How to Use Planning to Drive Positive Organizational Change

“The team is too stressed to spend time planning.”
“We have new administration; let’s wait until we know what they want.”
“Why bother? We will just be told what to do.”

While the idea of planning can evoke a range of emotions and responses, after working more than 30 years in health care, I still find it one of the most important and positive interventions for improving a team’s or organization’s health and impact. Here’s an example:

An exhausted clinical team stopped communicating, and individuals felt frustrated with each other. The program leader spent 1:1 time learning about those frustrations and used a weekly interdisciplinary team (IDT) meeting to prioritize new ways to structure their team time. They tested it over several weeks. The assessment and planning allowed team members to have their frustrations validated and created time to work together on solving challenges. Several months later communication improved, and the team was back to having regular and more productive team meetings. It started with the program leader taking time to learn, and the team discussing and prioritizing issues together.

All too often teams and/or leaders have a difficult time getting started in a planning exercise because they:

• Believe it is too involved of a process
• Don’t feel they have the time
• Are hesitant to prioritize near- or long-term goals because everything around them feels uncertain or unstable

Here are three tips to help jumpstart your planning efforts regardless of situation, role, program, organization, or team structure.

Planning is a loaded term. Business planning, strategic planning, operational planning, program planning…it can quickly become complicated and even stressful when someone mentions planning. Expectations begin to run high (“Let’s do a one-day retreat and figure out all of our priorities for the next ten years!”) as do emotions (“Are they going to change my job?” “Will they decide to eliminate our program?”).

To avoid over-investing in planning or confusing a team or organization, pause and think through your planning needs. Below are three common times when a team might need to do some focused planning.

Morale is low; stress is high; poor communication among team; team meetings feel unhelpful

Suggested Planning Steps: Team Planning

1. Conduct a team assessment to understand issues (1:1 meetings are suggested as a first step).
2. Prioritize which opportunities for improvement you will tackle (consider a team voting exercise).
3. Create a one-page, 12-18 month team workplan and timeline (what, who, when).

Team is being asked to go to new sites; volumes change dramatically; seeing more complex or different patients

Suggested Planning Steps: Program Design Planning

1. Interview key referring clinicians and leaders to understand changes.
2. Review/refine program mission statement and scope (are you seeing the right patients?).
3. Prioritize ideas to test (e.g., narrow referral criteria, adjust patient assignments).

New administration; new competitors in the market; major expansion; volumes outpacing staffing capacity; significant turnover

Suggested Planning Steps: Strategic or Business Planning

1. Conduct a needs assessment to understand the needs of the organization, patients and family caregivers, and referring clinicians.
2. Prioritize program needs for near- and long-term (staffing, team structure, recruitment, referral criteria).
3. Develop a multi-year financial budget (staffing, volumes, costs, etc.).

Planning principles help facilitate open, positive, and productive discussions with key stakeholders and establish realistic expectations for purpose and approach. Some things to remember:

• Planning is an iterative process and not a one-time event. There will be many opportunities to provide input and adapt as more is learned.
• A plan is simply a guide. Getting too attached to the “perfect” plan can lead to long, drawn out planning processes.
• Planning is about trade-offs. Prioritization is difficult but necessary. An effective planning process helps leaders, teams, and organizations rationalize where and when it is best to deploy often limited resources.

Getting teams and organizations aligned around a common understanding of the purpose of the planning and the best approach increases the likelihood of constructive engagement and “calms the waters” so folks can come with open minds and good ideas.

It’s true that planning can feel very complicated as more information is gathered and more people become involved. I would argue that is the healthy part of planning. Gathering new information and diverse perspectives leads to richer insights and better decisions. Fundamentally, planning is a fairly simple process:

Step 1: Discovery/needs assessment.
Learn what you can about what’s going on around you, problems or opportunities to address, and factors that could impact priorities and plans.

Step 2: Synthesis and prioritization.
Review findings from your discovery step, and identify 5-8 key challenges and/or opportunities critical to address over some time horizon (next quarter, 12-18 months, or 2-3 years).

Step 3: Plan development.
Lay out a plan that describes priorities, impact, who will lead a priority area, resources needed, timing, etc.

Plans can take various forms. For example, a business plan would include compelling data that rationalizes your business goals, a budget, and staffing plan. A team improvement plan would cover areas such as team processes, communication, or training. A helpful deliverable from most any planning initiative is a workplan or timeline that reminds the team of what they agreed upon and is used to track progress or re-assess priorities.

As one clinician leader recently shared with me: “If you plan well, you are better able to respond and adapt to the changes around you.”

Planning is a helpful tool to engage a team, leaders, and an organization—and an opportunity to generate new ideas, build relationships, and open new dialogue. And even when it doesn’t feel like it, taking time to plan in the short term often saves you time and hassle in the long term. If done regularly it can be a powerful way to continuously reinforce positive change, bring new energy to a team by working together to solve problems, and give permission to validate challenges as well as think about opportunities for the future.

CAPC offers a range of planning tools and resources, whether to support program planning and design or improve team function and health.

• Program Start-Up Toolkits: Tools for building inpatient, clinic/outpatient, and home-based palliative care programs, including needs assessment tools for inpatient and community-based programs
  
• Planning Forward in the COVID Era Toolkit: A series of tools to help teams adjust and plan though this particular period of uncertainty caused by the pandemic
  
• Building and Supporting Effective Palliative Care Teams Toolkit: Team planning tools, webinars, and resources to help assess teams and develop plans to improve team function and health
  
• Virtual Office Hours: Open-topic, small group virtual consulting calls, including Making the Case for Palliative Care: Demonstrating Value through Measurement; Planning for Community-Based Care: Getting Started; Business Planning for Palliative Care Programs; and Improving Team Effectiveness and Resilience