Strategic Mapping & Strategic Mapping & Program AlignmentProgram Alignment

Aligning Experiences – Expectations – Resources – Outcomes

May 24, 2005 TAHSA Annual Meeting - 2005 2

Session Agenda1. Introduce Sears2. Introduce Project Initiative3. Review application of Choice in dining service4. Present process for mapping from a strategic

objective to a tactical initiative5. Conduct the Mapping Exercise for Craig6. Conduct the Mapping Exercise for the Corporate

Program7. Review Process, Q & A

May 24, 2005 TAHSA Annual Meeting - 2005 3

Session Objectives

1. Discuss need for new service options

2. Introduce Choice as a service culture

3. Present process for mapping from a strategic objective to a tactical initiative

4. Discuss outcome benefits and barriers

May 24, 2005 TAHSA Annual Meeting - 2005 4

SMRS Strategic Objectives

1. Community of Choice

2. Financial Enhancements

3. Quality of Living/Quality of Work

4. Operational Effectiveness

May 24, 2005 TAHSA Annual Meeting - 2005 5

The Customer Value Of Positive ExperienceA Memorable Feeling Created By You As A Result Of Us

Relative Customer Value

EXPERIENCE

SERVICE

GOOD

RAW MATERIAL

Source OfCustomer Loyalty

Created WithinThe Customer

Created ByA Provider

May 24, 2005 TAHSA Annual Meeting - 2005 6

Operational Culture

Rhythms of Daily Living is an operational culture that aligns resources and expectations of service experiences. RDL works in collaboration with initiatives of environmental culture change advocated by other organizations. The core service model for liberating residents and staff from an institutional paradigm is dining service. Dining is a catalyst and enabler to initiate change across coordinated services.

May 24, 2005 TAHSA Annual Meeting - 2005 7

Rhythms of Daily LivingRhythms of Daily LivingThe core of RDL is the opportunity to exercise choice residents’ for how they choose to live their day and staff choice for care delivery. This creates a collaborative coalition of residents and caregivers working together in a living environment. RDL facilitates the delivery of care, the experience of living and the dignity of self-determination.

RDL is a management principle that aligns the natural rhythms of residents and the support they need. The organizing principle of RDL is that people should be able to make meaningful choices in their daily lives – on their own or with assistance. RDL relies on caregivers to help define and achieve outcomes that balance individual choice and system efficiency.

May 24, 2005 TAHSA Annual Meeting - 2005 8

“Some facilities studied, usually the lower turn-over ones, were in the process of thinking about how to increase individualized care. For example, the researcher asked, what are you doing if anything about resident choice. ‘We are looking at it. Ideally, we want them to eat when they want. We encourage them to tell us what care they want, a shower or bath, or to get up when they want.”

Page 5-49 Appropriate of Minimum Nurse Staffing Ratios in Nursing Homes, Phase II Final Report prepared by Abt Associates for the Centers for Medicare and Medicaid Services, December 2001.

May 24, 2005 TAHSA Annual Meeting - 2005 9

Alignment

The appropriate positioning of systems and resources to attain a defined goal, mission, outcome or culture

May 24, 2005 TAHSA Annual Meeting - 2005 10

When Landing A Plane, What Is The Main Thing? 1

1. Concepts and Diagrams From The Power of Alignment - How Great Companies Stay Centered and Accomplish Extraordinary Things By G. Labovitz/V. Rosansky

Left Of RunwayAltitude Too High Aligned

Air Speed

Cross Winds

Altitude

Wind Speed

Pitch

May 24, 2005 TAHSA Annual Meeting - 2005 11

The Main Thing For SMRS

Choice

May 24, 2005 TAHSA Annual Meeting - 2005 12

Plan Transition Process and Commit ResourcesWrite Program Transition Budget and Operating Narrative

Organize

Codify

Organize For Culture Change Establish “Experience” Alignment Teams To Define/Implement Transition

Codify Policies/Procedures and Training By Function Write & Task Procedures/Training Using RDL© Base

Choice Dining AlignmentPlan and Develop

Plan

Evaluate “Readiness” With Leadership, Managers & Residents/FamiliesDefine Outcomes Baseline and Expectations

Evaluate

Define Define Service Functions and Outcomes For Each ExperienceIdentify Beneficiaries/Benefits and Diagram Service Functions

May 24, 2005 TAHSA Annual Meeting - 2005 13

STRATEGIC OBJECTIVES – TACTICAL IMPLEMENTATION PROJECT MAPPING

As dining options and program enhancements are discussed, specific initiatives are defined and envisioned by department management and staff. These new “dining experiences" require a specific definition process from concept to strategic alignment to tactical implementation.

Executive and Board leadership must clearly identify specific strategic organizational considerations. Leadership must clearly define their expectation and measurement of a successful contribution to the community strategic vision. This must take place prior to the initiation of Map 1.

May 24, 2005 TAHSA Annual Meeting - 2005 14

STRATEGIC OBJECTIVES – TACTICAL IMPLEMENTATION PROJECT

MAPPINGThe following are the task requirements for this process:1. Identify Service Initiatives 2. Define Their Contribution To Strategic Objectives3. Define Appropriate Measurements Of Successful Experience

Outcomes4. Identification Of Resource And Operational Intersects5. Identification Of Intersects And Roles Of Other Contributing

Departments6. Structure Of The Process For Resource Allocation To Develop The

Defined Initiative7. Sequencing Of The Tasks8. Implementation of the Initiative.

May 24, 2005 TAHSA Annual Meeting - 2005 15

Map Process #1, 2 ,3 Strategic Objectives

Community of Distinction

Financial Enhancement

Quality of LivingQuality of Work

OperationalEffectiveness

Map#1Strategic Objective Benefit

Map #2Benefit Measure

Measurement Tool

Map #3 Administration Regulatory Operations Personnel PP&E Community

Operational Resource Requirements

Budget Impact $/FTE’s

May 24, 2005 TAHSA Annual Meeting - 2005 16

Map Process #4, 5Map #4CollaboratingDepartments

Nursing Resident Services

Therapies Pastoral Housekeeping Maintenance Activities

Task

Map #5TaskImplementation

Nursing ResidentServices

Therapies Pastoral Housekeeping Maintenance Activities

Procedure

Policy

ResourceRequirement

Inform/Train

Measure

May 24, 2005 TAHSA Annual Meeting - 2005 17

Project Management

ID Task Name

12 Review Horizon Proposal

13 Approve and Accept

14

15

16 Organize

17 Presentations of service concept and education

18

19 Define

20 Review community operational expectations & outcomes

21 Identify and assign measurements

22

23 Plan

24 Coordinate Plan for Installation

25 Develop Plan for Coordinated Training

S M T W T F S S M T W T F S S M T W T F S S M T W TApr 25, '04 May 2, '04 May 9, '04 May 16, '04

Craig MethodistWindflower Dining Program

May 24, 2005

Aligning Experiences - Expectations – Resources – Outcomes

May 24, 2005 TAHSA Annual Meeting - 2005 19

Discussion TopicsCurrent Operations OverviewSelection of the InitiativeContribution to the Strategic ObjectiveBenefit MeasureOperating Resource RequirementsCollaborating DepartmentsDevelopment and Sequencing of tasksImplementation Review of Project

May 24, 2005 TAHSA Annual Meeting - 2005 20

Current Operations1. 64 Cottage Homes

2. 108 Apartments

3. 40 Assisted Living Apartments

4. 60 Bed Nursing Unit

5. 60 Bed Alzheimer's Unit

6. 109 Canyon’s Apartments (Lunch Only)

May 24, 2005 TAHSA Annual Meeting - 2005 21

Selection of the Initiative

1. Improve quality of meals

2. More resident choice

3. Faster response to resident needs

4. Positioned for additional possible future initiatives

5. Maintain our position as a preferred service provider

May 24, 2005 TAHSA Annual Meeting - 2005 22

Contribution to the Strategic Objective

1. Provide First Class Services

2. Enhance Residents Choice

3. Continue to Build Census

4. Develop “Seamless Service”

May 24, 2005 TAHSA Annual Meeting - 2005 23

Benefit Measure

1. Community: Best of Amarillo2. Financial Enhancement: Record breaking

Census 3. Quality of Living: Improved Satisfaction4. Quality of Work: Direct Interaction with Staff5. Operational Effectiveness: Less Waste

May 24, 2005 TAHSA Annual Meeting - 2005 24

Operating Resource Requirements

1. Administration: Co-Develop Plan, Approve finances

2. Regulatory: TDHS Involvement

3. Operations: Develop- Procedures and Operating Plan

4. Personnel: Staffing Requirements /Training

5. PP &E: Design Facility and Spec. Equipment

6. Community: Resident Involvement

May 24, 2005 TAHSA Annual Meeting - 2005 25

Collaborating Departments

1. Nursing:

2. Resident Services

3. Housekeeping

4. Maintenance

5. Activities

May 24, 2005 TAHSA Annual Meeting - 2005 26

Development & Sequence of Tasks1. Dietary

2. Administration

3. Corporate

4. Nursing

5. Environmental Services

6. Activities

May 24, 2005 TAHSA Annual Meeting - 2005 27

Implementation

1. Construction /Equipment

2. Staff Training / Procedures

3. Opening Plan in Phases

4. Daily Review of Operations

Sears MethodistCorporate Dining Program

May 24, 2005

Aligning Experiences - Expectations – Resources – Outcomes

May 24, 2005 TAHSA Annual Meeting - 2005 29

SMRS Operational Initiative

1. Resource Leveraging

2. Consistent Standards

3. Collaboration with Other Departments

4. Common tools & systems

May 24, 2005 TAHSA Annual Meeting - 2005 30

Sears Dining Mapping ProgramStrategic

Objectives

Community of Distinction

FinancialEnhancement

Quality ofLiving

Quality ofWork

OperationalEffectiveness

Map#1StrategicObjective Benefits

CORPORATESTANDARDS-SANITATION

ESTABLISHSEARS

STANDARDSAND

MAINTAINMARKETBRAND

ASSUREHIGHEST

RETURN ON RESOURCEINVESTMENT

HIGHLEVELS OF SERVICE &QUALITY

AREEXPERIENCED

BYRESIDENTS

DAILY

MAXIMUMUSE OF

AVAILABLERESOURCES

May 24, 2005 TAHSA Annual Meeting - 2005 31

StrategicObjectives

CommunityOf

Distinction

FinancialEnhancement

Quality ofLiving

Quality ofWork

OperationalEffectiveness

Map #2OutcomeMeasure

- POSITIVE STATE SURVEYS

FOR PUBLICREVIEW

- CLEANERCOMMUNITIES

- REDUCED LABOR - IMPROVEDEQUIPMENTMAINTENANCE

INCREASED RESIDENT SATISFACTION

IMPROVEDWORKENVIRONMENT

LESS TIME SPENT MONITORING SANITATION

Measurement Tool

- 0 DEFICIENCY- HIGH LOCAL BoH SCORES

- LABOR COST PER RESIDENT DAY- EQUIPMENTREPAIR COST

QUARTERLY RESIDENT SURVEYS

STAFFRETENTION

MEALS PER LABOR HOUR

May 24, 2005 TAHSA Annual Meeting - 2005 32

Map #3Operational Resource Requirements

Administration Regulatory Operations Personnel

SANITATION STANDARDS

SUPPORT DIRECTORS WITH SITE VISITS

STATE SURVEY PROTOCOLFEDERAL AND STATE REQULATORY REQUIREMENTS

OPEN & CLOSE CHECK LISTSDAILY WALK THROUGHSWEEKLY INSPECTIONSCLEANING PROGRAM

DIRECTOR TRAINING ON PROCEDURES AND FORMSSTAFF TRAING ON CLEANING TECHUICHNES

Budget Impact $/FTE’s

$100 PER CAMPUS FOR TRAINING COST

REDUCTION OF .35 DISHWASHER FTE

Strategic Objectives Strategic Objectives

Community of Distinction

Financial Enhancement

Quality of LivingQuality of Work

OperationalEffectiveness

May 24, 2005 TAHSA Annual Meeting - 2005 33

Map #4Collaborating Departments

Nursing Resident Services

Therapies Pastoral Housekeeping Maintenance Activities

Task

Map #5Task Implementation

Nursing Resident Services

Therapies Pastoral Housekeeping Maintenance Activities

Procedure

Policy

Resource Requirement

Inform/Train

Measure

May 24, 2005 TAHSA Annual Meeting - 2005 34

Contact

Dan Look – 770-565-4006

Dining Management Resources, Inc.

3605 Sandy plains Road

Suite 240-269

Marietta, GA 30066

dcl@dm-resources.com

www.dm-resources.com