In Phase One of this project, we worked with senior management and divisional department heads to:

• Review internal and external factors impacting the District's development into a fully integrated health system
• Identified and prioritized key issues
• Determined factors critical to the District's success as an integrated system

In Phase Two, we assisted the system's divisions and support departments with the development of business plans, including an analysis of critical success factors, and development of goals and objectives. We also developed a description of the system's evolution as an integrator of care, discussed new directions and opportunities, and outlined components of a system vision.

In Phase Three, we were retained by Stevens Healthcare to continue to work in a variety of ways with the system's key executives to ensure attainment of goals and objectives, including:

• An on-site opinion survey was conducted with employees from various departments. MeetingKit for Windows (from Enterprise Solutions) was used to assemble the information and display the results in graphical form for output to the final report.

• Further refinement of critical success factors and strategies
• Development of key performance indicators used to measure the system's success in achieving its objectives

"The consultants were a valuable resource in our development of a strategic planning model. More importantly, they kept us focused on those areas critical to our success. They helped change our thinking from 'operational' to 'strategic'."

• Review, revision and recommitment to the hospital's mission, values and vision
• Education and discussion of an integrated partnership with the medical staff
• Discussion of key environmental trends, and their implications for St. Peter's
• Development and prioritization of strategies
• Opportunity for fellowship and team building among retreat attendees

We used the following techniques to complete this assignment:

• Pre-retreat questionnaire assessing key issues and priorities, areas for strengthening the mission, strengths and weaknesses, critical success factors, significant areas of opportunity, and issues impacting excellence in governance
• Hospital-developed environmental assessment and overheads to guide the retreat process
• Large group discussion and small group breakouts to brainstorm solutions
• The brainstorming/consensus software StrategEASE® was used to in the large discussion groups to facilitate the gathering of ideas and developing group consensus. The participants used an IBM laptop as the tool to help them input their ideas to the group and also to register their votes and opinions developed by others. All the laptops were networked together and the groups' input was displayed on a screen in front of the room. This eliminated the requirement for flipcharts pasted

• Mission and goals
• Board structure and process
• Relationships
• Strategic planning
• Quality assurance
• Evaluation of new hospital services
• Community relations.

Using LHS's existing self-assessment methodology, Ruehle & Associates and The Walker Company created a StrategEASE® computer hardware/software application which allowed LHS board members to conduct their self-assessment using a portable computer-based local area network (LAN). This application enabled the board to simultaneously and anonymously evaluate their performance and immediately see the results of the evaluation in graph form on a "public display" screen in the front of the room. Directors were able to rate their performance, see a group ranking of individual performance indicators and assess the degree of consensus among themselves on each indicator.

During the same self-assessment meeting, Directors also simultaneously identified strategies to address performance weaknesses, leadership opportunities and other factors, creating a prioritized action list. A complete report of all self-assessment results, including graphs, tables, individual director comments and process explanation, was provided for next-day distribution.

"I learned more about my board in the self-evaluation session than I have about them over the past 1 1/2 years. I can't tell you how beneficial the process was for me."

We conducted telephone interviews with prospective CFOs, produced written profiles of leading candidates and researched references of finalist candidates.

• Vision
• Mission
• Goals
• Critical Success Factors
• Implementation Strategies

In addition RAI worked with 13 major departments within Swedish Medical Center over a two year period to assist them in development of their individual plans and alignment with the organization's strategic plan. One department was Patient Financial Servi es. Within the first year of implementing their strategies, Patient Financial Services identified over $100,000 in costs that were taken out of their processes.

• Allow retreat participants to engage in a focused dialogue about the most significant ways to bring association value to systems;
• Prioritize the results of the dialogue, and display the degree of consensus across the association leadership spectrum; and
• Analyze the impact and feasibility of implementation of the prioritized concepts.

Walker/Ruehle gathered a broad range of input from the health system executives, which was subsequently prioritized by a small group of executives who were also involved in small group discussions at the Associations retreat. In that retreat participants in small groups brainstormed ideas, came to consensus on their top three ideas, and were then involved in a further prioritization of the entire group's top 15 ideas. Association retreat participants then evaluated the health care system executives prioritized input on the basis of impact and feasibility of accomplishment within 18 months, using a "cross impact" feature of

A complete written report of the process and all input, including summary tables and graphs, was presented to participants at the end of the Associations in Transition retreat.

"They consistently exhibit flexibility, focus, and an exceptional commitment to meeting client needs. I would recommend them hightly"

• Strategic planning for the association's constituency sections
• Key informant interviews of staff and members on a variety of topics
• Focus groups

Walker/Ruehle used a combination of traditional facilitation and electronic meeting management to capture raw input from each session, primarily for use in prioritizing key ideas and generating a list of eight focus group subjects for exploration on days three and four.

• Definition of an IDS for THA member services development purposes
• IDS roles in THA success
• Criteria for IDS membership and governance
• IDS advocacy issues
• Potential new resources required to support IDS development needs
• Potential changes to THA's dues structure and methodology to reflect the growth of ID Ss

A detailed written report summarizing the process, IDS development issues, critical success factors, new ways to provide value to ID Ss, alternative organizational models, and conclusions and recommendations was developed and approved by the THA Executive Committee.

• Discussing critical success factors and achieving new levels of excellence and service at VHA, including representation and advocacy; education; membership and the member services; ensuring financial stability; leadership; role in community health improvement; data and information; and building coalitions and collaboration.
• Brainstorming strategies to address Association critical success factors.
• Analysis and prioritization using StrategEASE®, coupled with a cross-impact analysis rating each solution for its feasibility and benefit to the Association.

Prior to the retreat, we distributed and analyzed a survey which probed Director attitudes in the areas of the Association's key priorities, views on the Association's mission and vision, the impact of external trends on the Association, analysis of VHA's service in several critical service areas, perceptions of Association strengths and weaknesses, possible Association goals and governance issues. The information collected was analyzed by we prior to the retreat and used as a tool in crafting the retreat agenda. In addition, the materials were presented to the retreat participants as an "internal organizational assessment" which framed many of the issues discussed during the retreat.

A detailed summary report was prepared which summarized the 1 1/2 day retreat results.

• Key issues which CHA must understand and tackle
• Assumptions about the future of hospitals and health systems
• Maximizing strengths and weaknesses: Reengineering to create new member service opportunities
• Critical success factors in achieving optimum success
• Shaping the Future: The vision
• Getting there: Steps to take after the retreat

Following the retreat, Ruehle/Walker prepared a comprehensive report including the following key components:

• Retreat process and objectives;
• Summary of the current CHA position, including information about the Colorado healthcare industry, membership, dues income, development of integrated health systems, and a potential new association name;
• Assumptions for the future;
• Key issues facing Colorado healthcare providers;
• CHA operating assets and liabilities;
• Major factors in CHA success;
• Shaping the CHA future, including new mission directions, and development of a multi-faceted CHA vision;
• Managing change: Next steps in CHA's transformation.

• Defining the critical needs of MHA's current and future members
• Anticipating the changes that will take place in the healthcare and association environment
• Determining how the association's overall mission as well as governance and services must be restructured to prepare for the future
• Recommending to the MHA Board of Directors a comprehensive strategic plan to: 1) Redefine MHA's mission (and possibly change MHA's name to reflect its changing membership; and 2) Describe the most appropriate methods for financing and restructuring the association to fulfill its new mission

We designed, distributed and analyzed a comprehensive member survey; designed, prepared materials for and facilitated several focus groups and task forces, and worked closely with the association's members and a Strategic Planning Committee on all aspects of strategic plan design and execution. Results included a new mission and name, streamlined governance processes, new bylaws and other organizational changes designed to strengthen the association's performance in meeting member needs.

The assignment objectives included the following:

• Engage in a dialogue about NAHHS' current governance status, and potential alternatives for creating a governing leadership structure which best reflects the association's membership, and which can most effectively lead the Association into the future.
• Discuss NAHHS' dues structure, and potential options which to ensure dues methodology equitability and appropriateness as a tool for ensuring the financial strength and viability of the association.

During the course of the three committee meetings, staff and committee members considered several key questions, including:

• What is the compelling purpose of the association? How will it change as the market changes, and as new member categories are added?
• What significant changes are occurring in the Nevada healthcare environment, and what impacts will those changes have on the way the association serves its current and future members?
• What will NAHHS look like in the year 2001?: Members, services, affiliations with other organizations, staffing, etc.

We prepared and coordinated background materials, developed meeting agendas, lead discussion, summarized the results of each meeting, and designed a report format which incorporated interim committee findings and committee recommendation to the Board of Directors.

• Survey rural hospitals' current situation, including:
  • Hardware Installed
  • Software Installed
  • Current Vendor Satisfaction Level
  • Information Systems Annual Budget
  • Stand-Alone System vs Network
  • In-House vs Service Bureau
• Identify the most critical vendor core competencies required by Nebraska hospitals;
• Determine the most important emerging information systems needs which must be effectively met by vendors;
• Develop a request for proposal (RFP) to be distributed to qualified firms;
• Conduct site visits of most qualified firms; and
• Make recommendations on firms which are positioned to meet Nebraska rural hospitals' information system requirements.

Following the Information Systems Survey, Ruehle/Walker prepared a comprehensive final report that included the following key components:

• Survey process, objectives and major issues
• Summary of focus group input and results
• Emerging needs, requirements and vendor core competencies
• Emerging Information Systems Requirements
• CEO skills for the future
• Current Information Systems Status
• Vendor recommendation for three different scenarios
  • Local network
  • State wide network
  • Independent systems

Once the plan was designed, RAI's role was to facilitate quarterly meetings that measured progress and adjusted strategies to meet competitive pressures. RAI also conducted focus group meetings with Regional managers to determine field requirements.

A key tool used in this analysis was the ISIS model. This 5 step process helped Bartell develop a structure for evaluating I/S projects.