Malcolm Baldrige National Quality Award - American Society for ...

It creates multiple levels of leadership review of the AP before
it is marked with an “Approved” status. At each level, the
approver has the ability to provide feedback and return the AP
back to the owner. This multi-level review ensures key
outcomes are achievable and can be sustained. Once an AP is
approved, the AP owner can proceed with recording frequent
status updates as well as creating the required quarter reports.
Work plan status updates are reported quarterly via the APQR
and include details on process measures, progress made,
lessons learned, and next steps. At the end of each quarter, the
APQR are reviewed and approved through the approval chain.
This process allows leaders to identify actions and resources
needed to sustain or spread the outcomes of work plans. APs
are available to all employees via the intranet. All employees
can access and view AP, associated status updates, quarterly
reports and all associated work plans within the organization.
SCF also actively shares plans with key external partners [Fig.
P.1-7]. The VPLT communicates SCF’s plans to ANTHC
during various meetings of the JOB, its subcommittees and
Executive Management Team as well as other key partners
[P.1b(3)], enabling the primary care (i.e., SCF) and specialty
hospital care (ANTHC) to work collaboratively across the
continuum.
Recent improvements to the annual planning piece of the SPC
include involving a “coordinator” early on in AP development
to review and provide feedback. This process includes
reviewing APs with AP owners and a division designee to
improve awareness of how work plans are linked to corporate
initiatives. This provides another opportunity to capture blind
spots. The FCS [Fig. 1.1-2] now also includes a subcommittee
of the PI Committee responsible for facilitating the SPC.
2.2a(3) Resource allocation: SCF ensures that financial
resources are available by planning, forecasting, and seeking
partnerships and funding. Revenues for the next fiscal year
(beginning October 1) are forecasted several months during
the January-March period of the SPC. Forecasts are largely
based on actual results from the most recent full fiscal year,
and year-to-date results from the current fiscal year. Any other
known or “forecastable” factors are considered to determine a
final estimate to be used for budget preparation. Such factors
may include inflation or volume assumptions, overall or by
service lines; expected Congressional appropriation increases
or decreases (a percent of SCF funding comes as an IHS
appropriation); new or terminating grant funding; significant
changes in Medicaid payment methodology (a substantial
portion of third-party payments are from Medicaid); and, new
programs planned. Financial projections for new business
investments are based on market and payor information and
include start-up, phase-in, and fully implemented or “mature”
budgeted amounts. If the start-up, phase-in, or fully
implemented new business is not expected to generate enough
revenue to cover the expenses, an allocation from corporate
reserves is identified and designated.
Assessment of financial risks is an ongoing process based
largely on recent past and current financial results from
operations, as well as general knowledge of SCF’s
marketplace and regulatory environment. SCF formulates
long-term financial plans with the knowledge that it is not
possible, or even desirable, to maintain operating margins at
10
the levels experienced 10 years ago. Long-term financial
planning at SCF includes evaluating levels of service which
can be supported based on funding projections.
The VPLT also monitors the impact of the influx of AN/AI to
the Anchorage area based on SCF’s financial position.
Because it is understood that this immigration of C-O is
causing expenditures to grow faster than offsetting revenue,
managers are held accountable for managing to the budgeted
bottom line for each program. SCF’s Finance Division tracks
and monitors revenue and expenses and identifies deviations
from anticipated levels. The Revenue Committee monitors and
communicates third party net revenue results, addresses
revenue-related opportunities for improvement and
recommends opportunities to enhance net revenue. In order to
increase funded services to its existing and expanding C-O
base, SCF is implementing additional Medicare and Medicaid
funded activities, improving cost reporting to enhance costbased
reimbursement, working with state service delivery
departments and the Medicaid program, making revenue
information available to managers in the Data Mall, reviewing
its revenue cycle and hiring employees to implement revenue
cycle improvement. The Revenue Committee sponsored a
work group to research Medicaid enrollment trends and
identify opportunities to enhance this critical revenue source.
SCF manages its costs by making expenditure information
available to managers, involving managers in budget
development, developing tools to track costs over time,
changing its model of care to emphasize wellness and active
management of chronic disease, addressing the family as a
unit, eliminating duplication and multiple visits to the greatest
extent possible, allowing employees to “work to the limit of
their license,” and targeting complex users of services to
identify what type of services these C-O really need.
SCF takes an active role in its relationship with funding partners,
including the IHS; the State of Alaska, its largest third-party
payor via the Medicaid program; and the Alaska Mental Health
Trust Authority, in policy and operational matters. The
relationships serve to identify current and future needs, and
allow for policy development, problem solving, identifying
elements of risk and working together to resolve them.
To support appropriate workforce planning levels, SCF uses a
comprehensive staffing formula that enable it to project, for
every 1,200 C-O empanelled, the FTE and cost to sustain its
action plan changes. Projected staffing needs drive HR’s
Corporate Recruitment Plan, which includes strategies for
providers, clinical support staff, administrative support and
other employees. These formulas serve to ensure that realistic
budgets are set to accomplish long-term staffing needs along
with short-term solutions, such as temporary and contract
workers [5.2a(1)].
2.2a(4) Workforce plans: Growth in the AN/AI population in
Anchorage and increased C-O demands for service have
significant implications for staffing. SCF supports
accomplishment of its CO and action plans with HR and DC
APs. The HR and DC departments use a combination of
formal and informal feedback to improve or add programs
[5.1b(2)]. A major focus of these APs is building SCF’s
workforce capability by attracting employees, increasing the