The U.S. healthcare industry presents many challenges for healthcare leaders, including an aging population, lower reimbursements, staff shortages, information security, and regulatory and legislative burdens. To address these issues, leaders need to balance limited resources and adapt new knowledge into practice. Failure to do so places the health of their organization and patients at risk. To address these challenges and reach their desired vision, healthcare leaders need to think strategically.
A connection can be drawn between the strategic planning carried out by healthcare leaders and the strategic planning used in the game of chess. By learning about the nuances of chess, healthcare leaders may improve their strategic planning process. Those who adopt this chess-based planning model may be better equipped to provide the most important solutions for their organization, improving the health and experience for their teams and patients.
How healthcare leaders address challenges
In 2013, Harvard Business Review identified six defining actions of strategic leadership: anticipate, challenge, interpret, decide, align, and learn.1 In his seminal 1980 book, Competitive Strategy: Techniques for Analyzing Industries and Competitors, Michael Porter identified various strategies to enhance competitiveness.2 Other models have been designed around competitive strategy, and Porter’s continues to be a well-known framework.3
Using these models and competencies, healthcare leaders can address everyday and long-term challenges, finding solutions when making compromises and evaluating trade-offs. While every challenge is unique, the strategic decision-making process used to evaluate trade-offs and address challenges by healthcare leadership is reminiscent of the competitive strategy implemented by chess players.
Chess as a model
1. Phases of a chess game
A game of chess can be split into three main parts: the opening, middlegame and endgame. Each part requires a different strategy and mode of thinking. For instance, opening moves often follow the same few strategic principles. The middlegame is the least predictable and premeditated part of the game. As a result, there are endless strategies that can lead to success. During the endgame — the final chapter of a game of chess — the margins for error are very slim, and an expert player must be paying close attention and have a clear vision to win. Understanding every part of the game and the correct transitions between phases is crucial.
Healthcare leader viewpoint: Evaluate the situation
A healthcare leader must understand short, middle and long-term planning and recognize the differences to be successful. For example, leadership efforts in a recently formed organization, potentially the result of a merger, will likely need to address historical and evolving customs, goals, assumptions, markets, differentiators, competitive landscapes and product/place/pricing/promotion decisions of the new entity. Established organizations, in addition to continuing to address these topics, may draw on assessments of strengths, weaknesses, opportunities and threats (SWOT). Project management and process improvement may be increasingly important in optimizing systems for increased effectiveness. Mature organizations will likely focus on other priorities such as operational excellence and the need for practice transformation.
- Learn more: A member-benefit SWOT analysis tool and overview of how to fill each quadrant is available online at mgma.com/swot-tool.
2. The king
In chess, all strategy and planning begin with two goals in mind: attacking the opponent’s king and defending your king. Simply put, “[the king] is the focal piece of the game.”4 Without a checkmate of the king, a player cannot win the game no matter how much he or she has dominated the opponent. Chess masters keep this objective in the back of their minds from opening to endgame.
Healthcare leader viewpoint: Focus on the needs of the patient
In healthcare, a successful leader must also promote an organizational vision that emphasizes high-value patient care. Research and innovation only become beneficial when providers translate the science and actualize improved health and outcomes for patients. An effective healthcare leader must always keep in mind how actions affect patient health. The unique organizational mission, vision and value proposition need to be central and top of mind when shaping decisions related to patient care and the entire patient experience.
3. Development of pieces
In modern chess, every player starts with eight pawns, two rooks, two knights, two bishops, a queen and a king. What separates the winner from their opponent is the ability to ensure their pieces are working together, they take advantage of each piece’s strengths, and they engage as many pieces as possible. This concept is referred to as development. From start to finish, development is a key part of strategy. Each move must be made to strengthen the player’s position and account for every piece to be successful.
Healthcare leader viewpoint: Optimize employee development
Organizational learning and leadership development are key challenges that must be attended to by all healthcare leaders. Every leader must possess the ability to enhance teamwork and engage talent. Diversity, equity and inclusion (DEI) are essential to creating environments where all colleagues are welcome and are given unique and creative opportunities to thrive. Leaders must be attentive to budgets, talent management processes and other available resources. They then must create an effective system that fosters synergy among these resources and use their strengths to achieve the best possible outcomes. For example, as part of the development strategy, healthcare leaders should focus on all the pieces; i.e., strategic hiring, mentoring, development planning, coaching and succession conversations.
4. Sacrificing and exchanging
From the start of a game of chess to the end, pieces are developed, captured or traded by players to enhance their chances of winning. However, trading away pieces with no purpose will not bring a player closer to victory. When chess masters exchange their pieces, they do so to gain a competitive advantage. These advantages include realizing a material advantage, recognizing a positional advantage, eliminating key pieces, facilitating an attack, coordinating the defense or reducing their competitor’s activity.5 At the expert level, it is even common to sacrifice pieces. Experts may give up one of their pieces to gain a developmental edge or guarantee future tactical opportunities. There is a plan behind it that ultimately leads to victory.
Healthcare leader viewpoint: Prioritize investments
Leaders are continuously faced with a finite amount of resources that they must utilize in the best way to achieve success. They must carefully examine existing processes and strategically focus on ways to eliminate waste, simplify and automate. Keeping in mind that letting go of certain processes or ways of working will give the organization an edge in pursuing higher-value goals. Effectively acquiring and managing human and capital resources to recruit and retain the best physicians, allied health staff, and technology is critical in achieving desired outcomes. Leadership tactics include strategic planning and thinking, competitive scenario planning, return on investment analyses and value-stream mapping to optimize patient care.
In chess, a key to victory is being able to weaken the opponent’s forces by taking his or her pieces without losing any of yours. There are a variety of different tactics, but they all have the same objective: to capture your opponent’s pieces while keeping yours. One of the most common tactics in chess is the “fork,” which occurs when you move a piece to a position where it attacks two of your opponent’s pieces simultaneously. Since your opponent has only one turn until you move again, he or she can only move one of the pieces under attack. Thus, on your next turn, you may capture the other piece.
Healthcare leader viewpoint: Optimize value creation
The comparison with chess strategy is applicable as healthcare leaders must keep in mind that resources are limited, but problems and opportunities are nearly infinite. When they effectively invest resources to obtain and deploy physicians, allied health staff and technology, the likelihood of success will increase. Healthcare leaders will benefit by utilizing lean thinking, agile methodologies, value-stream mapping, kaizen events and other process improvement strategies, which can help identify and eliminate waste that will ultimately optimize the value created by the team. Similar to the moves of the chess master, these strategies will align the vision with objectives and key results. Examples include enhanced patient relationship communication with the use of digital technologies, artificial intelligence and other transformational tactics.
6. Time management
There are also psychological aspects practiced, mastered and integrated into the strategic approach by chess masters. One example is time management. In competitive chess, each player is normally given a certain amount of time to make a move. This is regulated by a chess clock. If the opponent runs out of time, he or she will lose the game. Players must manage the clock.6 To do so, there are a few key strategies to follow:
- Don’t spend too much time on obvious or premeditated moves.
- Allocate enough time when creating and visualizing the plan but less time when executing the plan.
- Always continue to think and strategize when it is your opponent’s turn and anticipate his or her move ahead of time. This strategy is strongly emphasized by some of the world’s greatest chess masters, as “predicting your opponent’s moves and understanding [their] patterns of thinking is an indispensable part of calculation.”7
These clock management strategies are often utilized in competitive chess and show the importance of mastering the psychological component of the game.
Healthcare leader viewpoint: Focus on operational excellence
Successful healthcare leaders strategically plan like a chess master by applying various strategies, such as:
- Carrying out short-term, medium-term and long-term plans, understanding that not everything can be done at once.
- Keeping the ultimate objective in mind: the health and experience of their patients.
- Using teamwork and talent management strategies to create optimal cohesion between physicians, allied health staff and technology.
- Budgeting capital and resources aligned with organizational objectives and key results.
- Determining the best way to deploy resources for maximum efficiency.
Keep the game of chess top of mind as you launch annual and ongoing strategic planning. Applying this strategic decision-making process may help healthcare leaders plan for and execute strategies in complex, uncertain and changing circumstances. Leaders will achieve success by staying engaged from opening to endgame, learning new ways to evaluate the continuous challenges and trade-offs they face each day.
- Shoemaker PJH, Krupp S, Howland S. “Strategic Leadership: The Essential Skills.” Harvard Business Review. January-February 2013. Available from: bit.ly/3kb6JIk.
- Porter ME. Competitive Strategy: Techniques for Analyzing Industries and Competitors. 1980. Free Press, New York.
- For Porter’s Five Forces Model and other business frameworks to consider, visit bit.ly/3wya0UA.
- Hellsten J. Mastering Chess Strategy. 2010. Gloucester Publishers Limited, London, 78.
- Pachman L. Modern Chess Strategy. 1963. Dover Publications Inc., New York, 2 and 73.
- Naroditsky D. “The Art of Time Management.” Chess.com. July 15, 2019. Available from: bit.ly/3k9XqIv.
- Weeks M. “Phases of a Chess Game.” Chess for All Ages. Available from: bit.ly/3wB5HI6.