2009 Strategic Plan Presentation Final2

Strategic Plan 2009-2013Cleveland County HealthCare System

Chart a New Course

A Time of Change After many years of successful Growth, leading Quality, improving Service, high employee morale and exceeding our budget 2007 and 2008 have seen declines in several elements of performance at CCHS Previous Strategic Plans have predicted a coming time of turmoil..

Those time are here. We have entered the Perfect Storm!Cleveland County HealthCare System2

The Perfect Storm

Cleveland County HealthCare System

3

The Perfect StormThe Dilemma of Multiple Sites

What are the elements of this perfect storm? In the analogy, the following would be suggested:


4


What are the elements of this perfect storm? In the analogy, the following would be suggested: The merger between CRMC and KMH has changed the focus from one hospital to multiple hospitals. This has left a vacuum that to date have not addressed. The strategy for managing this vacuum was to have each hospital run by a COO/CNE, Despite heroic effort by Veronica and Sherri, this strategy was not successful in filling the vacuum An additional negative artifact of the COO/CNE strategy is that the CNE function was over-run by the COO function.

Brian Gwyn, as the new Executive VP & COO is fully empowered going forward..he is the boss.


5

Past CCHS Org Chart


6


What are the elements of this perfect storm? In the analogy, the following would be suggested: Along with this org chart problem, communications back to all stakeholders became insufficient This will be resolved going forward in that it is one of Brians core strengths, I am meeting more frequently with physicians on strategy and we will significantly increase our marketing efforts both externally and internally.


7


What are the elements of this perfect storm? In the analogy, the following would be suggested: Some stakeholders have never accepted the logic of the CRMC / KMH merger, Without the real growth potential to be had in Kings Mountain, living the Mission at any location will be difficult given our community growth and our demographicsIf we are able to expand the primary care base at KMH, this strategy will work The new strategic plan lays out complimentary options for growth outside of Kings Mountain as well


8

The Perfect StormThe Regulatory Imperative

What are the elements of this perfect storm? In the analogy, the following would be suggested: The CAP & JCAHO surveys were significantly different and their findings and conditional accreditation required 24 months of consuming Leadership focus leaderships eye was diverted from other important strategies and communications


9

The Perfect StormOther Elements of the perfect storm

What are the elements of this perfect storm? In the analogy, the following would be suggested: We have been without a Strategic Plan for 18 months. This was mostly because of our interest in implementing the Clinical Practice Council strategy and because we were waiting to see what Gaston Memorial Hospital was going to do in system affiliation. That has been resolved now as our competitor is standing alone and coming at us competitively with both guns blazing.


10

The Perfect StormOther Elements of the perfect storm

What are the elements of this perfect storm? In the analogy, the following would be suggested: The Clinical Council process has struggled No CMO leadership until recently Even though it was always intended as a control sharing strategy, many issues have not gone through this process.


11

The Perfect StormA New Way to Care for Patients - Hospitalists

What are the elements of this perfect storm? In the analogy, the following would be suggested: The conversion from SMA as an admitting group to employed Hospitalists taking care of both un-assigned patients as well as patients for an expanding number of non-admitting practices has been challenging challenging in staffing, challenging in coordinated quality, challenging in community acceptance and challenging in integrating the service into the overall care structures.

We have come to a point where CCHS has a team that we can build upon.Cleveland County HealthCare System12

The Perfect StormA New Way to Care for Patients - EMR

What are the elements of this perfect storm? In the analogy, the following would be suggested: The EPACT conversion was a major shift in how care is delivered for almost every care giver leading to huge learning curve anguish along with real system failures and software bugs. This system is what Mayo Clinic pegs their national and international reputation partly upon We have often seen first hand what happens to patients when information is not able to be shared horizontally

This conversion was painful for all and I understand the medical staffs frustration The worst is behind us !


13

The Perfect StormA Change in our Growth Curve

What are the elements of this perfect storm? In the analogy, the following would be suggested: Declining utilization of hospital services have take significant focus of Administration 50% is accounted for in less admissions to anywhere 50% is accounted for by a loss of marketshare to our primary competitor

Patient Discharges16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 013547 13851 14167 14443 12776 10663 9295 8702 9015 9130 10593 12402

6775

7482

7866

2008 P

1994

1997

1999

2001

2003

2005

2007

1995

1996

1998

2000

2002

2004

2006

2008 B


14

The Perfect StormA Change to our Physicians Economic Model

What are the elements of this perfect storm? In the analogy, the following would be suggested: Declining practice profitability leading to real physician economic needs that have been difficult for CCHS to address Increasing rules and regulations keeping us from helping as we once could Declining profitability keeping us from helping because we can no longer afford to

Such issues have taken huge amounts of Administrative time and focus and in some cases also damaged trust This same problem is going on in every marketplace right now


15

A Different Ending! This strategic plan will take courage, cooperation and great effort to accomplish, but it will assure that healthcare in Cleveland County continues to make a difference in the lives of the people we serve We will come through this storm Together!Cleveland County HealthCare System16

Tough QuestionWhy is Administration getting bigger and the people who do the work are getting smaller?2003 2006

CEO

John Young

CEO

John Young

COO/CNE CRMC

Veronica Poole-Adams

COO/CNE CRMC

Veronica Poole Adams

COO KMH

Vacant (Hank Neal)

COO/CNE KMH

Sheri DeShazo

VP CNE KMH

Regina Gregg

AVP KMH

Nadine Harris

VP Med Staff Dev

Sam Cooper

VP Med Staff Dev

Sam Cooper

VP Support

Alex Bell

VP Support

Alex Bell

Executive VP

Mark Hudson

Executive VP

Mark Hudson

VP Outreach

Dotty Leatherwood

VP Outreach

Dotty Leatherwood

VP CFO

Rose Coyne

VP CFO

Rose Coyne

VP Corporate Counsel

AVP HR

VP Systems

2003 Dan Sweat 23 FTEs 1206 total FTEs Debbie Kale 52.43 FTEs / Exec 4.2 FTEs / AOBLiz Popwell


VP HR

VP Systems

Cleveland County Liz Popwell HealthCare System

2006 Dan Sweat 25 FTEs 1301 total Debbie Kale FTEs 52.04 FTEs / Exec 4.6FTEs / AOB

17

Tough QuestionWhy is Administration getting bigger and the people who do the work are getting smaller?2008

CEO

John Young

CNE CRMC

Veronica Poole Adams

2008 17 FTEs 1260 total FTEs 74.11 FTEs / Exec 4.2FTEs / AOB

CNE KMH

Sheri DeShazo

AVP KMH

Nadine Harris

VP Med Staff Dev

Sam Cooper

Retiring end of 08

VP Support

Alex Bell

Executive VP (COO)

Vacant

VP Outreach

Dotty Leatherwood

VP CFO

Rose Coyne


Dan Sweat

Promotion to CMC NorthEast

VP HR

Debbie Kale

VP Chief Ancillary Officer (CAO)

Liz Popwell Cleveland County HealthCare System

18

Brian.this is where I end and you begin. I have given you a few slides for each pillar and one slide for 2009 2013 strategy. Feel free to adapt to your needs and style These are all the points in the strategic plan I will take no more than 15 - 20 minutes



Strategic Plan 2009-2013

Chart a New Course

Mission StatementCleveland Regional Medical CenterCRMC Kings Mountain Hospital&

As a member of the Cleveland County HealthCare System family serving our community and the surrounding region, Cleveland Regional Medical Center and Kings Mountain Hospital provide a focused variety of safe, high quality, patientcentered services and educational programs for the benefit of the people we serve, regardless of their ability to pay. As a part of the Carolinas HealthCare System, we strive to offer seamless, coordinated systems of clinical care.

Chart a New Course

Mission StatementCleveland Regional Medical CenterCRMC Kings Mountain Hospital&

As an organization that values people, we will live this mission by practicing caring, commitment, integrity and teamwork!

Chart a New Course

Vision StatementCleveland Regional Medical CenterCRMC Kings Mountain Hospital&

Cleveland County HealthCare System will serve the patient first, consistently respond with our best, and champion health in our community. As an integral component of the Carolinas HealthCare System, we will align and grow our services based upon the needs of those we serve and the strategies of our regional system. We will realize this vision through the empowered efforts of a caring, committed healthcare family and an engaged and talented medical staff.Chart a New Course

Strategic Plan 2009 2013Seven Pillars of Commitment

Patients - Families - Community - Physicians - Hospital Family

Employee Satisfaction

QUALITY

Customer Service

Financial / Operational

GROWTH

Community Benefit

Medical Staff


Chart a New Course


24

Key Assumptions of the Environment 2009 - 2013 Community growth will slowly accelerate Economic Development will improve gradually Demand for caregivers will exceed supply Competition will increase from many providers Consolidation of healthcare will continue Slow-down of national economy will continue Governmental and payor oversight on quality and access Higher expectations from consumers Declining margins for medical staff Behavioral Health will continue to impact Emergency Rooms HealthCare reform will come, not in the near futureCleveland County HealthCare System25

Pillar for Employee SatisfactionLong Term Goal: To be the Employer of Choice as measured by being in the top decile of Employee Satisfaction Surveys

Quality

Service

Financial Viability

Growth


Cleveland County HealthCare SystemWe believe that our success is founded on our hospital family; if we focus on our people, everything else gets better! We further believe that the best way to focus on our people is to develop our leaders!Cleveland County HealthCare System26

The Right Mix is essential to Quality% of total employment by employee type2006 NC Hospitals 2008 CRMC & KMH

Nursing 46%

Other 29%Nursing 43%

Other 35%

Administrativ e 11% Allie d he alth 12%

Pharmacy 2%

Allied health 17%

Pharmacy 2% Administrativ e 3%

*NCHA 2008


Employee Turnover- CCHS

2007 - 20083.0% 2.5% 2.0% 1.5% 1.0% 0.5% 0.0%2.57% 2.72%

Turnover Rate

1 .96% 1 .39% 1 .59% 1 .52% 1 .77% .39% 0.95% 1 .20% 1 .03% 1 0.97%

Threshold

Target

Ju l Au g Se p O ct N ov D ec Ja n Fe b M ar Ap r M ay Ju ne

Maximum Probable

Advisory Board Benchmark Overall Turnover Rate 18.3% annually or 1.5% per month


Work Climate Survey- CRMC

C R M C E m p lo ye e S u rv e y O v e ra ll S a tis fa c tio n84 82 80 78 76 74 72 2007* 2006*

* CEP Pr o c e s s

2005*

2004*

Ju n e -0 2

M a y -0 0

F e b ru a ry -9 8


Work Climate Survey- KMH

K M H E m p lo ye e S u rv e y O v e ra ll S a tis fa c tio n80 79 78 77 76 75 74 2007*

* CEP Pr o c e s s

2006*

2003


Employee Satisfaction Strategic Priorities 2009 - 2013Foster a culture that recognizes the importance of employees and their contributions to system goals: Leadership Development, Sustainability Prioritizing objectives MIP Restructuring

Identify and develop future leaders Employee / Leadership Accountability Recognition Orientation and Re-orientation Care giver training and continuing education Retention of productive members of team Benefit Structure analysis

Maximizing the supply chain of care giver training Leadership Best Practice Principles


31

Pillar of QualityLong Term Goal: To be in the top Decile in selected publicly reported vertical Quality Indicators

Quality

Service

Financial Viability

Growth


Cleveland County HealthCare SystemWe believe Quality, from the vertical individual or component level perspective, is the essential foundation of healing.We define Quality as safe, effective, appropriate care that meets or exceeds the needs of all those we serve. Cleveland County HealthCare System

32

CHS & CCHS Enterprise= CRMC Performance = KMH Performance = CHS Performance

Acute Myocardial Infarction100

Heart Failure100 90NC Avg CHS

90

NC Avg CHS

80

80 70

70 Q1 07 n=604 Q2 07 n=565 Q3 07 n=656 Q4 07 n=675 Q1 08 n=632

Q1 07 Q2 07 n=1039 n=976

Q3 07 n=969

Q4 07 Q1 008 n=1161 n=1066

Pneumonia100 90 80 70 60 Q1 07 Q2 07 n=1417 n=1007 Q3 07 n=934 Q4 07 =1469 Q1 08 n=1422NC Avg CHS

Surgical Care Improvement Project*100 90 80 70 Q1 07 Q2 07 Q3 07 Q4 07 Q1 08 n=1926 n=1794 n=1959 n=1696 n=2329*Dotted line represents change in SCIP methodology.

NC Avg CHS


AHRQ Survey 2008: Overall BenchmarkTeamwo Supervisor rk in expectation units Mgt support Continuous Improvement Overall Feedback and Open-ness Perception of Commun. Safety Frequency of events Teamwork across units Staffing Handoffs Nonpunitive Response

CMC Mercy Pineville University Randolph CMC-Northeast

CRMC KMH


= above mean

= below mean

Quality Strategic Priorities 2009 - 2013 System-wide approach to Quality and Patient Safety Vision CHS / CCHS CRMC / KMH Acute / Sub Acute Nursing / Radiology (example)

Place the physician in front of the Quality Agenda Maintain existing outcome excellence and develop new outcome excellence Maximize publicly reported Quality Indicators Strategic plan for imaging and hospitalists Patient safety strategy implementation Electronic Medical Records strategyCleveland County HealthCare System35

Pillar of ServiceLong Term goal: To be in the Top Decile in Patient Satisfaction and develop strategies, tactics and systems for excellent horizontal patient care

Quality

Service

Financial Viability

Growth


Cleveland County HealthCare SystemWe believe Service is quality from the patients perspective and encompasses the horizontal system of healing and compassionate caring.

We define Service as safe, effective, comprehensive, coordinated care that meets or exceeds the needs of all those 36 we serve. Cleveland County HealthCare System

Focus Group PerceptionsMeasure First Mention Awareness Overall Preference Factor Association - Best Doctors - Best Nursing Care - Advanced Equipment/Technology - Caring/Friendly Staff - Most Convenient - Best Reputation for Quality - Best Overall 31% 22% 45% 21% 2% 36% 37% 23% 33% 19% 36% 69% 24% 28% 9% 9% 11% 10% 8% 10% 11% 3% 3% 2% 5% 17% 3% 3% Carolinas Med. Ctr. 7% 19% Cleveland Regional 71% 48% Gaston Memorial 9% 15% Kings Mount. 11% 6%


Measure - Inpatient Medical/Surgical - Obstetrics - OP Surgery - Emergency - Heart - Cancer - Orthopedic Surgery - Womens Health - Neurological/Neurosurgical - Pediatrics - Diagnostic Imaging Inpatient Utilization Share Emergency Utilization Share OP Surgery Utilization Share OP Services Utilization Share

Carolinas Med. Ctr. 21% 6% 8% 10% 46% 34% 25% 9% 35% 19% 11% 18% 3% 6% 2%

Cleveland Regional 49% 53% 59% 61% 23% 26% 39% 53% 31% 39% 55% 56% 70% 50% 53%

Gaston Memorial 14% 19% 15% 13% 11% 13% 15% 17% 12% 13% 14% 14% 10% 19% 14%

Kings Mount. 5% 3% 6% 10% 2% 1% 3% 5% 4% 4% 8% 4% 16% 9% 15%


Emergency Department by Calendar Year

Service % Excellent

CRMC Emergency Department

KMH Emergency Department


Emergency Service Scores thru July 2008

Cleveland Regional Medical Center

Kings Mountain Hospital


Inpatient Services by Calendar Year Service % Excellent

CRMC Inpatient Satisfaction

KMH Inpatient Satisfaction


Customer Service Strategic Priorities 2009 - 2013 Develop and deploy a patient relationship management focus for service Strategic Plan for patient advocacy Improve ED throughput Maximize satisfaction scores

Develop, implement and monitor Horizontal Care Hospitalists Oncology Breast Center Medical Patients

Maximize Customer satisfaction ED Outpatient Inpatient HCAPS


42

Pillar of Financial Viability/ Operational ExcellenceLong Term Goal: On average, meet or exceed A rated and budgeted performance

Quality

Service

Financial Viability

Growth


Cleveland County HealthCare SystemWe believe in our mission of caring for those in need regardless of ones ability to pay. Though we know the margin is not the mission. We also understand that without a margin there is no Cleveland County HealthCare System mission! 43

Operating MarginCCHS Operating Margin7.00% 6.00%4. 3% 5. 3% 4. 6% 5. 5%3.1% through the second Quarter 08

5.00% 4.00% 3.00% 2.00% 1.00%

4. 2%

4. 4%

3. 4%

3. 6%

3. 3%

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008 B

Actual Operating M argin

Budgeted Operating Margin

3. 1%


44

Financial Viability/Operational Excellence Strategic Priorities 2009 - 2013 Organizational design and corporate infrastructure for planning and execution Identify opportunities for maximizing economies of scale, efficiencies and productivity Consolidation of Services Prioritization of Services

Advance operational excellence Lean

Maintain A rating in margins and ratio Adopt Management Action Plan process


45

Pillar of GrowthLong Term Goal: 80% market share in our primary market (CHS & CCHS)

Quality

Service

Financial Viability

Growth


Cleveland County HealthCare SystemWe believe it unlikely there will be a trend towards higher reimbursement As margins decline, growth becomes essential!Cleveland County HealthCare System46

Outpatient VolumesOut- Patient Visits100000 90000 80000 70000 60000 50000 40000 30000 20000 10000 088,534 74,904 75,635 77,987 87,580

Annualized through second quarter

82,622

33,452 17,146 19,652 22,254

38,257

37,537

39,599

44,650

45,946

ED Visits80,000 70,000 60,000 50,000 40,000 30,000 20,000 10,000 064,645

20 08

20 08 B


19 94

19 95

19 96

19 97

19 98

19 99

20 00

20 01

20 02

20 03

20 04

20 05

20 06

20 07

P

69,132 70,822

75,796

61,796

61,412

37,094 36,546

33,138

39,405 35,592 38,022 33,336 33,751 35,205

CRMC & KMH ED Visits

2008 Budget

20 08

P 20 08 B

19 94

19 95

19 96

19 97

98

19 99

20 00

20 01

02

03

04

20 05

20 06

20 07

19

20

20

20


47

Inpatient & Surgery VolumesPatient Discharges16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 013547 13851 14167 14443 12776 10663 9295 8702 9015 9130 10593 12402


6775

7482

7866

2008 P

1994

1997

1999

2001

2003

2005

2007

1995

1996

1998

2000

2002

2004

2006

CCHS Surgical Volume14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 2008 P 2008 B 1994 1996 1999 2001 2003 2004 2006 1995 1997 1998 2000 2002 2005 2007

2008 B


Inpatient

outpatient

CAS

Column 448


CMC, CRMC & KMHAll Marketshare from 1993 - 2007 NC Database

Primary Service AreaExpected Marketplace decline =

Updated Q3 2007

Through

-134CMC Actual Decline = -19 115 Discharge gain in CMC Marketshare (code STEMI)

Expected Marketplace decline = -906 CCHS Actual Decline = -1,366 -460 Discharge lost to Competitors Marketshare Gain

Expected Marketplace decline =

-159Caromont Actual Gain = 195 354 Discharge gained in Caromont Marketshare

Expected Marketplace decline = -136 Other Actual Gain = 10 146 Discharge gained in Other Marketshare

h s t e k r a M %

70 60 50 40 30 20 10 0

6 . 8 5

. 8 5

6 . 9 5

3 . 6 5

. 2 1 9 . 0 1

2 1

2 1

4 . 0 1 3 1

3 . 1

5 . 1

5 . 9

3 . 9

6 . 8

4 . 8

. 8

9 . 8

CMC

7 . 9

CRMC

KMH

GMH

Other

1

2004

2005

2006Expected Marketplace decline = -183 KMH Actual Decline = -339 -156 Discharge lost to Competitors Marketshare Gain

2007

HCIA SoleSource

0 1 49


Growth Strategic Priorities 2009 - 2013 Advance development and alignment of physician and hospital networks Look for partnering opportunities Complete the primary care base expansion around KMH Find new product lines or marketplaces with growth and margin potential Regional approach to cancer care Cardiology at KMH Vascular Surgery Breast Center CT Virtual Cath Wound Management Behavioral Health expansion/replacement Strategies to win back market share Expand campuses to allow for future growth Determine and implement Hallmark Services Compete into Rutherford County Spine Surgery Cardiac Rehab/Wellness Center South Carolina Strategies Medical Oncology Strategic plan Western CHVI strategic plan50


Pillar of Community BenefitLong Term Goal: Remain a leader in philanthropy and assure that our services to the community exceed our estimated tax liabilityPatients - Families - Community - Physicians - Hospital Family


QUALITY

Customer Service


GROWTH

Community Benefit

Medical Staff

Cleveland County HealthCare SystemWe believe that CCHS must be a good corporate citizen and lead our community in philanthropy.Cleveland County HealthCare System51

Pillar of Medical Staff RelationsLong Term Goal: Significant changes in clinical operations and capital investments will be evaluated and prioritized through the Clinical Council Process with recommendations going to the Medical Executive Committee or the Administrative Council for final approval as appropriate.


QUALITY

Customer Service


GROWTH

Community Benefit

Medical Staff

We believe that our medical staff should be our active partners through the Clinical Practice Councils. Through that partnership, we will maximize the care of the patient as well as the work environment of the caregivers and the physicians.Cleveland County HealthCare System52


Clinical CouncilsChosen ModelFunctional Integration: Clinical Council Model

CMO

*

TRUSTEES

MECCMO

EXECUTIVES

MANAGERSSERVICE CHIEFS

MEDICAL STAFF

CLINICAL PRACTICE COUNCILS

STAFF

* Dotted line to the Trustees for credentialing and quality issues

The Bard Group 2006- All rights reserved


53

Medical Staff Relations Strategic Priorities 2009 - 2013 Improve partnerships relationships with physicians in leadership and operational excellence Assure Clinical Councils are successful in guiding change Increase face time with medical staff Increase IT and communication connections with medical staff Assure non-admitting physicians remain connected to hospitals CRMC/KMH Medical Staff Relationships Graduate Medical Education Accelerating process and greater choices for interested acquisition opportunities


54

The Perfect Storm?

2009 2013 will be a time of change, and a new course will adjust our sails as the head winds arrive!

Chart a New Course


55

Marketplace Analysis


56

QUESTIONS

Chart a New Course


57

2009 Strategic Plan Presentation Final2

Documents

Transcript of 2009 Strategic Plan Presentation Final2