workbook Strategic Restructuring for California Community Clinics: Self-Assessment Workbook compensate for your shortcomings in this area?

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1 Strategic Restructuring for California Community Clinics: Self-Assessment Workbook C A LIFORNIA HEALTHCARE FOUNDATION The p u r p o s e o f t h i s assessment instrument is to assist your organization in determining its readiness to undertake a strategic restructuring process. The questions on pages 2 18 are designed to stimulate thinking and discussion about your organization s strengths, assets, and challenges, and on how these might be leveraged, strengthened, and/or addressed by partnering with another organization. This process can be best accomplished through candid discussion within the organization that includes board, management team, and staff (either all staff or a representative group, depending upon the size of the organization). Seeking various perspectives from within your organization enriches the discussions, and ultimately provides better guidance regarding strategic restructuring options. For each area listed, please consider and indicate your answers to the following questions: How would you characterize your organization s current capacity in this area (using the capacity continuum provided)? What are your key strengths or assets? How might they be leveraged through strategic restructuring? To what degree does/do the organization(s) with which you are considering partnering value or need your capacity What are your challenges or deficiencies How might they be mitigated through strategic restructuring? compensate for your shortcomings in this area? This tool asks you to rate your organization s strengths on a continuum. The descriptions on the capacity continuum may not fit your organization exactly. Feel free to highlight elements from different boxes where more than one description applies to your situation. For example, if one line of service is significantly different than another, you may circle two different numbers and explain this in the narrative (box). Similarly, you may not have identified a potential organizational partner at this point, or you may have identified more than one. In either case, we encourage you to adapt your discussions (and responses) accordingly. When thinking about potential partners, consider organizations that share your mission and/or organizations that you believe would complement your organization s work. Other organizations that have used this assessment tool found it useful to have different staff and even board members complete the form individually and then come together to discuss their individual results. Doing this can highlight some important perspectives as you consider your next steps. Questions on pages look more generally at strategic restructuring, and ask you to consider how restructuring might help your organization respond proactively to changes in your environment, innovate, grow, and/or expand your impact. workbook To what degree does/do the organization(s) with which you are considering partnering Type your answers in the PDF form fields in each section. Sep t e m b e r 2011

2 I. Services We excel in the services that We are well positioned to We have adequate capacity We stretch our capacity to We do not have the capacity we provide. These services offer the services we provide. to offer the services we offer the services we provide, to deliver the services we anticipate and are well aligned These services effectively provide, which are generally and as such we sometimes must provide in order to meet to meet constituents needs. meet constituents needs. We sufficient to meet constituents fail to meet constituents constituents needs. We do We offer unique services offer services that few others needs. We do not offer unique needs. We do not offer unique not offer unique services, that others do not, or provide do, or provide them with a services, but the services we services, and it is sometimes and it is often a struggle to them with a level of capacity, level of capacity, quality, or do provide we do with a solid a struggle to deliver services deliver services with adequate quality, or expertise that expertise that few can match. level of capacity, quality, or with adequate levels of levels of capacity, quality, or competitors lack. expertise. capacity, quality, or expertise. expertise. C. What are your challenges or deficiencies How might they be mitigated through strategic restructuring? shortcomings 2 California HealthCare Foundation

3 II. Staffing and Workforce We have a demonstrated We are able to attract and We can adequately staff We struggle to attract We do not have the staff ability to attract and retain retain well-qualified staff. All our services. Although and retain staff with the expertise necessary for the high-quality staff. All our our staff have the knowledge our staff are qualified and knowledge and skills delivery of all of the programs staff are well equipped and expertise required to knowledgeable, none stand necessary to deliver needed our constituents need. with the knowledge and deliver our services, and a few out as recognized experts in programs. expertise required to deliver are recognized as experts in their field. our services, and many are their field. recognized as experts in their field. C. What are your challenges or deficiencies How might they be mitigated through strategic restructuring? shortcomings Strategic Restructuring for California Community Clinics: Self-Assessment Workbook 3

4 III. Leadership We have excellent staff We have strong staff We have adequate staff We have barely adequate We are currently without leadership; our staff leaders leadership with both the leadership with solid staff leadership, and need to key staff leadership in either are respected both within management skills and content management skills and content develop greater management management or content expert the organization and in the expertise needed for the expertise. skills and/or content expertise positions. broader community for their organization s success. for the organization s success. proven management skills and content expertise. C. What are your challenges or deficiencies How might they be mitigated through strategic restructuring? shortcomings 4 California HealthCare Foundation

5 IV. Board We have a high-functioning We have a board that is good We have a board that Our board sometimes struggles Our board is largely board that provides strong at fulfilling its aggregate roles fulfills the most basic board to fulfill its basic roles and dysfunctional; it does not strategic and fiduciary and individual responsibilities. functions. The board and responsibilities. The board and consistently meet its basic guidance, represents the The board and executive executive director/ceo work executive director/ceo often responsibilities and board organization in the community, director/ceo work very well fairly well together. find themselves at odds. members do not work well and helps raise needed funds. together. together and/or experience The board and executive antagonism with the executive director/ceo effectively work director/ceo. as partners for the benefit of the organization. C. What are your challenges or deficiencies How might they be mitigated through strategic restructuring? shortcomings Strategic Restructuring for California Community Clinics: Self-Assessment Workbook 5

6 V. Financial Position We can comfortably fund all We have been able to fund our We are keeping our head We will have a deficit this We are in significant financial organizational operations operations and services this above water for now. We are year and are not certain that trouble with multi-year deficits and services, and we have a year without making any cuts managing any debt adequately we can make any further cuts that make our future very surplus with which to fund in expenses, and anticipate and/or have some access to in expenses without harming uncertain. We are carrying reserves. We have greater the same next year. We are liquidity. service delivery. We are more debt than we can service access to loans/lines of credit managing any debt with great carrying more debt than we and/or have poor access to than we need and/or have success and have good access should and/or have minimal liquidity. excellent access to liquidity. to liquidity. access to liquidity. C. What are your challenges or deficiencies How might they be mitigated through strategic restructuring? shortcomings 6 California HealthCare Foundation

7 VI. Financial Management We have a robust financial Our financial function is good; Our financial management Our financial management Our financial management management function, with our staffing and systems are function is adequate; our function is barely adequate; function is inadequate to our the staffing and systems to well equipped to meet our staffing and systems rarely our staffing and systems are needs; we lack the staffing and accurately account for revenue accounting and reporting have a problem meeting our stretched to deliver accurate systems to ensure accurate and expenses and to generate needs. Our billing function accounting and reporting accounting and reporting. Our accounting and reporting. Our timely financial reports. Our is strong, and our accounts needs. Our billing function and billing function needs work billing function is inadequate billing function is excellent, receivable status is good. accounts receivable status are and our accounts receivable and our accounts receivable and our accounts receivable both adequate. status is of minor concern. status is of major concern. status is very good. C. What are your challenges or deficiencies How might they be mitigated through strategic restructuring? shortcomings Strategic Restructuring for California Community Clinics: Self-Assessment Workbook 7

8 VII. Compliance We have state-of-the-art We have strong systems in We have adequate systems The systems we have in place The systems we have in place systems in place to effectively place to prevent, detect, and in place to effectively to prevent, detect, and resolve to prevent, detect, and resolve prevent, detect, and resolve resolve any inappropriate prevent, detect, and resolve any inappropriate business any inappropriate business any inappropriate business business practices, improper any inappropriate business practices, improper conduct, practices, improper conduct, practices, improper conduct, conduct, and/or violations practices, improper conduct, and/or violations of law need and/or violations of law and/or violations of law. of law. We are engaged in and/or violations of law. We improvement. We sporadically are ineffective. We are not We systemically engage in continuing efforts to improve often engage in efforts to engage in efforts to improve currently engaging in efforts ongoing efforts to improve the quality of our operational improve the quality of our the quality of our operational to improve the quality of our the quality of our operational performance. operational performance. performance. operational performance. performance. C. What are your challenges or deficiencies How might they be mitigated through strategic restructuring? shortcomings 8 California HealthCare Foundation

9 VIII. Contracts We are highly satisfied with We are mostly satisfied We are neither satisfied We are somewhat dissatisfied We are dissatisfied with the the range, number, and with the range, number, nor dissatisfied with the with the range, number, and range, number, and terms terms of our contracts. We and terms of our contracts. range, number, and terms terms of our contracts. We of our contracts. We have are typically successful in We are often successful in of our contracts. We have have had mixed success in been unable to successfully negotiating favorable terms negotiating favorable terms had adequate success in negotiating favorable terms negotiate favorable terms for new contracts. We have for new contracts. We have negotiating favorable terms for new contracts. We have for new contracts. We have several ongoing/renewable some ongoing or renewable for new contracts. We have few ongoing or renewable no ongoing or renewable contracts supporting core contracts supporting core a few ongoing or renewable contracts supporting core contracts supporting core programs and services. programs and services. contracts supporting core programs and services. programs and services. programs and services. C. What are your challenges or deficiencies How might they be mitigated through strategic restructuring? shortcomings Strategic Restructuring for California Community Clinics: Self-Assessment Workbook 9

10 IX. Information Technology We have reliable in-house We have reliable IT support We have an outside vendor We have limited access to We have very low capacity information technology (IT) and use technology in a for IT support and have some IT support, and have some with respect to technology use support and are creative number of ways in our down time in our systems. difficulty ensuring that our and IT support; this puts our in our use of technology organization (i.e., finance, We have plans to implement systems meet our day-to-day operations and services at risk. to support patient communications), but are patient management or EHR, needs. Our web presence is Our web presence is poor or management, electronic still grappling with bringing but implementation has not less than adequate. lacking. health records (EHR), finance, patient management or EHR yet begun. Our web presence communications, fund online. We have a solid web is adequate at this time. development, etc. We have a presence. strong, vital web presence. C. What are your challenges or deficiencies How might they be mitigated through strategic restructuring? shortcomings 10 California HealthCare Foundation

11 X. Fund Development We always raise the annual We consistently raise the We somehow manage to raise We periodically struggle to We consistently struggle to funds we need to operate annual funds we need to what we need every year. We raise the annual funds we raise the annual funds we our organization and provide operate our organization and have good relationships with need and our ability to meet need and often fall short of our needed services. We have provide needed services. We donors and funders. our fund development goals is fund development goals. Our excellent relationships with have strong relationships with uneven. Our relationships with relationships with donors and donors and funders. donors and funders. donors and funders need work. funders are deficient. C. What are your challenges or deficiencies How might they be mitigated through strategic restructuring? shortcomings Strategic Restructuring for California Community Clinics: Self-Assessment Workbook 11

12 XI. Marketing and Communications We have a very robust We have a good We are usually able to We are barely able to We consistently fail to get communications function that communications function that adequately communicate our effectively communicate an effective message out is able to target our messages generates positive public message, with limited access with constituents and don t to constituents, and have to constituents in a way that relations for our organization. to distribution channels for reach those beyond an inner little understanding of supports service delivery, We have some access to dissemination. circle. We don t have access what distribution channels fund development, and our good distribution channels to to distribution channels to are available to help us brand. We have good access disseminate our message. disseminate our message. disseminate our message. to appropriate distribution channels to disseminate these messages to the public. C. What are your challenges or deficiencies How might they be mitigated through strategic restructuring? shortcomings 12 California HealthCare Foundation

13 XII. Reputation and Brand Recognition Our constituents are well Our brand is generally well Some people in the community We have some brand We have little brand aware of and experience recognized and most of our recognize our brand and its recognition, but its value is recognition and its value our services in a way that is constituents experience our value. experienced inconsistently by is eroding because some positive and consistent. We services in a way that is our constituents. constituents have experienced are highly regarded as an positive and consistent. our services in a way that is organization. As a result, our consistently not positive. brand is recognized and our name has value. C. What are your challenges or deficiencies How might they be mitigated through strategic restructuring? shortcomings Strategic Restructuring for California Community Clinics: Self-Assessment Workbook 13

14 XIII. Influence Our access to influential We have good access to those We have some access to those We have little access to those We have no access to organizations, policymakers, who are able to help us further who are able to help us further who are able to help us further influential organizations, the media, and community our work and mission, and are our work and mission, though our work and mission, and are policymakers, the media, leaders is strong; we are sometimes asked for input on we are only occasionally asked rarely, if ever, asked for input or community leaders; we often asked for our input matters involving the work of for input on matters involving on matters involving the work are never asked for input on when there s a critical issue or our organization. the work of our organization. of our organization. critical issues involving the debate that involves the work work of our organization. of our organization. C. What are your challenges or deficiencies How might they be mitigated through strategic restructuring? shortcomings 14 California HealthCare Foundation

15 XIV. Facilities We have ample space for our We have adequate space We have just enough space We lack adequate space We are working in space offices and medical services, for our offices and medical for our offices and medical for our offices and medical that is wholly inadequate to sufficient to accommodate services, but not enough to services, which is becoming services, compromising our house our offices and medical some growth; our facilities are accommodate growth; our somewhat of a challenge; ability to serve constituents; services; our facilities are situated in an ideal location facilities are situated in a our facilities could be better our facilities are not well poorly located, maintained, and are very well maintained good location and are well located, maintained, and/or located, consistently and/or equipped. and equipped. maintained and equipped. equipped. maintained, or adequately equipped. C. What are your challenges or deficiencies How might they be mitigated through strategic restructuring? shortcomings Strategic Restructuring for California Community Clinics: Self-Assessment Workbook 15

16 XV. Purchasing Our purchasing systems are Our purchasing systems are Our purchasing systems are Our purchasing systems need Our purchasing systems are excellent. We have access good. We have access to adequate. We have access to improvement. We have access poor. We are paying over to very competitive pricing competitive pricing for many of fair pricing for most of our key to fair pricing for some of our market on key purchases, such for all our key purchases, our key purchases. purchases. key purchases, but feel we as administrative supplies and such as administrative could be getting a better deal services, capital equipment, supplies and services, on others. laboratory services, capital equipment, laboratory medical/surgical supplies, services, medical/surgical pharmaceutical products and supplies, pharmaceutical services, technology, and products, technology, and telecommunications. telecommunications. C. What are your challenges or deficiencies How might they be mitigated through strategic restructuring? shortcomings 16 California HealthCare Foundation

17 XVI. Strengths and Challenges: Summary A. In which of the areas identified above (pages 2 16) is your organization most strong? Please list in priority order (strongest first) B. In which of the areas identified above (pages 2 16) is your organization most challenged? Please list in priority order (greatest challenge first) C. Which areas might you most want to strengthen through strategic restructuring? Please list in priority order Strategic Restructuring for California Community Clinics: Self-Assessment Workbook 17

18 XVII. Compatibility with Potential Partner Organization(s) The following questions are applicable if your organization is already in discussions (or negotiations) with one or more potential partners. A. How much overlap is there between your mission and vision and those of your potential partner(s)? (Use a 1 5 scale, where 1=not at all similar and 5=extremely similar.) Explain: B. How compatible are your values and culture with those of your potential partner(s)? (Use a 1 5 scale, where 1=somewhat compatible and 5=extremely compatible.) Explain: C. How high is the level of trust between your organization and your potential partner(s)? (Use a 1 5 scale, where 1=very low and 5=very high.) Explain: D. How would you rate your past experiences with your potential partner(s)? (Use a 1 5 scale, where 1=somewhat negative and 5=very positive.) Explain: E. How similar are your programs and services to those of your potential partner(s)? (Use a 1 5 scale, where 1=not at all similar and 5=extremely similar.) Explain: F. How much overlap is there in the types of clientele served by your organization and those served by your potential partner(s)? (Use a 1 5 scale, where 1=not at all similar and 5=extremely similar.) Explain: G. How much geographic overlap is there between the area served by your organization and that served by your potential partner(s)? (Use a 1 5 scale, where 1=not at all similar and 5=extremely similar.) Explain: 18 California HealthCare Foundation

19 XVIII. Strategic Restructuring as a Proactive Strategy Considering how your organization s strengths, assets, and challenges might be complementary to those of a potential partner is a critical first step when identifying and evaluating opportunities for strategic restructuring. Equally important is considering the potential of strategic restructuring for enabling you to respond proactively to changes in your environment, and to innovate, grow, and/or expand your impact. With that in mind, consider the following questions: A. How might strategic restructuring support your organization s ability to innovate? B. How might strategic restructuring support your organization s ability to respond to changes in your operating environment? Specifically, how might it help your organization more effectively prepare for and respond to health reform? C. Are there other ways in which strategic restructuring might help your organization advance its strategy and/or increase its impact? Strategic Restructuring for California Community Clinics: Self-Assessment Workbook 19

20 XIX. Summary Overall, what do you believe is the most important thing you can achieve through strategic restructuring that you could not achieve on your own? A u t h o r Heather Gowdy, MBA, Senior Manager, La Piana Consulting A b o u t t h e Fo u n d a t i o n The California HealthCare Foundation works as a catalyst to fulfill the promise of better health care for all Californians. We support ideas and innovations that improve quality, increase efficiency, and lower the costs of care. For more information, visit us online at 20 California HealthCare Foundation