We often see the “Pillar” planning paradigm in our healthcare strategic planning practice. There are usually four to six areas of strategic effort—pillars—including: quality; finance; community; people; growth, and; service. Under these headings, organizations have specific goals, objectives, tactics, and measures.

The Pillar model is popular and enduring because it’s familiar, it looks easy, and it works. Almost everyone recognizes it, and even board members who are unfamiliar with healthcare recognize its roots in The Balanced Scorecard©. It has “legitimacy.” It neatly summarizes many concepts into a single page; it’s easy to understand, and easy to use as a communication tool. It apportions organizational activity across a range of important areas. That feature also offers “something for everyone,” which builds consensus. Finally, there’s enough change in the field; why ditch something that works?

That said, there have not been many improvements to it. And one of its weaknesses is that nothing compels Pillar users to address a universal truth: management never has the luxury to just “run the business” or just “change their business.” It must be doing both. Weaker strategic plans ignore one; stronger plans always address both. Why? Because both parts present risks, rewards, and trade-offs, and both require organizational planning, resource allocation (people, money, time), assessment, and communication. It’s a particularly dangerous flaw in a dynamic, complicated markets like healthcare.

To greatly improve the planning and communication value of the pillar model, add this one improvement: for each pillar, classify each activity as to whether it is intended to “change the business” or intended to “run the business.”

If your organization is like most, it will—on the first pass—identify few or no “run” activities. Because plans are typically oriented to the future, not the moment, plans seldom speak to important—often essential—activities that are not subject to change, but are pivotal to success. “Run” activities are usually processes (hiring, revenue cycle, bedside care, customer service, regulatory compliance, etc.) that must perform predictably and well in order to maintain margins, market share, reputation, and the like. When these processes decay, they distract management, alienate constituents, and impose unplanned costs. By distinguishing “run” activities from “change” activities, leadership more effectively communicates its priorities, in part by affirming the worth of “routine” (though complicated and difficult) processes and the people responsible for them (rather than appearing to take them for granted). This helps unify the management team and its efforts. Calling out run/change more deliberately—and transparently—allocates resources. In doing so, it also invites deeper examination as to whether certain “run” activities are due for “change”


At a senior leadership (or middle management) meeting, ask participants to classify every aspect of the strategic plan—strategies, goals, objectives, tactics, and measures—as important for “running” or “changing” the business.

People will hedge and want to say “This one is both.” Don’t let them; force a choice. It might be uncomfortable; it will be revealing. If you’re satisfied with the results, terrific. If not, you’ve found an improvement opportunity, and can adjust as necessary.

Morgan Healthcare Consulting, LLC, developed and conducts workshops in using the PILLARS+© MODEL, a series of tools that glean additional value from the traditional “Pillar” strategic planning framework.