1. Strategic Mapping & Program Alignment Aligning Experiences – Expectations – Resources – Outcomes

2. May 24, 2005 TAHSA Annual Meeting - 2005 2 Session Agenda 1.Introduce Sears 2.Introduce Project Initiative 3.Review application of Choice in dining service 4.Present process for mapping from a strategic objective to a tactical initiative 5.Conduct the Mapping Exercise for Craig 6.Conduct the Mapping Exercise for the Corporate Program 7.Review Process, Q & A

3. 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

4. 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

5. May 24, 2005 TAHSA Annual Meeting - 2005 5 The Customer Value Of Positive Experience A Memorable Feeling Created By You As A Result Of Us Relative Customer Value EXPERIENCE SERVICE GOOD RAW MATERIAL Source Of Customer Loyalty Created Within The Customer Created By A Provider

6. 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.

7. May 24, 2005 TAHSA Annual Meeting - 2005 7 Rhythms of Daily Living The 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.

8. 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.

9. 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

10. 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 Runway Altitude Too High Aligned Air Speed Cross Winds Altitude Wind Speed Pitch

11. May 24, 2005 TAHSA Annual Meeting - 2005 11 The Main Thing For SMRS Choice

12. May 24, 2005 TAHSA Annual Meeting - 2005 12 Plan Transition Process and Commit Resources Write 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 Alignment Plan and Develop Plan Evaluate Readiness With Leadership, Managers & Residents/Families Define Outcomes Baseline and Expectations Evaluate Define Define Service Functions and Outcomes For Each Experience Identify Beneficiaries/Benefits and Diagram Service Functions

13. 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.

14. May 24, 2005 TAHSA Annual Meeting - 2005 14 STRATEGIC OBJECTIVES – TACTICAL IMPLEMENTATION PROJECT MAPPING The following are the task requirements for this process: 1.Identify Service Initiatives 2.Define Their Contribution To Strategic Objectives 3.Define Appropriate Measurements Of Successful Experience Outcomes 4.Identification Of Resource And Operational Intersects 5.Identification Of Intersects And Roles Of Other Contributing Departments 6.Structure Of The Process For Resource Allocation To Develop The Defined Initiative 7.Sequencing Of The Tasks 8.Implementation of the Initiative.

15. May 24, 2005 TAHSA Annual Meeting - 2005 15 Map Process #1, 2,3 Strategic Objectives Community of Distinction Financial Enhancement Quality of Living Quality of Work Operational Effectiveness Map#1 Strategic Objective Benefit Map #2 Benefit Measure Measurement Tool Map #3AdministrationRegulatoryOperationsPersonnelPP&ECommunity Operational Resource Requirements Budget Impact $/FTEs

16. May 24, 2005 TAHSA Annual Meeting - 2005 16 Map Process #4, 5 Map #4 Collaborating Departments NursingResident Services TherapiesPastoralHousekeepingMaintenanceActivities Task Map #5 Task Implementation NursingResident Services TherapiesPastoralHousekeepingMaintenanceActivities Procedure Policy Resource Requirement Inform/Train Measure

17. May 24, 2005 TAHSA Annual Meeting - 2005 17 Project Management

18. Craig Methodist Windflower Dining Program May 24, 2005 Aligning Experiences - Expectations – Resources – Outcomes

19. May 24, 2005 TAHSA Annual Meeting - 2005 19 Discussion Topics Current Operations Overview Selection of the Initiative Contribution to the Strategic Objective Benefit Measure Operating Resource Requirements Collaborating Departments Development and Sequencing of tasks Implementation Review of Project

20. May 24, 2005 TAHSA Annual Meeting - 2005 20 Current Operations 1.64 Cottage Homes 2.108 Apartments 3.40 Assisted Living Apartments 4.60 Bed Nursing Unit 5.60 Bed Alzheimer's Unit 6.109 Canyons Apartments (Lunch Only)

21. 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

22. 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

23. May 24, 2005 TAHSA Annual Meeting - 2005 23 Benefit Measure 1.Community: Best of Amarillo 2.Financial Enhancement: Record breaking Census 3.Quality of Living: Improved Satisfaction 4.Quality of Work: Direct Interaction with Staff 5.Operational Effectiveness: Less Waste

24. 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

25. May 24, 2005 TAHSA Annual Meeting - 2005 25 Collaborating Departments 1.Nursing: 2.Resident Services 3.Housekeeping 4.Maintenance 5.Activities

26. May 24, 2005 TAHSA Annual Meeting - 2005 26 Development & Sequence of Tasks 1.Dietary 2.Administration 3.Corporate 4.Nursing 5.Environmental Services 6.Activities

27. 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

28. Sears Methodist Corporate Dining Program May 24, 2005 Aligning Experiences - Expectations – Resources – Outcomes

29. 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

30. May 24, 2005 TAHSA Annual Meeting - 2005 30 Sears Dining Mapping Program Strategic Objectives Community of Distinction Financial Enhancement Quality of Living Quality of Work Operational Effectiveness Map#1 Strategic Objective Benefits CORPORATE STANDARDS- SANITATION ESTABLISH SEARS STANDARDS AND MAINTAIN MARKET BRAND ASSURE HIGHEST RETURN ON RESOURCE INVESTMENT HIGH LEVELS OF SERVICE & QUALITY ARE EXPERIENCED BY RESIDENTS DAILY MAXIMUM USE OF AVAILABLE RESOURCES

31. May 24, 2005 TAHSA Annual Meeting - 2005 31 Strategic Objectives Community Of Distinction Financial Enhancement Quality of Living Quality of Work Operational Effectiveness Map #2 Outcome Measure - POSITIVE STATE SURVEYS FOR PUBLIC REVIEW - CLEANER COMMUNITIES - REDUCED LABOR - IMPROVED EQUIPMENT MAINTENANCE INCREASED RESIDENT SATISFACTION IMPROVED WORK ENVIRONMENT LESS TIME SPENT MONITORING SANITATION Measurement Tool - 0 DEFICIENCY - HIGH LOCAL BoH SCORES - LABOR COST PER RESIDENT DAY - EQUIPMENT REPAIR COST QUARTERLY RESIDENT SURVEYS STAFF RETENTION MEALS PER LABOR HOUR

32. May 24, 2005 TAHSA Annual Meeting - 2005 32 Map #3 Operational Resource Requirements AdministrationRegulatoryOperationsPersonnel SANITATION STANDARDS SUPPORT DIRECTORS WITH SITE VISITS STATE SURVEY PROTOCOL FEDERAL AND STATE REQULATORY REQUIREMENTS OPEN & CLOSE CHECK LISTS DAILY WALK THROUGHS WEEKLY INSPECTIONS CLEANING PROGRAM DIRECTOR TRAINING ON PROCEDURES AND FORMS STAFF TRAING ON CLEANING TECHUICHNES Budget Impact $/FTEs $100 PER CAMPUS FOR TRAINING COST REDUCTION OF.35 DISHWASHER FTE Strategic Objectives Community of Distinction Financial Enhancement Quality of Living Quality of Work Operational Effectiveness

33. May 24, 2005 TAHSA Annual Meeting - 2005 33 Map #4 Collaborating Departments NursingResident Services TherapiesPastoralHousekeepingMaintenanceActivities Task Map #5 Task Implementation NursingResident Services TherapiesPastoralHousekeepingMaintenanceActivities Procedure Policy Resource Requirement Inform/Train Measure

34. 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