Meeting the Triple Aim Means Accepting Constant Change

Kap Wilkes, Program Manager II

As a sailor I recognize that change is a constant; at every moment the wind and sea require the boat to adjust. Of course these adjustments are not made randomly. I know where I want to end up and I know a lot about my boat and crew.  As a captain and crew that wants to win the race there are a few other things that we have done to increase our odds: we have a plan in place for communicating, we pay attention to the weather, and we have developed our skills and knowledge to be able to quickly adjust. Although the crew on the boat is smart, we have practiced and we are confident in our execution; there are a lot of aspects to keep track of and they are constantly changing.  Some are factors we need to monitor, some are due to the particular people we have working together and others are external to the boat. They all impact us as we move through the course. In fact they are constantly impacting us. We don’t change the game plan mid-race very often, but we are constantly making adjustments to improve our speed and execution. Now here is the thing about sailboat racing, the game isn’t over at the end of one race. We have our eye not only on the finish line but to win the series. To do that, we have to be able to repeat our performance over and over. In between races we continue to hone our skills and build our knowledge; getting ready for the next race. With an eye on winning the series the entire crew engages in the strategic winning cycle.

In the world of health care organizations today, working to improve care to patients, reduce costs, and improve the health of populations, achieving the Triple Aim, is like working to win a sailboat race series.  One of the keys to success is engaging in the strategic winning cycle for handling change and ensuring sustainability. As in the sailboat race, health care organizations have internal and external forces that require agile adjustment to the execution and implementation. Doing this without knowing where you are going, communicating with the rest of the team so they too can make adjustments or checking your surroundings will ensure that you do not cross the finish line first; ever. In fact, if you ignore the interconnected nature of your boat, your crew, and the wind and sea, you will most likely come in dead-last. To avoid this place of distinction is a huge motivator for sailboat crews and for health care organizations too. Because being dead-last means that the people in your community are not receiving the best care possible, or worse, they may lose their local health organization entirely! The strategic planning cycle is dynamic, iterative and it is critical to engage in the process if you want to win improved health for your community:

• Analyzing and planning creates an opportunity to develop strategic objectives to drive an organization toward its mission and vision. Sustainable business strategies are dependent on the active involvement of an organization’s leadership, staff, and board of directors.

• Documenting and communicating the business strategy facilitated through a management framework, such as the Balanced Scorecard, supports the development of critical partnerships, increases staff engagement, and incorporates holistic thinking into planning.

• Implementing and executing the business strategy through carefully selected initiatives operationalizes the strategies; aligning the organization’s actions with its mission and vision.

• Monitoring and adapting progress based on measurable targets, established through a process improvement framework builds capacity within the organization for handling change.

Troubleshooting the strategic winning cycle: if you are already engaged in a strategic winning cycle, but are struggling with working as a team or having trouble with execution then check to make sure your crew knows where you are heading. Your organization’s vision provides everyone with something to aim for and directs your crew’s decisions.  If your organization is at a turning point, perhaps with new leadership or a significant change in your operations or the health care environment, jump into the strategic winning cycle at the Analyze and Plan phase. This is the time to review your surroundings and your plan to see if there are significant course changes that need to be made. If you are well into your implementation be sure to monitor progress so that you can make effective adjustments.  If your boat speed is faltering; check your sails, adjust the helm and put your crew’s knowledge and skills to work.