June 2023 MITE Hot Topic: Strategy Alignment: Working together to achieve common goals

Author: Joyce Doyle, Performance Improvement Specialist, Operational Transformation

Learning Objectives:

  1. Understand the 4 major steps of strategic alignment
  2. Know when and how to start a Catchball conversation
  3. Connect daily improvement work and organizational goals

MaineHealth has been taking part in a structured approach toward improvement for the past 10 years – Operational Excellence and Lean/Six Sigma. In that time we have seen a great deal of successful improvements. So why have we not realized wide-spread improvements on our system-wide measures like the quality dashboard, patient experience scores, and strategic aims? The answer is that many of these improvements occurred in pockets across the system without alignment to the larger goals.

As MaineHealth transitions to a five-year strategic plan, we are simultaneously reviewing and revising our approach toward improvement. While maintaining the tools and methodology, we are now adopting and adapting the concepts of strategic alignment to provide focus for our improvement efforts. Hoshin Kanri is a Lean term that translates to direction or compass needle, and control or management – essentially, strategic alignment. Adding Hoshin, or direction, to the continuous improvement we have been doing will result in more meaningful influence in our outcomes.

Figure 1: Relationship of Daily Management and Hoshin¹

By implementing strategic alignment, MaineHealth looks to narrow what Michael Mankins and Richard Steele termed the “strategy-to-performance gap.”2 In their assessment, many organizations fail to properly communicate the strategy outlined by the leadership, resulting in frontline teams not understanding what they need to do. To avoid that, we are employing our existing Daily Management workflow – the organizational huddles, Gemba, Improvement Boards and KPIs – to develop a robust, systematic approach to alignment.

Here are the four major steps toward achieving this:

  1. Create a Strategic Plan. MaineHealth leaders have developed a single plan for the entire system with five-year and fiscal-year goals, which is being tracked and updated on a system scorecard.
  2. Develop Tactics. We break down those broad objectives identified in the strategic plan, and translate them into actions designed to a specific end. The MaineHealth Scorecard is tied to Local Health System Scorecards, which in turn feed the team/unit Department Scorecards. Using a Driver Diagram, we can consider what activities influence the broader goals, and align each level of the work to set targets that will help us succeed together.
  3. Take Action. Using Improvement Boards, KPIs, projects, and Kaizen events, teams will implement changes in their ongoing processes which they can track back to show influence on outcome goals. Each action is supported by data.
  4. Review and Adjust. We must have open lines of communication – both vertically and horizontally. This is commonly called “Catchball,” but instead of a ball we toss knowledge back and forth to one another. What scorecard goals are teams focused on now? What actions are being taken to impact that goal? What barriers need to be moved? How can we work together? These are the questions that need to be asked and answered by everyone. And as we hear what others are doing, we adjust our own timelines and improvement work.

What does this mean to you? To be successful, everyone needs to take part. The first step is to talk with teams, co-workers, and supervisors about prioritized goals. You must know your Wildly Important Goal that needs to be accomplished in order to provide a focus for any improvement work moving forward.3 Once you know your focus, you’re ready to make meaningful improvement. Join in a Gemba, talk about goals during team huddles, take part in Improvement Boards and data collection. By understanding how our daily work affects other MaineHealth teams and the organization as a whole, and engaging in focused improvement, we can get closer to our True North: to make our communities the healthiest in America.

You can learn more about Strategic Alignment tools including Department Scorecards and Idea Generation, and find tools and templates, on the Operational Transformation-OpEx website.


  1. “Why You Should Link Hoshin Kanri with A3 Problem-Solving,” by Mark Reich. Lean Enterprise Institute. July 30, 2020. Why You Should Link Hoshin Kanri with A3 Problem-Solving – Lean Enterprise Institute
  2. “Turning Great Strategy Into Great Performance,” by Michael Mankins and Richard Steele. Harvard Business Review. July-August 2005. https://hbr.org/2005/07/turning-great-strategy-into-great-performance
  3. Covey, Sean. 4 Disciplines of Execution. Simon & Schuster, 2015.

Additional reading:

“Alignment is an Essential Foundation for Healthcare Organizations’ Goal Setting,” HealthStream. April 1, 2021. https://www.healthstream.com/resource/blog/alignment-is-an-essential-foundation-for-healthcare-organizations-goal-setting
Dennis, Pascal. Getting the Right Things Done. Lean Enterprise Institute, 2006.

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