1. growth planning: tools and strategies to win the growth race presented by: terry glasscock senior...
TRANSCRIPT
1
Growth Planning: Tools and Strategies
to Win the Growth Race
Presented by:Terry Glasscock
Senior Project Consultant
January 22, 2014
Health Choice Network Of FloridaJune 2014
3
Growth? Why?
• Congress’ own Commission on Entitlement Reform reported that SS, Medicare, Medicaid and interest on the national debt will exceed all federal income by 2030!
• Annual budget fights will not resolved as long as congress is so polarized.
• The longer we wait to enforce changes the more painful the results will become…in the mean time more people will fall through the cracks and into CHCs
• Affordable Care Act
Number of Workers Per Retiree
1990 2000 2010 2020 2030
54.5
4
3
2
5
Federal Receipts vs. Entitlements
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
12034
2035
2036
2037
2038
2038
2040
0
4
8
12
16
20
Baseline SS, Medicare, and Med-icaid
(As percent of GDP)
6
Defense51%
Social Security13%
Medicaid1%
Safety Net6%
International Affairs5%
Transportation4%
Interest6%
Everything Else15%
1962
Defense23%
Social Security20%
Medicare13%Medicaid
10%
Safety Net13%
International Affairs1%
Transportation3%
Interest6%
Everything Else12%
2011
Federal Government Spending
MedicaidMedicareS.S.43%
MedicaidMedicareS.S.20%
7
International Monetary Fund
• The United States must either decrease benefits for Medicare and Medicaid by 50% or increase taxes by 60% to maintain solvency of those programs.
8
A Race? Why?• Limited government resources (productivity becomes more
important – increasing income and controlling expenses)
• New payment system based on number of patients not number of visits. (Goal: more patients with fewer visits)
• Accountable Care Organizations will create more powerful competition.
• Affordable Care Act will change the “payer” playing field.
• Demographics will slowly change both your patient mix and the type of services demanded (who will capture them – chronic v. acute)
• A race against the system and against becoming irrelavent
9
We Need To Get Started
10
Who will succeed?• Successful centers will be the ones who are
willing to take risk in an uncertain environment and who have a well-founded plan to manage the downside risk (ACTIVE)
• The need for rapid growth will likely advantage health centers that have already achieved a certain level of scale.
• Active smaller centers that are less sophisticated will also be trying to get in the game
• Passive centers will not succeed
11
New Management Skills Will Be Needed
• The growing sophistication of the active centers will create need for learning “cutting edge” management techniques
• The pressure for speed and a high level of technical knowledge will continue to grow.
• Learning to manage strategically will become essential
• Acquiring reliable management information for making decisions will also be essential
12
Managing Strategically
Demographics,Government
Policy
StrategicInfluences
(Landscape)
Impact Analysis
What might happen
Action Plan
What to do when it does happen
Who you are
Strengths/Weaknesses
Who you are
Strengths/Weaknesses
Self-Assessment
1. Self Assessment
14
Self-Assessment
• What you do
• Why you do it
• How you do it
• What you do well
• What you could do better
• Operational capacity
• Financial capacity
• Physical capacity
Who you are
Strengths/Weaknesses
Who you are
Strengths/Weaknesses
15
Self-Assessment –Looking at Yourself
• Mission fulfillment
• Efficiency – measuring outputs
• Effectiveness – measuring outcomes
• Capacity – measuring capability
16
Vision
• What is your collective vision of who you should be?
• What could change that?
• Is this a shared vision?
• What are the outlier visions?
17
Mission
• Is your mission consistent with your vision?
• Is it focused on need, not just symptoms?
• In other words, does it empower not just treat?
• Does it support and derive support from like-minded organizations in your community?
18
Services
• Are they focused on need?
• Have needs changed?
• Are they effective in filling needs?
• Do they fulfill the mission?
• Where are they on a mission/margin evaluation?
19
Systems• Do they work?
• Do you really know how they work?
• How did they evolve?
• What has changed since they were first created?
• Do you measure outputs or outcomes?
• What happens at the “water cooler”.
• Mattress Tags
• Transformative systems
20
Structure• A circular organization• How close to the edges do you manage?• Organi-zation – Organism – Biological
paradigm not mechanical• Creating Adjacent Possibilities through
structure.• Should your structure be changed? Can it
be changed?
Some Tools for Self-Assessment
21
22
Strengths, Weaknesses, Opportunities Threats
• List your organization’s primary (program and administrative) strengths and weaknesses—internal forces working for and against your organization achieving its mission.
• List your organization’s key opportunities and threats — political, economic, social, technological, demographic, or policy trends that are or may impact our organization’s ability to achieve its mission.
• Draw lines connecting any opportunity or threat that may be either positively or negatively impacted by any of the organization’s strengths or weaknesses
Tool: Listing and Diagramming a SWOT Assessment
23
24
Name oforganization
Ability to provide service
Quality of service
Why did you rate the ability to provide service the way you did? Why did you give the rating on quality of service?
Our program:
4 3 21
Excellent Good Fair Poor
4 3 21
Excellent Good Fair Poor
Competitor:
4 3 21
Excellent Good Fair Poor
4 3 21
Excellent Good Fair Poor
Competitor:
4 3 21
Excellent Good Fair Poor
4 3 21
Excellent Good Fair Poor
Competitor:
4 3 21
Excellent Good Fair Poor
4 3 21
Excellent Good Fair Poor
Tool: Analysis of Competitive Position
Tool: Create a “Who’s Who” ListDo you use a consultant? Who?
Who makes what decisions for the organization
Whether to use an existing committee or a strategic planning committee for such activities as coordinating the work and assisting with some of the planning activities (such as external stakeholder interviews, research, etc.)
If using a strategic planning committee, deciding who should be on that committee. If using ad hoc task forces, deciding membership of those committees (including the decision as to whether non-board members might be on those committees)
Who will be the primary writer of the plan (with guidance from a consultant if necessary)
The sequencing of discussions (i.e., “do data collection first and then have a retreat” or “kick off the planning process with a board/staff retreat and then create issue-focused board/staff task forces to collect and analyze data and make recommendations to the board of directors”)
25
Tool: The Readiness ChecklistThe following conditions for successful planning are in place: Yes No Unsure or N/A
1.Commitment, support, and involvement from top leadership, especially the executive director and board president, throughout the entire process
2.Commitment to clarifying roles and expectations for all participants in the planning process, including clarity as to who will have input into the plan and who will be decision makers
3.
Willingness to gather information regarding the organization’s strengths, weaknesses, opportunities, and threats; the effectiveness of current programs; needs in the community, both current and future; and information regarding competitors and (potential) collaborators
4.
The right mix of individuals on the planning committee—strategic thinkers and actionaries (individuals who are in a position to see things through to completion), as well as big-picture (conceptual) thinkers and detail-oriented (perceptual) thinkers
5.Willingness to be inclusive and encourage broad participation, so that people feel ownership of and are energized by the process
26
6.An adequate commitment of organizational resources to complete the planning process as designed (e.g., staff time, board time, dollars spent on the process for market research, consultants, etc.)
7.A board and staff that understand the purpose of planning, recognize what it is and is not able to accomplish, and have clarity about the desired outcomes of the process and issues to be addressed
8.
A willingness to question the status quo, to look at new ways of doing things; a willingness to ask the hard questions, face difficult choices, and make decisions that are best for the organization’s current and future constituencies as well as a willingness to support organizational change as a result of the planning efforts.
27
Tool: The Readiness Checklist
9. The organization has the “financial capacity” to sustain itself for the immediate future without a financial “crisis” appearing to detract from strategic planning
10. Top management’s commitment to carefully considering recommendations made during the planning process rather than disregarding decisions in favor of his or her intuitive decisions
11. There is no serious conflict between key players within the organization (although a healthy dosage of disagreement and perhaps some heated discussions can be expected during a strategic planning process)
12. There are no high-impact decisions to be made in the next six months by an external source.
13. No merger or other major strategic partnership effort is under way (separate strategic planning conversations are not taking place while strategic restructuring negotiations are taking place).
14. Board and top management should be willing to articulate constraints and non-negotiables upfront.
15. A commitment to tie the strategic planning process to the organization’s annual planning and budgeting process—to create a detailed annual operating plan for the upcoming year, and monitor/revise the strategic plan as needed
16. A commitment to allocating sufficient resources to support the implementation of core strategies
28
Tool: The Readiness Checklist
2. Landscape
30
Landscaping• You can’t manage what you don’t know
• What lies ahead (environmental scan)
• Demographic shift (overwhelming)
• Government healthcare policy
• Government fiscal policy
• National and global economy
• Local economy
• Invite stakeholders to provide input
– Community
– Patients, Providers, staff
– Government: local, state, federal
– Other social services
• There is no “future” there are possible “futures”
Demographics,Government
Policy
Result: Possibilities Inventory
Identify Multiple
Issues Per Category
FederalOrigin
StateOrigin
LocalOrigin
Specific toYour CHC
Demographic Trends (aging baby boomers and their impact)
Healthcare Policy (the effect on Medicare and Medicaid)
The Economy
Workforce Issues
Tool: Environmental Scan
32
Identified Issue
Who will research
Possible Outcomes
Possible negative considerations
Possible positive considerations
What will be affected and how: Vision, Mission, Services, Systems, Structure
Tool: Issue Identification Guide
33
Internal Stakeholders
Outcome of contact with them? Questions they can answer? What information do you want to gather from this stakeholder?
How best to involve them (such as surveys, discussions at regularly scheduled meetings, retreats, in-depth program evaluation worksheets, etc.)
Details (this column may be filled out when starting to implement data collection phase: time frame and who is responsible for implementation)
Staff—do you want to engage:
All of the staff Management team Some staff (specific) Volunteer staff
Board of directors
External Stakeholders (Patients, Partners, Allies, Community)
Specific individuals to be interviewed (such as director of
finance, development director)
Tool:Internal Stakeholder Input Guide
34
Tool: External Stakeholder Input Guide
(List specific names if possible)
Why talk with them? Relationship building or information gathering, or both?
Outcome of contact with them? Questions to answer? What information do you want to gather from this stakeholder?
How best to involve stakeholder (i.e., questionnaires, interviews [face-to-face or phone], focus groups, meetings, etc.)
Details (this column may be filled out when starting to implement data collection phase: Time frame and who is responsible for implementation)
Constituents/clients (current, past)
Institutional funders (foundations, corporations, government agencies)
Government officials
Organizations we partner with
Individual donors
Ex-staff, ex-board members
Other
3. Impact Analysis
36
Impact Analysis• What possibilities did we find in landscaping
• What are the operating and financial implications of each of those possibilities.
• Listing the possibilities and the impacts on the CHC of each one
• Prioritizing the probabilities
• Analyzing the impact on each possibility
• Capital Needs, human resources
Possibilities and implications
Result: Impact Catalogue
37
Each Impact Implication
Programs Effected
Systems Effected
Organizational Structure Effected
Best Case Implications: Operational/Financial
Worst Case Implications: Operational/Financial
Tool: Impact Analysis
38
Program Impacted
Implication (Cost, revenue, Staff, etc)
Structure and Systems Impacted
Implication (cost, staff, capacity, expertise)
Possibility Description
Tool: Implication Catalogue
4. Action Planning
40
PossibilityImpact Scenario
Probability(Very Likely, Likely,
Unlikely)
Importance(High, Medium,
Low)
Priority Rank
41
Action Plan• Contingencies
• “What if” planning
• Match the impacts with action items
• Solving future problems
• How to mobilize resources
• “Back-to-the-Future” planning
• Maximizing positive possibilities
• Minimizing negative possibilities
• Timeline estimates for intervention
• Community Activation
What to doWhen to do it
Result: Action Immediacy Plan Action Contingency Plan
42
What was a problem 10 years ago? What was the strategy to resolve the problem? What resources were necessary to solve the problem?
What is the problem you face today? Based on your experience what should your strategy be to resolve the problem? What resources will be needed?
Past Problem description
What strategy succeeded or failed? What obstacles were faced?
What resources were needed to succeed: Who: internally/externallyWhat did they do?When? Sequence of events
What did success or failure look like?
Current or future Problem description.
Based on experience what is your best strategy to resolve this problem? What obstacle will be faced? What would success look like?
What resources will need to be empowered?Who: internally/externally.What do they need to do?When will they need to do it?
What will success look like?
Tool: Back To The Future Planning
43
HIGH MISSION IMPACT
LOW VIABILITY
BUSINESS DECISION =
HEART: Keep but contain costs
HIGH MISSION IMPACT
HIGH VIABILITY
BUSINESS DECISION =
STAR: Invest in continuance and growth
LOW MISSION IMPACT
LOW VIABILITY
BUSINESS DECISION =
QUESTION MARK: Discontinue or give
away
LOW MISSION IMPACT
HIGH VIABILITY
BUSINESS DECISION =
MONEY MAKER: Enhance impact
Viability
$
Mis
sio
n
?
Tool: Program Decision Matrix
44
New skills that may be needed New positions or new training Require systems changes, structural changes?
List the major changes that may need to happen/will happen as a result of the strategic plan:
Changes that will impact staff and the skills they may need in the future
Changes that will impact the structures and systems that may need to be modified to support the changes
Changes that will impact how the organization’s culture (mindset) may need to be modified to support the changes
Tool: Skills Assessment
45
Program or service
What is the program's current level of activity? (This question, of course, applies only to existing programs. New programs will not yet have a current level of activity.)
What is its proposed growth strategy (expand, maintain, decrease, eliminate, start new program, modify existing program)?
What is the program's projected future level of activity?
For each of your proposed future programs or services:
What is the program's current level of activity? (This question, of course, applies only to existing programs. New programs will not yet have a current level of activity.)
What is its proposed growth strategy (expand, maintain, decrease, eliminate, start new program, modify existing program)?
What is the program's projected future level of activity?
Tool: Program Adjustment
46
Administrative Functions Goal(s) Long-Term Objectives/Priorities Staffing and benefits
Public relations and communications
Infrastructure: information systems, technology, facilities, etc.
Planning, evaluation, quality control
Financial Functions Goal(s) Long-Term Objectives/Priorities Financial management
Resource development
Governance Functions Goal(s) Long-Term Objectives Board of directors
Networking and collaboration
Tool: Managing ChangeFor each administrative, financial, and governance function, list the overall goal or objectives and any long -term objectives/priorities to be included in the strategic plan
47
Proposed strategy
Assumptions, facts, and values that support this proposed strategy
What possible obstacles do we face in implementing this strategy?
How to respond to possible obstacles: strategies for overcoming obstacles and short-term priorities
What triggers might encourage us to reevaluate this strategy?
Tool: Action Strategy Worksheet
48
Action Step
Mission/Need
(High, Medium, Low)
Capacity
Needs
Admin/Gov
Steps
Political
Action Needed
Financial
decisions
Timing
Tool: Action Step Worksheet
49
Must Be An Annually Renewing Plan
Demographics,Government
Policy
StrategicInfluences
(Landscape)
Impact Analysis
What might happen
Action Plan
What to do when it does
Who you are
Strengths/Weaknesses
Who you are
Strengths/Weaknesses
Self-Assessment
To Help You
• Strategic Growth Assessment for your center will be paid for by HRSA:
Terry [email protected]
• Complimentary Financial Trend Analysis for your health center if you send 5 years of Audits to:
Steve [email protected] 50
