The Financial Impact of Your Strategic Initiatives

Craig Holm and Kurt Barwis are presenting a 50-minute concurrent session at this year's SHSMD Connections in person annual conference on the STRATEGIC PLANNING & BUSINESS DEVELOPMENT Track, held in San Antonio, September 19-21.

Traditionally, strategic planning is completed with high level financial analysis. For some organizations, the deeper financial dive has become necessary with a merger of sorts between a Strategic and Financial Plan. The Strategic and Financial Plan incorporates two interdependent processes. This presentation will provide a high level description of the process involved as well as a case study of an organization that set out on this path, including the opportunities and challenges that were identified along the way.
The Financial Impact of Your Strategic Initiatives
Featured Speakers:
Craig Holm | Timothy Ajayi, CPA
Craig has over 25 years of experience in directing consulting engagements for physicians and physician group practices, community hospitals, large health systems, and academic medical centers. In combination with his experience in healthcare operations, this gives him a very full understanding of the issues faced by clients. An experienced speaker, Craig has presented to a wide range of regional and national healthcare organizations including the American College of Healthcare Executives, Healthcare Financial Management Association, Society for Healthcare Strategy & Market Development, and the Healthcare Strategy Institute. 

Tim Ajayi is the Assistant Chief Financial Officer, responsible for managing Bristol Health's Financial Accounting, Budgeting, Financial reporting, Supply Chain and Accounts Payable and partial oversight of Revenue Cycle. Prior to Bristol Health, Tim was the Director of Finance and General Accounting at South Nassau Communities Hospital, and he has previously held Finance, accounting and audit roles at other Health Systems and KPMG, a big-four Public Accounting firm. Tim graduated from the Queens College of the City University of New York with a dual Bachelors degree in Accounting and Information Systems and Economics and a Master of Science in Accounting.

Tim is a licensed Certified Public Accountant in New York and a member of the American Institute of Certified Public Accountants, Healthcare Financial Management Association (HFMA) and American College of Healthcare Executives (ACHE).
Transcription:
The Financial Impact of Your Strategic Initiatives

Intro: The following SHSMD podcast is a production of DoctorPodcasting.com.

Bill Klaproth (Host): ON this edition of the SHSMD podcast, we're going to talk about the financial impact of your strategic initiatives. So, let me ask you this. Have you fused your strategic and financial planning processes together?

Mm, crickets. Not good. All right. Let's talk about this with Craig Holm and Timothy Ajayi on merging your financial and strategic planning processes together. We have to think about this differently because actually they go together kind of like salt and pepper, like bread and butter. Like gin and tonic. Yes, I, in fact, I will, thank you very much. A little twist of lime in there. That would be great. Okay. Let's get to it. Right now.

This is the SHSMD Podcast, Rapid Insights for healthcare strategy professionals in planning, business development, marketing, communications, and public relations. I'm your host Bill Klaproth. And in this episode, we talk with Craig Holm, Director at Veralon Partners and Timothy Ajayi, Assistant Chief Financial Officer at Bristol Hospital and Healthcare Group. At this year's SHSMD Connections 21 in San Antonio, they did a session on the financial impact of your strategic initiatives. And that's what we're going to talk about today.

Craig and Tim, welcome to the SHSMD podcast. As you know, we start every episode of the SHSMD podcast with Rapid Insights. One quick tip, someone can use to make their marketing communications better today, Craig, you're up first. Give us your Rapid Insight.

Craig Holm (Guest): My Rapid Insight is to help to foster implementation of a strategic and financial plan by incorporating reactor panels. Reactor panels are constituents who will help to build the strategic plan and that they help to build the strategic plan will help to implement the strategic plan. So reactor panels who will be used, to test fundamental assumptions and preliminary concepts would be members of the board, senior leadership, community leaders, and physician leaders.

Host: All right. Excellent. Remember those reactor panels. So thank you for that. Tim, you're up next. Give us your Rapid Insight.

Timothy Ajayi, CPA (Guest): Strategic planning is a living and breathing document. So, it's something that you can't just build and put on the shelf. It's something you have to, you know, evaluate, reassess and constantly, you know, reference; because the environment is changing and you may, in essence, realize that you have new strengths, weaknesses, opportunities, or threats and you may need to go in a different direction.

Host: Excellent. So, constant re-evaluation if you will. And I like how you put it as a living document there. It's very good. Well, Craig and Tim, thank you for being here. We really appreciate this. So Craig, traditionally strategic planning is completed with high level financial analysis and for some organizations, the deeper financial dive has become necessary with a merger of sorts between a strategic and a financial plan. So, the strategic and financial plan incorporates two interdependent processes. So, can you tell us about this melding of these processes? What is involved?

Craig: Yeah. Classic strategic planning includes four elements. An environmental assessment, which is really describing the current position of an organization. Organizational direction, which is what's the desired future state, strategy formulation, which is how to get there and then implementation planning, which are very specific actions and initiatives to accomplish and achieve the vision and to address the critical planning issues.

In the past, strategic plans were much too long-term, five years, 10 years. And if we think about the last couple of years, can you imagine planning for five or 10 years during a pandemic environment? Classic strategic plans became much shorter, became much more real in terms of quantifying, particularly financially quantifying the impact of strategic initiatives.

And that was the process that was used in the strategic and financial plan for Bristol, where in the strategic plan, probably 50 or 60 initiatives were developed. And for those, about 25 or 30 had financial quantification to see whether or not there was a return on investment for each of the strategic initiatives and so that they could be measured.

Host: Tim, you want to chime in on that?

Tim: Yeah. And to add to that, the reason why the strategic and financial plans have been combined is you really can't do one without the other. I mean, frankly, in this resource intensive environment, you can't develop a strategic plan without having the resources or figuring out the resources to implement the plan and you can't achieve a viable financial plan unless you've developed successful strategies to in essence thrive in this ever-changing healthcare environment. So it made sense to fuse the two together because they really can't be done separately.

Host: So Tim, let me ask you this then, as you reflect on the process, this fusing of the two together, what are the takeaways or the lessons that you learned in this process?

Tim: What we learned in the process was it really helped for example, with our board members, it really helped them get familiar with the threats, the opportunities, the strengths that we face as a healthcare organization, the political environment. It truly became our true north in terms of helping what we realized from the strategic plan was we then in essence, when we start our budget presentation, for example, we would start with the strategic plan, here is where we said we would be.

And here are the opportunities in the current environment, here is why we may not be able to achieve A, B, C, D E. But that's still the plan. That's still the goal. We'll still work towards that. And then in essence, it also helps as you go to the board for capital requests and for investment and opportunities, they know this is all working towards that identified goal. So, in reflecting, that was the opportunity that derived from this is that it helped kind of guide the whole organization as to this is where we want to head to. This is where we're hoping to get to.

Host: Absolutely. So, Craig, let me ask you this and hearing Tim talk about this and this fusing process, how has this changed? It sounds like this is something more recent. How has strategic and financial planning changed then through the the years?

Craig: Couple of things. During this whole strategic plan process occurred right during the onset of the pandemic. And so, in the past, strategic plans could be very long-term and we had to build in a fair amount of contingency planning for what could happen during the course of implementation of the strategic plan should COVID come raging back. Which it did, in several phases and the regulatory environment changed, sources of capital infusion from the federal government, from the state of Connecticut occurred during this process due to the pandemic and competitors were not sitting on the sideline.

And so reimbursement, regulatory influences, pandemic influence, changed this. And so, Bristol built in a fair amount of contingency planning throughout and also alternative scenario planning so that if a competitor was likely to do this, how might Bristol respond, if COVID did that, then how might Bristol could and should respond.

If, Bristol started losing nursing staff, and needed to hire agency nurses, how might Bristol respond to that? And so there are a fair number of contingency plans that were built into this strategic and financial plan. The importance of coupling financial planning with strategic plan is exactly what Tim had alluded to earlier to make the plan real. And then as implementation occurred, so that metrics could be established and performance against those metrics could be regularly calibrated.

Host: Absolutely. Did you have anything you wanted to add to that, Tim?

Tim: I think what partner with Veralon helped us do was it brought the nationwide expertise and helped us consider the healthcare landscape. The things that were still making their way down to the Northeast, the opportunities, but also in essence, the regulatory environment that were still making their way down, that maybe we hadn't started seeing, but would definitely come into play within the strategic plan purview. So that brought their expertise into that, and then helped us develop a more robust plan to help anticipate those possibilities. And in essence, plan for it.

Host: Right. So, Tim, earlier you were talking about the lessons or the takeaways that you learned throughout this. I'm curious, what corrections did you have to make upon the approval and implementation of the strategic and financial plan as you earlier said, you know, this is kind of a living document. Tell us about what course corrections you had to make.

Tim: So, for example, as Craig alluded to, this plan was developed prior to COVID. So, if you look at what has happened within the COVID environment, you have, in essence now had a shortage of staff, which you have to plan for all those things. Part of our strategic plan was basically gaining efficiencies from our revenue cycle department. So,as a result of that plan, we invested in that area. We enhanced the capabilities of the staff and also built new reports to also develop the accountability. But in essence, in order to achieve the full efficiency of revenue cycle, you not only need to collect more from the claims, but you also need the volume.

So we've had to adjust that plan and review that plan and to be able to communicate that, although this is where we projected, we would be, because of COVID, and because of all the pressures, maybe we are not able to get to that set efficiency within the year, but still show how we're working our way towards that plan.

Craig: Yeah. Another reflection on this process. And Tim would agree to this, that we do strategic plans, financial plans for a lot of organizations and Bristol has one other unique characteristic, which we haven't talked about, which I'm convinced that this is one of the big reasons why we coupled financial planning with strategic planning.

The CEO, the chair of the board and the chair of the strategic plan committee are all CPAs. And so their lens is financial, and I think that if we had come up with just esoteric, etherial, in the cloud strategic plan initiatives, they would have said, what's the financial impact. Each of these three CPAs.

Tim: Absolutely. And not just the financial impact, but how in essence, would we be able to afford the investments required to achieve those strategic plans?

Host: Yeah, they want to see real numbers.

Tim: Absolutely.

Craig: Exactly. And they're going to say this might be a good idea, but we had run, remember Tim, we looked at, income statement. We looked at balance sheet. We looked at return on investment. We looked at cashflow scenarios for each of these strategic initiatives, very robust financials associated with a strategic plan.

Tim: Absolutely.

Host: Craig I was going to ask you, you've been at this a long time and you just mentioned you started with the income statement and other things. Where does someone start a process like this, for someone listening to this podcast? Where should they start?

Craig: I think to start, there's some very good books on healthcare strategic planning. And I think to start with a classic strategic plan where answering the basic questions, where are we now? Where should we be going? And how do we get there? And then how do we execute? But where are we now is an environmental assessment?

It's looking at the internal environment, the external environment, where should we be going? That's vision. Where do we want to be in three years? Mission. What's our purpose. And then, critical planning issues. One thing we always think about is not to have 10 critical planning issues, but three or four high-impact critical issues to address and then very specific strategies for each of those.

And then in implementation, I know that Bristol, including Tim were very assigned responsibility for specific strategic initiatives. But then as we said before, in terms of starting, associating financials with that, and then tracking performance, particularly financial for each of these initiatives.

Host: And then Tim, from the hospital side, how did you start? What should someone know from the hospital side when starting this, someone that might share your same position at a hospital?

Tim: From my perspective, you definitely need the buy-in of your board because ultimately this is a document that has to basically go through all the levels of the organization. It has to become, as I alluded to earlier, a living and breathing document, but it's something that all your employees, even if they don't understand the details, must understand in essence, the organizational goals and the objectives where you want to be as an organization.

So, it's important to get the buy-in of the board. That this be something that the board embraces because ultimately, you have to have their input and their approval in order to be successful at implementing some of these.

Host: Yeah, that's excellent advice. So, thank you both for that. So, as we wrap up, let me ask you the same question, but get an answer from each of your perspectives. So, Craig, let me start with you. What else should we know about this? Is there anything we're missing? Anything we don't know or anything we didn't talk about? What else should we know about this marrying of the strategic and financial plan?

Craig: I think the foundation of this is the strategic plan, but I think to couple that, in a strategic plan, as I said earlier, there often are 60 or 70 or 80 initiatives, but they can't all might be quantified financially. One may be improve the morale of the rank and file nursing staff so that we don't have to hire agencies. And that doesn't necessarily have to have a financial component to this. And at our session, that we held in San Antonio, we were asked, all the strategic initiatives, were each of them assessed in terms of their financial impact? Well, the only ones that made the list that carried forward were viewed to having a high impact.

So I think looking through the lens of each of the initiatives and judging, which were important, but not all of them could have a financial impact, but those that were, had a very serious financial impact in terms of both revenue, expense, and cash flow.

Host: That's excellent, very good. And then Tim, from the hospital side, then what else should we know about this?

Tim: I would say the fact that in this day and age from a healthcare environment, regardless of the size, it's critical to have a strategic plan. The environment is it's changing, it's ever changing. You have the political forces, you have all the different factors. It's important to if you're not going to always kind of just running after the changes, it's important to plan so that you're evaluated. What are all the possible changes that may happen in the political landscape? For example, over the next five years, what are all the changes that may happen? And then, of course, a change like COVID may happen where we don't necessarily anticipate the impact, the severe impact of it.

But even when a change like that happens, you could then tap into different facets of your plan and then maybe just magnify your response to match the incident. My takeaway is it's absolutely critical to have a plan, especially for any healthcare organization out there. If you don't have the expertise internal, it's important to reach out and get resources of someone that definitely has the expertise to help you consider all these factors and to put a robust plan together. It's also important to get the voice of the entire organization. So, you don't want to do this just from a mid to higher level management perspective. You definitely want to get the input of all your employees as well.

Host: Really good advice. What's that saying? Failing to a failure to plan is planning to fail. I think it goes so, that totally makes sense. And then get the voice of all of your employees. So great advice. Okay. Thank you so much. This has really been interesting and informative. Craig and Tim, I really appreciate your time today. Thank you both.

Tim: Thank you.

Craig: Thank you. This was fun.

Host: And once again, that's Craig Holm and Tim Ajayi and to learn more about SHSMD, please visit shsmd.org. That's S-H-S-M-D.org. You can also visit our education page to learn about our upcoming programs at shsmd.org/education. And if you've found this podcast helpful, and please, how could you not with guests like this? Come on, man. Please share it on all of your social channels and please hit the subscribe or follow button to get every episode.

This has been a production of Dr. Podcasting I'm Bill Klaproth. See ya!