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Strategic Planning in Healthcare:The Experience ofthe University ofWisconsin Hospital and Clinics

DONNA K. SOLLENBERGER

S U M M A R Y 1111999, after 25 years of stable leadership from a single CEO,the University of Wisconsin Hospital and Clinics (UWHC) Authority Boardnamed a new CEO. The 471-bed academic medical center had recently experi-enced significant ch ange and challenges. In 199 6, it had e merged as a publicauthority, a statutory designation by the state of W isconsin tha t moved the hos-pital and clinics from the University of Wisconsin and the state of Wisconsin,and created it as a quasi-public entity with its ovm board. In 1999, when thenew CEO was nam ed, the hospital was experiencing a loss of revenue an d mar-ket sha re, operating deficits, a 22 percent nurs e vacancy rate, and p atient satis-faction scores below the 40th percentile. The first task assigned to the newCEO by the board was the development of a new strategic plan that would

reverse these trends and position U WH C as a prem ier academic hospital.The CEO began a strategic planning process that involved leaders, physi-

cians, and staff from throughout the hospital and clinics, its affiliated med icalschool, and the physician practice plan. This article describes the collaborative,integrative, and communicative strategic planning process UWHC used;details the organization of the process; describes the results achieved byUW HC ; and lists the lessons learned along the way.

Donna K. Sollenberger is president and chief executive officer at the Universityof W isconsin H ospital and Clinics in Madison, W isconsin.

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T H E STAT E OF THE H O S P I T A L I N

THE W I N T E R OF 1999

In December of 1999,1 was appointedpresident and chief executive officer oftheUniversity of Wisconsin Hospital andChnics (UWHC), a 471-bed academicmedical center with over 20,000 admis-sions and 500,000 outpatient visits annu-ally. Prior to that, I had been the chiefoperating officer of two academic hospi-tals, and while I had participated in strate-gic planning, I had never led those efforts.I had seen planning efforts fail from alack of organizational participation, from

a failure to use the strategic plan to driveoperations and organizational investment,and from a failure to stretch the visionand goals to dramatically transform theorganization. Thus, I found the UWHC

situation simultaneouslyThe ultimate exhilarating and daunting;

responsibility and driving exhilarating becauseIfinally had the opportunityto lead the effort, but

daunting because for thefirst time the planning andresponsibility ultimately

fell to me. The boardas well as theentire organizationhad great expecta-tions for new directions.

While UWHC had benefited from 25years ofstable leadership, by December of1999 UWHC had been through recent,dramatic change. As part ofthe University

of Wisconsin System, the prior CEO hadreported to the university chancellor. Thehospital had also been a part ofthe state ofWisconsin, subject to all its policies andprocedures. In 1996, the hospital separatedfrom the state and the university andbecame a public authority with the CEOreporting to its ovwi goveming board. In thesummer of 1999, the hospital opened twonew offsite outpatient clinics that were not

force for strategic

planning must be theCEO.

meeting volume and financial expectations:margins had eroded from 3.1 percent to 1.2percent in one short year despite a 9.5 per-cent charge increase, the nurse vacancy rateexceeded 20 percent, overall patient satis-faction scores hovered below the 40th per-centile for academic medical centers, andemployee morale was palpably low. No onehad held the chief financial officer positionfor four years, and the strategic plan lackedfocus. Clearly, a new direction was needed.

STRATECIC PLANNING BEGINS

Action withoutvision is a nightmare.Japanese Proverb

Successful planning begins with owner-ship ofthe process. While some organi-zations choose to appoint a strategicplanning leader, the ultimate responsi-bility and driving force for strategic plan-ning must be the CEO. Many individualsmay help with the process, but ulti-

mately the CEO, working with the board,is responsible for strategy and direction.This sets the tone at the top.

While the CEO is responsible fororganizational strategy, the use of anexperienced, outside consultant to facili-tate the process is critical for success.The outside consultant should bring anational overview ofthe healthcareindustry and the ability as a neutralparty to drive the organization to a deci-sion about strategic direction and issues,particularly ones where organizationalleaders have considerable or variedpoints of departure.

A request for proposal (REP) that con-tains clear planning objectives, consul-tant responsibilities and experience,deliverables, and an achievable timetableis needed, as is the identification of


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consultants familiar with healthcare,and, in U W HC's case, academic health-care. Once the RFP is issued, ph oneinterviews w ith the res pond ers, on site

interviews with the finalists, and carefulreference checking allow the organiza-tion to select the consu ltant that is thebest fit for the CEO and the board.

S U C C E S S F U L S T R AT E G I C

P L A N N I N G B E G I N S W I TH

C A R E F U L P R E P L A N N I N G

Spectacular achievements are always preceded

by unspectacularpreparation.Roger Staubach,Former NFL Quarterback

The CEO and outside consultant can spendas much as two months in the preplanningstage. At UWHC , preplanning began byidentifying over 80 individuals fromthroughout the hospital, medical school,practice plan, and comm unity to interviewand from whom to elicit opinions on keyissues facing UWHC. From these inter-views, the following key needs emergedthat guided the creation of five strategicplan subcommittees:

1. improvement of service and access forpatients;

2. strategies to retain and recruit UWHCemployees, particularly in nursing ;

3. identification of a differentiating mar-

ket role;4. better alignment among the medical

school, practice plan, and hospital; and5. adoption of a clear and unified direc-

tion with respect to a local hospital.

One hundred individualskey hospitalleaders, management and frontlineemployees, medical school and practice

plan leaders, and m embers ofthe boardsofthe hospital and practice planwereinvited by the CEO to participate in thecommittees shown in Figure i. The five

working groups and five nput avenuesreported to the leadership comm ittee,which reported to the UW HC AuthorityBoard.

The invitation to participants statedthat they were expected to attend eachmeeting. The letter also included an esti-mation ofthe number of meetings (gen-erally no more than four, two-hourmeetings over a three-month period), the

topics each work group w ould address,and the beginning and ending dates forthe group's work. In the case ofthe lead-ership comm ittee, we scheduled twoadditional meetings to finalize the plan.If the individuals receiving the invitationcould not attend all or a majority oft hemeetings, they were encouraged todecline the invitation to allow someoneelse to participate. (Very few peopledeclined the invitation, and meeting

attendance was nearly 100 percent!)Each work group and the leadership

comm ittee were assigned a UWHC staffperson to manage the meetings, notes,and process . The work groups also wereassigned a staff person from the decisionsupport department to manage informa-tion and data requests. We also named afacilitator from the outside consultantgroup to each work group and the leader-

ship committee. The leadership commit-tee included the chairs of each ofthe workgroups to ensure coordination ofthe workgroups' work product with the leadershipcommittee. The CEO provided a charge toeach work g roup , as well as a list of goals,responsibilities, and members.

An internal support person, in ourcase a senior m anag em ent analyst, was

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Figu r e 1 : Organizational Structure ofthe Strategic Plan

Physician ReactorPanels

Health ScienceForums

Standard ofservice

Scheduling/access

Admiss ions /discharge

Operatingrooms

Bed capacity Outpatient

capacity

Ambulatoryutilization

Culture Information

systems Patient

satisfaction Care

systems

Culture andmoraleOrganizationalvaluesHR trendsCompensationFringe benefitsNursing andallied healthprofessionalsSupport staff

UWHCBoard of Directors

1LeadershipCommittee

* ' " ' ' ' " A "

Criteria toevaluateprioritiesPotentialprogrammaticinvestmentsPrimary careService linedevelopmentInter-

institutional/

organizationalprogramdevelopment

Strategic PlanningIntranet Site

Patient and FamilyForums

Employee Forums

FinancialperformanceProgrammaticperformanceAccess to futurecapitalClinicalresourcemanagementCapacityAmbulatory

utilizationManaged careproducts andpricingFundraisingIS d evelopmentFacilitiesdevelopment

Local andregional

Ambulatorystrategy

Local hospitalrelationship

Branding Outreach Primary care

identified to support the CEO in the plan-ning initiative.A master schedule of all ofthe m eetings, responsible individuals, anddates, times, and locations was created. Inaddition, we developed a strategic plan-ning materials list. The CEO gave eachcommittee member a topic-appropriatebook with a handwritten, personal mes-sage inside . In addition, five to six articleswere sent in advance to provide a basis for

the work groups' and leadership commit-tee's work. The decision support depart-ment prepared data sets and supportmaterials for each work group and com-mittee member to provide an environ-mental assessment o fthe organization.

All participants were invited to attenda two-hour training session to review thegoals ofth e plan, the responsibilities ofthe members ofthe work group and


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leadership committee, the key findingsofthe consultant interviews, and theorganizational structure ofthe strategic

planning initiative. The meeting also

allowed th e CEO to introduce th e chairsand facilitators ofthe leadership com-mittee and the five work groups.

To elicit input from throughout th eorganization, ou r key constituents, andcustomers, we created five additionalinput avenues:

1. Physician reactor panels to allow th eplanning groups to present to internaland referring physicians th e plans asthey were developed and to elicit th ephysicians' feedback throughout th eprocess.

2. Health science forums that presented

evolving work group plans to faculty andleadership ofthe schools of nursing,

pharmacy, and medicine, and thatsolicited feedback.

3. Patient and family forums that created

opportunities for customers to react to

plans as they were developed.4 . Employee forums that provided frontline

employees with eight opportunities forinput.

5. A strategic planning intranet site topost evolving plans for employee reac-tions. In addition, employees coulduse an e-mail address to submit sug-gestions to any ofthe work groups.

PLAWWONC BECDMS

Remember it wasn't raining when Noah builtth e ark.

Howard Ruff, author and financialadvisor

In September, 2001, th e work groups andleadership committee began their initial

work. While th e work groups beganreviewing data, attacking th e criticalissues, and forming recommendations,the leadership group started to review the

vision and market position statements.(The mission statement was no taddressed because UWHC's mission was

established by Wisconsin statute.) All par-ticipants were encouraged to "think out-side th e box." The vision and marketposition statements th e leadership com-mittee developed follow.

Vision:

UWHC will be the foremost healthcareprovider and employer in Wisconsin, serv-ing as a statewide and national leader forpatient care, education, research, and com-

munity service.

Market Position:

UWHC will position itself as a market-responsive, regional healthcare provider

of choice that offers a broad array of qual-ity clinical services and emphasizes inno-

vation, learning, and cutting-edgeresearch.

VA L U E S

Values are like ingerprints. Nobody's are the

same, but you leave 'em all over everything

yo u do.

Elvis Presley

Another group led by the manager ofrecruitment and comprised of formeremployees ofthe month developed a setof recommendations for organizationalvalues. This group was not a formal partofthe planning process, something Iwould change in the future. The impor-tance of this group is that, heretofore,UWHC did not have consistent and well-

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articulated values. The group met multi-ple times to develop the following set ofvalues to recommend to the leadershipcomm ittee, which ultimately adopted them:

UWHC is guided in the pursuit ofthe mis-

sion and vision bya set of core values

expressed in the word CARE. These

values are:

Compassionate Care Compassionatecare takes the form of listening andresponding to the needs of all patientsand customers.

Active Learning As an academicinstitution, we are comm itted toproviding active, lifelong learnin gopportunities for patients,staff,students, and the community.

Respect for Others We believe thatpeople who are treated with respectwill respond positively. In allinteractions, we will be courteous,kind, honest, and fair.Excellence and Innovarion We strive toachieve the highest standards ofexcellence in all we do. Expressedindividually and through teamwork,our com mitm ent to excellence isasource of pride for those associatedwith UWHC.

COALS AND STRATEGIES

Don't be afraid to take a big step when one is

indicated. You can't cross a chasm in twosmall steps.

David Lloyd George, FormerPrime Minister of England

The work groups created plans thatthey forwarded to the leadership com-mittee. The leadership com mittee usedthe reports to finalize five goals that

would enable UWHC to attain its visionand market position:

1. Achieve preeminence in selected, dis-

tinct tertiary services.2. Substantially elevate service quality and

improve access for all of UWHC's cus-tomers.

3. Realize the full potential of existingresources, including recent significantinvestments in the local markets andprimary care.

4. Produce sufficient financial perfor-mance and capital funds to m eet the

requirements ofthe strategic plan androutine operations.

5. Unify the clinical and academic enter-prise (UW Medical School [UWMS],UW Medical Foundation [UWMF], andUWHC) to speak with a single voice inthe market.

To meet the strategic goals, the leader-ship committee adopted ten core strategiesthat would allow UW HC to achieve thecultural change needed for future success.These strategies were highly interdepen-dent, requiring more alignment amongthe three UW Health partners, enhance-men t of UWHC's role in the market, andimprovements in service and access.

I. Develop an organizational culturethat reinforces UWHC's values andpriorities, based on the core belief

that patients come first. This goal wasthe product of considerable debateabout the core value of patient careinan academic setting. Ultimately, allparticipants in the leadership com-mittee decided that everyone's focuswhile practicing in the hospitals andchnics must be the patient, perhapsan obvious principle to some, but in


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an academic healthcare sett ing, a keydecision that allowed us to focus onservice as well as technical expertise.

2. Align the strategic, economic, opera-

tional, and organization interests ofUWHC, UWMF, and UWMS toensure a coordinated approach to themarket and other providers. Until2OOO, the CE Os oft he practice pla nand hospital, as well as the dean, hadnot met regularly. No formal mecha-nism for programmatic and capitalplanning existed. This goal commit-ted to much more collaboration, con-solidation, and coordination.

3. Align the economics, technology, andorganization of ambulatory carewithin UW Health. U W H C , U W M F,and UWMS all owned and operatedclinics under the brand of UWHealth, yet each clinic had its owninformation system, i ts own set ofpolicies, and different service stan-dards, which created confusionamong patients using the variousclinics.

4 . Prom ote "UW Health" as "the" acade-mic health system. The leadershipcomm ittee believed that co mm onbranding ofthe physician group andhospitals and clinics "UW Health"would minimize market confusion andtake advantage of UW H ealth's strongbrand recognition.

5. Define the collective relationship of

UW HealthUWHC , UWMF, andUW MS with a local hospital aroundthe clinical and academic n eeds o f UWHealth. Our area includes a local hos-pital that has an academic affiliationwith the medical school and serves asthe practice site for one-third of UWHealth physicians w ho function as acommu nity-based group practice. The

leadership committee believed thatgaining a better overall understandingofthe relationship between the localhospital and UW Health was essential

for future clinical and academic suc-cess.

6. Develop distinctive tertiary serv ices,and position UWHC as the preemi-nen t regional referral resource w hile atthe same time maximizing the value ofsignificant prior investments in thelocal market and primary care. Theleadership committee decided that theem phas is for the local mark et and pri-

mary care woiild be on access and ser-vice, while future investm ents shouldbe made in eight areas called "clinicalprogram focus" priorities. The fiveboxes at the top of Figure 2 rep resentthe service lines for fixture strategicdevelopment and investment, while thebands along the bottom represent thespecific populations that would receivethe most investment for the future.

7. Improve the profitability of UWHC'spayer arrangements. Several capitatedmanaged care contractual relationshipswere creating su bstantial losses forUWHC. For fiiture financial health,UWH C had to improve reim bursementand utilization within these contracts.

8. Improve employee retention andrecruitment. To reduce the turnoverand vacancy rates, particularly in nur s-ing, UWH C com mitted to improve i ts

culture, physical plant, and compensa-tion. Changes to be pursu ed includedimproved parking; increased work andbreak spaces; expanded training oppor-tunit ies that emphasized change man-agement /performance improvement /customer service training; and man-agement skills training for supervisorsand managers .

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F I G U R E 2 Service Line Developmentat U W H C

Transplant Cardiovascular Oncology NeuroscienceTrauma

Critical Care

t t t t t

When we meet targets,we

set new g oals so that we

are continually improving

our performance.

9 . Simplify and optim ize the system s,proce sses, and facilities that supportaccess, service, and care m anagem entat UWH C, specifically, informationtechnology imp rovem ents ,the admis-sion and discharge process,andimp ro v emen t s in patient flow andinpatient capacity.

10. Increase service to the communityand take a proactive role in shapingand supporting sound legislative andpuhlic policy agendas. This strategy

was added when the leader-ship committee asked,"what is missing from thestrategies articulatedtodate.^" UWHC needed agreater comm unity pres-

ence because our contributions werenot well recognized by the com mun ity.

In addition, we needed to createagreater advocacy rolefor healthcarepolicy, reimbursement, and graduatemedical education.

The work grou p reports were consoli-dated into two docu men ts,a comprehen-sive and detailed report that managementwould use for implementation, andan

eight-page report that wotild be availablefordistribution throughout the organizationand to the public. The repo rt was entitledHealthCAREfor the 21st Century, and theUWHC Authority Board adopted the planin March of 2 0 0 2 .

IMPLEMENTATION

Both tears and sweat are salty, but they render a

different result. Tears will get you sympathy,

sweat will get you change.

Rev. Jesse Jackson

Once the Authority Board approved theplan, the UWHC executive council and theoperations council began implem entation.The two councils developed ann ual operat-ing goals, and individual m anag em entgoals developed d uring the evaluation

process were linked to organizational goals.For each operating goal, the tea m assignedan executive/senior management sponsorand developeda detailed list of tacticsanddeadlines. Each sponsor assum ed responsi-bility to provide quarterly executive counc ilupdates.

In 20 02 , UWH C developed formal busi-ness plans for oncology, cardiovasailar.

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transplant, and children's services. Weestablished targets including market share,adm issions, clinic visits, and profitability,and administrative directors were hired towork with the service-line physicianleaders.

PROGRESS MEASUREMENT

You cannot manage what you cannotmeasure.Phil Murphy

At this po int, the executive council real-ized that UWHC needed a much more

consolidated and robust means to managethe implemen tation. We began to developan organizational dashboard that con-tained important measures that linkedtothe annual operating and strategic goals.The senior vice presidentfor medicalaffairs and the CFO were the executivesponsors ofthe dashboard development.Initially, we developed six domainsofexcellence. Beneath each domain, welinked specific measures to organizational

strategic goals. The six domains includedpatient satisfaction; market positionpatient access; clinical effectiveness, qual-ity, and safety; opera tional efficiency;employee growth and management;andfinancial health.

The executive and operations councilsactively participated in the dashboarddevelopment. We used simple visualcuesred, yellow, and greento indicateprogress toward meeting the goals. Wealso identified the target measu re u singavailable benchm arks, such as percentilerank for hospitalsin the patient satisfac-tion survey, or we developed our own tar-gets based on our current performanceand the goal we wanted to achieve. Thesetargets became part of the dashboard,andthe monthly outcomes allowed usto

measure our progress toward the statedgoal. Any measure in the red or yellowoutcome category required the seniormanag er or executive responsiblefor that

target to submit an improvement planwith dates for completion. That plan wasmonitored by the executive counciltoensure implementation ofthe correctiveplan. In addition, when we met targets,we set new goals so that we were con tinu-ally improving ou r performance.

After the executive and operationscouncils had used the dashboardfor oneyear, we began to roll out the dashboardto

80 directors. Each director received one-on-one training in its use, development ofvariance reports, and application ofthedashboard principles to their areas. Whilewe did not have individual departm entaldashboards at the time of director rollout,we decided it was importantfor all man-agement to understand the organizationalgoals. We have subsequently developed"The Dashboard Dozen,"a series ofUWHC's 12 most success-critical factorsfrom the dashboard, and we share it withall employees and postit on the intranet.

UPDATING THE PLAN

Excellence is the gradual result of always striv-ing to do better.

Pat Riley, head coach ofth e 20 06 NBAchampions, the Miami Heat

In the spring of2003, the CEO andAuthority Board decided UWHC shouldengage an outside consultant and updateour plan. While we had achieved signifi-cant results, we were concerned that theoriginal plan migh t be missing importantelements. We also committed to a three-year planning cycle, but w ith the caveat thateach three-year plan would not necessarily

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be a full-blown review ofth e missio n,vision, and values or a complete environ-mental assessment.

The differences in the second plann ing

initiative versus the first included:

selection ofth e outside consu ltant bythe hospital,with considerable input andconsensus rom he CEO ofthe medicalgroup and the dean;

a decision not to upda te the mission,vision, and values and, instead, tofocus on the goals and strategies; and

reduction in the nu mb er of interviews

(from 80 to 50).

The consultant interviews concludedthat UW HC had ma de great progresstoward me eting the 2 001 plan goals; how-ever, the financial performance and unifiedenterprise goals firom the 200 1 plan n eededto receive greater emph asis b ecause lessprogress had been made. In addition, theUWHC Board and the executive teamdecided th at quality, capacity, an d ma rke tpresence would have a direct impact onUWHC's ability to flirther distance itselffrom the competition.

The organization ofthe planning effortlooked very similar to the one th ree yearsprior; however, we replaced the employeeretention an d recruitment w ork group witha quality work group because mos t ofth einitiatives for employee growth were nowembedded into operations, and consider-

able progress had been made. In addition,from the time we completed th e first plan,public reporting of quality had becom emuch more commonplace, and we neededa more comprehensive, organizationalapproach. The new plann ing structure isshow n in Figure 3.

As a result ofthe second plann ing initia-tive, UWHC added one organizational goal

while the other five rem ained essentiallythe sam e. Because the hospital is located ina 30-year-old building and is now land-locked, the sixth goal stated that the hospital

must continue the development of on-campus and off-campus solutions toaddress future facility needs. In addi-tion, we developed the following ninestrategies instead often.

1. Achieve a culture of quality that pro-duces superior patient care outcomesand customer service.

2. Align the strategic, economic, opera-

tional, and orga nizational interests ofUWH C, UWMF, and UWMS to ensurean overarching commitment to qualityand a coordinated appro ach to caredelivery.

3. More tightly align ambulatory careacross UW Health to improve patientservice and decrease costs.

4. Increase operating efficiency to maxi-mize utilization of current resources toaccommodate future capacity needs.

5. Become the ultima te emp loyer for Madi-son and the region.

6. Increase the proportion of patient activ-ity from outside the local market forboth inpatient discharges and outpatientclinic visits.

7. Enhance structure and infrastructure foroutreach to achieve regional alliancesand promote increased inpatient andoutpatient activity from outside the local

market.8. Achieve or exceed targe ts for fina ncial

performance to fiind capital and strate-gic priorities.

9. Enhan ce service to the com mim itythrough leadership in improving accessfor un derserved populafions, legislativeadvocacy for sound health policy, andcontinued outreach and education.

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F D C U R E 3 Mid-Cycle Strategic ReviewOrganizational Structure

UWHC Board

of Directors

Leadership Com mittee(Steering Com mittee)

Model ofcareOutcomes

CustomerServicePatient andstaff safetyProcessesand systemsInfrastruc-ture

Future staffneeds- Model of

careassump-tions

Future facilityneeds- Distribution

of services- Future

expansion

Outreach andreferralnetwork

developmentOut-of-areadraw forprogramprioritiesInfrastructureto supportout-of-areapatients

UW HealthcommitmentCommon

processes,systems, an dinformationStructure andincentives togrow UWHealth

Unified H FinancialEnterprise i H Performance

WorkGroup H WorkGroup

UtilizationmanagementOperational

efficiencyPhilanthropyContracting

During the planning process wechang ed slightly the clinical prog ram focusareas. We em phasiz ed the special popiila-tions of geriatrics an d wo me n; however, weincorporated the em phasis on childrenthro ugh the clinical priority areas. While wecontinued our organizational commitmentto critical care and tra um a, we did n ot des-ignate it as a clinical priority area this time.Ou r revised clinical prog ram focus areasincluded children, trans plant services, car-diovascular services, oncology, neuro-science, and orthopedics.

We presented the new p lan to theUWHC Authority Board at its March 2004me eting, w here it was adopted. Aptly enti-tled FOCUS for the Future, the plan wasagain the subject of man y com mun icationsthrougho ut the organization in written andface-to-face forums among the Authority

Board, physicians, hospital leadership andmanagement, and frontline employees.

R E S U LT S

...right efforts will invariably bring about right

results.James Allen, author ofAs a Man Thinketh

The results of this structured approach toplanning, implementing, and measuringdemo nstrate its success.

Patient SatisfactionAdult inpatient satisfaction has increasedfrom the 37th percentile of hospitals of450 to 599 b eds to consistently exceed the90th percenti le ofthe same comparisongroup for over four years. This result isshown in Figure 4.

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F I G U R E 4 : Adult Inpatient Satisfaction Results June 2000 to March 20 06

B FY2000,Q l n FY2005,Q l FY2006,Q3TOO _

80 _

60 _

40 _

20 _

n

I

I^ ' '

Employee Recruitment and Retention

Nurse vacancy fell from i8 percent to 4.2percent; overall hospital vacancy ra tes fellfrom 8 percent to 4.8 percent, andemployee turnover rates declined from16.9 percent to 12.2 percent. Nurseturnover rates declined from 12.5 percentto 7.6 percent.

Financial PerformanceThe operating marg in increased from 0.5percent to 4.4 percent; the total m arginincreased from 1.2 percent to 5.9 percent.Days cash on hand decreased from 142days to131 days, while the value of oneday's cash increased from $1,078,890 to$1,833,000.

During the same period, cash reservesincreased from $145,773,000 to$23 9,584,000 . Days in accounts receiv-able decreased from71 days to 44 days.

Philanthropic giving increased from an

average of$1 million per year in June of20 00 to $10 million per year from July of2003 through June of 200 6.

O P E R AT I O N A L E F F I C I E N C YLengths of stay declined from 6.2 days to5.3 days. Patients' diversions declined froma high of 100 to fewer than 20 per month.

Through a structured long-stay reviewprocess, discharges with a length ofstaygreater than 30 were reduced from anaverage of199 in first quarter of 2003 to80 in March of 20 06 .

Clinical Effectiveness, Quality,and SafetyDuring 2003 to 2006, UWHC receiveda num ber of national recognitions basedon its subm ission of quality data. Theseinclude being named a 2004 Quest for


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Quality finalist by the American Hospi-tal Association, a 2003 and 2004 Solu-cient Top 100 Hospital, a 2005Solucient Top 100 Heart Hospital, a top

quartile performer in the Leapfrog Sur-vey, and in April 2005 one of 50 Excep-tional U.S. Hospitals by Consumer'sDigest.

In the fall of 2005, UWHC was thetop performer among 73 academichealth centers in a quality and account-

ability study conducted by UniversityHealth System Consortium. The trans-plant program exceeded all national and

regional United Network for OrganSharing (UNOS) benchmarks, and Uni-versity Health Systems Consortiumnamed the cardiovascular program a

best performer for acute myocardialinfarction in 2004.

By the end of fiscal year 2006, everystrategic operating goal had been met orexceeded, with some goals achieved upto two years ahead of plan.

C R I T I C A L S U C C E S S FA C T O R S

Success is a journey, not a destination. It

requires constant effort, vigilance, and

reevaluation.

Mark Twain

The leaders of every planning initiativeshould take time to examine what the par-ticipants learned from the process and

understand the factors critical for suc-cess. Our experience produced the fol-lowing list of lessons learned.

All components ofthe plan must bestrategically managed and integrated.Figure 5 represents the strategic planframework that needs to be managedand the UWHC annual operating ini-

tiatives that are used to achieve theplan.

The process must be collaborative,involving physicians, frontline

employees, and management, as wellas leadership from other partner insti-tutions, such as the medical schooland practice plan.Involve many people through focusgroups, reactor panels, and groupcommunication, but keep workinggroups and leadership committeessmallno more than 12 people.Use of an outside facilitator with expe-

rience at similar organizations is amust so that you take advantage of themost current national thinking as wellas have someone who will push andchallenge your assumptions.The plan must focus on those pro-grams and competencies that arelikely to help achieve distinctivenessin the market and promise the great-est levels of successful outcomes.Make tough decisions and prioritize.

Your organization doesn't haveenough people, space, or money toimplement all the good ideas and pro-grams that will surface.Implementation and outcome mea-sures must receive the same focus andrigor as development ofthe strategicplan. In fact, all operational goals andinitiatives must help to advance theplan. If not, they should be parked or

eliminated.Have the right people with the right skillsto implement the plan; you may need toinvest in people through training.Plans should be revised at least everythree years. The marketplace andhealthcare change rapidly enough thata thorough examination ofthe plan andmodifications are needed frequently.

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F I G U R E 5 UWHC Strategic Management Framework

Component

Continuous, evolvingplans

Continuous, managedimplementation

Finance and operationsintegrated

Strategy andmanagementintegrated

Description

Annual, ongoing, dynamicstratigic planning process

Annual, ongoing,structured and controlledimplementationprocess

Ongo ing interaction, notlimited to budget orproject review

Ongoingdecision makingdriven bystrategicdirection

UWHC Initiatives

Implementationsubcommittees

Budget plann ing

Capital planning

Program planning

Define what wewill and willnot do

Integrated budget

development process Integrated program and

resource planning Principles of decision making

driven by the plan

Strategic planning and ma nagem entmust become embedded into the

fiber ofthe organization. All goals,decisions, and investments must bemade to mee t the plan goals.

Cood tools to track and report onprogress are essential.

The process must be led from the topwith the CEO in charge ofth e plan.The culture of comm unication andfocus m ust be led by the CEO and theexecutive team to create a culture ofstrategic managem ent and focusthroughout the organization.

Comm unicate, comm unicate,communicate!

In the end, you can do everythingexpressed in this article, but you willget nowhere if you do not have the lead-ers who will inspire the workforce andemployees and physicians who will do

the work believing that they can make adifference.

Today, strategic management hasbecome embedded in the culture ofUW HC. People are encouraged andempowered to make decisions and act inways that advance a well-communicatedstrategic plan. We have seen no limit towhat individuals and teams can achievewhen their energy, commitment, andskills are harnessed by a strong, cohesiveplan. Staff at UWHC have respondedenthusiastically, and leaders are commit-ted to future strategic planning to keepthe organization productively focused andcontinually renewed.

REFERENCES

Allen, J. "James Allen Quote s." [Online resou rce;retrieved 8/7/06.] www.brainyquotes.com.

Jackson, J. 19 94. "Action."In Speaker's Sourcebook II.Englewood Cliffs, NJ: Prentice-H all, Inc, p. 15.

Lloyd George , W. "William Lloyd George Qu otes."


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[Online resource; retrieved8/7/06.]www.brainyquotes.com/quotes/html.

Murphy, P. [Online resource; retrieved 11/7/06.]en.thinkexist.com/quotes/phil-murphy.

Presley, E. "Principles a nd Expediency, Values."[Online resource; retrieved8/7/06.] JosephsonInstitute of Ethics, www.josephsoninstitute.org/quotes/quoteprinciple.html.

Riley, P. "Pat Riley Quotes." [O nline resourc e;retrieved 8/7/06.]

Thinkexist.com/quotes/pat_riley.Ruff, H. 1994. "Preparation." InSpeaker's Source-

book II. Englewood Cliffs, NJ; Prentice-Ha ll,Inc, p. 301.

Staubach, R. 1994. "Preparation." InSpeaker's

Sourcebook II, Englewood Cliffs, NJ; Prentice-Hall, Inc, p. 301.

Twain, M. "Mark Twain." [Online resource;retrieved 8/7/06.] www.leader-values.com/con-tent/quotes.asp?Letter=M.

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ARTICULO 1 HOSPITALES

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