HEALTHCARE · ACADEMIC / PHYSICIAN GROUP · SUBSIDIARY / DIVISIONAL STRATEGY · STRATEGIC
ALIGNMENT PLANNING
Everyone in Their Lane
When a strategic plan without divisional alignment is just a document
Is this your situation?
This engagement may resonate if your organization is experiencing any of the following:
Your strategic plan has been approved and your organization restructured to support it, but each department is still figuring out how to make it real in their daily work
Leaders understand their strategic role but haven’t yet translated it into a concrete plan that integrates new priorities with their existing commitments and constraints
Implementation has stalled or fragmented because no one has facilitated the conversation about how each department will actually execute against the plan
New roles, additional team members, or additional resources are needed to execute the plan but haven’t yet been formally identified or requested
The Strategic Dilemma
A plan in place. A structure aligned. Implementation still undefined.
A large academic physician group within a major university-affiliated hospital system had completed a rigorous strategic planning process and restructured its organization to support the plan. Five strategic initiative teams had built integrated plans. Role Clarity had defined what each functional area owned strategically. The department had, for the first time in its history, both a plan and a structure built to deliver it.
And yet implementation had not fully taken hold. In a department of more than 600 physicians operating across seventeen specialty divisions, the gap between understanding your strategic role and knowing how to execute against it within your daily operational reality is significant. Physician leaders were managing full clinical, teaching, and research commitments alongside new strategic responsibilities. Administrative leaders were navigating restructured teams and new offices alongside existing operational demands.
The question was no longer what each area owned strategically. The question was how each department and functional area would actually implement the plan — integrating new strategic priorities into existing commitments, identifying what needed to shift, and determining what additional resources, roles, or advocacy were required to make execution real.
What Made It Hard
The distance between strategic ownership and operational execution
Role Clarity had answered the structural question: is this organization built to support the plan? The answer was yes. But knowing what you own strategically and knowing how to execute on that ownership within the constraints of your existing workload, team, and resources are two different things. That gap — between strategic understanding and operational execution — is where most implementation efforts stall.
In a clinical environment, that gap is wider than most. Every department leader was simultaneously managing physicians with patient care and teaching responsibilities, as well as research project commitments, while navigating new reporting relationships and strategic priorities. Without a structured process to help each area integrate the new with the existing, the risk that new strategic priorities would fall to the bottom of the list was all too real. They needed a structured process and experienced support to complete their plans and shift resources.
Implementation planning also surfaced issues not fully resolved during strategic planning. In many cases, new roles were needed, or team capacity was insufficient to maintain performance on existing commitments and take on new priorities. Those gaps needed to be identified explicitly and resolved before execution started.
The engagement and our approach
Strategic Alignment Planning: from strategic ownership to operational execution
Focused Momentum applied its Strategic Alignment Planning process to guide each functional area and administrative team through building concrete implementation plans. The process is designed to answer a specific question for each department and function: given what you now own strategically, how will you actually deliver on it?
Strategic Alignment Planning is not a top-down cascade of goals. It is a facilitated process in which each department or functional area examines the strategic plan from its own operational position — with its existing commitments, constraints, and capacity visible — and builds a concrete implementation path. The process is structured around six core questions:
THE STRATEGIC ALIGNMENT PLANNING PROCESS: SIX CORE QUESTIONS
1. What changes does this new strategic plan immediately present to your existing plans and commitments?
2. What is missing from the strategic plan that you need to include in your departmental or functional area implementation plan?
3. What is your departmental or functional area role in delivering on the organizational strategic plan?
4. To what degree is this a shift in how you currently operate, and what does that shift require of you?
5. Define your departmental or functional area goals for the strategic plan’s timeframe — inclusive of your existing commitments and the new priorities coming from the strategic plan.
6. What is needed — in terms of new roles, additional team members, resources, influence, or advocacy — for you to successfully implement against these strategic plan goals?
These questions do three things simultaneously: they surface the operational reality each area is working within, they integrate new strategic priorities with existing commitments rather than adding them on top, and they identify the roles, resources, and support each area needs to execute. The result is not a high-level strategic intention. It is a workable implementation plan.
Facilitating Strategic Alignment Planning across functions and admin teams
Focused Momentum guided each of the eight functional or administrative teams through the Strategic Alignment Planning process. Each team examined the strategic plan from their operational perspective, identified what the plan required of them alongside existing commitments, and developed a concrete implementation plan with defined goals, clear roles for execution, and documented resource requirements.
Identifying role shifts and new team requirements
A critical output of the Strategic Alignment Planning process was the explicit identification of where existing roles needed to shift and where new team members were required to support implementation. These were not discovered after execution began — they were surfaced during planning, so the department could act on them before gaps became barriers.
Surfacing and resolving resource and advocacy gaps
Each department and functional area identified what additional resources, institutional influence, or advocacy they would need to successfully execute against their strategic goals. These needs were surfaced, documented, and escalated where appropriate — ensuring that implementation was resourced before it began, not scrambled for after it stalled.
Sustaining alignment through three-year implementation plans
Strategic Alignment Planning is not a one-year operational planning exercise. As teams progress through the strategic planning timeframe, priorities shift, new challenges emerge, and team composition changes. Focused Momentum’s Strategic Alignment Planning sessions encouraged each team leader to think through how to balance acting on new priorities with current workloads and capabilities. At times this meant that strategic goals needed to be delayed until the team could effectively manage them. By working across all teams, the Focused Momentum team was able to share these timeline changes in real time to coordinate implementation plans.
The Result
Implementation that held — with everyone in their lane
The Strategic Alignment Planning process produced the operational clarity the strategic plan required. Each department and functional area moved from understanding their strategic role to having a concrete, fully resourced implementation plan aligned to the broader departmental direction.
OPERATIONAL INTEGRATION
Each initiative team built an implementation plan that integrated new strategic priorities with existing commitments, making execution realistic rather than aspirational
ROLE CLARITY IN EXECUTION
Where strategic roles were defined by Role Clarity, Strategic Alignment Planning defined how each role would execute, closing the gap between ownership and action
RESOURCE IDENTIFICATION
New roles, team members, and resource requirements surfaced during planning were acted on before implementation began, preventing the gaps that cause plans to stall
REDUCED FRAGMENTATION
With each department’s implementation path explicit and aligned, leaders reported fewer competing priorities and a stronger ability to focus on the work that mattered most
SYNERGISTIC ACTION
By having one team lead Strategic Alignment Planning, changes were communicated immediately to others when goals shifted and those shifts impacted other areas, ensuring synergistic departmental implementation
PLAN DURABILITY
Three years into implementation, the strategic plan continued to guide organizational decision-making, sustained by the operational alignment structures Strategic Alignment Planning establishedEverybody has their lane. Everyone has deliverables now. And I think there’ll be fewer distractions moving forward. It’s a really good place to start, and it has really grounded us.
— Tracy Serafini, Director of Strategy and Communications, large academic physician group
The transformation enabled by Strategic Alignment Planning was not just operational. It was cultural. In an environment where the previous management approach had been described as resembling a game of Whack-a-Mole, the explicit process of asking each department what they needed, what they were committing to, and what they needed to make that commitment real created a fundamentally different implementation experience.
What this means for you
The strategic principle behind this result
Strategic plans are written for organizations. They are implemented by departments and functions, each with their own existing commitments, constraints, and operational realities. The gap between an approved plan and an executed one is almost always an implementation gap. Committed leaders fail to recognize that facilitated conversations are required to connect the strategic direction to the operational reality in each part of their organization.
Strategic Alignment Planning is that conversation. It does not cascade goals from the top. It facilitates a process in which each department examines the plan from its own operational position, integrates new strategic priorities with existing commitments, and identifies what needs to change. It can then build the concrete implementation path it needs to be successful. When it is done well, departments stop waiting for direction on how to act and start delivering on commitments they believe in.
If your organization has a strategic plan and a structure built to support it, but implementation is stalling, fragmenting, or failing to produce the focus you expected, the missing step is probably not more planning or more structural change. It is the facilitated process that connects the plan to the operational reality of each department and function and makes execution concrete rather than aspirational.
Recognize your situation in this story?
Let's talk about what a strategic planning engagement with Focused Momentum would look like for your organization.