Kristy Nichols's Profile

We have a variety of shared governance models with our partners that present various challenges and opportunities. When we partner with community hospitals in a joint operating agreement both institutions retain their board structures and have a combined joint operating board. The joint board serves to make strategic decisions on behalf of the total partnership while some reserve powers concerning these decisions rest with the individual boards. One key issue we encounter is who employs the partner CEO, CFO and CMO. It is challenging when the CEO is employed at the local hospital level and doesn’t represent the full partnership across the market. It is also challenging if the community hospital is a public entity.

Shared governance also brings to bear employment considerations, specifically as it relates to who employs which employees, shared employment models and comp and benefit alignment. System integration is also a key consideration in making these partnerships work – specifically, whose systems, EMR, rev cycle, IS, accounting, etc. will be utilized the manage the operations.

Great question. We are also growing very rapidly and have a very aggressive business development and partnership growth strategy. We measure the value of the work in a variety of ways – at the system level we look at margin growth from partnerships, growth in patient base, $ generated from solutions provided to partners, etc.

However, evaluating partnerships at the system level does not give you the full picture of the VALUE of each partnership so we have created a partnership value dashboard. This dashboard include almost 100 metrics for each facility that role up into what we call our TOP 20 value metrics. These are a combination of quality, operational, financial and synergy metrics. In the dashboard we measure the value of the partnership for both organizations compared to benchmark and combine it for a shared Value. Value indicators include core quality measures like RAMI, ECRI & HCAPs , physicians recruited to the market, discharges, visits, surgeries, % change in transfers to and from both facilities, gains/losses in operating income, service line consolidation synergies and synergy savings in areas like supply chain, IS, rev cycle, EMR. Quantifying the value at this level is critical to the long-term sustainability of the partnership as all parties want to know what they are getting out of it.

Metric Benchmark

1 RAMI ≤ 0.70
2 ECRI ≤ 0.65
3 HCAHPS Overall Rating %ile 65th
4 New MDs Recruited to Market 12% growth YOY
7 Discharges 4% growth YOY
8 Visits 6% growth YOY
9 IP and OP Surgeries 7% growth YOY
10 Transfers from Partner to OHS 10% growth YOY
11 % Total Transfers to OHS Facility YOY Improvement
12 Telemed Consults YOY Improvement
13 Total JOA Income YOY Improvement
14 OHS JOA IS Impact YOY Improvement
15 Partner JOA IS Impact YOY Improvement
16 Productive FTEs per AOB varies
17 Supply Cost per Adj. Discharge varies
18 Total Value to Partner YOY Improvement
19 Total Value to OHS YOY Improvement
20 Total Value of Partnership YOY Improvement

We consolidate service lines with our clinically and financially integrated partnerships. This is usually a 12 month process and we have seen great success at expanded access, improved quality and growth in volume. Our experience has been in the areas of oncology, cardiology, pediatrics, infusion, orthopedics, women’s services, & neurology. There are many regulatory consideration as you plan and evaluate these consolidations. Obviously, best location for the patients in the market, clinical and staff compentencies, employment considerations, volume growth projections and operational efficiencies are key considerations. I can send you our project planning template for managing the integration of service lines with our partners.

We partner and intergate with many different types of health care organizations and cultural alignment is the number 1 issue we encounter in every situation. In order to successful, even if you are just focusing on internal cultural alignment is ensuring that everyone is aligned toward the same vision and goals.

You indicated your strategy has changed. How have you communicated and planned with the team to align them with that strategy? Do they understand why the strategy is changing and the value behind the change? Do they understand what will happen if you don’t change? Do they understand their role in the change?

Once this is done you may need to identify your thought leaders at every level and begin the process of having the same level of conversation system wide using them as leaders and facilitators – pushing the vision and goals to every level of the organization and getting feedback about what is working and what is not and what the change will mean for them.

Ultimately, the team’s participation and understanding of the change is key to your success. this will also show you who isn’t aligned and who likely won’t align going forward and these may be changes you need to make.

i recently used the teaming model to facilitate hard discussions with my team and it was very useful. Happy to share.