There should be a steering group within the HO to lead the development and implementation of a strategic plan; this group should represent all interests and include people with leadership skills. Ideally, this group should be led by its chief representative,who will act as the driving force and display strong commitment to the project and should include someone who is familiar with SP methodology. The group must have real executive power to avoid being perceived as a mere planning entity. When the HO is sufficiently large, it is very useful to provide a specific physical space (the SP Office), which is the epicenter of the planning process. Sometimes an ‘‘external facilitator’’ for SP is contracted; this is the person in charge of organizing, motivating, and networking all actions, giving them shape and connecting them in time and space. When required by the circumstances, this is a role often assigned to a consultant. To address the different aspects of analysis and generate ideas, working groups have to be created that report to the steering group. These should be cross sectional and well coordinated to avoid duplicating work and to fully focus on the assigned tasks. The number of these groups will increase, the greater the size of the HO for which they are attempting to plan. One aspect that may adversely affect the planning process is associated with the relative lack of strategic thinking among the health workers in the HO service.Healthcare professionals manage short-term situations very effectively and make quick decisions based on current diagnosis and treatment models and algorithms, which serve as a guide in taking clinical decisions. The long-term features very little in their daily work, which requires practical and immediate answers to specific problems that are usually tangible and quantifiable. Their work is usually efficient within the known, due to its repetitive nature. In contrast, physicians manage uncertainty and vagueness with difficulty and do not go looking for problems as these tend to arrive on their doorsteps and are usually routine. Physicians have a working philosophy of ‘‘hands-on’’ and ‘‘first line of action.’’ Strategic
planning may present them with a challenge because they have to face problems that are not well defined, have no known
precedents, evolve unpredictably, are barely quantifiable, and yet require a response. Physicians have problems dealing with ambiguity and problems that cannot be systematized. To minimize any undesirable effects, the difference between
the professional skills specific to physicians in the HO services and those required when they are placed in the position of participating in or leading a strategic plan should be taken into account.