Want to Take Your Mission and Vision to New Heights? Build a New Facility

1. Want to Take Your Mission and Vision to New Heights? Build a New Facility Vic Topo President/CEO Center for Life Management Derry, NH www.CenterForLifeManagement.org

2. Learning Objectives • Understand the importance of facilities in relationship to your mission & vision • Identify and overcome barriers standing in your way • Recognize how a new facility can assist in implementing Strategic Plan goals

3. Purpose for Being Here • How the building and use of a new facility can transform your mission and vision for years to come

5. BackgroundHow It All Got Started! • New Leadership – 1999 • Physical Plant Challenges • Separate facilities, missions, and cultures • Strategic Plan 2000

6. New Leadership • Hired in 1999 (outside) • Hired new CFO (inside) with other Senior Management changes • Tale of two systems • Numerous opportunities for organizational change

7. Physical Plant Challenges • Ownership of 5 older facilities • Deterioration of facilities/costly structural improvements • Shift in use of facilities • Quality of work environment • Perception of clients

8. Separate Facilities Missions and Cultures • 2 Residential/3 Outpatient facilities • Tale of two distinct populations • Relationship to town, for each location • Multiple cultures, each misunderstood

9. Strategic Plan 2000 • Population changes • Recreated mission, vision, people and principles • Alignment of strategic goals • Consolidation emerged as Big Hairy Audacious Goal (BHAG) Jim Collins

10. Why Consolidation As A Goal? • Operational/Inefficiencies → Efficiencies • Operations/Clinical Silos → Continuity of Care • Finances/Funding challenges → Growth Opportunities • Realignment of Assets → What has your equity done for you lately?

11. Operational Inefficiencies → Efficiencies • Standardize policies & processes across programs • Eliminate duplication of tasks • Streamline use of technology • Reduce overhead costs

12. Operational/Clinical Silos →Continuity of Care • Increase access to care within and across programs • One mission, one vision • Enhanced team work relationships

13. Financial/Funding Challenges → Growth Opportunities • Strategic positioning with declining reimbursements • Reduced overhead costs, infrastructure • Investments community outreach as focus of care

14. Realignment of Assets →What Has Your Equity Done For You Lately? • Assessment of long term debt and equity • Assets leverage access to bond financing • Smarter long term investment in new state of the art, energy efficient facility

15. Why Consolidation In New Facility • HR and human capital • Quality of environment to deliver care • Location and primary care integration • Strategic position in community • Leverage use of technology

16. HR and Human Capital • Quality of work environment correlated with productivity • New opportunities for team building and learning (day to day) • Continued education, training, E-learning

17. Ideal Environment for Care • Stigma busting at front door • Creating place for healing • “Evidence based design” • State of facility = State of services?

18. Location and Primary Care Integration • Program drives real estate decisions • Align strategic goal of integration with consolidation • Proximity to medical park (78,000 sq. ft.)

19. Strategic Position In Community • Main thoroughfare business district • Name displayed on building/signage • Engenders brand recognition & loyalty • Derry/Londonderry Chamber of Commerce “Business of the Year”

20. Leverage Use of Technology • New Telecommunications Tools • Alignment of strategic goal with new building • Use of mobile technology • Enhances development of Electronic Health Record (EHR)

21. Recognizing & Overcoming Barriers to Building Anew • Contracts with funders • 501(c) 3’s undercapitalized • Beware of negativity • Bark vs. Forest

22. Overcoming Barriers to Building • Know thy contract language! • Statewide mission = local mission? • Museums, schools, hospitals can , why not CMHC’s. • Persist with “It can be done” mind set • “Open Space” thinking

23. Considerations Before Consolidation/Building • Access to care/transportation • Employees and stakeholders questions/ concerns • Variance in population growth across region, county • Current/projected rates of penetration • Minimize disruption in direct care/productivity

24. Five W’s – Know Thy Vision • Why? – Mission today, vision tomorrow • What? – Community impact, stigma busting health status • Where? – Location matters • When? – Gauging organization readiness • Who? – Prevalence/Incidence data

25. Transition Timeline – Old to New Facility • Purchase land (3.5 acres - $555,000) June 2005 • Released RFP to lenders/banks August 2005 ●Ocean National Bank chosen as lender October 2005 ● Memo to Staff announcing Relocation Plan October 2005 ●1st press release informing public/stake- holders re: relocations October 2005 ● Relocation planning underway inside CLM November 2005 ● Begin sale of properties November 2005 • Developed “lease back” strategy November 2005 • CLM assessed all processes and infrastructure November 2005 • Released RFP to 3 builders December 2005

26. Transition Timeline – Old to New Facility-Continued- ● Completed sale of 1st property January 2006 ● Use of bond financing (NHHEFA) - 4 million January 2006 ● Selected Opechee Construction Company February 2006 ● JSA Architects/Interior Design hired July 2006 • Site Plan approved by Town July 2006 • Groundbreaking Ceremony September 2006Resumed sale of two remaining properties November 2006 • Completed sale of 2nd property September 2007 ●Move into new facility July 2007

27. Assembling/Acquiring Best Consolidation/Building Team • Find expert in consolidation/new construction • Partner with senior leadership and board • Find lender that’s right for you • Communication strategy for staff/stakeholders • Consolidation → Relocation → New Facility: Parallel projects

28. What Should Newly Built Facility Look Like?“Begin With End In Mind” • Beware of design build concept • Consistency of mission & vision • Core business now/future - “futurity decisions” • Familiarize with healthcare design trends • Type of work and treatment environment?

29. Top Five Design Essentials • More than just aesthetics • Tranquil inviting atmosphere • “Comfort in nature” design concept • Natural light (nearly all treatment areas) • Fit with New England landscape

30. Our Finished Product – The New Facility • 28,000 sq. ft. concrete poured, steel frame (2 story) • 42 treatment rooms • Triage/Crisis intervention area • Large tinted & reflective windows throughout facility • Three waiting areas with flat screen TV’s • On-site pharmacy • Conference & training rooms

31. Our Finished Product – The New Facility • Two group therapy rooms • Central administration area • Centralized health records (EHR in progress) • New furniture & phone system

32. From New Facility to New CLM • Diminished past weaknesses & failures • Gave us (we took it) opportunity to reassess everything • Public Relations – Business of the Year • Unleashed “People Power” to contribute more

33. From New Facility to New CLM: Key Performance Indicators Before Move After Move (YTD) ●Admissions 2,793 3,432 (projected) ●Units of Service 301,554 331,416 (projected) ●Total Served 3,517 5,239 ●Turnover 16 8 ● Revenues 8.4 m 9.4 m

34. Conclusions • What does your facility(s) say about you • Multi Year Project – Strive for progress not perfection • Open Space Goals & Fiscal realities can co-exist • New Facility = Win/Win → Internal customers (employees) & external customers (funders, stakeholders)