CAH HOSPITAL STRATEGIC PLANNING MODEL

PHIL CAMPBELL, FACHE

Develops strategic plans for rural and CAH-eligible hospitals

Integrates comparisons of clinical and operational performance measurements with state and national benchmarks

Creates an effective decision-making tool for everyday operations

CAH Strategic Planning Model

“Because what you measure gets done.”...Tom Peters, In Search of Excellence

CAH Strategic Planning Model Effective

Comprehensive

Low cost

Meets ORYX requirements

Builds on past successes

Builds confidence in management

Effective

The planning model provides more than a notebook on a shelf and a checkmark on a JCAHO surveyor’s form.

The planning model integrates planning into all facets of the organization through coordinated reporting by core business drivers.

The plan creates a decision matrix which directs focus on values, mission and the vision for the future.

Core Business Drivers

Comprehensive

Utilizes 6 core business drivers which represent major divisions of healthcare operations addressing “real life” rural hospital operations

Low Cost

Specifically created by a rural hospital administrator for rural hospitals with limited resources

Utilizes existing data available through state health planning agencies

Utilizes CHIPS, a high-quality, low-cost source of DRG-specific data with cohort benchmarking

Meets ORYX Requirements

Utilizes a format consistent with – ORYX requirements

– JCAHO accreditation standards

– Malcolm Baldrige Quality Criteria

Builds on Past Successes

The strategic planning process utilizes past organizational successes to serve as key data elements that emphasize the positive contributions of management.

The planning process provides a dynamic motivational framework for management to highlight past successes and implement bold plans for the future.

Builds Confidence in Management

The process builds confidence in management by recognizing past contributions and involving management in every step of the process.

Presentations will utilize key managers during the data presentation phase of the process.

The final draft presentation will position the administrator and the Sr. management team in leadership roles for the plan implementation phase.

“Leadership and communication are the same thing.” Kip Tindell, CEO The Container Store, voted for two years the Best Company to work for in America.

Decision Making MatrixApplying Hoshin Planning Principles

Mission/Vision Consistency Test - This the starting point for all strategy development, clinical and operational performance measures, goals and objectives. Is what you are doing consistent with Mission and Vision?

Performance Outcomes Data – Identifies performance gaps and opportunities that drive creation of goals and selection of quality improvement priorities.

Performance Improvement Process - Emphasizes participation in planning process review at all organization levels through existing standing committees.

Strategy Development Reflects Mission, Vision and Values

Core Business Drivers

•Quality healthcare provider• Valuable asset to the community

•Essential economic employment base

Mission StatementRevisits Why The Hospital Exists

Core Business Drivers

Where does the hospital needto be in five years

to fulfill its mission?

Vision StatementDefines Future Direction

Core Business Drivers

•Quality •Customer Focus•Diversity •Fairness

•Value of employees, volunteers

Values States Guiding Principles

Access

Physicians Emergency services Specialty services, i.e.

• Surgery• OB• Multi-specialty clinics

Performance Measure

Physician Demand & Deficit Analysis

Financial Performance

$3200

$3100Best

Practice national bench-mark.

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500

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4000

'99 '00 1stQtr

2ndQtr

Local State National

Cost Per Adjusted DischargeProfitability AssumptionsCapital AvailabilityRevenue Management

CAH, DSH, MDHAppropriate UtilizationRegistration ProcessBilling

Performance Measures

• Budget Achievement

• Cost per Adjusted Discharge

Customer Satisfaction

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'99 '00 1stQtr 01

2ndQtr 01

External

Employees

Med Staff

Customer Satisfaction Rating2nd Qtr ‘01

Measure Key CustomersExternal

Patients & FamiliesCommunity LeadersConsumers

InternalEmployeesMedical StaffVolunteers

Performance Measures

• Survey & Focus Group Results

Compliance

The captain of the Titanic didn’t have a backup plan for unseen problems

Compliance PlanCompliance OfficerTrained EmployeesCodes of EthicsPeriodic External Coding

Review

Performance Measure• Effective Compliance Plan

with External Review

Process Quality

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86

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'98 '99 '00 '01

Your Hosp. Natl. Avg.

JCAHO SCORECQI Operational in Major Clinical Areas

JCAHO Survey Readiness

Clinical/Operational Measures Driving Decisions

Performance Measures• JCAHO Grid Score

• Survey Readiness Program Participation (Orion)

Outcomes Quality

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43 3830

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'99 '00 1st Qtr 2nd Qtr

Your Hosp Cohort Benchmk

Door to NeedleThrombolitic Therapy

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20

40

ORYX Clinical Measurement System Driving TQM Priorities

Consistent Reporting in All Reports and Agendas Using Key Business Drivers Format

Performance Measures• Integrated Clinical (ORYX)

and Operational Outcomes

Performance Measures (1 of 3)

Access – Physician Recruitment Plan Success

– New Services Implemented from Strategic Plan

Financial Performance

– Budget Achievement

– Cost Per Adjusted Discharge compared with

State and National Benchmarks

Performance Measures (2 of 3)

Customer Satisfaction – Documented Improvement in Satisfaction Survey

Data– Positive Results Reported from Medical Staff

Focus Groups Compliance

– Compliance Plan Implemented– Compliance Officer in Place– Periodic External Review of Coding Implemented

Performance Measures (3 of 3)

Process Quality– Acceptable JCAHO Grid Score– Continuous Survey Readiness Program Implemented

in CQI– Core Business Drivers Format Used in All Agendas,

Reports, and Minutes

Outcomes Quality – ORYX Clinical Performance Measurement System

Implemented– Clinical and Operational Performance Goals

Achievement Reported

“Go” or “No Go”CAH Application Decision

1. Completed Comprehensive Strategic Plan

2. Define CAH Long-Term Assumptions

3. Review Specific CAH Financial Projections

4. Review Barriers to Success Clinical Operational Political (EX. state Medicaid adopting Medicare CAH rules)

CAH? Yes No

CAH Strategic Planning Process(1 of 2)

EXECUTIVE DECISION

PRELIMINARY MANAGEMENT TEAM MEETING

DATA PRESENTATION TO PLANNNG TEAM

DRAFT STRATEGIC PLAN PRESENTATION

COMPLETED STRATEGIC PLAN WITH CAH DECISION

• Understand the Process• Establish Agreement and Timetable

• Define Roles & Responsibilities• Select Dates• Decision: Data Elements• First Rough Draft of Performance

Measures

• Includes Board, Senior Management, and Invited Community Leaders

• Brainstorm to Rough Draft Mission, Vision, Values, and Core Performance Measures

• Core Performance Measurements Selection by Administrator

CAH Strategic Planning Process(2 of 2)

EXECUTIVE DECISION

PRELIMINARY MANAGEMENT TEAM MEETING

DATA PRESENTATION TO PLANNNG TEAM

DRAFT STRATEGIC PLAN PRESENTATION

COMPLETED STRATEGIC PLAN WITH CAH DECISION

• Final Draft Presentation of Strategy and Goals by Administrative Team

• Agenda, Minutes, Reports Reflect Measures by Core Business Drivers

Completed Strategic Plan Outline

Mission Statement

Vision Statement

Values Statement

Core Business Drivers� Performance Measures� Strategies

Goals• Objectives to

Achieve Goals

Strategy Outline Example(1 of 3)

Core Business Driver: Access

Performance Measure: Physician Demand & Deficit Analysis

Strategy:

• EX. Recruit Three Primary Care physicians during next 36 months. One (1) Primary Care Physician and One (1) General Surgeon in 2004

• Initiate Orthopedic Surgery Program in 2005

Strategy Outline Example(2 of 3)

Goal 1. EX. Add Primary Care Physician in 2004

Objective 1.1 – Finalize placement of Dr. Smith with Dr. Jones during 1st Quarter.

Objective 1.2 - Complete compliance review of physician guarantee and medical office building rental agreement by 2/1/04 for practice start date of 7/1/04.

Objective 1.3 - Remodel medical office building by 6/1/04.

Strategy Outline Example(3 of 3)

Goal 2. Review Current Gen. Surgeon Search

Objective 2.1 - Involve active staff surgeons in search process.

Objective 2.2 - Consider changing physician recruiting contractor.

Goal 3. Initiate Search for Ortho by 2/01/05.

Goal 4. Evaluate and report progress quarterly

Planning Data Elements(1 of 2)

List of past successes. Information Source: Internal Physician demand/deficit analysis. Information

source: State Health Planning Active searches. Commitments. Internal JCAHO survey report. Internal Performance Improvement Plan. Internal. Outcome measures/ORYX reports. Internal

Plan of Patient Care. Internal Copy of Mission, Vision, Values Statements.

Internal Capital plans, funding sources. Internal

CAH financial analysis. External Income Statement -12 months. Internal Organizational Chart. Internal Audits—3yrs. Internal Cost reports. Internal Customer Satisfaction studies. Internal

Employee Handbook. Internal Compliance Plan summary. Internal DRG Specific CHIPS Utilization Reports.

External Service line profitability. Internal

Planning Data Elements(2 of 2)

Completed Strategic Plan

Use your plan Don’t allow your strategic plan to sit on a shelf.

Operationalize your planIncorporate performance measures into agenda templates and force them to be reviewed monthly and quarterly