Building Consensus Upward: How to get your strategies implemented by Senior Management
By Michael Strilesky and Danny Brywczynski

continued from HFMA Visions, Issue 5


Case Study: Tony, Director of Radiology

Background
Tony is the director of radiology services at a 300 bed community hospital in a fast growing, highly competitive suburban market.  Tony began his career with the same hospital nearly 20 years ago as a radiology technician and has climbed the ranks to become the director 8 years earlier.  After early success in his career, Tony senses that he has hit a plateau; it appears that many of his ideas are falling on deaf ears within the senior leadership team. 

Recently, the radiology group approached Tony regarding the need to acquire a new Picture Archiving and Communication System (PACS) technology solution at the hospital.  According to the radiologists, PACS is required to ensure that the hospital can:

• Maintain the loyalty of high referring physicians,
• Increase efficiency by expediting turnaround time, and
• Ensure adequate radiologist coverage.

Knowing that he does not have the money in his capital budget, Tony is reluctant to approach senior leadership until he can provide a viable recommendation around this business problem. 

Step 1: Documenting the Business Case
Knowing the importance of sustaining radiology referrals to the hospital, Tony recognized the criticality of meeting the needs of the referring physicians, the radiologists, and providing the appropriate services within the organization.  If a new PACS solution was in the hospitals future, Tony recognized that a well thought out plan was necessary to prove to senior management the importance of acquiring this technology. 

As a Director within the department, his ideas regarding the operational and relational impact that PACS could provide came pretty easily.  Tony quickly documented some of the benefits as follows:

• Improve radiologists workflow
• Improve operational workflow
• Eliminate excess staff
• Decrease turnaround time
• Create remote reading capabilities
• Catalogue patient history
• Store images digitally
• Develop film and paper-less department

Tony concluded his brainstorming session by looking at previously implemented strategic initiatives to understand overlying themes that prompted senior executives to pursue similar initiatives.  After a short review, it was evident that a thorough analysis of the economic opportunity was required to catch the attention of the team.  Tony worked with decision support and identified that the prospect of not implementing this technology could provide a risk to the hospital’s financial performance, and the prospect of proceeding with the technology provided a reasonable financial upside to the hospital.    

To highlight this importance, three scenarios were created:

Best Case: Assuming increased referrals to the system due to improved referring physician satisfaction and quicker report turn-around times from the Radiologists

Worst Case: Assuming no change in referrals and minimal impact on operations and turn-around time with the Radiologists

Likely Case: Assuming a moderate increase in referrals to the system, with a gradual increase in turn around time and operational improvements within the department.  

Step 2: Building the Communication Plan
As Tony continued to work through the communication plan, he understood that the CEO of the hospital, a well-rounded thinker, approached these types of decisions from many different perspectives.  Realizing he would likely have only 30 minutes to present his materials, and facilitate discussion with the group, it was clear that his brainstorming session produced much more information that he could reasonably explain during this timeframe.

To effectively communicate to the team, Tony developed a high level summary to describe the business case, economic opportunity, impact on operations, and benefits for the Radiology group.  Focusing on these key topics, Tony was able to create a single handout for the group.  This handout provided the executive team with high level information that, he believed, would engage the group in what hoped to be a productive strategic discussion. 

Realizing that his financial scenarios would likely be questioned by the CFO, Tony also developed a detailed list of assumptions that drove the models.  Although he prepared a set of material summarizing the assumptions and financial detail, Tony did not initially pass this information out for two reasons:

• To limit the time senior executives spent in the financial detail, and
• To funnel questions to an area Tony was prepared to answer.

Step 3: Empower Action with the Senior Leadership Team
As Tony left the senior leadership team, he was thrilled with the outcome.  The meeting was scheduled for 30 minutes but lasted longer due the team’s urgency around the material Tony had developed.  Because of Tony’s presentation, the team determined that this issue warranted further discussion and ended up discussing the acquisition of a PACS technology solution for a full hour. 

Following the meeting, the CEO complimented Tony on how well organized his thoughts and materials were, and how productive the discussion was.  The single handout addressed concerns from each party in the room, ensuring that operations, finance, and business development were included in the discussion.  The CFO was happy to see that Tony had the necessary financial detail that he would review after the meeting.

Summary
This case study highlighted an example of how a director can provide significant strategic value to the senior leadership team and organization.  Not only did Tony elevate his value in the organization, he empowered the leaders within the organization to expedite decision making while leveraging his department-level experience to drive action within the group discussion. 

The key leanings to help “Build Consensus Upward” that were portrayed in the case study can be summarized as follows:

• Determine what’s “Worked Before.”  Analyze what drives your hospital executives to make decisions and implement action.

• Create a “Sense of Urgency.”  Determine the opportunity and/or risks that are associated with pursuing or not pursuing the strategy.  Whenever possible, quantify the economic opportunity or risk.

• Communicate “The Big Picture.”  Use simple and well thought out materials to tell your story (pictures, maps, graphs and charts work well).  In many cases, less is more when communicating to senior executives; however, be prepared with the detail if questions do arise.

• Provide a “Recommendation.”  Go one step beyond a recommendation to the senior team; provide your recommendations for immediate action items and be firm.

• Create “Action.”  Build time into your presentation for further action planning; empowering the senior leadership team to make a decision is a significant benefit to the overall success of the initiative and ultimately, your career growth.

Michael and Danny work for Charis Healthcare, a strategic consulting firm in Hudson, and can be reached at Michael.Strilesky@charishealthcare.com and Danny.Brywczynski@charishealthcare.com.