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okay everybody this is Seth Sinclair good afternoon or maybe good morning depending on where you are I am the president and CEO of plan for healthcare again thank you all for taking the time to join today I'm coming to you guys from Northern Virginia where we are getting pummeled by a pretty good snowstorm outside and so I've been a little bit nervously watching the the weather and hopefully I don't lose power right in the middle of this webinar if we do I think I have a back-up plan but so let's hope that goes smoothly and I'm here today to talk about this idea of business planning and business planning best practices and how they can specifically benefit VA medical centers these are planning best practices that really would benefit any organization but for today the focus will be on VA medical centers and we'll take a detailed look at how this model can unfold inside a VA hospital organization so for the webinar today we will talk about start by talking about the general planning challenge that every Medical Center faces to some degree and then I'm gonna link that into how business planning helps address that planning challenge we're gonna talk about how what does a business planning process look like how is it organized what are the outcomes what do you need are there downsides what are the challenges that go along with trying to run them on this and what are the key success factors I'll summarize we'll do questions will end promptly in an hour I can promise you guys that will stop at 1:00 p.m. Eastern and if you do have questions through the session you can use the GoToWebinar functionality to submit those I may not be able to get to them right away but I will at the very least do my best to try to attend to those by the end I will be reporting this webinar and for folks who have registered we generally will send them back out and so you can share it if you've got anyone else in your organization that might want to see this and then we also do post these or I can share a link with you guys where all of our webinars are posted online so just a quick personal introduction Who I am against at Sinclair I have been working for many years in the area of management consulting leadership development and strategic and project planning I actually grew up with a father who worked in VA he retired as a senior executive back in 2003 which is a long time ago but that was you know made a big impression on me in terms of understanding VA and valuing it as an organization and just professionally I personally had the privilege of working with a very wide range of VA organizations that goes back over 12 years I've worked with everyone from certainly VA hospitals in the field to central program offices VBAC FM so I've really touched on many parts of the organization the methods and best practices that we're going to talk to you talk about today are they really they come from work that I started doing out in the field with VA medical centers as far back as 2011 and that was work that was being done with teams of very experienced subject matter experts folks who spent long careers in the organization who worked their way progressively up from staff levels all the way up to the highest levels of senior administration both in terms of Management administration and finance and so having the opportunity with those those types of people with that expertise to look at what works and put that together that's really the foundation that we've built on and that we'd like to talk to you about today okay so why does it matter why are we even talking about this or why would anybody have any interest in this idea of business planning well it goes back to a planning challenge that every VA Medical Center to some degree face every year I completely recognize that all medical centers are unique in some way I you know we've had the opportunity to work with some of the largest in the system in urban settings to some smallest in very rural settings and so I've seen the wide range of organizational characteristics that are in the VA system but that being said they are all going to face a similar set of decisions and constraints first every Medical Center has got to figure out their local priorities and leadership is tasked with asserting those specific goals objectives and initiatives that they wish to accomplish at that local level so we know oh and again systematically VA has some system-wide goals and priorities we'll talk a little bit more about that but at the local level there needs to be clarity on what the organization is trying to accomplish for at least one to three years into the future then the next thing that needs to be understood is what are the operational needs and resources that are required to achieve those priorities so we're talking about things like staff and you know other things that are cost money find control points dollars associated with those contracts whatever they might be facilities so you've got this operational component where there has to be a clear picture of what does it take to operate the organization in accordance with the priorities that leadership is trying to execute and then of course there's a third major component to this challenge which is figuring out how do we get all this stuff done within our budget with with what we can't afford there obviously is a limit every Medical Center is going to get a budget there's only so much in terms of their resources that they're going to be able to use so the question that's posed to leaders at every Medical Center is how do i align this organization how do I line up my operations in order to achieve the priorities that are important here in a way that is financially responsible and that's a process that needs to happen every fiscal year again not easy so maybe variable some sites as we know may be in a very tight financial position some maybe have more resources either way the challenge of trying to figure out how to best apply those to a line to priorities and operations is always going to be the question that must be addressed now there are other things that make this difficult there are other you know attributes of these organizations and challenges that we've observed over the years that we know make it hard to do a good job tackling this planning challenge certainly one is that there is no standardized process across the system for performing this facility level type of planning that we're going to talk about today there's not a consistent tool set for some sites they you know do almost nothing with this type of planning others have homegrown tools if you will but there's not a consistent set there's varying philosophies from site to site and the way to approach planning so you end up with different approaches and this is a major one I really do empathize with the leadership teams at many of the medical centers who they might want to take on this type of planning but because they are you know often consumed with the fire of the day if you will whatever it might be whether it's you know sales scores that are you know really putting pressure on leadership there might be media attention there's other mandates and things that are pushed down that must be handled with urgency so leadership really struggles often to be proactive to get ahead of the game and to be able to look forward with their planning it doesn't help when you have a leadership turnover which we know there can be quite a bit and so if a medical center director and associate director chief of staff you know certainly the fiscal leadership the HR leadership if these positions are turning over on a regular basis it makes it very difficult for that organization to be able to get a grip on this planning challenge okay we know priorities are changing administration change the the focus of the organization changes some of the models requirements that are pushed down again are changing you know right now everyone's trying to figure out what is the implication going to be of the mission Act and the new standards which is just another very very timely example of you know what does mean from a planning perspective sites have different levels of business acumen some have the data some have the expertise if you will to plan effectively and some don't and then just historically speaking a lot of VA hospitals do tend to operate in a siloed manner meaning the services don't necessarily talk to each other through the planning process and so it makes it difficult to really achieve good integration if you will from a planning perspective and then of course as I mentioned every say it's got their unique considerations maybe their geography what are the things they do there what are the services they offer what is the demand going forward and so how all of those things come together within a planning framework all right so all these things make it hard but that's why we've got a model here calling business planning as a way to help tackle that it's not the only way but for the purpose of this call we're going to talk about it as a very very effective way can be a very effective way to take on this planning challenge so let's jump in and take a closer look so of course I've got to start with the definition and we'll start with a very simple saying a business plan is something that defines a framework for operational and financial success so again going back to this planning challenge that framework is going to need to incorporate priorities operational needs and factor in the financial parameters so a business planning process is one through systematically those all come together that's going to be informed again by goals and priorities very significant service level input and then everything is being balanced and weighed against the financial constraints okay and just a word of caution I think semantics become challenging when we talk about this I do recognize that when we you know mention strategic planning tactical planning operational planning budgeting and then now I'm throwing in business planning and so folks will say I don't really understand the difference what do these things really mean are they really distinct from each other are they truly the same thing and I don't want to get too caught up in that obviously I'm going to try to differentiate and focus on business planning but one thing that does help is for any organization that's going to this type of framework it is very beneficial to establish a common language and understanding so we can be clear about how those different elements of planning all do work together and how they are different and from each other so just keep that in mind and I will speak to that more as we move through the presentation okay so what I'd like to do here is give you guys really the highest level view of how business planning works and again the foundation for business planning should be the facilities priorities right of course they are also being influenced by broader organizational priorities but that is the foundation from which business planning proceeds from there then we have this jumped ahead hold on one second we have this bottom-up type of input there's a very strong bottom-up component to business planning and so every service in the medical center puts together a comprehensive business plan for the coming year so of course as we move forward I'm going to talk about the details of what goes into those now once those plans are developed everything comes forward for management review leadership is going to look across everything and they're going to evaluate all of these plans in the context of priorities and resource constraints all right so they're gonna have to do some math they're gonna have to look at their budget allocation they're going to look at that allocation and they're going to dig into it to figure out what really do they have discretion on and what is sort of fixed and from that they're gonna be able to assess what can we afford what does this budget permit us to support and then from there that through you know continued review dialogue feedback and we'll talk about the process in more detail is when all of that will come together all of this input from the service level through this manage review is pushed together to form one integrated facility business plan and then from there that then results in a feedback loop to the services to help them finalize their individual service plans okay so that's the big picture of business planning how the dots are connected and this is again something that would be repeated on an annual basis when this is done if you get through this process it puts the organization in position to move into the next fiscal year with this framework for success in place all right so for the rest of the presentation I'm gonna go into a lot more detail about what's happening in some of these areas and then we'll get into the considerations at the local level for what does it take to get this done I did mention again I wanted to try to show where this concept of business planning fits into a broader planning hierarchy right so here you see sort of a classic planning structure you've got mission at the highest levels mission then begets strategy strategy is trying to answer the question at the highest levels of well how are we going to accomplish this mission of course we know the mission in in VHA is very clear and so then that is then translated into broader strategies that's where you know there's influence at the administration level certainly and at the Vaiko level they're going to be tailoring that usually those are five year time horizon that's then further decomposed down into more specific goals and then as that then is pushed down into the network level they become progressively more detailed and then that's decomposed all the way down to the Medical Center level and it begins to show up in the form of detailed objectives priorities goals and again don't let the semantics confuse us too much but bottom line is as you get to the Medical Center level they become more clear you answer the question of how are we going to fulfill these goals here in this organization and what is important to us locally and then that needs to translate down into operating plans and budgets and so that's really where business planning fits business planning fits at the level at the Medical Center level and it is the process through which the organization can translate the goals that have been handed down and those priorities that have been developed at the local level into an operating plan that's how business planning relates to the other aspects of this broader planning hierarchy all right so let me this is just a really high level look at characterizing business planning and comparing it against I'd say sort of more traditional I'll use the term old school planning philosophy that we've observed and when I say old school I really do mean old school I don't think there's still a lot of medical centers that truly run the way that I'm characterizing in this traditional planning although I've seen examples that are pretty similar to this in an old school kind of approach to planning most of the planning is done in a very centralized top-down fashion so it's it's leadership and fiscal that really are you know the primary decision makers they are primarily using prior year foundation from which to look at the needs or plan for the coming year okay so this is sort of the whole at the most simple level this is the idea of taking a budget or a plan from the prior year and doing the old copy to this year and plus it up a little bit okay and you know it can work but what becomes difficult is when organizational priorities shift that model doesn't really it's not very agile it's difficult to then shift the overall operational and budget aspect of planning to align back to the priorities so it tends to be a bit more reactive and in that model the staff is not very engaged at the service level your service chiefs planning is more dictated to them you know resources and expectations for accomplishments are pushed down and services are expected to proceed as tasked okay now I'm not I'm not necessarily going to say that this doesn't work or is inherently bad there are organizations that manage very tig tly in this way and can can be successful now on the other side if you implement a full business planning approach like we're talking about here today it is much more decentralized it does have that very strong bottom-up component where services are feeding the planning process if you will there's a lot of communication and feedback a lot of dialogue throughout this process both upward to management and downward if you will back to the services and then I would even say horizontally if you think about it that way across services and everything is very need-based all the planning is tied back to priorities and therefore as they change from year to year there is the ability to shift priorities and to shift resources towards the greatest area of need if you systematically implement it if you run a model like this and you do it in preparation for each fiscal year it is very proactive and it established as a foundation that leadership can use to react to in the year if things do change okay but proactive for developing a foundation and then gives you the ability to react as needed because you already have a solid plan in place and then this model is very highly engaged in terms of service Chiefs being a part of it contributing but owning their plans as well and becoming managers of their resources you know once we get through the planning process now what I see so when I go out into the field and you know working with sites on putting models like this in place what I am most typically see is a little bit of a hybrid probably between these two you know these two philosophies here in in most cases what I'll see is sort of a I'll call it a budget call model where services are a part of planning they are asked for input into planning for the coming year but it's often limited to resource only and even within resources sometimes it'll really be focused on you know fund control points or overtime for example and the gap that I'll see is the services aren't being asked to really build a comprehensive plan where they have their detailed objectives and priorities and action plans okay and so that's a little bit of forced chatting when we talk about what what goes into business planning but that's the gap that I normally see and again now I have seen facilities who certainly are closer to implementing a full business planning concept there may be some details that are tweaked timing is certainly something that can vary the level of detail that they expect this or services to go into and planning the level of transparency and collaboration when it comes to decision making those are all things that might vary from site to site but there are sites that are very close to taking that approach all right so I wanted to give you guys kind of take a step back before we drive down into detail and look at a business planning cycle from a holistic perspective and within the view of sort of an annual picture okay and if you're able to see I understand it might be a little small depending on your computer in your screen what you're gonna see here is this starts with this step number one up here in the voucher one o'clock if you will on the screen and it all again begins with setting those fiscal year priorities all right and so in a perfect world if I were to draw this up ideally yeah and this is based on my experience and what I've seen work well that spring time early year is a great time for that to happen all right and we've actually done a whole other webinar on strategic analysis and what a strategic planning looks like we've got two of those actually so I'm not going to talk too much about what we would recommend would happen in order for those priorities to be developed but I again would say that this is a great time of the year for that thinking to happen and at least by April May at the latest for leadership to be able to come forward and say hey here's the five major things we're trying to accomplish this year all right very very important that they are clearly communicated out to the organization all right now I will say some organizations that even do employ this business planning type approach they may attempt to do that without having those priorities asserted it's not a deal breaker it's still possible to have success because there are some enduring key drivers I mean right now for example we all know access huge key driver patient experience huge key driver all every leader in VA just what was it just two weeks ago you know all together talking about patient experience so we know that that's a major key driver for the organization certainly quality certainly employee engagement in satisfaction those are enduring key drivers that even if the facility has not clearly articulated you neat priorities those can still be used as the basis to inform a planning model like this okay now as you move forward essentially what needs to happen and and and everything in here is oriented to having this business planning done before the next fiscal year begins that's really what everything in here is all about okay so in that May time frame to get organized to be able to get a business planning cycle kicked off if you will that's over here on the right number two is and then to you know get everybody working on it it get everything set up configured scheduled get your service Chiefs involved get them ticked off working on their plans and then what you want to do is give your services some time so it's it's very appropriate to give them several weeks maybe even a couple you know months eight weeks to go through that process they're very busy so we want to be respectful of that and at the same time you know we want to give them sort of a framework and deadlines to work in so we can help them get through the process right once that happens and again late July early August would be optimal the services can finalize their plans submit them and then we go through a briefing process we'll talk a little bit about that but essentially in a really well-run business planning cycle there are very comprehensive briefings given the leadership on those plants it's all part of the dialogue that is needed in order for this model to really work a lot of feedback given there okay then as we move down here right around the six o'clock we have our seventh step and that's where leadership's got to really kick into decision-making mode this is where financial parameters are defined and this is where leadership looks across all of these plans and begins to make their decisions they are asking the question based on everything that was proposed from the service perspective then how do I actually what can I actually support what do I approve what do I support and how does that translate back into plans that would then be handed back to the services okay so all of that needs to be communicated and everything then can be finalized so there's going to basically be two outputs from these okay there's going to be a facility level aggregated plan and then individual approved service level plans and if you do this right you can have it all locked up by 9:30 and as you cross over into the new fiscal year on 10 1 you are good to go you've got a very very solid planning foundation it's very integrated across the organization and you know you're able to move into the year with a family with a framework in place okay you then from there certainly you're transitioning into what we would call execution mode that's where you're actually going out and doing the work that has been defined in the plans on timing just a word I will say it's not always realistic to organize it this way there may be a bunch of different variables that make it hard to follow this type of calendar at the same time some sites actually leadership may prefer to rotate this forward clockwise if you will and in terms of the steps why wouldn't you do that well for some sites the belief is that you don't know enough about your budget in the August timeframe and even September to make all the decisions you'd like to make to finalize this business planning and I would just say that I totally understand that we've seen sites be very successful actually initiating business planning more in September October and then wrapping things up in November so they essentially use quarter 1 as sort of the planning framework and then they really execute for the remaining three quarters in the year that can work very well I would just say that I think when an organization matures to get really good at business planning they do have the ability to make good budget decisions and assumptions even before everything is known to them with their budget and then once you get into the year if more information about the budget becomes available or as it becomes available you have a framework in place to go back and then adjust the plans that were developed okay so some sites very conservative with their financial planning estimates so maybe they're very tight in terms of the resources that they have deemed to be affordable they allocate accordingly and then let's say there's a revised EM cast you know a final that comes out in December January or whatever it might be well let's say there's more resources available it's not difficult to go back in and then add those back into the organization because you've already got this really detailed framework that you can work from to go back and do that type of analysis all right so again this isn't the only way to do it but this is certainly a view of a best practice that we recommend when we are involved in helping with this all right so what I'd like to do is ask you guys to put on your hat of being a service chief okay so we you know we've talked at a macro level about how business planning works but what I'd like to do is give you guys a more detailed view of this service level experience and again this strong bottom-up component which is heavily driven by the services so what is it that we're asking the services to do what we're saying to them is all right we want you to put together a fully complete plan and it needs to touch on a lot of stuff not just resources and we want you to really systematically look at yourself and think about sort of you know who you are what do you do where do you want to go and then where do the resources come into that okay so let's take a detailed look at what we're asking them to really plan around all right so these are just some of the elements these are most of the elements and there may be others but that we are asking those services to work on in developing a plan so again the questions here's that we're challenging them to ask who are you what is your scope and mission what how are you performing currently are you doing well where are you struggling what's what are the opportunities that you'd like to take advantage of and what are some of the threats that you might need to be weary of or planning against to prevent things from happening in the coming year rent negative outcomes what does your workload look like where do you think that's going okay and then what is it that you propose to prioritize at the service level and then of course how does that drive what the facility is trying to accomplish and then then it makes sense with all of that analysis and foundation done then it makes sense to start thinking about sources so the question becomes if I were to be able to accomplish these objectives that I am asserting if I were to meet the workload if I were to take advantage of opportunities then what are the resources I would need to operate effectively in the coming year all right so again we're not breaking apart resources they are part of the planning equation for the service now I'm gonna just very briefly touch on some of the elements because we could do a whole session on this some of these are tricky but I did at least want to speak to them because the reality is if your organization is considering putting a framework like this in place you've got to come up with a way to figure out how to do this okay so I think anybody on here who works with data or who you know maybe works in a service administrative officer or whatever it might be we can probably all agree that looking at workload can be a challenge alright so that depends on the service that depends on the data quality that depends on the input certainly of data you know data capture if you will workload capture there's a lot of variables but one thing I will tell you is when you put a business planning process in place it can help with a lot of those challenges because the services become very incented to take a closer work a close look at their workload if they haven't already what we're going for without trying to here in this session tackle all of the challenges about how do you really quantify workload how do you measure it how do you compare it what we're looking for is for the service to put together a sound estimate okay we want a credible estimate of where it looks like workload is going for the coming year all right why again now you got to put your hat back on Emilia the leadership team and you're all these services are going to come in and present a business plan to you and they're going to have resource requests so the service chiefs goal is to help leadership get a clearer picture of what it looks like the workload trajectory is all right now perfection is not the goal here alright and there are some base guidelines and data points out there historical data certainly is useful all right to show trends over the you know prior periods and then there's always the opportunity to go look at some of the the overall facility projection data every facility there are demand projections there are about projections on workload by at least by if it's not down to the type of service level it's by type of service provided and so we would expect to see some correlation with those projections okay and those projections actually do a pretty good job of taking a lot of variables into account to include very specific market you know unique demand in that market and you know now throw in something like the Mission Act and you know certainly raises questions on where that's going to go but bottom line is we need the service to think about workload to be thoughtful about it not perfect but to give us a decent picture of the trajectory ultimately if I'm a director or the leadership team reviewing these I'd like to know the total percent change in workload and and have an understanding of how that then ties back to resources okay so then let's talk about these tactical objectives that we're asking the service to build okay so I would recommend that every service is building at least five if not a couple more very well-formed very smart objectives time focus is for the upcoming fiscal year some certainly can span multiple years but the typical focus is going to be a one-year focus every objective that a service writes should there should be a linkage back to one of those facility priorities or at least a key driver right and so you know sometimes the service might look at this and say hey I'm really just gonna do what I have been doing all along and the answer is there are still some objectives there are still outcome based objectives that should be framing the way that you do operate okay and so for a service to be able to define a smart objective and then further decompose them down into a mini action plan if you will that's the best practice that we're shooting for now for those of you guys that you know or may be thinking about your organization you're thinking about your service chiefs I will say you know their ability to do a good job of this does depend on their experience and planning and their business acumen sometimes there is a learning curve to get them to be able to you know put together a good tactical objective framework I can give you a plenty of examples of some that have been very poorly constructed I you know a tactical objective a bad tactical objective if you will would say bring on two more FTE ok we see those that's ok you know we certainly want to work on that a good tactical objective would be more you know improve access by 4 percent in a specific location or clinic and achieve that by you know quarter to 2020 and the from there breaking that down into you know what needs to be done is there need to be some kind of an assessment to look at gaps is there a study that needs to be done is there some space configuration that needs to be implemented and then you know certainly from there how do you know at the end whether or not you've met your goals or not all that can be broken down and should be built in to every single services business plan ok so it takes a little work but I'll tell you once you've got once you can turn the corner and get your services to build well aligned well-defined tactical objectives it is a game changer for all the rest of the planning elements that flow from there so in this business planning framework planning for resources is of course crucial and within resources FTE is the biggest chunk for most Medical Center's FTE are going to be about 65% of total resources so being able to effectively plan for staffing is a major success factor and so what we ask the services to do in a business planning framework is to take a close look at their turnover to think about the losses to think about all the back fills that need to be happening okay to think about approved positions that haven't been filled yet and to look at you know then what are new opposed positions that they are putting on the table in the context of the business plan so there's you need to leave them there needs to be a process through which they go through this progression of thinking and they are able to document a staffing plan that reflects all of these inputs and then really it should be reconciled with the services or chart ultimately we can talk more about that but asking services to do this yes they are having to look into a crystal ball a little bit if you will again if you're doing this in june/july if you were to do it this june/july looking to 2020 certainly they're not going to know everything but no one is in a better position than a service chief to make this type of planning projection right so we want we need them to provide this type of input certainly benchmarking can be a part of this analysis you can look at like facilities if they are structured accordingly there's some data out there by cost Center it's an imperfect way of comparing site to site but there are ways to do benchmarking to help that service chief be grounded in how they're putting this plan together even another aspect that can be extremely beneficial depending on how the facility ultimately does budgets and tracking is to look at the time dimension of when these things are going to happen and that can help us build a cumulative look of the total FTE need by service for the coming year and then of course can be rolled up and looked at from the facility perspective okay just a quick note on the other resource request areas when it comes to contracts fund control points over time fee providers I didn't put that on here what we want the services to do is look at their historical data validate it again there is data cleanup to be done certainly with the FTE as well right we all know tiel's can get lost fund control points who owns them contracts where are they assigned are they're being tracked and managed is over time being correctly recorded back to the service based on how the services are based on how these services are organized all of those are things that in the first year of a business planning process or taking a close look at this sometimes we surface issues okay so part of this is validating historical Dateline what do we have here before what is my service have and is it correct do we need to do any cleanup and then you're gonna make projections for these for the coming year and I'll make that argument again that they need to be connected back to tactical objectives and correlate clearly with workload and staffing okay I have seen services come in and sit in front of the leadership team and they'll bring in you know overtime requests for example and it shows a significant increase from the past year at the same time the workload projection doesn't show much change and there were also requests for additional FTE okay now is that you know typical that a service would come in and do that maybe not and it may not necessarily be wrong but we do have to empathize with the leadership teams who are trying to make tough decisions who are trying to look at their their total financial constraints and if you were sitting in that chair you would likely push back and ask the question how come you need overtime if you also have made these other projections all right so we are we are putting the service in a position to need to put together a integrated plan where the dots are connected taking it a step further when the service is sitting down to go through this exercise it is a great time for them to think about all the other things they need for the year education travel furniture space considerations equipment what a great time for them to look at all of those things do a needs assessment think about the requirements and input them into the business plan so again and a lot of facilities what we see is these elements sort of live in their own tracks and that's okay but what I would suggest is building them into business planning means they are all together holistically in one place and then they can be reviewed in a way that makes sense and everything is connecting the dots within this business plan and then everything in these individual areas can then be rolled up and when it comes to the decision making budget decision making all of these pieces can be looked at holistically and then plugged in and then in turn again all of this ultimately results back in agreements that are given to the services alright so again I just I highly recommend that those are part of this model and not left outside of it now once services have gone to the effort to put together a very good business plan then it's only fair that leadership would give them an opportunity to come in and brief it and that there would be dialogue okay so that's a best practice and so in that best practice and facilities do it different ways some will really cram it into a whole week the leadership team basically goes into a room you know you need a good you need a good space to do this by the way where the services can come in sometimes the services will bring their staff and they'll present they'll run through their plan there will be a feedback loop another best practice you're not seeing on here by the way is for the leadership member who's responsible for that service to take a look at the plan before it comes into the management briefing that saves a lot of time and can you know really hone in the presentation that's given to the leadership team we heavily recommend full ELT participation as a best practice okay and I know that's a challenge but I have seen examples where a service comes in and the ELT you know is only partially there and that can really can really frustrate the service who you know went to the trouble to put a good plan together and then you know it hampers decision-making later if you're having to revisit everything you know because folks weren't in the room at key points and during key discussions so I would just recommend that the structure is set up if it needs to be spread out over multiple weeks and scheduled that's fine very crucial that services are given detailed feedback so that they can go back and if needed make adjustments to their plans before they're finalized and then just keep in mind that if a leadership team sits through these briefings and I would even recommend that this fiscal HR maybe your Vera coordinator potentially facilities engineering it may make sense for them to all have representatives in the room because they are going to hear things from these business plans that are going to be very relevant to them and and what they're trying to accomplish for the year and so when that happens at the end of this process leadership is in a fantastic position to take a holistic look at the needs that are being set forth from the operational level okay so I'm gonna take a few more minutes to wrap this up and then I'm actually gonna breeze through an example of a service business plan but let me talk about how it all comes together here at the end all right so I'm using the term roll up roll up in my language here is the process through which all of the needs are looked at together evaluated and decision making is made so leadership and fiscal they decide what they can afford they go through that process then they actually allocate budgets to the services all right and so again it minimally that's going to be FTE overtime fine control points then that's passed back to the service in the form of an agreement it's all documented leadership can put special instructions in there so there's clarity on what's being approved okay the services then can acknowledge or sign those agreements how that's handled is different flight by site and then you move into this execution and monitoring phase with those types of service level agreements in place and facility level total plan in place everything you need to monitor your execution both in terms of accomplishing tactical objectives but also looking at resources all those pieces are there so looking at and having a governance process through which you looked at planned versus actual and to be able to see where it looks like services may be either under or over using or projected to under or over use all of that is available now we've done all the work to create that alright and then that facilitates decision making and and truly and even though I know sometimes you know some facilities or services would almost you know think of this is impossible if you use this model to its full effectiveness if you're partially through the year and you've got services who for whatever reason are not able to utilize their resources they can be reallocated to other areas of need that is actually realistic and we've seen it happen and yes you know some services may be defensive but remember business planning is redone every year so if a baseline needs to be reset it can be the last thing I want to see is for a Medical Center to go into the year and have resources that it didn't make full advantage of and that weren't put to the highest areas of need and then of course the other side of the coin is the other thing you don't want to see is a Medical Center who doesn't have a grip on this and ends up in a very poor financial position and at the end of the year is you know projecting a significant deficit which we all know is something that is not sustainable okay so benefits so again when you run a business planning model leadership is really it's a great view of the needs everything is very systematic and integrated lots of dialogue lots of feedback from leadership to services on you know I didn't really talk about it but if you think about it business planning can drive tremendous efficiencies by being able to look across the organization and seeing the needs of the different services and again starting to connect those dots with a more horizontal integration if you will this can actually drive huge financial results for an organization if this model is put in place on it really helps prioritize resources it can be very transparent this is something services really appreciate they know that they may not get what they want at the service level but at least it's transparent at least everybody understands how it works services become more attuned to the idea that the total financial the constraints of the facility are you know limit what can be done and it gives them more insight to that which is extremely powerful okay having service level agreements is just a best practice you know it's expectations its clarity and I mentioned before business planning is quite decentralized so we're empowering our service chiefs to run their service when they've got a business plan they're given you know approval to run with those tactical objectives they've got their resources they should be able to run and they shouldn't have to be coming back constantly as long as they're in their budget they shouldn't have to be constantly coming back resource committee to ask for resources okay and that that there in turn encourages them to develop their business plan and ownership and then when it comes to execution throughout the year it really is an enhanced level of communication so in order for this to work key success factors things that kind of have to be in place in order for this to be successful leadership's got to want to do it that's seems obvious but leadership has got to be plugged into this at the least they are advocating and leading the decision-making process you need someone to run the process you need an owner of business planning ad is a good champion usually sometimes someone you know the CFO or some combination of the two someone from leadership office really the whole organization has to be clear on how this works they have to agree on the principles there's got to be the data cleaned up and available okay expectations to services have got to be made clear fiscal HR other admin functions must be a part of this they're all in there at minimally they are informing the process but optimally again they're all part of the decision-making services are involved you close it out you go through the model you actually make your decisions push it forward and then we need good integration what you don't want to do is do this and then get stuck running sort of a parallel management process or a parallel legacy process that's confusing and you guys don't have the time to do that so the governance structures really need to come into place so if you were thinking about putting this model in place in your medical center for 2020 just keep in mind and there's a lot of things on here that are very similar to what I had on the last slide just keep in mind that you're gonna need a champion you've got to have all the administrative support you've got to have the horses if you will to put planning and scheduling all these events together right to communicate with the Chiefs to set up the briefings you got to get the data in there you've got to train your service chiefs you've got to teach them how to do a business plan and they need a tool to develop a business plan and you need something that allows you to build the plans and then something that allows you to aggregate the plans and do the decision-making you need a communication plan every aspect of business planning you got to get the governance structure in place and then certainly you've got to have that framework in place for monitoring okay now very quickly before I I'm gonna breeze through an example of a plan I should mention you know putting a business plan model in place does come with some challenges and risks there's no doubt about okay now as you've guessed my position is you know putting this in place is well worth overcoming these challenges and managing these risks and there's just a few here but it is time-consuming certainly compared to nothing it you know it may feel like it's a lot of work to quit business planning in place I believe the payback is there many many many times over and that the time will ultimately be saved leadership Stein keeps time because there's clarity because there has been good communication so it's gonna prevent a lot of issues downstream but when you're in the middle of doing this especially in the first year it is time consuming okay the distraction factor I understand we've seen this I just sat with the director of the other day she was telling me how difficult it is right now constantly being called out of the office again lots of focus on sale travel I mean just all these things okay it's manageable but we have to keep in mind that that can make it very difficult to execute data issues like we've already talked about the the challenge of needing to be able to support service chiefs so that they know what they're doing all right that is how do you train them you know the challenge is that and the risk is if you don't they will not buy in and if service chiefs fall off if they don't see that if they're not given clar ty on what's expected of them if they're not supported and helped along the way and if they don't understand what's in it for them they will not buy it I mentioned before sort of a partial implementation can lead to duplication which then results in frustration so for example if you put business planning in but then it doesn't really connect with your RMC process you know it's just that now it's confusing and so people have a hard time linking decisions that are made to business planning to decision making later all right and then our observation of course again is because there's sort of a lack of standard meth and toolset out there it's hard if you're starting from scratch and you don't have that resource available to you it can be very very difficult to get off the ground okay all right breezing through an example and when I say quick I mean quick this is just a viewpoint of you know a service that has put together a business plan it's going to be hard for you guys to see what you're seeing here is it being done in the tool set that we've developed for this and it was just the best example that I had to show you guys today again I did not come on here to make a sales pitch I just wanted to talk about business planning being a best practice for VA and this is just a look at one of them so this is a service who's gone through and done a qualitative analysis of strengths weaknesses opportunities and threats everything is nicely documented in here connected back to key drivers this is a view of a service doing some workload projections historical baseline the unit's customized to the service and making a projection for the coming period and being able to look at total percent change and some justification around that here's a view in the context of a business plan of a service doing what we call a make buy analysis I'm sure everybody's familiar with that but for them to look at opportunities where maybe there's more advantageous ways in house out of house purchase lease whatever it might be that is very valuable in a business plan we've seen services who have built in multiple of these as part of their business planning total business planning approach building those tactical objectives you know detailing those out building in you can kind of see down here this has been further broken into you know action items being able to roll these up look at them systematically obviously very key but again just an example of a service who's gone ahead and put those together for a fiscal year requests for the other resources making you know pulling in historical data for contracts when control points making the request for the coming year typing in justification in an explanation rolling it up to look at the total requests this is just a view of a service going in and starting to build a staffing plan down here at the bottom and that's sort of a graphical representation of the cost if you will of that staffing plan Illustrated above putting in those positions they're thinking about those losses and gains and proposed in the time dimension and building them in helps us draw the big picture equipment so you know I know most facilities are either have implemented or in the process of implementing SEPA and so you know you don't need to duplicate that in business planning but like I said before I would recommend that that discussion happens as a part of business planning so pulling those in and discussing those types of requests during business planning briefings is something that just makes perfect sense okay you know I mentioned that you know a facility is going to go through the process of calculating what they can afford so having a template that's you know standardized for that looking at all revenue looking at expenses looking at things like average salary to be able to determine what can be affordable having all that done and and you know some sites are very comfortable communicating the results of that analysis out to the services again increasing their perspective and buy-in and then here's just a view of if you put your leadership hat back on and think about them going service by service and actually beginning to plug in resource approvals if you will along with additional instructions you know this is just a view of how one way to do it of course there's other ways to do it and ultimately that all coming together to kickout service agreements that can be reviewed agreed to signed and tracked okay and then when all that's in place like I said you've got a wonderful foundation in place to transition to monitoring and that's where you can really begin to look at the comparison of actual to budget and project it to budget and engage in decision-making at the service level your Chiefs can keep an eye on this and the facility can keep an eye on this and this is the basis for resource management for the rest of the year moving forward okay so in summary you know I agree with you guys you know this is something that would benefit VA the VHA as a whole the consistent approach certainly an integrated model is something that drives alignment and decision-making it drives savings you know there's that does require leadership support and processes and tools and it does take a couple years to get it right 100% okay however even in that first year the turnarounds that we have seen are amazing in just you know one year even for an organization that did not have good historical planning discipline and you know maybe does not have business acumen in place it's year two year three where really things start clicking and they all come together I will mention one thing this is a planning model that really works well for any facility not just ones that are poor performers not just ones that need a financial turnaround again even if you're a high performer and doing well we you know the future is always going to have some degree of uncertainty and also we know that if no resources may change and so you need to have a framework no matter how well you're doing now to be able to handle those variables in the future so again thank you all our contact information is here I think you know most folks on do know that we do have best practices and a tool set that facilitates this so if you would like to learn more about about that please do contact me my information is here otherwise I just want to thank you guys all for being on today for taking the time and I will hang on here if anybody did in fact have any questions I didn't see any submitted through the chat but I will hang on in case anybody does and I will provide a copy of the webinar back to all of you so thank you again appreciate your time hope you guys are all warmer and a little less snow than we have here and we'll look forward to talking to all again in the future