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Case Study

How Hywel Dda Hardwired Flexibility into Strategic Planning

15 Minute Read


The challenge

Covid-19 made strategic planning and decision-making difficult because the disease was new, health systems had little information about it, and executives needed to make decisions quickly and prioritize those decisions rigorously. After adopting “pandemic response” frameworks, leaders realized that previous planning and decision-making structures were inefficient given today's rapidly changing environment. Now, leaders are struggling to hardwire the flexibility they achieved during the pandemic into their strategic planning processes.

The organization

Hywel Dda University Health Board is a publicly funded integrated care system serving 384,000 people in Midwest Wales, U.K. It is part of NHS Wales. The system funds and manages acute, primary, community, mental health, and dental care, as well as services for people with disabilities across its provider sites.

The approach

Hywel Dda took four steps to revamp both its strategic framework and its process for setting strategy. They audited and reorganized their previous strategic plans to eliminate overlap of old mandates. They added flexibility to their strategic planning mindset and created two teams to constantly scan the environment for variables that would affect their long-term plans. They hardwired a lighter-touch governance structure developed during Covid-19 that puts non-executives in critical roles to deliver against new objectives.

The result

The new strategic framework was well-received across Hywel Dda’s executive teams. The changes made to how they think and talk about strategic planning, and the associated process changes, now allow the organization to respond to environmental pressures quickly and tweak their long-term plans as needed. These changes increased autonomy and accountability of leaders at the board, executive, and unit levels.



How Hywel Dda hardwired flexibility into its strategic planning process

In the wake of the Covid-19 pandemic, Hywel Dda's executive team and board created a new strategic framework and decision-making structure that embraces flexibility and agility. The structure enables the system to rapidly respond to emerging pressures and mandates and adjust their strategic priorities accordingly. It also empowers leaders throughout the organization to own and carry out work on any new priorities.


The  Four Steps

The executive team took four steps to create a new strategic framework and decision-making structure capable of rapidly flexing to meet any emerging demand on the health system.

  • Step

    Audit your previous strategic priorities with an eye for redundancy

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    Introduce a narrative in which flexibility is part of strategic planning

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  • Step

    Split goal setting and feasibility assessment into two functions

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    Empower non-execs to carry out new objectives

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How we know it’s working

Hywel Dda audited and restructured their strategic plan in the middle of a pandemic. The realities of the crisis laid bare the need for change, and the executive team responded promptly. While it’s only been a few months, they have already seen positive, qualitative results. After presenting the new strategic framework to the board, the chief executive said, “There was universal recognition that it was right, it had resonance, people knew and understood the strategic objectives. They could easily grasp these goals.” Because the planning objectives can constantly be re-evaluated and modified by the TSG and SEG, this model enables greater latitude to respond to situational changes. The model gave the board a clear view of the organization’s operating environment, thus making their work in responding to change easier.

The Welsh NHS Confederation requested that each of the seven health boards in Wales capture what they learned in the Covid-19 pandemic. Hywel Dda engaged more than 100 senior leaders through virtual interviews and questionnaires. Feedback on the changes in governance structure included comments like: “There have been reductions in levels of bureaucracy with most comments of this nature praising the increase in pace," and “[Staff felt] greater empowerment with less [need for] support from management/senior leaders.”  Many leaders shared that this structure has shifted the organization’s ethos from corporate accountability (the organization and its executives are “on the hook” for everyone meeting expectations) to personal accountability (each individual has agency to make decisions that will help them meet expectations). This made leaders more accountable to complete their individual action items and showed that they had a clear mandate to do so.

Supporting Artifact
supporting artifact

“Developing the 3 Year Plan for the Period 2021/22 - 2023/24,“ Hywel Dda Board Meeting documents, 24 September 2020; “Strategic Discover Report,” Hywel Dda University Health Board, July 2020; Hywel Dda University Health Board, Wales, UK; Advisory Board interviews and analysis; "Public Board: Maintaining Good GovernanceCOVID-19,” Hywel Dda Board Meeting documents, 30 July 2020.

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