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CHRIS SODERQUIST

Strategic Forum

Tell me, I forget.

Show me, I remember.

Involve me, I understand.

—Ancient Chinese proverb

Real-Life Story

In March 2005, a nationally known health-care provider wished to develop a long-term strategy for delivering dialysis services. The dialysis system is notoriously hard to manage due to a wide variety of factors: high expenses (both operating and capital investments), technologically sophisticated processes requiring a variety of staff skills, burnout and rapid turnover of nursing staff, and patient scheduling conflicts. Also, dialysis is often the result of a progressive disease that saps the strength and morale of patients and staff. Further, Medicare regulations dictate a treatment regimen that medical professionals consider less than ideal—so to provide exceptional service usually takes the organization into the red. In addition, with the surge in adult onset diabetes that is expected to result from an increasingly aging and obese population, there is the potential for demand to overwhelm capacity in the near- to midterm.

Over the course of three months, an external consulting team interviewed the staff (physicians, nurses, and administrators) to identify the major issues (many mentioned above) and examine the historical trends, as well as projected future trends. Because it was clear the stakeholders held vastly different assumptions about the future, as well as what were optimal treatments, the consulting team suggested a Strategic Forum (computer simulation model) where physicians, nurses, and administrators were provided a practice field to:

1. Understand future population scenarios

2. Explore different treatment strategies

3. Observe implications of treatment strategies on population, staff, and expenses

4. Test the ability of process capability to facilitate the efficacy of strategies

During the Strategic Forum, participants were amazed to see a wide discrepancy in assumptions about future patient dynamics, as well as the wide variety of desired treatments. In particular, physicians were more likely to suggest innovative treatment strategies, while administrators and nursing staff—who understood the financial and staffing implications—saw a more tempered approach to migrating to innovative strategies. The resulting conversations brought the entire stakeholder group onto the “same page” regarding optimal treatments and how to systemically orchestrate a strategy to implement. The staff is now in an ongoing process of revising the computer simulation (and map shown in figure 1) to include insights generated from the forum—they are in a continuing process of learning regarding the dialysis system.

Figure 1. A Section of the Forum Map

The Basics: Answers to Frequently Asked Questions

WHEN IS A STRATEGIC FORUM APPROPRIATE?

Although it works well for a variety of strategic (even tactical) issues, it is especially suited for issues where the future is filled with uncertainty, where multiple scenarios are likely to occur, and where there is little data to understand how the current system works. In addition, it’s ideal in organizations where there are contentious debates about multiple strategies because the highly experiential process (system mapping and computer simulation) helps to “cool off” the personality focus and get the group to concentrate on the issues.

HOW DOES A FORUM WORK?

A forum works by helping the group apply a different paradigm to the development of their mental models of how the system works. This paradigm leads them to:

• Look at the issues as long-term (behavior over time) patterns rather than events

• Develop an operational mental model using a visual language that reduces ambiguities and forces rigorous thinking/testing

• Use computer simulation as a way to test the usefulness of the mental model

WHAT SHOULD I KNOW ABOUT MAPPING AND SIMULATION?

Mapping is used to synthesize the implicit mental models of stakeholders into an explicit visual representation. Simulation software translates those maps into something a computer can use to test out “what ifs” regarding the synthesized mental model. The mapping methodology used in a forum relies upon the more sophisticated (and operational) language of stocks and flows. This language better represents time delays, leading indicators, bottlenecks, and unintended consequences—increasing the likelihood of identifying appropriate levers and timing for pulling those levers—than the more commonly employed causal loop mapping methodology. It also enhances mental simulation of how the group believes the organization/system works.

HOW DO I KNOW WHAT SHOULD BE INCLUDED IN THE FORUM MAPS/MODELS?

All models (whether mental or those turned into computer maps/models) are developed using a particular lens of what we value—what we think is important to understand, or what performance we wish to develop or improve. Although organizations can build forum models focusing on the performance measure du jour, they would be well advised to use a systemic or integral framework for what to include. The Balanced Scorecard (chapter 50) framework (Financial, Customer, Business Processes, and Learning & Growth) provides an excellent and systemic frame of what to include—how to develop measures in each of those areas. Other frameworks worth mentioning include Triple Bottom Line frameworks or Ken Wilber’s Four Quadrant framework.

IF I WERE INTERESTED IN DELIVERING A FORUM, WHAT ARE THE STEPS I’D NEED TO FOLLOW?

1. Identify the issue as something requiring a systemic understanding

2. Locate a competent system dynamics practitioner

3. Assemble a multidisciplinary team (internal and external) to understand the issues and how the system works

4. Develop simple maps and ask for rapid feedback across stakeholder groups to assess usefulness of map

5. Build and test the model(s) with a core team of stakeholders

6. Create learning objectives and learning environment for forum

7. Implement forum and generate list of next steps

8. Don’t shelve the models/maps! Rather, use them in an ongoing process of updating the key assumptions in the models/maps, and hold annual forums to evaluate current applicability of model and strategy to the organization.

WHAT’S THE LONG-TERM IMPACT OF A FORUM ON THE ORGANIZATION?

Once an organization implements a forum, strategic discussions tend to become more in line with a systems-thinking paradigm. Leaders begin to ask: What are potential unintended consequences? Is there internal consistency with the strategic objectives? How will this unfold over time—is there some way to better orchestrate implementation? If we are achieving objectives, what are leading indicators that will help us assess this sooner?

Table of Uses

About the Author

Chris Soderquist ([email protected]), president of Pontifex Consulting, helps individuals, teams, and organizations in building capacity to develop strategic solutions to complex issues. With his extensive experience in Systems Thinking/System Dynamics, group facilitation, communication skill development, and statistical/process analysis, he integrates the “hard stuff” and the “soft stuff” for effective, actionable solutions. Representative clients include: Boeing, Dow Chemical, WW Grainger, Hewlett-Packard, Merck, MnDOT, NASA, Nextel, Northrop Grumman, Sustainability Institute, and the World Bank.

Where to Go for More Information

REFERENCES

Kaplan, R., and D. Norton. The Strategy-Focused Organization. Boston: Harvard Business School Press, 2001.

Richmond, Barry. “The Strategic Forum: Aligning Objectives, Strategy and Process.” System Dynamics Review 13, no. 2 (1997).

Soderquist, C., and M. Shimada. Operational Strategy Mapping: Learning and Executing at the Boeing Company. Waltham, MA: Pegasus Communications, 2005.

INFLUENTIAL SOURCE

Wilber, Ken. Introduction to Integral Theory and Practice: IOSBasic and the AQAL Map. Boulder, CO: Integral Institute, 2003.

ORGANIZATION

Pontifex Consulting—www.pontifexconsulting.com