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November 7, 2019
Evidence Synthesis
November 7, 2019

Scholarly Paper.. Nursing

Leading the W ay

How to develop a strategic mindset Follow these steps to think more strategically. By Rose 0. Sherman, EdD, RN, NEA-BC, FAAN, and Tanya M. Cohn, PhD, MEd, RN

K a te * is the manager o f a busy emergency department (ED) in a large health system. She recently applied for the health systems nursing director for emergency and urgent care services position, but she wasn’t selected. In a follow-up discussion with her immediate supervisor, Kate learned that strong strategic thinking skills are ex­ pected o f potential candidates and that senior organi­ zational leadership d idn’t perceive her as a strategic thinker. In addition to being disappointed that she wasn’t selected, Kate also was confused about what it meant to be seen as strategic and how she could devel­ op those skills.

derstanding of healthcare challenges, trends, and busi­ ness drivers. This may require a change in mindset from a myopic focus on what’s happening in her ED to a broader health system perspective on the impact of initiatives. In her interview, Kate may have been miss­ ing key industry information on internal and external trends impacting emergency and urgent care services.

Developing a strategic mindset is a learnable skill, but it takes practice. You need to be willing to challenge the status quo and question as­ sumptions when you frame strategic choices. This re­ quires a clear understanding of how to strategically think through situations, develop strategic awareness, and link strategic plans to frontline clinical work.

Defining strategic thinking Strategic thinking is more than designing a plan of ac­ tion. It’s a way of thinking about the risk, profit, and cost of decisions or solutions. Strategic decisions are

made with an understanding of the organization’s current daily functions and environment along with consid­ ering past, current, and future chal­ lenges. For Kate to transition from manager of a busy ED to health sys­ tems nursing director for emergency and urgent care services, she needs to move beyond frontline operational de­ cisions that usually involve providing care and staffing-based solutions. The expectation in the new position is that she can strategically evaluate the prof­ it and cost for the large health system as it relates to community utilization of the ED and urgent care services. To effectively accomplish this, Kate needs to understand how the current system functions and how to optimize cost- effective care for the community.

Another aspect of strategic thinking is looking at a problem through the three steps of reframing, reflecting, and

Strategic thinking skills have become a critical differ­ entiator among candidates for healthcare leadership ad­ vancement. Kate’s confusion is understandable because the type of feedback she received often comes without concrete guidance about how to move forward. To be more strategic in her thinking, Kate needs a solid un­

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systems thinking. When reframing and reflecting, you take a step back and look at different perspectives of a problem. For example, if during Kate’s interview she was asked about wait times in the ED, she might have talked about what she’s done with her team to streamline triage, which can be effective at reducing wait times. However, she also could have reframed the problem by reviewing published evidence and clin­ ical data from the ED. Then through systems thinking, the root of strategic thinking, she could identify the functionality of the health system as a whole and criti­ cally think about long-term solutions, including how to balance ED costs with urgent care center profits through better use of urgent care and shared resources.

Strategic thinking also can be applied during direct patient care. For nurses, this means going beyond com­ pleting daily patient care tasks and reframing and re­ flecting on that care to identify opportunities. These opportunities can be questioning sacred cows of prac­ tice and viewing them through the lens of evidence- based practice. Using strategic thinking, direct patient care nurses can engage key stakeholders and make criti­ cal practice changes.

Developing strategic awareness Developing a strategic approach in your thinking re­ quires a different way of looking at your environment. An issue for Kate and many other leaders is that they often take a “heads down” approach to their work, failing to “look up” and observe the trends that affect their health systems. Leaders must commit time to be more reflective and develop the necessary skills to be­ come more strategic. They need to recognize the in­ terdependence and interconnectivity of all parts of a system and that a significant trend in one area has a potential impact on others. As a strategic leader, you also need to avoid becoming too attached to a specif­ ic direction or outcome because it may reduce your ability to quickly change direction when new informa­ tion is received.

To recognize the types of trends that can impact your work, you need to become more strategically aware. This involves a willingness to look beyond your own organization and sometimes even beyond healthcare to assess for changes. This thinking process extends your awareness beyond the doors of your organization, be­ yond the confines of your industry or service sector, and beyond your current, day-to-day reality.

Take these steps to expand your strategic awareness: 1. Spend time with leaders who are strong strate­

gic thinkers and ask them how they reach their assessments.

2. Notice changing conditions in your environment, such as demographic trends and consumer ex­ pectations.

3. Ask tough questions and be curious in discussions with patients, families, staff, and other stakehold­ ers. Invite opposing viewpoints to challenge your own thinking.

4. Evaluate workforce trends locally and nationally to assess the potential impact on your organiza­ tion moving forward.

5. Track the economy and political legislation be­ cause both can ultimately impact reimbursement and regulation.

6. Expand your reading to understand what’s hap­ pening in related industries such as pharmaceu­ ticals, medical suppliers, and insurers.

7. Monitor interesting trends in technologies and ask “What, if anything, does this mean to our health system?”

8. Be more reflective in analyzing changing trends in your environment over time. Ask yourself: “What’s not working here anymore, and what do we need to do about it?”

9. Be willing to challenge your own assumptions. Keep an open mind about new information and avoid jumping to quick assumptions about what it may mean.

10. Be prepared to make decisions more quickly and take more risks. Manage these risks well and don’t let opportunities pass you by.

Neither awareness nor strategy alone is sufficient. But when awareness meets strategy, it has the potential to change the world.

Linking organizational strategic plans to frontline work Strategic leaders understand the importance of creat­ ing a culture of learning that actively involves frontline staff in the organization’s strategic direction. When or­ ganizational leaders develop strategic plans for risk management, cost reduction, and profitability, they must effectively communicate those plans to frontline staff. An integral component of strategic thinking is gaining the buy-in of stakeholders and all key partici­ pants. The result is a clear link between forward think­ ing and direct patient care so that those providing the care are able to see what they contribute to the unit and the organization.

In the position that Kate applied for, she might be expected to communicate strategic initiatives to ED staff across the health system. For instance, if a deci­ sion is made to expand freestanding urgent care ser­ vices through a geographic area, discussion should in-

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elude the impact on current ED services. Kate could walk the staff through this discussion using a strategic planning tool such as a SWOT (strengths, weaknesses, opportunities, threats) analysis to provide evidence for the organizational decision and evaluate potential im­ pact. The discussion will empower direct patient care providers to contribute to the decision-making by de­ veloping strategic thinking skills, too. Kate would want to enlist staff to add their ideas and to evaluate the pro­ cess after the new initiative is introduced.

Strategic initiative success ultimately depends on pro­ active communication, trust building, and frequent en­ gagement. A good strategy can move organizations in new directions and open up new opportunities, but it won’t happen without leaders who demonstrate a strong strategic mindset.

Practice, practice , p ractice With the pace of change in healthcare and increased levels of competition, strategic thinking is no longer a nice-to-have but rather a must-have. As Kate learned, honing strategic thinking is vital to both leadership de­ velopment and advancement. The journey to building strategic thinking skills might be uncomfortable at first because your views will be challenged, and you won’t have all the answers. Expertise in this area requires

practice. It’s always possible to be surprised by unex­ pected environmental changes, but strategic thinkers usually have considered possible shifts long before they impact the organization. ★

*Name is fictitious.

Rose 0 . S herm an is a d ju n c t professor fo r th e M a ria n K. Shaughnessy Nurse Leader­ ship A cadem y a t Case W estern Reserve in C leveland, Ohio. She is th e a u th o r o f The Nurse Leader Coach: Become th e Boss No One W ants to Leave. Read h er b log a t em e rg in g rn le a d e r.c o m . Tanya M . Cohn is an associate professor o f p ractice an d a consulting nurse sc ien tis t a t S im m ons U n ive rs ity in Boston, Massachusetts.

Selected references B.E. Smith Team. Top 12 healthcare trends for 2018. January 16, 2018. besmith.com/trends-and-insights/articles/healthcare-trends-2018- report

Bowman NA. 4 ways to improve your strategic thinking skills. Har­ vard Business Review. December 27, 2016. hbr.org/2016/12/4-ways- to-improve-your-strategic-thinking-skills

Gross R. The links between innovative behavior and strategic think­ ing. Contemp Manage Res. 2017;13(4):239-54.

Shirey MR. Cultivating strategic thinking skills. J Nurs Admin. 2012; 42(6):311-4.

Tajpour M, Hosseini E, Moghaddm A. The effect of managers strate­ gic thinking on opportunity exploitation. Scholedge Int J Multidiscip Allied Stud. 2018;5(6):68-81.

Adeluisa De Guzman, MSN ’15

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