Leading the Way Discussion

Leading the Way Discussion

Leading the Way Discussion

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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Leading the Way Discussion


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. Leading the Way Discussion

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?”