Health Industry Services

CASE 1: Single Hospital System – Comprehensive Governance Assessment

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 pressures, ACCORD teamed up with the board and its other advisors to conduct a detailed review of the system’s governance legal 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 a draft set of 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.

CASE 2: Three Community Hospitals – Collaborative Arrangement Exploration

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

ACCORD 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 conducting 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 all of the above information 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 at the time, one of the three hospitals violated its agreement to not discuss opportunities with other providers in the region and, at the last minute, pulled out of the discussions with the other two hospitals.  The remaining two hospitals moved forward with immediate plans for integration of clinical services and other collaborative efforts but determined that a full merger no longer was the optimal arrangement for them.

Case 3: Large Health System – Specialty Physician Alignment  

Client Profile: A 14 hospital health system with over 100 outpatient sites
Project Type: Physician alignment planning facilitation
Challenge: To facilitate a 3-way planning process among two large, competing cardiology groups and the health system, with the goal of developing a contractual relationship that would benefit all three parties 

ACCORD Solution and Results:

Over the course of one year, ACCORD designed and facilitated a number of planning sessions among the leadership representing the three parties.  Since the parties were not interested in developing a joint venture, we educated the participants on the types of arrangements available to them and the psycho-social dimensions that could make or break the deal the parties were attempting to put together. Due to events outside the control of the parties, discussions were put in abeyance for almost one year.

After the hiatus, ACCORD was reengaged to resume the planning process.  This time, the leadership of the cardiology groups worked with us on a parallel path to discuss the possibility of a merger of the two groups. After the cardiology groups agreed to merge, the negotiations with the health system accelerated and were brought to a successful conclusion.

Today, this health system is in a close, legal relationship with the premier cardiology group in its primary market. The parties have achieved gains in clinical quality and mutual financial benefits, without the burden and expense of forming a joint venture entity.

CASE 4: Large Health System – Integration of Acquired Clinics

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 to address some of the emotional issues that often occur after physicians have given up total control of their practices.

Over the course of several years, the health system acquired dozens of physician groups representing hundreds of physicians. The health system’s multi-specialty medical group is now one of the largest in the country and is profitable and continues to win numerous quality awards.

CASE 5: Comprehensive Strategic Planning

Client Profile: A 410-bed, Catholic-sponsored health system in the Midwest
Project Type: Comprehensive, highly participative, strategic planning project – A Collaboration with DGA Partners
Challenge: The previous strategic plan had been achieved with the opening of a new regional medical center. The board and the new CEO wanted to identify the next steps in the system’s evolution as a ‘revolutionary and futuristic health care delivery system based on patient-focused care.’ They also wanted to use the strategic planning process to understand and prioritize issues that had surfaced as a result of combining four separate entities into one healthcare system. In addition, the CEO was interested in building relationships with physicians, employees, community leaders, and other key stakeholders.

ACCORD / DGA Solution and Results:

ACCORD and DGA teamed up with the CEO and the Vice President of System Development (VPSD) to design and facilitate a comprehensive strategic planning process. The engagement began with the careful selection of a Planning Work Team (PWT) that included the Leadership Council, physician leaders, and board members. The PWT provided oversight as ACCORD secured input from key internal and external stakeholders such as representatives from the sponsoring congregation, physicians, the entire middle management group, the board’s strategic planning committee, and over 25 other external community leaders. In total, hundreds of individuals provided input on their vision for the system, the strengths, weaknesses, opportunities and threats, and priority actions for the short-term.

Simultaneously, DGA prepared a comprehensive, data-based, market, financial, and environmental assessment for the organization. The assessment resulted in key findings regarding the market area definition, the purchaser market, the competition, the physician supply, and the financial status of the system. DGA and ACCORD partnered closely with the VPSD to ensure that strategic-level trends and conclusions were displayed clearly, concisely, and graphically. That material was provided to the PWT prior to a day-long retreat in which DGA and ACCORD led the PWT through an assessment of the internal and external environments. This enabled the PWT, and ultimately other key stakeholders, to identify the critical strategic questions facing the system over the next five years. 

ACCORD then facilitated two additional PWT retreats as well as a series of group feedback sessions with many of the same stakeholders who had participated in the input sessions. The result was a complete, 5-year strategic plan that included a mission, core values, a five-year vision, three-year goals, and one year objectives.

At the conclusion of the engagement, the CEO commented that the strategic planning process had resulted in both a clear direction for the future and a unified culture. Those who had come from four different organizations now shared the same vision of what they could become together. They had also developed a common set of values to guide their behavior along the way. And, all of the key stakeholders became focused on four priorities for the short-term: system growth, market leadership, integrated infrastructure, and culture development.

A year later, the system saw marked increases in satisfaction scores for patients, employees, and physicians. Just as importantly, the system achieved the market leadership position within its region, which led to enhanced financial stability. As a result, they were able to accomplish both their mission and margin targets.