Ensuring Success A Local Approach to Strategic Planning

1. Ensuring Success A Local Approach toStrategic Planning Brian Shockney, HFA, FACHE Vicki Byrd, BA

3. Memorial Hospital Founded in 1925 Located in Cass County, Indiana County Not-For-Profit 7 member Board of Trustees 83 Acute Care Inpatient Beds $120 Million Gross Revenue Memorial Hospital Foundation Third Largest Employer in Cass County

4. Mission “Your Community Resource For Optimal Health” Vision Memorial Hospital is a progressive market leader that utilizes innovative services and technology to provide compassionate, customer-centered care. We are committed to health and wellness to achieve an optimal quality of life.

5. Our Values

7. Objectives • To share with you a journey that creates success • To help you realize that none of this is revolutionary – every organization can do it • Ignite the desire to ensure planning and strategy are an important part of your organization’s ongoing responsibilities • Learn at least one new concept or idea

8. Start With A New Mindset • The Kind of Thinking That Got Us Into The Problem Won’t Get Us Out – Albert Einstein • Success Is Most Appropriately Measured Not By What We Have Accomplished, But By The Difficulty Of The Questions We Are Willing To Address – Paul Hawken • Luck Is A Matter Of Preparation Meeting Opportunity – Oprah Winfrey

9. Why Develop Strategic Plans? • If you fail to plan – then you plan to fail • Performance is the key to success • Solves major issues through reflecting on the whole organization (seen and unseen) • Communicates to everyone – what is important

10. So Many ModelsTo Choose From BASICS Goal-Based Self-Organizing Curriculum-Based A-B-C-D Bottom-Up Issues-Based Listening To The People Scenario Top-Down Organic

11. Free Advice The model is not important. What is important is to ensure the process and structure fits the culture of your organization.

12. Formal Planning • Builds upon and dependent upon preservation and rearrangement of existing goals, products, and services • Focused solely on the quantitative • Comfortable for organizations where reports, numbers, forecasts, and data only are needed for decision making (Annual Budgeting) • Usually a result or tasks that results from strategy

13. Strategic Thinking • The most successful strategies are not plans, they are visions • “Capturing what we learn from all sources (both the soft insights from your personal experiences and the experiences of others throughout the organization and the hard data from research and the like” – Henry Mintzberg • It involves intuition and creativity able to freely appear through processes carried out by various people at various levels in the organization that are deeply involved in the issue at hand

14. Strategic Thinking • It has to occur outside of the organization chart boxes that fosters informal learning and produces new perspectives • Incorporates qualitative information • Balances between data-driven decision making and soft forms of information including gossip, hearsay, and other scraps of information • Works in organizations that value input from every level – most importantly customers

15. Tacit Knowledge By definition, tacit knowledge is knowledge that people carry in their minds and is, therefore, difficult to access. It is most often overlooked in planning and decision making, however, it is critical to your success.

16. Tacit Knowledge • Often, people are not aware of the knowledge they possess or how it can be valuable to others. • Tacit knowledge is considered more valuable because it provides for people, places, ideas, and experiences. • Effective transfer of tacit knowledge generally requires extensive personal contact and trust.

17. Tacit Knowledge • Simply put: "We know more than we can tell." • Tacit knowledgeconsists often of habits and culture that we do not recognize in ourselves.

18. Do you REALLY care what your employees know will work or needs to be changed for your success? They Do. And so do your customers!

19. Tacit Knowledge • In the field of knowledge management the concept of tacit knowledge refers to a knowledge which is only known by an individual and that is difficult to communicate to the rest of an organization. • Knowledge that is easy to communicate is called explicit knowledge. • The key is to use a process that transforms tacit knowledge into explicit knowledge. “Useable Information”

20. Memorial’s Journey • 1998 – Routine planning creates a routine organization • Many strategies and goals with 50% completion/success • 1999 - Executive Visioning/Strategic Thinking • Board, Medical Executive Committee, Executive Leadership • 2001 – “Advance” • Executive Visioning/Strategic Thinking • Added Department Directors • 2008 – Baldrige Journey Begins • Inverted Organizational Chart and “Advance” • 2009 – Year Round Strategic Advances • Employee Roundtables/Surveys

21. Strategy Advance Employees Board Executives Department Directors Invert The Pyramid Department Directors Executives Employees Board

22. Information GatheringTools • Employees • New Personnel Orientation • Employee Roundtables • Focus Groups • Annual Employee Survey • President/Employee Meetings • Department & Meeting Visits • Executive Rounds • Assignment to Initiative Task Forces

23. Information GatheringTools • Management • Annual Employee Survey • Department Director’s Meeting • Formal Strategy ‘Advances’ (2/year) • Wednesday Stand Up Strategy Briefing • Assignment to Initiative Teams

24. Information GatheringTools • Executives • Annual Employee Survey • Executive Leadership Meetings • Formal Strategy ‘Advances’ (2/year) • Wednesday Stand Up Strategy Briefing • Leadership of Initiative Teams

25. Work Groups Defined • Committee: Long-standing group of individuals organized around a common strategy but with multiple goals • Team: Short-term (< 12 months) group of individuals organized around a common goal that requires process identification and change • Task Force: Quickly organized group of individuals organized around a common task to identify best practice, fix a common cause issue and provide input to a team (JIT)

26. Why is this important? • To ensure participants and the rest of the organization understand the scope of work and time frame for completion • Resources, Resources, Resources • Establish lines of communication and reporting • Avoids overlapping work from other groups and communication of successes • Command accountability • Follow-up should account for 10 times the effort of planning and selecting

27. The “Advance” The troops assemble to develop the battle plan and design its execution.

28. Ground Rules • Participate Actively • Communicate Professionally • Listen Carefully • Speak With Respect – One Person At A Time • No Side Conversations • Speak From Knowledge Not Assumptions • Hold All Confidences & Information • Call ‘Time Outs’ and ‘Fouls’ As You See Them • Take Breaks As We Need Them • Have Fun! • Sometimes,It’s About Process And Not Outcome

29. Environmental Scan

30. Environmental Assessment(SWOT Analysis) • Strengths, Weaknesses, Opportunities, Threats • Yes, it is important… • Gets everyone on the same page to start • Helps everyone understand your perspective • To know where you are to see if you are moving toward somewhere else • Must be a brutally honest assessment of the current state

31. Identify Barriers to Our Success&Solutions To Overcome The Barriers

32. Barriers To Success Physicians Financially Constrained and Seeking More from Hospital not Less Increasing Bureaucracy & Work Required for Hospital Success Solutions To Overcome Align Hospital : MD financial incentives Low salary High RVU bonuses 2. Make creative practice opportunities available ½ time No call, etc. Hospitalist only Allow clinical autonomy Bonus for excellent clinical performance Medical Staff

33. When It’s The Right Thing To Do… • Renegotiated Salary and Incentives of ALL Employed Physicians/Providers • Not for the faint of heart • Lost a couple of primary care physicians • Kept the end in mind • Improved Satisfaction Rate • From 8 Providers to 36 Employed Providers in 15 Months

34. Brainstorm Other Goals & InitiativesYou Would Like The OrganizationTo Achieve

35. Process for Strategies • Brainstorm • Sticky notes and flip charts • Clarify Each Idea • Be sure everyone understands your intent • Combine like items • Affinity Diagrams • Group in like categories • Assign strategy name to groupings • If More than 10 Large Groupings…Multi-Vote • Sticky-dots to gain priority • Select the top 10 to move forward

36. Strategy #1

37. How many diets does it take to lose weight?

38. Answer: Only The One You Stick To

39. Gut & Reality Check It’s easy to let the process of planning take over and miss […Forest For The Trees] What Really Needs To Get Done. Ensure accomplishment as well as performance. A Lack of AccountabilityBy Dan Beckham May 18, 2009 in HHN Magazine online site

40. What Needs To Stay?Are We Missing Anything?[Tacit Knowledge] Carry Forward To Organizational Priority List 1.) Is It Critical To Our Success? 2.) Will It Get Done Anyway? 3.) Will It Defy Mathematics? Everyone will be working to accomplish our priorities… Last Call!

41. Prioritize The List From Highest Priority to Lowest Priority… Importance to the Mission Greatest contribution to the organization’s success Ability to accomplish < 12 months. [Score 1 (Low Value) – 5 (High Value) ]

42. Prioritized List Take the Top 3-5 Depending on the Organization’s Available Resources

43. Determine Your Format • Traditional • Initiative/Goal • Objective • Strategies • What, How, Who, When • Initiative, Goal, Role, Function • Baldrige Pillars and Scorecard Again, what fits your organization’s culture?

44. Bridging The Gap BetweenStrategy & Action MISSION VALUES STRATEGY: Our Game Plan The Balanced Scorecard STRATEGIC INITIATIVES: What WE need to do PERSONAL OBJECTIVES: What I need to do STRATEGIC OUTCOMES Customer Focus Quality Outcomes Financial & Market Process & Operations Workforce & People Desired Outcome: The Gut Check

45. When It’s The Right Thing To Do… • Renegotiated Salary and Incentives of ALL Employed Physicians/Providers • Not for the faint of heart • Lost a couple of primary care physicians • Kept the end in mind • Improved Satisfaction Rate • From 8 Providers to 36 Employed Providers in 15 Months

46. Improve Physician Practices STRATEGIC PLANNING & LEADERSHIP Customer Focus Quality Outcomes Financial & Market Process & Operations Workforce & People Measurement Measurement Measurement Measurement Measurement Net 3 additional Providers Press/Ganey Satisfaction Questionnaire >90% Score >95% Compliance with e-Prescribing Initiative 15% Increase in Practice Performance Increase Net Referral Revenue per Provider by 4% • Increase • Average Daily • Patient Seen • By Provider by • 1 patient per day • Selection of • Primary Vendor • for Office EMR • by July 1st • Develop space • allocation • Plan by May 1st Participants in Employee survey of >85% Turnover % < 5% Quarterly Office Meetings w/ Training Sessions >75% attendance Desired Outcome: Maintain or decrease practice expense while increasing referrals and patient access

47. When It’s The Right Thing To Do… • Renegotiated Salary and Incentives of ALL Employed Physicians/Providers • Not for the faint of heart • Lost a couple of primary care physicians • Kept the end in mind • Improved Satisfaction Rate • From 8 Providers to 36 Employed Providers in 15 Months

48. Getting It To The Department Level & Employee Work-life

49. Department MeasuresWhen you come to work each day, what are aiming for?How do you contribute?How do you know if you were successful?

50. Department Measures • Customer Focus • Quality Outcomes • Financial & Market • Process & Operations • Workforce & People • Pick at least 2 measures, post, and follow