The implementation and success of a strategic plan depends on the support of key stakeholders. This in turn depends on your ability to communicate clearly and persuasively with dec

www.greenbranch.com | 800-933-3711 15

PRACTICE MANAGEMENT

STRATEGIC OPERATIONAL PLANNING

D uring the recent 2016 presidential race, it became evident that significant changes will be made to the accessibility, delivery, and compensation of healthcare services in the United States. One of

the approaches likely to gain further momentum is popu- lation health management (PHM), with a focus on value- based care. PHM is focused on meeting the Triple Aim of improving the quality of healthcare services, improving patient satisfaction, and reducing costs. To survive in this environment, providers will need to develop strategic plans to help their institutions and medical practices evolve to a PHM model. Although strategy and operations often are approached as two separate and distinct functions, PHM requires the two to be combined. Whereas a strategic plan paints the vision for the organization over the next five years, an operational plan implements its goals and typi- cally is completed within one year.

Although a good strategic plan is needed for adding medical services in a community or determining how to beat market competition, operational planning is what determines how quickly those plans are achieved and how well that service is provided. The operations of any medical organization largely determine the quality of care deliv- ered, productivity of physicians, satisfaction of patients, and culture of the organization.

The value of this combined approach of “strategic op- erational planning” is illustrated in the following examples, which contrast a patient’s experience in a new urgent care center that employs this model with a more traditional ap- proach. In both scenarios, a patient on crutches is seeking treatment for a painful and swollen ankle.

Center A: Strategic Operational Planning The patient arrives at the Center and is immediately greeted with a smile by the receptionist, asked whether he needs assistance, and directed to the registration kiosk. The kiosk has secure seating, and the patient sits comfortably while he scans his photo identification, insurance card, and credit card for any potential outstanding balance or out-of-pocket expenses. The patient electronically signs all applicable forms.

Within five minutes after registration, the patient is escorted by the medical assistant (MA) to the exam room for triage and x-rays. The physician reviews the films and examines the patient. She diagnoses a sprained ankle, and discusses the diagnosis with the patient, answering all questions and verbally discussing discharge instructions. The physician offers the patient sample over-the-counter medication to help with the pain to tide him over until he can get to the pharmacy, which the patient accepts and takes. The patient is given the option to purchase the

Strategic Operational Planning: Why Healthcare Organizations Need to Adopt this Dual Approach Under Population Health Management Sarah F. Clarke, MBA*

Government regulations and population health modeling have operational planning intertwined with determining the future of healthcare organizations. Practices can no longer form sound strategic plans without including operational leaders and implementers as members of the strategic team. Health organiza- tions must consider both operations and strategy in the planning process to survive and thrive in the new healthcare era. By doing so with careful planning and execution, practices can maximize revenue, reduce expenses, grow their practices, manage risk, and satisfy patients and employees.

KEY WORDS: Strategy; operations; population health management; patient satisfaction; value-based care; planning; training.

*Senior Consultant, Rosen, Sapperstein & Friedlander, LLC, 130 Admiral Cochrane Drive, Suite 102, Annapolis, MD 21401; phone: 410-897-9888; e-mail: [email protected]. Copyright © 2017 by Greenbranch Publishing LLC.

16 Medical Practice Management | July/August 2017

www.greenbranch.com | 800-933-3711

ankle boot for $75 or take a prescription to obtain it from another vendor.

The patient opts to purchase the ankle boot, is fitted by the MA, and escorted to check-out. The patient pays for the ankle boot, and is asked if he prefers printed or elec- tronic discharge instructions and summary of visit. The patient chooses electronic copies that he can view on his smartphone. The patient completes the electronic patient satisfaction survey and gives the center excellent ratings. Additionally, he posts positive comments on social media regarding the Center. The entire patient visit takes less than one hour. The Center electronically sends the patient a thank you card for choosing the Center for his healthcare needs.

Center B: Traditional Approach The patient arrives at the Center and walks to the recep- tion area. Without making eye contact, the receptionist instructs him to sign in and have a seat. Fifteen minutes later, the patient is called by the receptionist, who requests his photo identification and insurance card, and gives him a clipboard with papers to complete.

The patient has difficulty walking back to his seat. As he is completing the forms, the receptionist calls him to re- trieve his photo identification and insurance card, and the patient hobbles to the reception desk again. Upon returning to his seat he completes the forms, and then returns to the receptionist with clipboard. As he takes his seat his ankle is throbbing. He waits another 10 minutes before the MA calls his name to escort him to an area in the hallway to obtain his weight. She then takes him to the exam room for triage.

The physician comes in to do an examination and then orders x-rays. The medical receptionist takes him for the x-rays, and, upon return to the exam room, he waits an- other 15 minutes for the physician to return. The physician informs the patient that he has a badly sprained ankle and that the MA will fit him for an ankle boot.

The patient waits for the MA, who returns in 15 minutes with an ankle boot for the patient and demonstrates how to wear the boot properly. The physician returns 10 minutes after the boot has been placed on the patient, and provides discharge instructions and answers questions. The MA es- corts the patient to the checkout area, where he is surprised to learn that the ankle boot costs $75. After he has paid for the visit, the patient is given written discharge instructions. The entire patient visit took almost two hours. The patient leaves the Center stating that the service was poor and he will not return. The Center does not address the complaint.

WELL-RUN OPERATIONS TAKE PLANNING

Excellent customer service and efficiency typically are the products of well-run operations, not personalities. The friendly medical receptionist in the strategic operational

planning model has been through a training program with clear guidelines on greeting patients, registration, and cus- tomer service. The receptionist is monitored on his or her performance with reviewed evaluations.

Incoming calls and follow-up inquiries are handled by a separate call center so there is no distraction from cus- tomer service or unnecessary delays at the front. A robust electronic medical record (EMR) system verifies eligibility and benefits immediately. A timely patient satisfaction survey captures staff performance, and staff are given in- centives to perform well. Why hasn’t all this training and operational preparation happened in the “parallel” model as well?

WHAT’S MISSING IN THE TRADITIONAL MODEL

Let’s imagine the strategic planning meeting for the tradi- tional model. Urgent care is encroaching on primary care practices. Competing centers are scheduled to open in the region in the fall, so it is important to open centers now to maintain market share and compete in the population health arena. In the traditional model, the finance person crunches the numbers, the marketing director estimates the number of potential clients in the facility’s geographic area, human resources and the physician recruiter hire the team, and everyone agrees to move forward and open the facility.

What went wrong in the traditional approach to opening a new urgent care center? 77 What is the traditional model missing? 77 What are the best practices for urgent care centers? 77 Where is the customer service consideration that makes

a patient want to return to an urgent care center? 77 Where is the well-planned technology to streamline

operational efficiencies?

Patients are looking for quality service provided in a timely manner by compassionate people. By rushing stra- tegic implementation without operational planning, this urgent care center is setting itself up for negative patient experiences.

Healthcare organizations must consider both operations and strategy during the planning process in order to survive and thrive.

This urgent care center would only have to make a few changes in the implementation process—such as con- tacting the EMR vendor for kiosk set-up, maximizing the potential of the existing EMR system for eligibility/benefits

www.greenbranch.com | 800-933-3711

Clarke | Strategic Operational Planning 17

verification ability, developing standing orders for com- monly presenting problems, and providing incentives to front-line staff—to be able to look forward to producing satisfied patients and positive relationships within the community. Its next strategic plan then would be where to extend the model, not how to fix it.

Under PHM, hospitals, physician practices, and public health organizations can no longer form sound strategic plans without operational leaders and implementers as members of the strategic team. Healthcare organizations must consider both operations and strategy during the planning process in order to survive and thrive in the new healthcare era.

HOW TO CREATE AN EFFECTIVE STRATEGIC TEAM

How can your organization form an effective strategic team? Take the following steps.

Create an Innovative Culture In a rapidly changing environment, it is critical to develop a culture that encourages innovation and risks. Forming a phenomenal team, but maintaining a culture of compla- cency, finger-pointing, and unhealthy competition will un- dermine all efforts. Plan a retreat for your team to develop this shared culture, attend conferences and network with similar teams, and involve your human resources staff to amend policies to begin to change the cultural atmosphere. Cultural changes do not happen overnight, so consistency in promoting the cultural shift is paramount.

Assess and Communicate Priorities Determine the major focus for your organization, whether it entails expanding your primary care network or reducing emergency department visits for a specific diagnosis. This internal assessment goes back to the foundational questions of “Who do you want to be?” and “Where do you start?” The next step is to determine who, and what, you need to get the job done. Start by assessing your internal talent. You may need to contract with a consultant to determine what positions are missing in your organization. Not all positions require the recruitment of new personnel. Match your cur- rent team’s skillsets to tasks that are needed. The result may be changing positions or titles of your current staff.

Evaluate and Recruit Staff For population health management, finding someone skilled in working with the ambulatory services model is key to forming a feasible strategy. For health systems, this would include a vice president/executive director of opera- tions with the responsibility of determining integration of physician practices with each other, referring practices,

and a hospital flagship. The vice president would have the support of directors of operations for middle manage- ment, with one director for every five medical practices. The medical practices would have practice administrators.

The support departments include, but are not limited to: compliance, medical/clinical director, IT, revenue cycle management, human resources, financial analysis, mar- keting, and accounting. Develop teams and subteams with project leaders for implementation. The vice president of operations should form an implementation team to deter- mine optimum time frames for implementation.

Hospitals often understand which management levels are necessary to operate their facilities, but fail to realize that the same levels are needed for ambulatory services op- erations that have large patient volumes. Also, institutions may be able to reorganize to meet their structural needs by reallocating current staff, or partnering with nonprofit community organizations and payers for outreach and care coordination services.

A highly respected, Maryland-based teaching hospital did just that. To develop its framework for PHM, the hospi- tal secured an $800,000 grant from the Maryland Commu- nity Health Resources Commission to focus on reducing emergency room visits. The hospital used the funds to hire care coordinators who coordinated care for mental health, substance abuse, and transportation and housing needs for patients who had utilized its emergency department four or more times in the past four months. It partnered with the nonprofit HealthCare Access Maryland for care coordination needs.1

Prioritize and Develop a Timeline for Initiatives Determine which initiatives are feasible within the current budget. A common mistake is not having the funding to execute well. The budget should include staff, IT, training, and other resources needed.

One of the major obstacles for health systems and medi- cal practices is the lack of a managed care director who is connected with federal and state regulatory agencies and monitors, and who understands and communicates relevant regulatory changes. Without someone in this role, implementation then becomes a last-minute, unplanned rush for compliance, resulting in unhappy physicians, patients, and staff.

Develop subset teams for initiatives. Designate a proj- ect leader who chairs weekly meetings and reports to the executive team.

Provide Training Train your team not only on the subject matter, but also on how to appreciate differences in perspectives and experi- ences. Your degree of success depends not only on sharing ideas and accepting critical feedback, but also on uniting

18 Medical Practice Management | July/August 2017

www.greenbranch.com | 800-933-3711

the team on an agreed-upon course of action that may not have been the first choice for all team members. The most effective leaders will require periodic training on change management and team development.

Track and Communicate Successes Communicate! Remember, sending one email is not com- munication. Repetition is key—by communicating through meetings, newsletters, memos, emails, phone calls, and for- mal or informal presentations. For non-immediate initia- tives, submit proposals for consideration in future budgets.

Reward Success Goals and means of measuring them are the prerequisites to rewards. Otherwise, rewards can backfire and cause discontent among members of a team who view the dis- bursement of rewards as unfair or biased. Goals and their achievement should be transparent, communicated in a formal written format, and discussed during team meet- ings. Who is rewarded shouldn’t be a surprise. Reward not only individuals, but also teams and leaders. Rewards should always inspire others to reach higher. Rewards may take many forms, including recognition (e.g., Excellent Service Hall of Fame, reward banquet), monetary rewards (e.g., bonuses, gift cards), additional paid time off, a special parking spot, and promotions.

A monumental change like this shift to value-based care and the need to develop and implement strategic opera- tional planning is critical. It does not need to be compli- cated, but it does need to be planned and done correctly for the best results. Anticipate that you will need to make investments in training across the board for your organi- zation. Expect resistance and anger stemming from a fear of change. One of the biggest impediments to individual learning is fear—fear of failure, fear of embarrassment, fear of losing one’s job. People fear change because it is the unknown. Change takes them out of their comfort zone and requires effort. Learn not only to embrace change but also how to sell it. Knowing how to innovate and manage change will soon become a requirement in job descriptions and performance reviews.2 Most importantly, expect mis- takes and redirection. View these as exciting opportunities for growth and success. After all, there are no great suc- cesses without the preceding lesser failures. Y

REFERENCES 1. Dahl O. Why healthcare leaders need to develop learning organiza-

tions to succeed. Executive View. June 1, 2016. www.mgma.com/ practice-resources/mgma-connection-plus/executive-view/2016/ june-2016/why-healthcare-leaders-need-to-develop-learning-organi zations-to-succeed.

2. Llopis G. 5 most effective ways to sell change. Forbes . November 5, 2012. www.forbes.com/sites/glennllopis/2012/11/05/5-most-effective- ways-to-sell-change/#71bd90fd7d3c.

Don’t Let Internet Critics Spoil Your Reputation

A Social Media Guide for Physicians and Medical Practices

Establishing, Managing, and ProtEcting Your onlinE rEPutation:

Establishing, Managing, and ProtEcting Your onlinE rEPutation:

$64.00 print $51.00 eBook

USD

To Order: • Mail: Box 1164

Williamsport, PA, 17703-9929 • Phone: 800.933.3711 • Fax:

410.329.1510 • Web: www.greenbranch.com

Maybe you’re not a big social media user—but your patients are. And they use social media sources when they’re finding a doctor. Given these stakes, you can’t afford to leave your online reputation to chance. Kick off your social media efforts today with Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices, a comprehensive guide to physician use of social media not available anywhere else. Written by social media physician expert Kevin Pho, MD (KevinMD.com) this guide shows doctors how they can brand themselves. It also provides insider tips on how to respond to online reviews and a guide on how to work with all of the major rating sites.

Also Available in All Popular eBook Formats!

Table of Contents Chapter 1: Disrupting the Healthcare

Landscape

Chapter 2: Your Online Reputation Today

Chapter 3: Defining Your Online Identity Through Social Media

Chapter 4: Creating Your Digital Footprint

Chapter 5: Rating Sites

Chapter 6: Safeguarding Your Online Reputation

Chapter 7: Professionalism in the Digital Age

Chapter 8: Connect and Be Heard: My Journey from Social to Mainstream Media

Reproduced with permission of copyright owner. Further reproduction prohibited without

permission.

Article

Beyond the status quo – setting the agenda for effective change: The role of leader within an international school environment

Allan R Morrison

Abstract In today’s competitive and rapidly evolving educational environment, the ability to implement appropriate and effective change is of critical importance to an international school’s ongoing success. This study examines leadership characteristics and styles that support the development and forward momentum of a change agenda within the context of an international school envi- ronment. Results from a mixed methods research design found that the leadership characteristics most frequently linked to effective change included: (i) being visionary; (ii) being committed to school/staff; and (iii) creating a collegial/supportive work environment. The paper analyzes these and other results through the lenses of: (i) setting directions; (ii) developing people; and (iii) developing the organization. Findings specific to the international school situation are also presented. Finally, suggestions for developing a framework for an international school ‘change management’ paradigm are presented.

Keywords leadership characteristics, change management, educational leadership, international schools

Introduction

In the international school market, an ability to implement appropriate and effective change is of

critical importance to a school’s ongoing success in today’s competitive and rapidly evolving

educational environment. In general, research done on schools has shown that a key component

in the success of school improvement initiatives is the effectiveness of its leadership (Glover and

Tomlinson, 2012; Hargreaves, 2010; Stoll and Fink, 1996). Without effective leadership, a

school’s forward momentum stalls and defaults to the status quo.

The issue, then, becomes one of defining what role a leader plays in promoting effective change.

However, ‘despite the proliferation of numerous theories, models, and multistep approaches,

leaders continue to lack a clear understanding of change, its antecedents, effective processes, or

Corresponding author:

Allan R Morrison, Delia School of Canada, Tai Fung Avenue, Taikoo Shing, Hong Kong.

Email: [email protected]

Educational Management Administration & Leadership 2018, Vol. 46(3) 511–529 ª The Author(s) 2017 Reprints and permission: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/1741143216682500 journals.sagepub.com/home/ema

the ability to successfully engage organizational members in change initiatives’ (Gilley et al.,

2009: 38).

If the concept of leadership is examined more holistically, it is apparent that there are actually two

potentially competing components within a leader’s role that can have a direct impact on the style of

leadership an individual employs. First, from the macro-perspective, there is the ‘structural dimension’,

which focuses on the management apparatus including, for example, decision-making protocols and

policies/procedures. Then, at the micro-level, we have a more ‘human dimension’, which considers the

form of the interactions between a leader and his or her staff. In many ways, this highlights a manager

versus leader dichotomy. This potential struggle between management and leadership reflects the fact

that ‘[m]anagement’s mandate is to minimize risk and to keep the current system operating, [while

leader-driven] change, by definition, requires creating a new system’ (Kotter, 1995: 60). More recently,

Kotter has argued that ‘management is about coping with complexity’ while ‘leadership is about coping

with change’ (Kotter, 2013: 6). A new system, by definition, implies uncertainty and increased potential

risk. If leadership is about change, and change is equated with instability, which management tries to

minimize, then there is an inherent conflict between the concepts of leadership and management (Mor-

rison, 2013). As such, educational leaders are presented with a dilemma – if the process of change ‘comes

on too strong, the culture will rebel . . . [conversely] if the leader is overly respectful of the existing

culture, he or she will become absorbed into the status quo’ (Fullan, 2011: 62).

Therein lies the paradox. And yet, modern-day educational leadership development continues to

train leaders (in contrast to managers) who are then transplanted into very hierarchical structures

and expected, in many cases, to manage rather than lead. The structural constraints leaders

encounter within their organizations can hinder their ability to transform the system and reinvi-

gorate it for further growth (Morrison, 2013).

I would argue that educational institutions, full of creative minds, both teacher and student,

should be centers of exploration for new ideas to challenge the status quo and yet, ‘schools have

become fundamentally conservative institutions which have historically resisted change and

sought to preserve continuity with their past experiences’ (Stoll and Fink, 1996: 5). I would further

argue that school improvement must be an ongoing, evolutionary process, sensitive to new issues

and societal changes, in order to not only challenge the status quo and move society forward, but

also to stimulate continuous improvements in student outcomes.

A key question is, therefore, ‘How does a leader go beyond the status quo and set the agenda for

effective change?’ Specifically, the questions guiding this study include: (i) what are the leadership

characteristics that support the development and forward momentum of a change agenda within

international schools? and (ii) is there a single leadership style that lends itself to most successfully

effecting change in an international school setting?

The answers to these questions will then be used to form a framework to illustrate how leaders,

specifically leaders within an international school environment, can drive the change process forward

in an effective manner, thereby minimizing the impact of an organization’s tendency toward stasis.

Significance of study

In recent years, the study of the role of leadership in bringing about change has been a strong focus

within academe. While Fullan (2010: 76) notes that ‘there has been more written about leadership

in the literature on organizations than any other topic [in recent years], and there are no signs that it

is abating’, the ‘empirical evidence linking any leader’s internal state to their use of effective

leadership practice . . . although growing, is not yet extensive’ (Leithwood et al., 2006a: 8).

512 Educational Management Administration & Leadership 46(3)

Re

Collepals.com Plagiarism Free Papers

Are you looking for custom essay writing service or even dissertation writing services? Just request for our write my paper service, and we'll match you with the best essay writer in your subject! With an exceptional team of professional academic experts in a wide range of subjects, we can guarantee you an unrivaled quality of custom-written papers.

Get ZERO PLAGIARISM, HUMAN WRITTEN ESSAYS

Why Hire Collepals.com writers to do your paper?

Quality- We are experienced and have access to ample research materials.

We write plagiarism Free Content

Confidential- We never share or sell your personal information to third parties.

Support-Chat with us today! We are always waiting to answer all your questions.