Strategic management system in a healthcare setting--moving from strategy to results

One of the historical challenges in the healthcare system has been the identification and collection of meaningful data to measure an organization's progress towards the achievement of its strategic goals and the concurrent alignment of internal operating practices with this strategy. Over the last 18 months the Toronto East General Hospital (TEGH) has adopted a strategic management system and organizing framework that has led to a metric-based strategic plan. It has allowed for formal and measurable linkages across a full range of internal business processes, from the annual operating plan to resource allocation decisions, to the balanced scorecard and individual performance evaluations. The Strategic Management System (SMS) aligns organizational planning and performance measurement, facilitates an appropriate balance between organizational priorities and resolving "local" problems, and encourages behaviours that are consistent with the values upon which the organization is built. The TEGH Accountability Framework serves as the foundation for the entire system. A key tool of the system is the rolling three-year strategic plan for the organization that sets out specific annual improvement targets on a number of key strategic measures. Individual program/department plans with corresponding measures ensure that the entire organization is moving forward strategically. Each year, all plans are reviewed, with course adjustments made to reflect changes in the hospital's environment and with re-calibration of performance targets for the next three years to ensure continued improvement and organizational progress. This system has been used through one annual business cycle. Results from the past year show measurable success. The hospital has improved on 12 of the 15 strategic plan metrics, including achieving the targeted 1% operating surplus while operating in an environment of tremendous change and uncertainty. This article describes the strategic management system used at TEGH and demonstrates the formal integration of the plan into its operating and decision making processes. It also provides examples of the metrics, their use in decision-making and the variance reporting and improvement mechanisms. The article also demonstrates that a measurement-oriented approach to the planning and delivery of community hospital service is both achievable and valuable in terms of accountability and organizational responsiveness.