2007-2008 Strategic Plan

DRAFTED 4/25/07

Facilitated by

MJ Philps & Associates LLC, Upland CA

April 2007

The 2007-2008 MCDH Strategic Planning Process was made possible through support and funding by the Medicare Rural Hospital Flexibility Program (FLEX) Office of Rural Health Policy under a grant through the California State Office of Rural Health

Mendocino Coast District Hospital in 2012

Statement of a MCDH Ideal Future

INTRODUCTION

This Statement of a MCDH Ideal Future was drawn from comments made during more than thirty interviews of a broad cross section of the Hospital’s key constituencies and during Strategic Planning meetings which preceded the March 31, 2007 Mendocino Coast District Hospital Strategic Planning Retreat.

This Ideal Future Statement reflects where the Hospital can realistically expect to be in five years given a sincere commitment by the organization to:

• Vigorously pursue opportunities open to it.
• Creatively use available resources.
• Anticipate, adapt to, and manage change.

Mendocino Coast District Hospital in 2012

Statement of a MCDH Ideal Future

By 2012, MCDH will have:

• Achieved long term financial viability as evidenced by a solid record of profitable operations (a year to year excess of revenue over expenses).
• A consistent record of strong ongoing financial management supported by the most effective customer friendly financial/billing and payment systems.
• The capacity to support significant capital improvements and equipment purchases.
• Developed a physical plant which meets all State and Federal regulatory requirements (including seismic standards).
• Become very competitive with area hospitals, possibly serving as a model for rural community hospitals.
• Very attractive, nicely appointed patient rooms and common areas.
• A new or significantly upgraded hospital infrastructure (chillers, boilers, generators, etc.)
• An appropriate array of equipment and technology required to support a progressive full service Critical Access Hospital.
• A medical staff of sufficient size with the right mix of medical specialties required to be competitive with area hospitals and which fully meets community expectations with respect to range of specialities.
• A medical staff which operates in a practice enfironment that is highly collegial, financially rewarding, and offers opportunities for expanding cllinical skills and experience.
• Developed an enhanced and expanded range of services which emphasizes doing the basics very, very well while providing the greater Mendocino Coast community with an expanded array of financially viable rograms consistent with the Hospital's ability to deliver services in a safe, competent and efficient manner.
• A hospital staff that has fully internalized and embraced a philosophy of customer service and patient/family satisfaction similar to market leaders in the healthcare and service industries (e.g. Mid-Columbia Medical Center, Hilton Hotels, Disney Company, etc.).
• A high esprit de corps: A strong committment to teamwork and mutual respect among all levels of the organization reflected in strong organizational pride projected to the community.
• An established track record of providing very high quality care which meets or exceeds all established State and Federal regulatory guidelines as well as current voluntary quality goals and targets.

Mendocino Coast District Hospital

2007-2008 Strategic Goals and Objectives

GOAL AREA: Relationship with Community

ISSUE STATEMENT

A series of developments over the past four years (e.g. hospital financial instability and failure of the parcel tax) have served to undermine community confidence in Mendocino Coast District Hospital. Although much has been achieved over the past six months to regain community trust, much remains to be done to ensure that the hospital organization enjoys the full support and confidence of Mendocino Coast residents.

MCDH needs to inform the community of:

• Progress made to date by the Hospital in achieving financial stability.
• The full range of services MCDH has to offer including the specific services, technologies, and range of physician expertise available locally.
• MCHD’s truly unique characteristics when compared to most rural hospitals in terms of its retention of OB, full service surgery, etc. as well as its relatively high market share (67%) and percentage of ER visits admitted to the Hospital.
• The Hospital’s strong interest in working with all agencies and organizations in Mendocino County to ensure development of a strong, coordinated local health delivery system.

STRATEGIC GOAL

Building on progress made to date, it is the strategic goal of MCDH to achieve the highest possible level of trust and support among Mendocino Coast residents based on confidence that their hospital is stable, well managed, viable long term, and deserving of financial contributions from the community.

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Relationship with Community

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Relationship with Community (Continued)

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Relationship with Community (Continued)

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Relationship with Community (Continued)

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Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Relationship with Community (Continued)

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Quality of Care

ISSUE STATEMENT

Opinions expressed during interviews, at meetings of the Strategic Planning Sub-committee, during the management team planning session, and at the MCDH Strategic Planning Retreat, reflect a strong desire among management, employees, medical staff, Board members, and community leaders, that Mendocino Coast District Hospital develop a culture which enables MCDH to provide patients with an “ideal” patient experience. Such comments also indicated that a range of physical plant improvements is needed to make these expectations a reality. Finally, there seems to be a shared interest in acquiring and implementing a strong and effective customer service program.

STRATEGIC GOAL

It is the strategic goal of MCDH to develop the capability of providing the patients it serves, with the “ideal” patient experience fostered by:

• The movement of patients/customers through an easy to navigate, seamless system from point of entry to completion of diagnostic or treatment procedure, discharge and follow-up.
• Provision of exquisite customer service and responsiveness that conveys a sense that everyone in the organization, physicians, management, clinical staff, other employees, etc. stand ready at all times to be a proactive advocate for the patient.
• Achievement of excellent patient outcomes as evidenced by meeting or exceeding national quality targets and standards.
• A superb ability of all components of the organization to work together as a cohesive team.

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Quality of Care

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Scope of Services

ISSUE STATEMENT

Residents of MCDH.s primary and secondary service areas have high expectations regarding the range of services they expect their hospital to provide. They resent making long time-consuming trips to distant medical centers for services that could and should be provided locally. At the same time, they expect the range of services which MCDH provides to reflect a focus on doing the basics right, and are acutely aware that if MCDH pursues esoteric services which are not financially feasible it places the hospital’s long term financial viability at risk. The challenge for MCDH is to strike a proper balance between what the community expects and what the hospital can prudently provide.

STRATEGIC GOAL

It is the strategic goal of MCDH to provide residents of its primary and secondary service areas the full range of healthcare services that are within the hospital’s financial capability and clinical competence, thus ensuring that to the extent possible:

• MCDH retains all appropriate patients.
• Travel by Mendocino Coast residents to outside medical centers for care is minimized.
• MCDH is very well positioned to compete with other acute hospitals across the board and in key service categories (e.g. OB, orthopedics, lab, etc.).

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Scope of Services

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Physical Plant & Equipment

ISSUE STATEMENT

Like many Hill-Burton era hospitals, Mendocino Coast District Hospital’s physical plant has outlived its natural useful life (generally considered to be 30-35 years for most healthcare structures). While the physical plant appears to have been well maintained and has a new modern outpatient addition to the Hospital, inpatient rooms, common areas, and service support areas of the facility are badly in need of a total renovation, upgrade or replacement. Several years ago, the Hospital’s deteriorating financial position forced the postponement of a badly needed replacement of the facility’s infrastructure (e.g. boilers, chillers, generators, etc.). Thus, there is a critical need to move forward in addressing infrastructure issues. Also, MCDH like all rural California hospitals faces the daunting challenge of meeting California SB1953 seismic standards. The existing facility must meet these standards by 2013 or occupy a replacement facility by 2015. Finally, it is simply reality that given the Hospital’s current financial position, it will be some time before MCDH achieves an excess of revenue over expenses sufficient to fund significant facility improvements. In the meantime, it must rely on Mendocino Coast Hospital Foundation and a successful Capital Campaign to provide financial resources needed for any major capital improvements.

STRATEGIC GOAL

It is the strategic goal of MCDH to develop a state of the art physical plant and campus, which is attractive, highly functional, and supports the Hospital’s efforts to provide patients with the “ideal” patient experience” in terms of patient flow, attractiveness of patient rooms, clinical support and common areas, hospital grounds, etc. This physical plant (either totally renovated or replaced) should:

• Include dependable new infrastructure components, boilers, chillers, generators, etc.
• Meet the requirements of CA SB1953 seismic standards.
• Support the full range of new and existing services (e.g. OB, plastic surgery, orthopedics, etc.) needed to meet the healthcare needs of Mendocino Coast residents.

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Physical Plant & Equipment

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Financial Performance

ISSUE STATEMENT

Over the past six to ten months, MCDH has made significant strides in achieving increased financial stability. This represents a substantial improvement from a period of successive and sizeable financial losses, which undermined for MCDH, the confidence and trust of residents of Fort Bragg, and other coastal communities. This progress has been possible because of strong hospital leadership, sound financial management, and the availability of cost based reimbursement under the Critical Access Program. However, the confidence of the community will not be fully restored until MCDH achieves a sustained positive financial performance...successive years of an excess of revenue over expenses.

STRATEGIC GOAL

It is the strategic goal of MCDH to achieve sustained, positive,

financial performance that:

• Reflects a year after year excess of revenue over expenses
• Completely restores the confidence and trust of the community
• Encourages area residents to make needed financial contributions to the Hospital
• Will eventually allow MCDH to undertake needed capital improvements in addition to those supported by Mendocino Coast Hospital Foundation.

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Financial Performance

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Financial Performance (Continued)

Mendocino Coast District Hospital

2007-2008 Strategic Goals and Objectives

GOAL AREA: Market Position

ISSUE STATEMENT

When compared to most rural hospitals across the US, MCDH’s market position is relatively strong. While the hospital’s market share has declined over the past three years (a trend which the Hospital should seek to reverse), its 67% market share is significantly higher than most rural hospitals, which typically have market shares between 25 and 50%. Likewise, while many rural hospitals lie in the shadow of large urban centers (which might have a 25-40% share of the rural hospital’s local market) MCDH’s main competition for patients comes from facilities having 6% or less market share in MCDH’s primary service area. All but one of these competitor hospitals is between one and two hours driving time from Fort Bragg. There are several areas, however, in which MCDH should redouble its efforts to regain and grow market share.

These include:

• Orthopedics: Which will require recruitment of a second orthopedist (who accepts a wide range of insurances).
• OB: In which MCDH market share losses have been significant.
• Lab services: Which represents one of the only areas in which hospitals from the outside have established a presence on MCDH’s home turf.

STRATEGIC GOAL

It is the strategic goal of MCDH to maintain and improve its current strong market position and to achieve a significant reversal in the decline of market share in such key areas as orthopedics, OB, and lab through proactive efforts to build market share in these and other selected product lines.

Mendocino Coast District Hospital

2007-2008 Strategic Goals and Objectives

GOAL AREA: Market Position

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Medical Staff

ISSUE STATEMENT

MCDH is fortunate to have a very excellent medical staff (90%of the medical staff is Board Certified) that is progressive, cohesive, and highly supportive of the Hospital. Furthermore, based on interviews conducted during the strategic planning process, the medical staff appears eager to take advantage of any available opportunities to enhance their clinical skills and knowledge through continuing education, training, attendance at conferences, etc. Unlike many rural hospitals, MCDH does not have to contend with “sprinkling and snaring.” This is a practice employed by many large urban medical centers that “sprinkle’ their own physicians into a rural community and then reward these physicians based on their ability to “snare” patients away from the rural hospital. MCDH’s continued ability to retain and recruit high caliber physicians depends on the quality of the local practice environment and the degree to which local medical practices are financially rewarding. MCDH needs to pay close attention to physician compensation. It also needs to convey to the community that the Hospital’s ability to achieve its “ideal future” depends on success in recruiting and retaining quality physicians.

STRATEGIC GOAL

It is the strategic goal of MCDH to develop and maintain a medical staff of sufficient size and breadth including specialty mix, background, education, and expertise needed to support the range of services required to meet the needs of the Hospital’s primary and secondary service areas, and to regain and grow market share and compete vigorously with competitor hospitals in key service areas (e.g. OB, and orthopedic surgery).

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Medical Staff

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Medical Staff (Continued)

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Medical Staff (Continued)

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Personnel Staffing

ISSUE STATEMENT

MCDH is fortunate to have a well-trained, well-educated staff who are extremely hard working and dedicated to provide quality care in a caring manner. During interviews, comments made suggested MCDH staff is keenly interested in the future of the Hospital. Staff indicated that in addition to a strong financial performance by MCDH, regaining the community’s trust and confidence depended on the Hospital’s ability to build a “culture of caring” through cooperation and teamwork within and between departments. In the Management Team strategic planning session, considerable discussion centered around the need to acquire a proven customer/patient relations program. Specifically mentioned as a source of customer relations support was the Planetree model (The Dalles OR). However, MCDH needs to avoid regarding customer service program training as a silver bullet solution for achieving excellent customer/patient relations practices. While a customer relations program might be very helpful, success in this area will depend on the extent to which employees, staff and management, share a common view of MCDH’s “ideal future” and are committed to make it a reality.

STRATEGIC GOAL

It is the strategic goal of MCDH to:

• Continue to attract and retain a well trained and educated staff of highly qualified and motivated individuals committed to creating an environment which fosters the “ideal” patient experience.
• Maintain a positive and attractive working environment which is very professional and is characterized by a spirit of teamwork and cooperation between departments and among all components of the organization.

Mendocino Coast District Hospital 2007-2008 Strategic Goals and Objectives

GOAL AREA: Personnel Staffing

Mendocino Coast Health care District
Strategic Plan: 2000 - 2005
Executive Summary

Mendocino Coast Health Care District's (MCHCD) mission, combined with the difficult challenges in healthcare, prompted the Board to undertake a strategic planning process to chart the hospital's course for the next 3 to 5 years. It is understood that unforeseeable events in the external and internal environment will make it necessary to modify the plan; however, the document provides a basis from which to make changes. Similarly the planning process helped to articulate the leadership's values and the organization's role; these provide a context for making adaptations to the plan as necessary.

The active participation of the board, management and community during the planning process shaped the content of the plan and created a foundation of uniform understanding from which progress can be monitored.

This Executive Summary presents the strategic headlines - - the driving forces, goals and key initiatives of the plan.

1. Pressures on healthcare providers for performance in terms of cost, quality and service - will only escalate over the next several years.
   
   • Governmental payers, primarily Medicare and Medi-Cal, are expected to continue holding down reimbursement levels to hospitals and physicians. Providers, like MCHCD who are dependent on governmental payers, will face continuing pressure to keep expenses within revenue.
   • Regulations, such as California SB 1953 related to earthquake retrofitting of hospitals or the attempted legislation to regulate staffing ratios, will place demands on hospitalsí capital and operations.
   • Public expectations for quality, service, access and affordability will remain high; consumers demand for, and access to, information will increase their ability to measure and compare performance
   • These factors will require on-going efforts to improve efficiency while maintaining quality and service; they also imply there will be limited ability to generate funds internally to invest in equipment, facilities and service development
     
     
2. MCHCD serves a community of 25,000 people who are dependent on local health care professionals for acute care. The demographic characteristics signal expectations for MCHCD's scope of services.
   
   • Eighty-five percent of MCHCD's patients reside within a 15-mile radius of the hospital. This primary service area has almost 20,000 people with population growth of less than 0.4% per year during the 1990s.
     
   • The demographic trends show increases in the Hispanic population (over 14% of the county population) and a growing number of elderly (17% of the primary service area compared to 14% of the county population).
     
   • These characteristics indicate that MCHCD can expect continuing demand for obstetrical care from the younger, Hispanic populations as well as for conditions such as diabetes and cervical cancer, which have higher incidence in Hispanic groups. The older population will require cancer and cardiac care particularly, as well as ophthalmology and general primary care.
     
   • The community has limited health insurance coverage and almost no managed care coverage. Seniors are enrolled in traditional Medicare and 19% of the county is enrolled in Medi-Cal. Without many large employers to provide group insurance, the population tends to have limited coverage through individual plans or is without healthcare coverage at all.
     
   • The relative geographic isolation of the coast towns highlights the communityís reliance on MCHCD for emergency services particularly.
     
     
3. MCHCD's role and market position point to the opportunities for program development
   
   • The MCHCD leadership and community participants describe the organization's roles and priorities as 85% direct provider of acute care services, 10% healthcare resource and 5% catalyst for a healthy community.
   • MCHCD's market share of the primary service area has been 68% for the last several years demonstrating the reliance that the community places on the hospital. In specific services, notably General Surgery, Gynecology and Orthopedics, MCHCD has lost market share; there is an opportunity to regain position in these services. MCHCD's market share of the secondary service area is 26%.
   • MCHCD's goals for growth are to increase service to the primary service area by expanding the range of services, to increase market share in General Surgery and Orthopedics and to increase use of MCHCD by the secondary service area.
   • Near-term initiatives to meet these goals are to implement telemedicine for Dermatology, promote Caring for Women, and promote ambulatory surgery. Mid-term initiatives include expanding telemedicine to Otolaryngology, Allergy and Cardiology, expanding the diabetes program (including bi-lingual availability) and assessing feasibility of offering cardiac rehabilitation. By the third year of the plan, other initiatives are to evaluate complementary medicine and extending services in Gynecology and Oncology.
     
     
4. Operations need to be competitive in terms of price, quality and service.
   
   • Even though the community is dependent on MCHCD for emergency services, it has choices for acute care.
     
   • MCHCD's productivity improvement initiative use quantitative benchmarks from the MECON company and patient satisfaction survey scores. Management uses the benchmarks to set targets for improving practices within the hospital.
     
   • A core strategy for the hospital is to develop approaches that set standards for quality inpatient care and also improve efficiency of inpatient episodes. A Hospitalist Service is one approach that is being evaluated. Alternatively, a task force of physicians, management and employees would be charged with evaluating clinical care methodologies.
     
   • Major initiatives in operations are to design and implement clinical pathways and clinical protocols. These tools are used to establish clinical standards, monitor costs, when shared with patients, increase patientís understanding of their treatment regimen.
     
   • As necessary, approaches will be designed and implemented to reinforce or improve customer service orientation among employees and professional staff.
     
     
5. The interdependencies of hospital and medical community are especially critical in less urban areas and need to be cultivated in the Mendocino Coast Health Care District to enhance value for all stakeholders.
   
   • Overall, the medical staff's qualifications are good. Among community leaders, board members, hospital personnel and physicians themselves, there is a range of perceptions regarding some physiciansí work ethic and approach to service.
     
   • As part of its role as health care resource, MCHCD will work with the medical community to assure availability of services in those specialties that the size of the population can support.
     
   • As opportunities arise, a Business Oversight Committee will be formed to evaluate, design and oversee activities of mutual interest to physicians and the hospital. Similar to the group that is overseeing evaluation of a Hospitalist Service, the Business Oversight Committee may include a majority of physicians who are interested in and committed to development of opportunities.
     
     
6. Multiple financial strategies need to be initiated now to ensure long-term viability
   
   • Planning participants recognized the fragility of the hospital's financial situation as the most important strategic issue.
     
   • MCHCD's dependence on governmental payers combined with the limited private coverage in the community indicates that margins will continue to be thin.
     
   • Yet achieving excess of revenues over expenses is necessary to be able to invest in equipment and development of services. All net income of the hospital is reinvested to maintain and advance the hospitalís facilities and services.
     
   • Investment in facilities are required over the next several years not only to comply with state earthquake standards, but also to improve functionality for current clinical care approaches and to increase patient and visitor comfort.
     
   • To meet the goal of a net operating margin of 1%, the hospital will re-engineer processes for optimum efficiency and develop approaches to maximize collection of payments from third-party payers.
     
   • Grants are a source of funding that will be pursued as often as possible. Preferably, grants will be used for capital investments or feasibility studies rather than routine operating expenses. Near term grants should be pursued for telemedicine. At the same time, a process will be developed and implemented with routine scanning for grants availability, identification of resources for grant writing and design of processes for grant administration.
     
     
7. Communications in general and information technology in particular are requirements for long-term and on-going development of all stakeholders in the organizationís future.
   
   • As a publicly funded institution, MCHCD has an obligation to its local community for open board meetings. The board and management leadership expresses a deep commitment to open and candid exchange of information.
     
   • Routine mechanisms and forums will be developed, in addition to taping of the board meetings, to facilitate communications. A series of events (health fairs, open houses), a speakers bureau, communication through the media and public interactions through newsletters will be developed.
     
   • Information technology is an important aspect of the hospital's infrastructure that enhances communications. Information systems are used for management (performance reporting, purchasing, and inventory control), and exchange of clinical information (test ordering and result reporting). Electronic communications can be an effective way to link physicians to the hospital and each other. The Internet is a way to get health information to consumers and, eventually, to interact with patients regarding personal health advise and even scheduling. MCHCD needs to develop a long-range plan for information technology. Funding may be available through grants for the design and evaluation of alternative systems.