Planning for an Unknowable Future

The defining features of the strategic planning challenge are uncertainty and time.  More than anything else, considerations of time and uncertainty dictate how we approach strategic planning.  All strategic planning is based on imperfect knowledge and involves assumptions about the future.  By definition, strategic planning is future-oriented, and the future by nature is uncertain.  No matter how determined we are to be fully prepared for a situation, there are finite limits to our ability to plan for the future.  The more certain the future is, the easier it is to plan.  Alas, the difficulties with healthcare strategic planning.

Uncertainty increases with the length of the planning horizon and the rate of change in the healthcare environment.  By planning horizon, I am referring to how far into the future we try to shape events.  In order to be of any use, strategic planning must try to anticipate and actively influence the future.  By anticipating the future, strategic planning allows us to prepare and coordinate our actions.  The farther in to the future we can plan, the more time we can allow ourselves to prepare.  However, the farther into the future we plan, the wider the range of possibilities and the more uncertain our forecast.  A fundamental tension thus exists between the desire to plan far into the future in order to facilitate preparation and coordination, and the fact that the farther into the future we try to plan, the less certain we can be, and the less relevant our preparations may be.

Given the uncertainty of healthcare reform, we must recognize that the object of strategic planning is not to eliminate or minimize uncertainty, but to allow us to decide and act effectively in the midst of the uncertainty that is healthcare reform.  While strategic planning contains an element of forecasting, we must recognize that the object of strategic planning is not to predict the future.  To be clear, how accurately a strategic plan forecasts the future is not generally a measure of the plan’s effectiveness.  Rather, the measure of effectiveness is how effectively strategic planning allows us to adapt to an uncertain future.

Not only is healthcare reform uncertain, it is (and will continue to be) always changing.  Consequently, strategic plans tend to lose their value over time, and they must be updated as the healthcare landscape changes.  The more frequently and quickly the healthcare landscape changes, the more often a strategic plan must be revised.  Since physician leaders are already busy taking care of patients, we must use available strategic planning time wisely.  All planning takes time, so remember that strategic planning done well in advance of the need to act may actually permit us to act more quickly when the time for action arrives.


Contact ABISA for healthcare consultancy support or speaking engagements.

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