Strategic Prioritization and Deselection: Being transformative in the beginning stages of an endemic

By Dr. Seleem R. Choudhury, March 31, 2022

On the cusp of entering an endemic state, organizations are deciding what to turn their attention to “after COVID.” Wise leaders will recognize that this is not as simple as carrying on with their pre-COVID strategies. No organization has been immune to the shockwave of disruption that the pandemic has caused (Lagasse, 2020). This is especially true in the healthcare field. Hospital staff and resources are strained from bearing the weight of pandemic changes and regulations as well as the loss of skilled staff in the Great Resignation. You simply cannot “pick up where you left off” strategically when your workforce—the essential piece to actually accomplishing any strategy—is burned out and struggling. Something has to give. 

Traditionally, at the beginning of a strategic planning activity, the organization establishes a vision focusing on the desired future state. This future state is usually based upon understanding the current state, forecasting, and looking for opportunities to excel among a playing field that is familiar. Yet today, the healthcare, business, chain supply, workforce, economic, governmental, state, and regulatory landscape is far from familiar. The past two years have been an extended “strategic resilience test” of sorts (Diedrich, Northcote, Röder, & Sauer-Sidor, 2021). While all organizations understand the importance of strategic planning and implementation, only those with high levels of situational awareness will thrive post-COVID.  Put simply, situational awareness is “knowing exactly who you are, where you are, where you are going, and how you will get there, within your rapidly changing environment” (Afterburner Team, 2022).

Situational awareness requires a dynamic review not just of your strengths as an organization, but your limitations within the current environment. In healthcare, a years-long pandemic and a decimated and tired workforce presents organizational limitations that demand organizations to rethink their old, all-ambitious strategic plan that requires numerous detailed sub-plans, resources, funding, and metrics. Instead, the strategic plan needs to be narrowed, unifying, well-paced, and focused. Today, the biggest strategic decision for healthcare institutions will require boldness, but it isn’t about doing something new. Rather, it is about doing something less.

“Strategic deselection”

The landscape we find ourselves in is unfamiliar. While healthcare organizations could push through and aim to succeed in their myriad pre-pandemic priorities, this transition period from pandemic to endemic is an opportunity to consider what would be most advantageous to focus on, what needs to be done and what does not.  This is an opportunity to prioritize and deselect, rather than to add.

Sg2, a healthcare consultancy company that focuses on healthcare trends and unique solutions, states:

“The ability to prioritize the most impactful initiatives the organization is positioned to execute over the short-term, while simultaneously deselecting those that could derail it, will be essential to ensure sustainability” (Sg2, 2018).

Often organizations do not have the ability to or see the benefit of pausing existing initiatives. A lack of “sunset” processes in many organizations make it difficult to determine when to retire a strategic plan  (Hollister & Watkins, 2018)ollH. Deselection is about triaging the strategic plan, understanding that all tasks cannot possibly be saved based on existing capacity. This requires leadership willing to make difficult decisions about what needs to be discarded or paused to give only the top priority their full attention. A focus on only one to three key priorities will allow the organization to use limited resources well, and will give staff a chance to recharge by being attentive to and report on only a small number of priorities.

Define criteria for selection and deselection

It is normal behavior for organizations to focus more on what they need to do than the things they have already accomplished. This is called the “Zeigarnik effect.” Psychologists describe it as a “psychological phenomenon describing a tendency to remember interrupted or incomplete tasks or events more easily than tasks that have been completed” (Good Therapy, 2016).

There are multiple tools and strategies that can help organizations overcome this tendency in order to have laser-like focus on only their most essential goals. A simple tool to aid strategic prioritization and deselection is a matrix. This tool can help an organization narrow their options “by systematically comparing choices through the selection, weighing, and application of criteria” (Public Health Foundation, 2022).

A prioritization matrix is often used with Six Sigma, and the above prioritization matrix breaks tasks out into two dimensions: “Do Now” and “Do Later,” and “Crucial” and “Not Crucial.” The matrix, once completed, can help illuminate what should be done, delayed, and deselected. Though simple in form, using the prioritization matrix effectively is hard work, requiring organizations to make difficult trade-offs and stop initiatives that were once enthusiastic about.

Stephen Covey is celebrated for his famous business quote: “The main thing is to keep the main thing the main thing” (Kruse, 2012). The concept sounds simple, but any leader knows that it is easier said than done. For an organization and its leaders, keeping in mind what strategies are primary, secondary, and which priorities rank lowest will help promote unity and confidence in decision-making (Rodenhizer, 2016).

Successful strategic implementation processes require the work and attention of employees and managers at all levels within a healthcare organization. The workforce is the main driver for implementation of strategy. Common business wisdom states that the more projects you do the less effective you become. “Staggering or postponing strategic imperatives” will reduce the number of projects handled at once, which effectively reduces the “number of projects per person” (Steyn, & Schnetler, 2015). Today, as healthcare organizations revisit their strategies, initiatives that include unlimited projects, ambitious milestones, and metrics success should be used judiciously, especially in the context of a distressed workforce.

Overload can result in “costly productivity and quality problems and employee burnout” (Hollister, & Watkins, 2018). Waves of healthcare and hospital workers have quit their jobs (or their entire profession) because of moral distress, exhaustion, compensation, poor treatment by their hospitals or patients, or some combination of these. These losses leave the remaining healthcare workers with “fewer trusted colleagues who speak in the same shorthand, less expertise to draw from, and more work” (Yong, 2022). It is critical for the health of our employees, and thereby the health of our organizations, that more strategies are minimized or deselected, and only the absolute necessities receive prioritization to move the organization forward.

Read more from Dr. Seleem Choudhury at seleemchoudhury.com

Resources:

Afterburner Team (2022). Three Ways to Improve Your Situational Awareness. Afterburner.

Diedrich, D., Northcote, N., Röder, T., & Sauer-Sidor, K. (2021). Strategic resilience during the COVID-19 crisis. McKinsey and Co.

Good Therapy (2016). Zeigarnik Effect. Good Therapy.

Hollister, R., & Watkins, M. (2018). Too Many Projects. Harvard Business Review. September–October 2018, 64–71.

Kruse, K. (2012). Stephen Covey: 10 Quotes That Can Change Your Life. Forbes.

Lagasse, J. (2020). COVID-19 is forcing rural hospitals to rethink their business models. Healthcare Finance News.

Public Health Foundation (2022). Prioritization matrix. Minnesota Department of Health.

Rodenhizer, S. (2016). The Main Thing Is to Keep the Main Thing the Main Thing. Quotation Celebration.

Sg2 (2018). Transformative Planning: Strategic Prioritization and Deselection. Sg2.

Steyn, H., & Schnetler, R. (2015). Concurrent projects: How many can you handle?. South African Journal of Industrial Engineering, 26(3), 96-109.

Yong, E. (2022). Hospitals Are in Serious Trouble. The Atlantic.