Strategic Mapping & Program Alignment Aligning Experiences – Expectations – Resources – Outcomes.

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


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


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.


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.


Alignment

The appropriate positioning of systems and resources to attain a defined goal, mission, outcome or culture


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


The Main Thing For Horizon House

Choice


PLAN & DEVELOP

Organize

Alter

Codify

Train

Improve

Choice Dining AlignmentProcess Overview

Plan

Evaluate

Define

Assess

Implement


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


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.


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.


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


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


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


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


Choice Dining Continuous Alignment

Improve

Train

Alter

Assess

EffectivePractices


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.


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?"


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


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.


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


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.


“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.


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.


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


Contact

1. Dan Look – 770-565-4006

2. Dining Management Resources, Inc.

3605 Sandy plains Road

Suite 240-269

Marietta, GA 30066

1. [email protected]

Strategic Mapping & Program Alignment Aligning Experiences – Expectations – Resources – Outcomes.

Documents

choice residents

staff choice

dining servicepresent

new dining experiences

strategic alignment

individual choice

organizing principle

mapping exercise