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					                                      A C A L L TO AC T I O N F O R C R I T I C A L ACCESS HOSPITAL S

Beyond the Numbers: Strategic Moves and Tools in Pursuit of Gold Standard Performance
How can CEO/CFOs achieve Gold Standard Performance?
It takes a joint effort. Gold Standard Performing CEOs understand the value of tapping “the three Is” (information, ideas, and insights) from their key stakeholder groups: board
members, physicians, employees and community leaders. The following paragraphs offer practical, street-smart ideas of what CEOs and CFOs can do to engage stakeholders as
“partners in progress” toward Gold Standard Performance.

C E O Ac t i o n s :
In CAHs, the CEO shoulders much of the responsibility to enhance the organization’s           2.   Continuous Development. High performing CEOs are never complacent.
viability. Most CEO annual performance plans include strategic planning; budgeting;                They continuously refresh their understanding of performance measures; how they
recruiting physicians; creating a patient-centered culture; establishing an employee re-           are calculated; their value and limitations; and the actions that are most likely to
spectful work environment; and in general, continuously innovating to improve the                  yield strong results.
range and quality of health care services for the community.
                                                                                              3. Networking and Benchmarking. It is often lonely at the top. Great CEOs
1.    Balanced Scorecard Performance. Many hospitals are experimenting with                      look for opportunities to exchange ideas with respected colleagues in a variety of
      the use of “Balanced Scorecards” that show a specific performance expectation (tar-
                                                                                                 face-to-face and electronic networking opportunities at state hospital associations
      get) that balances the pursuit of good results in five common areas. (Both hospi-
                                                                                                 and special CAH gatherings. Comparative performance ratios and case studies can
      tal-wide and by each service/department. See Studer Group’s Performance Pillars at
                                                                                                 help CEOs continuously refine their skills and mindsets in their pursuit of Gold
                                                                                                 Standard Performance
            • Service
            • People
                                                                                              4. Improved Data. Work with your accounting and medical record staff to con-
            • Quality
                                                                                                 tinuously refine your measurement of key financial, quality and safety metrics to
            • Financial
                                                                                                 compare to Gold Standard targets.
            • Growth

      Great CEOs earn enthusiasm and loyalty from their followers by setting clear and        5. The biggest action CEO/CFOs can take is to engage stakeholders in
      fair stretch objectives for each unit, and then recognizing and rewarding the high           the pursuit of Gold Standard Performance.
      performers. LarsonAllen’s Critical Access Hospital Gold Standard Performance Summary
      emphasizes the financial ratios, but recognizes the financial results are only possible
      year after year, when the hospital makes progress in all areas.

pg.   1   Critical Access Hospital Gold Standard Performance Summary Tools
                      A C A L L TO AC T I O N F O R C R I T I C A L ACCESS HOSPITAL S                                                                                                 (continued)

Beyond the Numbers: Strategic Moves and Tools in Pursuit of Gold Standard Performance

B o a rd Ac t i ons:
CEO/CFO actions to mobilize the board for supportive pursuit of Gold Standard         4. Increase debt capacity update and strategies for expansion to afford five
Performance:                                                                             key investments:
                                                                                              Investment 1: Physician specialty coverage
1. Conduct board executive briefing: utilize LarsonAllen’s Gold Standard Performance           Investment 2: Technology enhancements
   Worksheet to reinforce the board’s understanding of the following:                         Investment 3: IT improvements
      • The importance of prudent financial planning and benchmarking for opera-               Investment 4: Employee development
         tional vitality                                                                      Investment 5: Facility improvements
      • The methods and indicators used in benchmarked performance assessments
      • The need for annual performance reviews and updates of benchmark stan-        5. Expand understanding of the interdependency of “the big 5” dimensions of
         dards                                                                           Balanced Score Card performance:
                                                                                              • Quality
2. Enhance strategic financial planning and budgets.                                           • Patient safety
                                                                                              • Physician satisfaction
3. Adopt quarterly performance reporting and discussion:                                      • Service volume growth
      • What is it                                                                            • Financial liquidity
      • How to do it
      • Why to do it (early warning with time to encourage interventions and mid-
         course corrections or refinements)

                                                                                                                                       Critical Access Hospital Gold Standard Performance Summary Tools   pg.   2
                                      A C A L L TO AC T I O N F O R C R I T I C A L ACCESS HOSPITAL S                                                                                  (continued)

Beyond the Numbers: Strategic Moves and Tools in Pursuit of Gold Standard Performance

P hy si c i a n Act i ons:                                                                   Em ployee Actions:
CEO/CFO actions to inform and engage physicians in the performance improvement               CEO/CFO actions to engage middle managers and employees to pursue Gold
plans for the hospital and/or local health care systems:                                     Standard Performance:

 1. Provide executive briefing in group and one-on-one with active medical staff and           1. Conduct shift-focused, inter-departmental briefings on the Gold Standards: how
    any consulting specialists or locum tenens of where your hospital stands vis-à-vis the       they were developed, why they are important; and how they can be used to enhance
    Gold Standard Performers.                                                                    internal performance of all services and departments.

      As with board members, discuss the importance of benchmarked performance                2. Include employees in the process by inviting their suggestions on how best to
      assessments as a critical input to the strategic and operational planning and              strengthen revenue generation and cost-reduction process improvements with ideas
      budgeting.                                                                                 for an enhanced commitment to patient care quality and safety.

 2. Develop a one-page assessment of how progress toward Gold Standard Performance            3. Refer to financial benefits if performance could move from current levels to those of
    helps the physicians’ patients and practice.                                                 the Gold Standard Performers.

 3. Engage physicians in a two-hour focused discussion of how expanded clinical service       4. Enhance employee and departmental recognition programs for those that best
    quality and safety can improve the organization’s ability to advance toward Gold             advance their activities toward Gold Standard Performance, and celebrate their
    Standard Performance.                                                                        accomplishments and contributions to a “performance driven culture.”

 4. Develop a refined process to engage physicians in the capital budgeting and allocation     5. Engage middle managers in a half-day strategy session on how best to use the Gold
    process for the next fiscal year.                                                             Standard Performance process improvements in next year’s budgeting activities.

 5. Engage physicians in defining enhanced activities to expand the amount of
    procedural focused services performed at the hospital to strengthen long-range
    economic vitality.

pg.   3   Critical Access Hospital Gold Standard Performance Summary Tools
                       A C A L L TO AC T I O N F O R C R I T I C A L ACCESS HOSPITAL S                                                                                               (continued)

Beyond the Numbers: Strategic Moves and Tools in Pursuit of Gold Standard Performance

C o m m u n i t y Actions:
CEO/CFO actions to engage the community in a shared understanding of, and                    Next Steps:
commitment to CAH Gold Standard Performance:                                                 Continuously Improved Benchmarking
 1. Conduct an executive briefing at Chamber of Commerce and related economic                 CAH boards and CEOs need to continuously refine their reliance on
    development bodies about the CAH Gold Standard principles and practices and              benchmarking studies of their performance compared to Gold Standard
    their importance to the vitality of the communities serviced by the CAH. Invite          Performers. Gold Standard Performers can not afford to be complacent.
    their suggestions on how they and the hospital might best advance toward Gold            A continuous pursuit of evidence-based performance opportunities is
    Standard Performance, and the different ways to measure the value of Gold Standard       essential to safeguard rural communities’ access to health care services and
    Performance to their community. (See Attachment 1 for illustrative ideas).               employment.

 2. Develop and disseminate to the community real human interest stories of patients         LarsonAllen intends to help champion the continued use of financial
    that have and are benefiting from the enhanced financial and service strength the          performance indicators of the valuable Flex Monitoring Team, as well
    CAH is achieving by virtue of its pursuit of Gold Standard Performance. Use photos       as encourage the development of small clusters of six to seven CAH
    and direct quotes from patients, their families and their caregivers to put the “human   organizations into “Performance Enhancement ‘Networks’” (PENs) that
    side” on the Gold Standard Performance numbers.                                          will foster exchange of best practices and shared educational initiatives.

 3. Develop an update of the economic value to the community of Gold Standard                Leaders interested in working with LarsonAllen to establish these networks
    Performance (see Attachment 2).                                                          can contact any of the Critical Access Hospital Gold Standard Performance
                                                                                             Committee members listed on page 17 of the report.
 4. Develop a shared “Briefing Kit” with local civic and business leaders to carry the
    drive to Gold Standard Performance to state health and economic development

 5. Collaborate with community and state leaders to advocate for expanded Federal
    policy to support CAHs and their pursuit of Gold Standard Performance.

                                                                                                                                      Critical Access Hospital Gold Standard Performance Summary Tools   pg.   4
                                      Attachment 1:                             AC HIEVIN G GOLD S TANDARD PERF ORMAN CE:
                                                                                POSSIBLE JOINT ACTIVITIES BET WEEN COMMUNITIES AND HOSPITAL S

The board and executive leaders of each CAH can help establish a number of activities with the organizations in their local community. The following list is only an illustration
of where conversations might begin. Convene a task force of civic and business leaders for a Saturday morning work session to refine and add to this list of possible strategies.
They will recognize the importance of retaining and enhancing the financial vitality of the CAH for the good of the overall community.

 Major Arena for Cooperation:                          Collaborators:                                            Possible Activities:

 Health protection                                 • County public health agencies                             • Health Fairs
 and promotion                                     • Schools                                                   • Screening clinics
                                                   • State chronic disease chapters of: heart, cancer, lung,   • Immunization drives
                                                     diabetes associations                                     • Fitness walks, rides and competitions
                                                   • State Rural Health Offices                                 • Healthy family awards
                                                   • State Office of Aging                                      • Healthy menus
                                                   • State-wide health insurers                                • Farm safety programming
                                                   • Local TV and radio outlets                                • Home safety programming
                                                   • Local newspapers                                          • Emergency preparedness drills
                                                   • Church groups                                             • Child health knowledge competitions ala spelling bees
                                                   • Restraunts and cafes                                      • Others:
                                                   • USDA Extension Office
                                                   • Police and fire departments
                                                   • State and County Medical Societies
 Attract health professionals                      • Banks                                                     • Expanded “Welcome Wagon” coupons and discounted services
 and spouses                                       • Real estate agents                                        • Competitive insurance packages
                                                   • Contractors                                               • Special scholarships for children funding support for CME and
                                                   • Local stores                                                tele-med links to larger medical centers to address risks of professional
                                                   • Local service providers                                     isolation of professionals and their spouses
                                                   • Insurance agents                                          • Others:
                                                   • Local print and broadcast media
                                                   • State professional societies

 Community knowledge                               • Health plans                                              • Adult and family tours
 of and support for the                            • Local media                                               • Presentations on new technologies, professionals, and facilities at all
                                                   • Schools                                                     interested groups
 medical and surgical                              • Civic clubs and groups                                    • Expanded Web site stories in all media that celebrate the human and
 services provided by                              • Chamber of commerce                                         technological side of the CAHʼs progress and plans
 the CAH                                           • Municipal officials                                        • Steady flow of press releases on progress and awards, accreditations
                                                   • Church groups                                               and licensures
                                                                                                               • Others:
 Philanthropic support                             • All organizations and leaders in the above                • Expanded volunteer and auxilliary programming
                                                     entities can be approached and engaged                    • Fund raising for capital campaigns and
                                                                                                                 technology upgrades
                                                                                                               • Shared grant writer with local schools and economic development
                                                                                                               • Discounted construction and related supplies for major facility
                                                                                                                 improvement projects

pg.   5   Critical Access Hospital Gold Standard Performance Summary Tools
                       Attachment 2:                          MACRO VALUE OF A FIN AN CIALLY S TRON G HOSPITAL TO A LOC AL ECON OMY

CAHs can be vital resources to any rural community. If CAHs achieve the financial strength of Gold Standard Performers,
they increase the probability of contributing these benefits to the economic vitality of the local community:

    •   A major employer: (payroll times five is the ripple effect of the purchasing power in local economy)
    •   Major service and product purchaser in local economy: (expense budget times five shows multiplier effect)
    •   Quality care helps attract and retain other employers and jobs in the economy
    •   Quality care enhances the quality of life for the people who live and work in the local community
    •   Primary care, emergency room care and back-to-work services help enhance the productivity of local employees

                                                                                                                         Critical Access Hospital Gold Standard Performance Summary Tools   pg.   6
                         B U I L D I N G T H E ROA D M A P TO P U R S U E
                         G OL D S TA N DA R D P E R F O R M A N C E

Critical Access Hospital Gold Standard Performance Worksheet
This exercise can generate discussions to help you clarify a sensible roadmap toward Gold Standard Performance. Engage leaders from each stakeholder group to work with you
to complete this worksheet. LarsonAllen is available to help as needed.

                      Stake Holder Group                                                            Desired Results From Stakeholder Group

         Top obstacles facing stakeholder groups in                                     Two to three practical actions to remove, reduce or work-around each
            pursuit of Gold Standard Performance                                                        obstacle to Gold Standard Performance






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