Scenario Planning as a Practical Tool for Developing

Scenario Planning as a Practical Tool for Developing Strategy

Scenario Planning as a Practical Tool for Developing Strategy Alexander M. Norbash, MD, MS, FACR Professor and Chair of Radiology Assistant Dean for Diversity Boston University School of Medicine

Relevant Disclosures I have no relevant disclosures related to this presentation

Poll Question #1 Which of the below statements do you most agree with? A. I believe in the need for strategic planning, and I am more strategic and adaptable than my practice B. I believe in the need for strategic planning, my practice is more strategic and adaptable than I am C. We are victims of our environment, Strategy discussions for Radiologists are of little practical applicability

Strategy Definition 1 Wikipedia • Greek "στρατηγία" (strategia), "art of troop leader; office of general, command, generalship"[1]) is a general, undetailed plan of action, encompassing a long period of time, to achieve a complicated goal.

Strategic Planning Essence • Identify beneficial partnerships – Recognize potential partners – Understand future needs • Grow based on past successes – Recognize what you do well – Be realistic about what you can do

Surprising?

SCARD ca 2006 • Anxiety regarding tripartite mission – Shriveling revenue per patient – No teaching dollars – Comparative Effectiveness Research replacing “interesting new device” research • Questions regarding role and purpose – Uncertain identity; 52 Radiology societies – Support group • RVU surveying • Sharing stories • New Chairs course • Result; fatalistic viewpoints

Poll Question #2 Are you familiar with “Scenario Planning”? A. Yes B. No

SCARD Scenario Planning • Dieter Enzmann’s brainchild – Norm Beauchamp as essential member of triad • 03. 28. 08 initial presentation to SCARD • Financing by ACR – Jim Thrall as champion

Scenarios are a Tool to Address Uncertainty Nirvana Chaos Betweenville “Envelope of Uncertainty” Single-Point Forecast

Scenarios are Representative Futures Nirvana Chaos Betweenville “Envelope of Uncertainty”

Cone of Possibility-by Dieter Enzmann The Future Now

Steps Involved in Scenario Planning-1 • Decision Focus definition • Verbalize intent • Forces and Drivers • Solicit collective input and tap “wisdom of groups”

Steps Involved in Scenario Planning-1 • Decision Focus definition –Verbalize intent • Forces and Drivers –Solicit collective input and tap “wisdom of groups” • “Axes of uncertainty” definition –Express disagreement in a civil manner • Scenarios –Create tangible visions

Steps Involved in Scenario Planning-2 • threats and opportunities for each scenario –Free associate for opportunities even in “worst” cases • strategy table • Identify strategic initiatives –Analyze concepts and variables to derive projects • Select products and services –Choose potential wins • Define Signposts and Roadmaps –Information gather

1. Define the Decision Focus 2. List Forces and Drivers

Workshop 1 We Identified the Decision Focus for the Scenarios, Key Decision Factors, and a Wide Range of External Forces Decision Focus: What programs and innovations in medical education, research, and clinical practices will SCARD catalyze in order to enhance the overall growth, effectiveness, and impact of radiology on patient health over the next 5 -10 years? Decision Focus Consumer 50 Forces Identified* Government Technology Funding Competition Actions Advances Patterns Service Models Education 59 Forces Identified* 37 Forces Identified* 61 Forces Identified* 27 Forces Identified* 28 Forces Identified* 41 Forces Identified* * We identified 303 external forces in total

K-J Process • Named after anthropologist Jiro Kawakita, creator of Affinity Diagrams which are one of the seven commonly considered management and planning tools* • Presumes that “experts” acting alone are accurate much less often than experts who interactively assess each others plans (experimentally shown as jump from 7 -79% where military strategy is concerned) *Affinity Diagram (KJ Method) Interrelationship Diagraph (ID) Tree Diagram Prioritization Matrix Diagram Process Decision Program Chart (PDPC) Activity Network Diagram

3. Define Axes of Uncertainty

From Drivers and Forces to Axes of Uncertainty; these three axes naturally fell into place following the first K-J process Individual Market Focus Centralized Threatening to Radiology Enabling to Radiology Single Specialty Disaggregated Business Model Technology/Science Determined through K-J process

4. Write Scenarios

The Opportunities Were Used to Develop SCARD’s Master Strategy Table

Example Strategy Initiative: Minimally Invasive Diagnosis and Therapy Value Proposition Offering Domain Product Improved academic performance Clinical Lower cost Interventional Radiology teams with CT-MRI-A/G 427 Service Provider Complete minimally invasive diagnostic services, 417 Radiologists Target Required Capabilities Partnerships Business Organiza Model tional Location Technology Skills Features Behavior Source Other Requirement s Radiologists U. S. University Establishing "Patient Simulations Radiology Internal Financial engineering a brand first" (imaging workflow development support departments culture interpretation, optimization procedures) Research Minimalist Multi-model team Mid-levels Medical -based IR Technology services, 427 Treatment Mall, 417 Patients Industrial Integrated engineering services departments Home diagnostics (i. e. ultrasound) 358 Industry vendors Patients' families Equipment mfrs Pay to develop new radiology applications Radiology research instrumentati on, scientific instrument design and development Knowledge Other of multiple academic diagnostic departments technologies Biomarker integrated homehealth imaging products, 437 Radiology application developers Equipment mfrs Equipment venders Ultrasound R&D Medical device manufacturers Robotics Portable imaging Combine Imaging d technology modalitie s Knowledge Private New payment/ management sector reimbursemen vendors - t codes equipment

List of all 22 Derived Strategies 1. Integrated imaging and pathology (whole 9 yards) 2. Job satisfaction (happy) 3. Comparative effectiveness research (CER) 4. Computer assisted detection (CAD) 5. Minimally invasive diagnosis and therapy 6. Payment determination (True. Pay) 7. Improving academic performance 8. Low dose imaging and tracking of lifetime radiation 9. Establishing operations management research in radiology departments 10. SCARD International 11. Business reengineering 12. Combined modalities 13. Decision support for medical imaging test ordering 14. Radiology efficiency optimization 15. Low cost radiology 16. Branded offshore teleradiology 17. One voice 18. Radiologist/patient relationship 19. Quality metrics 20. Partnering with retail 21. Virtual education 22. SCARD Today Red: not assessed

Spider Graph; Symmetry and Size Strategic Impact Economic Benefit to Radiologists Manageability/Fit Expenditure Risk

SCARD Strategy Initiative Ratings red = first 5, underlined = next Socialized Entrepr. Medicine Integrated imaging and pathology Low cost radiology Socialized Entrepr. Medicine Freefall Decision support for medical imaging test ordering Branded teleradiology Comparative effectiveness research One voice Minimally invasive diagnosis and therapy Radiologist/patient relationship Improving academic performance Quality metrics Low dose imaging and tracking of lifetime radiation Partnering with retail Establishing operations management research in radiology departments Virtual education Business reengineering Current SCARD direction SCARD status quo Freefall

Products/Services Broad Roadmap for Dose Initiative: P 111: Consumer Report re: Vendor Responsiveness 2 P 108: Radiation Safety Modules P 107: Radiation Safety Tutorial P 109: Practice Quality Improvement Template P 114: Publicize Dose Symposium P 112: Adopt “Imaging Wisely” Levels 2 & 3 P 113: Simulation Training in Fluoro P 110: Encourage Safe Imaging in Multidisciplinary Care Cycles P 104: Dose Dictionary P 106: Standardized Protocol Registry 1 P 101: Dose Report P 105: Personal Cumulative Total Dose P 102: Dose Tracking P 103: Universal Dose Metric Technologies/ Capabilities/Features T 107: Webmaster to Adapt Survey Monkey to Rad Dose T 103: Multidisciplinary Consensus Panel T 110: Partner With ACR T 102: On-line Education & Training T 105: Web Designer T 108: Web-based Tools T 114: Web-based Data Server T 109: Outsourcing Skills for Amazon. com-like Site T 115: Vendor Care Cooperation T 106: Simulation Tools T 113: Aggregation of Existing PQI T 112: PQI Template T 111: Web-based Access to Databases T 101: Technical Writer T 104: Admin Support Staff Signpost Topics E 101: Health Care Reform (all) E 103: AAPM as Important Player (P 104) E 102: ACR Collaboration (all) E 104: Emerging non-Ionizing Imaging Technology (all) E 108: Technical Measure Challenges (P 104) E 105: Increased Regulatory Oversight (all) E 106: Vendor Control led Data (P 104) E 110: Fast MRI Technology (all) E 107: Vendor Backlash (P 111) 2012 2013 2014 2015

Broad Roadmap for Quality Initiative: Products/Services P 20: Dieter’s Can’t Miss List P 22: LEAN: Translate TPS for Radiology P 04: Radiology K. P. I. Registry & Dashboard (Rad-Dash) P 03: “How-To” Manual for Residents’ Rotation P 06: Z-Vision P 17: Compendium of Quality Templates P 09: E-Journal: Operations Metrics P 15: No Faculty Left Behind P 01: Multi-Platform Freeware Tool P 18: Decision Support Request for Proposal P 10: E-Journal: Trends in Radiation Safety Technologies/ Capabilities/Features P 19: E-Journal: Quality Med Portal P 02: Master’s Degree: Rad. Safety & Quality P 11: E-Journal: IR Complications P 08: E-Journal: Operations Metrics P 12: Time Survey Tool P 14: Certification in Quality P 21: Peer Review Deluxe P 07: Rad. Qual and Safety Recurrence P 23: Deiter’s Report P 13: Radiation Accel Yardstick P 05: Quality Gap Corrector P 16: Six Sigma Project Template T 15: Team to Translate LEAN for Radiology T 03: Access to Data T 11: Dashboard: Mgmt Reporting T 06: Technical Publishing T 23: Standardization for Reports T 09: Web-Based Quality Consensus T 21: Technical Publication, Editorial Function T 24: Consensus Panel T 16: Six Sigma T 08: Software Tools T 01: Web Site Manager & IT Tools T 13: E-Tools for Mentor Contacts System T 22: Guide for Utilization Mgmt T 14: Project Manager for Measuring Time to Dx or Treatment T 17: Team to Define Radiology Needs Report T 19: Technical Publishing, Process Maps T 07: Operational Dashboard Interface T 20: Decision Systems P 24: Structured Reporting T 05: Online Education & Testing T 18: Integrated Educational DB T 12: Software/Team for Peer Review DBs T 04: Interface IR Complications DB T 10: Rad. Dose Team (E-Journal) T 02: Software Designer/Programmer Signpost Topics E 05: EMR Vendor Products (all) E 09: ACGME Rules/Regulations (P 22) E 10: ACR Collaboration (all) E 01: Healthcare Reform (all) E 02: Capitated Systems (all) E 06: Proliferation of Quality Improvement Templates (P 17) E 07: Sub-Specialty View of Structured Reports (P 24) E 03 Competing Quality Training (all) E 04: Ownership Locus of E-Health (all) E 08: M&A of Healthcare Systems (all) 2012 2013 2014 2015

SIG Products and Services-2012 • Dose-Brink – PQI templates, tutorials, registry • Minimally Invasive Treatment-Mauro – Combined certificate, filter registry, practice blueprint • Quality-Kruskal – KPI registry and dashboard, certificate process • Business re-engineering-Ros & Meltzer – Review consulting service, structured reports, dashboard • Virtual Education-Canon – Diagnostic simulator, Oslermed

SCARD 2012 • Assessment – Faster product delivery – Identification and empowering champions • Chairs should not be tapped for championing – SIG filtering and delayering – Create feedback loop reassessing SIs – Intersocietal partnerships are essential – Define project management infrastructure need

SIG Products and Services-2014 • Quality – Universal Scorecard; Kruskal/Rawson • Business re-engineering – Consulting Service; Meltzer – Toolkit; Beauchamp

Next Steps • The Consulting Service model is an example of a strategically generated product; its success hinges on deployment • Toolkit is the Consulting Service connected to the developing Universal Scorecard to learn lessons from best in class

Key Realizations • SCARD has chosen to boilerplate from approaches and products that have worked in the past • SCARD believes that identifying and building favorable partnerships are vital to leveraging survival and growth in “Our New World”

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