Health Care Management for Missionaries and Other Dummies

1. Health Care Management for Missionaries and Other Dummies • David Stevens, MD, MA (Ethics) • CEO CMDA

3. Important to Know What We Are Doing!

4. Important? • Medicine is not enough for Success • Poor Management, Poor Morale • Poor Management Leads to Conflict • Common Reason for Leaving Field

5. Good Management Starts With the Board Through GoodGovernance

6. Develop/Evaluate/Improve Governance Select/Dismiss, Supervise, Evaluate, Compensate CEO Encourage/Nurture CEO/Senior Staff Maintain Major Standing Policies Help Develop/Approve/Monitor Strategic Plan Determine Mission, Vision, Values Situational Analysis, SWOT, Ensure Financial Solvency & Integrity Represent organization Volunteer/Give Pray The Board’s Duties

7. Board Size? • To Small • Lack diversity - knowledge, experience and perspectives • Get into rut - old boy’s club, • To much for few to do. • To Large • Ex. Committee takes over, unwieldy, lack of personal relationship, ownership, difficulty in function/communication. • Right Size - 10-17 with a good chairman.

8. Board Members If you have the Right Board Members, the right things happen. If you have the Wrong Board members, the wrong things happen.

9. W h a m m y Wisdom What Should Board Members Bring? Work Wealth

10. Member Selection • Formal Orientation • Where we’ve been, Where we are, Where we are going. • Welcoming • Mentoring • Utilization • Evaluate - informal/formal • Term Limits/Reelection • Formal Recognition • Especially important for volunteers.

11. Board Officers Chair’s Job Description 1. Integrity of board process 2. Organizes and conducts meetings 3. Non-voting except deciding vote. 4. Speaks for the Board 5. Invites guests/presenters 6. Interprets policy to CEO/supports 7. Selects committee chairs/members 8. Ex- officio member of all committees 9. Sign appropriate documents 10. Link with constituency 11. Communicates between board and CEO • Chair • Job Description • Selection • Term Limits • Assessment/Feedback

12. Committees • All Committees do work for the board and make reports and motions to the board. No second needed. • Expedite board work • Better utilize members expertise • More intense focus into each area. • Staff help develop agenda. • Official minutes recorded and filed.

13. BOARD HATS Governance Hat Implementor Hat Volunteer Hat • Carries legal authority. • Worn only in properly called board meeting with quorum. • Decisions made as a group and supported by all. • Never worn when working alone. • CEO accountable only to decisions by whole board. • No authority. • What normally wear outside of committee or board meeting. • Worn when advising the CEO. • Worn when fund raising. • Worn when assisting staff under their supervision whether as a group or individually. • Limited authority • Seldom worn because staff implements board policies. • Worn when board policy or structure gives limited authority to carry out board action.

14. Board Policy Manual Reasons for Adoption • Efficiency of having all on-going Board policies in one place • Ability to quickly orient new Board members to current policies • Elimination of redundant, or conflicting, policies over time • Ease of reviewing current policy when considering new issues • Clear, pro-active policies to guide the Chief Executive Officer (CEO) and staff • Models an approach to governance that sister organizations might use.

15. Board Policy Manual • Length - 15-20 pages • Reviewed at every board meeting - modified at most. • Template available • Pull together present policies from minutes. • CEO draft. Governance modify and recommend. • Process “forces” better governance.

16. Articles of Incorporation Bylaws Board Policy Manual Administration Policies/Procedures

17. CEO’s Job Descriptions • Determines Strategies Within Policy Fences • Hires, Manages, Motivates and Fires Administrative Team • Develops, Funds and Supervises Budget • Implements Strategy • Monitors and Reports Progress • Develops and Enforces Administrative Policies • Non-Voting Ex-Officio Board Member • Spokesperson for Organization • Other Duties as Outlined in Board Policy Manual

19. CEO/Board - Relationship Hires, Supervises, Pays, Evaluates and Fires CEO Hires, Supervises, Monitors and Fires all Other Staff Sets Out of Bounds Areas with Major Policies Works Anywhere Within Policy Boundaries Develops with Administration & Approves Strategic Plan & Budget. Monitors Works to Accomplish Strategic Plan within Budget

20. Board Policies - CEO What He/She Can’t Do Expressed in Negative = Fences 1.1 Staff Treatment. With respect to treatment of paid and volunteer staff, the CEO may not cause or allow conditions, which are inhumane, unfair or undignified. Accordingly, he may not: 1.1.1 Discriminate among employees on other than clearly job related, individual performance or job qualifications. 1.1.2 Fail to take reasonable steps to protect staff from unsafe or unhealthy conditions. 1.1.3 Discriminate against any staff member for expressing an ethical dissent. 1.1 Communication and Counsel to the Board. With respect to providing information and counsel to the Board, the CEO may not permit the Board to be uninformed about matters essential to carrying out its policy duties. Accordingly, he may not: 1.1.1 Let the Board be unaware of relevant trends, anticipated adverse media coverage, material external and internal changes, particularly changes in the assumptions upon which any Board policy has previously been established. 1.1.2 Fail to submit the required monitoring data in a timely, accurate and understandable fashion, directly addressing provisions of the Board policies being monitored. 1.1.3 Fail to marshal as many staff and external points of view, issues and options as needed, for fully informed Board choices. 1.1.4 Present information in unnecessarily complex or lengthy form. 1.1.5 Fail to provide a mechanism for official Board, officer or committee communications. 1.1.6 Fail to deal with the Board as a whole except (1) for fulfilling reasonable individual requests for information or (2) for responding to officers or committees duly charged by the Board. 1.1.7 Fail to report actual or anticipated noncompliance with any policy of the Board.

21. CEO Visionary Organizational Skills Charisma Problem Solving Skills People Skills Spiritual Maturity National or Missionary?

22. Job Description

23. “A” Employees - innovator, problem solver, knowledgeable,, organized, leader, the more of these you have, the easier your job is. “B” Employees - good job, not innovator/problem solver, have to step in some because can’t solve messes “C” Employees - mediocre, don’t do job well, not bad enough to fire, generate messes, poor decisions, lack self discipline. “D” Employees - So bad justified in firing, bad mistake in hiring “F” Employee - Challenges your authority, polarizes your staff, tries to take over your institution or destroy it. Charismatic and leader. The ABC’s of Hiring

24. “A” Employees a. Get involved in strategic planning b. “Turn Loose” to motivate c. Give them the authority and resources d. Challenge them. Overall Management style Management Styles

25. Attracting The Right Staff Create a Family Tangible Benefits Intangible Benefits Motivate

26. Standards of Performance 1.Employee “Am I doing a good job?” 2. How? a. List of Duties b. Answer “I will have done this duty satisfactorily when….” c. More than one standards/duty c. Measurable & checkable 3. ”What gets measured gets done.”

27. Annual Evaluations 1. Address problems real time a. Discipline Techniques b. Termination 2. Opportunity to give kudos and set goals. 3. Self Evaluation 4. Evaluation by immediate supervisor 5. Both sign

28. Spiritual Ministry Prioritize Plan Elevate Participate Recruit Equip Measure Evaluate Integrate

29. Below the surface Go to cmda.org Center for Medical Missions

30. Questions?