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 www.studergroup.com): 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 leaders. 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 groups • 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 1 2 3 4 5 (Download from www.larsonallen.com/healthcare/cahgs.asp).