1. CAH HOSPITAL STRATEGIC PLANNING MODEL PHIL CAMPBELL, FACHE

2. 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

3. CAH Strategic Planning Model Effective Comprehensive Low cost Meets ORYX requirements Builds on past successes Builds confidence in management

4. 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.

5. Core Business Drivers Comprehensive Utilizes 6 core business drivers which represent major divisions of healthcare operations addressing “real life” rural hospital operations

6. 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

7. Meets ORYX Requirements Utilizes a format consistent with – ORYX requirements – JCAHO accreditation standards – Malcolm Baldrige Quality Criteria

8. 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.

9. 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.

10. Decision Making Matrix Applying 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.

11. Strategy Development Reflects Mission, Vision and Values Core Business Drivers

12. Quality healthcare provider Valuable asset to the community Essential economic employment base Mission Statement Revisits Why The Hospital Exists Core Business Drivers

13. Where does the hospital need to be in five years to fulfill its mission? Vision Statement Defines Future Direction Core Business Drivers

14. Quality Customer Focus Diversity Fairness Value of employees, volunteers Values States Guiding Principles

15. Access Physicians Emergency services Specialty services, i.e. Surgery OB Multi-specialty clinics Performance Measure Physician Demand & Deficit Analysis

16. Financial Performance Cost Per Adjusted Discharge Profitability Assumptions Capital Availability Revenue Management CAH, DSH, MDH Appropriate Utilization Registration Process Billing Performance Measures Budget Achievement Cost per Adjusted Discharge

17. Customer Satisfaction Customer Satisfaction Rating 2 nd Qtr ‘01 Measure Key Customers External Patients & Families Community Leaders Consumers Internal Employees Medical Staff Volunteers Performance Measures Survey & Focus Group Results

18. Compliance The captain of the Titanic didn’t have a backup plan for unseen problems Compliance Plan Compliance Officer Trained Employees Codes of Ethics Periodic External Coding Review Performance Measure Effective Compliance Plan with External Review

19. Process Quality JCAHO SCORE CQI Operational in Major Clinical Areas JCAHO Survey Readiness Clinical/Operational Measures Driving Decisions Performance Measures JCAHO Grid Score Survey Readiness Program Participation (Orion)

20. Outcomes Quality Door to Needle Thrombolitic Therapy. 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

21. 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

22. 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

23. 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

24. “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

25. 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

26. 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

27. Completed Strategic Plan Outline Mission Statement Vision Statement Values Statement Core Business Drivers Performance Measures Strategies â Goals Objectives to Achieve Goals

28. 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

29. 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.

30. 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

31. 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

32.  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. Int ernal Planning Data Elements (2 of 2)

33. Completed Strategic Plan Use your plan Don’t allow your strategic plan to sit on a shelf. Operationalize your plan Incorporate performance measures into agenda templates and force them to be reviewed monthly and quarterly