Strategic Planning in Healthcare:

The Experience ofthe University of

Wisconsin Hospital and Clinics

DONNA K. SOLLENBERGER

SUMMARY » 1111999, after 25 years of stable leadership from a single CEO,

the University of Wisconsin Hospital and Clinics (UWHC) Authority Board
named a new CEO. The 471-bed academic medical center had recently experi-
enced significant change and challenges. In 1996, it had emerged as a public
authority, a statutory designation by the state of Wisconsin that 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 the
new CEO was named, the hospital was experiencing a loss of revenue and mar-
ket share, operating deficits, a 22 percent nurse vacancy rate, and patient satis-
faction scores below the 40th percentile. The first task assigned to the new
CEO by the board was the development of a new strategic plan that would
reverse these trends and position UWHC as a premier academic hospital.
The CEO began a strategic planning process that involved leaders, physi-
cians, and staff from throughout the hospital and clinics, its affiliated medical
school, 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 by
UWHC; and lists the lessons learned along the way.

Donna K. Sollenberger is president and chief executive officer at the University

of Wisconsin Hospital and Clinics in Madison, Wisconsin.

D O N N A K. SOLLENBERCER • 17
 T H E STATE OF THE HOSPITAL I N
THE WINTER OF 1999
In December of 1999,1 was appointed
president and chief executive officer ofthe
University of Wisconsin Hospital and
Chnics (UWHC), a 471-bed academic
medical center with over 20,000 admis-
sions and 500,000 outpatient visits annu-
ally. Prior to that, I had been the chief
operating 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 a
lack of organizational participation, from
a failure to use the strategic plan to drive
operations and organizational investment,
and from a failure to stretch the vision
and goals to dramatically transform the
organization. Thus, I found the UWHC
situation simultaneously
The ultimate exhilarating and daunting;
responsibility and driving exhilarating because I
finally had the opportunity
force for strategic
to lead the effort, but
planning must be the daunting because for the
CEO. first time the planning and
responsibility ultimately
fell to me. The board—as well as the
entire organization—had great expecta-
tions for new directions.
While UWHC had benefited from 25
years ofstable leadership, by December of
1999 UWHC had been through recent,
dramatic change. As part ofthe University
of Wisconsin System, the prior CEO had
reported to the university chancellor. The
hospital had also been a part ofthe state of
Wisconsin, subject to all its policies and
procedures. In 1996, the hospital separated
from the state and the university and
became a public authority with the CEO
reporting to its ovwi goveming board. In the
summer of 1999, the hospital opened two
new offsite outpatient clinics that were not
18 • FRONTIERS OF H E A L T H SERVICES
meeting volume and financial expectations:
margins had eroded from 3.1 percent to 1.2
percent in one short year despite a 9.5 per-
cent charge increase, the nurse vacancy rate
exceeded 20 percent, overall patient satis-
faction scores hovered below the 40th per-
centile for academic medical centers, and
employee morale was palpably low. No one
had held the chief financial officer position
for four years, and the strategic plan lacked
focus. Clearly, a new direction was needed.
STRATECIC PLANNING BEGINS
Action without vision is a nightmare.
—Japanese Proverb
Successful planning begins with owner-
ship ofthe process. While some organi-
zations choose to appoint a strategic
planning leader, the ultimate responsi-
bility and driving force for strategic plan-
ning must be the CEO. Many individuals
may 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 for
organizational strategy, the use of an
experienced, outside consultant to facili-
tate the process is critical for success.
The outside consultant should bring a
national overview ofthe healthcare
industry and the ability as a neutral
party to drive the organization to a deci-
sion about strategic direction and issues,
particularly ones where organizational
leaders have considerable or varied
points of departure.
A request for proposal (REP) that con-
tains clear planning objectives, consul-
tant responsibilities and experience,
deliverables, and an achievable timetable
is needed, as is the identification of
MANAGEMENT 23:2
consultants familiar with healthcare,
and, in UWHC's case, academic health-
care. Once the RFP is issued, phone
interviews with the responders, onsite
interviews with the finalists, and careful
reference checking allow the organiza-
tion to select the consultant that is the
best fit for the CEO and the board.
SUCCESSFUL STRATEGIC
PLANNING BEGINS WITH
CAREFUL PREPLANNING
Spectacular achievements are always preceded meetings over a three-month period), the
by unspectacular preparation.
—Roger Staubach, and the beginning and ending dates for
Former NFL Quarterback the group's work. In the case ofthe lead-
The CEO and outside consultant can spend
as much as two months in the preplanning
stage. At UWHC, preplanning began by
identifying over 80 individuals from
throughout the hospital, medical school,
practice plan, and community to interview
and from whom to elicit opinions on key
issues facing UWHC. From these inter-
views, the following key needs emerged
that guided the creation of five strategic
plan subcommittees:
1. improvement of service and access for
patients;
2. strategies to retain and recruit UWHC
employees, particularly in nursing;
3. identification of a differentiating mar-
ket role;
4. better alignment among the medical
school, practice plan, and hospital; and
5. adoption of a clear and unified direc-
tion with respect to a local hospital.
One hundred individuals—key hospital
leaders, management and frontline
employees, medical school and practice
plan leaders, and members ofthe boards
ofthe hospital and practice plan—were
invited by the CEO to participate in the
committees shown in Figure i. The five
working groups andfiveinput avenues
reported to the leadership committee,
which reported to the UWHC Authority
Board.
The invitation to participants stated
that they were expected to attend each
meeting. The letter also included an esti-
mation ofthe number of meetings (gen-
erally no more than four, two-hour
topics each work group would address,
ership committee, we scheduled two
additional meetings to finalize the plan.
If the individuals receiving the invitation
could not attend all or a majority ofthe
meetings, they were encouraged to
decline the invitation to allow someone
else to participate. (Very few people
declined the invitation, and meeting
attendance was nearly 100 percent!)
Each work group and the leadership
committee were assigned a UWHC staff
person to manage the meetings, notes,
and process. The work groups also were
assigned a staff person from the decision
support department to manage informa-
tion and data requests. We also named a
facilitator from the outside consultant
group to each work group and the leader-
ship committee. The leadership commit-
tee included the chairs of each ofthe work
groups to ensure coordination ofthe work
groups' work product with the leadership
committee. The CEO provided a charge to
each work group, as well as a list of goals,
responsibilities, and members.
An internal support person, in our
case a senior management analyst, was
DONNA K. S O L L E N B E R C E R • 19
 Figure 1 : Organizational Structure ofthe Strategic Plan

Strategic Planning
UWHC
Intranet Site
Board of Directors

Physician Reactor
Panels
1
Leadership
Patient and Family
Forums

Committee
Employee Forums
Health Science
Forums

* ' " ' • ' ' " A"

• Standard of Culture and Criteria to Financial • Local and

service morale evaluate performance regional
• Scheduling/ Organizational priorities Programmatic • Ambulatory
access values Potential performance strategy
• Admissions/ HR trends programmatic Access to future • Local hospital
discharge Compensation investments capital relationship
• Operating Fringe benefits Primary care Clinical • Branding
rooms Nursing and Service line resource • Outreach
• Bed capacity allied health development management • Primary care
• Outpatient professionals Inter- Capacity
capacity Support staff institutional/ Ambulatory
• Ambulatory organizational utilization
utilization program Managed care
• Culture development products and
• Information pricing
systems Fundraising
• Patient IS development
satisfaction Facilities
• Care development
systems

identified to support the CEO in the plan-
ning initiative. A master schedule of all of
the meetings, responsible individuals, and
dates, times, and locations was created. In
addition, we developed a strategic plan-
ning materials list. The CEO gave each
committee member a topic-appropriate
book with a handwritten, personal mes-
sage inside. In addition, five to six articles
were 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 support
materials for each work group and com-
mittee member to provide an environ-
mental assessment ofthe organization.
All participants were invited to attend
a two-hour training session to review the
goals ofthe plan, the responsibilities of
the members ofthe work group and

2O • FRONTIERS OF HEALTH SERVICES MANAGEMENT 23:2

leadership committee, the key findings
ofthe consultant interviews, and the
organizational structure ofthe strategic
planning initiative. The meeting also
allowed the CEO to introduce the chairs
and facilitators ofthe leadership com-
mittee and the five work groups.
To elicit input from throughout the
organization, our key constituents, and
customers, we created five additional
input avenues:
1. Physician reactor panels to allow the
planning groups to present to internal
and referring physicians the plans as
they were developed and to elicit the
physicians' feedback throughout the
process.
2. Health science forums that presented
evolving work group plans to faculty and
leadership ofthe schools of nursing,
pharmacy, and medicine, and that
solicited 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 for
input.
5. A strategic planning intranet site to
post evolving plans for employee reac-
tions. In addition, employees could
use an e-mail address to submit sug-
gestions to any ofthe work groups.
PLAWWONC BECDMS
Remember it wasn't raining when Noah built
the ark.
—Howard Ruff, author and financial
advisor
In September, 2001, the work groups and
leadership committee began their initial
work. While the work groups began
reviewing data, attacking the critical
issues, and forming recommendations,
the leadership group started to review the
vision and market position statements.
(The mission statement was not
addressed because UWHC's mission was
established by Wisconsin statute.) All par-
ticipants were encouraged to "think out-
side the box." The vision and market
position statements the leadership com-
mittee developed follow.
Vision:
UWHC will be the foremost healthcare
provider and employer in Wisconsin, serv-
ing as a statewide and national leader for
patient 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-edge
research.
VALUES
m
Values are likefingerprints.Nobody's are the
same, but you leave 'em all over everything
you do.
—Elvis Presley
Another group led by the manager of
recruitment and comprised of former
employees ofthe month developed a set
of recommendations for organizational
values. This group was not a formal part
ofthe planning process, something I
would change in the future. The impor-
tance of this group is that, heretofore,
UWHC did not have consistent and well-
D O N N A K. S o L L E N B E R C E R • 21
 articulated values. The group met multi-
ple times to develop the following set of
values to recommend to the leadership
committee, which ultimately adopted them:
UWHC is guided in the pursuit ofthe mis-
sion and vision by a set of core values
expressed in the word CARE. These
values are:
• Compassionate Care—Compassionate
care takes the form of listening and
responding to the needs of all patients
and customers.
• Active Learning—As an academic
institution, we are committed to
providing active, lifelong learning
opportunities for patients, staff,
students, and the community.
• Respect for Others—We believe that
people who are treated with respect
will respond positively. In all
interactions, we will be courteous,
kind, honest, and fair.
Excellence and Innovarion—We strive to
achieve the highest standards of
excellence in all we do. Expressed
individually and through teamwork,
our commitment to excellence is a
source of pride for those associated
with UWHC.
COALS AND STRATEGIES
Don't be afraid to take a big step when one is
indicated. You can't cross a chasm in two
small steps.
—David Lloyd George, Former
Prime Minister of England
The work groups created plans that
they forwarded to the leadership com-
mittee. The leadership committee used
the reports to finalize five goals that
22 • FRONTIERS OF HEALTH SERVICES
would enable UWHC to attain its vision
and 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 existing
resources, including recent significant
investments in the local markets and
primary care.
4. Produce sufficient financial perfor-
mance and capital funds to meet the
requirements ofthe strategic plan and
routine operations.
5. Unify the clinical and academic enter-
prise (UW Medical School [UWMS],
UW Medical Foundation [UWMF], and
UWHC) to speak with a single voice in
the market.
To meet the strategic goals, the leader-
ship committee adopted ten core strategies
that would allow UWHC to achieve the
cultural change needed for future success.
These strategies were highly interdepen-
dent, requiring more alignment among
the three UW Health partners, enhance-
ment of UWHC's role in the market, and
improvements in service and access.
I. Develop an organizational culture
that reinforces UWHC's values and
priorities, based on the core belief
that patients come first. This goal was
the product of considerable debate
about the core value of patient care in
an academic setting. Ultimately, all
participants in the leadership com-
mittee decided that everyone's focus
while practicing in the hospitals and
chnics must be the patient, perhaps
an obvious principle to some, but in
MANAGEMENT 23:2
 an academic healthcare setting, a key
decision that allowed us to focus on
service as well as technical expertise.
2. Align the strategic, economic, opera-
tional, and organization interests of
UWHC, UWMF, and UWMS to
ensure a coordinated approach to the
market and other providers. Until
2OOO, the CEOs ofthe practice plan
and hospital, as well as the dean, had
not met regularly. No formal mecha-
nism for programmatic and capital
planning existed. This goal commit-
ted to much more collaboration, con-
solidation, and coordination.
3. Align the economics, technology, and
organization of ambulatory care
within UW Health. UWHC, UWMF,
and UWMS all owned and operated
clinics under the brand of UW
Health, yet each clinic had its own
information system, its own set of
policies, and different service stan-
dards, which created confusion
among patients using the various
clinics.
4. Promote "UW Health" as "the" acade-
mic health system. The leadership
committee believed that common
branding ofthe physician group and
hospitals and clinics "UW Health"
would minimize market confusion and
take advantage of UW Health's strong
brand recognition.
5. Define the collective relationship of
UW Health—UWHC, UWMF, and
UWMS—with a local hospital around
the clinical and academic needs of UW
Health. Our area includes a local hos-
pital that has an academic affiliation
with the medical school and serves as
the practice site for one-third of UW
Health physicians who function as a
community-based group practice. The
leadership committee believed that
gaining a better overall understanding
ofthe relationship between the local
hospital and UW Health was essential
for future clinical and academic suc-
cess.
6. Develop distinctive tertiary services,
and position UWHC as the preemi-
nent regional referral resource while at
the same time maximizing the value of
significant prior investments in the
local market and primary care. The
leadership committee decided that the
emphasis for the local market and pri-
mary care woiild be on access and ser-
vice, while future investments should
be made in eight areas called "clinical
program focus" priorities. The five
boxes at the top of Figure 2 represent
the service lines for fixture strategic
development and investment, while the
bands along the bottom represent the
specific populations that would receive
the most investment for the future.
7. Improve the profitability of UWHC's
payer arrangements. Several capitated
managed care contractual relationships
were creating substantial losses for
UWHC. For fiiture financial health,
UWHC had to improve reimbursement m
and utilization within these contracts.
8. Improve employee retention and
recruitment. To reduce the turnover
and vacancy rates, particularly in nurs-
ing, UWHC committed to improve its
culture, physical plant, and compensa-
tion. Changes to be pursued included
improved parking; increased work and
break spaces; expanded training oppor-
tunities that emphasized change man-
agement/performance improvement/
customer service training; and man-
agement skills training for supervisors
and managers.
m
DONNA K. SOLLENBERCER 23
 FIGURE 2 Service Line Development at UWHC
Transplant Cardiovascular
t t t t t
9. Simplify and optimize the systems,
processes, and facilities that support
access, service, and care management
at UWHC, specifically, information
technology improvements, the admis-
sion and discharge process, and
improvements in patient flow and
inpatient capacity.
10. Increase service to the community
and take a proactive role in shaping
and supporting sound legislative and
puhlic policy agendas. This strategy
was added when the leader-
When we meet targets, we
ship committee asked,
set new goals so that we "what is missing from the
are continually improving strategies articulated to
date.^" UWHC needed a
our performance.
greater community pres-
ence because our contributions were
not well recognized by the community.
In addition, we needed to create a
greater advocacy role for healthcare
policy, reimbursement, and graduate
medical education.
The work group reports were consoli-
dated into two documents, a comprehen-
sive and detailed report that management
would use for implementation, and an
24 • FRONTIERS OF HEALTH SERVICES
Trauma
Oncology Neuroscience
Critical Care
eight-page report that wotild be available for
distribution throughout the organization
and to the public. The report was entitled
HealthCAREfor the 21st Century, and the
UWHC Authority Board adopted the plan
in March of 2002.
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 the
plan, the UWHC executive council and the
operations council began implementation.
The two councils developed annual operat-
ing goals, and individual management
goals developed during the evaluation
process were linked to organizational goals.
For each operating goal, the team assigned
an executive/senior management sponsor
and developed a detailed list of tactics and
deadlines. Each sponsor assumed responsi-
bility to provide quarterly executive council
updates.
In 2002, UWHC developed formal busi-
ness plans for oncology, cardiovasailar.
MANAGEMENT 23:2
transplant, and children's services. We measure our progress toward the stated
established targets including market share, goal. Any measure in the red or yellow
admissions, clinic visits, and profitability, outcome category required the senior
and administrative directors were hired to manager or executive responsible for that
work with the service-line physician target to submit an improvement plan
leaders. with dates for completion. That plan was
monitored by the executive council to
PROGRESS MEASUREMENT ensure implementation ofthe corrective
plan. In addition, when we met targets,
You cannot manage what you cannot measure. we set new goals so that we were continu-
—Phil Murphy ally improving our performance.
After the executive and operations
At this point, the executive council real- councils had used the dashboard for one
ized that UWHC needed a much more year, we began to roll out the dashboard to
consolidated and robust means to manage 80 directors. Each director received one-
the implementation. We began to develop on-one training in its use, development of
an organizational dashboard that con- variance reports, and application ofthe
tained important measures that linked to dashboard principles to their areas. While
the annual operating and strategic goals. we did not have individual departmental
The senior vice president for medical dashboards at the time of director rollout,
affairs and the CFO were the executive we decided it was important for all man-
sponsors ofthe dashboard development. agement to understand the organizational
Initially, we developed six domains of goals. We have subsequently developed
excellence. Beneath each domain, we "The Dashboard Dozen," a series of
linked specific measures to organizational UWHC's 12 most success-critical factors
strategic goals. The six domains included from the dashboard, and we share it with
patient satisfaction; market position— all employees and post it on the intranet.
patient access; clinical effectiveness, qual-
ity, and safety; operational efficiency; UPDATING THE PLAN
employee growth and management; and
financial health. Excellence is the gradual result of always striv-
The executive and operations councils ing to do better.
>
actively participated in the dashboard —Pat Riley, head coach ofthe 2006 NBA
development. We used simple visual champions, the Miami Heat
cues—red, yellow, and green—to indicate
progress toward meeting the goals. We
-i
In the spring of 2003, the CEO and
also identified the target measure using Authority Board decided UWHC should
available benchmarks, such as percentile engage an outside consultant and update
rank for hospitals in the patient satisfac- our plan. While we had achieved signifi-
tion survey, or we developed our own tar- cant results, we were concerned that the
gets based on our current performance original plan might be missing important 70
and the goal we wanted to achieve. These elements. We also committed to a three-
targets became part of the dashboard, and year planning cycle, but with the caveat that
the monthly outcomes allowed us to each three-year plan would not necessarily m

DONNA K. S O L L E N B E R C E R • 25
 be a full-blown review ofthe mission,
vision, and values or a complete environ-
mental assessment.
The differences in the second planning
initiative versus the first included:
• selection ofthe outside consultant by
the hospital, with considerable input and
consensusfromthe CEO ofthe medical
group and the dean;
• a decision not to update the mission,
vision, and values and, instead, to
focus on the goals and strategies; and
• reduction in the number of interviews
(from 80 to 50).
The consultant interviews concluded
that UWHC had made great progress
toward meeting the 2001 plan goals; how-
ever, the financial performance and unified
enterprise goals firom the 2001 plan needed
to receive greater emphasis because less
progress had been made. In addition, the
UWHC Board and the executive team
decided that quality, capacity, and market
presence would have a direct impact on
UWHC's ability to flirther distance itself
from the competition.
The organization ofthe planning effort
looked very similar to the one three years
prior; however, we replaced the employee
retention and recruitment work group with
a quality work group because most ofthe
initiatives for employee growth were now
embedded into operations, and consider-
able progress had been made. In addition,
from the time we completed the first plan,
public reporting of quality had become
much more commonplace, and we needed
a more comprehensive, organizational
approach. The new planning structure is
shown in Figure 3.
As a result ofthe second planning initia-
tive, UWHC added one organizational goal
26 • FRONTIERS OF HEALTH SERVICES
while the other five remained essentially
the same. Because the hospital is located in
a 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 to
address future facility needs. In addi-
tion, we developed the following nine
strategies instead often.
1. Achieve a culture of quality that pro-
duces superior patient care outcomes
and customer service.
2. Align the strategic, economic, opera-
tional, and organizational interests of
UWHC, UWMF, and UWMS to ensure
an overarching commitment to quality
and a coordinated approach to care
delivery.
3. More tightly align ambulatory care
across UW Health to improve patient
service and decrease costs.
4. Increase operating efficiency to maxi-
mize utilization of current resources to
accommodate future capacity needs.
5. Become the ultimate employer for Madi-
son and the region.
6. Increase the proportion of patient activ-
ity from outside the local market for
both inpatient discharges and outpatient
clinic visits.
7. Enhance structure and infrastructure for
outreach to achieve regional alliances
and promote increased inpatient and
outpatient activity from outside the local
market.
8. Achieve or exceed targets for financial
performance to fiind capital and strate-
gic priorities.
9. Enhance service to the commimity
through leadership in improving access
for underserved populafions, legislative
advocacy for sound health policy, and
continued outreach and education.
MANAGEMENT 23:2
FD C U R E 3 Mid-Cycle Strategic Review—Organizational Structure

UWHC Board
of Directors

Leadership Committee
(Steering Committee)

Unified H Financial
Enterprise i H Performance
WorkGroup H WorkGroup
Model of Future staff Outreach and UW Health Utilization
care needs referral commitment management
Outcomes - Model of network Common Operational
Customer care development processes, efficiency
Service assump- Out-of-area systems, and Philanthropy
Patient and tions draw for information Contracting
staff safety Future facility program Structure and
Processes needs priorities incentives to
and systems - Distribution Infrastructure grow UW
Infrastruc- of services to support Health
ture - Future out-of-area
expansion patients

During the planning process we Board, physicians, hospital leadership and

changed slightly the clinical program focus
areas. We emphasized the special popiila-
tions of geriatrics and women; however, we
incorporated the emphasis on children
through the clinical priority areas. While we
continued our organizational commitment
to critical care and trauma, we did not des-
ignate it as a clinical priority area this time.
Our revised clinical program focus areas
included children, transplant services, car-
diovascular services, oncology, neuro-
science, and orthopedics.
We presented the new plan to the
UWHC Authority Board at its March 2004
meeting, where it was adopted. Aptly enti-
tled FOCUS for the Future, the plan was
again the subject of many communications
throughout the organization in written and
face-to-face forums among the Authority
management, and frontline employees.
RESULTS
...right efforts will invariably bring about right m
results.
—James Allen, author of As a Man Thinketh
The results of this structured approach to
planning, implementing, and measuring
demonstrate its success.
H
Patient Satisfaction C
Adult inpatient satisfaction has increased
from the 37th percentile of hospitals of
450 to 599 beds to consistently exceed the
90th percentile ofthe same comparison
group for over four years. This result is
shown in Figure 4. m

DONNA K. SOLLENBERCER • 27
FIGURE 4: Adult Inpatient Satisfaction Results June 2000 to March 2006

B FY2000, Ql n FY2005, Ql FY2006, Q3

TOO _

80 _
n
60 _

40 _

I
20 _

^''

Employee Recruitment and Retention Philanthropic giving increased from an

Nurse vacancy fell from i8 percent to 4.2
percent; overall hospital vacancy rates fell
from 8 percent to 4.8 percent, and
employee turnover rates declined from
16.9 percent to 12.2 percent. Nurse
turnover rates declined from 12.5 percent
to 7.6 percent.
Financial Performance
The operating margin increased from 0.5
percent to 4.4 percent; the total margin
increased from 1.2 percent to 5.9 percent.
Days cash on hand decreased from 142
days to 131 days, while the value of one
day's cash increased from $1,078,890 to
$1,833,000.
During the same period, cash reserves
increased from $145,773,000 to
$239,584,000. Days in accounts receiv-
able decreased from 71 days to 44 days.
average of $1 million per year in June of
2000 to $10 million per year from July of
2003 through June of 2006.
OPERATIONAL EFFICIENCY
Lengths of stay declined from 6.2 days to
5.3 days. Patients' diversions declined from
a high of 100 to fewer than 20 per month.
Through a structured long-stay review
process, discharges with a length of stay
greater than 30 were reduced from an
average of 199 in first quarter of 2003 to
80 in March of 2006.
Clinical Effectiveness, Quality,
and Safety
During 2003 to 2006, UWHC received
a number of national recognitions based
on its submission of quality data. These
include being named a 2004 Quest for

28 • FRONTIERS OF HEALTH SERVICES MANAGEMENT 23:2

Quality finalist by the American Hospi-
tal Association, a 2003 and 2004 Solu-
cient Top 100 Hospital, a 2005
Solucient 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's
Digest.
In the fall of 2005, UWHC was the
top performer among 73 academic
health centers in a quality and account-
ability study conducted by University
Health System Consortium. The trans-
plant program exceeded all national and
regional United Network for Organ
Sharing (UNOS) benchmarks, and Uni-
versity Health Systems Consortium
named the cardiovascular program a
best performer for acute myocardial
infarction in 2004.
By the end of fiscal year 2006, every
strategic operating goal had been met or
exceeded, with some goals achieved up
to two years ahead of plan.
CRITICAL SUCCESS FACTORS
Success is a journey, not a destination. It
requires constant effort, vigilance, and
reevaluation.
—Mark Twain
The leaders of every planning initiative
should 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 be
strategically managed and integrated.
Figure 5 represents the strategic plan
framework that needs to be managed
and the UWHC annual operating ini-
tiatives that are used to achieve the
plan.
The process must be collaborative,
involving physicians, frontline
employees, and management, as well
as leadership from other partner insti-
tutions, such as the medical school
and practice plan.
Involve many people through focus
groups, reactor panels, and group
communication, but keep working
groups and leadership committees
small—no more than 12 people.
Use of an outside facilitator with expe-
rience at similar organizations is a
must so that you take advantage of the
most current national thinking as well
as have someone who will push and
challenge your assumptions.
The plan must focus on those pro-
grams and competencies that are
likely to help achieve distinctiveness
in the market and promise the great-
est levels of successful outcomes.
Make tough decisions and prioritize.
Your organization doesn't have
enough people, space, or money to
implement all the good ideas and pro-
grams that will surface.
Implementation and outcome mea- m
sures must receive the same focus and
rigor as development ofthe strategic
plan. In fact, all operational goals and
initiatives must help to advance the
plan. If not, they should be parked or
eliminated.
Have the right people with the right skills
to implement the plan; you may need to
invest in people through training.
Plans should be revised at least every
three years. The marketplace and
healthcare change rapidly enough that
a thorough examination ofthe plan and
modifications are needed frequently.
m
DONNA K. S O L L E N B E R C E R • 29
 FIGURE 5 UWHC Strategic Management Framework

Component Description UWHC Initiatives

• Continuous, evolving • Annual, ongoing, dynamic • Implementation

plans stratigic planning process subcommittees
• Continuous, managed • Annual, ongoing, • Budget planning
implementation structured and controlled
• Capital planning
implementation
process • Program planning
• Finance and operations • Ongoing interaction, not • Define what we will and will
integrated limited to budget or not do
project review • Integrated budget
• Ongoing development process
• Strategy and
management decision making • Integrated program and
integrated driven by resource planning
strategic • Principles of decision making
direction driven by the plan

• Strategic planning and management
must become embedded into the
fiber ofthe organization. All goals,
decisions, and investments must be
made to meet the plan goals.
• Cood tools to track and report on
progress are essential.
• The process must be led from the top
with the CEO in charge ofthe plan.
The culture of communication and
focus must be led by the CEO and the
executive team to create a culture of
strategic management and focus
throughout the organization.
• Communicate, communicate,
communicate!
the work believing that they can make a
difference.
Today, strategic management has
become embedded in the culture of
UWHC. People are encouraged and
empowered to make decisions and act in
ways that advance a well-communicated
strategic plan. We have seen no limit to
what individuals and teams can achieve
when their energy, commitment, and
skills are harnessed by a strong, cohesive
plan. Staff at UWHC have responded
enthusiastically, and leaders are commit-
ted to future strategic planning to keep
the organization productively focused and
continually renewed.

In the end, you can do everything REFERENCES

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DONNA K. SOLLENBERCER • 31