Hospital leaders must continuously balance essential operational demands with long-term strategic goals in an increasingly complex healthcare landscape. A practical framework gaining traction is the concept of "big rocks"—critical but non-differentiating initiatives that, while consuming significant resources, sustain hospital operations without driving competitive advantage.

"Big rocks" represent substantial organizational commitments that are crucial to operations but do not inherently enhance market differentiation. These initiatives require extensive resources and attention but primarily serve to maintain hospital functionality rather than provide a competitive edge. Typical examples include facility renovations, electronic health record (EHR) system implementations, and regulatory compliance programs—necessary components of healthcare operations that rarely create strategic distinction.

Organizations often struggle to maintain authentic connections between leadership and staff. While many claim to value transparency, creating meaningful channels for open dialogue proves challenging for most. Through our journey with employee forums, we've discovered that structured, regular communication can transform organizational culture and build lasting trust in ways that occasional updates or mass emails never could.

The impact of these forums extends far beyond simple information sharing. They serve as dedicated spaces where employees can hear directly from leadership about the organization's journey – both its successes and its challenges. For instance, when our organization undertook a major electronic health record implementation, these forums became crucial spaces for sharing progress updates, acknowledging difficulties, and gathering feedback from staff who used the system daily. This direct communication eliminates the speculation and uncertainty that often breeds mistrust in organizations. When employees understand not just what is happening but why decisions are being made, they become more engaged and invested in the organization's success.

Delivering sustainable results requires more than just setting broad organizational targets. It’s about creating a system where every aspect of the organization, from leadership to individual departments, aligns its efforts with a unified purpose. To accomplish this, I propose using a “Pillar” framework by which we measure the success of our efforts across the critical areas of People, Process, and Plan (Employee Engagement/Culture, Lean Process Improvement, and Strategy).

These strategic pillars - Quality, Workforce, Patient Satisfaction, Finance, and Community - serve as foundational guides that shape our future. Each pillar will have overarching organizational goals that cascade down to specific departmental objectives, creating a cohesive framework where every hospital department plays an active role in achieving the organization’s mission.