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Strategic Planning (Who cares?)

Strategic Planning (Who cares?). February 5, 2008. Objectives. At the end of this class, the learner will be able to: 1) Understand key challenges facing healthcare today: -National and regional trends in healthcare -Dartmouth-Hitchcock’s unique situation

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Strategic Planning (Who cares?)

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  1. Strategic Planning (Who cares?) February 5, 2008

  2. Objectives At the end of this class, the learner will be able to: 1) Understand key challenges facing healthcare today: -National and regional trends in healthcare -Dartmouth-Hitchcock’s unique situation 2) Derive priority strategies and tactics from Dartmouth- Hitchcock’s organizational mission/vision/goals. 2

  3. Introduction 3

  4. Our Journey Began in 2006 • Theme Number 1: • People want to be excited about a vision. • Theme Number 2: • We are resting on our laurels; we need to honor our legacy and past • accomplishments, face our current state honestly, focus on the future • and move ahead. • Theme Number 3: • Empower us to help achieve the vision. Hold us accountable. • Help us develop as leaders. • Theme Number 4: • Help us work not in silos, but in systems focused on a common vision or • common set of goals. • Theme Number 5: • Clarify our current organizational structure and how decisions are made. • Strengthen the physician-administrator partnerships. • Theme Number 6: • We are an organization of push vs. pull systems. 4

  5. Clinical/Regional Strategic Planning Objectives: 2006-07 • Establish a single,unifying Vision for Dartmouth-Hitchcock (D-H) that provides a framework for strategic and operational planning and decision- making. • Develop specific goals and strategies to position D-H to achieve the Vision. • Define the market, clinical program and organizationalinitiatives D-H will pursue to realize the specific goals that support achievement of the Vision. • Develop a measurement and monitoring system to track implementation progress and assess the impact of the strategic initiatives. 5

  6. Guiding Principles of the Planning Process • Critically important work – an aligned vision of the future that influences all of our decisions • Aspirational, yet realistic – a plan that moves the organization to the highest attainable level • Process matters – a strong plan that comes from an open, disciplined process • Broad participation and active involvement– the best minds, intellectually engaged • Commitment to strategic direction and outcomes – commitment to build a consensus view and support a common course of action These Guiding Principles are influencing all of our planning efforts and outcomes. 6

  7. Board of Trustees Trustee Advisory Group Management Work Group Stakeholders Stakeholders Clinical/Regional Strategic Planning Structure The Clinical/Regional Strategy initiative had a unique structure. Project Team Stakeholders 7

  8. Clinical/Regional Strategic Planning Structure Each group has a different role and set of responsibilities. BOARD TRUSTEE GROUP MANAGEMENT WORK GROUP DEPARTMENTS / CENTERS Mission Discuss Approve Guide Recommend Vision Discuss Approve Guide Recommend Guide Discuss Goals Approve Recommend Review/Approve Advise/Sponsor Design Strategies Design Review Review Review Design & Implement Tactical Plan Develop & Implement Indicators Review/Monitor Review Review 8

  9. Clinical/Regional Strategic Planning Structure The two leadership groups guiding this planning process had important but distinct roles and responsibilities. • Provided strategic thought leadership • Designed and built momentum for a planning process that was consistent with the guiding principles • Engaged the organization at large to ensure broad stakeholder input • Assessed D-H Mission, Vision and Goals • Develop and recommend clinical/regional strategies • Recommend strategic priorities Management Work Group Charge • Guide and sponsor the development of the D-H Vision, Goals and clinical /regional strategy • Collaborate with the Management Work Group to evaluate the clinical/regional vision, strategy and plan • Build support for the planning process and its outcomes • Communicate regularly with and seek approval from, the full Board of Trustees Trustee Advisory Group Charge 9

  10. Clinical/Regional Strategy Development Process 10

  11. Guiding Principles We secured broad organizational participation. • Health care Trends assessment presented and discussed in multiple forums involving over 250 people • Trustees • D-H Medical Staff Annual Meeting • D-H Leadership Grand Rounds • Southern region medical directors and administrators • DHA CEOs and senior management group • Over 50 one-on-one interviews conducted • Trustees • D-H leadership • Clinical chairs • Medical school leadership • DHC medical directors • Site visits to all D-H clinical facilities and DHA hospitals were made • Medical directors • CECS leadership • DHA and D-H associated hospital CEOs • Members of DHC medical staff 11

  12. Guiding Principles • Management Work Group • Clinical Regional Strategy Trustee Advisory Group • Clinical Department Chairs • Board Initiatives Coordinating Committee • Board of Governors Several key leadership groups were engaged in the planning process. 12

  13. Management Work Group Activity There were 4 meetings of the Work Group. Work Group Meetings 1 & 2 Work Group Meetings 3 & 4 CURRENT & FUTURE STATE ENVIRONMENT Dartmouth- Hitchcock Mission, Vision & Goals • National trends • Regional dynamics • D-H current positioning • Affiliate positioning • D-H opportunities and challenges 13

  14. Management Work Group Engagement The discussions were intense and exciting. • Engagement – nearly full attendance at each Work Group meeting for the entire meeting • Thoughtfulness – robust dialogue and debate in large and small groups • Open and Honest – healthy tension between what we can do today versus what we wish to do in the future • Commitment – to making the plan “come alive” for everyone and influencing all that we do 14

  15. The Management Work Group made excellent progress Define the Strategic Context - Environmental Scan Establish Vision & Strategic Direction Set Up January, 07 January – February, 07 March – April, 07 • Trustee Oversight: Jan 18th • Work Group: February 5th • Work Group: March 1st • Work Group: March 19th, April 5th • Trustee Oversight: March 29th Meetings 15

  16. Environmental Scan 16

  17. Environmental Scan 4 components of the Environmental Scan were instrumental to defining D-H’s future state • Market/industry factors – How will the national trends impact our region and our organization(s)? • Our population – What is the profile of the population we serve and what are there health care needs? • The regional health care delivery system – Where are there gaps in healthcare, today and in the future ? • D-H current positioning – What platforms can we build upon for the future? 17

  18. National Trends We identified 7 forces that will reshape healthcare over the next 2 decades. Capital Access & Reimbursement Costs / Increased Calls for Reform Healthcare Industry Need to Demonstrate Value Aging Population Changing Healthcare Workforce Constrained Research Funding Transition to Outpatient Care 18

  19. Impact of National Trends Excerpts from Interviews and Work Group Activities The US health care system is underperforming today and the future is one of increasing demands and decreasing resources. “The aging of the population is the #1 issue – it will drive more demand, require us to effectively manage high risk patients with chronic disease and stretch the supply of health professionals.” “As the population requiring intensive/extensive health care grows, more staff will be needed at all levels. At the same time, declining reimbursements and increasing government regulation will reduce the attraction associated with a health care career.” “The financing and thus the adequacy of access to healthcare is likely to be the key issue nationally in the next ten years.” “Health providers will compete on the basis of how well they do their jobs.” There will be a continued push toward patient safety, outcome reporting and transparency. “Building the delivery systems and information systems sufficient to support the delivery of evidence-based, measurable and reportable quality of care in a zero-error environment.” “Reductions in federal research funding and higher costs of providing residency training will make it extremely challenging to finance the academic mission of AMCs.” Note: Comments Confidential 19

  20. Population Profile – Geographic Distribution Our service area contains 1.8 million people with almost half residing in the high growth Southern New Hampshire region Population Density by Region (2006) Population by Region (2006) Lebanon Notes: Population density is calculated as total population divided by total square miles within region. Source: Claritas, 2000 – 2011 0 to 100 101 to 200 201 to 599 600+

  21. Population Profile – Demographic Characteristics Vermont and New Hampshire have very homogeneous populations and they rank within the top 10 states in several demographic categories • High income • NH has the 6th highest median household income in the nation; VT is #23 • Ethnically homogeneous • VT is tied for #1 in percentage of white persons at 96.6% • NH is ranked #3 at 95.5% white • Well educated • Percentage of population with a college degree • VT – 29%, NH – 29%, US – 24% • Percentage of population with less than high school degree • VT – 14%, NH – 13%, US – 20% • Insured1 • The percentage of uninsured for VT and NH is only 8%, compared to 16% for the entire nation • Older • By 2016 50% of the population will be over age 45 • Source: U.S. Census Bureau,2000, 2005 American Community Survey • 2001 New Hampshire Family and Employer Health Insurance Survey; 2001 Vermont Household Health Insurance Survey 21

  22. Population Profile – Southern NH The Southern New Hampshire region is demographically unique within DHMC’s total service area • Larger and faster growing1 • Makes up 49% of the VT and NH population • Annual growth of Southern NH region between 2000-2006 was 1.3%, while other areas grew at 0.8% annually • Younger population1 • Higher percentage of <19 and 19-44 • Lower percentage of 45-64 and 65+ • Higher income2 • The Southern NH counties rank in the top 25% in median household income among all counties in NH and VT • Better insured3 • Southern NH has a lower rate of uninsured (7%) compared to other regions (13%) • Ethnically diverse2 • Population in the Southern counties is more diverse – having higher percentages of Black, American Indian, and Asian residents. • Increasing hospital utilization 4 • The discharge rate in Southern Region has increased between 2001-2004 (+2.9 discharges/1000), while the discharge rate among the other regions has declined in the same time period (-1.3 discharges/1000). • Claritas Data 2006 • U.S. Census Bureau, 2005 American Community Survey • 2001 New Hampshire Family and Employer Health Insurance Survey; 2001 Vermont Household Health Insurance Survey • NH and VT State Data, 2001-2004 22

  23. Regional Health Care Delivery - Profile DHA Hosp. D-H Clinic Non-DHA Hosp. The health care delivery system in Southern New Hampshire in many ways reflects the demographic trends of the region Hospitals in Our Region • 49 hospitals in the region • 41 acute care • 8 specialty (VA, Rehab, Psych) • 19 critical access hospitals • Only 6 hospitals have more than 200 beds, 4 of which are in southern NH • DHMC - Lebanon • Fletcher Allen - Burlington • CMC - Manchester • Elliott - Manchester • St. Joseph’s – Nashua • Concord Hospital - Concord 23

  24. Regional Health Care Delivery - Gaps The regional delivery system has significant gaps in access and is not currently organized to provide services that are coordinated, cost effective and of consistent quality. Excerpts from Interviews and Work Group Activities “The fragmentation andlack of service coordination in the region will lead to duplication of services and technology which will continue to increase the cost of healthcare delivery.” “Competition among the Southern NH hospitals is heating up – each of them wants to establish high end services and are actively purchasing physician practices.” “Little planning is occurring with respect to the care of the elderly population and the healthcare system required to care for this segment of the population.” “We will see a growing gap in post acute and long term care services as needs increase.” “Quality and accessibility are unbalanced.” “Safety and standard of care issues exist in care provided at some of the smaller medical centers.” “Lack of integrated information systems necessary to coordinate care and track patient health status and outcomes over time.” “Funding what will inevitably be the mismatch between regional need and what gets paid.” Note: Comments Confidential 24

  25. DHA Hosp. D-H Clinic D-H Positioning – Delivery System Profile Population - 1.8 million *Unique Patient = Each PERSON that had an interaction with DH (MH or DHC) that generated a charge 30% to 44% < 15% 15% to 29% 45% to 59% 60%+ DHA Hosp. D-H Clinic Note: Unique patients defined as all individuals served by DH between FY03-FY06. Unique patients may be understated if a DH patient has not received service at DH between FY03-FY06. Percent of Total Population Served by DH FY2003 – FY 2006 25

  26. D-H Positioning – Our Volume Growth DHC office visits have grown 10% in the last 4 years with the majority of visits occurring in the South DHC Outpatient Visits by Location 1.63M 1.59M 1.62M 1.53M 1.48M 14% Growth 31% 32% 32% 32% 33% 61% 61% 61% 62% 63% 16% Growth 8% 7% 7% 6% 4% 26

  27. D-H Positioning – Growth MHMH admissions are growing twice as fast as the market rate and equally as fast as visits to DHC Lebanon 16% Growth MHMH Annual Admissions 27 Excludes: Observation Patients, Normal Newborns

  28. D-H Positioning – Total Discharges MHMH is strongest up and down the I-91 corridor and is slowly increasing its reach across the entire service area MHMC% of total market discharges (2004) Total VT and NH Discharges (2004) N= 157,493 Lebanon Manchester < 5% 5% to 14% 15% to 29% 30% and above Note: Includes 0-18, Excludes VA Discharges, Psych, and Rehab Source: Claritas; NHHA and VHA Data 28

  29. D-H Positioning – High Case Weight Discharges MHMH is much stronger among higher acuity cases and is increasing its reach across the service area MHMH % of total admissions with high CMI (2004) MHMH High Case Mix Discharges by Region (2004) N= 20,824 Lebanon Manchester Note: High case weight cases defined as DRG case weight > 2.25 and account for 12% of all service area discharges. Includes 0-18. Excludes VA Discharges, Psych, and Rehab Source: Claritas; NHHA 2004 and VHA 2004 Data < 5% 5% to 14% 15% to 29% 30% and above 29

  30. D-H Positioning – High Case Weight Discharges In Manchester, Nashua and the Seacoast regions, more High Case Weight Cases are referred to Boston than to MHMH. Percent of High Case Weight Discharges by Hospital Group (2004) Discharges 12,594 8,227 Note: High case weight discharges defined as DRG case weight > 2.25; Local hospitals include DHA Source: Claritas; NHHA and VHA Data, excludes Ages 0-18 30

  31. D-H Regional Positioning - Gaps The relationships within the D-H system – including the clinics in the south and the D-H alliance in the north – have some gaps that need to be addressed. Excerpts from Interviews and Work Group Activities “The population growth is 1-2 hours south of Lebanon and while we have a large physician presence there, we have no technical presence – to improve the health of the population, we need to increase primary care while in order to support that agenda financially, we need to build our technical revenue in the south” “We have regional relationships with many providers but we do not have a true system that coordinates care and allocates resources to serve our population in the most efficient and effective way.” “This orqanization needs a southern campus that includes a hospital just to maintain excellence in our training programs” “We have a Children’s Hospital here in Lebanon, when the growth in pediatrics is occurring to the south of us, we need to have a strategy for pediatrics in the south” “Our efforts to bolster community hospitals has certainly been of benefit to them, but it has resulted in decentralization of effort with lots of little buckets of activity scattered across the region… each focused on maximizing their individual financial performance.” “I propose that we not expand DHA, but expand D-H to cover all of NH and eastern VT, by expanding our group operation, acquiring local practices and local hospitals to create an integrated operation that really works and benefits the patients” Note: Comments Confidential 31

  32. D-H Positioning – Platforms for the Future DH’s many strengths including its size and market presence, clinical and academic expertise, and existing regional relationships that offer multiple strategic opportunities for the future. Excerpts from Interviews and Work Group Activities “Our brand image and reputation are strong in the public’s mind and represent a platform to expand our potential for leadership in the future…we are the “place to go when you are really sick.” “Our facilities are top notch and our presence in the market is meaningful.” “Our academic reputation differentiates us and strengthens our ability to lead; it also presses us to stay on the leading edge of medicine everyday.” “Relative to other medical centers in the region, we have a strong balance sheet that continues to improve. If we decide to flex that strength in a focused direction, we will probably be successful; if we decide to cover all bets, needs and wants, our financial strength will dissipate over a relatively short period of time.” “CECS data indicates that integrated, multidisciplinary, monopolizing group practices are the most efficient for delivering care.” “Our people are our greatest strength…nationally known faculty, relatively satisfied staff, strong administrative leadership.” 32 Note: Comments Confidential

  33. D- H Positioning – Opportunities for the Future D-H has an opportunity to make a significant impact on health care in our region. Excerpts from Interviews and Work Group Activities “D-H should be a leader in developing innovative ways to provide population-based care by bringing regional providers together and proposing economic systems that promote the most effective care. The lack of an optimal economic system has been and will continue to be a barrier if left unaddressed.” “We need to be more than leaders; we need to be organizers and operators of an integrated health care system for New Hampshire and eastern Vermont.” “We need to influence political change to help shape public policy and be sure that we can continue to provide needed services and get paid adequately for the care.” “D-H should be a source of knowledge for the region in terms of assessing and communicating the effectiveness of new technologies, treatments and disease management initiatives.” “Drive the distribution of expert care across the region; in partnership with local hospitals or on our own.” “One of the brightest jewels in our crown is CECS and we should take advantage of their work to improve healthcare locally and set a pattern for the nation.” “D-H should be the model for the region of standard and safe care.” “As the largest system, we should be the best - we should and can set the standard.” “Provide immediate access to the highest quality tertiary care” Note: Comments Confidential 33

  34. Environmental Scan - Summary • External Forces • Aging population will drive increased demand in all settings • All providers will be under increasing pressure “to do more with less” • Our primary geographic service areas are continuing to take divergent paths • There are significant gaps in the delivery system today in both the rural and urban areas D-H has an opportunity to make a significant impact on health care in our region • D-H Positioning • - Largest and most sophisticated health care organization in NH • - Nationally known academic programs and the most advanced clinical programs in the region • Deep knowledge about evidence-based medicine and established standards of care in many areas • Strong relationships throughout the region but lacking an organized delivery system of care 34

  35. Formulating the Strategy: Mission, Vision and Goals 35

  36. Formulating the Strategy Language of Strategic Planning Identity of the organization – what is our purpose, who are we? Mission Desired future position – what do we want to be, what are we trying to create? Vision Drivers for achieving the Vision – what will take us there? Goals Specific, detailed initiatives for achieving goals – both market facing and internal requirements – how do we get there? Strategies Step by step tasks, timelines and accountabilities for executing the highest priority strategies – how will we make it happen? Tactical Plan Measurement and monitoring - how will we know when we get there? Indicators 36

  37. IV. Formulating the Strategy M I S S I O N VISION 37

  38. IV. Formulating the Strategy Environmental Context Work Group Exercises Work Group Surveys Interviews Market Analysis GOALS Review, Discuss, Analyze, Synthesize, Refine Outputs Inputs VISION 38

  39. Formulating the Strategy – Mission, Vision and Goals Memorable: • Simple is Better: Short, memorable and plain language Inspirational: • Keep the inspiration: The reasons we went into medicine • “Healthiest population” should come alive in the vision Achievable: • Make the concepts in the goals more “real” and measurable • Emphasize the ways in which D-H can and does impact the health status of the region Relevant: • As an AMC, we need to incorporate “learning” into the goals • We must engage the rest of the region to achieve the vision, thus we need to add the concept of engaging others in the goals • Mission and Vision need to be better aligned The Work Group emphasized the need for the Mission, Vision and Goals to be meaningful for the entire organization 39

  40. Formulating the Strategy – Mission, Vision and Goals • “Really exciting to see, something that we have needed for a long time” • “We need to be the pace setters and leaders of the healthcare transformation, this work builds the foundation to take us there” • “This provides clarity that DHC, MHMH and DMS are all headed in the same direction” • “Help leadership to decide between competing priorities and force choices – we can’t do everything” • “The mission, vision and goals explicitly differentiate us in the region as a premier academic medical center” The Trustee Advisory Group has been enthusiastic about the development of the Mission, Vision and Goals. 40

  41. Visioning Our Future State - Why We Exist ? DHA OTHERS Dartmouth- Hitchcock Societal Value Local National International DMS CECS Dartmouth College TUCK THAYER 41

  42. Dartmouth- Hitchcock The D-H Vision - Creation of Societal Value Societal Value Healthiest Population Possible Optimize Health & Minimize Burden of Illness 42

  43. Mission Dartmouth-Hitchcock Mission - New Dartmouth-Hitchcock Mission - Previous To provide the highest quality health care and comfort to the ill, to prevent illness among the well, and to advance health care through education, research, community service and the improvement of clinical practice. We advance health through research, education, clinical practice and community partnerships, providing each person the best care, in the right place, at the right time, every time. 43

  44. Vision Dartmouth-Hitchcock Vision - (09/24/07) Achieve the healthiest population possible, leading the transformation of health care in our region and setting the standard for our nation. 44

  45. Organizational Goals Promote Patient and Family Centered Care: Unwavering commitment to provide care that is coordinated, effective, efficient, compassionate and safe. Advance Our Academic Mission: Vigorously promote the education of tomorrow’s health care leaders as well as the creation, dissemination and application of new knowledge in support of our mission and vision. Close the Quality Gap:Lead the way in discovering and closing the gap between the best that can be and where we are today. Attract and Engage Others: Build essential partnerships and convene group and community resources at the local, regional and national levels to achieve our vision. Create Systems that Work: Establish a population based health care system supported by technology and processes that improve health outcomes, efficiency, access and continuity. Build an Empowering Culture: Enable people toattain ever-increasing levels of excellenceby establishing environments of continuous learning and accountability. Practice Careful Stewardship:Steadfast dedication to create the highest value given the resources available. 45

  46. D-H Strategic Plan Summary Strategic Initiatives Five Strategic Initiatives have been identified by the Steering Committee to support the achievement of the D-H Mission and Vision. Mission, Vision, Goals Education and Research Strength Leaders in Quality Operational Imperatives 5 Concurrent Strategic Planning Task Forces People Population Health Management Tertiary Quaternary Care Leadership Southern NH Growth Information Technology Finance Service & Access 46

  47. Strategic Planning Steering Committee - Role The Steering Committee leads the overall Strategic Planning effort. Strategic Planning Steering Committee • Serve as the ultimate designers of a compelling Strategic Plan for guiding the future of D-H • Provide strategic thought leadership maintaining a D-H-wide rather than constituency-specific, perspective • Test, synthesize and prioritize the recommendations of the Task Forces • Engage the organization to ensure broad stakeholder input and buy-in • Steer the Strategic Plan recommendations through the Board review and approval process 47

  48. Strategic Planning Task Force - Role The Task Forces have critically important roles in the further refinement of our Strategic Plan. Strategic Planning Task Forces • Provide thought leadership and subject matter expertise bringing leading edge ideas to the planning process • Actively engage and participate in Task Force research and deliberations • Solicit internal and external input and review • Recommend to the Steering Committee powerful but realistic strategies and tactics for achieving the desired future state • Acknowledge risks and identify potential remediation strategies 48

  49. Strategic Planning Task Forces - Profile Strategic Planning Task Forces • Task Force Charge • Develop Strategic Plan for assigned initiative • Task Force Composition • Leadership - joint clinical and administrative team • Membership composition - No more than 15 members from across the organization selected by the Task Force leadership team • Steering Committee participation – Task Forces will be made up of some representatives who do not participate on the Steering Committee and not all Steering Committee members will participate directly in Task Forces • Timing • Task Forces kick-off meetings held in October • Final recommendations due by the end of February • Monthly progress reports to Steering Committee 49

  50. Strategic Planning Task Forces - Leadership Task Forces have been charged with developing a plan for advancing each of the five Strategic Initiatives. 50

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