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LeadingAge, New York – Annual Conference
Wednesday, May 20, 2015
Michael Keenan, President & CEO
Good Shepherd Communities
Scot Park, CPA, Principal
Artower Advisory Services, LLC
Strategic Planning in an
Era of Healthcare Reform
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• Why engage in strategic planning?
• What is strategic planning?
• How do you go about strategic planning?
• What do you learn from strategic planning?
• How do you keep your plan from becoming an
expensive bookend?
• Why can’t you have some fun with strategic planning?
From Abstract to Concrete
We will answer the following questions:
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Part One
What’s driving the need for strategic
planning?
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Macro Driver # 1
Demographic
&
Socioeconomic Realities
Age Wave: Basic Supply & Demand
Global Revaluation
Generational Attitudes
Cost
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Macro Driver # 2
Healthcare Reform
Integration
Transparency & Reporting
Business Models
Market Positioning
Elizabeth Teisberg
Associate Professor of
Business Administration
Darden Graduate School
of Business
The University of Virginia
Michael Porter
Bishop William
Lawrence University
Professor at Harvard
Business School
Rising Number of
Uninsured
Costs of Innovation &
Technology
Burdensome
Administrative Costs
Provider Overtreatment
Incentives
Lack of consumer
responsibility for cost
Slow penetration of
Information Technology
Value Based Healthcare Delivery
http://www.youtube.com/
watch?v=Z3fKyWydweo
Drivers of Healthcare Reform
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THE BIG IDEA
How to Solve
The Cost Crisis
In Health Care The biggest problem with health care isn't with
insurance or politics. it's that we're measuring the
wrong things the wrong way. by Robert S. Kaplan
and Michael E. Porter
SEPTEMBER 2011
REPRINT r1109B
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Macro Driver # 3
From Sick Care Healthcare
Paradigm Shift in Thinking
Population Health Management
Wellness & Behavioral Health
Personalized Care
Precision Medicine
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Macro Driver # 4
Technology
Communication
Information
Care Delivery
The ONE Thing…..
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Industry Trends & Drivers
Key Takeaways
Survival depends on being
•visionary
•competitive
•adaptive
•resilient
•valuable
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Part Two
What is strategic planning?
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Strategic Planning
From the Greek word, στρατηγία or,
stratēgia, "art of troop leader; office
of general, command, generalship"
Great Strategists
Through History
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Everyone Needs A Mentor
Thinking Strategically requires gaining a
perspective that is objective relative to the
world around you.
Planning Strategically requires the ability to
position within that framework of objective
understanding.
Acting Strategically requires the pursuit of
initiatives leveraging the value of position
attained.
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Part Three
One approach to strategic planning
Current State Understanding
• Sourced
• Aggregated
• Organized
• Analyzed
• Compared
• Contrasted
• Tested
• Evaluated
• Monitored
What questions
should we be asking?
Who do we ask?
What are the answers?
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Vision Construct
Mission Values
Vision
Strategy
“Vision is the art of
seeing what is
invisible to others.”
~ Jonathan Swift
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Example Future State Vision 1
“We will become a nationally
recognized integrated delivery provider
of accessible, innovative and affordable
services and care to aging seniors
throughout Plainville County.”
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Example Future State Vision 2
“Being committed to assisting persons age
successfully through spiritual enrichment
and wellness programs, <our organization>
will become a sustainable, nationally
recognized and fully integrated provider of
care and housing to seniors throughout the
western region.”
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Example Future State Vision 3
“Catholic Health Services is committed to becoming the most highly sought after post-acute/long-term care partnership relationship of all major acute care hospitals in Southern Florida.”
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Example Future State Vision 4
“Senior Care is an innovative and
comprehensive integrated service and care
delivery provider and benefactor to
vulnerable seniors in <our market>; to
continue pursuing our mission we must
ensure our financially viability and be
positioned to respond quickly to change.”
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Strategic Imperatives 1
“We must be in a position to . . .
• …increase the overall average level of acuity of the
patients we care for by a factor of 1.25.”
• …expand the geographic reach of our impact and the
constituency we serve.”
• …develop and expand our organizational resources
(e.g., workforce) in anticipation of expanding services.”
• …develop or secure the necessary skills, experience
and expertise to create and expand home and
community-based services.” 32
Strategic Imperatives 2
“We must be in a position to . . .
• … assess, monitor and evidence the quality of
care we provide to all of our relevant
stakeholders and constituencies.”
• … have a consistent brand image that aligns with
and supports our Future State Vision.”
• … achieve long-term financial sustainability that is
not threated by government payment sources.”
• … take greater advantage of our foundation in
operationalizing our Organizational Initiatives.”
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Example Organizational Initiatives 1
“We will . . .
• …sponsor, initiate and facilitate a community-based
physician network focused on heart failure .”
• …launch a formal rebranding strategy.”
• …develop an evidence-based approach for reaching
out to potential acute care partners based upon Six
Sigma Process Improvement protocols.”
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Example Organizational Initiatives 2
“We will . . .
• … invent and commercialize a new smart phone app that connects our campus and HCBS growth initiatives with our targeted markets.”
• … develop a new CCRC campus in the southern portion of <the County>.”
• … develop an incentive-based compensation structure for management and direct caregiving employees.”
• … launch the <organization> Institute.”
• … expand our PACE program by 25% in three years.”
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Example Enabling Characteristics
“We need to be able to . . .
• … provide visionary leadership.”
• … offer the highest quality care available.”
• … react to change with resiliency.”
• … demonstrate IT interoperability.”
• … evidence patient outcomes.”
• … empower our caregiving staff.”
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Example Measures of Success
“We will be successful if we . . .
• … reduce our cash operating deficit by $5MM within three years.”
• … increase our gross margin by $1MM.”
• … increase the number of lives served/touched by 2,500 in five years.”
• … expand our market penetration by a 15-mile radius within 10 years.”
• … achieve a 10-year average growth of 8% per annum in our foundation.”
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Pulling It All Together Why Planning Efforts Fail
A Lack of . . .
Urgency
Communication
Discipline
Accountability
Empowerment
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Useful Resources
LeadingAge, New York – Annual Conference
Wednesday, May 20, 2015
Evolution from “Fear Driven” Model
to “Opportunity Driven” Model
to “Vision Driven Model”
Strategic Planning
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• 1870 House of the Good Shepherd - Sponsored by Good Shepherd Episcopal Church - Located on Binghamton’s South Side
• 1890 Fairview Home for Aged Women - Sponsored by the Susquehanna Presbytery
- Located on Binghamton’s East Side
Who We Are
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Who We Are (cont’d)
• 1968 Good Shepherd Fairview Home created by merger of House of the Good Shepherd and Fairview Home for
Aged Women • 1986 Good Shepherd Fairview Foundation created
• 1998 Good Shepherd Fairview Home became member of UHS (local hospital system)
• 2001 Good Shepherd exited the UHS system
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Who We Are (cont’d)
• 2009 Good Shepherd Village at Endwell opened only fee-for-service CCRC in NYS
• 2009 - 2011 Good Shepherd Village at Endwell focused on stabilizing occupancy
• 2009 Good Shepherd Communities
established as parent (FGS, Inc. dba GSC)
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Strategic Planning at Good
Shepherd - Early Attempts
• Alliance with UHS system
– Fear driven - “managed care is coming…”
– While consultants were retained, the process seemed
aimed at justifying the decision rather than evaluating it
– 2001 exit was based on our experience with the
system, more realistic assessment of the perceived
threat posed by managed care, and internal
recognition that, given the environment at that point in
time, our vision\mission could be better served as an
independent LTC provider or system
“Fear Driven”
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Strategic Planning at Good
Shepherd - Early Attempts (cont’d)
• Exploring improvements at GSFH and\or building a new facility
– Opportunity driven
• Retained a consultant to better understand the needs of Broome County’s elderly population
– Market analysis identified a need no one was meeting
– Upscale market in Broome County looking for an alternative to what was currently offered
– Recommended we build a CCRC
“Opportunity Driven”
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Strategic Planning at Good
Shepherd - Early Attempts (cont’d)
• Good Shepherd Fairview Home Renovations - $2.2M
HEAL NY Grant
– Reduced SNF beds
– Relocated and expanded our dedicated Rehab Unit
– Created ALP level of care
– Created Café and Main Street
– Managed workforce to accommodate reductions in SNF beds and a new level of care without the need for layoffs or reduction in hours
• Good Shepherd Village at Endwell
– Approached by local landowner with an opportunity
– Regulatory - 46A option to create fee-for-service
model
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Current Strategic Planning at
Good Shepherd
• 2013
– GSC Board directed CEO to develop a Strategic Plan
– CEO explained the Strategic Plan had to be Board driven
• 2014
– RFP initiated and Artower retained as consultant
– Developed plan and expectations
“Vision Driven”
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2014 Strategic Planning
Board Retreat
• Timing
– Two consecutive days offsite (Friday - Saturday)
– One day follow up three months later
• Joint Retreat of Board of Good Shepherd Communities
(mirror Board with GSFH and GSVE) and GSC
Foundation
– Senior Staff also participated
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2014 Strategic Planning Board
Retreat (cont’d)
• Focus of the Retreat:
– Strategic Plan Imperatives – We must be in a position to…
– Organizational Initiatives – We will…
– Measures of success – We
will be successful if we…
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2014 Strategic Planning Board
Retreat (cont’d)
• Day 1 - Individual and Group Approach
– Identifying strengths, weaknesses, threats and opportunities (SWOT)
– Visioning - where did we see ourselves three years from now? Five years from now?
• Developed Strategic Imperatives
– The group ranked strategic imperatives developed by
individuals
– Pared down from 50+ to less than 10
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2014 Strategic Planning Board
Retreat (cont’d)
• Day 2 - Individual and Group Approach
– Individual case studies
– Team assimilation
– Drilled down to potential Organizational Initiatives
across the teams
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2014 Strategic Planning Board
Retreat (cont’d)
• Day 3 – Finalization of the plan
– Produced new vision statement
– Reviewed and revised:
o Strategic Imperatives
o Organizational initiatives
o Measures of Success
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Vision Statement
Good Shepherd Communities Vision
To enhance Good Shepherd Communities’
outreach through innovative development
of quality care, services and housing
provided to seniors in our current markets
and beyond, with an unyielding
commitment to all of our stakeholders.
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1. Develop a process for promoting and evaluating staff development and
retention through appreciation, recognition, education and reasonable
compensation.
Our greatest resource is the individuals who provide care and services to our
residents. Each role in our organization is vital to the care we are able to provide.
Staff retention is the key to consistency of care and will be a major focus of Good
Shepherd Communities.
• Organizational Initiatives: We will…
- Evaluate the programs for staff recognition currently being utilized to
determine if they are reaching the greatest number of employees possible
- Assess the needs of our supervisory staff and provide additional training in
the areas of staff development, coaching, and employee relations
- Coordinate education for line staff beyond mandatory inservices so they
may experience personal growth and satisfaction
• Measures of Success:
- Reduction in staff turnover
- Increase in resident satisfaction
Strategic Initiatives
We must be in a position to:
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Strategic Initiatives (Cont’d)
2. Utilize an assessment methodology that will allow the organization to
objectively assess new business opportunities as they are presented.
This tool will allow us to evaluate opportunities based on a Strategic Alignment,
Risk, and Structural and Tactical assessment to assure we are moving in the right
direction.
• Organizational Initiatives: We will…
- Develop an assessment tool that will incorporate adherence to mission
and financial capability, determine if we have sufficient knowledge and
experience to pursue the opportunity and if the opportunity will enhance
our brand
• Measures of Success:
- Utilization of form by strategic planning committee
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Strategic Initiatives (Cont’d)
3. Assess the infrastructure and capability to develop and deliver
management services and develop necessary business plans if feasible.
Based on a positive result on the assessment, the next step will be for the
organization to complete a self study to determine if we have the human, physical
and financial resources to achieve the objective and if not, can we develop a
business plan that will fulfill any needs lacking.
• Organizational Initiatives: We will…
- Conduct an evaluation of non-direct care departments to determine
whether they have capacity to offer services on a fee-for-service basis. If
the department does not have capacity, conduct a study to determine what
resources are necessary should we elect to deliver management services to
another entity
• Measures of Success:
- By year end, each department will submit staffing and operational
needs to accommodate additional services
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Strategic Initiatives (Cont’d)
4. Ensure the operating boards of Good Shepherd Communities and
Foundation communicate and agree on the key elements of our
strategic planning process and outcomes.
We recognize that communication between our boards is essential if everyone is to
have a clear and articulate vision.
• Organizational Initiatives: We will…
- Propose joint board meetings at least two times annually
- Consider joint executive committee meetings
- Consider joint meetings
• Measures of Success:
- Number of joint meetings
- Survey of Board members and their knowledge and awareness of
each Board’s activities
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Strategic Initiatives (Cont’d)
5. Create a formal community outreach program to help establish and
build all stakeholder relationships. We need to ensure the greater community is aware of Good Shepherd Communities
and all we offer. We need to ensure we are building relationships with federal, state
and local organizations to advance our vision and integrate as a part of the greater
community
• Organizational Initiatives: We will…
- Create a marketing plan to promote Good Shepherd Communities
- Make Good Shepherd Communities viewed as the primary resource
for information on aging as opposed to simply housing and healthcare
• Measures of Success:
- Plan itself
- Tracking of calls for information and resource utilization
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6. Identify potential partners for senior housing and care development
opportunities.
As an organization, we need to explore affiliations and potential collaborations with
providers to assist all parties in achieving our missions.
• Organizational Initiatives: We will…
- Develop criteria to identify potential facilities that may be at risk due to
size, location and/or financial difficulties
- Develop a letter introducing Good Shepherd Communities which
highlights the benefits of affiliation
- Have the board determine what items are significant and what aren’t prior
to any discussion taking place
• Measures of Success:
- Number of firms contacted and\or evaluated for partnership
opportunities
Strategic Initiatives (Cont’d)
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Examples of Implementation
1. Recruitment/Retention
• Management Training Program
• Change in employee recognition program
• Increased engagement of employees
2. Methodology
• Strategic Assessment
• Risk Assessment
• Structural Assessment
• Tactical Assessment
Opportunity Assessment Matrix
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Examples of Implementation
(cont’d)
3. Infrastructure
• Currently being done
4. Operating boards
• Holding more joint meetings
• Bringing boards together at least two times annually
• Placed Foundation Board members on Strategic Planning Committee that is
meeting quarterly
5. Outreach
• Speaker’s bureau
• Informational insert in newspaper
• Medical Director speaking monthly on radio about senior care and Good
Shepherd Communities
6. Identifying development opportunities
• Beginning discussions with and identifying people to look at partnerships
and expansion.
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To Avoid the Pitfalls that Lead to
Failure of Our Strategic Plan
A Lack of…
•Urgency
•Communication
•Discipline
•Accountability
•Empowerment
Create…
•Deadlines and benchmarks
•Written and verbal tools
•Clear assignments\targets
•Board level Strategic
Planning Committee
•Culture of creativity and
infrastructure that allows
time to devote to planning
as opposed to “putting out
fires.”