Occasionally, those who have participated in strategic planning will hear the lament, “I’m afraid, now that the strategic planning sessions are over and the plan has been approved, it will end up on a shelf gathering dust.” And sometimes the concern is legitimate. Despite a process eliciting the best thinking of an organization and engendering enthusiasm, momentum can atrophy. What can leaders do to ensure that the aspirations embodied in their strategic plan are accomplished? Here are six approaches that can help.

Ownership and alignment

It’s understood that people give their best efforts to initiatives in which they feel a sense of ownership. People tend to own what they help create. Individuals who participate in designing the future of their organization display a pride of ownership that can translate into energetic commitment.

It is the CEO’s job, above all, to own the organization’s vision. The vision answers the question, What do we aspire to become? A strategic plan is the story of an organization’s future, crafted with input from throughout the organization. The CEO of one organization with which I worked started every board meeting with a personal story that reinforced how her organization was fulfilling its vision.

A set of focused, driving strategies answers the question, How will we accomplish the aspirations set forth in our vision? Defining these strategies is the work of senior leaders. It is in the driving strategies that the experience and judgment embodied in an executive team come most forcefully into play. Focus is key, however: The number of strategies should be about seven. That means there are things leaders deliberately decide not to do.

In my experience, employees welcome strategic direction. Without clarity regarding the organization’s future, they can become anxious and unable to engage. Employees value leaders who share a compelling vision and the driving strategies the organization will pursue. They also, however, expect some explanation of why the vision is worth accomplishing along with the rationale for the driving strategies.

Leaders can cascade ownership in the strategic plan by widely articulating vision and driving strategies, then expanding the number of people invited to answer the question, Within the boundaries of our vision, what do we need to do to accomplish our driving strategies? The answer to that question will provide the material out of which leaders can refine strategies and build tactics.

It is at the tactical and action level that ownership ought to be most widespread. Tactics and action plans are more numerous and specialized than the driving strategies they support. Each driving strategy should be supported by a handful of tactics, and each tactic should be supported by a handful of actions.

Board members also need ownership in the strategic plan. They gain that ownership by participating in defining the plan through the level of the driving strategies. Tactics and action plans should be the prerogatives of management. Ownership by board members is intensified because they are expected to approve the strategic plan as well as its resource commitments. One of the most consistent desires I’ve heard board members articulate is for more strategic conversations and decision-making in board and committee meetings.

Alignment is a desired outcome of strategic ownership. There should be one master strategic plan, and there must be a disciplined process for bringing other plans into alignment with it. Throughout the organization, understanding and commitment are needed to reshape the work of the present into the work of the future. No organization operates with one plan alone — usually there are a variety of plans, such as marketing plans, human resource plans, capital plans, budgets and annual operating plans. These often need to be recrafted to reflect the direction set forth in the strategic plan, which may involve doing new things or halting ongoing or contemplated initiatives. To create greater focus for the daily work of the organization, strategic alignment shouldn't slather more onto already full plates but rather should take some things off people’s plates.

Sustained focus

Because the strategic plan identifies the organization’s key aspirations as well as what it is most important for the organization to do, it is the primary context for making the organization’s most important decisions. In the executive suite and the boardroom, key decisions — those that carry high costs and potentially significant consequences — should reflect the organization’s overall strategic direction. Such decisions should be consistently tested against the question, Does this fit our strategic plan? The connection to the strategic plan should be explicit. If that connection is unclear or doubtful, the answer ought to be no.

An argument can be made for beginning every regularly scheduled board meeting with an update on one of the organization’s driving strategies. The top leaders for one of health care’s most successful health systems once suggested to me that they could see their driving strategies on the ceiling above their bed at night.

Few organizations have the capability or the resources to pursue much more than a handful of driving strategies at a time. It’s easy, particularly in a turbulent environment, to get distracted by the next big thing. But chasing the latest trend can draw attention, energy and resources away from the work most essential to accomplishing a shared vision. It can also give the organization whiplash.

In today’s environment, a vision ought to have a lifespan of three to five years — and driving strategies should have lifespans of one to three years. Changes should be made slowly to driving strategies and even more slowly to the vision. When change is needed, it ought to begin first at the level of tactics and action plans.

Continually up to date

SWOT (strengths, weaknesses, opportunities, threats) analysis is popular. It’s also notoriously inefficient and often ambiguous. People’s time and attention spans are limited. Time spent debating whether something is a strength or an opportunity is wasted. In reality, strengths are invariably opportunities. And weaknesses are invariably threats.

Identifying and prioritizing a single list of a dozen critical strategic issues is all that’s needed to develop and update the situational context for a strategic plan. Issues can be dropped when they lose relevance or added as the situation shifts. Doing this on a regular basis keeps the strategic plan up to date.

Presuming the board convenes monthly, the executive team can revise strategic issues when necessary and then share these revisions along with their implications during the next board meeting. Strategies and tactics should be replaced as they are accomplished or when a major change in overall direction is required. If a change in strategic issues necessitates a change in driving strategies, the executive team can make recommendations at a regular board meeting. Because most changes to tactics and action plans fall within the prerogatives of management, they can be carried out without board approval.

Every three years or so, the organization’s vision will probably need to be recrafted. Mission, in contrast, is the constant purpose of the organization. It sets the permanent outer boundaries of what the organization will and won’t do. As such, it generally should not be changed — one hospital in the Northeast inscribed its mission on a boulder outside its main entrance.

Clear relevance

Individuals throughout the organization should be able to answer the questions, Where do I fit and how can I contribute? In the end, all of those asked to commit to a strategic plan should be able to see how its accomplishment will be good for patients, good for the organization and good for them.

Leaders can make the strategic plan more relevant by telling stories. They can use anecdotes and metaphors to give the plan more clarity and meaning. They can highlight the efforts of people throughout the organization who are lifting it toward its aspirations. In speeches and casual conversation, they can turn the strategic plan into what it should be: an engaging story about the future.

To turn the strategic plan into the daily work of the organization, it must be written and communicated in plain English and organized in a way that’s easy to understand. You should be able to fit an entire strategic plan on two pages. (Identifying specific tactics and action plans will take a few more pages.) Somebody with no exposure to the organization should be able to read those two pages and understand where the organization is headed, how it intends to get there and what major challenges it expects to encounter. Five-dollar words are always better than $100 words. An organization I once encountered described its vision as “horizontal synergistic nichemanship.” Seriously! Imagine front-line employees trying to fit themselves into that.

Nomenclature is important not only in the writing of the plan but in how the components of the plan are defined. Mixing up definitions or applying them inconsistently confuses people. Confusion results in misdirection and sucks up energy.

The difference between strategies and goals is a common source of confusion. A driving strategy is not the same as a goal. A goal is an endpoint — the end zone on a football field, for example. A strategy is how you intend to move the ball down the field and into the end zone.


Strategic plans live in the realm of accomplishment. The test for accountability related to strategic plans should always be whether the organization accomplished what it said it would accomplish. Accomplishment is different from performance associated with goals. Without accomplishment there is no performance. In my experience, the one factor that has the greatest impact on putting a strategic plan on the shelf is lack of accountability. Board members fail to ask the CEO and the executive team whether the strategic plan is being accomplished on schedule. Instead, they approve, monitor and incentivize performance alone. But organizations perform at some level regardless of what they accomplish. It’s important to monitor and incentivize both accomplishment and performance.

I know some board members who carry a copy of their hospital’s strategic plan in their pocket or purse in the form of a trifold brochure. On more than one occasion, I’ve seen a board member hold the strategic plan in the air and say, “Are we accomplishing the plan we approved?” It’s one of the most important questions for good governance.

Properly conceived and orchestrated, a strategic plan describes a compelling destination in the future and a pathway to that future. Accomplishments are the milestones along that path. But those accomplishments must generate desired performance.

To establish accountability and measure performance, the organization needs an instrument panel. That instrument panel should measure the performance that's most important. Think of the instrument panel in an early model Cessna airplane. It measured the essential fundamentals, including airspeed, altitude, direction and fuel consumption. To improve performance in airspeed, for example, you need a strategy such as “improve the airplane's aerodynamics.”

For a health care organization like a hospital, it's worth considering what is fundamental to its instrument panel. I'd suggest quality and satisfaction (patients and staff), as well as financial indicators to answer the question, How are we performing? Performance goals ought to be set relative to competitors and peers as well as past performance. More important, they should be set within the context of the organization's aspirations, as embodied in the strategic plan. In other words, what level of performance is necessary to realize our aspirations? Sometimes this will necessitate identifying a “stretch goal.”

The strategic planning process itself should be accountable. One of its key accountabilities relates to efficiency. Those participating in a planning process tend to be busy. They are willing to commit their time, judgment and experience, but they want those resources used productively. That means planning sessions should start on time and end on time. It means every session should produce definable results that contribute in a clear way to building the plan. It means the process doesn’t stall or get sidetracked. It means there is evidence that participants’ input is heard and reflected in the plan. And it means they are continually kept up to date as to the status of plan development, accomplishment and performance. Absent these outcomes, participants can rightly become frustrated as well as disengaged and fail to support the strategic plan.

If organizational performance lags targeted goals, then the next question is, Why? The answer may lie in the strategic plan. Perhaps the environment has shifted. Maybe the driving strategies were off-target. Or it's possible that aspirations were unrealistic. There is, after all, a difference between vision and hallucination.

Disciplined implementation

There's another reason that performance generated by a strategic plan may be disappointing. It may not be effectively implemented. Solid implementation won't just happen. It has to be designed and pursued with discipline.

To operationalize strategic accountability and support implementation, a strategy leader should be assigned to each driving strategy. This leader should designate a half-dozen individuals for a strategy team to implement the strategy. While strategy leaders will have responsibility for a driving strategy, they will also have, as executives, responsibility for implementation of the strategic plan overall. The driving strategies and tactics are highly interrelated and interdependent, and strategy leaders manage them collectively as the road map to achieving vision. It is critical that the efforts of the strategy leaders stay coordinated and connected. Executives ensure that this happens.

It is important to recognize that strategic responsibility is different from functional responsibility. The latter derives its impact from formal authority and well-defined functional roles (e.g., operations, finance, marketing, sales, contracting, compliance). Strategic responsibility should be regarded more as a form of influence than authority. Driving strategies and tactics often will cut across functional lines of responsibility. Because of this, those in charge of implementation can feel uncomfortable and may initially set off defensive reactions related to functional turf.

The CEO must ensure that strategic responsibility is well-used. In some instances, there may be a need to mitigate disputes. Ultimately, the CEO must convey the message that strategic responsibilities are as important as functional responsibilities. Executives should be accountable not only for their functional responsibilities but also for their strategic responsibilities. This can be reinforced through the design of executive compensation and recognition systems.

In addition to assembling a strategy team, a strategy leader may designate tactic leaders to pursue implementation of particular tactics. (Some tactics are more consuming and complex than others.) Tactic leaders, in conjunction with their strategy leader, might handle this on their own, they might seek out a physician co‑leader or they might initiate formation of a tactic task force. Every task force should have a written “charter” that defines the specific task to be accomplished as well as its timing and allocated resources.

If a tactic task force is formed, it should have the appropriate number and mix of people. Each task force should have five to seven members and reflect relevant perspectives and experience. Task forces may include physicians, service line leaders, nurses, administrators and support personnel. Certain tactics will benefit from the expertise and perspectives contributed by individuals in the front-line delivery of care or from individuals who have unique experience.

Executives should convene in monthly strategy implementation sessions. The purpose of these sessions includes coordination at the level of tactics; identification of overlaps, redundancy or gaps among tactics; communication of progress, including barriers to implementation; and evaluation of the overall impact of implementation. Tactics that have been accomplished or are no longer relevant should be replaced. Progress should be conveyed succinctly and consistently to stakeholders in a way that is succinct and consistent. If significant shifts in the organization’s environment occur, executives need to discuss the implications of that for driving strategies and tactics and then adapt accordingly.

Strategic planning is an investment in the future of the organization. It takes time and commitment. Getting the most out of that investment is obviously important. These six approaches can help.

Dan Beckham is the president of The Beckham Co., a strategic consulting firm based in Bluffton, S.C. He is also a regular contributor to AHA Today.

The opinions expressed by the author do not necessarily reflect the policy of the American Hospital Association.