1. N NCHN Spring Conference April 18, 2005 Jill Zabel, Manager Wipfli Health Care Practice Network Formation, Evolution & Evaluation

2. Objectives Network Life Cycle Stages & speed of development Evaluation A tool for sustainability

3. Why do networks form? Quality Initiatives Recruiting Spread Risk Education Referrals Professional growth Advocacy Share services Purchasing Technology access Managed Care contracting Grant access

4. Network Life Cycle DEVELOPMENT GROWTH MATURATION PERFORMANCE & PROCESS IMPROVEMENT PLATEAU STAGNATION & DECLINE

5. Network Development Why? Goal-driven Activity-driven How? Informal Formal What? Solid Base Includes Sustainability & Evaluation DEVELOPMENT

6. Network Growth Added Objectives Added Demand Added Services Added Members Added Funding GROWTH

7. Network Maturation Getting There Strategy Motivation Evaluation Staying There Strategy Motivation Evaluation MATURATION

8. Network Stagnation & Decline Why? Shaky purpose Weak development Change Constraints Relationship dynamics Lack of support Conflicting agendas Poor communication Leadership STAGNATION & DECLINE

9. Network Stagnation and Failure Our observances & opinions Lack of focus and discipline in defining the network’s “business” Fuzzy objectives Network members have different agendas or strategies Services lack value or relevance Unequal levels of commitment, involvement, benefit Poor communication, governance, leadership, execution of strategies

10. Avoiding Network Stagnation and Failure What the research* says Solid business plans Clear Missions and Goal Statements Compelling need for network Balance between Mission and Margin A strategic orientation allows ability to deal with changing environment * University of Minnesota Rural Health Research Center, Working Paper #31(Jan 2000), #55 (Nov 2004)

11. Let’s Talk About Evaluation To improve To build organizational capacity To empower To demonstrate value To provide information for decisions about programs Why Evaluate?

12. Evaluation Reveals Where You Are DEVELOPMENT GROWTH MATURATION PERFORMANCE & PROCESS IMPROVEMENT PLATEAU STAGNATION & DECLINE

13. Program Evaluation Is NOT about proving the success or failure of a program. Think about what you need to know to make program decisions What’s working and what is not? How well are you delivering value to stakeholders? What do your members, stakeholders, customers and funders need to know?

14. Basic Evaluation PROCESSOUTCOMES INPUTS Resources Money Facilities Clients Staff How the program is carried out. What do you do? Members share benefits Patients served OUTPUTS Units of measurement Number of members Number of people served Impact of program Money saved Education Patients or members receiving services There is no set recipe for evaluation…

15. Evaluation Approaches Goals-based Are you meeting your overall objectives? Process-based How does your program really work? Strengths? Weaknesses? Outcomes-based What are the benefits for members? Patients? All or some approaches can be useful

16. Evaluation Methods Questionnaires, surveys Interviews Documentation review Focus Groups Case Studies Internal or External Evaluation

17. Network Sustainability Have a plan Monitor and measure Balance between Margin and Mission

18. Critical Success Factors for Networks Strong sense of mutual ownership Common goals among members Clear mission and objectives Equitable governance structure Adds Value A clear “value proposition” Strong and consistent communication within network Meeting needs not readily available from other sources

19. Making the Connection DEVELOPMENT GROWTH MATURATION PERFORMANCE & PROCESS IMPROVEMENT PLATEAU STAGNATION & DECLINE Where are you? How do you know? Where do you want to be?

20. “The advantage of not looking at a map is that you don’t have to admit you’re lost.” Source: Rural Wisconsin Health Cooperative

22. Questions? Comments? For more information about this topic, please contact: Jill Zabel, Manager Wipfli Health Care Practice 4000 Lexington Ave N, Suite 201 St. Paul, Minnesota 55126 651.636.6468 jzabel@wipfli.com