DDHA 8503 Week 11 Strategic Plan Example

Protect Clinic Hours by Fixing the Inbox: A Three-Year Strategic Plan for a Fourteen-Clinic Primary Care Group, With the Organization's Own Reactions Written In

Student Name

Walden University

DDHA 8503: Strategic Management and Systems Thinking

Instructor Name

Month Day, Year

Protect Clinic Hours by Fixing the Inbox: A Three-Year Strategic Plan for a Fourteen-Clinic Primary Care Group, With the Organization's Own Reactions Written In

Executive Summary

Brightwater Medical Group's greatest strategic risk over the next three years is the loss of clinical hours, as clinicians reduce their time or leave. The patient messaging inbox is a major cause, because inbox work that spills into evenings builds burnout, and burnout leads clinicians to cut back. Fewer clinic hours then make visits harder to get, which leads patients to send more messages, which makes the inbox worse. This plan sets three objectives: make inbox work part of the paid workday, make sure messages that need a visit get one without taking access from everyone else, and align what the group pays for with what it says it wants. Each objective lists the actions, the reactions those actions will provoke and the measures that will show whether it is working. Board approval is requested for the plan as a whole, for the compensation change in Objective 1 and for the decision on online visit billing in Objective 3.

Situation

Brightwater's fourteen clinics receive about 11,000 patient messages a week, along with about 19,000 automated notifications that land in clinicians' inboxes. Two forces outside the group will keep this volume rising: federal rules that release test results to patients immediately, and continuing growth in portal use. A third, the national shortage of primary care clinicians, makes every lost clinic hour hard to replace. Inside the group, last year's analysis traced a loop in which the inbox backlog drives evening work, evening work drives burnout and burnout drives lost clinic hours, with delays of a year or more that hide the connection. Shanafelt et al. (2016) found that burnout among physicians was followed by reductions in their professional work effort, which is the link the board should worry about most. A pilot over the past six months reduced repeat messages and evening inbox time but lengthened waits for routine visits and produced workarounds that showed where the changes pressed hardest.

Objective 1: Make Inbox Work Part of the Paid Workday

Actions. Credit protected inbox time with productivity units equal to the visits it replaces, starting next fiscal year. Give every clinician two protected hours a week, rising to three for clinicians with panels above 2,000 patients. Expand the nurse triage pool by four nurses, funded by the savings expected from lower clinician turnover.

Expected responses. Clinicians with large panels will use protected time for messages instead of booking patients into it, because the penalty is gone. Some clinicians will see protected time as permission to work fewer evenings, which is the intent. Routine visit capacity will fall slightly, and schedulers will hear more complaints about waits. The finance department will report a short-term fall in visit revenue before any benefit in turnover appears, and will be tempted to reverse the credit.

Measures. Early: evening inbox minutes per clinician from record system logs, reviewed monthly. Lagging: clinical hours offered per clinician and clinician turnover, reviewed annually.

Objective 2: Give Messages That Need a Visit a Visit, Without Draining Routine Access

Actions. Keep the fast-lane video slots, but offer each patient their own clinician's held slot first. Cap fast-lane slots at three per clinician per week in the four most constrained clinics until routine access recovers. Redesign triage so that medical questions are acknowledged within one business day by a nurse, removing the incentive for patients to label them as refill requests.

Expected responses. Patients will continue to use the fast lane as a route to visits; capping slots in constrained clinics will push some of them back to the routine schedule. Triage nurses will escalate cautiously at first under the new acknowledgment standard. Some patients will still mislabel messages, though fewer if they experience triage as a service rather than a barrier. Murray and Berwick (2003) note that delay persists unless demand and capacity are balanced together, so access may improve slowly.

Measures. Early: repeat messages within seven days and the share of refill requests that are actually medical questions, reviewed monthly. Lagging: third-next-available routine visit and how often patients see their own clinician, reviewed quarterly.

Objective 3: Align What Brightwater Pays For With What It Says

Actions. Remove online visit revenue from the finance department's budget target. Decide, as a board, whether billing patient messages is a goal. The recommendation is to bill only messages from patients whose plans carry no cost sharing for online visits, because the one published evaluation of billing at a health system showed little change in how many messages patients sent (Holmgren et al., 2023), so the revenue is small and the cost to patients with deductibles is real. Add continuity and inbox time to the standing agenda of clinic leadership meetings.

Expected responses. The finance department will lose a revenue line and may resist; the board's explicit decision is meant to settle that. Some clinicians who had begun billing will stop, and a few patients who had been charged will notice the change. Clinic leaders will spend meeting time on continuity, which some will regard as a distraction from productivity.

Measures. Early: patient billing complaints, reviewed monthly. Lagging: patient-reported ease of reaching the care team in the annual survey.

Monitoring Schedule

Table 1

Monitoring Schedule for the Board

The board receives a one-page summary of early measures each quarter and the full set annually.

Assumptions

This plan assumes that inbox work is a major cause of burnout at Brightwater, which is supported by published research and by the group's own data but has not been proven locally. It assumes that crediting protected time will change how clinicians use it, which the pilot suggests but did not test directly. It assumes that four additional triage nurses can be hired within a year. It assumes that drafting software will not substantially reduce reply time within the plan's period; if it does, Objective 1's staffing could be scaled back. Each assumption will be reviewed at the first annual review.

Appendices

Appendix A contains last year's loop analysis and consequence review. Appendix B contains the environmental scan. Appendix C contains the alignment audit. The board does not need these to approve the plan, but they show the reasoning behind it.

References

Holmgren, A. J., Byron, M. E., Grouse, C. K., & Adler-Milstein, J. (2023). Association between billing patient portal messages as e-visits and patient messaging volume. JAMA, 329(4), 339-342. https://doi.org/10.1001/jama.2022.24710

Murray, M., & Berwick, D. M. (2003). Advanced access: Reducing waiting and delays in primary care. JAMA, 289(8), 1035-1040. https://doi.org/10.1001/jama.289.8.1035

Shanafelt, T. D., Mungo, M., Schmitgen, J., Storz, K. A., Reeves, D., Hayes, S. N., Sloan, J. A., Swensen, S. J., & Buskirk, S. J. (2016). Longitudinal study evaluating the association between physician burnout and changes in professional work effort. Mayo Clinic Proceedings, 91(4), 422-431. https://doi.org/10.1016/j.mayocp.2016.02.001