strategic planning in an era of health ... - leadingage ny

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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

http://hbr.org/search/R1109B



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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

http://4.bp.blogspot.com/-EofFMTl3gdo/Tdm7jbq7DlI/AAAAAAAAB8s/D4wNp7h2Vtk/s1600/225px-Sim%C3%B3n_Bol%C3%ADvar_2.jpg

http://4.bp.blogspot.com/-qHchR9Kh75U/Tdpwcd72DgI/AAAAAAAAB9M/-8PcfYhQ4mg/s1600/225px-Oliver_Cromwell_by_Samuel_Cooper.jpg

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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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“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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“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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“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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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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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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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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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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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.


- 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


- Utilization of form by strategic planning committee

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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.


- 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


- By year end, each department will submit staffing and operational

needs to accommodate additional services

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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.


- Propose joint board meetings at least two times annually

- Consider joint executive committee meetings

- Consider joint meetings


- Number of joint meetings

- Survey of Board members and their knowledge and awareness of

each Board’s activities

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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


- 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


- 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.


- 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


- Number of firms contacted and\or evaluated for partnership

opportunities


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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.”

strategic planning in an era of health ... - leadingage ny

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