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Tying it together

9 February 2013

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As a practice manager you may be managing a high-achieving clinical practice that is providing great patient care, but does this extend equally into the management of the business?

If you are managing a practice then chances are you are managing some, if not all, of the key areas that I’ve covered in previous articles; income generation,1 marketing,1 expenditure2 and HR.3 Ideally you’ll also have in place a system to monitor, measure and report on these areas.4

If you are managing all of these aspects, you are not just managing the practice, you are also managing key functions of the business. 

While from a business sense it is vital to be in control of these areas, it is also important to ensure you are not managing them in isolation from each other and the business objectives. They should not be separate areas of the business working toward independent goals. 

So how do you tie all of these functions together? What ensures they are not unmonitored, unmeasured and with nothing to determine their success? What makes sure that your staff, marketing and finances are all working in harmony?

The answer is ‘strategy,’ and if you’re fully managing
the business then you’ll be in control of strategic management too.


Why you need a strategy

Every business is likely to have a vision even if it is not explicitly communicated. Partnerships in general practice are no different, and even if they are not openly shared and agreed, individually the partners are likely to have their own personal goals. What every business needs is a strategic plan which brings together these individual aims into one shared goal; a strategy that communicates the overall vision and provides a clear understanding of what values will be adhered to and where the business is aiming.

There are many reasons why a strategy is one of the most important things your business will possess:


  • Clearly defined, it will provide a direction for the individual, the team and the whole organisation.
  • Communicated and followed with commitment and belief, it will provide a purpose to every aspect of the work. 
  • Created and implemented together, it will engage, motivate and strengthen teams.
  • Measured against, it will highlight success and flag failure.
  • Used as a guide for management it will aid decision-making in its reminder of the overall goal. 


Setting your strategy

So how do you set a strategy? How do you capture all of the hopes and fears, strengths and weaknesses and pull them together into something achievable and agreed by all?

As with any big complex task, it is less daunting and more successfully completed when broken down into a simpler ‘step by step’ process. In the case of strategy setting there are three distinct stages; analysis, evaluation and implementation. 


Strategic analysis

The first step is to make sure you are involving the right people at the right time. In general practice, the ‘away day’ is the typical occasion of choice where all this analysis and soul-searching takes place. This will usually be a formal meeting outside of the practice involving the partners, practice manager and possibly other key staff.  In addition to the away day, your patient group can also be used to consider and evaluate strategies. As major stakeholders they should not be excluded from the process and will certainly bring a different view to that of the practice principals.

The other major group to include are the practice staff. Consulting with them from the beginning of the process will ensure their engagement and will provide another valuable perspective. Once you have decided which groups will be included in the discussions you then need to decide what form they will take. Without planning beforehand, or following a structured process, it is unlikely that they will be as productive and you may well end up with a result that is unrealistic or inappropriate. It is often a good idea to employ a neutral and external facilitator to help ensure there is some structure to the analysis, but if you do go it alone there are some tried and tested tools that can be used.


SWOT analysis

The strengths, weaknesses, opportunities and threats (SWOT) analysis looks at internal factors; strengths and weaknesses, and external factors; opportunities or threats. Possible items identified might be:


  • Strengths: high skill levels, cash reserves.
  • Weaknesses: equipment shortages, unsuitable premises.
  • Opportunities: increasing local population, need for new services.


Threats: increased competition, limited employment pool.

Factors identified are usually shown in a grid similar to the one shown in Figure 1 and can be used to encourage further discussion exploring potential strategies of utilising strengths, developing weaknesses, grasping opportunities or combating threats. 


PEST analysis

PEST is an acronym for ‘political’, ‘economic’, ‘social’ and ‘technological’. It is a tool used to consider which environmental factors are affecting the organisation now and which of these will be the most important over the next few years. The factors identified are then put within these four headings.

In some cases the issues can seem big and uncontrollable, such as political changes, but a business can always implement strategies to make the most of the opportunities presented or to minimise threats. 


Competitor analysis

It is also useful to consider what your competitors are doing. Even though general practice is encouraged to work collectively within the newly formed clinical commissioning groups (CCGs), to a large degree they are also in competition with one another. It is wise to continually monitor existing practices and potential new competitors and to assess:


  • What are their objectives?
  • What are their strengths and weaknesses?
  • How are they performing?
  • What is their strategy?


The answers to these questions will make clear how you compare to your competitors, and also if there are any services that you are failing to offer. This analysis can also identify areas not being fulfilled by your competition and areas that may be overcrowded.

This may point to providing a service already being offered by others so you are not left behind. Alternatively it may suggest services to fill a gap in the market or offering something new that differentiates you from other practices.


Strategic evaluation

Once your analysis and investigation is complete, you should be left with a clear idea of some potential strategic options and goals. It is important to discuss these further in order to finally decide on a manageable number of objectives that everyone buys into and which are realistically achievable. Your evaluation of the potential strategies should assess each option for suitability, feasibility and acceptability.

‘Suitability’ considers whether the strategy can improve the business and whether it makes best use of the strengths and opportunities. At a successful outcome, will the business be stronger financially, or possess better skills, premises or equipment? Does it have the necessary strengths or can they be realistically developed, and does the strategic opportunity exist?

‘Feasibility’ asks whether the physical, human and financial resources are available and if it is possible to implement them successfully. For any chosen strategy, the physical, human and financial resources must be available to support it. To answer the question of feasibility, a resource audit should be conducted to assess how capable it will be of achieving a strategic aim. This audit must thoroughly examine the resources in the following areas and consider what is available against what is needed:

Physical resources: equipment and premises (age, condition, etc).

Human resources: numbers, skills, flexibility.

Financial resources: available cash, available funding, identify resources needed and costs.

There may be a ‘gap’ between what is available and what is required, but this does not automatically mean a strategy isn’t feasible. Before you decide, assess if the gap could be bridged with additional resources.

‘Acceptability’ considers if the strategy will be acceptable to staff, patients and other stakeholders and whether the necessary change can be managed. For a strategy to be acceptable, it is vital that the analysis has taken in all stakeholder groups and that there has been real engagement. If that has not happened then the strategy is unlikely to be acceptable to everyone. 

Most business strategies will usually necessitate some organisational change, such as new premises, skills, technology or working practices. The bigger the objective, or more complicated the project, the greater the change usually required. Before deciding on a strategy, the business should decide if it has the leadership and management capability to manage the change process. Managing change is a skill of its own with individuals and businesses specialising in managing this and who can always be employed to assist if needed.


Strategic implementation

Once you have identified possible strategies and evaluated them to produce your chosen strategy or strategies, you are ready for implementation. 

First identify what the critical success factors (CSFs) will be. These are the factors that are absolutely vital for success, and there may well be several. After this, decide what the key tasks are in order to achieve each critical success factor; again, there may be a number of tasks for each factor. By planning in this way you are able to break down a bigger more intimidating project into smaller, more achievable pieces of work. There may also be an order in which the tasks and critical success factors need to be accomplished. If Figure 3 represents the launch of a new service which requires funding, additional staff and marketing, then clearly the finance ‘CSF A’ would need to be in place first, and staff (CSF B) at least appointed before marketing (CSF C) commenced.  

Finally, allocating responsibility for completing these key tasks to a person or team helps share the workload, and provides a sense of ownership and a collective responsibility for achieving the strategy. It is important to ensure that every person, team and aspect of the organisation has goals that feed into the overall strategy which should serve to tie the organisation together. 

Throughout the whole strategic process, communication is vital for everyone to know what is expected and aimed for. All stakeholders should be kept fully informed, as the achievement of a strategic objective is easily derailed if people do not understand why something is happening or what they should be doing. Most important are the practice staff and patients, but also consider associated professionals, groups and the local community.

The successful realisation of the business plans will require the efforts of the whole team so it is important to report progress regularly and share successes and failures. If everyone is being asked to contribute then everyone should be told what the business is striving to achieve and how well it is doing. l


Gary Hughes is a practice business manager and practice management consultant based in Berkshire. He has more than 25 years’ experience in healthcare management and is a member of the Management in Practice editorial board.



1. Hughes G. Is your marketing delivering success? Management in Practice 26:62-4.

2. Hughes G. Tightening the purse strings. Management in Practice 30:65-7.

3. Hughes G. Who is driving the business? Management in Practice 28:48-50.

4. Hughes G. The measurement of success. Management in Practice 27:72-4.