You Expected...what?! Alignment of Services, Expectations & Outcomes Aligning Expectations – Resources – Outcomes

You Expected...what?!You Expected...what?!Alignment of Services, Alignment of Services, Expectations & Expectations & OutcomesOutcomes

Aligning Expectations – Resources – Outcomes

April 20, 2004 SCANPHA Annual Meeting 2

Agenda

Environmental View A Culture of Curing vs. a Culture of Caring Defining Alignment Current Process Presentation Process Management Dip Your Bucket Where You Lay Hit the Pool, Beach or Links


Must Rising Acuity Levels Mean Lower Dining Quality ?

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Independent Living Assisted Living Memory Enhanced Skilled Nursing

Nutrition Quality Food Quality Service Quality Life Quality


Rhythms of Daily LivingRhythms of Daily Living

The core of RDL is the opportunity to exercise choice – residents’ for how they choose to live their day and staff choice for care delivery. This creates a collaborative coalition of residents and caregivers working together in a living environment. RDL facilitates the delivery of care, the experience of living and the dignity of self-determination.


RDL is a management principle that aligns the natural rhythms of residents and the support they need. The organizing principle of RDL is that people should be able to make meaningful choices in their daily lives – on their own or with assistance. RDL relies on caregivers to help define and achieve outcomes that balance individual choice and system efficiency.


Alignment

The appropriate positioning of systems and resources to attain a defined goal, mission, outcome or culture


When Landing A Plane, What Is The Main Thing? 1

1. Concepts and Diagrams From The Power of Alignment - How Great Companies Stay Centered and Accomplish Extraordinary Things By G. Labovitz/V. Rosansky

Left Of RunwayAltitude Too High Aligned

Air Speed

Cross Winds

Altitude

Wind Speed

Pitch


Resident Services

Administration

EnvironmentalServices

Health&

WellnessDining

23+Departments

Quality Work

Quality Care

Resident Services

Administration

EnvironmentalServices

Health&

WellnessDining

23+Departments

??

Families

Residents

Staff

StandardsOrgs.

Owners

Lenders

Vendors

Insurers

Regulators

Consultants

Management

What Is The Main Thing We Must Achieve?


The Main Thing For Senior Care

Choice


“Some facilities studied, usually the lower turn-over ones, were in the process of thinking about how to increase individualized care. For example, the researcher asked, what are you doing if anything about resident choice. ‘We are looking at it. Ideally, we want them to eat when they want. We encourage them to tell us what care they want, a shower or bath, or to get up when they want.”

Page 5-49 Appropriate of Minimum Nurse Staffing Ratios in Nursing Homes, Phase II Final Report prepared by Abt Associates for the Centers for Medicare and Medicaid Services, December 2001.


PLAN & DEVELOP

Organize

Alter

Codify

Train

Improve

Choice AlignmentProcess Overview

Plan

Evaluate

Define

Assess

Implement


Servant Leadership

“I don’t necessarily have to like my players and associates, but as the leader I must love them. Love is loyalty, love is teamwork, love respects the dignity of the individual. This is the strength of any organization.”

Vince Lombardi


Stakeholders

Community LeadershipResidentsFamily MembersStaffBoardRegulators


Leadership Roles

Board / CEO Executive Management Team Operational Management Team Staff Execution


Board & CEO

Define Mission and MinistryStrategic Outcomes & InitiativesListen For What Resources Are

RequiredReview Outcome Measurements


Strategic Intersect Grids

Anticipated Outcomes Measures Stakeholders Resources


Anticipated Outcomes

Clinical Cultural Experiences Staff & Resident Satisfaction Regulatory Financial Impact


Strategic Intersects – Anticipated Outcomes

PROJECT COMMUNITY OF

DISTINCTION

FINANCIAL ENHANCEMENT

QUALITY OF LIVING

OPERATIONAL EFFECITVENESS

POS System Improved management of production controls, improved tracking of billable supplies

Ability to implement DBP

MOW Increase presentation of community Brand into the community

Increased revenues and improved efficiencies of the existing resources

Improve QoL for MOW clients

Increased operational effectiveness for facilities

Campus Dining Program

Continuity of standards throughout the community

Increased cost efficiencies Improved QoL for all residents and work environment for staff

Increased effectiveness in all appropriate operational areas


Executive Management Team

Clarify “Main Thing” and Strategic Objectives Identify Preliminary Alignment Measures Begin to Frame Initial Service Alignment Team

(SAT) Approach Prepare Resident, Regulators and Stakeholders

Briefing and Education Process


Feasibility Analysis & Budget

High Level GAP Analysis of Community Capacities: Operational Cultural Environmental Fiscal Mission


Strategic Intersects – Measures

PROJECT CLINICAL CULTURAL STAFF & RESIDENT

QoL

OPERATIONAL EFFECITVENESS

POS System Ability to implement DBP

MOW Improved Increased revenues and improved efficiencies of the existing resources





Increased cost efficiencies Improved QoL for all residents and work environment for staff



Outcome Measures

Clinical Cultural Experiences Staff & Resident Satisfaction Regulatory Financial Impact


Operational Management Team Conduct Operational Capacity Self-Assessment Using SAT’s Review, Edit and Validate Outcome

Targets Configure Process for Use of the SAT’s during

Process Implementation


Strategic Intersects – Stakeholders

PROJECT RESIDENTS FAMILIES REGULATORS PROSPECTIVE RESIDENTS

POS System EASE OF USE, INCREASED VALUE, EDUCATION

EDUCATION MINIMAL / NO IMPACT

MARKET DIFERENTIATION, SIGNATURE SERVICE

MOW NO IMPACT COMFORT OF NUTRTION AND VISITS

QUALITY & SAFETY

INTRODUCTION


SEAMLESS EXPERIENCE

CONSISTENT PROGRAM OF EXPECTATIONS

CONSISTENT CLINICAL MEASURES

MARKET DIFERENTIATION, SIGNATURE SERVICE


1. Engagement Get All Stakeholders Involved

Ask For Opinions Allow Refuting Of Assumptions and Ideas

2. Explanation Enable Stakeholders To Understand Final Determination

3. Expectation Clarity Make Explicit All Roles, Responsibilities and Measurements

Confirm Cultural ReadinessThree Principles Of “Fair Process”

Fair Process: Managing In The Knowledge EconomyHarvard Business Review, 8/97, By W. Kim and R. Mauborgn


Strategic Intersects – Staff

PROJECT NURSING DINING MAINTENANCE HOUSEKEEPING

POS System Tracking of durable goods

Choice, DBP Billing Billing

MOW

Campus Dining

Program


Resources Intersects Administration: fiscal, management and leadership

considerations Regulatory: compliance criteria (grouped by clinical and

operational considerations) Systems: software programs, forms, policy & procedures,

protocols Personnel: staffing requirements, training, HR. The impact

on each care disciplines is identified by department PP&E: Property, Plant & Equipment necessary to perform

the tasks and functions


Strategic Intersects – ResourcesPROJECT ADMINISTARTION REGULATORY SYSTEMS PERSONNEL P,P & E

POS System Ability to implement DBP

Hardware & Software, Wiring

MOW Improved Increased revenues and improved efficiencies of the existing resources



Transport Equipment



Increased cost efficiencies

Improved QoL for all residents and work environment for staff



Process Management

The detail of the Grids Onto the PM Tool Use of a Process Management system to:

Identify Project Tasks Define Time Required to Complete Detail Sequencing and Coordination of Tasks Assign Responsibility & Accountability for

Completion Ability to Efficiently Track Multiple Moving Teams Detailed Cost Assessment


Into the Pool

Identify the “Main Thing” Initiate the Alignment Process Use of Consulting Services Start in the Shallow End of the Pool

Documents

You Expected...what?! Alignment of Services, Expectations & Outcomes Aligning Expectations – Resources – Outcomes