Strategic Mapping & Strategic Mapping & Program AlignmentProgram Alignment
Aligning Experiences – Expectations – Resources – Outcomes
March 8, 2005 IAHSA - Spring Conference 2
Session Objectives
1. Introduce Choice as a service culture
2. Review application of Choice in dining service
3. Present process for mapping from a strategic objective to a tactical initiative
4. Conduct the Mapping Exercise for a Current Project Initiative
5. Review Process, Q & A
March 8, 2005 IAHSA - Spring Conference 3
The Customer Value Of Positive ExperienceA Memorable Feeling Created By You As A Result Of Us
Relative Customer Value
EXPERIENCE
SERVICE
GOOD
RAW MATERIAL
Source OfCustomer Loyalty
Created WithinThe Customer
Created ByA Provider
March 8, 2005 IAHSA - Spring Conference 4
Operational Culture
Rhythms of Daily Living is an operational culture that aligns resources and expectations of service experiences. RDL works in collaboration with initiatives of environmental culture change advocated by other organizations. The core service model for liberating residents and staff from an institutional paradigm is dining service. Dining is a catalyst and enabler to initiate change across coordinated services.
March 8, 2005 IAHSA - Spring Conference 5
Rhythms of Daily LivingRhythms of Daily LivingThe core of RDL is the opportunity to exercise choice residents’ for how they choose to live their day and staff choice for care delivery. This creates a collaborative coalition of residents and caregivers working together in a living environment. RDL facilitates the delivery of care, the experience of living and the dignity of self-determination.
RDL is a management principle that aligns the natural rhythms of residents and the support they need. The organizing principle of RDL is that people should be able to make meaningful choices in their daily lives – on their own or with assistance. RDL relies on caregivers to help define and achieve outcomes that balance individual choice and system efficiency.
March 8, 2005 IAHSA - Spring Conference 6
Alignment
The appropriate positioning of systems and resources to attain a defined goal, mission, outcome or culture
March 8, 2005 IAHSA - Spring Conference 7
When Landing A Plane, What Is The Main Thing? 1
1. Concepts and Diagrams From The Power of Alignment - How Great Companies Stay Centered and Accomplish Extraordinary Things By G. Labovitz/V. Rosansky
Left Of RunwayAltitude Too High Aligned
Air Speed
Cross Winds
Altitude
Wind Speed
Pitch
March 8, 2005 IAHSA - Spring Conference 8
The Main Thing For Horizon House
Choice
March 8, 2005 IAHSA - Spring Conference 9
PLAN & DEVELOP
Organize
Alter
Codify
Train
Improve
Choice Dining AlignmentProcess Overview
Plan
Evaluate
Define
Assess
Implement
March 8, 2005 IAHSA - Spring Conference 10
Plan Transition Process and Commit ResourcesWrite Program Transition Budget and Operating Narrative
Organize
Codify
Organize For Culture Change Establish “Experience” Alignment Teams To Define/Implement Transition
Codify Policies/Procedures and Training By Function Write & Task Procedures/Training Using RDL© Base
Choice Dining AlignmentPlan and Develop
Plan
Evaluate “Readiness” With Leadership, Managers & Residents/FamiliesDefine Outcomes Baseline and Expectations
Evaluate
Define Define Service Functions and Outcomes For Each ExperienceIdentify Beneficiaries/Benefits and Diagram Service Functions
March 8, 2005 IAHSA - Spring Conference 11
STRATEGIC OBJECTIVES – TACTICAL IMPLEMENTATION PROJECT MAPPING
As dining options and program enhancements are discussed, specific initiatives are defined and envisioned by department management and staff. These new “dining experiences" require a specific definition process from concept to strategic alignment to tactical implementation.
Executive and Board leadership must clearly identify specific strategic organizational considerations. Leadership must clearly define their expectation and measurement of a successful contribution to the community strategic vision. This must take place prior to the initiation of Map 1.
March 8, 2005 IAHSA - Spring Conference 12
STRATEGIC OBJECTIVES – TACTICAL IMPLEMENTATION PROJECT
MAPPINGThe following are the task requirements for this process:1. Identify Service Initiatives 2. Define Their Contribution To Strategic Objectives3. Define Appropriate Measurements Of Successful Experience
Outcomes4. Identification Of Resource And Operational Intersects5. Identification Of Intersects And Roles Of Other Contributing
Departments6. Structure Of The Process For Resource Allocation To Develop The
Defined Initiative7. Sequencing Of The Tasks8. Implementation of the Initiative.
March 8, 2005 IAHSA - Spring Conference 13
Map Process #1, 2 ,3 Strategic Objectives
Community of Distinction
Financial Enhancement
Quality of LivingQuality of Work
OperationalEffectiveness
Map#1Strategic Objective Benefit
Map #2Benefit Measure
Measurement Tool
Map #3 Administration Regulatory Operations Personnel PP&E Community
Operational Resource Requirements
Budget Impact $/FTE’s
March 8, 2005 IAHSA - Spring Conference 14
Map Process #4, 5Map #4CollaboratingDepartments
Nursing Resident Services
Therapies Pastoral Housekeeping Maintenance Activities
Task
Map #5TaskImplementation
Nursing ResidentServices
Therapies Pastoral Housekeeping Maintenance Activities
Procedure
Policy
ResourceRequirement
Inform/Train
Measure
March 8, 2005 IAHSA - Spring Conference 15
Project Management
ID Task Name
12 Review Horizon Proposal
13 Approve and Accept
14
15
16 Organize
17 Presentations of service concept and education
18
19 Define
20 Review community operational expectations & outcomes
21 Identify and assign measurements
22
23 Plan
24 Coordinate Plan for Installation
25 Develop Plan for Coordinated Training
S M T W T F S S M T W T F S S M T W T F S S M T W TApr 25, '04 May 2, '04 May 9, '04 May 16, '04
March 8, 2005 IAHSA - Spring Conference 16
Alter
Alter Procedures, Training, Tasking, ResourcesConfirm and Eliminate Practice Conflicts
Train
Improve
Choice Dining AlignmentImplement
Learn Improved ProceduresDemonstrate Understanding
Measure Satisfaction and Efficiency ResultsEvaluate/Report Result Scores
Assess
Identify Opportunities For Improvement Assess Practices To Find Procedures Not Practiced
March 8, 2005 IAHSA - Spring Conference 17
Choice Dining Continuous Alignment
Improve
Train
Alter
Assess
EffectivePractices
March 8, 2005 IAHSA - Spring Conference 18
Culture of Caring vs. Culture of CuringThere is a significant difference between these two
cultures. A culture of curing, the medical model, requires workmanship of certainty – specific, objective, regimented procedures to achieve a specific outcome. A culture of caring, the LTC model, requires workmanship of risk – the collaborative relationship to create a quality of living experience that is subjective and defined by the resident and care provider at the moment of service.
March 8, 2005 IAHSA - Spring Conference 19
Workmanship of Riskvs. Workmanship of Certainty
The distinction between workmanship of risk and workmanship of certainty turns on the question "Is the result predetermined and unalterable once production begins?"
March 8, 2005 IAHSA - Spring Conference 20
Workmanship of Risk Leadership Attributes
Workmanship of certainty requires a traditional hierarchical leadership style.
Expectations are defined by the leadership Outcomes are measured against static benchmarks The process is predetermined and always
replicated
March 8, 2005 IAHSA - Spring Conference 21
Workmanship of Certainty Leadership Attributes
Workmanship of risk is best developed with a servant leadership model of direction.
Leadership defines, through collaborative development, the expectations.
The role of servant leadership is to then provide the community direction and then assure that staff have the necessary resources and environment for achieving the experiential outcomes.
March 8, 2005 IAHSA - Spring Conference 22
Comparison of CulturePioneer Network
Institution-Directed Culture
1. Staff provide standard “treatments” based on clinical
2. Institutional defined schedule and routines – resident comply
3. Work is task oriented and staff rotates assignments – interchangeable residents
4. Centralized decision making
5. Hospital environment
6. Structured activities
7. There is a sense of isolation and loneliness
Choice – Directed Culture
1. Staff enters into a care giving relationship based upon individualized care & resident desire
2. Residents and staff design the schedules
3. Care is relationship-centered, consistent assignments
4. Frontline decision making
5. Environment reflects the comforts of home
6. Spontaneous activities
7. Sense of community and belonging
March 8, 2005 IAHSA - Spring Conference 23
Servant Leadership
Servant-Leadership is a practical philosophy which supports people who choose to serve first, and then lead as a way of expanding service to individuals and institutions. Servant-leaders may or may not hold formal leadership positions. Servant-leadership encourages collaboration, trust, foresight, listening, and the ethical use of power and empowerment.
March 8, 2005 IAHSA - Spring Conference 24
“Some facilities studied, usually the lower turn-over ones, were in the process of thinking about how to increase individualized care. For example, the researcher asked, what are you doing if anything about resident choice. ‘We are looking at it. Ideally, we want them to eat when they want. We encourage them to tell us what care they want, a shower or bath, or to get up when they want.”
Page 5-49 Appropriate of Minimum Nurse Staffing Ratios in Nursing Homes, Phase II Final Report prepared by Abt Associates for the Centers for Medicare and Medicaid Services, December 2001.
March 8, 2005 IAHSA - Spring Conference 25
Quality of Living ConsiderationsA large proportion of nursing home residents are malnourished
and up to half are substandard in body weight, leading to serious consequences including infections, hip fractures, and even death. The environment in which residents eat and the degree to which residents may choose when and what to eat can affect residents’ health (malnutrition and dehydration) and quality of life (perceived safety, enjoyment, social relationships, individuality, autonomy, choice). [i],[ii],[iii]
1. [i] Burger, S.G., Kayser-Jones, J., and Bell, J. P. “Malnutrition and Dehydration in Nursing Homes: Key Issues in Prevention and Treatment.” National Coalition for Nursing Home Reform. June 2000.
2. [ii] Chou, S., Boldy, D., and Lee, A. “Resident Satisfaction and Its Components in Residential Aged Care.” The Gerontologist 42:188-198, 2002.
3. [iii] Kane, R. “Long-Term Care and a Good Quality of Life” The Gerontologist 41:293-304, 2001.
March 8, 2005 IAHSA - Spring Conference 26
Session Objectives
1. Introduce Choice as a service culture
2. Review application of Choice in dining service
3. Present process for mapping from a strategic objective to a tactical initiative
4. Conduct the Mapping Exercise for a Current Project Initiative
5. Review Process, Q & A
March 8, 2005 IAHSA - Spring Conference 27
Contact
1. Dan Look – 770-565-4006
2. Dining Management Resources, Inc.
3605 Sandy plains Road
Suite 240-269
Marietta, GA 30066