Appendix J-1: Sustainability Planning for Community Quality Collaboratives: Ten Key Questions to Guide Your Planning Efforts
Report #1: Oregon Health Care Quality Corporation
The author would like to thank the following people from the Oregon Health Care Quality Corporation (also known as the Oregon Community Quality Collaborative) for contributing to this document: Nancy Clarke, Executive Director; the Market Scan and Sustainability Planning Committee: Jerry Cohen, Chris Ellertson, Pam Haworth, Matt Seibt, and Karen Stral; and the Board of Directors and staff.
The author wishes to thank the following people for reviewing this report: Jan De La Mare, MPAff, Agency for Healthcare Research and Quality; Karen Shore, PhD, Center for Health Improvement; Nancy Clarke, Oregon Health Care Quality Corporation; and Peggy McNamara, MSPH, Agency for Healthcare Research and Quality.
AHRQ appreciates citation as to source. Suggested format follows: Lejnieks, L. Sustainability Planning for Community Quality Collaboratives: Ten Key Questions to Guide Your Planning Efforts; Report #1: Oregon Health Care Quality Corporation. Rockville, MD: Agency for Healthcare Research and Quality, December 2008.
We consider our Learning Network tools to be works in progress and always welcome your comments. Please forward suggestions to AHRQ's Peggy McNamara at email@example.com.
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Based on the real life experience of the Oregon Community Quality Collaborative (Community Quality Collaborative), this report provides a roadmap for a Community Quality Collaborative to develop a tailored sustainability planning approach. Over a period of seven months in 2008, the Agency for Healthcare Research and Quality (AHRQ) funded a sustainability planning project for the Oregon Health Care Quality Corporation. The end product of the work in Oregon is provided in the Appendix, and is also available in the Sustainability Toolbox (Item #11: Oregon Health Care Quality Corporation Strategic Sustainability Plan).
This report is one component in a technical assistance program on sustainability developed by AHRQ for its Learning Network for Community Quality Collaboratives. The program toolbox includes two reports based on real life experience in two pilot projects: one in Oregon and one in Louisiana. The goal of this sustainability program is to support Community Quality Collaborative leaders and members in defining strategies that will lead to productive and financially sound collaboratives that grow, thrive, and deliver significant value over time.
For more information about this program and to access the electronic documents in the Toolbox, go to http://www.cvelearningnetwork.org/doc.asp?id=50.
About the Oregon Health Care Quality Corporation (Oregon Community Quality Collaborative)
The Oregon collaborative had been in operation about 4 years when this sustainability planning work took place. The collaborative already had demonstrated a good growth pattern, starting with approximately $60,000 in funding and growing to more than $1.2 million. A steering committee — called the Market Scan and Sustainability Committee — had been created to focus on this process. At the end of the planning cycle, this Committee was disbanded and the responsibility delegated to the standing Executive Committee.
The remainder of this report summarizes the sustainability planning experience in Oregon.
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As part of the sustainability program, seven leading practices were identified in three case studies of successful collaboratives. A key component of the recommended sustainability planning approach involves evaluating the application of these practices and targeting the biggest gaps for immediate attention.
The seven leading practices are:
- Responding to Compelling Market Circumstances.
- Maintaining Effective Leadership.
- Achieving Balance Among Stakeholders.
- Delivering Tangible Value.
- Communicating Proactively.
- Establishing a Transparent Management Style.
- Employing Rigorous Prioritization.
Each leading practice is described in detail in the Sustainability Program Overview.
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Part I: Taking a Fresh Look at the Landscape
This section provides insight into how to assess the current state of the collaborative and its environment. This assessment is critically important in determining if the Community Quality Collaborative is on track and where it should focus future efforts. Ideally, this portion of the planning should be conducted by a neutral party with "fresh eyes" to gain the most insight.
Question #1: Where do we need to focus our efforts? (What are our strengths and weaknesses?)
In each of the two pilot projects, the consultant and executive leadership narrowed the focus to two or three of the leading practices. In Oregon, the organization already had been working on leadership, governance, and organizational effectiveness issues, which provided a solid foundation for additional sustainability work.
The sustainability pilot project was designed to focus on the following three practices:
- Leading Practice #1: Responding to Compelling Market Circumstances.
- Leading Practice #4: Delivering Tangible Value.
- Leading Practice #7: Employing Rigorous Prioritization.
Question #2: Where is the "energy" in our region?
A key component of the Oregon pilot project involved scanning the Oregon market for an updated view of the players, programs, and needs. In this process, the consultant contacted seven market leaders, including Board members and others, and conducted structured interviews. A template for this type of interview is included in the Toolbox. Each interview lasted about one hour and yielded important insights for the Board and Executive Director including:
- The Oregon Community Quality Collaborative, formally known as the Oregon Health Care Quality Corporation, occupied a recognized and respected niche. No other organization was perceived to have such broad multi-stakeholder collaboration in place.
- There was a common perception that "nobody" was leading or innovating across the stakeholder groups. While certain stakeholders were recognized as leaders, their efforts were perceived to be more internally focused.
- Leaders expressed increased interest in access to care, relative value, and affordability issues, out of necessity.
- Significant discussion centered around the pending proposal for state health reform and the role that the Oregon Community Quality Collaborative could play. This led to a conclusion that the Oregon Community Quality Collaborative was positioned to be a "contractor of choice" on key quality provisions. It also produced recommendations that the Oregon Community Quality Collaborative increase communication with key decision-makers to ensure that its capabilities were well understood.
Question #3: How do we compare to other relevant organizations?
The Oregon Health Care Quality Corporation Board, which represents the Community Quality Collaborative, found the comparisons to other successful collaboratives particularly helpful. (For more information, see the three Case Studies included in the Toolbox.) Specifically, by comparing the sources of funds and uses of funds as applied in other collaboratives, the Oregon Board concluded that:
- The existing funding model was less diversified than the models of comparison organizations.
- The organization's funding had become less diversified over time.
- In particular, other health care collaboratives were receiving more funding support from Government sources and purchasers.
Question #4: Is our vision clear and well supported?
Before defining specific priorities, it is important to validate the guiding vision of the organization. The Oregon collaborative already had a well-defined vision and supporting strategies, which were affirmed by the Board as part of this process.
Question #5: What do our stakeholders, including funders, value?
A critical component in planning for sustainability is having a clear, current, and neutral understanding of what stakeholders, including funders, value and will support. This was accomplished in the Oregon planning project through the market leader interviews described above, as well as individual surveys of key stakeholders. The selected stakeholder group included all Board members and selected others, to ensure a balance of perspectives. The surveys were conducted online, using a low-cost electronic survey tool. The results of the surveys, as well as the actual questions, are provided as examples in the Toolbox.
In the process of discussing the vision, program options, and survey feedback, the Oregon Board affirmed that the organization's core value lies in aggregating data and publicly reporting on that data. This was underscored by the prevalence of these activities in the existing program work.
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Part II: Rigorous Prioritization
This section provides insight into how to shape the various inputs — such as market data, comparisons to other organizations, and stakeholder feedback — into actionable priorities.
Question #6: What model will we use to define and manage priorities?
While the content is more important than the format, the Oregon Community Quality Collaborative found that simple graphic charts were very helpful in visualizing the total work effort and priorities. In particular, the Board requested visuals that would show the distribution of work, and the growth of resources, over time. The priorities were presented in annual snapshots, to show the planned progression of programs and resources. The actual charts are included in the Toolbox as an example.
In addition to the visual charts, the Board requested additional background information about each of the programs. To make the most of limited Board meeting time, this information was provided in a document as pre-meeting reading material. This was an important step in the process that ensured that all participants had a shared understanding of the work. It also preserved valuable meeting time for weighing the strategic options, rather than explaining the details of the programs.
Question #7: What are our priorities?
Reaching consensus on priorities was the central focus of the Oregon project that occupied a substantial portion of two consecutive Board meetings. In the end, program work was organized into five "tracks" that helped to streamline the discussion:
- Track #1 — Performance Measurement & Public Reporting: The core value and foundation of the Community Quality Collaborative, as discussed above.
- Track #2 — Foundation Commitments: Work related to the core activities of performance measurement and public reporting that had already been committed to existing funders.
- Track #3 — Organizational Development: Supporting activities including sustainability planning and contributing to the health policy discussions in the State of Oregon.
- Track #4 — New Program Development: Leading opportunities for program expansion, as identified in the stakeholder feedback.
- Track #5 — Watch List: Additional opportunities valued by stakeholders that were not included in the 2-year planning vision for various reasons, such as resource constraints and lack of clear direction.
For more information about the Oregon priorities, see the Oregon Health Care Quality Corporation Strategic Sustainability Plan, included in the Toolbox.
Question #8: How will we define effective strategies to deliver on our priorities?
Once the priorities are defined, it is important to have a clear, well-documented picture of what it will take to achieve them. A more detailed planning process began during the Oregon consulting project and will continue under the direction of the Executive Director and Executive Committee. The completed plan includes high level strategies to support each priority. These strategies were defined in the course of the planning discussions and approved by the Board as part of the completed plan.
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Part III: Delivering Tangible Value
The most important part of a sustainability plan is the execution, which must be focused on delivering tangible value to the market.
Question #9: What do we need in order to execute on our defined strategies?
In support of the agreed upon progression of programs and priorities, the Oregon Board affirmed a clear set of tangible strategies. To review the actual strategies, see the Oregon Health Care Quality Corporation Strategic Sustainability Plan, pages 15 through 16, in the Sustainability Toolbox: http://www.cvelearningnetwork.org/doc.asp?id=50.
In addition, the Board requested updates every six months, in the form of a consolidated dashboard. This dashboard illustrates the intersection of all program, development, and sustainability work to provide a complete picture of the progress being made by the Oregon Community Quality Collaborative. A snapshot of this dashboard is included in the Sustainability Toolbox: http://www.cvelearningnetwork.org/doc.asp?id=50.
Question #10: How will we monitor our progress (and ensure that our plan doesn't just gather dust)?
The Oregon Board recognized the importance of continuing to focus on sustainability issues and delegated this responsibility to the Executive Committee. The final Plan includes a matrix of roles and responsibilities to ensure that each individual or Committee is clear on its charge and deliverables.
To ensure that the plan is realized, the Board directed that status reports be presented at each Board meeting (scheduled every other month). The Board also directed that the plan be formally reviewed by the Board no less frequently than every six months.
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In summary, the chart below illustrates the strategic planning process, which was applied in Oregon as follows:
- The Vision had already been well defined, and was affirmed by the Board at the first planning session.
- Therefore, the Committee focused on confirming the Universe of Possibilities and the intersection of Capabilities, Priorities, and Funding. For many organizations, the biggest challenge of sustainability is in balancing these three factors.
- The resulting Plan reflects those conclusions and defines the Strategies, Execution Plan, and Monitoring approach.
This process yielded the following lessons learned for the Oregon group, which also may apply to other Community Quality Collaboratives in their sustainability planning efforts:
- Significant progress can be made in about six months with limited resources.
- Identify a driver who has the time and skills to keep the process moving; subject matter knowledge is very helpful.
- Break the process into chunks; preview and refine with a small group.
- Make sure all participants are up to speed on the current objectives and programs: refresher may be needed.
- Keep surveys simple.
Even if a Community Quality Collaborative does not have extensive resources to support an in-depth sustainability planning process, a small, focused group can make good progress by applying the experience from the pilots, along with the examples and templates provided in the Toolbox.
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