Governance Renewal & Scorecard Gordon Cheesbrough Chair, NYGH - - PDF document
Healthcare Leaders Dialogue Conference Governance Renewal & Scorecard Gordon Cheesbrough Chair, NYGH January 18, 2008 The NYGHs Learning Journey: Our Board did not wake up one day and say: We need a Balanced Governance
Healthcare Leaders’ Dialogue Conference
Gordon Cheesbrough Chair, NYGH
January 18, 2008
The NYGH’s Learning Journey:
need a Balanced Governance Scorecard.”
learning journey.
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Financial Implosion:
$23 Million Deficit
Epicenter of SARS I & II
2
Governance Realities:
Provincial Re-Design:
system in the Province of Ontario.
the LHIN and our board.
for outcomes.
3
Board Responsibilities Ensure Benefit To “Owners” Hold the CEO Accountable For “Ends Policies” Provide Stewardship For Mission/ Vision/Values Monitor Executive Performance with BSC Ensure Financial Health Ensure Quality-
Caring Accountable to the LHIN For Outcomes
“Because trustees are more emotionally distant from the day-to-day action of the organization, they are often in a better position to see things fro ma balcony perspective. They can observe the whole dance floor -- without getting caught up on the dance.”
Adaptive Leadership 4
Balanced Governance Scorecards Pointer-Orlikoff Model Modified Policy Governance Carver Model
Provincial Priority:
for system integration won’t work unless community governance evolves.
evolving best practices for stewardship and accountability and the new system design.
5
Renew al Process:
June, 2008
Feb, 2007
Decision on Governance Renewal
7 four-hour meetings with Task Team of 13 people
April, 2008
Learning & Management
5 four-hour meetings with Task Team on targets/ alignment
Jan, 2008
Phases:
Scorecard and bring to Board on January 9th, 2008.
with the Board structure; with the hospital’s scorecard & CEO/ CMAC’s Accountability Agreements; and, develop the governance performance reporting system for retreat in June, 2008.
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community -- including the highest standard of patient safety.
relationship with the Central LHIN & MOHLTC.
tone at the top to achieve an organization that has:
continuous improvement, respect, trust
5. Structures and Functioning - Board must be consistent with best practices for:
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6. Continue execution of Enterprise Risk Management
7. Ensuring a strong relationship with physicians and other health care professionals 8. Talent Management:
leaders (including physician leaders)
9. Ensuring patients have a good experience. 10. Information system for the Board – scorecard with clearly defined metrics for effective governance. 11. Community relations and understanding community health needs.
Strategic Destination Statement:
Ends to Be Achieved
* Financial * Target Stakeholders & High Level Value * Distinctive Contributions & Deliverables * Environment Awareness/Recognition/Perception/Image * Geographic Reach * Alliances/Partnerships/Affiliations/Relationships (Internal & External)
Process Capabilities At Which We Must Excel
* Core * Support
Enablers
* Members & Staff * Culture * Leadership * Organization * Information
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Governance Destination Statement:
Focus on:
* What we are capable of doing (ideally, what we are best at doing) * What we want to and should do (ideally, what we are passionate about doing) * What the environment will support (ideally, significant opportunities)
Destination Statement Should: * Be clear, understandable, explicit
* Reflect explicit choices * Identify distinctive value * Be aligned with your overall mission & values * Be future-focused * Identify your logic regarding ends & means * Demonstrate internal alignment
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Gov erna nc e f or a communit y te ac hing hospita l in a c ontinuum of healt h care, prov iding compa ssionate and qualit y c are t o dive rse communitie s in Nort h Toront o and beyond – crea ting a de st ina tion of choic e f or patie nts, employe es, phys icia ns and v oluntee rs Pati ent/ Fam ily:
i le Quality Care & Patient S a f ety
as the A irline I ndustr y
ar e
n t Safety
i le Patient Exper ie n c e
( or Best “Possible”?)
Decision Making
Needs, Values, Pr iorit ie s, Wishes
achin g Hospital Citizenry/ Comm un ity:
S ervices Perceived as Ef fective & Eff icient to Meet Needs
am less Customer Exper ie n ce Acr oss th e HC System/ Cont inuum – Na vi gation & Coord ina t ion – Easier Mo ve m ent
Illness Prevent ion
n the Continuu m
Serv ic e, at Righ t Tim e, with Right Pro vider, I n Right P lac e, at t he Right Cost
r s & In tegration o f Ser vice s to C u st omers Overall H ospit al Cult ure:
:
spect
Pub lic Awareness & Recogni tion: (includ es LHIN , Gov. , Co mmunity, Physici ans, Empl
s, B anker s, Donor s, Peer s/ Other Hospitals & B
ds)
Care
ally Re spo nsib le W a y
ader & Role Model
ad e r sh ip
Boun daries
t ual Contr ibutor to A S ust a in able & Viable H C S ystem
ach (e .g.., Inf ec t ions, Pr oducts/ Ser vic es)
f or Employ e es & Ph ysic ian s Fin ancial:
Fisca l He a lth – Balance d B u dget
esour c es Directed t o Ne ed s/P rior ities (Equipm e n t, People, Services)
sou rces
ver aged Resou rces
sour ces
b ility
LHIN/ Gov e rn ment :
b ility Agr ee m ents with the LHIN
u ild St rong Relation ship s wit h the LHIN & MOHLTC
Ends to Be Achieved Process Capabilities Required
S trateg y & Vi si on:
t ive l y Parti cipate in the D e velop ment o f, then App rove, Vision, S trategy , Targets & K e y Init ia t ives
gy
j or F inancial Decisio ns Fou ndat ion:
Ho sp ital Fou ndation Eff orts in S uppo rt of Hospital S trategic Ob jectives L H IN:
Partn e r sh ips & Int e gr ation I nitiatives
solut ion of C r oss LHIN Issu e s
s Com m unicat ion/ Comm un ity:
Tea m
r and
an Advocate for the Hospital
y S takeholder C
C
P atients/ Fam ilie s
S takeholder R elatio nsh ips
Co mmunit y in Understand ing Health Care Needs & Healthcar e S ystem Plan ning & P rior ity S etting Qu ality:
esults
y Init iatives
Safet y Im provem e n ts Fi nancial :
Financial Reso urces
Practices for Financial P lanning & Managem e n t – Fiscal Polic ie s
t ing & Capital Budgets
ial Inf ormat ion
n age m ent Pr actice s & Appro ve Audited F inancial Statem e n ts
l Perf orm a n c e
E nablers
Board Inf ormat ion R e q uirem e n ts:
cess to Str ategic Inf orm a t ion
essible, Use ab le , R elevant Info rmatio n Tools & Sy stem s to Suppo rt Gover nance Obj e ctiv e s Board Mem bers/ Le ad er s:
t ion, Mix, Evaluation o f Board Memb e r s
Board Trainin g & Developm e n t
ct ion of B ehavior al Str engths, Skil ls, Knowledg e & Exp e r ience Ne ed e d to Sup port t he Hospital Vision & Str a t egy
s
h ange
atio n
cr uitmen t
ct ive s & P rovid e for Eng a gem ent/ Par ticipation, Ro bust Discussions, Re spon sib le Decision Making , a s well as Ef ficiency
Them e s/ Ob jec t ives
r nance Focused vs. Operation Governa nce Stru cture & Processes:
l Members, Comm ittees, F ull Board
alan c ed G overnance Scor ec ar d Aligned w ith Hospital Balanced Sco reca r d
St rategy Management S ystem
t e Boar d Str uctur e s & P rocesses Consist e n t with Best Pr a ct ice s:
e
Commu nity Reps)
t ions, Mem bers
etin g Durat ion & F requency
Governan c e Cu ltu r e:
gem ent to Nurtu re an En vironm e n t of:
b oration
spect and Trust
Hospit al St aff :
Securit y, Rec
Development
Pr ofessio nals
Physicians:
n ce Deep I nvolvemen t in Hospital S trategy F orm ulation & Ex ec u tion
Phy sician Leaders
Phy sicians
Fr iendly Hosp ital Leadershi p/Manag ement :
Comm itted Le ad e r s at Every Level
S tro ng Hospital Le ad e r sh ip & Management Risk Managem ent & Comp liance:
r prise Risk Manage m ent & Comp liance ( En sur e Compliance & P revention & Managem e n t of Risks)
pu tation
Covenants
b ility & Transparency
ar & Reliable Disclosures
r e
t ion with Key S takeholders & F under s In format ion Managem ent:
Deve lo pment o f In form ation System Po licies & Practices Physicians:
r with P hysicia n s in Plannin g & Decision Making to Tap Collective Wisdom
r se e/Ap prove P hysician Staf fing/ Credent ia lin g
r se e P hysicia n Talent Managemen t & Leadership Developm ent
r se e P rocess f or S elec t ion of Medical Leadership Hosp ital Hum an Resources (Ov e rall ):
Emp loyee Hea lt h & Saf ety
esource St rategy & Oversee Ex e cu tion
O verall HR P la n ning, Talent Management, P erfor mance Ma n a g e m e n t, Developm ent & S ucce ssion Risk Manag ement & Com plian ce:
Enter prise Risk Management Ef fort (Risk Analysis, e t c . )
e
the Accountabilities to Them
C
n ts
Hosp ital M anagem e n t/ Leadershi p:
Talent Management/ S ucce ssion P la n ning/ Leadership Developm ent fo r Key Lea d e r sh ip P ositions (CEO, COS/CMAC, Other S r. & P hysician Leader s)
w, Re cogn ize / Acknowledge & Reward Executive P e r for mance
r uit, S e lect, Coach, S uppor t, Evaluate, Compensate CEO & COS/ CMAC
b le for Out comes
w/ Appro ve C EO & COS /CMA C P e r for mance Plans (Accou ntability Agr ee m ents)
Leading, S erving
u lture: Ethics, P rinciples, Values, Coll a b oration , Stewardship , Open
f e Place for Due Diligen c e: P rob ing, Quest ions
b ility & Tru st
GOVERNANCE DESTINATION IN TWO TO FIVE YEARS
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service to patients & families & a safe work environment for staff.
Customer/ Stakeholders Outcomes
capital projects.
Financial Outcomes
targets met.
commitments.
leaders, physicians & volunteers.
communities.
projects.
leader in our LHIN, the MOHLTC & the communities we serve.
Understanding” with Foundation.
aligned with hospital capital needs.
strategy development and with performance reports & review process.
execution.
processes and with the reviews of financial performance.
budgets, and monitor financial performance.
access & experience reviews.
efforts, and practices to improve patient access & experience.
Governance Processes
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communication and relationships with key internal and external stakeholders.
internal & external stakeholders.
monitoring process.
Agreement.
Provider & Stakeholder Accountability & Relationships
projects.
technology policies and plan.
Agreements.
& CMAC completed and documented.
and review, compensate & support their performance.
credentialing process.
strategy & plan.
plan.
management & succession planning.
NYGH Human, Organization, & Information Capital
plans and practices.
Risk Management & Compliance
reports on the status of compliance & improvement efforts.
requirements.
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accessibility of information, etc.
support governance objectives.
Information Capital
assess:
Board meetings Clarity of Board roles & responsibilities (& objectives, metrics, targets & initiatives) Performance of Board against
Board size, composition, quality Board committees & strategy Efficiency & effectiveness of overall Board & Board Committees (e.g. utilization of time & competencies discussions, decision protocols, etc) Level of engagement of members (by theme/ task, etc)
practices & aligned with the hospital strategy & Strategic Management System.
governance culture.
collaboration, respect, openness, learning, trust & accountability, consistent with the established Code of Conduct.
Organization Capital
recruitment, nomination, & election processes applied in appointing new members & chair positions.
with succession plans in place.
membership & leadership succession.
(based on self/ other assessments).
enhancement plan (plan vs. actual).
governors needed to support the hospital vision & strategy.
Human Capital Governance Enablers
Quantum Transformation Technologies
By Ted Ball
s your hospital really ready for the emerging future? Does your organization want to learn about “best practices” for Board/Management collaboration? Would you be interested in learning about proven methodologies that would enable your Board to “add value” to your hospital’s operational efforts on improving quality, safety & patient satisfaction?
At a recent OHA/IPAC Webinar, North York General Hospital’s Board Chair outlined how the aligned scorecards for governance and management has enabled their hospital to make meaningful improvements in quality, safety and patient satisfaction rates – as well as a leveraged use of the Board’s time, and improved relationships with management and physicians. Attached for those interested in a more indepth exploration of The Balance Governance Scorecard Methodology, is a slide- deck presentation by NYGH’s past Board Chair, the late Gordon Cheesbrough. This presentation outlines their Board’s learning journey from Destination Statement to Governance Strategy Map, to the perspectives, objectives and measures for their hospital’s Balanced Governance Scorecard.
“This Partnership- Building Leadership Workshop will help build synergy, adaptability and resilience at your hospital.”
Would you be interested in exploring how the “lessons learned” from NYGH’s Balanced Governance Scorecard Alignment Process might be adapted to your organization’s unique circumstances? Would you be prepared to invest the time and money required to build synergy, adaptability and resilience at your organization? If you believe – as I do – that the healthcare system will undergo a significant transformation
your organization to develop collaboration among your governance and managerial leadership -- just as you are about to face the challenges of addressing the significant quality and cost issues ahead.
Tel: (416) 581-8814 Fax: (416) 581-1361 website: www.quantumtransformationtechnologies.com
2 The strategic direction of the Excellent Care for All Act and the economic realities that a new (or renewed) provincial government must address in the Spring Budget of 2012, can be expected to combine to drive deep change in Ontario’s healthcare system over the next three or four years. Is your hospital ready for these changes? Do you have the Board leadership capacity and capability to drive these changes?
LEADERSHIP RETREAT
Return-on-Investment
A customized Leadership Capacity- Building Workshop co-designed with the CEO & Board Chair – for $15,000 with facilitators Ted Ball and Ken Moore. We are the only “suppliers” who have created a Balanced Governance Scorecard Learning Journey and offer a custom- designed leadership retreat. Does your organization have the leadership capacity to survive, adapt and thrive in the emerging environment? Perhaps we can support your hospital’s governance & managerial leadership team prepare for the unfolding future.
Tel: (416) 581-8814 Fax: (416) 581-1361 website: www.quantumtransformationtechnologies.com
My colleague Ken Moore of Quantum Innovations of Austin, Texas and I are offering a customized Governance Leadership Retreat that will provoke thinking, build relationships and enable your hospital to better understand how Governance/Management Alignment can contribute to significant improvements in your hospital’s performance in the years ahead. At this workshop, your organization will have an opportunity to assess the Balanced Governance Scorecard framework that we developed with North York General Hospital. This will enable your hospital to determine what adjustments or modifications you need to make to reflect emerging best practices as you determine your own path ahead. Hopefully you will select the 1.5 Day Workshop option to create a powerful learning experience that enables governance & managerial leaders to think about how your
provide the highest return-on-investment for your hospital. We deeply understand that no two organizations are alike. If you think that this type of education/organizational development initiative has a “good” to “excellent” Return-On-Investment – in terms of the potential benefits to your hospital’s performance – we suggest that the CEO call me for an initial consultation/exploration about how a 1.5 day Leadership Retreat could “add value” to your
address your unique circumstances.
CONSULTATION