Strategic Planning (Who cares?) February 5, 2008.

Strategic Planning

(Who cares?)

February 5, 2008

Objectives

At the end of this class, the learner will be able to:

1) Understand key challenges facing healthcare today:

-National and regional trends in healthcare

-Dartmouth-Hitchcock’s unique situation

2) Derive priority strategies and tactics from Dartmouth- Hitchcock’s organizational mission/vision/goals.

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Introduction

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Theme Number 1:• People want to be excited about a vision.

Theme Number 2:• We are resting on our laurels; we need to honor our legacy and past

accomplishments, face our current state honestly, focus on the future and move ahead.

Theme Number 3:• Empower us to help achieve the vision. Hold us accountable.

Help us develop as leaders.

Theme Number 4:• Help us work not in silos, but in systems focused on a common vision or

common set of goals.

Theme Number 5:• Clarify our current organizational structure and how decisions are made.

Strengthen the physician-administrator partnerships.

Theme Number 6: • We are an organization of push vs. pull systems.

Our Journey Began in 2006Our Journey Began in 2006

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1. Establish a single, unifying Vision for Dartmouth-Hitchcock (D-H) that provides a framework for strategic and operational planning and decision- making.

2. Develop specific goals and strategies to position D-H to achieve the Vision.

3. Define the market, clinical program and organizational initiatives D-H will pursue to realize the specific goals that support achievement of the Vision.

4. Develop a measurement and monitoring system to track implementation progress and assess the impact of the strategic initiatives.

Clinical/Regional Strategic Planning Clinical/Regional Strategic Planning Objectives: 2006-07 Objectives: 2006-07

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Guiding Principles of the Planning ProcessGuiding Principles of the Planning Process

• Critically important work – an aligned vision of the future that influences all of our decisions

• Aspirational, yet realistic – a plan that moves the organization to the highest attainable level

• Process matters – a strong plan that comes from an open, disciplined process

• Broad participation and active involvement – the best minds, intellectually engaged

• Commitment to strategic direction and outcomes – commitment to build a consensus view and support a common course of action

These Guiding Principles are influencing all of our planning efforts and outcomes.

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Project Team

Stakeholders

Management Work Group

Trustee Advisory Group

StakeholdersStakeholders

Board of Trustees

Clinical/Regional Strategic Planning Clinical/Regional Strategic Planning Structure Structure

The Clinical/Regional Strategy initiative had a unique structure.

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MissionMission

StrategiesStrategies

Tactical PlanTactical Plan

IndicatorsIndicators

VisionVision

GoalsGoals

BOARD MANAGEMENT WORK GROUP

Guide Recommend

Review/Approve

TRUSTEE GROUP

Approve

Guide RecommendApprove

Guide RecommendApprove

Advise/Sponsor Design

Review Review Review

ReviewReview Review/Monitor

Clinical/Regional Strategic Planning StructureClinical/Regional Strategic Planning Structure

Each group has a different role and set of responsibilities.

DEPARTMENTS / CENTERS

Discuss

Discuss

Discuss

Design

Design & Implement

Develop & Implement

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Trustee Advisory Group Charge

• Guide and sponsor the development of the D-H Vision, Goals and clinical /regional strategy

• Collaborate with the Management Work Group to evaluate the clinical/regional vision, strategy and plan

• Build support for the planning process and its outcomes

• Communicate regularly with and seek approval from, the full Board of Trustees

Management Work Group

Charge

• Provided strategic thought leadership

• Designed and built momentum for a planning process that was consistent with the guiding principles

• Engaged the organization at large to ensure broad stakeholder input

• Assessed D-H Mission, Vision and Goals

• Develop and recommend clinical/regional strategies

• Recommend strategic priorities

The two leadership groups guiding this planning process had important but distinct roles and responsibilities.

Clinical/Regional Strategic Planning Clinical/Regional Strategic Planning Structure Structure

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Clinical/Regional Strategy Development Process

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Guiding PrinciplesGuiding Principles

We secured broad organizational participation.

• Health care Trends assessment presented and discussed in multiple forums involving over 250 people

– Trustees– D-H Medical Staff Annual Meeting– D-H Leadership Grand Rounds– Southern region medical directors and administrators– DHA CEOs and senior management group

• Over 50 one-on-one interviews conducted – Trustees– D-H leadership– Clinical chairs– Medical school leadership– DHC medical directors

• Site visits to all D-H clinical facilities and DHA hospitals were made

– Medical directors– CECS leadership – DHA and D-H associated hospital CEOs– Members of DHC medical staff

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•Management Work Group

•Clinical Regional Strategy Trustee Advisory Group

•Clinical Department Chairs

•Board Initiatives Coordinating Committee

•Board of Governors

Several key leadership groups were engaged in the planning process.

Guiding PrinciplesGuiding Principles

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Management Work Group ActivityManagement Work Group Activity

• National trends• Regional dynamics• D-H current positioning• Affiliate positioning • D-H opportunities and

challenges

Dartmouth-Hitchcock Mission,

Vision & Goals

Dartmouth-Hitchcock Mission,

Vision & Goals

CURRENT & FUTURE STATE ENVIRONMENT

Work Group Meetings 1 & 2 Work Group Meetings 3 & 4

There were 4 meetings of the Work Group.

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• Engagement – nearly full attendance at each Work Group meeting for the entire meeting

• Thoughtfulness – robust dialogue and debate in large and small groups

• Open and Honest – healthy tension between what we can do today versus what we wish to do in the future

• Commitment – to making the plan “come alive” for everyone and influencing all that we do

The discussions were intense and exciting.

Management Work Group EngagementManagement Work Group Engagement

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Establish Vision & Strategic Direction Set Up

Define the Strategic Context - Environmental

Scan

January, 07 January – February, 07 March – April, 07

Me

eti

ng

s • Trustee Oversight: Jan 18th

• Work Group: February 5th

• Work Group: March 1st • Work Group: March 19th, April 5th

• Trustee Oversight: March 29th

The Management Work Group made excellent progress

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Environmental Scan

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Environmental ScanEnvironmental Scan4 components of the Environmental Scan were instrumental to

defining D-H’s future state

1. Market/industry factors – How will the national trends impact our region and our organization(s)?

2. Our population – What is the profile of the population we serve and what are there health care needs?

3. The regional health care delivery system – Where are there gaps in healthcare, today and in the future ?

4. D-H current positioning – What platforms can we build upon for the future?

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National TrendsNational Trends

AgingPopulation

Capital Access & Reimbursement

ChangingHealthcare Workforce

Need to Demonstrate

Value

We identified 7 forces that will reshape healthcare over the next 2 decades.

Constrained Research Funding

HealthcareIndustry

Transition toOutpatient

Care

Costs / IncreasedCalls for Reform

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Impact of National TrendsImpact of National Trends

The US health care system is underperforming today and the future is one of increasing demands and decreasing resources.

“The aging of the population is the #1 issue – it will drive more demand, require us to effectively manage high risk patients with chronic disease and stretch the supply of health professionals.”

“As the population requiring intensive/extensive health care grows, more staff will be needed at all levels. At the same time, declining reimbursements and increasing government regulation will reduce the attraction associated with a health care career.”

“The financing and thus the adequacy of access to healthcare is likely to be the key issue nationally in the next ten years.”

“Health providers will compete on the basis of how well they do their jobs.” There will be a continued push toward patient safety, outcome reporting and transparency.

“Building the delivery systems and information systems sufficient to support the delivery of evidence-based, measurable and reportable quality of care in a zero-error environment.”

“Reductions in federal research funding and higher costs of providing residency training will make it extremely challenging to finance the academic mission of AMCs.”

Note: Comments Confidential

Excerpts from Interviews and Work Group Activities

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Population Profile – Geographic DistributionPopulation Profile – Geographic Distribution

Population by Region (2006)

Lebanon

Region 2006 Pop%of Total

Projected Growth 06-

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Southern NH 883,256 48% 5.6%

All other regions 951,818 52% 3.9%

Grand Total 1,835,074 4.7%

600+201 to 599101 to 2000 to 100

Population Density by Region (2006)

Our service area contains 1.8 million people with almost half residing in the high growth Southern New Hampshire region

Notes: Population density is calculated as total population divided by total square miles within region. Source: Claritas, 2000 – 2011

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• High income– NH has the 6th highest median household income in the nation; VT is #23

• Ethnically homogeneous– VT is tied for #1 in percentage of white persons at 96.6%– NH is ranked #3 at 95.5% white

• Well educated– Percentage of population with a college degree

• VT – 29%, NH – 29%, US – 24%– Percentage of population with less than high school degree

• VT – 14%, NH – 13%, US – 20%

• Insured1 – The percentage of uninsured for VT and NH is only 8%, compared to 16% for the entire

nation• Older

– By 2016 50% of the population will be over age 45

Population Profile – Demographic Population Profile – Demographic CharacteristicsCharacteristics

Source: U.S. Census Bureau,2000, 2005 American Community Survey• 2001 New Hampshire Family and Employer Health Insurance Survey; 2001 Vermont Household Health Insurance Survey

Vermont and New Hampshire have very homogeneous populations and they rank within the top 10 states in several demographic categories

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• Larger and faster growing1

– Makes up 49% of the VT and NH population– Annual growth of Southern NH region between 2000-2006 was 1.3%, while other areas grew

at 0.8% annually• Younger population1

– Higher percentage of <19 and 19-44 – Lower percentage of 45-64 and 65+

• Higher income2

– The Southern NH counties rank in the top 25% in median household income among all counties in NH and VT

• Better insured3

– Southern NH has a lower rate of uninsured (7%) compared to other regions (13%)• Ethnically diverse2

– Population in the Southern counties is more diverse – having higher percentages of Black, American Indian, and Asian residents.

• Increasing hospital utilization 4

– The discharge rate in Southern Region has increased between 2001-2004 (+2.9 discharges/1000), while the discharge rate among the other regions has declined in the same time period (-1.3 discharges/1000).

Population Profile – Southern NH Population Profile – Southern NH

1 Claritas Data 20062 U.S. Census Bureau, 2005 American Community Survey3 2001 New Hampshire Family and Employer Health Insurance Survey; 2001 Vermont Household Health Insurance Survey4 NH and VT State Data, 2001-2004

The Southern New Hampshire region is demographically unique within DHMC’s total service area

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Regional Health Care Delivery - ProfileRegional Health Care Delivery - Profile

Hospitals in Our Region

• 49 hospitals in the region

• 41 acute care

• 8 specialty (VA, Rehab, Psych)

• 19 critical access hospitals

• Only 6 hospitals have more than 200 beds, 4 of which are in southern NH

• DHMC - Lebanon

• Fletcher Allen - Burlington

• CMC - Manchester

• Elliott - Manchester

• St. Joseph’s – Nashua

• Concord Hospital - Concord

The health care delivery system in Southern New Hampshire in many ways reflects the demographic trends of the region

DHA Hosp. D-H ClinicNon-DHA Hosp. 23

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Regional Health Care Delivery - GapsRegional Health Care Delivery - Gaps

“The fragmentation and lack of service coordination in the region will lead to duplication of services and technology which will continue to increase the cost of healthcare delivery.”

“Competition among the Southern NH hospitals is heating up – each of them wants to establish high end services and are actively purchasing physician practices.”

“Little planning is occurring with respect to the care of the elderly population and the healthcare system required to care for this segment of the population.” “We will see a growing gap in post acute and long term care services as needs increase.”

“Quality and accessibility are unbalanced.” “Safety and standard of care issues exist in care provided at some of the smaller medical centers.”

“Lack of integrated information systems necessary to coordinate care and track patient health status and outcomes over time.”

“Funding what will inevitably be the mismatch between regional need and what gets paid.”

The regional delivery system has significant gaps in access and is not currently organized to provide services that are coordinated, cost effective and of consistent quality.



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D-H Positioning – Delivery System ProfileD-H Positioning – Delivery System Profile

D-H Regional Delivery System

• D-H – Lebanon

• 4 Large D-H Clinics in the South

DHA Hosp. D-H Clinic

Population - 1.8 million

Population

2006

D-H Patient Population

% Pop Served by

D-H

All Regions

1,835,074 615,763 33.6%

Excl. NW VT and NH Seacoast

1,288,914 590,923 45.8%

Percent of Total Population Served by DH FY2003 – FY 2006

< 15% 15% to 29% 45% to 59% 60%+30% to 44%

DHA Hosp. D-H ClinicNote: Unique patients defined as all individuals served by DH between FY03-FY06. Unique patients may be understated if a DH patient has not received service at DH between FY03-FY06.

*Unique Patient = Each PERSON that had an interaction with DH (MH or DHC) that generated a charge

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D-H Positioning – Our Volume GrowthD-H Positioning – Our Volume GrowthDHC office visits have grown 10% in the last 4 years with the

majority of visits occurring in the South

0

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000

1,800,000

2002 2003 2004 2005 2006

Other Southern Clinics Lebanon

31% 32% 32% 32% 33%

61% 61% 61% 62% 63%

8% 7% 7% 6% 4%

1.48M1.53M

1.59M 1.62M 1.63M

DHC Outpatient Visits by Location

16% Growth

14% Growth

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D-H Positioning – GrowthD-H Positioning – GrowthMHMH admissions are growing twice as fast as the market rate

and equally as fast as visits to DHC Lebanon

14,915

15,955

16,48416,750

17,296

13,500

14,000

14,500

15,000

15,500

16,000

16,500

17,000

17,500

2002 2003 2004 2005 2006

MHMH Annual Admissions

Excludes: Observation Patients, Normal Newborns

16% Growth

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D-H Positioning – Total DischargesD-H Positioning – Total Discharges

Total VT and NH Discharges (2004) N= 157,493

Note: Includes 0-18, Excludes VA Discharges, Psych, and RehabSource: Claritas; NHHA and VHA Data

< 5%

REGION

MHMH % of Total

Discharges

Change in MHMH % of Total Market Discharges

02-04

Upper Valley 46.7% + 2.7%

North Country 19.3% + 0.7%

Conn. Valley South 14.1% + 1.7%

Lakes Region 7.4% - 0.3%

Central Vermont 12.9% + 2.8%

Manchester/Derry 2.4% + 0.6%

Rutland 7.5% + 0.4%

Concord Area 4.6% + 0.7%

Nashua/Monadnock 2.5% + 0.4%

NH Seacoast 1.7% + 0.1%

Northwestern Vermont 1.2% + 0.2%

Total 9.6% + 0.7%

5% to 14% 15% to 29% 30% and above

MHMC% of total market discharges (2004)

Lebanon

Manchester

MHMH is strongest up and down the I-91 corridor and is slowly increasing its reach across the entire service area

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D-H Positioning – High Case Weight DischargesD-H Positioning – High Case Weight Discharges

Note: High case weight cases defined as DRG case weight > 2.25 and account for 12% of all service area discharges. Includes 0-18. Excludes VA Discharges, Psych, and RehabSource: Claritas; NHHA 2004 and VHA 2004 Data

MHMH is much stronger among higher acuity cases and is increasing its reach across the service area

MHMH High Case Mix Discharges by Region (2004) N= 20,824

REGION

MHMH % of Total Market

Change in MHMH % of Total Market Discharges

02-04

Upper Valley 75.4% + 5.7%

North Country 53.6% + 2.9%

Conn. Valley South 46.8% - 1.5%

Central Vermont 38.0% + 7.5%

Lakes Region 13.4% - 0.9%

Rutland 22.1% + 2.1%

Concord Area 10.4% + 1.3%

Nashua/Monadnock 7.1% + 2.6%

Manchester/Derry 4.5% + 1.0%

NH Seacoast 2.8% + 0.0%

Northwestern Vermont 2.5% +0.3%

Grand Total 20.7% + 1.8%

Lebanon

MHMH % of total admissions with high CMI (2004)

30% and above15% to 29%5% to 14%< 5%

Manchester

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D-H Positioning – High Case Weight DischargesD-H Positioning – High Case Weight Discharges

Note: High case weight discharges defined as DRG case weight > 2.25; Local hospitals include DHASource: Claritas; NHHA and VHA Data, excludes Ages 0-18

Percent of High Case Weight Discharges by Hospital Group (2004)

In Manchester, Nashua and the Seacoast regions, more High Case Weight Cases are referred to Boston than to MHMH.

12,594

8,227

Discharges

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D-H Regional Positioning - GapsD-H Regional Positioning - Gaps

“The population growth is 1-2 hours south of Lebanon and while we have a large physician presence there, we have no technical presence – to improve the health of the population, we need to increase primary care while in order to support that agenda financially, we need to build our technical revenue in the south”

“We have regional relationships with many providers but we do not have a true system that coordinates care and allocates resources to serve our population in the most efficient and effective way.”

“This orqanization needs a southern campus that includes a hospital just to maintain excellence in our training programs”

“We have a Children’s Hospital here in Lebanon, when the growth in pediatrics is occurring to the south of us, we need to have a strategy for pediatrics in the south”

“Our efforts to bolster community hospitals has certainly been of benefit to them, but it has resulted in decentralization of effort with lots of little buckets of activity scattered across the region… each focused on maximizing their individual financial performance.”

“I propose that we not expand DHA, but expand D-H to cover all of NH and eastern VT, by expanding our group operation, acquiring local practices and local hospitals to create an integrated operation that really works and benefits the patients”


The relationships within the D-H system – including the clinics in the south and the D-H alliance in the north – have some gaps that need to be addressed.

Note: Comments Confidential 31

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D-H Positioning – Platforms for the FutureD-H Positioning – Platforms for the Future

“Our brand image and reputation are strong in the public’s mind and represent a platform to expand our potential for leadership in the future…we are the “place to go when you are really sick.”

“Our facilities are top notch and our presence in the market is meaningful.”

“Our academic reputation differentiates us and strengthens our ability to lead; it also presses us to stay on the leading edge of medicine everyday.”

“Relative to other medical centers in the region, we have a strong balance sheet that continues to improve. If we decide to flex that strength in a focused direction, we will probably be successful; if we decide to cover all bets, needs and wants, our financial strength will dissipate over a relatively short period of time.”

“CECS data indicates that integrated, multidisciplinary, monopolizing group practices are the most efficient for delivering care.”

“Our people are our greatest strength…nationally known faculty, relatively satisfied staff, strong administrative leadership.”

DH’s many strengths including its size and market presence, clinical and academic expertise, and existing regional relationships that offer multiple strategic opportunities for the future.



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D- H Positioning – Opportunities for the FutureD- H Positioning – Opportunities for the Future

“D-H should be a leader in developing innovative ways to provide population-based care by bringing regional providers together and proposing economic systems that promote the most effective care. The lack of an optimal economic system has been and will continue to be a barrier if left unaddressed.”

“We need to be more than leaders; we need to be organizers and operators of an integrated health care system for New Hampshire and eastern Vermont.”

“We need to influence political change to help shape public policy and be sure that we can continue to provide needed services and get paid adequately for the care.”

“D-H should be a source of knowledge for the region in terms of assessing and communicating the effectiveness of new technologies, treatments and disease management initiatives.”

“Drive the distribution of expert care across the region; in partnership with local hospitals or on our own.”

“One of the brightest jewels in our crown is CECS and we should take advantage of their work to improve healthcare locally and set a pattern for the nation.”

“D-H should be the model for the region of standard and safe care.” “As the largest system, we should be the best - we should and can set the standard.”

“Provide immediate access to the highest quality tertiary care”

D-H has an opportunity to make a significant impact on health care in our region.



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Environmental Scan - SummaryEnvironmental Scan - Summary

D-H has an opportunity to make a significant impact on health care in our

regionD-H Positioning

- Largest and most sophisticated health care organization in NH

- Nationally known academic programs and the most advanced clinical programs in the region

- Deep knowledge about evidence-based medicine and established standards of care in many areas

- Strong relationships throughout the region but lacking an organized delivery system of care

External Forces

- Aging population will drive increased demand in all settings

- All providers will be under increasing pressure “to do more with less”

- Our primary geographic service areas are continuing to take divergent paths

- There are significant gaps in the delivery system today in both the rural and urban areas

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Formulating the Strategy: Mission, Vision and Goals

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Identity of the organization – what is our purpose, who are we?

Desired future position – what do we want to be, what are we trying to create?

Drivers for achieving the Vision – what will take us there?

Specific, detailed initiatives for achieving goals – both market facing and internal requirements – how do we get there?

Measurement and monitoring - how will we know when we get there?

Step by step tasks, timelines and accountabilities for executing the highest priority strategies – how will we make it happen?

Language of Strategic Planning

Formulating the Strategy Formulating the Strategy

MissionMission

StrategiesStrategies

Tactical PlanTactical Plan

IndicatorsIndicators

VisionVision

GoalsGoals

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VISION

M

I

S

S

I

O

N

IV. Formulating the Strategy IV. Formulating the Strategy

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VISION

GOALSReview, Discuss, Analyze, Synthesize,

Refine

IV. Formulating the Strategy IV. Formulating the Strategy

Inputs

Work Group Exercises

Work Group Surveys

Interviews

Market Analysis

Environmental Context

Outputs

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Memorable: – Simple is Better: Short, memorable and plain language

Inspirational: – Keep the inspiration: The reasons we went into medicine– “Healthiest population” should come alive in the vision

Achievable:– Make the concepts in the goals more “real” and measurable– Emphasize the ways in which D-H can and does impact the health status of the

region

Relevant: – As an AMC, we need to incorporate “learning” into the goals

– We must engage the rest of the region to achieve the vision, thus we need to add the concept of engaging others in the goals

– Mission and Vision need to be better aligned

The Work Group emphasized the need for the Mission, Vision and Goals to be meaningful for the entire organization

Formulating the Strategy – Mission, Vision Formulating the Strategy – Mission, Vision and Goals and Goals

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The Trustee Advisory Group has been enthusiastic about the development of the Mission, Vision and Goals.

• “Really exciting to see, something that we have needed for a long time”

• “We need to be the pace setters and leaders of the healthcare transformation, this work builds the foundation to take us there”

• “This provides clarity that DHC, MHMH and DMS are all headed in the same direction”

• “Help leadership to decide between competing priorities and force choices – we can’t do everything”

• “The mission, vision and goals explicitly differentiate us in the region as a premier academic medical center”

Formulating the Strategy – Mission, Vision Formulating the Strategy – Mission, Vision and Goals and Goals

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Visioning Our Future State - Why We Exist ?Visioning Our Future State - Why We Exist ?

Dartmouth-Hitchcock

Dartmouth-Hitchcock

Societal Value

DartmouthCollege

DartmouthCollege

CECS

Loc

al

Nat

iona

l

Inte

rnat

iona

l

THAYER

DMS

TUCK

DHA OTHERS

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Societal Value

Dartmouth-Hitchcock

Dartmouth-Hitchcock

Healthiest Population

Possible

Optimize Health & Minimize Burden of Illness

The D-H Vision - Creation of Societal ValueThe D-H Vision - Creation of Societal Value

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MissionMission

We advance health through research, education, clinical practice and community partnerships, providing each person the best care, in the right place, at the right time, every time.

Dartmouth-Hitchcock Mission - New

To provide the highest quality health care and comfort to the ill, to prevent illness among the well, and to advance health care through education, research, community service and the improvement of clinical practice.

Dartmouth-Hitchcock Mission - Previous

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Dartmouth-Hitchcock Vision - (09/24/07)

Achieve the healthiest population possible, leading the transformation of health care in our region and setting the standard for our nation.

VisionVision

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Close the Quality Gap: Lead the way in discovering and closing the gap between the best that can be and where we are today.

Practice Careful Stewardship: Steadfast dedication to create the highest value given the resources available.

Promote Patient and Family Centered Care: Unwavering commitment to provide care that is coordinated, effective, efficient, compassionate and safe.

Build an Empowering Culture: Enable people to attain ever-increasing levels of excellence by establishing environments of continuous learning and accountability.

Create Systems that Work: Establish a population based health care system supported by technology and processes that improve health outcomes, efficiency, access and continuity.

Attract and Engage Others: Build essential partnerships and convene group and community resources at the local, regional and national levels to achieve our vision.

Advance Our Academic Mission: Vigorously promote the education of tomorrow’s health care leaders as well as the creation, dissemination and application of new knowledge in support of our mission and vision.

Organizational GoalsOrganizational Goals

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D-H Strategic Plan SummaryD-H Strategic Plan Summary

5 Concurrent Strategic Planning

Task Forces

Strategic Initiatives

Southern NH Growth

Tertiary Quaternary Care Leadership

Leaders in Quality

Education and Research Strength

Operational Imperatives

Population Health Management

Mission, Vision, Goals

Information Technology FinanceService & Access

People

Five Strategic Initiatives have been identified by the Steering Committee to support the achievement of the D-H Mission and Vision.

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Strategic Planning Steering Committee - RoleStrategic Planning Steering Committee - Role

Strategic Planning Steering Committee

• Serve as the ultimate designers of a compelling Strategic Plan for guiding the future of D-H

• Provide strategic thought leadership maintaining a D-H-wide rather than constituency-specific, perspective

• Test, synthesize and prioritize the recommendations of the Task Forces

• Engage the organization to ensure broad stakeholder input and buy-in

• Steer the Strategic Plan recommendations through the Board review and approval process

The Steering Committee leads the overall Strategic Planning effort.

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• Provide thought leadership and subject matter expertise bringing leading edge ideas to the planning process

• Actively engage and participate in Task Force research and deliberations

• Solicit internal and external input and review

• Recommend to the Steering Committee powerful but realistic strategies and tactics for achieving the desired future state

• Acknowledge risks and identify potential remediation strategies

Strategic Planning Task Force - RoleStrategic Planning Task Force - Role

Strategic Planning Task Forces

The Task Forces have critically important roles in the further refinement of our Strategic Plan.

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Strategic Planning Task Forces - ProfileStrategic Planning Task Forces - Profile

• Task Force Charge

– Develop Strategic Plan for assigned initiative

• Task Force Composition

– Leadership - joint clinical and administrative team

– Membership composition - No more than 15 members from across the organization selected by the Task Force leadership team

– Steering Committee participation – Task Forces will be made up of some representatives who do not participate on the Steering Committee and not all Steering Committee members will participate directly in Task Forces

• Timing

– Task Forces kick-off meetings held in October

– Final recommendations due by the end of February

– Monthly progress reports to Steering Committee

Strategic Planning Task Forces

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Strategic Planning Task Forces - LeadershipStrategic Planning Task Forces - Leadership

Task Force Leaders

Population Health Management John Butterly, MD

Gene Nelson

Education and Research Strength Jim AuBuchon, MD

Ron Sliwinski

Leaders in Quality George Blike, MD

Linda Von Reyn, PhD, RN

Tertiary and Quaternary Care Leadership Bill Edwards, MD

Michael Ward

Southern NH Growth Sandy Burstein MD,

Chris Schon

Task Forces have been charged with developing a plan for advancing each of the five Strategic Initiatives.

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Leaders: John Butterly and Gene Nelson

Population Health Management Task Force – Summary Population Health Management Task Force – Summary

• How do we define Population Health Management? (i.e. services, programs, individual response)• What are the gaps that we see in the region today? • What is our role in managing the health of the population? • What other relationships do we need to foster to make our efforts successful?• How will we manage our patient population across the continuum of care from prevention to

palliative care? • What is the current health status of D-H employees? Where are the big gaps? What can we do to

better manage the health of these employees? • What efforts will we undertake to re-align payment systems to reward effective health

management? • How do we secure resources to invest in this which is traditionally outside the scope of our

responsibilities? • How will we measure our success?

Rationale: To achieve our vision D-H must assume a more proactive role in managing the overall health of our population (including Preventive Care, Primary Care, Chronic Care, Geriatric Care, Behavioral Health).

Sample Questions to be Answered:

Charge: Develop a plan that will define the strategies and tactics D-H will take to manage the health of our population. Specific deliverables to be worked on include: definitions and core measures for population health management, standardized methodologies for tracking health status across NH and VT, specific population groups on which to focus, proposed short term and longer term initiatives and the related business case and resource requirements.

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Leaders: Jim AuBuchon and Ron Sliwinski

Research & Education Strength Task Force – Summary Research & Education Strength Task Force – Summary

• What is the size and focus of our current research portfolio by department (clinical and basic sciences)? Where are our current strengths and weaknesses? What is our financial performance by department (clinical and basic sciences)?

• What are the key drivers that will impact research over the next 5-10 years (e.g. technology, genetic mapping and therapies, computing, translational capability, funding, ability to enroll patients /subjects, etc)?

• What are the implications of these changes for D-H and DMS?• What relationship should there be between our research agenda/ portfolio and our clinical

programs? How does the research agenda interface with D-H’s mission and vision? • What are our goals for the future and what is the resulting research agenda for D-H and DMS? • What are the key environmental changes that will impact medical school curriculum across the

country in the next 5-10 years? How is DMS prepared to adjust to those changes? • How will we support the required faculty time to achieve our education goals?• How will D-H monitor and measure our performance?

Rationale: Research and Education are essential to achieving the D-H Vision and should be an integral part of all that we do.


Charge: Develop a plan for the future of research and education at D-H. Specific deliverables to be worked on include: future state for D-H & DMS research portfolio and education programs, strategies for achieving future state, implementation plan and timeline, agreed upon performance measures and goals.

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Leaders: George Blike and Linda Von Reyn

Leaders in Quality Task Force - Summary Leaders in Quality Task Force - Summary

• How do we ensure that we are the quality leader in the region and that various constituencies see us as the quality leader once we attain that?

• How do we most effectively export our successes to other providers in the region and beyond? – How will we influence the national agenda on quality? What research and education

initiatives must be pursued? • What quality and cost performance must we demonstrate to influence the current payment

system? Where and how can we make the biggest impact on quality at D-H ? • How will we define quality standards and metrics? What is the measurement set and what are our

targets? • What are other leading organizations doing today to ensure top quality? How do we mobilize D-H

to adopt best practices from other organizations? How will we set the best practice standard in the years to come?

Rationale: To impact that health of populations, we must pursue our path to lead the way in discovering and closing the gap between the best that can be achieved and where we are today


Charge: Establish our long term vision for Quality and develop specific initiatives for achieving that vision. . Specific deliverables to be worked on include: current state assessment, vision for the future of patient centered care at D-H, strategies for building organizational commitment and performance, tactics for monitoring and remediation of performance issues

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Leaders: Bill Edwards and Michael Ward

Tertiary and Quaternary Care Leadership Task Force - Summary Tertiary and Quaternary Care Leadership Task Force - Summary

• What tertiary/quaternary services are/will be needed by the residents of NH and VT?• Where are the gaps by geography?• How will we provide tertiary/quaternary care to these residents? In Lebanon? Rural? Southern

NH? • What models would we employ at community hospitals?

– How will we secure referral channels? Dedicated physician presence, etc• What centralized care is likely to be distributed care in the future?• What are the emerging services and technologies and where should we invest? How will we

decide?

Rationale: As the only AMC in New Hampshire and the major provider of highly specialize services we must continue to be the preferred regional resource for the diagnosis and treatment of the most complicated and resource intense medical conditions.


Charge: Develop a model for the provision of tertiary and quaternary care services throughout the NH and VT region by key service line and geography. Specific deliverables to be worked on include: market assessment, business cases, implementation timeline and metrics to monitor performance

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Leaders: Sandy Burstein and Chris Schon

Southern New Hampshire Growth Task Force - Summary Southern New Hampshire Growth Task Force - Summary

• What do we hope to achieve over the next 10 years in Southern NH? Clinically? Financially? What do we want to become? How will we measure success?

• How do the needs of each community vary and how will we meet those needs? • What is the scope of services that we will provide locally? Where will they be located? How will they

be organized? • How do we organize and deliver sub-specialty care and how does that relate back to Lebanon?

Which services will we collaborate on with non-D-H providers and which services are we willing to compete on?

• How will we provide inpatient services? Do we have multiple hospital affiliations along specific service lines or a single hospital affiliation in each of the major geographic areas that we currently serve?

• How will we migrate teaching and research programs? Which ones?• How do we need to be structured both in terms of governance and operations to be able to support

Southern NH growth? • What are the resources required to achieve our goals?

Rationale: To achieve the healthiest population possible and to support our clinical, education and research programs we must establish a stronger position in the Southern NH region


Charge: Develop a strategic plan for the Southern Region of New Hampshire. Specific deliverables include: Southern N.H. growth objectives by HSA. Growth strategies by service/program and geography, associated models for each growth strategy, business case and associated financial projections, implementation timeline.

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Group Exercise: Making strategic planning come alive!

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Strategic Planning (Who cares?) February 5, 2008.

Documents

Transcript of Strategic Planning (Who cares?) February 5, 2008.