1. UCSF Clinical Enterprise Strategic Plan Presentation to Faculty Council October 16, 2008 Prepared for

2. 1 Strategic Plan: Timeline Today

3. 2 Clinical Enterprise Strategic Plan 2002 Strategic Plan Previous Context Significant growth imperative Increased capacity Improved financial & operating performance Increased customer service/satisfaction Created Mission, Vision, and Values Planned Mission Bay 2008 Strategic Plan Current Challenges Capacity constrained Challenging FY08 budget Increased competition Continued shift in insurance dynamic SB1953 seismic requirements – Mission Bay cost

4. 3 Clinical Enterprise Strategic Plan Mission: Caring, Healing, Teaching and Discovering. Vision: To be the best provider of health care services, the best place to work and the best environment for teaching and research. Values: Embodied in the acronym PRIDE: P for Professionalism, how we conduct ourselves and our business R for Respect for our patients, families, ourselves and each other I for Integrity, always doing the honest, right thing D for Diversity, understanding and embracing the diverse beliefs, needs and expectations of our patients, community and employees E for Excellence, what we strive for in everything we do Foundational Statements

5. 4 This 2008-2015 Clinical Enterprise Strategic Plan defines the next evolution of UCSF, building on existing strengths and focusing on opportunities for improvement Strategic Plan: Direction Three key goals serve as the foundation for this Strategic Plan Clinical Growth Best Care Shared Accountability Financial Performance

6. 5 Strategic Plan: Themes CLINICAL GROWTH 1. Maximize the Potential of the UCSF Inpatient Facilities 2. Match Patient Mix to UCSF’s Mission and Program Capability 3. Expand Functional Ambulatory and Office Capacity 4. Achieve a More Effective UCSF Referral Outreach BEST CARE 5. Create the Next Generation UCSF Care Delivery Model 6. Provide the Highest Value Care to Patients 7. Educate, Recruit and Retain the Best Talent SHARED ACCOUNTABILITY 8. Define a Stronger Culture of Shared Accountability and Action 9. Achieve the Operating and Clinical Cost Improvements Necessary to Sustain a 6% Operating Margin (language still being reviewed)

7. 6 Strategic Plan: CLINICAL GROWTH Recommendation 1.1: Increase functional bed capacity by 60+ beds across both major campuses Strategy 1.1.A: Complete 16 ICU-bed addition on Parnassus, to be operational by end-2008 Strategy 1.1.B: Decrease risk-adjusted inpatient ALOS to the average UHC benchmark or better Strategy 1.1.C: Improve average bed occupancy at Mt. Zion to 75% (from less than 60% today), adding an additional 15-20 beds to functional inpatient capacity Theme #1: Maximize the Potential of the UCSF Inpatient Facilities

8. 7 Strategic Plan: CLINICAL GROWTH Recommendation 2.1: Focus adult incremental growth in high and moderate complexity care Recommendation 2.2: Ensure that programmatic growth occurs in a rational and controlled fashion Recommendation 2.3: Ensure future patient mix supports UCSF’s educational and research requirements Recommendation 2.4: Encourage Departments to commit to a set of institutional policies that are intended to stabilize UCSF’s sponsor mix to ensure financial viability Theme #2: Match Patient Mix to UCSF’s Mission and Program Capability

9. 8 Strategic Plan: CLINICAL GROWTH Recommendation 3.1: Improve exam room utilization (visits/room/day) to allow a 10%-15% growth in ambulatory visits within existing infrastructure Recommendation 3.2: Ensure that there is sufficient office space available to support projected growth of the clinical enterprise Recommendation 3.3: Focus the development of any ambulatory growth (exam room or outpatient ancillary capacity) off the main campus Theme #3: Expand Functional Ambulatory and Office Capacity

10. 9 Strategic Plan: CLINICAL GROWTH Recommendation 4.1: Create and implement an Institutional Outreach Oversight Committee that will act on behalf of the enterprise and be responsible for prioritizing and coordinating future UCSF outreach initiatives Recommendation 4.2: Work closely with the School of Medicine, translational research scientists and others to ensure linkages and appropriate volumes for teaching requirements and clinical trials through outreach initiatives Recommendation 4.3: Focus on building and enhancing relationships with community providers in Northern California to ensure patients are cared for in the appropriate care settings Recommendation 4.4: Focus UCSF marketing strategies on increasing awareness of the UCSF brand regionally Theme #4: Achieve a More Effective UCSF Referral Outreach

11. 10 Strategic Plan: BEST CARE Recommendation 5.1: Increase the number of non-resident (mid-level providers) and mixed (both mid-level providers and house staff) services to reduce reliance on the resident model Recommendation 5.2: Explore residency expansion initiatives in select departments, if aligned with institutional clinical priorities without affecting the quality of the training programs Recommendation 5.3: Develop core teaching and non-resident staffing models for inpatient units as needed by service Recommendation 5.4: Restructure workflow on inpatient units to allow all clinical providers to spend more time with the patient Recommendation 5.5: Ensure the care delivery model supports a consistent standard of clinical care regardless of time of day or day of the week Theme #5: Create the Next Generation UCSF Care Delivery Model

12. 11 Strategic Plan: BEST CARE Recommendation 6.1: Create an organization and infrastructure that allows the UCSF clinical enterprise to tie its value proposition to superior quality, patient safety and clinical outcomes Recommendation 6.2: Communicate UCSF’s results in clinical quality, patient safety and clinical outcomes to a broad external audience Recommendation 6.3: Enhance service standards for the UCSF clinical enterprise so that it is competitive in the Bay Area market Theme #6: Provide the Highest Value Care to Patients

13. 12 Strategic Plan: BEST CARE Recommendation 7.1: Develop recruitment initiatives that enable UCSF to meet its goals around clinical growth and patient mix Recommendation 7.2: Create retention initiatives that allow UCSF to identify and develop the next generation of UCSF leadership Recommendation 7.3: Strengthen the relationship between UCSF and its employees Theme #7: Educate, Recruit and Retain the Best Talent

14. 13 Strategic Plan: SHARED ACCOUNTABILITY Summary Assessment of Today’s Model: High level of patient service variability, financial result High level of decentralization, local discretion Low level of shared success definition, expectations Low level of transparency across the enterprise High level of frustration, sense of lost potential Theme #8: Define a Stronger Culture of Shared Accountability and Action

15. 14 Strategic Plan: SHARED ACCOUNTABILITY Expectations – Defining Success (per KSA) 1. Define clinical service credo distinct from academic freedoms  Service to patients the priority in clinical enterprise work 2. Clear service standards expected across all clinical participants 3. Operating leadership roles aligned with demonstrable expertise 4. Participation a major institutional value, i.e. not discretionary

16. 15 Strategic Plan: SHARED ACCOUNTABILITY Transparency – Reporting Progress (per KSA) 1. Reporting vs. (just) approving clinical enterprise aims  Current clinical enterprise strategic plan the starting basis 2. Use of comprehensive dashboards and scorecards 3. Broad, disciplined disclosure of progress and lack thereof, good and bad 4. Scheduled use of advisory boards, open faculty sessions to vet status

17. 16 Strategic Plan: SHARED ACCOUNTABILITY Incentives – Reinforcing Success (per KSA) 1. Recognize patient service acumen by the clinical faculty  Leadership roles, governance participation, compensation 2. Align institutional clinical support with results and plan aims 3. Align career opportunity pathway with proven clinical excellence

18. 17 Strategic Plan: SHARED ACCOUNTABILITY Ten Year Financial Plan Assumes Several Key Assumptions: Reduced Length of Stay to UHC Benchmarks (6.3 to 5.85 in select services) Decrease in FTEs/Adjusted Occupied Bed (8.08 to 7.76) Increase in Case Mix Index (1.98 to 2.08) Flat Volume in MediCal Theme #9: Achieve the Operating and Clinical Cost Improvements Necessary to Sustain a 6% Operating Margin

19. 18 Financial Implications

20. 19 Strategic Plan: Next Steps Next steps include: SOM Faculty Council, Clinical Affairs Committee, Academic Planning and Budget, Senate Coordinating Committee, DOM Chiefs Meeting  Please advise if you would like us to present at one of your Department meetings Two Town Halls Led by Interim Dean Hawgood and Mark Laret in mid October Formal approval from:  Chancellor’s Office  Faculty Senate Dissemination to the Public  On-line postings – official Summary of the Plan  Public Relations and Marketing (articles, brochures) Create Detailed Implementation Plan (see next page) Address Issue of Shared Accountability

21. 20 Implementation Plan: Metrics and Measures ThemesMeasures of SuccessDetailed Reports (Compare Current to 2015 Target) Strategic Plan Dashboard (Compare Current to 2015 Target) Maximize Potential of the Current UCSF Inpatient Facilities Decrease number of days each inpatient unit exceeds 100% capacity Decrease % of patients being held in the ED or PACU while waiting for a bed Decrease in adult and pediatric ALOS Decrease in inappropriate one day admissions (Define – Reece?) Increase in transfers to post-acute facilities – decline in ALOS Quarterly reports by product line (Adult / Peds and PRN/ Mt.Zion)  CMI  Inpatient discharges  Outpatient visits  % Medi-Cal Current ALOS compared to UHC risk- adjusted average by product line ADC by unit (10:00am, 2:00pm and midnight) Percent occupancy for the adult (split Parnassus and Mt Zion) and children’s inpatient chassis (Target Occupancy = X) Target ALOS = X Target OR utilization = X Match Patient Mix to UCSF’s Mission and Program Capability Increase in institutional CMI Growth of volume in targeted product lines or services Decrease the % of inpatient Medi-Cal patients to the lower of 2002 or 2006 percentages in each service Departmental adherence to Outpatient Referral Guidelines Exceed minimum volumes needed to ensure teaching accreditation in each program Quarterly reports by product line (Adult / Peds and PRN/Mt.Zion)  CMI  Inpatient discharges  Outpatient visits  % Medi-Cal Annual review of recruitment plans by department Secret shopper for Outpatient Referral Guidelines Annual review of teaching Risk Registrar Target CMI = X Target Volumes = X Target Medi-Cal = X Programs at risk for losing teaching credentials Expand Functional Ambulatory Capacity Growth in ambulatory visit volume by department Volume growth in imaging by modality, and in OP surgery/procedures (why are these combined) Increase in % of ambulatory activity occurring off- the Parnassus campus Decline in % of faculty without an office Ambulatory visits by department Number of designated exam rooms by department Ambulatory visits/room/day by department Assigned offices (and associated square footage) by department Professional revenue per sf of clinic space by department Target Ambulatory Visits = X Target visits/room/day = X No. of Faculty w/out offices = X