ACCORD helps health care organizations realize their potential – their visions of what they want to become. And ACCORD strengthens organizations by providing them with the management and governance strategies they need to respond to the rapid and dramatic changes in today's health care environment.
ACCORD does this by helping clients to:
- Develop strategic plans using a participative approach to ensure stakeholder support;
- Develop plans to achieve strategic goals and objectives;
- Ensure that governance and management structures support organizational strategies;
- Facilitate processes that result in collaborative arrangements and/or mergers among health care providers;
- Assess and shape organization culture;
- Increase team effectiveness at the board, executive, and medical staff levels;
- Enhance board and management performance.
The process of strategic planning is as important as the plan. Through participation in the process, stakeholders "buy in" to the changes that result and resistance to the plan is reduced, if not eliminated. For these reasons, ACCORD ensures a "team approach" to strategic planning through:
- Meaningfully involving the organization's key stakeholders: sponsors, board, physicians, senior management and other relevant parties;
- Eliciting board and executive staff input into the planning process to be used;
- Creating a workable, flexible plan with clear accountability for implementation.
Through these participative processes, clients clarify their mission and core values, identify their vision for the longer-term future, develop measurable goals, and create shorter term objectives.
ACCORD's strategic planning counsel can be as comprehensive as the client desires, i.e., beginning with information gathering and proceeding through implementation. Or, consultants can offer targeted planning interventions on specific issues, such as new product/service development.
Typical steps in a comprehensive strategic planning engagement include:
Convene a project initiation meeting;
Orient the planning task force;
Gather and analyze data / information;
- Conduct stakeholder input sessions;
- Facilitate strategic planning retreats with planning task force;
- Conduct stakeholder feedback sessions;
- Facilitate planning task force follow-up meeting;
- Prepare final strategic plan document.
In any case, ACCORD's approach is collaborative, working with the client's data, expertise, and staff, thus minimizing the cost to the client and increasing the likelihood of successful implementation due to the active participation of key stakeholders in the process.
One of ACCORD's major areas of expertise is health care governance. Both Ed Kazemek and Pam Knecht have served as members of nonprofit organizations, and both are Governance Advisors (and board faculty) of The Governance Institute, the largest national organization dedicated to enhancing governance effectiveness through education and research. ACCORD consultants write extensively on governance topics (See the Resources section of the website for recent articles and white papers).
ACCORD provides a wide range of governance consulting assistance, from a one-time board retreat to a comprehensive assessment of governance structure and functioning. Brief descriptions of each governance service are provided below.
Comprehensive Governance Assessments
ACCORD recognizes that the massive changes taking place in the health care industry have forced organizations to re-think their governance models. As experts in governance, the firm provides technically sound and implementable recommendations based on:
- Comparative research and analysis of similar organizations;
- The Governance Institute's extensive research database;
- Interviews with key board members and executives regarding current governance and organization structures;
- ACCORD's observations regarding the unique characteristics and strategy of the organization; and
- Application of the firm's experience and expertise in creating effective and efficient governance functioning and structure.
ACCORD's assessments result in specific, actionable recommendations for how to improve governance at multiple levels. The type of issues identified and addressed through a comprehensive governance assessment often include:
- Aligning the governance structure with the organization’s mission and vision;
- Streamlining the number of boards and committees across the organization;
- Clarifying roles, responsibilities, and authority among the various boards and committees and between board and management;
- Redefining the composition of each board and committee;
- Modifying policies and procedures to ensure they are consistent with best practices and legal and regulatory requirements (e.g., the Internal Revenue Service's Form 990 Instructions);
- Increasing communication among and within governance entities;
- Improving the effectiveness and efficiency of board and committee meetings.
Board Orientation and Education
For boards to be effective in this challenging health care environment, their individual members must receive up-front orientation and on-going education. ACCORD works with clients to develop materials and facilitate sessions for both new and existing board members in large group settings (e.g., all who serve in governance) or in small meetings (e.g., the hospital or system board).
As a result of these educational / orientation sessions, board members gain a better understanding of the following:
- What boards do (e.g., core responsibilities, fiduciary duties of board members);
- The environment in which health care boards operate (e.g., national health care trends);
- What other boards are doing (e.g., best practices);
- What boards can do differently to be more effective.
ACCORD consultants are also knowledgeable facilitators and speakers for board retreats. ACCORD can custom-design and facilitate an entire board retreat, or speak on a specific topic as part of a conference.
Issues addressed during board retreats have included:
- Education on national health care issues;
- Information on governance best practices;
- Board self-evaluation and action planning;
- Board goal-setting;
- System / Hospital strategic direction-setting;
- Kick-off for a comprehensive governance assessment;
- Board responsibilities and fiduciary duties.
- Board Evaluation and Development
- To make good decisions in the rapidly-changing health care environment, boards and committees must be working well. The best way to determine if a governance function is effective is to institute a periodic board evaluation and development process.
ACCORD uses customized self-evaluation surveys or standardized tools from The Governance Institute in San Diego, California, to help evaluate the effectiveness of the entire governance function and of individual board members. Consultants then recommend specific developmental actions aimed at increasing the effectiveness of the board, committees, and board members. The result is a governance work plan that the board can use throughout the year to ensure it is continually enhancing its performance.
Merger / Acquisition / Collaboration Services
Financial and competitive pressures are causing both strong and weak health care organizations to look for ways to join together for mutual benefit. The management and facilitation of these efforts must begin long before the "letter of intent" is signed. Indeed, failure to address key organizational issues up-front causes many merger/collaboration initiatives to fail or, at the very least, not achieve the objectives that originally stimulated the discussions.
ACCORD, with assistance as needed from other allied consulting firms, helps to create lasting relationships through mergers, acquisitions, and other collaborative arrangements among potential "partners". These services include:
Design and Facilitation of the Entire Process
An organized approach for pursuing the merger or collaborative relationship must be established early in the process, including the formation of a joint steering committee, identifying other outside assistance required, developing a work plan, and identifying methods for involving key stakeholders. ACCORD assists in the above and then provides facilitation services in all major meetings and events related to the merger/collaboration process and documents the results of each step.
Readiness and Culture Compatibility Assessment
Norms, beliefs and values of the organizations must be examined to determine cultural compatibility and answer the critical question as to whether or not the arrangement is worth the effort. This assessment includes clarification of the benefits of collaboration as compared to the parties remaining independent. It also includes ensuring that the parties have a unified vision for the long-term evolution of the new organization being created.
Strategic and Financial Planning
A full array of strategic planning and financial analysis services are available, including: due diligence; valuations; recommendations for optimal consolidation of service lines; medical staff and support functions; identification of revenue enhancement opportunities; third party review of payer contracts; cost savings opportunities; debt capacity and capital structure planning; impact on operating and capital expenditures; volume and revenue projections; and comparison of financial results with and without the merger/collaboration arrangement.
Governance Structure Determination
Appropriate governance structures, policies and procedures that address the political and fiduciary requirements of the collaborating parties are critical ingredients in the long term success of the merger/collaborative arrangement. ACCORD works with the boards to design effective and efficient governance structures and processes, including identification of committee structures, clarification of role/responsibilities among boards and boards and management, and application of governance "best practices."
A merger is not a discrete, short-lived project, but rather, an ongoing change process that must be led and managed from initial discussions through a period of two to three years after the papers are signed. ACCORD helps to ensure that assignments and accountability for implementation are clearly spelled out.
Communications Counsel Throughout the Collaboration Process
During times of significant uncertainty and change, rumors fly, morale plummets, and internal productivity suffers. Externally, local news media and community leaders need to be informed and involved. ACCORD helps the collaborating organizations determine when confidentiality is required, and when open communications are needed, ACCORD can provide professional assistance in this important area.
The majority of health care organizations today are members of multi-unit systems and continue to strive for meaningful integration. For those organizations considering the formation of or joining a health care system, ACCORD helps its clients determine the most appropriate strategy to pursue.
In the event that an organization decides to pursue forming or joining a health care system, ACCORD facilitates processes and decision-making events focused on:
- The nature of the relationship (e.g., merger, acquisition, alliance, etc.);
- Governance arrangements;
- Organization and management structures;
- Strategic plan development;
- Physician integration
ACCORD typically teams up with the client's legal, financial and other advisors on engagements of this type.
For evolving health systems struggling to reap the benefits of their business model, ACCORD offers its clients the following services designed to enable them to take advantage of the massive changes occurring in the health care industry:
- Conducting a “System Development Assessment” to clarify the organization’s current situation and identify obstacles to further integration;
- Aligning the organization’s governance and management structures with the system strategy;
- Facilitating structured interventions to resolve conflicts related to system development.
Physician Relationship Enhancement
To be successful, health care delivery organizations must foster healthy relationships among physicians, and between physicians and the hospital or health system. Strong, effective relationships with physicians result in higher quality clinical care, improved patient satisfaction, increased access to care, and improved financial results for all parties.
ACCORD helps build physician relationships of any type: physician to physician; physician to administration; and physician to board. ACCORD's approach to physician relationship development is facilitative and collaborative in nature. By encouraging each constituency group to honestly express their ideas and concerns in a safe environment, problems that were previously “unsolvable” become manageable. Once all parties have moved into a problem-solving mode, they can identify the best structures for aligning their interests (e.g., joint ventures, management contracts, employment, etc.) and work together towards the common goal of providing high quality care to patients. As a result, they help one another become more successful both professionally and financially.
The following issues are typical of those addressed during the discussions and planning sessions that ACCORD facilitates:
- Developing a shared understanding of the benefits of strong physician relationships for the physicians, the health system, the board, and the community served;
- Identifying potential barriers to successful physician relationships;
- Developing integrated service lines across multiple facilities;
- Creating alternative physician-hospital business models;
- Resolving conflict among physicians, board members, and administration;
- Clarifying roles and responsibilities within the clinic and/or corporate setting;
- Agreeing on action plans regarding physician collaboration initiatives.
Organization Assessment and Design
ACCORD provides in-depth analysis of organizational and management structures and can help executive staffs manage significant change in organizations through:
- Evaluating an organization's structure, reporting relationships, decision-making processes, and communications channels;
- Presenting structured feedback, conclusions, and recommendations; and
- Assisting with change implementation.
Specifically, ACCORD provides the following types of consultation:
Especially helpful in faith based health care organizations, the process used by ACCORD helps systems evaluate how well they are:
- Living their missions and values;
- Supporting their internal customers;
- Fostering the development of collaborative relationships;
- Ensuring the perpetuation of the health care ministry.
Using tailored instruments and interventions, ACCORD offers outcome-oriented team effectiveness consulting that allows executives and managers to:
- Identify team strengths and weaknesses;
- Confront conflict;
- Build consensus on how to improve team effectiveness;
- Identify ways to make the team more effective; and
- Utilize team members' distinct skills.
Aligning Structure with Strategy
ACCORD provides objective analysis and opinion regarding the congruence between an organization's vision/strategy and its organizational structure. ACCORD's services also include recommendations for changing the management or governance structure and counsel on implementing those changes.