Case Studies

Don Seymour & Associates Case Studies

Focusing on Imperatives for Success At a Community Hospital

Client Profile: Full service 200-bed community hospital in a highly competitive Northeastern suburban market. Project Type: Comprehensive strategic planning engagement with strong process component involving trustees and approximately 125 physicians. Challenges: Assist the board and management in separating strategic issues from tactics and operations, while keeping the board focused at an appropriate, governance level. Educate the board regarding the importance of meeting identified community need for additional physicians versus catering to the self interest of physicians opposing recruitment. Don Seymour & Associates Solutions and Results: DS&A facilitated the development of a strategic plan including: development of a clinical plan including five service line priorities and the resources required to support them; the need for a $250 million replacement hospital; an approach to recruiting 100 new/replacement physicians over a 10 year period; and identification of sources and uses of capital to support strategic initiatives while maintaining a strong balance sheet and meeting routine capital needs. The plan was endorsed by the Medical Executive Committee and greeted with acclaim by the Board of Trustees, which was composed of some "tough graders" including senior executives from major corporations, the managing partner of an international management consulting firm, a professor from a well-known graduate school of business and a professor of health policy.

Restructuring Hospital Board to Improve Effectiveness

Client profile: A respected, community teaching hospital with ties to a major academic medical center and a reputation for clinical excellence. Project type: Board self assessment coordinated by the governance committee Challenge: Initially, to help the parent board, frustrated by what it perceives as its own lackluster performance, to manage two competing factions within the board and governance committee in order to find enough common ground for continued discussions. Later, to assist trustees in understanding that a "less is more" approach (stepping back from operations and management work and redefining governance work) would actually lead to more effective trusteeship. Don Seymour & Associates Solutions and Results: DS&A conducted extensive interviews with individual trustees from the parent, hospital and foundation boards; senior executives at the hospital and foundation level and the trustees of two legacy organizations (which controlled two separate, large endowment funds). The results of the interviews were presented to the steering group and used as the basis to identify key hurdles and to "call the question." Three meetings of the steering group resulted in consensus on the issues, potential options for addressing them and recommended solutions. It was agreed that the board would be reduced in size through attrition. Appropriate term limits were established; the committee structure was revised with an emphasis on board work (a charge was developed for each committee); interlocking relationships were established among the parent and other boards and consistency was established in the bylaws among all corporations. In addition, the frequency of meetings was reduced; the consent agenda (which already existed in theory) was reactivated and job descriptions for board officers were developed.

Bader & Associates Case Studies

Initiating Major Governance Improvements Through Board Self-Assessment Survey

Client Profile: A Mid-Atlantic community hospital Project Type: Board self assessment and improvement process Challenge: To help a new CEO and forward thinking Executive Committee to adopt contemporary governance practices, potentially including term limits. The board had been passive and had traditionally deferred to management. The governance changes needed to be accomplished without alienating long-serving trustees and physicians accustomed to guaranteed, ex-officio positions despite potential conflicts of interest. Bader & Associates Solution and Results: Bader & Associates used The Governance Institute’s Board Self Assessment survey to identify board policies and practices that differed from national norms and merited discussion at an educational retreat. The board agreed on a comprehensive Board Development Plan, and engaged Bader to work over nearly a year to implement a change strategy. The board successfully adopted a new role description, a transition to term limits, a new approach to physician membership developed in consultation with medical staff leaders, a new committee structure, and a leaner and more strategic approach to board meetings, among other improvements.

Enhancing Performance of Quality-Related Responsibilities by a Community Hospital Board

Client Profile: Community hospital board in a Mid-Atlantic state Project type: Board education as part of a board self assessment process Challenge: To help a new CEO, CMO and committed Governance Committee get the board more engaged in overseeing and supporting the hospital’s strategic quality initiatives Bader & Associates Solution and Results: Using The Governance Institute’s Board Self Assessment survey, Bader & Associates helped the board to evaluate itself. We designed a board retreat to discuss the results, including a strong emphasis on the board’s role in quality. We made a presentation on current improvement trends and identified eight specific practices boards use to set quality goals, monitor performance, incentivize management, and engage physicians fully engaged as partners. The board adopted a comprehensive Board Development Plan with a strong quality component.

ACCORD Limited: Selected Case Studies

Preparing a Comprehensive Governance Assessment for a Single Hospital System

Client Profile: An expanding 200+ bed Pennsylvania single hospital system Project Type: Comprehensive governance assessment including structure, policies, and practices Challenge: To assist the board in upgrading its governance function at the same time the board was experiencing intense external scrutiny over its practices ACCORD Solution and Results: Working under extreme time pressure, ACCORD teamed with the board and its other advisors to conduct a detailed review of the system’s legal governance documents, structures, policies, practices, strategic vision, minutes of board and committee meetings, self-evaluation information, board orientation program, education plans, financial situation, and more. We interviewed all of the board members, senior executives, and physician leaders individually to understand their perspectives on the system’s governance strengths, weaknesses, suggestions for improvement, and to understand the politics and culture of the organization. After completing the assessment phase of our work, we prepared draft findings, observations, and recommendations for presentation to the full board and senior executive team. During a 3-hour working session with the board, we educated the board on “best practice trends” in not-for-profit governance; reviewed the draft report; and, secured the board’s feedback on the recommendations. Based on the results of the board work session, we prepared a final report and a number of key policies and procedures for immediate implementation by the board and its committees. We also provided a list of additional policies and governance practices for implementation over a phased timeline. The comprehensive assessment has resulted in a revised governance structure for the system, including the immediate formation of a Governance Committee to oversee the implementation of the study recommendations; a new set of critical board policies; and a number of practices to enhance how the board carries out its responsibilities. The quick action taken by ACCORD also helped to alleviate some of the external pressures that the board was experiencing.

Integrating Acquired Clinics into a Large Health System

Client Profile: A large multi-hospital system in the Midwest Project Type: Integration and business planning Challenge: To quickly integrate physician groups as they were being acquired by the health system, in order to ensure the success of the acquisitions ACCORD Solution and Results: As the health system was implementing its strategy to employ large numbers of physicians, ACCORD was retained to design and facilitate planning sessions with the acquired physician groups during and immediately following the acquisition process. We convened meetings with clinic leadership to help them understand what the integration process would entail; develop one year business plans, including measurable goals for each clinic site; and address some of the emotional issues that often occur after physicians have given up total control of their practices.

Alliance Case Studies

By working together in these cases, Alliance partners were able to provide clients with high quality services that responded to every aspect of their situations.

Assessing Governance for Health System Board

Client Profile: Large Southeast health system with a parent board for the system and tertiary care hospital, and subsidiary boards for rural hospitals, a foundation, and for-profit enterprises Project Type: Comprehensive governance assessment and enhancement Challenge: Help a new CEO and a visionary, committed board to take a fresh look at governance structure and practices. The board wanted to ensure that it was following nationally recommended governance practices and exercising effective strategic leadership and fiduciary oversight. Our Solution and Results: Bader & Associates and ACCORD Limited teamed on this project. We reviewed a full range of board policies and documents, interviewed every corporate director and key leaders in management and subsidiaries, and brought our findings and recommendations to several meetings with the Governance Committee and full board. Some recommendations involved a shift from the traditional culture. The consultants helped educate directors about rising external governance standards and helped craft pragmatic solutions. As a result, the board adopted stronger policies to demonstrate board independence, clarified the parent board’s reserved powers over the foundation and other subsidiaries, strengthened its oversight of quality and patient safety, and initiated a process to enhance board-medical staff communications.

Strategic Decisions for New England Home Care And Hospice Organization

Client Profile: Home health and hospice organization that included one of only two inpatient hospices in the state Project Type: Board self assessment and development retreat leading to a strategic planning process Challenge: To help the board of this respected but financially challenged organization assess and improve its effectiveness. Subsequently, to help the board and management make critical decisions about the organization’s future. Our Solution and Results: Initially, Bader & Associates was engaged to conduct a board retreat to educate directors in good governance practices and adopt a board development plan to address improvement opportunities. We met with the Governance Committee, reviewed background documents, and designed and administered a self assessment questionnaire. During candid discussion at the retreat it became clear the board was gridlocked over questions of its strategic future and lacked a means of addressing them. As part of preparing a Board Development Plan, we helped directors organize a board-led strategic planning process. DGA Partners was engaged to conduct leadership interviews, analyze key financial and market data, and develop a strategic and financial analysis of four future scenarios. DGA Partners then facilitated a second board retreat to examine the options, choose a desired scenario, and prepare to engage in discussions with a desired strategic partner to develop a new facility.

Exploring Collaborative Arrangements Between Three Community Hospitals

Client Profile: Three Michigan hospitals in close proximity to one another Project Type: Collaborative arrangement facilitation Challenge: To determine if three competing hospitals could form a local health system through the formation of a joint operating agreement, merger, or some other structural arrangement Our Solution and Results: ACCORD was retained by the three hospitals to serve as a neutral facilitator of the deliberations of the three boards and CEOs. We structured the discussion process, including the formation of a Task Force consisting of the CEOs and board leaders from each organization; conducted individual interviews with the Task Force members to gauge the feasibility of the undertaking; reviewed relevant documents; provided advice on communications; and educated the Task Force members on the range of options available to the three hospitals. We also recommended retaining DGA Partners to conduct a “base case” study to determine the likely financial impact if the parties were to not come together in some arrangement. We facilitated several meetings of the Task Force to explore the information listed above, and reached the conclusion that a merger was the most desirable collaborative model, in terms of meeting the healthcare needs of the community and ensuring financial stability for the three organizations. Unknown to us at the time, one of the three hospitals violated its agreement not to discuss opportunities with other providers in the region and pulled out of discussions at the last minute. The remaining two hospitals moved forward with immediate plans for integration of clinical services and other collaborative efforts. They determined that a full merger was no longer the optimal arrangement for them.