UCSF Clinical Enterprise Strategic Plan Presentation to Faculty Council

UCSF Clinical Enterprise Strategic PlanPresentation to Faculty Council

October 16, 2008

Prepared for

2

SEPTAUG

Stakeholder Interviews

Town Halls*

DEC JUL OCT

Readiness vs. 2015, Identify IssuesResponses, implications, & requirementsSub-Committee Reports

STAGE 2 – UCSF READINESS AND RESPONSES TO CHALLENGES

Steering Committee

Strategic Retreats

Sub-Committees

Strategic Oversight Committee

Confirm process, work plan, and rolesUnderstand UCSF’s DNA (Acuity model) Set the stage: In 2015, we believe…

Create a shared understandingOrganize to address the challenges

MEETINGS

Sub-Comm. Outputs and Implications

Draft UCSF Strategic RoadmapShared strategies for a shared visionConsensus on strategic planModification of 10-year financial plan Submission of final report

STAGE 3: BRINGING IT ALL TOGETHER: UCSF’S ROADMAP TO THE FUTURE

STAGE 1 – CHARTING THE LAY OF THE LAND: 2015 MARKET

JUNMAYAPRMARFEBJAN

MONTHS

SEPTAUG

Stakeholder Interviews

Town Halls*

DEC JUL OCT

Readiness vs. 2015, Identify IssuesResponses, implications, & requirementsSub-Committee Reports

STAGE 2 – UCSF READINESS AND RESPONSES TO CHALLENGES

Steering Committee

Strategic Retreats

Sub-Committees

Strategic Oversight Committee

Confirm process, work plan, and rolesUnderstand UCSF’s DNA (Acuity model) Set the stage: In 2015, we believe…

Create a shared understandingOrganize to address the challenges

MEETINGS

Sub-Comm. Outputs and Implications

Draft UCSF Strategic RoadmapShared strategies for a shared visionConsensus on strategic planModification of 10-year financial plan Submission of final report

STAGE 3: BRINGING IT ALL TOGETHER: UCSF’S ROADMAP TO THE FUTURE

STAGE 1 – CHARTING THE LAY OF THE LAND: 2015 MARKET

JUNMAYAPRMARFEBJAN

MONTHS

**

Strategic Plan: Timeline Today

3

Clinical Enterprise Strategic Plan

2002 Strategic PlanPrevious Context

Significant growth imperative

Increased capacity

Improved financial & operating performance

Increased customer service/satisfaction

Created Mission, Vision, and Values

Planned Mission Bay

2008 Strategic PlanCurrent Challenges

Capacity constrained

Challenging FY08 budget

Increased competition

Continued shift in insurance dynamic

SB1953 seismic requirements – Mission Bay cost

4

Clinical Enterprise Strategic Plan

Mission:

Caring, Healing, Teaching and Discovering.

Vision:

To be the best provider of health care services, the best place to work

and the best environment for teaching and research.

Values: Embodied in the acronym PRIDE:

P for Professionalism, how we conduct ourselves and our business

R for Respect for our patients, families, ourselves and each other

I for Integrity, always doing the honest, right thing

D for Diversity, understanding and embracing the diverse beliefs, needs and expectations of our patients, community and employees

E for Excellence, what we strive for in everything we do

Foundational Statements

5

This 2008-2015 Clinical Enterprise Strategic Plan defines the next evolution of UCSF, building on existing strengths and focusing

on opportunities for improvement

Strategic Plan: Direction

Three key goals serve as the foundation for this Strategic Plan

Clinical Growth

Best Care

Shared Accountability

Financial Performance

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Strategic Plan: Themes

CLINICAL GROWTH

1. Maximize the Potential of the UCSF Inpatient Facilities

2. Match Patient Mix to UCSF’s Mission and Program Capability

3. Expand Functional Ambulatory and Office Capacity

4. Achieve a More Effective UCSF Referral Outreach

BEST CARE

5. Create the Next Generation UCSF Care Delivery Model

6. Provide the Highest Value Care to Patients

7. Educate, Recruit and Retain the Best Talent

SHARED ACCOUNTABILITY

8. Define a Stronger Culture of Shared Accountability and Action

9. Achieve the Operating and Clinical Cost Improvements Necessary to Sustain a 6% Operating Margin (language still being reviewed)

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Strategic Plan: CLINICAL GROWTH

Recommendation 1.1: Increase functional bed capacity by 60+ beds across both major campuses

Strategy 1.1.A: Complete 16 ICU-bed addition on Parnassus, to be operational by end-2008

Strategy 1.1.B: Decrease risk-adjusted inpatient ALOS to the average UHC benchmark or better

Strategy 1.1.C: Improve average bed occupancy at Mt. Zion to 75% (from less than 60% today), adding an additional 15-20 beds to functional inpatient capacity

Theme #1: Maximize the Potential of the UCSF Inpatient Facilities

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Recommendation 2.1: Focus adult incremental growth in high and moderate complexity care

Recommendation 2.2: Ensure that programmatic growth occurs in a rational and controlled fashion

Recommendation 2.3: Ensure future patient mix supports UCSF’s educational and research requirements

Recommendation 2.4: Encourage Departments to commit to a set of institutional policies that are intended to stabilize UCSF’s sponsor mix to ensure financial viability

Theme #2: Match Patient Mix to UCSF’s Mission and Program Capability

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Recommendation 3.1: Improve exam room utilization (visits/room/day) to allow a 10%-15% growth in ambulatory visits within existing infrastructure

Recommendation 3.2: Ensure that there is sufficient office space available to support projected growth of the clinical enterprise

Recommendation 3.3: Focus the development of any ambulatory growth (exam room or outpatient ancillary capacity) off the main campus

Theme #3: Expand Functional Ambulatory and Office Capacity

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Recommendation 4.1: Create and implement an Institutional Outreach Oversight Committee that will act on behalf of the enterprise and be responsible for prioritizing and coordinating future UCSF outreach initiatives

Recommendation 4.2: Work closely with the School of Medicine, translational research scientists and others to ensure linkages and appropriate volumes for teaching requirements and clinical trials through outreach initiatives

Recommendation 4.3: Focus on building and enhancing relationships with community providers in Northern California to ensure patients are cared for in the appropriate care settings

Recommendation 4.4: Focus UCSF marketing strategies on increasing awareness of the UCSF brand regionally

Theme #4: Achieve a More Effective UCSF Referral Outreach

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Strategic Plan: BEST CARE

Recommendation 5.1: Increase the number of non-resident (mid-level providers) and mixed (both mid-level providers and house staff) services to reduce reliance on the resident model

Recommendation 5.2: Explore residency expansion initiatives in select departments, if aligned with institutional clinical priorities without affecting the quality of the training programs

Recommendation 5.3: Develop core teaching and non-resident staffing models for inpatient units as needed by service

Recommendation 5.4: Restructure workflow on inpatient units to allow all clinical providers to spend more time with the patient

Recommendation 5.5: Ensure the care delivery model supports a consistent standard of clinical care regardless of time of day or day of the week

Theme #5: Create the Next Generation UCSF Care Delivery Model

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Recommendation 6.1: Create an organization and infrastructure that allows the UCSF clinical enterprise to tie its value proposition to superior quality, patient safety and clinical outcomes

Recommendation 6.2: Communicate UCSF’s results in clinical quality, patient safety and clinical outcomes to a broad external audience

Recommendation 6.3: Enhance service standards for the UCSF clinical enterprise so that it is competitive in the Bay Area market

Theme #6: Provide the Highest Value Care to Patients

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Recommendation 7.1: Develop recruitment initiatives that enable UCSF to meet its goals around clinical growth and patient mix

Recommendation 7.2: Create retention initiatives that allow UCSF to identify and develop the next generation of UCSF leadership

Recommendation 7.3: Strengthen the relationship between UCSF and its employees

Theme #7: Educate, Recruit and Retain the Best Talent

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Strategic Plan: SHARED ACCOUNTABILITY

Summary Assessment of Today’s Model:

High level of patient service variability, financial result

High level of decentralization, local discretion

Low level of shared success definition, expectations

Low level of transparency across the enterprise

High level of frustration, sense of lost potential

Theme #8: Define a Stronger Culture of Shared Accountability and Action

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Expectations – Defining Success (per KSA)

1. Define clinical service credo distinct from academic freedoms

Service to patients the priority in clinical enterprise work

2. Clear service standards expected across all clinical participants

3. Operating leadership roles aligned with demonstrable expertise

4. Participation a major institutional value, i.e. not discretionary

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Transparency – Reporting Progress (per KSA)

1. Reporting vs. (just) approving clinical enterprise aims

Current clinical enterprise strategic plan the starting basis

2. Use of comprehensive dashboards and scorecards

3. Broad, disciplined disclosure of progress and lack thereof, good and bad

4. Scheduled use of advisory boards, open faculty sessions to vet status

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Incentives – Reinforcing Success (per KSA)

1. Recognize patient service acumen by the clinical faculty

Leadership roles, governance participation, compensation

2. Align institutional clinical support with results and plan aims

3. Align career opportunity pathway with proven clinical excellence

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Ten Year Financial Plan Assumes Several Key Assumptions:

Reduced Length of Stay to UHC Benchmarks (6.3 to 5.85 in select services)

Decrease in FTEs/Adjusted Occupied Bed (8.08 to 7.76)

Increase in Case Mix Index (1.98 to 2.08)

Flat Volume in MediCal

Theme #9: Achieve the Operating and Clinical Cost Improvements Necessary to Sustain a 6% Operating Margin

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Financial Implications

UCSF Finanical ForecastNet Income - Scenario Analysis

0

40,000

80,000

120,000

160,000

FY2008 FY2009 FY2010 FY2011 FY2012 FY2013 FY2014

Do

llars

( in

th

ou

san

ds)

Base Scenario Scenario 1 - ALOS Scenario 2 - CMIScenario 3 - Payor M ix Scenario 4 - Combined Revenue Scenario 5 - FTE per AOB (8.08)

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Strategic Plan: Next Steps

Next steps include:

SOM Faculty Council, Clinical Affairs Committee, Academic Planning and Budget, Senate Coordinating Committee, DOM Chiefs Meeting

Please advise if you would like us to present at one of your Department meetings

Two Town Halls Led by Interim Dean Hawgood and Mark Laret in mid October

Formal approval from:

Chancellor’s Office

Faculty Senate

Dissemination to the Public

On-line postings – official Summary of the Plan

Public Relations and Marketing (articles, brochures)

Create Detailed Implementation Plan (see next page)

Address Issue of Shared Accountability

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Implementation Plan: Metrics and MeasuresThemes Measures of Success Detailed Reports

(Compare Current to 2015 Target)Strategic Plan Dashboard (Compare Current to 2015 Target)

Maximize Potential of the Current UCSF Inpatient Facilities

• Decrease number of days each inpatient unit exceeds 100% capacity

• Decrease % of patients being held in the ED or PACU while waiting for a bed

• Decrease in adult and pediatric ALOS• Decrease in inappropriate one day

admissions (Define – Reece?)• Increase in transfers to post-acute

facilities – decline in ALOS

• Quarterly reports by product line (Adult / Peds and PRN/ Mt.Zion)

CMI Inpatient discharges Outpatient visits % Medi-Cal

• Current ALOS compared to UHC risk-adjusted average by product line

• ADC by unit (10:00am, 2:00pm and midnight)

• Percent occupancy for the adult (split Parnassus and Mt Zion) and children’s inpatient chassis (Target Occupancy = X)

• Target ALOS = X• Target OR utilization = X

Match Patient Mix to UCSF’s Mission and Program Capability

• Increase in institutional CMI• Growth of volume in targeted product

lines or services• Decrease the % of inpatient Medi-Cal

patients to the lower of 2002 or 2006 percentages in each service

• Departmental adherence to Outpatient Referral Guidelines

• Exceed minimum volumes needed to ensure teaching accreditation in each program

• Quarterly reports by product line (Adult / Peds and PRN/Mt.Zion)

CMI Inpatient discharges Outpatient visits % Medi-Cal

• Annual review of recruitment plans by department

• Secret shopper for Outpatient Referral Guidelines

• Annual review of teaching Risk Registrar

• Target CMI = X• Target Volumes = X• Target Medi-Cal = X• Programs at risk for losing

teaching credentials

Expand Functional Ambulatory Capacity

• Growth in ambulatory visit volume by department

• Volume growth in imaging by modality, and in OP surgery/procedures (why are these combined)

• Increase in % of ambulatory activity occurring off- the Parnassus campus

• Decline in % of faculty without an office

• Ambulatory visits by department • Number of designated exam rooms

by department• Ambulatory visits/room/day by

department• Assigned offices (and associated

square footage) by department• Professional revenue per sf of clinic

space by department

• Target Ambulatory Visits = X• Target visits/room/day = X• No. of Faculty w/out offices = X

Documents

UCSF Clinical Enterprise Strategic Plan Presentation to Faculty Council