Episode 053: Strengths, Weaknesses, and Weekend Retreats

Speaker 1: You are listening to Your Practice Made Perfect; support, protection, and advice for practicing medical professionals, brought to you by SVMIC.

Brian: Hello. Thanks for joining us. My name is Brian Fortenberry. Got a great podcast this week. We're going to be talking about strategic planning and that process - and there's a lot that can be involved in that - and we've got two great people here that are going to help us out. From SVMIC, we have Mr. Steve Dickens, thanks for being here. And also, Sarah Ligon is here. Welcome guys.

Steve: Thank you, Brian. Thanks for having us.

Sarah: Hey.

Brian: Well, before we get started, and get into this process that we're going to talk about, tell us a little bit about yourselves, and tell us a little bit about your background, for our listeners. Steve, go ahead.

Steve: Thank you, Brian. Steve Dickens, I'm currently the vice president of medical practice services at SVMIC. I've spent the last 25 years working in healthcare in a variety of roles including the last 10 years at SVMIC. Managed several different practices over the years, hospital background, homecare background, served as chair of the National MGMA, and I'm just happy to be here with the opportunity to help practice executives and physicians.

Brian: Well, thank you. Having had the pleasure of working with you, I happen to know you're incredibly intelligent, certainly in this area, and you are a great resource and thank you for taking the time. And Sarah, the same to you. Tell us a little bit about yourself.

Sarah: Yeah, so I'm the current administrator for Old Harding Pediatrics here in Nashville. I grew up there, I have a background in education, but I've been at Old Harding for 20 years. I just sort of fell into that, and I found that healthcare was a love of mine, and so, that's what I'm doing now. I'm a past president of TMGMA, and Nashville MGMA and-

Brian: We have the minds for this, with all this MGMA background. So, let's start off with what in the world is the strategic planning process?

Steve: The strategic planning process is really about identifying what is important to an organization, where they want to go, what are the steps to get there, who is in charge of those steps, even at a more in-depth level, what are the resources that it's going to take to get there, and then, what is the timeline about it? In setting goals, it's really important that the organization identify all those elements of who, what, when, and how they are going to get there in order to measure whether they are making progress.

Brian: It's all those things, and I guess it's kind of making sure everybody's on the same page?

Steve: It is. Strategic planning is really good opportunity for the leaders of an organization to come together, and instead of following their own individual agendas, deciding what the greater good of the whole is. And in order to get into that process, everyone who comes to the table has to make the recognition that what may be best for me, individually, may not be best for the practice, or for all of the physicians.

So, we set those things aside, and there can be many things that go into the process. Generally, there is research, and preparation for the actual planning process itself may require interviews, surveys, and different types of research.

Brian: This is certainly not something that just happens by accident. You're having to prep and plan for this, correct?

Sarah: I think the biggest issue is the planning. Taking the time before you ever get to that point of what your goals are, who's involved, who you want there, the time needed, is it a day thing? Is it a weekend thing? Is it a night thing? How much time you're willing to spend, and then who you want involved with that. And then, what are your goals?

I think you have to start with what your goals are to even know how to start planning. To me, that's the biggest part, is what are the goals for this?

Steve: Sarah raises an excellent point. First of all, it can literally take months from the decision to have a strategic retreat to the actual execution of the retreat itself, because of what goes into the process. But, in terms of talking about what your goals are for the retreat, that is separate from the goals that will come out of the retreat.

One of the first things that we do when a practice asks us to come in and lead a retreat for them, I like to sit down with the physician leader and the group practice administrator, or manager, as well to talk about what a successful outcome looks like to them. Because if they aren't on the same page, if they don't have realistic goals, then it really becomes a waste of everyone's time.

And then from there, it may very well become a conversation with multiple physicians, or at least all the members of the board of directors who are going to be attending the retreat as well.

Brian: It does require, often then, some buy-in from more than just one party?

Sarah: Right. Everyone has to buy in. If there's no buy-in, there's no end result.

Steve: Yes.

Sarah: You won't leave this with any kind of good outcome.

Brian: So, from an SVMIC perspective, how does SVMIC get involved in this strategic planning process with groups or administrators?

Steve: Our involvement begins with a request from a practice executive, or a physician leader to come in and lead a strategic retreat. From there, the initial appointment is scheduled, and again, I like to meet with both the lead physician and the group practice administrator as well, to determine what their goals are. Once I have a sense of what their goals are, we can move on to what the process looks like, depending on the size of the organization and how complex it is. It may be as simple as just conducting a survey of the stakeholders, and then providing that information back, getting the date on the calendar, deciding what the agenda looks like, talking about "Well, here's what everyone said, where do we want to go with this?"

In larger organizations, there generally are face-to-face interviews with the physicians, the board of directors. Often times, we will survey the staff as well to see if their opinions align with those of the physicians, and that can be quite interesting when they have differing opinions on the strengths and weaknesses of the organization. Depending on the conversation, if they want to get into recruitment or expansion, there may be market research associated with that, until finally, we get to the day of the meeting, and we go through a conversation about what is strategic planning.

We talk about the effect of governance to make it work, and then we go through the results of the surveys, which will include the physician's opinions of the organization, what's important to them. It may include the staff's opinions and what's important to them, and then we'll talk about what are the things that are going well in the practice, what are the things that are not going well, and what are the opportunities moving forward. And then following that, an action plan will develop from that conversation.

Brian: Are there unrealistic expectations, often, when it comes to physicians or administrators? And you certainly would know, from a practice perspective, as well as an organizational perspective, Steve, when you're looking at it from there. But, to me, thinking about it, it would be difficult to go into a situation, and you have unrealistic expectations from the physicians, and they think, "Oh, well, we'll just do this business plan," you're like, "It's not that simple." How do you deal with that?

Sarah: That's a really good question because I think it kind of goes back to the planning and you setting those goals ahead of time. I do think it depends on your group. I think you're going to have those that think you can solve all problems in a five-hour setting, and that's just not feasible. So, I think you have to go back and define what are my goals for this? Are we talking about a three-to-five-year plan? Or, are we just talking about financial issues today? What are our goals?

So, I think that is incumbent on a little bit of your administrator and whoever is going to help you mediate that to set that foundation for the goals. We cannot tackle that issue in the setting today. We're going to tackle these issues. And it's, I think, during that session you have to be willing to say, "We're not talking about that today. Let's get back on task." I think it's all about controlling the situation, sticking with what you planned, sticking with the goals at hand, and also, just, again, setting those realistic expectations of what is doable in that.

I also think, one issue we find in healthcare, and group practices, and hospitals, everywhere, is that you probably need to do them more often, we don't do them enough. It's time-consuming. Planning is difficult. It takes money, it takes brain power, and so, I think that's another problem. If we did them more often, you would solve a lot more issues, but you can't solve the world's problems in a weekend. So, doing them more often, I think would also be helpful.

Brian: Steve, how do you like coming into that situation, as maybe an outsider, and you're coming into facilitate or assist, how do you help that process of unrealistic expectations, or keeping them on track?

Steve: There are a couple of ways. First of all, it is about the lead up to the strategic retreat, and anytime I begin a strategic meeting, I always begin with a conversation about the elements that are required to be successful, and about what it is that we're trying to accomplish. Sometimes the conversation is simply about agreeing that something needs to change, and everyone has to go into it with the understanding that we're not going to solve the world's problems in a day, or a weekend, and that it is an ongoing process, which brings up a really good point that Sarah made.

We really don't do three to five-year strategic plans anymore. Healthcare is evolving at such a rapid pace. We're finding most organizations are looking at a 12-to-24-month plan and reassessing more frequently. And when I say most groups are doing that, I mean the groups that are doing strategic planning. Far too many groups chose not to do strategic planning and think this is something that they can get together and do once every five years, and it's an overwhelming task. Most groups need to touch it more often. And she raises another good point too about expectations.

You have to be realistic in what those are. And the two things that I see which will doom a strategic planning process are ineffective organizational governance and the wrong culture. If any member who is there and part of the retreat walks out and says, "I don't buy into this," it has failed.

Brian: So it does take complete buy-in?

Steve: It does. It does.

Brian: I guess that really goes back to what both of you were saying about making sure, on your prep, on the front end, that it's kind of like a lawyer, you never ask a question you don't already know the answer to, you don't set a goal going in, maybe, to a strategic retreat, that you don't know there's already going to be buy into.

Steve: Right, and it's generally, fairly easy to identify what the issues are going to be from the interviews, and from the surveys. The question then becomes what direction do they go in. And that's where it's really helpful to do the prep work of the interviews and the surveys so that I, as a facilitator, have an idea of what's going to come up, and one of the questions that I like to ask physicians and the practice administrator before I get to the actual day is, “What are the elephants in the room?” I don't want to be surprised by anything.

Brian: Right.

Sarah: I think that's also what hurts practices sometimes when you don't have regular meetings, regular things, is you have blow-ups, you have the elephant in the room, you have things aren't taken care of regularly and you lose that team. You lose that comradery, you lose that practice. People become individuals instead of a group, especially if you have multiple offices. You don't see each other all the time. So, I think that's even more important when you have multiple sites, bigger sites. It's just as important for a two doc practice to do this, but I think the bigger you are, it's more important to do it more often because you lose that team.

Everybody starts to become an individual, and then you spring a retreat, or a planning meeting, whatever it is, on a group and that's when things are aired, versus along the way, and then when you get to these, you can't deal with the business. You can't plan, you can't do the important things, because you've lost that comradery, and it becomes about the individual, not the team.

Steve: That is a great point. I did a retreat a few months ago, and it was a large group, and the physicians represented multiple office locations, and so, it took awhile for them to warm up to one another, and as the day went on, there were things that came up, "Oh, well I didn't know that," or, "Well, we should have discussed that. Why didn't you call me with that?" And so, it's easy to get distracted.

So, it's very important for the facilitator to keep a focus on the day, and it is very tough for physicians sometimes to be told, "Okay. You've talked enough. This is not pertinent. This is not what we're going to do. You can address that at your next board meeting,” or, “We need to move that over and pick that back up later." It is a tough role for the facilitator, but it is about making sure that the people who aren't saying anything, pulling out of them to get buy-in, or to find out if they don't agree, and it's fine if everyone doesn't agree, but by the time that you leave, we have to have come to some consensus.

Brian: That's a great point, because the person that is not as vocal, or doesn't have that outgoing personality, may sit in the corner and then you get to after the meeting, they said nothing, but they don't buy in, as you said, if the person that doesn't buy in, there can be one and it's failed already. And so, you really have to make sure there's open communication. And to your point, Sarah, whenever you're talking about multiple locations like that, you get these silos, that's the cliché word that everybody uses, but when you get together, everybody always goes into protective, defensive mode when it comes to their part of that.

And so, then you gotta break that down before you can ever get even past that. You know, when we were talking about how frequently you have these, Steve, you were saying that some people aren't doing it at all. And certainly that's bad, but, you know, the 5 to 10 year. Healthcare seems to be changing so much so fast with legislation and just technology in itself, what is a good timeframe, you think, that practices should be doing this because the target is constantly moving?

Steve: Well, I think at a minimum, practices should probably be doing a strategic discussion at least every two years, every 18 to 24 months, and part of that is because it makes it less overwhelming. If you will do it more frequently, the conversation doesn't have to last as long. Many people think, "Oh, we have to go away for a weekend. We'll have to go on Friday night. We won't be home until Sunday." We don't see a lot of that anymore.

If you are doing this on a regular basis, then you can spend four to six hours and have a really good conversation about that, as opposed to this thing that we dread every three to five years.

Sarah: I think as an administrator, even what I'm finding, is that you do have to step up and push that. Because we are finding that physicians are working more, they're working harder, but it's hard to find that time. Their home life is just as busy as everyone else. Their practices are just as busy, and it's really hard to find that time. So, I think you just have to be willing to push, and push, and push to make that an important part of the practice, but it's hard.

Brian: Yeah, and they’re challenging topics, obviously, that you're going to have to spearhead in this. What is some of the benefits that you guys have personally seen, maybe an example that would go a long way to convincing someone, maybe that's listening today that, "We haven't don't this before, but wow, I heard about this, and there was a positive outcome." What is some benefit that, maybe, some of you, Steve, that you've led, or Sarah, that you've experienced in your practice, that has come out of strategic planning that really made a difference?

Steve: I think a lot of times, it makes the group more cohesive, bringing those physicians together, realizing we have the same problems, we have the same concerns, we have the same challenges. We, often times, will do a financial assessment of the practice, or we'll do a compensation assessment of the practice, and they are surprised to find out that they are doing as well as their peers. In some cases, they're doing better than their peers, and that will give them a lot of comfort in getting that information, and it helps them make decisions about, do we want to invest money here? Can we afford to do this, where these things are going better?

Probably the most significant benefit I see coming out of this is when they make real decisions about whether they want to merge with another practice, whether they want to hire another physician, whether they want to open another location.

Sarah: That's what I would say. I mean, I'm echoing Steve just a little bit, but for a lot of people, it's the big decisions. It's technology, maybe a large technology purchase, maybe a large workflow change, but it's also do we want to hire another physician? Do we want to do a new building? Do we want to bring somebody in? What kind of changes do we want to make? New services, but the biggest thing that he hit on was that team building. You see 'em walk out, you know, we talked about that splintering, or maybe they feel like individuals coming in, but if they do that more often, you see them all of a sudden walking out, like their friends again.

Brian: Right.

Sarah: You know, they started out kind of friends, and then they practice separately, and they don't see each other very often in that way, and they go in, and all of a sudden, they kind of come out like, "Oh, we do have the same goals." They may not always match up exactly, but in the end, they want to take care of patients, clinical decision making is always high on the list, it's all about the patients, and oftentimes, that they realize the goals are the same. Getting there might be a little bit challenging, but the goals are often the same.

Steve: And for the practice administrator, it gives him or her direction.

Brian: Yeah.

Steve: So, often times, because in a group where there are multiple physicians, the administrator may be getting differing directions from those individuals, and when everybody comes together as a group, it's an opportunity to remind them ... Well, the administrator actually works for the group as a whole, and it sets his or her work plan for the next 12, 18, 24 months.

Sarah: That's an excellent point.

Brian: Well, and I would think, part of this too, is we often live in a society that nobody ever tells you what you do right, they always tell you what you do wrong. This to me seems like a good opportunity to get together, Steve, to your point early, of here's what we're doing right. Here's what's good, and being able to say, "Do we want to add another physician because we're doing so well in our business, we're getting so busy now, maybe we can open up another location." So, it is some reinforcement of positive, not just all negative, right?

Steve: Right.

Brian: What would you guys say to, in your case, Sarah, like other practice executives that are planning to do this, they're maybe the edge of it, don't know where to go, don't know where to jump off, and when we get in the boat, we're all going to be on the boat together. What would you say to those practice executives of your best advice in entering this process?

Sarah: I would say don't put it off, first of all. I think that's the biggest thing people do. I mean, I've done it, other practices do it, don't put it off. Don't be so scared that you just keep putting it off. Just jump in, ask for help, ask SVMIC, ask somebody, somebody you're comfortable with. Ask a peer that's done it before, ask them for help. But don't wait. Start the planning early, make it fun, as much as you can.

Brian: Right.

Sarah: Make sure your physicians are prepared, give them information, don't blindside them. Make sure they know what's going on, but I think, from my perspective, is don't put it off, because I think that's what people do. I've done it, others do it, but you've just got to jump in. Set the date, have a goal, do it no matter what.

Brian: It's almost like you feel, I don't have the time to do it, but you almost don't have the time to not do it, either.

Sarah: Yeah, you just gotta do it.

Brian: You just gotta jump in there. To that point, Steve, from a facilitator's standpoint, as we start to wrap up, what would you advise? We've talked about a lot of these things already, but what couple of key things would you tell practice administrators, physicians, and those out there, this is what you need to do, certainly thinking about the process before you enter the process and then once you're there?

Steve: First of all, don't wait to the last minute to schedule it. If you've got to make a decision about renewing a lease, or renewing an employment agreement, you can't call two or three weeks, or a month beforehand, and say, "Hey, we need to do this," there is generally months of lead time up to this to do the process appropriately. Make sure everyone in the group is on board with the process. You have to make sure that there is consensus about why we are doing this.

Be open and honest with whoever's facilitating it, and there are many people out there who can facilitate a strategic retreat. Most practice executives are qualified to do it, the reason that they don't do it is because it allows them to participate in the process, and it also puts someone with an independent mindset in there to facilitate the conversation. The facilitator really should not have an opinion one way or the other, and physicians should understand that a facilitator is not going to give them the plan.

They are simply going to keep the conversation on track. They will ask difficult questions, they will push people to participate, they will push people to not participate, so that at the end of the day, whatever ends up on the plan, on the wall, or wherever it is, is about what they've decided to do with the best information they could get, and the best practices available.

Brian: I think that is so important. It sounds like, to me, that it is being willing to do it, willing to prepare, and then making sure everybody is on the same page. We will certainly put show notes to our podcast today. Steve, I'm certain they can get in touch with you, correct? At SVMIC?

Steve: Absolutely.

Brian: And we'll put other information out there. Guys, I really appreciate you being here today, to talk about this important process.

Sarah: You're welcome. Thank you.

Steve: Thank you.

Speaker 1: Thank you for listening to this episode of Your Practice Made Perfect with your host, Brian Fortenberry. Listen to more episodes, subscribe to the podcast, and find show notes at SVMIC.com/podcast.

The contents of this podcast are intended for informational purposes only and do not constitute legal advice. Policyholders are urged to consult with their personal attorney for legal advice, as specific legal requirements may vary from state to state and change over time.