How health systems can construct an effective strategic plan for innovation.
With new innovations entering the market and different priorities from one healthcare executive to another, it is essential for health systems to create a strategic plan. The strategic plan should be a comprehensive document based off the health system’s mission and core values. The plan can give employees and the communities in which the health system serves, a clear understanding of the roadmap to achieving better outcomes.
John Colmers, MPH, is the vice president of healthcare transformation and strategic planning at Johns Hopkins Medicine. Since the start of his tenure in 2011, Colmers works to position the health system to respond to healthcare reform and other near-term and long-term market forces. He played a vital role in the creation of the Innovation 2023 strategic plan, which has six pillars that encapsulate the mission of Johns Hopkins.
Colmers received his bachelor’s degree from Johns Hopkins University and obtained his master’s in public health degree from the University of North Carolina at Chapel Hill. Before his work at Johns Hopkins Medicine, he served as the secretary of the Maryland Department of Health and Mental Hygiene, where he was responsible for protecting and improving the health and well-being of people in Maryland.
I spoke with him about his approach to developing a strategic plan, how the community has helped create the goals of the plan and how other health systems can build theirs.
Editor’s note: This interview has been lightly edited for length, style and clarity.
John Colmers: JHM has created a strategic plan for our entire enterprise. The plan is built on the three parts of our mission: improving and leading the world in clinical care, discovery and the training of the next generation of health professionals. This is the second strategic plan we have created, and it went into effect in fiscal 2019.
The six goals are to: improve the quality and affordability of healthcare, support the well-being of our people and our communities, work like one organization, push the boundaries of science and education, aim for precision in everything we do and make JHM easy. All of the goals we established have very precise sets of outcome measures of the next four years and include specific strategies and implementation components that filter their way throughout the organization.
John Colmers: In light of the environment in which academic medical systems are operating today and the changing pressures that are placed on us financially by payers, the government and others, it is important for us to advance largely through innovation. It is what has created us to be the leading organization that we are. In order to continue to be a leader, we think it’s essential to be leaders in all of these areas.
In improving the quality and affordability of healthcare, it is recognition of both improving outcomes for individuals and populations and to make healthcare more affordable for all. Some of that will come through the innovation that we are able to produce.
We strive to support the well-being of our people and communities. We can’t operate without having a workforce that is composed of people who are able to bring their best and have proper balance in their work life. At the same time, we recognize that for the communities that we serve — in thinking about the world from a population health standpoint — it’s essential for us to think of their well-being more broadly than medical care.
Working like one organization and making JHM easy means that we want to internally and externally operate in a way that’s easy for our patients and the people who work here and take advantage of the system we have created.
Pushing the boundaries of science and education is at the core of who we are. We want to continue being leaders in that.
Finally, aiming for precision in everything we do begins with an understanding of the role of precision medicine going forward. It’s essentially saying to the organization as a whole that we want to bring data and analytics to everything we are doing. That would include things such as precision education to make sure our training programs, for example, are geared toward the individual learner. An understanding of big data in education and in areas of quality and affordability but also in business decisions that we make.
We adopted this plan in language we think is more approachable by those in our community, our employees. Rather than use language that is less approachable, these statements are designed so that people can understand these things in a clearer fashion than had been the case previously.
John Colmers: At the core, and the reason we titled the strategic plan “Innovation 2023,” is that we think that is who we are. We have been that way since our founding in the 19th century, when the idea of academic medicine in this country began. Throughout our history, we have been on the cutting edge of innovation. We are of the belief that in order to thrive in the 21stt century, we have to continue to support that type of innovation in all that we’re doing. And in light of the complexities I mentioned earlier, it’s essential that we’re able to be as efficient as we can in our operations.
Making ourselves more affordable. Continuing to produce great outcomes. Generating the types of efficiencies that are associated with working like one organization. But doing so in the same way that we can be sure that for people who are trying to innovate, we are making their job as easy as possible.
All of these are driven by supporting innovation.
John Colmers: We want to advance the type of treatment in care for individuals as we move from focusing on individual disease states to a greater understanding of the way in which environment and many other factors come into play in the years going forward.
We’re living now in an age where there has been an explosion of data, computational capabilities and the ability to understand how systems operate. When we think of precision medicine, we want to take advantage of it going forward. Our understanding of a particular disease is advancing by us understanding that it is likely not a single disease, but in clinical, meaningful subsets of those diseases, which are explained and derived through the use of large data and computational abilities. Going forward, we want to lead the way in disease and understanding that. Our true competitive advantage, if we have one, is in our ability to discover those subsets of diseases and implement meaningful treatments for those faster than the next guy. We are not likely to be as nimble or less expensive than others. But if we can operate in a way that is advancing that understanding of disease and the treatment of it, we will be successful.
Our goal all along, from our initial founding, was to take the science and marry it to the clinical care. That’s the combination of the school and the hospital. And in the 21st century, the application of that is essentially what we’re attempting to do.
The challenges that we’re facing are challenges of execution and funding. The execution is around our ability to stop doing things that we no longer need to do and redirect resources to those areas that we do need to improve. The challenges are also associated with the way in which we are being funded and our ability to generate sufficient margins to continue to attract and retain the best talent and to support the cost of research, which continues to need to be supported by clinical activity and philanthropy.
John Colmers: Part of it is driven by these points identified in the strategic plan. Working like one organization means that we are structuring ourselves so that we are not replicating throughout the organization but finding efficiencies as best we can. Aiming for precision in all that we do is not just about precision medicine but using decision science to help us in the development of evaluating various business planning opportunities and activities there. Making ourselves and healthcare more affordable and outcomes associated with that, which is essentially improving value, will help generate that, particularly as payment systems move further away from fee-for-service to more populated-based, outcome-based or value-based payments.
John Colmers: The first strategic plan we created when I was here was the first enterprise-wide strategic plan for the organization. We had lots of plans prior to that, but creating a unified strategic plan was something that was new to the organization. There, we identified six pillars and did a lot of the work associated with linking the strategic plan to business planning activities, incentive compensation plans and enterprise risk management. So the strategic plan wasn’t a document that sat on a shelf, but it was a living, breathing mechanism that, in many ways, became the tool for communicating what we were doing to the board and to our various communities.
The most important change that we worked on this time around was this notion of creating a more accessible plan. The language that is more accessible is something that we worked hard to do and we created a plan that is in many ways outward facing. We can say to the world that this is what we plan on doing, these are the things that are important to us and these are the priorities that we have identified. At the same time, we have an inward-facing plan that is proprietary and not shared with the world at large. It’s consistent with the public-facing plan. So we can continue to do much more detailed work and be able to communicate to ourselves in language that is perhaps less accessible and more detailed. The outward-facing plan says what we’re doing and identifies how we are going to measure ourselves. The inward-facing plan is really much more associated with implementation for each year over each of those six goals.
We’ll have annual implementation plans and very specific tasks and activities that are going to be accomplished and linked to individuals within the organization to whom the dean, CEO and executive vice president hold accountable. So we have identified leaders who are then responsible for the implementation of the plan.
John Colmers: In the aim for precision pillar, that could include things associated with work that we are doing around the development of our Precision Medicine Centers of Excellence. So, here we have identified within the organization a series of these centers that are funded around disease states and activities. This includes work associated with the development of a data platform that can be used uniformly by any and all of these Precision Medicine Centers of Excellence. There’s a lot of detail around how to create that data platform for precision medicine, implementing it and maintaining it. So we need to account for that and the details around the timing of that, when that gets accomplished, who is accountable for that, how those systems are developed. They need not be in the outward-facing plan but are essential in supporting the work through the inward-facing plan.
John Colmers: That type of feedback in part led us to the change in the plan that included this more approachable language. We listened through the feedback and town hall meetings that we had and through more formal solicitation of opinions. On a regular basis, we conduct town hall meetings around the individual topics. Each month, there might be a town hall meeting that covers one of these topics, and there’s opportunity then for feedback.
We will constantly update the plan and manner in which we communicate it based on that type of feedback. Now, the work is largely associated with driving the structure and design of the plan into individual entities. So, that means each of the hospitals and business units, all the way down to individual clinical departments. All of the directors within the school of medicine are working on their own version of the strategic plan around these six goals as well. It really is working to cascade the plan throughout the organization.
John Colmers: It is always going to be unique to each organization. You begin with your mission and vision for the organization. That has to be very uniquely identified by the circumstances that you’re facing. You’re going to conduct an environmental assessment that determines what your environment is likely to be. You’re also going to include a top-down and a bottom-up approach to defining the plan. If a plan is exclusively from the leadership of the organization down, it won’t be as successful as one that includes robust feedback from below the organization. By the same token, it cannot be exclusively driven from the bottom-up, it has to be a thoughtful direction given from the top-down.
Then, finally, based on the lessons we’ve learned here, is the critical importance of leadership. Our leaders have made the strategic plan and its implementation the core of their mission here and used it throughout to evaluate the success of the organization and for individuals overall.
John Colmers: Among the most important things I’ve learned is the importance of being a good listener and your ability to take in what others are saying and listen before you talk. That is an essential element of leadership, and oftentimes we come late to that. Part of it is, we just have to be able to sit back and listen.
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