then leads to three-year rolling strategic planning, which hopefully will give you the ability to do outstanding crisis planning when and if it is ever required. We connect these dots by creating what we in CHRISTUS call the “umbrella strategy,” which I will also discuss in a future blog post.

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