Ensuring Success A Local Approach to Strategic Planning

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Ensuring Success A Local Approach toStrategic
Planning

• Brian Shockney, HFA, FACHE

Vicki Byrd, BA
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Memorial Hospital

• Founded in 1925
• Located in Cass County, Indiana
• County Not-For-Profit
• 7 member Board of Trustees
• 83 Acute Care Inpatient Beds
• 120 Million Gross Revenue
• Memorial Hospital Foundation
• Third Largest Employer in Cass County

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Mission Your Community Resource For Optimal
Health Vision Memorial Hospital is a progressive
market leader that utilizes innovative services
and technology to provide compassionate,
customer-centered care. We are committed to
health and wellness to achieve an optimal
quality of life.
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Our Values
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Objectives

• To share with you a journey that creates success
• To help you realize that none of this is
  revolutionary every organization can do it
• Ignite the desire to ensure planning and strategy
  are an important part of your organizations
  ongoing responsibilities
• Learn at least one new concept or idea

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Start With A New Mindset

• The Kind of Thinking That Got Us Into The Problem
  Wont Get Us Out Albert Einstein
• Success Is Most Appropriately Measured Not By
  What We Have Accomplished, But By The Difficulty
  Of The Questions We Are Willing To Address Paul
  Hawken
• Luck Is A Matter Of Preparation Meeting
  Opportunity Oprah Winfrey

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Why Develop Strategic Plans?

• If you fail to plan then you plan to fail
• Performance is the key to success
• Solves major issues through reflecting on the
  whole organization (seen and unseen)
• Communicates to everyone what is important

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So Many ModelsTo Choose From
BASICS
Goal-Based
Self-Organizing
Curriculum-Based
A-B-C-D
Bottom-Up
Issues-Based
Listening To The People
Scenario
Organic
Top-Down
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Free Advice

• The model is not important.
• What is important is to ensure the process and
  structure fits the culture of your organization.

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Formal Planning

• Builds upon and dependent upon preservation and
  rearrangement of existing goals, products, and
  services
• Focused solely on the quantitative
• Comfortable for organizations where reports,
  numbers, forecasts, and data only are needed for
  decision making (Annual Budgeting)
• Usually a result or tasks that results from
  strategy

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Strategic Thinking

• The most successful strategies are not plans,
  they are visions
• Capturing what we learn from all sources (both
  the soft insights from your personal experiences
  and the experiences of others throughout the
  organization and the hard data from research and
  the like Henry Mintzberg
• It involves intuition and creativity able to
  freely appear through processes carried out by
  various people at various levels in the
  organization that are deeply involved in the
  issue at hand

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Strategic Thinking

• It has to occur outside of the organization chart
  boxes that fosters informal learning and produces
  new perspectives
• Incorporates qualitative information
• Balances between data-driven decision making and
  soft forms of information including gossip,
  hearsay, and other scraps of information
• Works in organizations that value input from
  every level most importantly customers

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Tacit Knowledge

• By definition, tacit knowledge is
• knowledge that people carry in their minds and
  is, therefore, difficult to access.
• It is most often overlooked in planning and
  decision making, however, it is critical to your
  success.

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Tacit Knowledge

• Often, people are not aware of the knowledge they
  possess or how it can be valuable to others.
• Tacit knowledge is considered more valuable
  because it provides for people, places, ideas,
  and experiences.
• Effective transfer of tacit knowledge generally
  requires extensive personal contact and trust.

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Tacit Knowledge

• Simply put
• "We know more than we can tell."
• Tacit knowledge consists often of habits and
  culture that we do not recognize in ourselves.

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Do you REALLY care what your employees know will
work or needs to be changed for your success?

• They Do.
• And so do your customers!

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Tacit Knowledge

• In the field of knowledge management the concept
  of tacit knowledge refers to a knowledge which is
  only known by an individual and that is difficult
  to communicate to the rest of an organization.
• Knowledge that is easy to communicate is called
  explicit knowledge.
• The key is to use a process that transforms tacit
  knowledge into explicit knowledge.
• Useable Information

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Memorials Journey

• 1998 Routine planning creates a routine
  organization
• Many strategies and goals with 50
  completion/success
• 1999 - Executive Visioning/Strategic Thinking
• Board, Medical Executive Committee, Executive
  Leadership
• 2001 Advance
• Executive Visioning/Strategic Thinking
• Added Department Directors
• 2008 Baldrige Journey Begins
• Inverted Organizational Chart and Advance
• 2009 Year Round Strategic Advances
• Employee Roundtables/Surveys

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Strategy Advance
Employees
Board
Executives
Department Directors
Invert The Pyramid
Department Directors
Executives
Employees
Board
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Information GatheringTools

• Employees
• New Personnel Orientation
• Employee Roundtables
• Focus Groups
• Annual Employee Survey
• President/Employee Meetings
• Department Meeting Visits
• Executive Rounds
• Assignment to Initiative Task Forces

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Information GatheringTools

• Management
• Annual Employee Survey
• Department Directors Meeting
• Formal Strategy Advances (2/year)
• Wednesday Stand Up Strategy Briefing
• Assignment to Initiative Teams

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Information GatheringTools

• Executives
• Annual Employee Survey
• Executive Leadership Meetings
• Formal Strategy Advances (2/year)
• Wednesday Stand Up Strategy Briefing
• Leadership of Initiative Teams

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Work Groups Defined

• Committee Long-standing group of individuals
  organized around a common strategy but with
  multiple goals
• Team Short-term (lt 12 months) group of
  individuals organized around a common goal that
  requires process identification and change
• Task Force Quickly organized group of
  individuals organized around a common task to
  identify best practice, fix a common cause issue
  and provide input to a team (JIT)

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Why is this important?

• To ensure participants and the rest of the
  organization understand the scope of work and
  time frame for completion
• Resources, Resources, Resources
• Establish lines of communication and reporting
• Avoids overlapping work from other groups and
  communication of successes
• Command accountability
• Follow-up should account for 10 times the effort
  of planning and selecting

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The Advance

• The troops assemble to develop the battle plan
  and design its execution.

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Ground Rules

• Participate Actively
• Communicate Professionally
• Listen Carefully
• Speak With Respect One Person At A Time
• No Side Conversations
• Speak From Knowledge Not Assumptions
• Hold All Confidences Information
• Call Time Outs and Fouls As You See Them
• Take Breaks As We Need Them
• Have Fun!
• Sometimes, Its About Process And Not Outcome

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Environmental Scan
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Environmental Assessment(SWOT Analysis)

• Strengths, Weaknesses, Opportunities, Threats
• Yes, it is important
• Gets everyone on the same page to start
• Helps everyone understand your perspective
• To know where you are to see if you are moving
  toward somewhere else
• Must be a brutally honest assessment of the
  current state

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Identify Barriers to Our SuccessSolutions To
Overcome The Barriers
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Medical Staff

• Barriers To Success
• Physicians Financially Constrained and Seeking
  More from Hospital not Less
• Increasing Bureaucracy Work Required for
  Hospital Success

• Solutions To Overcome
• Align Hospital MD financial incentives
• Low salary
• High RVU bonuses
• 2. Make creative practice opportunities available
• ½ time
• No call, etc.
• Hospitalist only
• Allow clinical autonomy
• Bonus for excellent clinical performance

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When Its The Right Thing To Do

• Renegotiated Salary and Incentives of ALL
  Employed Physicians/Providers
• Not for the faint of heart
• Lost a couple of primary care physicians
• Kept the end in mind
• Improved Satisfaction Rate
• From 8 Providers to 36 Employed Providers in 15
  Months

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Brainstorm Other Goals InitiativesYou Would
Like The OrganizationTo Achieve
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Process for Strategies

• Brainstorm
• Sticky notes and flip charts
• Clarify Each Idea
• Be sure everyone understands your intent
• Combine like items
• Affinity Diagrams
• Group in like categories
• Assign strategy name to groupings
• If More than 10 Large GroupingsMulti-Vote
• Sticky-dots to gain priority
• Select the top 10 to move forward

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Strategy 1
Initiative What
Physician Practice Viability Determine Definition of Adequate Staffing Reduce Expenses O.H. Increase of Pts. Seen/Provider Remove Barriers to Patients Being Seen Gain Provider Buy-in/Support Standardize Office procedures Forms Collections Reports Coding Create Performance Dashboards for Reports to Providers RVU Quality Based Contracts Base Incentives
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How many diets does it take to lose weight?
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• Answer
• Only The One You Stick To

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Gut Reality Check

• Its easy to let the process of
• planning take over and miss
• Forest For The Trees
• What Really Needs To Get Done.
• Ensure accomplishment as well as performance.
• A Lack of AccountabilityBy Dan Beckham
• May 18, 2009 in HHN Magazine online site

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What Needs To Stay?Are We Missing
Anything?Tacit Knowledge

• Carry Forward To Organizational Priority List
• 1.) Is It Critical To Our Success?
• 2.) Will It Get Done Anyway?
• 3.) Will It Defy Mathematics?

Everyone will be working to accomplish our
priorities Last Call!
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Prioritize The List

• From Highest Priority to Lowest Priority
• Importance to the Mission
• Greatest contribution to the organizations
  success
• Ability to accomplish lt 12 months.
• Score 1 (Low Value) 5 (High Value)

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Prioritized List
Large Affinity Groupings Importance To The Mission Greatest Contribution Accomplish lt12 months Total Score
Physician Practice Viability 5 5 4 14





Take the Top 3-5 Depending on the Organizations
Available Resources
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Determine Your Format

• Traditional
• Initiative/Goal
• Objective
• Strategies
• What, How, Who, When
• Initiative, Goal, Role, Function
• Baldrige Pillars and Scorecard

Again, what fits your organizations culture?
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Bridging The Gap BetweenStrategy Action
MISSION
VALUES
STRATEGY Our Game Plan
The Balanced Scorecard
STRATEGIC INITIATIVES What WE need to do
PERSONAL OBJECTIVES What I need to do
STRATEGIC OUTCOMES
Customer Focus
Financial Market
Process Operations
Workforce People
Quality Outcomes
Desired Outcome The Gut Check
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When Its The Right Thing To Do

• Renegotiated Salary and Incentives of ALL
  Employed Physicians/Providers
• Not for the faint of heart
• Lost a couple of primary care physicians
• Kept the end in mind
• Improved Satisfaction Rate
• From 8 Providers to 36 Employed Providers in 15
  Months

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Improve Physician Practices
STRATEGIC PLANNING LEADERSHIP
Quality Outcomes
Financial Market
Process Operations
Workforce People
Customer Focus
Measurement
Measurement
Measurement
Measurement
Measurement
Participants in Employee survey of
gt85 Turnover lt 5 Quarterly Office
Meetings w/ Training Sessions gt75 attendance

• Increase
• Average Daily
• Patient Seen
• By Provider by
• 1 patient per day
• Selection of
• Primary Vendor
• for Office EMR
• by July 1st
• Develop space
• allocation
• Plan by May 1st

15 Increase in Practice Performance Increase N
et Referral Revenue per Provider by 4
gt95 Compliance with e-Prescribing Initiative
Net 3 additional Providers Press/Ganey Satisfac
tion Questionnaire gt90 Score
Desired Outcome Maintain or decrease practice
expense while increasing referrals and patient
access
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When Its The Right Thing To Do

• Renegotiated Salary and Incentives of ALL
  Employed Physicians/Providers
• Not for the faint of heart
• Lost a couple of primary care physicians
• Kept the end in mind
• Improved Satisfaction Rate
• From 8 Providers to 36 Employed Providers in 15
  Months

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Getting It To The Department Level Employee
Work-life
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Department MeasuresWhen you come to work each
day, what are aiming for?How do you
contribute?How do you know if you were
successful?
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Department Measures

• Customer Focus
• Quality Outcomes
• Financial Market
• Process Operations
• Workforce People
• Pick at least 2 measures, post, and follow

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Laboratory ExampleFollowing Each Phlebotomist,
Nurse, EMS, etc.
Blood Culture Contamination Rate (lt3) Blood Culture Contamination Rate (lt3) Blood Culture Contamination Rate (lt3) Blood Culture Contamination Rate (lt3)
Month Contaminated Collected Contamination Rate
January 2 121 1.65
February 3 155 1.93
March 4 171 2.33
TOTAL 9 447 2.0
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Improve The ProcessEach Year
PLAN
DO
STUDY
ACT
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Its All About Outcomes

• Do You have a Plan?
• Does The Plan Work?
• Evidence from Memorial

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2008 Initiatives

• Physician Practice Viability
• Community Health Needs Assessment
• Process Redesign Cost Reduction
• New Revenue Generation
• Upgrade Productivity/Labor/Reporting

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Hospital O/P Revenue vs. Phys Practice Revenue
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Admissions
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Avg. Length of Stay
Hospitalist Program Begins
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Paper Olympics Update
2008 Prizes
Gold 1 Full PTO Day
Silver ½ PTO Day
Bronze Pizza Party

• Most Approved Ideas
• Most Paper Savings
• Most Cost Savings

Cash Certificate Awards
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Success
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Success
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Success
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Express Med Impact
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Revenue
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PATIENT ENCOUNTERS (2003 2009)
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Productivity Hours
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Productivity Dollars
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Financial Performance
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Financial Performance
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Final Thoughts

• You cant get there overnight
• Memorials 3-5 Year Journey
• Rewards The Level of Risks You Take
• Do you really want to hear what customers say?
• Do you really want to hear what employees think?
• Be Passionate About Wanting To Achieve Success
• They model what they see (Actions speak)
• There is no ONE right way it must fit your
  culture and most importantly - achieve success

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Did We Meet Our Objectives?

• To share with you a journey that creates success
• To help you realize that none of this is
  revolutionary every organization can do it
• Ignite the desire to ensure planning and strategy
  are an important part of your organizations
  ongoing responsibilities
• Learn at least one new concept or idea

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• As we participate in a profession, economy, and
  our communities that are struggling, it is easy
  to focus on the negative and focus on our
  failures.
• While success in our profession is never easy to
  attain, Theodore Roosevelt said something that is
  appropriate for those of us participating in the
  planning for our organizations.

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• Far and away the best prize that life offers is
  the chance to work hard at work worth doing.
• Theodore Roosevelt