Phase I:
Our goal during this phase is to determine the broad content for the program. To accomplish this, we interview key physician, administrative, and nursing leaders to help us identify some of the organization's most pressing problems and evolving needs. We then determine the tools and skills that its physicians and other healthcare leaders need to address them.

There are four elements in our Phase I analysis:

• Strategy: What is the organization's strategy? Where is it headed? How much risk will it be assuming? What are its relationships with other healthcare organizations?
• Activities: What activities must the organization do well to achieve its strategy and which of these need additional development? For example, what operational capabilities need improvement? What systems and processes need modification?
• Tools: What conceptual capabilities are need to carry out the necessary activities (e.g. systems thinking, total quality management, management control system design)?
• Skills: What specific competencies and skills are needed to use the tools effectively (e.g. variance analysis between budget and actual results)? These skills tend to be in three areas: critical thinking, technical, and interpersonal.

Based on the information obtained from our interviews, we prepare a curriculum overview for the organization's review. We discuss it with senior management and make any needed changes. We then ask senior management to sign off on this document as the basic building block for Phase II.

Phase II:
Once we have sign-off on the curriculum overview, we begin the more detailed curriculum design effort. This includes:

• Selecting appropriate materials
• Determining how those materials should be presented (e.g., small groups, large didactic sessions)
• Sequencing the materials in the most appropriate way
• Identifying the most appropriate pedagogical techniques to use with the materials (e.g. case discussions, role playing, lectures, small group exercises)
• Choosing and scheduling faculty

We then prepare a detailed syllabus that includes the specific materials we intend to use and the learning objectives for each class session. We discuss our syllabus and thinking with senior management, and again make any needed changes.

Once the syllabus is complete, and senior management has signed off on it, we can move to Phase III.

Phase III:
In this last phase, we finalize all scheduling and logistics, distribute course materials and preparation guidelines to participants, and actually conduct the program.