1. You Expected...what?! Alignment of Services, Expectations & Outcomes Aligning Expectations – Resources – Outcomes

2. April 20, 2004 SCANPHA Annual Meeting 2 Agenda Environmental View A Culture of Curing vs. a Culture of Caring Defining Alignment Current Process Presentation Process Management Dip Your Bucket Where You Lay Hit the Pool, Beach or Links

3. April 20, 2004 SCANPHA Annual Meeting 3 Must Rising Acuity Levels Mean Lower Dining Quality ? ©

4. April 20, 2004 SCANPHA Annual Meeting 4 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.

5. April 20, 2004 SCANPHA Annual Meeting 5 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.

6. April 20, 2004 SCANPHA Annual Meeting 6 Alignment The appropriate positioning of systems and resources to attain a defined goal, mission, outcome or culture

7. April 20, 2004 SCANPHA Annual Meeting 7 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

8. April 20, 2004 SCANPHA Annual Meeting 8 Resident Services Administration Environmental Services Health & Wellness Dining 23+ Departments Quality Work Quality Care Resident Services Administration Environmental Services Health & Wellness Dining 23+ Departments ?? Families Residents Staff Standards Orgs. Owners Lenders Vendors Insurers Regulators Consultants Management What Is The Main Thing We Must Achieve?

9. April 20, 2004 SCANPHA Annual Meeting 9 The Main Thing For Senior Care Choice

10. April 20, 2004 SCANPHA Annual Meeting 10 “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.

11. April 20, 2004 SCANPHA Annual Meeting 11 PLAN & DEVELOP Organize Alter Codify Train Improve Choice Alignment Process Overview Plan Evaluate Define Assess Implement

12. April 20, 2004 SCANPHA Annual Meeting 12 Servant Leadership “I don’t necessarily have to like my players and associates, but as the leader I must love them. Love is loyalty, love is teamwork, love respects the dignity of the individual. This is the strength of any organization.” Vince Lombardi

13. April 20, 2004 SCANPHA Annual Meeting 13 Stakeholders Community Leadership Residents Family Members Staff Board Regulators

14. April 20, 2004 SCANPHA Annual Meeting 14 Leadership Roles Board / CEO Executive Management Team Operational Management Team Staff Execution

15. April 20, 2004 SCANPHA Annual Meeting 15 Board & CEO Define Mission and Ministry Strategic Outcomes & Initiatives Listen For What Resources Are Required Review Outcome Measurements

16. April 20, 2004 SCANPHA Annual Meeting 16 Strategic Intersect Grids Anticipated Outcomes Measures Stakeholders Resources

17. April 20, 2004 SCANPHA Annual Meeting 17 Anticipated Outcomes Clinical Cultural Experiences Staff & Resident Satisfaction Regulatory Financial Impact

18. April 20, 2004 SCANPHA Annual Meeting 18 Strategic Intersects – Anticipated Outcomes PROJECTCOMMUNITY OF DISTINCTION FINANCIAL ENHANCEMENT QUALITY OF LIVING OPERATIONAL EFFECITVENESS POS System Improved management of production controls, improved tracking of billable supplies Ability to implement DBP MOW Increase presentation of community Brand into the community Increased revenues and improved efficiencies of the existing resources Improve QoL for MOW clients Increased operational effectiveness for facilities Campus Dining Program Continuity of standards throughout the community Increased cost efficienciesImproved QoL for all residents and work environment for staff Increased effectiveness in all appropriate operational areas

19. April 20, 2004 SCANPHA Annual Meeting 19 Executive Management Team Clarify “Main Thing” and Strategic Objectives Identify Preliminary Alignment Measures Begin to Frame Initial Service Alignment Team (SAT) Approach Prepare Resident, Regulators and Stakeholders Briefing and Education Process

20. April 20, 2004 SCANPHA Annual Meeting 20 Feasibility Analysis & Budget High Level GAP Analysis of Community Capacities:  Operational  Cultural  Environmental  Fiscal  Mission

21. April 20, 2004 SCANPHA Annual Meeting 21 Strategic Intersects – Measures PROJECTCLINICALCULTURALSTAFF & RESIDENT QoL OPERATIONAL EFFECITVENESS POS System Ability to implement DBP MOW ImprovedIncreased revenues and improved efficiencies of the existing resources Improve QoL for MOW clients Increased operational effectiveness for facilities Campus Dining Program Continuity of standards throughout the community Increased cost efficienciesImproved QoL for all residents and work environment for staff Increased effectiveness in all appropriate operational areas

22. April 20, 2004 SCANPHA Annual Meeting 22 Outcome Measures Clinical Cultural Experiences Staff & Resident Satisfaction Regulatory Financial Impact

23. April 20, 2004 SCANPHA Annual Meeting 23 Operational Management Team Conduct Operational Capacity Self-Assessment Using SAT’s Review, Edit and Validate Outcome Targets Configure Process for Use of the SAT’s during Process Implementation

24. April 20, 2004 SCANPHA Annual Meeting 24 Strategic Intersects – Stakeholders PROJECTRESIDENTSFAMILIESREGULATORSPROSPECTIVE RESIDENTS POS System EASE OF USE, INCREASED VALUE, EDUCATION EDUCATIONMINIMAL / NO IMPACT MARKET DIFERENTIATION, SIGNATURE SERVICE MOW NO IMPACTCOMFORT OF NUTRTION AND VISITS QUALITY & SAFETY INTRODUCTION Campus Dining Program SEAMLESS EXPERIENCE CONSISTENT PROGRAM OF EXPECTATIONS CONSISTENT CLINICAL MEASURES MARKET DIFERENTIATION, SIGNATURE SERVICE

25. April 20, 2004 SCANPHA Annual Meeting 25 1. Engagement  Get All Stakeholders Involved Ask For Opinions Allow Refuting Of Assumptions and Ideas 2. Explanation  Enable Stakeholders To Understand Final Determination 3. Expectation Clarity  Make Explicit All Roles, Responsibilities and Measurements Confirm Cultural Readiness Three Principles Of “Fair Process” Fair Process: Managing In The Knowledge Economy Harvard Business Review, 8/97, By W. Kim and R. Mauborgn

26. April 20, 2004 SCANPHA Annual Meeting 26 Strategic Intersects – Staff PROJECTNURSINGDININGMAINTENANCEHOUSEKEEPING POS System Tracking of durable goods Choice, DBPBilling MOW Campus Dining Program

27. April 20, 2004 SCANPHA Annual Meeting 27 Resources Intersects Administration: fiscal, management and leadership considerations Regulatory: compliance criteria (grouped by clinical and operational considerations) Systems: software programs, forms, policy & procedures, protocols Personnel: staffing requirements, training, HR. The impact on each care disciplines is identified by department PP&E: Property, Plant & Equipment necessary to perform the tasks and functions

28. April 20, 2004 SCANPHA Annual Meeting 28 Strategic Intersects – Resources PROJECTADMINISTARTIONREGULATORYSYSTEMSPERSONNELP,P & E POS System Ability to implement DBP Hardware & Software, Wiring MOW ImprovedIncreased revenues and improved efficiencies of the existing resources Improve QoL for MOW clients Increased operational effectiveness for facilities Transport Equipment Campus Dining Program Continuity of standards throughout the community Increased cost efficiencies Improved QoL for all residents and work environment for staff Increased effectiveness in all appropriate operational areas

29. April 20, 2004 SCANPHA Annual Meeting 29 Process Management The detail of the Grids Onto the PM Tool Use of a Process Management system to:  Identify Project Tasks  Define Time Required to Complete  Detail Sequencing and Coordination of Tasks  Assign Responsibility & Accountability for Completion  Ability to Efficiently Track Multiple Moving Teams  Detailed Cost Assessment

30. April 20, 2004 SCANPHA Annual Meeting 30 Into the Pool Identify the “Main Thing” Initiate the Alignment Process Use of Consulting Services Start in the Shallow End of the Pool