“Forward Together:” An Interdepartmental Approach to Strategic Planning Implementation

Strategic planning processes that engage entire organizations, across teams and departments, can be truly transformational for healthcare systems seeking to make significant changes beyond more “conventional” goals such as business development and market expansion, according to Lisa Brady and Lindsey Duffy, both of whom are executives with St. Joseph’s Health in northern New Jersey.

In a session titled “Organizing for Ambitious Goals: An Inter-departmental Approach to Strategic Planning Implementation” during the SHSMD Connections Conference in October 2024, Brady, the former chief operating officer for the health system who is now the senior vice president and chief strategy officer, and Duffy, the system’s executive director of strategic planning, shared the details of St. Joseph’s “Forward Together” strategic plan for 2021 to 2024, which was formulated during the height of the COVID-19 pandemic in 2020. The organization is now poised to launch their new 2025-2028 strategic plan “A Legacy of Service. A Future of Growth.” In addition to sharing their experiences with SHSMD members, they applied lessons from their previous planning process throughout their own organization and to the next planning period.

The unique “Forward Together” planning process engaged about 42 teams within St. Joseph’s Health and led to the organization implementing dozens of new initiatives that increased revenues, reduced expenses, and enhanced efficiencies, while also working toward more system-specific goals related to health equity and access. As Brady explains, “In most health systems, strategic planning is seen as more of a growth or business development process. However, what we demonstrated through creation of ‘Forward Together’ is that not only are we focused on growth, we’re also focused on how do we operate more efficiently and how do we address health equity and access so that we are really fulfilling our mission.”

Not-So-Modest Goals

As with most health systems embarking on a strategic planning process, St. Joseph’s Health entered the 2021-2024 planning cycle with significant financial goals—in short, to find ways to generate organizational cost savings and/or revenue totaling $40 million over the three-year period. The needs were significant, given that many health systems across the country faced major financial challenges during and immediately after the COVID-19 pandemic. However, the health system, by its very design, had to think beyond these monetary goals.

St. Joseph’s Health was founded by the Sisters of Charity of Saint Elizabeth as a Catholic health system based primarily in Paterson, N.J., where its flagship hospital, the 600-bed St. Joseph’s University Medical Center is located. The health system also includes a 100-bed facility in nearby Wayne, N.J., as well as several outpatient clinics, ambulatory centers, and physician practices throughout the area. When the pandemic began in March 2020, St. Joseph’s Health was in the process of building a new ambulatory care site and an urgent care facility, as well as a new cancer center.

Still, it’s important to point out the system’s role as a “safety-net hospital” in the local community, Brady notes. The system, which sees more than 27,000 admissions and 400,000 ambulatory encounters annually, serves an area of New Jersey in which 40% of residents were born outside the United States. In addition, 60% of the system’s patients receive charity care and/or have Medicaid. In Paterson, 18% of the population is uninsured and 25% of households live below the federal poverty level. As a result, St. Joseph’s Health is “one of the biggest charity providers in the state,” Brady says.

The system’s workforce is also very diverse, with a systemwide diversity index of 75%.

“As a system, we are very diverse, and that’s a special part of St. Joseph’s Health,” Brady adds. “It was also a key factor in developing our strategic plan and implementing it.”

Indeed, any effective strategic plan needed to balance the system’s vital financial goals with the important role it plays in its local community.

A Collaborative Approach

To achieve this ambitious aim, the St. Joseph’s Health Strategic Planning Department partnered with colleagues across the system to not only develop the plan, but implement it in a way that would be effective and efficient. The unique, collaborative approach paired business unit leaders with project management experts to drive the process, according to Duffy. 

Making this effort more challenging was that the system was due to enter its next strategic planning cycle during the height of the COVID-19 pandemic in 2020-2021. Given that the pandemic hit poorer communities like Paterson “particularly hard,” Brady says, coupling financial goals with those addressing health equity and access was paramount.

Overall, the development of the strategic plan that became known as “Forward Together” took “about 16 months, with a number of stops and starts along the way” caused by the pandemic-related challenges, Duffy notes.

“It was important to have [a] collaborative process because we wanted a robust plan that touched the entire organization,” she recalls. “And we wanted buy-in from every part of the health system, especially coming out of COVID. We wanted a lot of people to feel a part of the plan development process and contribute to it.”

The Plan and Its Implementation

“Forward Together” developed 160 initiatives across three pillars—health access, health equity, and transformation—and eight strategic and foundational priorities (Figure).

As part of the process, the 42 teams involved in the formulation of the plan—each team included an executive sponsor, an operating team lead and a project manager, as well as stakeholders—developed an “action plan” that covered what teams would need over the next six months to implement these initiatives.

As Duffy explains, “this answered questions such as: How do we get started? What are the specific steps? What is the time line? Will this initiative increase revenues and/or reduce expenses? We also looked at what would it look like if we expanded a program or did away with it altogether? How would that impact the [local] community?”

The health system’s planning department graded each of the initiatives proposed by the teams, with “A” indicating they were ready to be implemented as is, according to Brady. Initiatives that received “A” grades included items such as supply chain standardization and improvements to the health system’s lab and pharmacy facilities. Ideas receiving a “B”—which suggested that they were ready to be implemented with more details needed, Brady says—included expansion of the system’s behavioral health and community medicine offerings.

Most of the initiatives received “A” or “B” grades, with others given “C,” “D,” or “I” (for incomplete) and sent back to the teams for further work, Brady recalls.

Nine months after the launch of the “Forward Together” strategic plan, related initiatives had brought St. Joseph’s Health to within 11% of its goal of $40 million in increased revenues and/or reduced expenses. In 2024, “Forward Together” initiatives—the system’s new shorthand for projects started under the plan—yielded $25 million in increased revenues and/or reduced costs. This year, that figure is projected to increase to $35 million.

However, given St. Joseph’s Health’s unique role in its local community—initiatives designed to improve outcomes and address disparities in areas such as perinatal health and diabetes and weight management, were also prioritized as part of the plan. The health system also took a DEI lens to its outreach and purchasing programs, with new emphasis given to working with women- and/or minority-owned businesses as vendors, for example. Progress in these and other areas is monitored regularly by project teams and hospital leadership.

Importantly, initiatives launched under “Forward Together” are implemented like any other major project within the health system, with project managers involved in oversight.

“Overall, this was a very successful process for us,” Brady notes. “With so many people involved, we really saw a lot of engagement in both the plan’s development and implementation, and that made a real difference.”

Brady emphasizes that the process was analyzed and optimized to develop the next plan, which has launched with this new year.