Build the right plan
With no backing from the organization as a whole, the strategic plan at the time simply wasn’t working. Scripps was losing money, there was little to nothing in the way of an overarching company culture, and the entire system suffered from the effects of weak relationships among its various levels and locations.
The strategic plan would never be realized in that kind of climate. So Van Gorder scrapped it altogether. Instead, he and his leadership team rolled out a tactical plan that acted as a form of triage, aimed at addressing the most severe problems first.
“We literally threw the strategic plan away, and that received immediate applause,” Van Gorder says. “Then we decentralized the organization as one of the first steps of the tactical plan, pushing accountability down to the hospital executives and medical staff. We weren’t hitting our targets, financially or otherwise, because there was no ownership.”
Van Gorder began to engage the system’s physicians by forming a physician leadership cabinet — bringing all of Scripps’ elected physician leaders onto a single council with the goal of assisting top management with critical decisions about the organization’s future.
The object was to begin stimulating ideas at the hospital level, and then giving the staff members an avenue for feeding their ideas to the corporate level.
The connection between the field and corporate levels is a key part of this stage. Without the connection to corporate, you run the risk of further entrenching the silo mentality, as employees at one location develop a best practice and might not be eager to share it with other locations if trust and familiarity aren’t present.
“In decentralizing, the object is to try to drive accountability back to the hospitals, but in doing so, recognizing that it creates the opportunity for even more silo orientation,” Van Gorder says. “Over time, what we’ve done is rebalanced that. There are things we need to do in a standardized way for more cost-efficiency and effectiveness. But at the same time you don’t want to lose the accountability key. So you develop a system where decisions are made at the local level but communication is very robust from the corporate level so that things are standardized across the organization.”
