Adding Value with Better Strategy and ATT Governance

Healthcare Executive November 1, 2004 | Rice, James A Meeting challenges requires “continuous governance enhancement.” In this era of intense scrutiny, a persistent squeeze on financial performance at a time of increasing capital needs, and the Institute of Medicine’s probes into patient safety and care quality, hospital boards will be driven to consider new commitments to and sophistication of their accountability, transparency, and talent development-what we refer to as “ATT Governance.” ATT Governance: Accountability, Transparency, Talent Development Hospitals are among the most complicated organizations ever to evolve in societies. They have multiple societal expectations pressed on them as one of their community’s largest employers and largest sources of capital investment and as a critical resource for the population’s overall health, productivity, and well-being. These large and complex organizations also seek sustainable vitality in markets characterized by rapid change in consumer demands, escalating costs of doing business, and exploding calls for ever more complicated- and difficult to staff-medical and information technologies.

Our recent review of several industry environmental scans’ indicates that system board leaders must become more knowledgeable about the following 14 themes:

* Escalating costs * New patient profiles based on changing demographics * Hospital demand for high-tech acute and high-touch ambulatory care * Growing consumerism in the health sector * New physician relationships * Focus on quality outcomes and patient safety * Care management investments * New medical and information technologies * Exploding capital challenges * New payor relationships * Health disparities’ erosion of ROI; less societal investment in acute care * Public health challenges for the hospital sector * Health gains from new community collaboratives * Expanded calls for new state and national policy framework CEOs and governance leaders need to sharpen their preparedness for a journey to governance greatness and to develop practical action plans for ATT-focused board work. The speed, clarity, and caliber of board decision-making processes and outputs must also evolve and be clearly understood. Board competencies must be enhanced; board education must be more fact and evidenced based; and board and committee meetings must be fewer and better; they also must involve the expertise and insights of more diverse views and life experiences from their local markets. These governance enhancement challenges become more complicated in hospital systems where turf, technology, and treasury functions are often neither sensibly planned nor managed. go to site att uverse coupon code

18 Strategic Challenges for Boards to Master How can hospital system boards enhance the capabilities of their processes and participants for great governance in the face of this challenging environment? Based on our assessment of developments during the next five years, as well as input from more than 300 hospital and health system directors and CEOs during Governance Institute Leadership conferences in 2004, we have identified 18 initiatives in six strategic challenge zones for modern hospital and health system boards to discuss and master. Each strategy requires new commitments for physician-board-CEO collaboration and engagement:

Strategy One: Strengthen strategic development and capital deployment * Engage in scenario-based and balance scorecard-focused strategic thinking and business planning * Expand medical and technology assessments and planning * Enhance the rigor of capital planning, allocation, and project monitoring; optimize access to capital Strategy Two: Support management’s pursuit of enhanced operational vitality * Continue to support sophisticated clinical and administrative process improvements * Advocate changes in IRS and government regulations that block physician-hospital cost sharing for health gain and gain sharing * Catalyze strategy exchanges with other industries for supply-chain value management Strategy Three: Nurture a culture that champions maximum quality outcomes and patient safety * Reach consensus on three to five key measures of quality and safety to be achieved * Adopt commitment to JCAHO’s six principles of patient safety * Expand transparency of clinical outcomes performance reporting to payors and communities Strategy Four: Establish a culture of performance-based employee recognition and development * Support management’s investments into the recruitment and development of scarce health professionals (even with competitors) * Reinforce management’s development of incentive-based compensation systems that reward excellent results and competency-based leadership development among middle and senior managers * Participate with senior management and physicians to celebrate employees that excel in world-class service and performance Strategy Five: Champion community-based, strategic alliances for health gain, not just healthcare * Collaborate to publish annual community health status trends and expectations * Support public-private partnerships for health protection and promotion * Enhance community linkages for expanded community benefits and philanthropy Strategy Six: Improve ATT Governance effectiveness * Strengthen benchmarked measures of board member and committee effectiveness (Accountability) * Expand reporting of organizational and board performance to stakeholders: physicians, payors, public, and politicians (Transparency) * Deepen investments into leadership and human resource development (Talent Development) 999 Action Plan: Your Guide for Continuous Governance Enhancement To avoid both the “paralysis of analysis” and a frustrating inability to follow through on strategy execution, we suggest that boards and their CEOs drive toward ATT Governance by forging consensus on three to five measurable and significant actions selected from the list above, and then executing a plan to accomplish these actions within the next 9 weeks, the next 9 months, and the next 9 years-a 999 Action Plan. see here att uverse coupon code

We find that boards believe they are doing a good job of governing their healthcare systems of multiple delivery sites, multimillion-dollar capital investments, and thousands of healthcare professionals. But the challenges of our industry demand that we continuously perform and govern better. To raise the bar on our organizations’ performance, we must raise the bar on our governance effectiveness-better strategy development and more ATT Governance.

Attribution and Clarification In the column “What Should Boards Be Doing?” which appeared in the July/August 2004 issue of Healthcare Executive, the editor acknowledges that many of the expressions and ideas contained therein can be found in Really Governing by Dennis Pointer and Charles Ewell (Delmar Publishers, 1996). This book is an excellent resource for further information on the subject.

[Reference] 1 We reviewed the following publications for information that contributed to our environmental scan: Health and Health Care 2010, Institute for the Future; Futurescan 2004-2008, Society for Healthcare Strategy and Market Development of the American Hospital Association, American College of Healthcare Executives, Solucient, VHA, Inc.; The Future of Health Care, Biennial Survey, Dcloitte; Forecast Top 10 Business Issues & Impacts 2003, Capgemini; “Eight New Directions for 2004″ (R. Reece, M.D.), HealthLeaders; Hospital of the Future: A Leaders Perspective (B. Dwyer, S. Widner, D. Beckham), Abbott Laboratories.

[Author Affiliation] This column was written by James A. Rice, Ph.D., FACHE, vice chairman of The Governance Institute, a leading, independent source of governance information and education for healthcare organizations across the United States.

The Governance Institute 6333 Greenwich Dr., Ste. 200 San Diego, CA 92122 (877) 712-8778 Rice, James A