Background The planning-execution gap is one of the main challenges facing any organization. According to the literature, the planning- execution gap is one of the leading causes of strategic and operational plan failure. Because of the complexity of healthcare, planning is more challenging. Inspired by Saudi Vision 2030 and guided by the National Transformation Program 2020, Royal Commission Health Services Program Yanbu (RCHSPY) made its Strategic and Operational Plan 2017–2020. The planning section identified the planning-execution gap as one of the main challenges impeding the progress of RCHSPY plans. This gap can result from many causes, such as ineffective communication, lack of measures and feedback, lack of collaboration, and weak alignment between strategic and operational plans. The planning section tried to study the gap by assessing the existing status and identifying the root causes in RCHSPY, then applying several tools and techniques in order to overcome this gap.

Methods RCHSPY aims to evaluate the involvement and awareness of all staff, particularly front liners and junior staff, about strategic and operational plans to ensure that they are fully oriented about the direction of the RCHSPY and that they feel their daily work is aligned with the direction of the RCHPSY strategic and operational plan. Surveys were carried out to assess the planning effectiveness and the planning-execution gap. The surveys asked staff about orientation, active participation, alignment, collaboration, and understanding of the initiatives and key performance indicators (KPIs). The survey results were supported by the analysis of 2017 and 2018 operational plan outcomes, as some significant findings have been observed.

Results The survey results showed that 50% of staff feel unsatisfied with their orientation, 34% feel unsatisfied about their participation in RCHSPY plans, 27% feel that their daily work is not aligned with RCHPSY plans, 50% feel unsatisfied about collaboration with other departments to implement different initiatives, and 25% replied that they never discussed RCHSPY in their departments. The 2017 and 2018 operational plan analysis of stumbling projects and initiatives showed four main challenges (4C): communication, collaboration, financial and managerial constraints, and connecting departmental KPIs to RCHSPY plans, which support the survey results.

Conclusion More effective communication methods are greatly required, such as interactive workshops and face-to-face meetings, to enhance the involvement and empowerment of all staff in the planning process. Feedback should be delivered to all concerned stakeholders in the form of quarterly reports and KPI results should be discussed at all levels, particularly at the departmental level. Future studies about the planning-execution gap should be done to monitor progress.