HELP WHERE HOSPITALS NEED IT ®
HELP WHERE HOSPITALS NEED IT ®
Community Hospital Blog
by Karen Barber, CEO, Yoakum Community Hospital
Leveraging Resources for Change
When I joined the Yoakum Community Hospital team in 2006, one of the biggest hurdles I faced was improving board-management relationships. I realized that addressing this challenge would be essential to paving the way for a better, more secure financial and operational future for the hospital and community. Elorine Sitka, Yoakum Board Trustee and Chair, shared this vision, and together, we turned ideas into reality.
As a 25-bed critical access hospital in rural Yoakum, Texas, it became apparent that trustees had not been receiving all the information they needed — in a timely way — to make well-informed decisions. We realized that trustees were challenged in performing their basic fiduciary and financial duties, and change was necessary to inspire and create a high-performing board dedicated to the hospital’s success.
As partners, our goal was to improve the hospital for the good of the community. We developed recommendations on ways to improve board relations and engagement – laying a solid benchmark for success for many rural hospitals.
Five Steps to Success
Certain basics are “must-haves” for continuous improvement in board-management relationships, including:
1. Clarify expectations regarding roles and responsibilities
Governance and management are distinct functions. At Yoakum today, board members view their role as strategists and overseers. They leave management and operations to hospital leaders and managers, although that wasn’t the case previously. Board members provide direction. Managers create and implement tactics to support board strategies. One significant consideration is to provide board members with updates to keep them in the loop.
Identifying specific responsibilities in written form can also help prevent confusion related to roles. Discussions about mutual expectations are important, too. What do trustees expect of the CEO? What types of things can a CEO do without prior board approval?
2. Foster open, consistent communications
Regular, informal phone calls and a weekly newsletter are great tools to keep board members informed. An online portal provides members with meeting materials to review at least a week in advance. Trustees are encouraged to reach out to leaders if they have a question or concern, as well as participate in meeting discussions and respectful debates.
3. Make meetings purposeful
Make board meetings organized and action-oriented. Take informational items off the agenda for trustees to read on their own. Focus face-to-face time on several major issues that require voting at board meeting time.
I strongly suggest that everyone “stick to the agenda.” The entire team is busy, so keep meetings short and on point. And set aside time to socialize. Sharing a meal together before getting down to business inspires fellowship and teamwork.
4. Create resourceful onboarding and continuing education
New trustee orientation is vital and should include meetings with key stakeholders, including the CEO and CFO, as well as important partner organizations. A tour of the hospital and distribution of educational materials including an organizational chart and a glossary of healthcare industry terms and acronyms are part of the process.
5. Identify potential trustees
A specific recruitment process for new trustees is key. At Yoakum, we maintain a running list of potential board members, keeping in mind leaders and colleagues with diverse backgrounds. Another consideration is to identify potential board members without any sort of personal agenda. The focus should be on improving the hospital for community health.
We also encourage board members to listen to presentations offered by hospital staff, and take advantage of state and other sponsored trustee education programs. At Yoakum, we also invest in an annual board retreat and involve trustees in monthly birthday celebrations and other hospital events.
Building on Success
Looking back, the difference at our board meetings today is obvious. Today we have a strong board and dependable, trustworthy leadership committed to a common purpose.
To learn how Yoakum Community Hospital developed a high-performing board, read this CHC case study.
By Jill Bayless, CHC SVP Clinical Services
Improving a hospital’s financial performance seems relatively simple – it’s driven by decreasing costs and increasing revenue. In reality it’s quite complicated to optimize these factors while keeping quality care top of mind. One of the biggest challenges for hospitals is managing staff productivity, which means maintaining the right number and mix of clinical staff based on patient diagnoses and volume. Optimizing productivity is critically important because the cost of labor is the greatest expense for a hospital.
In our experience, almost every hospital has some room to improve staffing productivity. Here are some top-line recommendations to help a hospital department run more like a successful business.
Some additional tips on staffing and productivity:
CHC offers a comprehensive assessment to help clients take an in-depth look at productivity and staffing concerns. Learn more about CHC Operational Assessment Services.
by Craig Sims, SVP, Southwest Hospital Operations, CHC
Community-based hospitals put the “care” in healthcare, and
Here are some best practice tips for positive, productive Board-CEO relationships.
- Did we focus on the right issues?
- Did we participate in an active way?
CHC offers a variety of advisory services depending on client needs — including board education — to help enhance hospital CEO-board relationships. Learn more about CHC Hospital Board Advisory Services.
by Michael Morgan, Director of Due Diligence and Strategic Analysis, CHC
An array of issues – from increasing charity care, bad debt and declining reimbursement rates to negative profit margins – create financial distress for rural hospitals. Despite today’s challenging operating environment, many rural hospitals across the country are using a practical approach to grow revenues and control costs.
Step 1: AWARENESS
Know the signs and symptoms of declining financial health
How does a hospital reach the point of “no return” where closure becomes inevitable? Were there warning signs along the way? Were they missed? Would the outcome have been different if danger signals had been noted and addressed?
Discussions around performance, growth and capital stewardship are at the heart of strategic planning for most health care organizations, and even though financial indicators are a harbinger of financial health, “finance” is often considered the responsibility of the chief financial officer or other “financial” folks. Budgeting is usually department-specific.
Like car dashboard warning lights, financial warning signs mean it’s time to sit up and take notice. A regular review of the most important indicators related to an organization’s financial health should be a shared responsibility for the entire health care team. Data points to focus in on include:
Step 2: INFORMATION GATHERING
Identify and assess significant financial indicators
Operational best practices include a monthly review by hospital leadership of key measures, many of which are listed above. Procedures should be put in place by the hospital’s finance department, with input from department managers, to produce accurate monthly stats and financial performance metrics to facilitate these periodic reviews. A closer look at financial indicators also should be part of the annual review and planning process. A key to financial improvement for hospitals is clear communication of expectations and goals across the leadership spectrum in order to accomplish desired changes.
Step 3: ANALYSIS & ACTION
Connect the dots for sustainability
Once data is available to everyone, the next step is to analyze the root cause. For instance, if inpatient admission volumes are down significantly in a current month compared to the same month in the previous year, the conclusion might be, “We think it went down because there were fewer flu cases this year compared to last year.” That may be true, but speculation can be risky. Do a deep data dive and take the guesswork out of the equation. What were the primary diagnoses of the admitted patients for each time period? Were there any abnormal physician trends? How do observation days this month compare? Understanding the trends and their causes is the key to creating actionable solutions.
Regular reviews of key financial indicators can identify operational best practices, support strategic planning efforts, enhance understanding and create accountability. These reviews can confirm or redirect efforts aimed at sustainability. The most critical element of the entire process is answering “why.” Only then can the team develop solutions to improve operating margins and avoid financial distress.
Learn more about CHC's Financial Improvement services.
By Cindy Matthews, Executive VP, CHC.
“Strategic planning” usually isn’t the issue. According to the Harvard Business Review, it’s how the process is developed and managed to support ongoing decision making. Here are some guidelines to restructure and facilitate the strategic planning process to make it more effective and relevant to your hospital’s daily operations.
(1) Assemble key stakeholders to create a clear vision for the future. The first step is to bring everyone to the table to discuss how the hospital can move forward effectively —board members, medical staff and hospital leadership. Explore your desired future state, asking questions such as “Where do we want to be, what’s helping or hindering us from moving forward, and how can we get there?” Talk about the hospital’s strengths and weaknesses too, internal and external. And don’t forget education as a component of the conversation. Share information on the hospital’s service area and patient demographics, market share, the Affordable Care Act and how it may be impacting patient volumes, and more. This visioning process is integral to effective planning.
(2) Identify strategies to support attainment of the vision. How will you achieve your desired outcome? Outline key operational, physician, employee, financial, technological and growth strategies for the next three years to help turn vision into reality.
(3) Develop action plans for implementation. Now that strategies are defined, the next step is to identify key tactics and measurements for each initiative. Be sure to document plans with timelines and accountability. Engage departments and staff in the strategy execution process. A disciplined approach helps everyone be accountable. A related note: make strategy development continuous, spreading strategy reviews throughout the year to focus on a single issue at a time. Don’t limit reviews to a two- or three-month time period.
(4) Align business planning with strategic planning processes. Business-unit focused plans related to service line growth, physician alignment, operational efficiency, clinical quality and patient engagement/satisfaction must be consistent with the organization’s strategic objectives. Leaders should work closely with hospital managers to ensure department and service line business plans and budgets align with hospital strategic planning efforts.
When we’re caught up in day-to-day operations, planning can become an afterthought or an exercise in futility. Reconfigure the process to clarify a shared vision, advance stakeholder collaboration, define responsibility and improve decision making.
Learn more about CHC Strategy and Vision Planning services.
CHC | 7800 N. Dallas Parkway, Suite 200, Plano, TX 75024 | 972.943.6400Copyright © 2017 Community Hospital Corporation