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2011 Business and Marketing Plan Going from Good to Great
The Beaufont Butterfly Effect
PlannedAdaptation
& Success
Changes and ChallengesGrowth and
Expansion
Growth and Expansion
New 60 bed Addition
M2 Goals increased
New Positions Needed Unit Manager / ADON
Faster Pace / Discharge Focus
60 Bed Kitchen Mentality
Couldn’t keep up with our success
No Systems in place
BEAUFONT TO BUTTERFLY
Resting on our Laurels
Celebrating accomplishments of the past
Getting by / Wind in our sail
Realization that we to Change
System Break Down
Policy and Procedure Holes
Identification of Systems
Developing the Eye of Expectation
Managing Systems
Recognizing Success
BEAUFONT TO BUTTERFLY
Employee Terminations / Turnover
Commitment Generating
Implementation
Resident Concerns – Status Quo disrupted
QA Development
Commitment Generating
Implementation
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Census Development 2010
• Said that we would increase our Market share % by 50% in 2009
2009 CJW Discharges: 2031 2009 BEF Admissions from CJW: 518 = 26%2008 Market Share Percentage: 17% = 50% increaseProjected to hold at 26% for 2010CJW 5% increase 2132 Discharges45.6 / month average from CJW to BEF =547 Admits2010 Projection = 26%
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Census Development 2010We were to create awareness of our new 60 bed addition
• December 2009 met with the CEO and COO of CJW medical to develop a relationship, invite for tour and speak on ARC
• Jan 2010 met with Case management team at St. Francis Hospital to discuss our ARC program and expansion
• February 2010 Director of Case Management In our facility to tour with Sharon Hayes the COO or CJW system
• April 2010 – Meeting with the Hospitalist Group for HCA to present ARC and speak on our Expansion. Medical Director Participation
• August 2010 Meeting with case management to discuss the rollout of the new CHF Cardiac Pilot program
• 2010-2011 Leverage the relations we have established this year to promote business
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Customer Service
We were to implement a pervasive customer service program.
• Bridge Builder program initiated: Awareness created and it was made part of our QA process. Ongoing training and discussion of daily concerns involve the associated bridge builder.
• CNA Mentor Program Implemented with success – members recognized in all staff and will participate in interview process.
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Customer Service
2010-2011 Initiative:
• Joe Groten scheduled to train facility on New Bridge Builder and 24 hour Experience process
• Bridge Builder Champion Selection to ensure continued focus
• Experience Excellence Program: 24 Hour experience with F/U welcome packet and red carpet treatment
• Customer Service Woven into the fabric at Orientation. Every presenter has a segment on Customer service and its importance
• Mentor Program to be expanded to other departments and positions
• Family Council Meeting: First meeting to be held on October 20th
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
What We Do
We Don’t Sell Stuff
Our Business is SERVICE!!!
In 2010 a major ingredient was missing
Center 2008 M2 2008 M2 Market Share
2009 M2 2009 M2 Market Share
MS Chg
Center Name
Beaufont 35 20 39 20 -----
Laurels of Willow Creek
50 29 54 27 -2%
Envoy of Stratford Hills
34 20 38 19 -1%
Envoy of Westover Hills
29 17 26 13 -4%
Laurels of Bon Air
25 14 40 20 +6%
Total M2 Volume
173 197
Beaufont M2 Market Share Trends 2008-2009
2007 2008 20090
500
1000
1500
2000
2500
0510152025303540455055
23.0
17.0
26.0
409316
518
1770 18532031
Medicare Discharges Center Admissions Market Share
Market Share TrendShare Analysis- Total Discharge Based
CJW Medical Center
Market Share TrendShare Analysis- Total Discharge Based
2007 2008 20090
50
100
150
200
250
300
350
400
450
0510152025303540455055
6.010.0
16.0
20 3662
316357
398
Medicare Discharges Center Admissions Market Share
St. Francis Medical Center
M2 Actual and Budget
Beaufont Health and Rehab Center
Sept '09
Oct '09
Nov '09
Dec '09
Jan '10
Feb '10
Mar '10
Apr '10
May '10
Jun '10
Jul '10 Aug '10
0
10
20
30
40
50
60
70
M2 Actual M2 Budget
What Does this mean
?
We experience essentially no M2 growth from September 2009 however the M3 average grew by
13.
As our Census Budget our Actual numbers plummeted
Inefficient Discharge ProcessDisengaged Admissions Dept
Total Admissions from all Sources
Beaufont Health and Rehab Center
2005 2006 2007 2008 2009 2010 projected0
100
200
300
400
500
600
316 309
409
316
518501
12 17 16 25 34 34.56 16 20 36
62 72
Chippenham / CJW St. Francis
St Mary’s Medical Center Specific Admissions
Beaufont Health and Rehab Center
2005 2006 2007 2008 2009 2010 YTD
0
5
10
15
20
25
30
35
40
12
17 16
25
34
23
St Francis Medical Center Specific Admissions
Beaufont Health and Rehab Center
2005 2006 2007 2008 2009 2010 YTD- Aug
0
10
20
30
40
50
60
70
6
1620
36
62
48
CJW Medical Center Specific Admissions
Beaufont Health and Rehab Center
2005 2006 2007 2008 2009 2010 YTD- Aug
0
100
200
300
400
500
600
316 309
409
316
518
334
Total Admission Volume
Beaufont Health and Rehab Center
2005 2006 2007 2008 2009 2010 Projected0
100
200
300
400
500
600
700
800
900
1000
477 481
566614
778
873
Competitor Analysis – The Laurels of Willow Creek
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years (54 m2 avg)
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Competitor Analysis – Laurels of Bon Air
Beaufont Health and Rehab Center
Laurels of Bon Air: (An Emerging Strength)25 to 40 M2 growth (2008-2009) --- 70% growth and 6% market share increase
5 Star FacilityZero Deficiency Survey 2010
Private rooms for short term patientsPhone service in every room
Administrator is a Laurel (18 years) Served as admin at University Park and Bon Air)
Competitor Analysis – Tyler’s Retreat and Iron Bridge
Beaufont Health and Rehab Center - The Butterfly Effect
Saber HealthcareCreated in 2001 ( Purchased 2 facilities)
2009 Total of 29 Facilities
William Wesberg ( President/Owner) Turn Around Expert – Fix Failing Homes Focus on Census and Development Father was a Nursing Home Admin
Competitor Analysis – Tyler’s Retreat at Iron Bridge
Beaufont Health and Rehab Center
Tyler's Retreat at Iron Bridge – 90 Bed Facility
New Facility – Large Rooms
60 Private rooms
14 Miles from CJW
Growing population of Skilled Patients AVG M2 24
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Center StrengthsCombating the Enemy
• Hospital Proximity
• Strong team communication and follow-up
• Physician Services – Daily Visits and intervention
• Rehab Gym – Lifeworks, State of the Art Equipment
• Rehab Team – Recovery Map
• Bridge Builders
• Excellent Relationships with our primary referral centers
Next Level Building
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Center StrengthsOutcomes
This will help to separate our services from
our competitors. No one can actually prove their therapy outcomes.
Discussion with hospitalist group – They want outcomes
Now tracked on PPS
New AD to send patient specific outcomes to case managers
Rehab Manager to visit orthopedic surgeons to discuss
Outcomes
Community Based Advertising
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Center Branding and Awareness
• Seminar Advertising
• Radio Advertising
• Ruritan Club Membership and Involvement
• Partners in Healthcare Seminars
• Church Group Community Service – Health Fair
• Church Group Community Service – LTC Planning
Hospital Based Advertising
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Center Branding and Awareness
Key Case Managers• Penny Woods• Leander Mondrey• Marrianna Thatcher• Sybil Jones
No True Relationship definite room for growth
Ground work has been laid for the new AD to build the
relationship with these. I have set the understanding that they will fully know what makes us
different.
Top Level Relationship Building• Peter Marmerstein – CEO• Sharon Hayes – COO• Jody Parker – Case Management Director
Developed Partnerships for ARC
Selected Exclusively to Pilot anew HCA Cardiac initiative
Personal Invitation from CEO to Attend quarterly meeting to improveHealthcare.
Hospital Based Advertising
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Preparing the Product
What do Residents Think?
What do Employees Think?
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
My Inner View Survey Results - 2010
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Dining Process
Implemented our Fine Dining Process in Feb 2010
2010 My Inner View Score 76% (National Average 72 - 2011 Goal 85%• New Dining Room Process Audit
1. Monitors Staff interaction 2. Service Flow3. Infection Control Items 4. Suggestions
Ensure Restaurant Style Dining that the quality of food is consistent
New RD and Dietary Manager will be vital in the implementation.
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Quality Nursing Care
Quality RN/LPN Care: 14 percentage points lower than our peers
• DON to hold 15 minute meetings with her leadership team and set specific goals for the week and measure their success
• HR manager to assist in situational leadership and management for the DON and concentrate on top notch customer service to ensure that nurses understand the meaning of quality service and appropriate communication
• Improve the interviewing and hiring process with focus on panel interviewing and involving the Unit Managers along with other nurse management individuals.
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Quality CNA Care
Quality CNA Care: 2 percentage points lower than our peers
• Engage the CNA mentoring program with Department support along with constant recognition of facility mentors
• Extended orientation class to include ongoing BASIC CNA skills classes delivered as refresher course
• Closed units implemented July 1. CNA’s hired for specific units ( LTC vs Rehab)
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Clinical Outcomes
Goal: Clinical Systems to be implemented at 100%• For our Revisit we are promising 0 deficiencies• 3 star in quality measures• Clinical Indicators are our guide to quality and success• 0% in-house by Ensuring Weekly Skin
monitoring/sweeps • Continue trend of decreasing falls ( Behavioral
Committee and Tracking through Falls instrument)• Falls as an IDT – Psychiatrist to intervene when
necessary – Discussion of appropriate interventions and if they are successful daily and in QA
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Clinical Outcomes
Slip in the clinical product
– 7 systems down from 8 last inspection
– 3 Stars in quality clinical outcomes down from 4 stars
– My Innerview results significantly lower than national average
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Clinical Outcomes
• Leverage the Medical Director to Funnel Patients and help with developing relationships with key referral Partners
• Nursing Administration Team– Management Training and Support– Reduce Turnover and Bring Stability to Nursing Staff
• Leverage Strong Nurse Consultant to Help Implement Systems
• Emphasize QI/QM Reconciliation, Med-Pass Audits, MAR/TAR Audits
• Unplanned Discharged Monitoring through War Room Process – Staff Developer Engaged to provide case review when necessary
• Manage to Systems and not People
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Employee Relations
• Most Recent Employee Opinion Survey Rated as an Orange
• Much of unrest is due to changes: MDS, physical plant, focus on facility vision ( LTC vs Short Term Rehab), Rehab Focus of Productivity.
• Top Concerns: Staffing, Communication between shifts, Supplies being available.
• Staying in front of the staff – communicating at every opportunity especially in all staff to reduce probability of confusion. Having the plan in place prior to changes occurring. (expect the change)
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Employee Relations
• Staying in front of the staff – communicating at every opportunity especially in all staff to reduce probability of confusion. Having the plan in place prior to changes occurring. (expect the change)
• Communicating the upcoming events prior to implementation – ensuring they feel as if their voice is heard
• Employee Recognition through Making a Difference Program.
• “Bumble Bee” Team- Focus on morale and employee events. Meets Monthly
Turnover and Retention Trends
2008 2009 20100
20
40
60
80
100
120
38.9246.63 44.7
107.198.57
90.19
Turnover Retention
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Labor Hour and Expense Control
Precisely Manage to Adjusted Census Levels
• Goes hand and hand with creating a “Census Culture”
– Knowing census daily and managing their department from a PPD standpoint
– Department Heads Report daily on PPD’s, Staffing and that days plan to correct if necessary
– From Staffing to Expenses using staffing adjustment sheets and Budget spend down sheets weekly
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Labor Hour and Expense Control
Manage Overtime Aggressively - Below 2%
• Staff to take ownership in their department through monitoring time punches, meal breaks, staffing needs, being good stewards of the resources that have.
• Open Positions make it difficult to manage this component.
• Instill “It Is My Money” Mentality
Operating Vs Patient Days
Beaufont Health and Rehab Center
Sept '09
Oct '09
Nov '09
Dec '09
Jan '10
Feb '10
Mar '10
Apr '10
May '10
Jun '10
Jul '10 Aug '10
0
50
100
150
200
250
Operating Linear (Operating) Patient Days
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Cash Collections
• Weekly A/R Meetings ( BOM and Administrator) with Consistent follow-up and note documentation – collection on small amounts as well – focus on A/R clean up – Admin to assist.
• 5 months in a row currently with a pick up from diligent A/R Activity
• Ensure collection policies are followed– Warrant and Debt not last step– Private pay residents paying up front
• Back-up admissions team in place to insure that we get contracts signed – Contract Status to be discussed daily
• Backup team to include department heads have been trained on the electronic contract process.
• Verify payor source prior to and on admission• 5 day discharge planning meeting addressing potential financial
concerns early on.
Measurement of Our Success
Annual Survey Results
Resident Satisfaction
SurveyQuality
Indicators
Bridge Builder
Feedback
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
Beaufont Health and Rehab Center
The Laurels of Willow Creek
Long standing relationships at Johnston Willis Hospital
M2 Market Leader several years
2 miles from Johnston Willis Hospital
Physical Plant dull and unattractiveTherapy Area unimpressive - Basic Equipment
Strategic Focus Summary
• Position to be the pre-eminent provider of high quality, customer-centric, transitional rehabilitation services in the Richmond market.
• Accomplish this strategy by executing the following initiatives:– Effective marketing, positioning, and Relationship Building .– Implementation of a pervasive and complete Customer Service
program and culture.– Improve Clinical Outcomes with a focus on system implementation– Improve employee relations by focusing on retention via
employee customer service, communication, and training.– M2 Market domination – Averaging 55 m2 census through
messaging and continued presence.