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TABLE OF CONTENTS
Strategic Prioritization: Why Your First Move Might Be Your Biggest Mistake
Discover how our approach to strategic prioritization can transform your organization and impact
This is part of a series on problem solving for innovations that scale
1. Goals and Metrics
Tech-Enabled Services Versus SaaS Business Model: Key Metrics
How To Achieve Financial Sustainability Without Sacrificing Impact
2. Problems
Strategic Prioritization: Why Your First Move Might Be Your Biggest Mistake
How To Get Results With Business Process Optimization
How to Find Your Ideal Client
3. Solutions
How To Eliminate Chaos With Backlog Prioritization
How to Prevent Scope Creep in Your Innovation Strategy
Strategic Decision Making Framework: Don’t Miss This Essential Tool
Process Improvement for 20 Extra Hours a Week
4. Team & Execution
How to Build Accountability in a Team: Your Essential Guide
Successful Innovation Strategy Requires Internal Alignment
The Challenge of Strategic Prioritization
Imagine you are the executive director of a community-based healthcare organization.
For years, your programs have relied on dedicated staff and volunteers to deliver essential services—from chronic disease management to maternal health education. Yet as demand grows, so does the pressure on your team.
Manual processes—such as paper-based patient records, handwritten appointment logs, and limited in-person consultations—are no longer sustainable. You know that transitioning to scalable, technology-enabled solutions is essential, but the many bottlenecks in your processes make it difficult to determine where to begin.
You are juggling multiple responsibilities, overwhelmed by the sheer number of priorities competing for your attention. The challenge of managing these competing demands leaves you frustrated and uncertain about where to focus your efforts. Every issue feels critical, and every decision seems weighty.
Faced with this overwhelming complexity, your first instinct might be to tackle the most visible issue or problem, implement a shiny new technology, or simply address the loudest complaint. But beware: your first move, driven by urgency or impulse, could be your biggest mistake.
These methods all share one key flaw: they lack a structured framework for identifying where you can achieve the biggest impact with the same resources.
Our approach to strategic prioritization urges you to begin with goals and problems first (instead of starting with solutions), using specific, carefully-chosen criteria to cut through the noise and focus on high-impact areas.
In the sections that follow, we outline key strategies for effective prioritization and introduce three practical criteria to help you identify top-priority problems and create clarity amidst the chaos.
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Strategic Prioritization: A Clear Goal Is A Prerequisite
Before diving into the heart of this piece—how to prioritize problems—it's crucial to acknowledge a fundamental prerequisite: a clear, prioritized goal or outcome.
While this piece doesn't focus on how to select or define your primary objective, having one in place is essential for effective problem prioritization.
Clear goals are specific, measurable, and time-bound objectives that align with an organization's mission and vision. They provide the context and direction necessary for identifying and prioritizing the problems that stand in the way of success.
For the purposes of this article, let's assume you've already established your primary goal through careful consideration and stakeholder input: "Increase patient capacity by 40% within the next two years while maintaining or improving quality of care.”
This goal aligns with the growing demand for community health services and the need for scalable solutions in healthcare delivery. It's specific, measurable, time-bound, and directly addresses the challenge of expanding access to care, which is a key factor in reducing preventable emergency room visits.
Strategic Prioritization: Challenges Are Your Fuel
The temptation to jump straight to solutions is strong.
For instance, you might decide to invest heavily in opening new clinic locations, only to later discover that physical space wasn't the primary barrier to increasing capacity. This well-intentioned impulse often leads to misaligned efforts and wasted resources.
Instead, by understanding the issues at their core, every subsequent action aligns with your mission and produces measurable outcomes.
(1) Conduct a comprehensive problem audit based on your goal
Gather input from all levels of your organization—from frontline staff to board members—using surveys, focus groups, and one-on-one conversations about what the biggest barriers to patient capacity are.
Take special care to consider highly the opinions of stakeholders closest to the problem. Their inclusion is crucial because they often have the most accurate and nuanced understanding of day-to-day challenges that impact the organization's goals, insights that can be overlooked by higher-level management or those not directly involved in the relevant processes. For example, receptionists and clinic coordinators might identify specific bottlenecks that aren't apparent to executives but significantly hinder the goal of increasing patient capacity.
Additionally, review key internal processes and customer journeys to identify the biggest bottlenecks in reaching your goal, whether to attract customers and deliver value. Doing so might reveal pain points and inefficiencies that might not be apparent through conversations alone. For more on journey mapping, see below.
Series about journey maps and north star moments to improve retention and delight
B2B Customer Journey Mapping: A Missing Link
The North Star Framework for Effective Member Retention
North Star Metric Framework: Five Key Changes to Make Today
What’s Missing In Your Donor Journey
(2) Define the problem more precisely
For instance, if patient throughput is a major bottleneck, ask questions to find out where the problem is most concentrated. For instance, is capacity most restricted for specific practices, patient populations, or time of day? Try to understand patterns based on the data you already have.
(3) Dig into the problem
Work with stakeholders closest to the problem to identify what differentiates the top 20% of situations that are most bottlenecked? What’s been tried already? Why haven’t these issues been fixed yet?
In our example, this analysis might reveal that the root problem isn't just a lack of physical space or staff, but inefficient processes and outdated technology hindering scalability.
Even if expanding clinic locations could be an important step to consider eventually, it is not the right time given your resources. Instead, it is more effective to focus on streamlining tech-enabled patient intake or triage processes to maximize your capacity before making a large upfront investment.
This method helps you avoid costly mistakes and positions your organization to make more substantial progress towards your goal of increasing patient capacity.
Strategic Prioritization: Criteria Enables Focus
Through root cause analysis and talking to numerous stakeholders, you're left with a list of potential problems hindering your goal of increasing patient capacity by 40% within two years.
Now, the challenge is determining which problem to focus on tackling first.
I offer three battle-tested criteria that can help you sift through the noise to prioritize the most impactful problems.
Let's start with the first criterion: Is it a core problem?
Prioritization Criteria: Core
Let's start with the first criterion: Is it a core problem?
Not all problems are equal in their impact on your goal.
Some issues, though noticeable, may have little effect on your ability to increase patient capacity; others, though less apparent, can significantly influence your organization's ability to scale.
The challenge is to differentiate these and pinpoint the core problems that truly matter.
To prioritize effectively, assess problems based on their impact on your primary goal (i.e., in our running example increasing patient capacity by 40% while maintaining quality of care).
Additionally, consider issues that contribute to gaps in key performance indicators or result in underperformance against competitors. This approach ensures that your efforts address the most critical challenges facing your organization.
Estimate potential improvements if a problem is resolved, or assess the decline in your goal if the problem remains unresolved.
Example
Going back to our example, evaluate each identified problem on its impact on patient capacity.
- While precise estimates are helpful, initial accuracy is less critical. You can use an "evidence quality" score later to assess confidence in these estimates.
- Alternatively, if such estimates are not possible, a simple 1-4 scale can distinguish between high and low impact problems (see last column)
Problem | Current Impact | Estimated Impact if Solved | Potential Contribution to Goal | Core Score |
Ineffective Patient Scheduling System | 20% of slots (200/week) unfilled or double-booked | Reclaim 160 patients/week, 16% capacity increase | 40% of needed increase | High (4) |
Issues with the current Electronic Health Record | 5% of appointments (50/week) run over by 10 minutes | Free up 25 slots/week | 6.25% of needed increase | Low (1) |
Patient Follow-up Process | 15% of appointments (150/week) used for potentially remote follow-ups | Free up 75 slots/week for new patients | 20% of needed increase | High (3) |
Inefficient Clinic Layout | 2% of appointments (20/week) delayed due to room availability | Reclaim 10 appointments/week | 2.5% of needed increase | Low (1) |
In this analysis, addressing the ineffective patient scheduling system may have the highest impact on the core score, contributing 40% to the capacity goal. The patient follow-up process ranks second, contributing up to 20% of the increase.
As you refine your problem analysis skills, consider estimating each problem's contribution to your goal based on key mechanisms and levers. This approach helps create a solution portfolio that maximizes your chances of reaching your goal, potentially addressing a set of problems that collectively exceed 100% of your needed increase.
Prioritization Criteria: Unmet
Many organizations mistakenly address only the complaints that are voiced or focus on areas presumed important by mission, leading to solutions for problems not seen as urgent by stakeholders.
A more effective strategy is to focus on areas where stakeholders are struggling and actively seeking improvement or assistance.
This desire for help typically stems from three key factors:
- Significant gaps in key performance indicators or underperformance against competitors
- Processes that drain energy or represent weaknesses
- Critical processes hampered by limited time, budget, or personnel
By addressing these areas, organizations can prioritize improvements that deliver the highest impact and secure strong stakeholder support.
We want to identify areas where relevant stakeholders, including those closest to and own improving the problem, feel they need help, rather than just what they consider important.
This distinction is key for uncovering true unmet needs, indicating that current solutions—your indirect competitors—are inadequate. This presents an opportunity for you to assist them in achieving their main goals.
Additionally, this approach allows you to connect with stakeholders where they are. Trying to convince them to address unrelated issues they do not see as problematic can be less effective. While challenging their perspective can be valuable, it is often better to wait until you have established trust.
Example
Let’s return to your goal of increasing patient capacity by 40% within two years while maintaining quality of care. After conducting stakeholder interviews and observational studies, you identify several potential areas for improvement.
Stakeholders closest to the problem were asked to rate their perceived need for improvement on a scale of 1 to 4, where 4 indicates a high need for improvement or help.
Problem | Stakeholder Comments | Perceived Unmet Need Score |
Ineffective Patient Scheduling System | "The scheduling system is okay, but it could be much better." | Highest(4) |
Issues with the current Electronic Health Record | "We really need a new EHR system." | High (3) |
Patient Follow-up Process | "Follow-ups are somewhat important, but we manage okay." | Moderate (2) |
Inefficient Clinic Layout | "We really need more space." | Highest (4) |
The Patient Scheduling System emerges as the top priority, scoring high on both perceived unmet need and core impact. This indicates a critical area for improvement that directly aligns with the organization's capacity goals.
In contrast, the patient follow-up process is more challenging to address because relevant stakeholders who are closest to the issue do not view it as a significant problem needing improvement. This perspective aligns with the Core score as well.
Prioritization Criteria: Urgent
The final element of strategic prioritization is urgency—assessing the extent of active problem-solving and the presence of critical deadlines to distinguish between issues that demand immediate action and those that can be addressed gradually.
Urgency reflects not only how much time, energy, and resources are currently being allocated to solving a particular problem but also whether there are looming deadlines where missing them could result in major negative consequences, such as regulatory penalties or failed audits.
Begin by clearly defining what constitutes an urgent problem for your organization, setting criteria that differentiate true emergencies—such as hard deadlines with significant repercussions—from less critical concerns or "fake deadlines" driven by internal pressures. Then, evaluate the degree of active problem-solving by observing the formation of task forces, overtime work, resource reallocation, or efforts to meet externally imposed deadlines.
Example
For example, you observe the following levels of active problem-solving for its identified challenges. There are no external deadlines for any of these problems, so that is not a relevant concern.
Problem | Observed Behavior | Urgency Score |
Ineffective Patient Scheduling System | Staff use manual workarounds and spend extra time managing appointments. Discussed in nearly every staff meeting. | Highest (4) |
Issues with the current Electronic Health Record | Staff have adapted well to the current system. Rarely discussed in meetings or solutions proposed. | Low (1) |
Patient Follow-up Process | Clinicians stay late to contact patients who miss follow-ups. Ongoing discussions and efforts driven by staff to improve outreach efforts. | Highest (4) |
Inefficient Clinic Layout | No current discussions or task forces for redesigning or expanding space. Staff seem content with current utilization. | Low (1) |
The Patient Scheduling System emerges as the most urgent issue, with staff actively implementing workarounds and frequently discussing it, indicating a pressing need for improvement.
In contrast, the EHR System and Clinic Layout show low urgency, as staff have adapted to the current EHR and seem content with the existing space, suggesting these issues, while potentially important, are not causing immediate operational challenges.
Example: Strategic Prioritization with Three Criteria
To prioritize effectively, you must evaluate problems holistically across all three criteria—Core, Unmet Needs, and Urgency—ensuring resources are directed toward issues with the greatest overall impact.
Problem | Total (average) | Urgency Score | Perceived Unmet Need Score | Core Score |
Ineffective Patient Scheduling System | Highest (4) | Highest (4) | Highest (4) | Highest (4) |
Issues with the current Electronic Health Record | Low (1.6) | Low (1) | High (3) | Low (1) |
Patient Follow-up Process | High (3) | Highest (4) | Moderate (2) | High (3) |
Inefficient Clinic Layout | Moderate (2) | Low (1) | Highest (4) | Low (1) |
Holistic Analysis
You should prioritize addressing the patient scheduling system first due to its high scores across Core, Unmet Needs, and Urgency. Solving this issue will have the most immediate and measurable impact on increasing patient capacity.
The next priority should be improving the patient follow-up process, which supports long-term scalability despite being slightly less direct in its impact.
Problems like the EHR system and clinic layout can be postponed or deprioritized entirely until more pressing challenges are resolved.
By synthesizing these criteria holistically, you ensure your resources are focused where they will have the greatest overall effect on achieving its mission to scale services while maintaining quality care.
Prioritization Criteria: Secondary Filters
Secondary filters are useful tools for narrowing down your focus when deciding between your top problems. They help refine your priorities without adding unnecessary complexity to the initial analysis.
These filters are particularly valuable for breaking ties between problems that appear to score closely together, ensuring your efforts are directed toward the most actionable and meaningful solutions.
Here are some secondary filters to consider that I’d put in order of importance.
(However, if any of the following secondary filters strongly resonate with you, consider replacing or adding it to your top list of primary filter criteria. It's generally advisable to keep your primary criteria to three or fewer to keep the process manageable.)
(1) Evidence Quality
If you only have room for one additional secondary criterion from this list, choose evidence quality.
Evidence quality measures your confidence in your scores, not by gut feeling or the loudness of opinions, but by evaluating the strength of supporting data.
This criterion helps prevent focus on "phantom" problems that may not actually be causing the issues you suspect.
This approach naturally supports a stepwise scaffolding method, particularly useful when tackling big problems. By taking small, quick steps to gather better data, you incrementally improve your confidence in scores and "level up" your evidence quality. This iterative process not only refines your understanding but also makes complex problems more manageable over time, breaking them into smaller, evidence-backed components.
Consider these contrasting examples:
A high-scoring problem on evidence quality is supported by multiple or high-quality sources, such as stakeholder interviews, operational metrics, and direct measurements.
For instance, if both staff surveys and appointment data confirm scheduling inefficiencies, this strengthens the case for prioritizing that problem over one based solely on anecdotal feedback.
Conversely, a lower-scoring problem might be based purely on intuition. For example, if you conducted a 5 "whys" exercise alone, without input from those close to the problem, the evidence quality would be weaker.
Ultimately, evidence quality encourages a stance of intellectual humility and curiosity, challenging your and your team’s own assumptions. By making evidence-based decisions, you counteract those based on speculation, bias, groupthink, or the loudest voices in the room.
For more on this incredibly critical concept and how to use it systematically, see:Strategic Decision Making Framework: Don’t Miss This Essential Tool
(2) Feasibility
Feasibility is my close second. When other top factors are equal, prioritize simpler and easier problems to solve, as these represent quick wins.
Feasibility assesses how likely you are to solve a problem cost-effectively and efficiently, considering your team's strengths, resources, and limitations. Problems score higher in feasibility when they have fewer dependencies, lower costs, or align with your team's strengths. These are easier to address without requiring significant operational changes or external support.
For instance, implementing a software update for scheduling may be far more feasible, aligning with your internal team's strengths, than redesigning clinic layouts. The latter could involve construction, regulatory hurdles, and hiring unfamiliar third parties due to a lack of internal expertise—creating additional dependencies and complexity.
By prioritizing feasible yet core problems, you can achieve tangible progress quickly, building momentum and confidence for tackling more complex challenges later.
(3) Pervasive
Pervasiveness refers to how widespread the problem is. The wider the problem, the broader your impact.
Consider how its pervasiveness not just within your organization but also across your broader market or stakeholder base.
A pervasive problem impacts many people or processes, making it a higher priority due to its potential for broad-reaching benefits.
For example, addressing a scheduling system that affects nearly every clinic staff member and patient is more impactful than fixing an isolated issue idiosyncratic to your clinic or a subset of your patients.
While important, pervasiveness is less critical than evidence quality or feasibility. A seemingly pervasive issue may be a phantom one that does not truly affect people very much. Or it could be too resource-intensive, which may harm your team morale and the organization’s sustainability if you pursue it too early.
(4) Dependency
Will tackling this problem today save you time and headache later?
Dependency checks whether delaying action will increase the difficulty or cost of solving the problem in the future.
Consider if the issue must be addressed early due to its significant impact on fundamental aspects like design or architecture. Identifying these dependencies late can severely delay projects.
For instance, consider a clinic using an outdated patient record system that lacks interoperability with modern healthcare technologies. The longer the clinic waits, the more complex and costly the eventual transition becomes, potentially requiring extensive data migration, staff retraining, and temporary disruptions to patient care.
Consider a clinic using an outdated patient record system that lacks interoperability with modern healthcare technologies. The longer the clinic waits, the more complex and costly the eventual transition becomes, potentially requiring extensive data migration, staff retraining, and temporary disruptions to patient care.
Dependency ranks lower than evidence quality because perceived future work is a common area where phantom problems can emerge. Feasibility and pervasiveness also rank higher, as it often makes more sense to build quick wins for more people and gather resources before tackling less urgent but systemic issues later.
Example Prioritization Criteria: Secondary Filters
You choose to use three criteria (pervasive, feasibility, and evidence quality) to better compare your top two problems. Considering how limited your staff is, you decide to focus on just one major problem for the quarter.
Problem | Pervasive Score | Feasibility Score | Evidence Quality Score |
Ineffective Patient Scheduling System | High (4). Affects all staff and patients daily, impacting every appointment scheduled. | High (4). Can be addressed with software updates and staff training, requiring minimal physical changes, and dovetails well with internal team strengths and tooling. | High (3). Problem supported by appointment data, staff surveys, and patient feedback, providing a comprehensive view of the issue. |
Issues with the current Electronic Health Record | Moderate (3). Impacts a significant portion of patients requiring follow-ups, but not all appointments. | Moderate (3). Requires development of new remote follow-up systems and potential changes to clinical workflows. | High (4). Well-documented problem through clinician time logs, patient retention rates, and comparative studies with other clinics. |
Your analysis shows that the patient scheduling system impacts nearly all staff and patients, can be efficiently resolved with software updates, and is strongly backed by operational data and staff feedback. It continues to be the highest priority overall, even after this secondary analysis, reinforcing your decision to dedicate time to address this issue in the upcoming quarters.
Strategic Prioritization: From Problems to Solutions
Now that you’ve prioritized your problems, now you can identify the best solutions to them.
The next item in the series will dive deeper into best practices and key criteria to do so.
👉 What’s your biggest challenge in this process? Share your feedback here or toggle by clicking.
This is part of a series on problem solving for innovations that scale
1. Goals and Metrics
Tech-Enabled Services Versus SaaS Business Model: Key Metrics
How To Achieve Financial Sustainability Without Sacrificing Impact
2. Problems
Strategic Prioritization: Why Your First Move Might Be Your Biggest Mistake
How To Get Results With Business Process Optimization
How to Find Your Ideal Client
3. Solutions
How To Eliminate Chaos With Backlog Prioritization
How to Prevent Scope Creep in Your Innovation Strategy
Strategic Decision Making Framework: Don’t Miss This Essential Tool
Process Improvement for 20 Extra Hours a Week
4. Team & Execution
How to Build Accountability in a Team: Your Essential Guide
Successful Innovation Strategy Requires Internal Alignment
Three Ways Joyful Ventures Can Help You
• 🔨 Template - Request it from our innovation advisors
• 🔎 Free Audit - Unlock growth with our innovation advisory
• 💌 Newsletter - Subscribe for innovation strategy insights👇
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