EXHIBIT 3 1 Functions That Sustain Operational Infrastructure

EXHIBIT 3. 2 Boundary-Spanning Activities of HCOs © 2016 Foundation of the American College

EXHIBIT 3. 3 Elements of the Epidemiologic Planning Model © 2016 Foundation of the

EXHIBIT 3. 3 Elements of the Epidemiologic Planning Model (continued) © 2016 Foundation of

EXHIBIT 3. 4 Leadership Structure, Communications, and Accountability © 2016 Foundation of the American

EXHIBIT 3. 4 Leadership Structure, Communications, and Accountability (continued) © 2016 Foundation of the

EXHIBIT 3. 5 Organization Structures for Hospitals and Healthcare Systems © 2016 Foundation of

EXHIBIT 3. 5 Organization Structures for Hospitals and Healthcare Systems (continued) © 2016 Foundation

EXHIBIT 3. 6 Mercy Health System’s Annual Planning Calendar © 2016 Foundation of the

EXHIBIT 3. 7 Qualitative Indicators of OFIs for Maintaining the Cultural and Operational Infrastructure (continued) © 2016 Foundation of the American College of Healthcare Executives (continues on next slide)

EXHIBIT 3. 8 Performance Measures for Infrastructure Functions © 2016 Foundation of the American

EXHIBIT 3. 8 Performance Measures for Infrastructure Functions (continued) © 2016 Foundation of the

Questions for Discussion 1. What do first-line leaders need to understand about how the HCO implements the functions of operational leadership? If you were helping a newly appointed first-line leader (for example, a head nurse or a food service supervisor), what would you say to her about each of the functions: a) Boundary spanning: how this HCO relates to its community b) Forecasting: how the HCO prepares for patients in each service line c) Knowledge management: what kinds of knowledge resources are available to her d) Accountability and corporate design: who owns the HCO, and how the owners retain control of patient care e) Continuous improvement: how she can identify OFIs and then change processes to improve f) Improving the operational structure: how the HCO applies the continuous improvement process to all its components, even the governing board © 2016 Foundation of the American College of Healthcare Executives

Questions for Discussion 2. The new leader is likely to be concerned about how the goal-setting, accountability, and continuous improvement functions play out for her unit. How would you reassure her that she can succeed in her new role? © 2016 Foundation of the American College of Healthcare Executives

Questions for Discussion 3. Senior leadership forms a PIT to be sure annual and long-term forecasting are as good as they can be. What data should the PIT review? With whom should it confer? What questions should the PIT ask to identify important OFIs in the forecasting process? © 2016 Foundation of the American College of Healthcare Executives

Questions for Discussion 4. Consider Exhibit 1. 2, the scope of comprehensive personal health services. Stakeholders need, and your HCO can offer, service lines in each of the care levels—primary, acute, rehabilitation, continuing, and palliative. What are the critical questions to be asked about the HCO’s actual plan? That is, how does the HCO determine that it should offer, or not offer, a given service line? © 2016 Foundation of the American College of Healthcare Executives

Questions for Discussion 5. The planning committee of the governing board believes that the HCO’s goal-setting efforts, the process shown in Exhibit 3. 6, might be improved. It will establish a PIT of trustees, senior leaders, and others to investigate. What data should the PIT review? With whom should it confer? © 2016 Foundation of the American College of Healthcare Executives

Critical Issues in Operational Leadership Maintaining contact with all stakeholder groups. Conduct surveys, listen, and hold formal meetings to ensure a balanced, timely flow of information from external to internal stakeholders. © 2016 Foundation of the American College of Healthcare Executives

Critical Issues in Operational Leadership Sizing the organization and its components. Use the epidemiologic planning model to size clinical and other units to meet clinical needs. © 2016 Foundation of the American College of Healthcare Executives

Critical Issues in Operational Leadership Measuring and improving performance. Maintain a system of complete, timely performance measures, goals, and benchmarks. Identify OFIs, support PITs, and negotiate and achieve improvement goals. © 2016 Foundation of the American College of Healthcare Executives

Critical Issues in Operational Leadership Supporting a learning organization. Maintain information, consultation, and training services to meet all performance improvement needs. © 2016 Foundation of the American College of Healthcare Executives

Critical Issues in Operational Leadership Resolving issues in a timely manner, and adhering to an annual calendar. Use the board’s authority to limit negotiations and prevent unnecessary delay. © 2016 Foundation of the American College of Healthcare Executives