Strategic Planning for Rural Health Networkss3.amazonaws.com/rdcms-himss/files/production... · iii STRATEGIC PLANNING FOR RURAL HEALTH NETWORKS ABOUT THE AUTHORS Katherine Browne

STRATEGIC PLANNINGFOR RURAL HEALTH

NETWORKS

by

Katherine BrowneDaniel Campion

andRobert Stenger

Editor: Christina Folz

March 2001

iiSTRATEGIC PLANNING FOR RURAL HEALTH NETWORKS

cademy for Health Services Research and Health PolicyThe Academy provides a professional home and technical assistance

resource for both researchers and policy professionals. Health servicesresearchers and policy professionals benefit from increased communicationand interaction, which help facilitate the translation of research into effectivehealth policies. The Academy also helps researchers and policy professionalsstrengthen their skills and expertise through both technical assistance andexpanded professional development opportunities (e.g., an annual meeting,health services research methods workshops, and other activities). TheAcademy aspires to be the preeminent source for stimulating the development,understanding, and use of the best available health services research and healthpolicy information by public and private decision makers.

unding for this publication was provided through a grant from TheRobert Wood Johnson Foundation (www.rwjf.org). Based in Princeton,

N.J., The Robert Wood Johnson Foundation is the nation’s largest philanthropydevoted exclusively to health and health care. It concentrates its grantmakingin three goal areas: to assure that all Americans have access to basic health careat reasonable cost; to improve care and support for people with chronic healthconditions; and to reduce the personal, social, and economic harm caused bysubstance abuse – tobacco, alcohol, and illicit drugs.

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iii STRATEGIC PLANNING FOR RURAL HEALTH NETWORKS

ABOUT THE AUTHORSKatherine Browne is a Senior Associate at the Academy for Health ServicesResearch and Health Policy. She works primarily on the Networking for RuralHealth project, which is funded by The Robert Wood Johnson Foundation.Her responsibilities include conducting network site visits that focus on strate-gic planning, developing curriculum for workshops and seminars, overseeingTargeted Consultation grants, and assisting in the development and review oftechnical assistance documents produced by the project. Ms. Browne earnedtwo Master’s degrees in business and health administration (MBA/MHA) fromWashington University in St. Louis and her Bachelor’s degree from theUniversity of Wisconsin-Madison.

Daniel Campion is a Senior Manager at the Academy for Health ServicesResearch and Health Policy, where he is responsible for developing and guid-ing national demonstration and technical assistance projects to expand accessto health care services and improve the functioning of health care markets.Currently, he is co-director of the Networking for Rural Health project, which isfunded by the Robert Wood Johnson Foundation. He also manages theAcademy’s contract to disseminate health services research findings to publicpolicy makers, funded by the Agency for Healthcare Research and Quality(AHRQ) User Liaison Program. Mr. Campion holds a Bachelor’s degree inbiology from the College of the Holy Cross, a Master’s degree from the YaleSchool of Management, and a certificate in Organization Development fromGeorgetown University.

Robert Stenger is a Research Assistant for the Academy for Health ServicesResearch and Health Policy. He participates in grant monitoring, writinggrantee briefs and newsletter articles, and workshop and meeting developmentfor the Robert Wood Johnson Foundation’s Changes in Health Care Financingand Organization (HCFO) program. He also assists with workshop develop-ment and writes reports and other publications for the Agency for HealthcareQuality and Research’s (AHRQ) User Liaison Program. Mr. Stenger receivedhis Bachelor’s degree in biology-chemistry and music in 1999 from WhitmanCollege.

ivSTRATEGIC PLANNING FOR RURAL HEALTH NETWORKS

ACKNOWLEDGMENTSThis report is based on presentations developed for Networking for Rural HealthWorkshops held in Little Rock, AR, Seattle, WA, and Boston, MA during 1999and 2000. We would like to thank the following presenters for developing thecore content for this report:

Gregory Bonk Robert H. Cameron Karen J. Minyard, Ph.D.HMS Associates Future Strategies, Inc. Georgia Health Policy Ctr.2280 Millersport Hghy. 667 N. Carpenter St. 1 Park Place South, P.O. Box 374 Suite 400 Suite 660Getzville, NY 14068 Chicago, IL 60622 Atlanta, GA [email protected] [email protected] [email protected]

Other presenters who contributed to this report include:Terry J. Hill, National Rural Health Resource Center, Duluth, MNAnthony Wellever, Delta Rural Health Consulting and Research, St. Paul, MN Kristen West, CHOICE Regional Health Network, Olympia WASteve Wilhide and Lisa Parker, Southern Ohio Health Services Network,Cincinnati, OH

v STRATEGIC PLANNING FOR RURAL HEALTH NETWORKS

TABLE OF CONTENTSINTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

WHY IS PLANNING IMPORTANT FOR NETWORKS? . . . . . . . . . . . . . . . .2

WHAT IS STRATEGIC PLANNING? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

PLANNING FOR THE PLANNING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

STEP 1: SCAN THE ENVIRONMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

STEP 2: FOCUS ON YOUR GOALS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Identifying Strategic Priorities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8Identifying Potential Solutions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8Evaluating Alternative Courses of Action . . . . . . . . . . . . . . . . . . . . . .10

STEP 3: ACT ON YOUR DECISIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Making a Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13Keeping on Track . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

APPENDICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

1STRATEGIC PLANNING FOR RURAL HEALTH NETWORKS

trategy is the great work of the organization. In situations of life ordeath, it determines survival or extinction. Its study cannot beneglected.”

—Sun Tzu, a leading Chinese philosopher-general who wrote The Artof War in the 6th Century B.C.

For any organization to be successful, it must have a clear sense of its mission,vision, and organizational values. In other words, laying out a careful strategicplan that articulates where an organization wants to go is a critical first step togetting there. Strategic planning is particularly important for broad, multi-member organizations such as rural health networks, which require individualsfrom various walks of life to come together voluntarily, balance many competingagendas, and agree on a common goal.

This report is intended as a guideline for approaching strategic planning in thecontext of a rural health network. It is a synthesis of information presented atseveral regional workshops conducted by the Academy for Health ServicesResearch and Health Policy in 2000 as part of the Networking for Rural Healthproject. The workshops were designed to teach rural health care leaders how todetermine and prioritize a network’s goals, identify the risks and rewards of theviable options, and decide and implement a course of action.

For the purposes of this document, a rural health network is defined as “aformal arrangement among rural health care providers (and possibly insurers,social service providers, and other entities) that uses the resources of more thanone existing organization and specifies the objectives and methods by whichvarious collaborative functions will be achieved.” This report and other techni-cal assistance materials for rural health networks are available on the Networkingfor Rural Health Website: http://www.ahsrhp.org/ruralhealth/rural.html; for afurther discussion about the nature of rural health networks, see “Principles ofRural Health Network Development and Management,” by Gregory Bonk.

INTRODUCTION

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2 STRATEGIC PLANNING FOR RURAL HEALTH NETWORKS

WHY IS PLANNINGIMPORTANT FOR NETWORKS?

ural health networks bring togethera diverse group of independenthealth care providers—and possibly

other agencies, employers, or communityorganizations—to address problems thatcannot be solved by any single entity work-ing alone. At the board level, networks aretypically represented by the chief executiveofficers of member organizations, each ofwhich has its own interests and priorities. Thus, network members must work togetherto strike a balance between their individualinterests and those of the network as awhole. This cooperative element makesstrategic planning for networks a morecomplicated venture than it is for otherorganizations and often introduces anelement of tension to the process.

Yet it is precisely because networks arecollaborative ventures that strategic planningis so important to their development andorganizational health. Because strategic plan-ning forces network leaders to listen to oneanother’s perspectives, sift through theirdiffering visions for the network’s future, andagree on common objectives, it provides anopportunity to build consensus, trust, andmorale within the network. It also enables

the network to identify how it can be mostuseful to each of its members and to thecommunity at large.

Rural health networks are unique in thattheir members are often both owners andcustomers of the products and services theyproduce. Strategic planning helps networkleaders to start thinking about the best wayto mobilize the money, talent, and technol-ogy available to them, set prices, and distrib-ute any retrieved earnings or profits. Theprocess can also foster an environment forformal contracting and agreement—animportant outcome in rural communities,which are sometimes characterized by tradi-tions of independence and a reliance oninformal business arrangements.

Finally, at a time when the U.S. health carefinancing and delivery system is fragmentedand economic competition among providersis fierce, strategic planning encourages lead-ers to identify the root causes of problemsrather than pointing fingers at one another.By promoting collaboration and communi-cation, the planning process can help easetensions among executive leadership,providers, insurers, and other groups.

R


WHAT IS STRATEGIC PLANNING?

trategic planning can be formallydefined as “the process by which theguiding members of an organization

envision its future and develop the necessaryprocedures and operations to achieve thatfuture” (Goodstein, Nolan, and Pfeiffer,1993). Planning provides an opportunity forexecutive leadership to separate themselvesfrom their day-to-day responsibilities andfocus on the bigger picture of where theirorganization is—both in terms of its owndevelopment and its status in the market—and where it wants to go over the next yearor more.

Strategic planning is often a precursor tobusiness planning, a separate but relatedorganizational process. While strategic plan-ning helps an organization define anddevelop a general business direction, busi-ness planning is the procedure for furtherassessing potential ventures identified duringstrategic planning. The business planningprocess involves making in-depth customer

and market analyses and designing detailedorganizational and management models bywhich a business will operate within a speci-fied time frame. (For a further discussion ofbusiness planning, see “The Art and Scienceof Business Planning for Rural HealthNetworks,” by Anthony Wellever and RobertCameron; it is available on the Academy forHealth Services Research and Health PolicyWeb site—www.ahsrhp.org.)

The goal of strategic planning, on the otherhand, is to develop a portfolio of strategicgoals and proposed initiatives for reachingthem. It is typically done by a committee ofkey stakeholders who meet regularly over aperiod of weeks or months. A network’sstrategic planning committee may be assem-bled by its director, its board, or an executiveplanning committee, and usually includes amixture of network executives and individu-als who represent a range of member organi-zations and community interests.

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PLANNING FOR THE PLANNING

ffective strategic planning beginswith self-awareness of the network.Thus, before embarking on a plan,

leaders should have a firm grasp of thecommon threats, interests, concerns, andneeds facing the network and its members,as well as a clear sense of where the networkis in its organizational life cycle (see box onpage 5). Engaging in an open discussionwith network members to gauge each oftheir priorities and how those fit in with thenetwork’s goals is a good way to prepare andorganize for planning.

members. Networks with a preponderanceof members of these latter types may have amore difficult time approaching planningthan other networks; it will be a challengefor them to identify goals important enoughto all the members to cement their allegianceto the network. But at the same time, theplanning process can help build the verymorale and commitment that thesenetworks lack. Thus, network leadersshouldn’t abandon the idea of planningsimply because they fear their network maynot be ready for it.

Hiring a consultant or outside facilitator tolead the strategic planning process can be agood way to introduce an impartial, thirdparty perspective to new networks or thosethat lack cohesion. Similarly, leaders mayfind that holding planning meetings in aneutral place—away from all the partici-pants’ work environments—can help build asense of fellowship among the group andfoster creative thinking.

Deciding how often to schedule meetingsand how long they should last also dependson the network. Networks that have neverengaged in planning before or who areinvolved with many strategic issues willundoubtedly need to devote more time andenergy to the process than will establishednetworks with clearly defined missions. In

E

ASK YOURSELF

� Why are we planning at thistime?

� What is our role? The role of others?� How do we establish a mandate?� What is our time frame?� What resources do we have available?� What is the readiness of the organization?

Source: Academy for Health Services Research and Health Policy, 2000 (Adapted from Charles Seashore, Consultant, Columbia, MD)

Individuals join networks for a variety ofreasons, including to aid in solving commu-nity health or social problems, the socialinteraction the network provides, or becausethey want to “keep an eye” on other


general, network leaders may want to sched-ule meetings no more than three weeksapart to keep the planning momentumgoing, with a goal of completing the strategicplan within several months.

If planning participants are likely to havestrong concerns about finding time to attendmeetings, scheduling short, tightly managedsessions may be more effective than settinglonger meetings with less structured agen-das. Another idea is to create sub-groups ofnetwork members for certain projects and

activities, rather than insisting that everymember participate in every activity.

After network leaders gain a sense of thebest way for their network to approach plan-ning, they are ready to begin. Strategic plan-ning is typically a three-step process: duringthe first step, the network scans the environ-ment it is operating in; in the second, itfocuses on where it wants to go; and in thethird, it decides and implements a course ofaction.

THE NETWORK LIFE CYCLE

Rural health networks pass through several developmental stages—formative, evolving,and mature. New networks are better positioned to succeed if they attempt projects ofshort duration that members believe they can complete. As the organization graduallygrows stronger and expands, it is often able to take on increasingly larger and moreinvolved projects. Among the milestones in network evolution are achieving financialindependence from member organizations, attracting additional members, and formingnew partnerships.

The maturation process is by no means linear and a network’s effectiveness is not necessar-ily related to its age; changes in the industry, the market, and members’ conditions cancause a temporary downturn—or upswing—in the network’s effectiveness.


STEP 1:SCAN THE ENVIRONMENT

canning the environment in which anetwork is operating is an importantfirst step in strategic planning,

because it helps to establish the “big picture”framework needed to both stretch andbound the planning conversation. Anetwork’s operating environment includes itsmember organizations, the people in thecommunities it serves, the health care marketin which it does business, and thegeographic region where it is located. Asshown in Figure 1, there are myriad ques-tions that can be asked to characterize anetwork’s operating environment, some ofwhich may be more important than others,depending on the issue a network wants toaddress. Appendix A contains a list of infor-mation sources that network leaders canconsult to collect data about their operatingenvironment. In most cases, not all questionscan be addressed—nor will all answers beneeded for a network to move forward.Indeed, networks rarely have perfect datathat show a clear, “correct” course of action,so leaders need to use their best judgmentbased on the available information.

Public perception and the political andeconomic climate within a community arealso important aspects of a network’s operat-ing environment that can play a large role inthe network’s choice of activities. Networkdirectors who have an intimate knowledge of

the values and desires of the communitiesthey serve can successfully anticipate poten-tial challenges and opportunities.Understanding the intricacies of local envi-ronments is thus a key challenge for networkleaders. A local sports rivalry or a bridgeconnecting towns on opposite sides of a rivercan influence public behavior regarding theuse of health services in unanticipated ways.

For some activities, member organizationsmay be required to share confidential infor-mation such as financial reports, clinicalrecords, and data on internal operations.Leaders should emphasize that the purposeof these analyses is to understand, not judge,the activities of network members, with thegoal of gaining a better understanding of thenetwork and its operating environment.

In some cases, a network needs little or noinformation about the environment it isoperating in to arrive at a decision about aparticular activity. For example, a networkconsidering consolidating its members’ ancil-lary service contracts probably needs onlythe opinions of network members and costestimates to make a decision about whetherto proceed. However, for more major under-takings—such as adding new product linesor services—background information isalmost always necessary to determinewhether an opportunity is worth pursuing.

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STEP 2: FOCUS ON YOUR GOALS

DENTIFYING STRATEGICPRIORITIESArmed with a solid knowledge of

the network’s operating environment,network leaders can begin to identify whichproblems or issues the network will addressin its strategic plan. Deciding whether agiven issue should become a priorityinvolves both evaluating the severity of theproblem and assessing whether the networkis in a position to do anything about it. Asmall network of rural hospitals may viewrising traffic fatalities as a serious publichealth problem in its county, but still rankthe problem as a low priority because itlacks the resources needed to improve thesafety of roads. (On the other hand, networkleaders should always try to envision solu-tions to problems from multiple anglesbefore dismissing them as unrealistic goals.In this case, the network may want to recon-sider addressing the rising traffic fatality ratein terms of what it can do: raising awarenessin the community about the incidence ofE.R. visits for auto-related injuries andtaking steps to improve local emergencymedical services, for example.)

Appendix B contains a sample worksheetthat can help network members rate theseriousness of problems by a variety ofmeasures, including how they affect thecommunity, how they affect network

members, and—most important—whetherthey warrant a coordinated response by thenetwork.I

ASK YOURSELF

� What are the key areas that determine our success?

� What long-range goals best support our mission?

� What objectives in our strategy arebeyond our reach?

� What would have to change to makethem realistic?


IDENTIFYING POTENTIAL SOLUTIONSOnce a network has identified the problemor problems it would like to address, it canstart thinking about networking activitiesthat could help solve them. At this stage,leaders should consider how potential activi-ties fit in with the network’s overall mission.For example, if a network has establishedthat its core purpose is disease prevention, itmay decide that sponsoring health screen-ings or educational outreach programs arepotentially appropriate responses to a highincidence of heart disease in the community.


Networks should also consider how poten-tial activities might affect the network’sfinancial margin. This is not to say thatnetworks should never engage in projectsthat help solve community health or socialproblems but don’t influence the bottomline. Rather, they should aim for balance: if anetwork is already engaged in several activi-ties that generate strong revenue streams, itmay be less concerned about taking on aproject that is likely to be less lucrative butwill benefit the network or community inother ways. Over time, most successfulnetworks develop a diverse portfolio ofactivities that, taken together, allow them tobecome self-sufficient. In other words, theiractivities yield enough benefits—whether interms of increased revenue or decreasedcosts due to improved operational effi-ciency—to offset the time, money, andresources the network has invested toprovide them.

One way to gauge the feasibility of potentialactivities is based on their long-term poten-tial to improve growth, efficiency, or capital:

Growth increasing the revenue of the network or expanding the volume of services it offers.

Efficiency improving the operation or decreasing the overhead and administrative costs of the network or its members.

Capital developing and building skills and other capacities of the network or its members.

Figure 2 highlights examples of potentialprojects that could improve the growth, effi-ciency, and capital for networks at each stageof development (formative, evolving,mature). Formative networks are best posi-tioned to focus on small, achievable projectsthat will help them build the momentumthey need to progress to the next stage ofdevelopment. While the specific activitieslisted in Figure 2 are not applicable to allnetworks, the growth/efficiency/capitalframework allows a broad range of proposedactivities to be identified, logically sorted,and compared to one other.

F I G U R E 2

EXAMPLES OF ACTIVITIES THAT MAY IMPROVE GROWTH, EFFICIENCY AND CAPITAL

Formative Evolving Mature

Growth Joint planning Joint marketing New services (e.g., Evaluation of Expanding service home health)programs lines Program integration

Efficiency Benchmarking and Administrative Shared servicesefficiency measures consolidations Service relocation

Capital Resource manuals Grant writing Common budgetingPeer networks/ Shared investments/ Resource planning/directory treasury consolidation


EVALUATING ALTERNATIVE COURSESOF ACTIONAt this stage, potential courses of actionneed to be evaluated under greater scrutiny.Specifically, network leaders need toconsider the potential risks of an activity, thepotential returns to the network and itsmembers, and the readiness of the networkto carry out the activity at this time.

Potential risks of a new venture may includefinancial loss, operational failure, organiza-tional challenges, or political resistance.Returns may also be financial (increasingnetwork revenues or market share) or non-financial (improving services in the commu-nity, building infrastructure, or achieving thenetwork’s mission). A network’s readiness tobegin a given project may be determined bythe magnitude of the change required toimplement it, the network’s capacity foraction, and the degree to which networkmembers support the activity.

Indeed, members’ commitment to a givenactivity is a key measure of a network’sreadiness to take on the project. Networkleaders need to recognize that members areparticipating in the network for differentreasons and have different levels of commit-ment to the network’s overall goals, and thatthis is normal in organizations with diversemembership. Figure 3 is a sample tool forevaluating how committed networkmembers are to various activities. Thisassessment can help gauge which activitiesare most valuable to members. Not everyactivity has to benefit every member, butevery member must realize some benefitfrom the network.

Figure 4 depicts a conceptual model forcomparing network ventures using thebroader risk/return/readiness framework. It

assesses several strategies a network mightpursue to expand its services, reduce itsadministrative costs, or generate revenue.The network’s options in this exampleinclude starting a managed care plan, addingobstetric services, marketing and distributingdurable medical equipment, consolidatingcontracting for ancillary services, consolidat-ing claims processing and billing, coordinat-ing primary care services, investing in amobile MRI unit, and publishing a resourcedirectory.

The figure indicates that starting a managedcare plan has a low level of readiness. That’sbecause it would probably require thenetwork to undergo a large degree ofchange, and members may be unwilling toassume the high financial risks needed toachieve the potentially high returns. Bycontrast, publishing a resource directorywould be easy and inexpensive to imple-ment, but many members already have simi-lar documents through their own organiza-tions; therefore, readiness is high, but riskand return are low. Appendix C contains aworksheet that uses the risk/return/readiness framework to compare multiplepotential programs or services.

ASK YOURSELF

� How attractive is the opportunity?

� What is the payoff for the community,the network, the members, etc.?

� What is the time frame?� What are the chances of successful

implementation?� What are the risks? Are they

acceptable?



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ob C

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STRATEGIC PLANNING FOR RURAL HEALTH NETWORKS 13

AKING A PLANOnce a network has identified whatit wants to do, it is ready to start

translating its vision into action. Typically,this process begins by drafting an implemen-tation plan—a document that details thecourse of action the network must take toaccomplish its objectives. Such a plan mayinclude a list of proposed activities, theperson or party responsible for each, thedesired outcome or deliverable, and a startand end date (see figure 5 for a sampleplan). Implementation plans often containboth short-term (e.g., one-year) and long-term (three-year) objectives.

When developing a plan, network leadersshould remember to promote incrementalchange. Breaking a broad objective downinto small, well-defined tasks can keep activ-ities on track and convince members thatthe network’s goals are achievable. Figure 6shows how detailed plans ensure that thenecessary steps are taken to produce thedesired deliverable.

Who prepares the plan is up to the network.A network’s planning committee may takeon the task itself or create other operationalstructures within the network to do it. Forexample, some networks form “actionteams” that include key people responsiblefor implementing projects. As a rule,

networks should try to involve all memberswith a stake in the project in developing theplan. Work should be divided fairly acrossnetwork members and according to theresources each organization brings to bear.

STEP 3: ACT ON YOUR DECISIONS

M

ASK YOURSELF

� What is the best way toinvolve all of the organi-zation in the process?

� Who is accountable for implementing the strategy?

� What roadblocks can be expected? What is the plan for dealing with them?

� Which stakeholders need to be informed?

� How will success be measured?


KEEPING ON TRACKEven after a network has mapped out animplementation plan for addressing its prior-ities, network leaders must continuallymonitor the network’s progress toward itsgoals. In this sense, the strategic planningprocess never really ends. Networks operatein highly dynamic environments and areconstantly faced with new challenges andopportunities—whether they be due to

STRATEGIC PLANNING FOR RURAL HEALTH NETWORKS14

shifts in funding, the loss of a key member,or a downturn in the economy. Even themost carefully designed strategic plan cannotaccurately anticipate what lies ahead for anetwork.

Thus, network leaders should be preparedto adjust work plans to reflect more accurateappraisals of needs, benefits, or resources inlight of changing circumstances. It’s also wiseto keep a record of activities that wererejected during the planning process; an ideathat wasn’t quite right at the time may be theanswer to the network’s problems later on. Providing strong leadership is one of themost intangible—but critical—roles anetwork leader must play to maintain theenthusiasm and cooperation of the networkas it moves toward its goals. The followingadvice is from directors of rural healthnetworks and consultants who have ledstrategic planning processes:

MEET OFTEN TO REVIEW PROGRESSStrategic planning is not a one-time eventand the strategic plan is not set in stone afterit is drafted. Bringing network memberstogether on a regular basis—perhaps once amonth—to review progress on a plan willgive them an opportunity to voice theiropinions and provide guidance about thebest way to proceed in light of recent chal-lenges or opportunities. Meeting regularlywill also give network members a sense ofownership and investment in the network’sactivities.

ENCOURAGE ACTIVE PARTICIPATION BYNETWORK MEMBERSFor new activities to happen, the network’sstaff cannot be the only agent for change.Network leaders can encourage networkmembers to become more involved in devel-

oping the network’s objectives by solicitingthe donation of staff time or services, estab-lishing sub-committees and other leadershipgroups, encouraging voluntary participationin network activities, highlighting smallwins, and recognizing important milestones.

RECOGNIZE AND EXPRESS DIVERSEVIEWPOINTSNetwork leaders, its staff and members, andresidents of the community all have uniqueperspectives. A network’s leader is responsi-ble for seeing the “big picture” as well asunderstanding the perspectives of individualstakeholders. Members are concerned abouthow the activities of the network will affecttheir own businesses. For staff, the networkmay represent their livelihood, so its successmay be particularly important to them.Residents of the community want to be surethat their health care system is stable andimproving. Network leaders need to weigheach of these viewpoints, be sure that othersunderstand them, and find solutions thatwill be acceptable to everyone.

MANAGE CONFLICT EFFECTIVELYConflict between network members whohave different goals or who view othermembers as competitors is inevitable. Ratherthan focusing on these conflicts as threats tothe network’s stability and future, networkleaders should view them as opportunitiesfor growth and compromise. Leaders whocan encourage network members to progresspast their initial disagreements are likely toreap rewards of increased trust and commit-ment to the network’s activities down theline. Strategies for effective conflict manage-ment include: being direct and open aboutareas of conflict; highlighting the sharedgoals of parties in conflict; ensuring that allparties feel respected and heard; and requir-


ing fair and equal participation in networkactivities by all invested parties. Look forwin-win solutions, and never assume a situ-ation is hopeless.

FIND THE ROOT CAUSE OF PROBLEMSAlthough most problems within the healthcare system are interrelated, network leadersmust strive to find the root causes of prob-lems (to the extent that they can) and helpnetwork members to recognize them as well.Network leaders should identify and analyzefactors contributing to a given problem andmake a sound hypothesis about what lies atthe heart of it. This will help to clarify howthe network might best address the issue.Leaders may also want to play the role of theskeptic or devil’s advocate in meetings, forc-ing network members to thoroughly evalu-ate problems and potential solutions.

BE AN EFFECTIVE MANAGEROther management tips for network leadersand directors include:

� Have hope and project a positive attitude.

� Always seek to inspire network members to action.

� Have a clear vision of where you want the network to go, and be aware of how your vision differs from those of key stake-holders.

� Be willing to take risks and say things that network members (for political or other reasons) can’t or won’t.

� Encourage respectful debates and solicit different perspectives.

� Be willing to say no. Staying focused can help maintain a network’s momentum.

F I G U R E 5

SAMPLE IMPLEMENTATION PLAN

Source: Greg Bonk. HMS Associates


F I G U R E 6

DETAILED IMPLEMENTATION PLAN

Source: Greg Bonk. HMS Associates


stablished networks as well asdeveloping ones should routinelyengage in strategic planning to

better understand the problems and oppor-tunities they face and to determine how thenetwork should approach them. An impor-tant ongoing function for any organization,the strategic planning process can revitalize anetwork by periodically reassessing its rolein the community. Although strategic plan-ning cannot purport to eliminate any of thechallenges rural networks face, it can makethe barriers to their success less daunting.

FURTHER READINGDunn P., “Brave New Rurals.” Hospitals andHealth Networks. November 1, 1999: 73(11). p. 46.

Goodstein L., et. al., Applied StrategicPlanning: How to Develop a Plan that ReallyWorks. McGraw-Hill, Inc., New York, 1993.

Hamel, G. and Prahalad, C.K., “Strategy asStretch and Leverage.” Harvard BusinessReview. March-April 1993. pp. 75-84.

Kanter, R.M. “Collaborative Advantage: TheArt of Alliances.” Harvard Business Review.July-August 1994. pp. 96-108.

McNamara, C., “Strategic Planning inNonprofit or For-profit Organizations.”

E

CONCLUSION &FURTHER READING

Management Assistance Program forNonprofits, St. Paul, MN. Available online athttp://www.mapnp.org/library/plan_dec/str_plan/str_plan.htm.

Zuckerman H.S., et al., “Alliances in HealthCare: What We Know, What We Think WeKnow, and What We Should Know.” HealthCare Management Review. 1995:20(1). pp.54-64.

RELATED RESOURCES FOR RURALHEALTH NETWORKSThe following documents are available onthe Networking for Rural Health project’s Web site at http://www.ahsrhp.org/ruralhealth/rural.html.

“Principles of Rural Health NetworkDevelopment and Management,” by GregoryBonk.

“The Science and Art of Business Planningfor Rural Health Networks,” by AnthonyWellever and Robert Cameron.

Business Planning Worksheets, by AnthonyWellever and Robert Cameron.

“Forming Rural Health Networks: A LegalPrimer.” By James W. Teevans.


APPENDICES

A P P E N D I X A

RESOURCES FOR HEALTH CARE DATA

State and Local Health Departments

State Insurance Departments

State and Metropolitan Hospital Associations

Statistics:GeneralDemographicsLabor-specific statistics

HCFA Statistics

Vital Statistics

State Profiles

Physician Data

Hospital Data

Managed Care Data

www.astho.org/state.html

www.naic.org/consumer.htm

www.aha.org/resource/links.asp

www.fedstats.govwww.census.gov/datamap/www/www.dol.gov

www.hcfa.gov/stats/

http://www.cdc.gov/nchs/

www.hrsa.gov/profiles

American Medical Association (www.ama-assn.org)Physician Socioeconomic StatisticsPhysician Characteristics and Distribution inthe U.S.Physician Marketplace StatisticsMedical Groups in the U.S.

American Hospital Association(www.aha.org)Various applicable resources (ex. HospitalGuide, Hospital Statistics)

Interstudy (www.hmodata.com)Competitive Edge series


Area of Interest Type of Information Sources Cost

Market � Demographics U.S. Census Bureau composition (www.census.gov/datamap/www/)

� Socio-economic Uses 1990 data Free� Race� Education status Claritas Connect (connect.claritas.com) Varies by

Provides current year estimates and 5-year level of projection specificity

Public health � Incidence rates Claritas Connect (connect.claritas.com) Varies by� Disease prevalence Provides current year estimates and 5-year level of

projection specificity� M&M by provider

Competitor � Providers in state Physician Dataanalysis � Services provided AMA (www.ama-assn.org)

� Market share by � Physician Socioeconomic Statistics: $395product line socioeconomic practice patterns of full time

practicing physicians

� Physician Characteristics and Distribution $160in the U.S.: data separated into three key sections -- trends(data on major professional activity, specialties, age, gender, and population ratios by nation, state and specialty), characteristics (physician population by age and gender, including country, year and school of graduation, specialties, and board certificat-ion), and distribution of physicians (census summ-ary data by stage, age, and gender, as well as specialty and activity by location, non-federalphysicians, and medical practice data)

� Physician Marketplace Statistics: topics including $400practice size, employment status, weeks worked, hospital utilization, fees, expenses by category, total revenue, net income, Medicare involvement, revenueby payer, managed care involvement, etc. Summary statistics are portrayed for 23 specialties and includestatistics for the nine census divisions and ten largest states.

� Medical Groups in the U.S.: AMA survey data and $100census information on medical groups

A P P E N D I X A ( C O N T . )




Competitor MGMA (www.mgma.com)Analysis (cont.) � Physician Compensation and Production Survey: $300

included are data on direct compensation and retire-ment benefits for over 30,000 physicians and mid-level providers in 102 specialties nationwide.Includes multiple productivity measures such as gross charges, ambulatory and hospital encounters,surgery/anesthesia cases and physician work RVUsaccessible by geographic area, level of capitation,years in specialty, single versus multispecialty pract-ices, and method of compensation.

Hospital DataAHA (www.aha.org)� Hospital Guide: profiles hospitals, healthcare $325systems, networks, alliances, and other health careorganizations, agencies and providers

� Hospital Statistics: analysis of the hospital market $299based on AHA Annual Survey of more than 6,200U.S. hospitals. Data tables are compiled in peer groups to compare across the following categories:Bed Size, Metropolitan Statistical Area (MSA), State,Census Division, and United States. Can determine the number and percentage of hospitals in local area that offer any one of 84 select services.

HCIA (www.hcia.com)� Profiles of U.S. Hospitals: uses more than 50 key $299performance measures to provide an in-depth look at more than 6,500 individual acute care and special-ty hospitals

� The Guide to Hospital Performance: contains $499statistical cost and charge information on individual hospitals, metropolitan areas, states, regions, and theU.S. (cost-of-living portion, average charges and costs, severity portion, risk-adjusted mortality index,percent of inpatient days greater than expected, information by service lines, demographic informat-ion, three years of the most recently available data)

� The Sourcebook: 59 measures of hospital perform- $399ance such as hospital capacity and utilization; patientand payor mix; capital structure; liquidity; revenues, expenses, and profitability; productivity and efficien-cy; and pricing strategies.



Competitor � The DRG Handbook: compare an institution’s $399Analysis (cont.) performance against national, state, and peer group

norms at the DRG level. Contains both all-payor and Medicare discharge data for examining either population.

Managed Care DataInterstudy (www.hmodata.com)� Competitive Edge series (three distinct parts -- HMO Directory, HMO Industry Report, and RegionalMarket Analysis): HMO enrollment info, penetrat-ion by state and MSA, general managed care trends.

Payer Data � Who HIAA (www.hiaa.org)� Rates � Source Book of Health Insurance Data: $35� Terms Information on trends in the health insurance and� Market share health care industries including health plan market

shares; persons covered; health expenditures; healthmanpower and facility data; and disability statistics.

A P P E N D I X A ( C O N T . )



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Documents

Strategic Planning for Rural Health Networkss3.amazonaws.com/rdcms-himss/files/production... · iii STRATEGIC PLANNING FOR RURAL HEALTH NETWORKS ABOUT THE AUTHORS Katherine Browne