Planning in private practice

Proper planning is essential to the execution of strategic initiatives in private practice. Planning is an inherent and fundamental part of leadership, and physicians (and administrators) are the single most important factor in effective planning. Private practice demands a flexible approach that adapts planning methods to each situation, taking into account the activity being planned.It requires an approach that can apply the various aspects of strategic planning that I have addressed in previous articles. This planning approach must encourage rather than stifle creativity since private practice depends on insight and creativity of leaders.

Impacting tempo

Leaders must always be sensitive to the importance of operational tempo and ensure that planning facilitates rather than inhibits tempo. In fact, effective planning should accelerate tempo by anticipating decisions and actions. This emphasis on tempo, while a guiding principle, is not an unbending rule. You should weigh the advantages of acting more quickly against the advantages of preparing more thoroughly.

Limit the details

Private practice requires plans with the proper level of detail, neither so detailed that they squash initiative nor so general that they provide insufficient direction. The proper level of detail depends on each situation and is no easy task to determine. As a rule, plans should contain only as much detail as required to provide staff members the necessary guidance while allowing as much freedom of action as possible.

Effective private practice planning is based on the recognition that the healthcare environment is intrinsically uncertain and unpredictable. Effective planning seeks not to eliminate uncertainty and risk, but to provide a framework that facilitates effective and focused action in the face of uncertainty and risk. Proper planning also recognizes the limits of foresight in a complex and changing environment like the healthcare industry.Planning should not attempt to impose precise order and control but rather provide enough structure to facilitate necessary cooperation and direction. However, the planning must not create so much structure that your practice sacrifices flexibility, tempo, or initiative (the hallmarks of what separate private practice from hospitals). Recognizing the proper balance in any given situation requires judgement.

Flexibility is key

The private practice approach to planning sees planning not only as a way of directing and coordinating actions but also of generating shared situational awareness and expectations, supporting the exercise of initiative, and structuring the thinking of leadership. Private practice emphasizes planning as a continuous learning and adapting process rather than as a scripting process. Private practice requires the ability to depart from the original plan to exploit fleeting opportunities.

The private practice approach to planning emphasizes the importance of establishing clear objectives even as it recognizes the difficulty of doing so in a complex, uncertain, and shifting environment like the healthcare industry. Effective planning should generally proceed from the establishing of goals and objectives to conceiving of broad courses of action to the detailing of the practical implementation of those courses of action. At the same time, the conceptual aspects of planning, to include establishing goals, should be responsive to the detailed requirements of execution.

Empower staff to act

The private practice approach to planning is based on the belief that in typically complex and shifting operational situations, the best approach is usually to plan in rough outline and delegate as many decisions as possible to staff members empowered to act on their own authority. In order to act appropriately, these staff members require a thorough understanding of the overall purpose or goal, which can only be provided by the practice’s leaders.

Create adaptive plans

Planning is a way of adapting the practice to its surrounding in two ways: by designing actions in advance of the need to act and by supporting the exercise of initiative during execution. Because of the unpredictability within the healthcare arena, a good plan should be flexible, allowing us to adapt quickly to a broad variety of circumstances. This obviates the need to develop explicit courses of action for an unlimited number of possible contingencies.The level of flexibility in a plan should be in direct proportion to the level of uncertainty and fluidity in the situation.

Initiative is central to private practice and you should plan with this thought firmly in mind. A good plan does not eliminate the need for initiative, but facilitates initiative. Do not think of a plan as an unalterable solution to a problem, but as an open architecture that allows your practice to pursue many possibilities. A good plan should maximize freedom of action for the future.It is a mistake to think that goal is to develop plans and then implement them rigidly. Your practice will rarely, if ever, carry out plans exactly the way they were originally developed.

How do you design adaptive, flexible plans?

First, establish objectives that are broadly, but not vaguely, defined; objectives which provide latitude in the manner of accomplishment. Second, develop loose, modular plans. These allow staff members to adapt without infringing on other parts of the plan. Third, develop plans with feedback mechanisms designed to provide information about how the action is developing and to identify the need to make adjustments to the plan. You may explicitly design decision points; points in a plan of action requiring a decision about how to proceed in execution. Fourth, design plans of action that permit multiple options in execution. You may design specific branches and sequels, planned alternatives or follow-on phases for likely contingencies, but you should also maintain the flexibility to pursue other options that are not planned. Do not try to develop plans for every possible eventuality and do not develop so many contingencies that the practice cannot prepare adequately for any of them. Fifth, develop plans which provide shared situational awareness and mutual expectations.A common understanding improves the ability to recognize the need to adapt and to cooperate with others while doing so. Finally, develop guidelines and plans that provide a compelling logic for action that makes it easier for staff members to exercise initiative while conforming to the higher purpose. The compelling logic for action finds expression in the leader’s intent for each staff member.