Aligning Leadership for Results: Operational Management Structure AMGA HR Council

Transcription

1 Aligning Leadership for Results: Operational Management Structure AMGA HR Council April, 2014 Bob Swanson, Vice President, People & Culture Additional Members of Project Team: Don Sanada, Chief Operating Officer Pattie Washburn, HR Business Partner Greta Beard, Organizational Development Consultant 1

2 Established by Catholic Sisters in 1890 Not-for-profit business guided by our mission, vision, and values Governed by Board of Directors, which consists of seven members of the Congregation of the Sisters of St. Joseph of Peace Established care facilities in Alaska, Oregon and Washington Employs more than 16,500 caregivers throughout hospitals, laboratories, patient service centers and clinics 800+ employed physicians and providers Networks of Care 4 2

3 Overview Project Background / Overview Recommended Roles / Responsibilities Project Approach / Guiding Principles Implementation Approach / Timeline aaaaaa Assessment Results / Observations Expected Outcomes Project Background PHMG is now a network working in partnership with the community-based hospital networks (NW, COL, and OWN) Northwest Network System Structure: System & Networks Columbia Network Oregon West Network Peace Health LABS Future System Shared Services: Finance & Accounting, People & Culture, IST, Clinical Quality, Legal, PFS, HIM, Facilities 3

4 Project Background PHMG is now a network working in partnership with the community-based hospital networks (NW, COL, and OWN) PHMG is accountable for delivering on the PeaceHealth Triple Aim: Improving individual care Improving population health Lowering the cost of care PHMG operational structures vary by community resulting in: Inconsistent management roles and responsibilities Different cost structures Project Background PHMG, as a whole, is underperforming in every area Patient Experience Panel Size Exceeding Median wrvus Achieving Desired Diabetic Bundle Outcomes Variations in operational management structures and role expectations exist between communities Improvement efforts are hampered by: Lack of clarity around roles and responsibilities Inconsistent skill levels of incumbents Lack of standard organizational structures to support change initiatives 4

5 Project Overview The purpose of this project was to review PHMG s operational management structures across the large communities and recommend changes that will deliver on PHMG s goal: To become a high-performing medical group that provides high quality, cost-effective care through efficient and effective clinic operations. Increased Role Clarity, Improved Engagement, Improved Performance Project Timeframe: February, 2013 June, 2014 Project Approach Feb May, 2013 Jun Jul, 2013 Aug Sep, 2013 Research medical group operational structures Compare and contrast internal and external structures Recommend standardized roles and accountabilities Oct Jan, 2014 Feb, 2014 Mar Jun, 2014 Analyze and recommend changes to current community organizational structures Implement organizational changes and assess skill gaps Enhance/develop leader skillsets 5

6 Project Approach Research medical group operational structures Gather external benchmark information Document current organization structures for large PHMG communities (Note Initial work focused on large communities; next phase will focus on smaller communities, PBEs, and critical access communities.) Compare and contrast internal and external structures Effectiveness in delivering on organizational goals Challenges in delivering on organizational goals Recommend standardized roles and accountabilities Balance quality and cost Support continuous improvement efforts Scalable and able to flex as conditions change Project Approach Community leaders analyze and recommend changes to their current organizational structures Review current structure against baseline algorithms Develop revised structures that incorporate the recommended roles and accountabilities Implement organizational changes and assess skill gaps Develop plan for staffing and transitioning to revised organizational structure Assess barriers and performance gaps (individual and community) Enhance / develop leader skillsets Create development plans to address skill gaps 6

7 Guiding Principles Organization Design Criteria Physicians / Providers: Supports a physician-led organization Improves provider satisfaction Network Structure: Maintains alignment with regional networks Supports development of and alignment with regional strategies Operational Effectiveness: Scalable, providing flexibility to design efficient, cost-effective organizational structures Clarifies role expectations Reduces duplication of efforts Improves operational effectiveness Accommodates rapid improvement initiatives and growth Supports recruitment / retention of leaders and caregivers Impact by Community Bellingham: Generally staffed according to the recommendations Move from one to two directors Heavily leveraging leads Longview: Recent reorg moving them towards these recommendations by eliminating managers and adding supervisors Recent reorg eliminated one of two director roles Eugene/Springfield: Leverage fewer directors and managers with additional supervisors/leads Eliminate COO role Vancouver: Directors being drawn into day-today operations in the absence of managers Reallocate resources by adding managers, supported by supervisors 7

8 Assessment Results Operational Management Roles Bellingham Eugene/ Springfield Longview Vancouver COO 1 Directors Managers Supervisors Clinical Leads Office Leads Physician Count Physician FTE APC Count Caregiver Count Caregiver FTE Assessment Mgt. Structure Metrics Bellingham Eugene/ Springfield Longview Vancouver Annual Visits 209, , , ,341 Visits / Mgr. 26,170 26,057 20,721 14,900 Current Mgrs (SUP) 40k Visits / Mgr Inc (Dec) in Mgrs (3) (6) (4) 4 Other Support Staff Other Support Staff / Mgr Note: Annual Visits from July, 2013 Physician Practices Standardized Operating Reports 8

9 Recommendations Define span of control for director role and optimize number of directors Optimize use of managers, supervisors, and leads by consolidating areas of oversight (i.e. reduce managers and replace with supervisors and/or leads) Define and implement metrics to guide staffing model decisions Recommended Operational Roles Network VP, Operations (1) Director, Operations (2 3) Primary Care Specialty Care Medical Specialties Surgical Specialties Sr. Manager, Clinic Operations Manager, Clinic Operations Supervisor, Clinic Operations Working Supervisor, Clinic Operations Clinic Lead Office Lead * Break Specialty between Medical and Surgical, as needed * Leverage one or more of these roles based on circumstances 9

10 Recommended Accountabilities Director Manager / Sr. Manager Supervisor Strategy Implement Implement & sustain Support, as needed Budgeting Lead Participate Support, as needed Financial Results P&L accountability P&L accountability Manage expenses Operational Performance Provider Relationships Clinic & Office Staff Relationships Meet / exceed performance targets Promote process improvement work PBE / critical access compliance Partner with Medical Directors on: Talent & performance management Provider issues Support / coach managers Implement efficient effective org. structure Talent & performance management Meet / exceed performance targets Lead process improvement work Partner with AMDs on: Talent management & performance management Managing provider relationships Support / coach supervisors Manage staff when supervisor role is not used Talent & performance management Meet / exceed specific performance targets Participate in process improvement work Day-to-day operational support to providers Manage staff Full employment authority for staff Talent & performance management * See detailed Accountability Matrix for additional information Talent Management: Building the workforce by identifying talent needs to support organizational goals and selecting, developing, and retaining talent to meet those needs. Performance Management: Managing the workforce through clear performance expectations, training and development, coaching, and performance feedback. Qualifications / Algorithm Recommendations Education Director Manager / Sr. Manager Supervisor Bachelor s Master s preferred Bachelor s (or equiv combo of educ & exper) Master s preferred Experience 5 yrs. in leadership 2-3 yrs.in leadership / 5 yrs. in leadership (4 yrs. of clinical mgt. exp.) Algorithms Metrics Director : Providers Manager : Providers Manager : Visits Ratios 1 Director : Direct / Indirect Reports Other Factors Standard 2 1 Primary Care 1 Specialty Extended 3 1 Primary Care 1 Specialty Medical 1 Specialty Surgery 1 Mgr : Providers Primary Care Only 1 Mgr : 35k 40k Visits Consider number and complexity of clinics, specialties, services lines, & programs Consider geographic location of clinics, services lines, and programs Bachelor s (or equiv combo of educ & exper) 2 years; 2 years in lead role preferred Supervisor : Caregivers 1 Supervisor : 30 Caregivers 10

11 Recommendation Scalable Model Options Senior Manager Manager Supervisor Lead Clinic Lead Office Sample Options Design an option that best addresses the specific complexities of the situation while staying within the guidelines for span of control and cost. Implementation Approach / Timeline Community-level Actions (system support PRN): By January 31, 2014 Develop revised organizational structures Develop plan for staffing and transitioning to revised organizational structure By February 28, 2014 Assess barriers and performance gaps (individual and community) Create development plans to address By June 30, 2014 Achieve FY14 targets 11

12 Expected Outcomes Achieve FY14 Vista targets Consistent performance and competency demonstrated across the system with respect to operational management roles Efficiency and effectiveness in implementing changes throughout the system Increased engagement of providers and leaders QUESTIONS 12