Improving Life, One Breath at a Time

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Improving Life, One Breath at a Time
1-800-LUNG-USA
www.lungusa.org
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Organizational Effectiveness Initiative

• Report to the American Lung Association Council
  and Chairs/Chairs-elect
• By William Kowalewski
• December 2004
• Washington, DC

www.lungusa.org
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Organizational Effectiveness Steering Committee
Members

• William Kowalewski, Chairperson
• Alfred Lynne Brannen, II, MD
• Bruce A. Herring
• Linda H. Newton
• Ellen Ceppetelli, MS, RN
• Stanton H. Hudson, Jr.
• Dean Schraufnagel, MD
• Kay Doerr, MS

• Dennis Duffy
• Ernest P. Franck
• Judge Cordell Meeks
• Edward Carter
• Edward Miller
• Lori Pickens
• Donald Clark
• Norm Childs ALA Staff
• Elliot Pagliaccio (TRI)

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Steering Committee Charge from the American Lung
Association Board

• Develop a process to examine and make
  recommendations to improve the organizations
  effectiveness in order to increase its impact on
  lung disease.
• Create a unique American Lung Association model
  to increase efficiency and effectiveness.

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Phases of Organizational Effectiveness

• Process Improvement Plan Completed
• Design Phase Completed
• Pre-implementation, technical assistance and
  Development Phase Now to May, 2005
• Implementation Phase Pending Board approval in
  May 2005, begins June 2005
• Monitoring and Assessment ongoing

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Background and Rationale for Organizational
Effectiveness

• A more complex, competitive environment.
• Organizational lack of focus and follow-through
  on strategic priorities.
• Related to this, a lack of clarity about our
  identity among the public.
• Lack of mechanisms to measure organization and
  customer outcomes.
• Governance that sometimes hampers quick action to
  leverage strategic opportunities.

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Background and Rationale for Organizational
Effectiveness

• Many local Lung Associations challenged to
  survive, rather than grow and thrive.
• Local re-organizations and consolidations in
  reaction to financial pressure, not planning.
• Need for more effective national/local
  partnerships.
• Volunteers and staff need new and different
  skills, opportunities and structure that focus on
  critical competencies.

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Background and Rationale for Organizational
Effectiveness

• Poor overall revenue position/trends
• Flat revenue for the last 37 years.
• Declining net assets.
• 2003 revenue 20 lower (inflation-adjusted
  dollars) than 1967.
• 9 of 11 public health competitors grew revenue at
  faster rates than we did in the last 10 years.

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Bottom Ten Performing Lung AssociationsAccording
to Overall TPI and Per CapitaFundraising Rankings
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Top Ten Performing Lung AssociationsAccording to
Overall TPI and Per CapitaFundraising Rankings
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Background and Rationale for Organizational
Effectiveness

• Multiple incorporated entities make alignment and
  impact difficult.
• Notwithstanding all the challenges
• Great volunteers and staff.
• Eagerness for change.

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Design Phase -- Guiding Principles

• The organization is committed to improving lung
  health through advocacy, education and lung
  health research.
• We are committed to retaining our historical and
  pervasive passion for our Mission.
• We commit ourselves to
• Our communities, our staff, our volunteers and
  our effectiveness.

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Design Phase -- Process

• Stakeholder groups
• National volunteers Local volunteers
• Chairs/Chairs-elect CLAS
• National staff Local staff
• Local CEOs Past National presidents

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Design Phase -- Process

• Six work groups with volunteers, Lung Association
  CEOs and national staff.
• Charged each to
• Be open, participatory and communicative.
• Use input from surveys and individuals.
• Seek guidance from diverse forums.
• Continuously assess if we are doing the best
  possible job, getting the best outcomes and
  finding every new opportunity to improve our
  performance.

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Design Phase Process6 Work Groups

• Organizational Assessment Seek and assess input
  on short/long term ways to improve.
• Balanced Scorecard Develop a practical and
  manageable outcome management and performance
  review system.
• Historical Perspectives Learn from past
  restructuring.

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Design Phase -- Process

• Corporate Design Develop a new corporate model
  and recommendations for governance, structure and
  national/field collaboration.
• Human Resources Develop mechanisms to aid
  volunteers and staff in transition.
• Communications Inform and involve all
  stakeholders.

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Design Phase Recommendations

• Following are the 37 recommendations of the six
  work groups, numbered as in the written report.
• We will eliminate redundancies in the final
  product among different groups recommendations.
  
• Some recommendations require development
  particularly the Governance section of Corporate
  Design and topic of Regional VPs.

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Design Phase -- Recommendations

• These following few recommendations are intended
  to be implemented in the short-term.
• R11 -- A national advertising campaign.
• R12 -- Set standards for local associations
  regarding computer technology.
• R13 -- The national office should provide a
  template for a successful merger.

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Design Phase -- Recommendations

• R1 The American Lung Association must become an
  outcome-focused, performance-driven organization.
• R2 Staff and volunteer training must be conducted
  on the Balanced Scorecard.
• R3 The American Lung Association must implement
  an annual performance review system the
  Balanced Scorecard Annual Cycle.

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Design Phase -- Recommendations

• R4 The Balanced Scorecard must be designed with
  key result indicators that reflect these
  perspectives
• -- Customers.
• Internal Processes.
• Financial.
• Results Learning.
• Governance.

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Design Phase -- Recommendations

• R5 The Balanced Scorecard should be implemented
  with the following structure
• Balanced Scorecard Coordinating Committee
• Balanced Scorecard Peer Support
• Regional Vice Presidents
• Constituent Associations/Local CEO
• National Headquarters Balanced Scorecard

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Design Phase -- Recommendations

• R6 To support the Balanced Scorecard
• Performance Review System we need
• A robust data tracking system.
• A measured roll out.

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Design Phase -- Recommendations

• R7 Additional Recommendations
• Strategic plan Lung Health and Operational Goals
  Balanced Scorecards must be integrated into
  performance-based system.
• A checklist of infrastructure, process and
  administration is needed to support the
  performance review system.

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Design Phase -- Recommendations

• R8 Our Organizational Effectiveness Plan
• should establish a preamble of common
• vision principles.
• R9 Mergers resulting in larger economic
• units are successful and should be encouraged.
• R10 An evaluation methodology must be built
• into all levels of the organization, to track and
• monitor outcomes.

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Design Phase -- Recommendations

• R14 Develop Best Practices to focus more
• directly on the Mission while answering
• Whom do we help who needs our help most?
• R15 Maintain engagement with volunteers
• with reduced responsibilities due to
  restructuring
• R16 Organize teams and create Tool Kits to
  support field offices.

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Design Phase -- Recommendations

• R17 If staffing changes become necessary
• handle them respectfully.
• R18 Examine all options including the legal
• and financial implications of removing the
• pension early retirement reduction for
  individuals
• with 30 years of service who are not yet 65 or
• introducing early retirement buyout packages, to
• name a few.

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Design Phase -- Recommendations

• R19 Recommendation for Long-Term Action
• Develop regional staff for implementation of
  national communications initiatives.
• Develop a shared local and national media
  database.
• Generate data showing progress made in the fight
  against lung disease and report these annually to
  the board.

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Design Phase -- Recommendations

• R19 Recommendation for Long-Term Action
• Formulate a smaller leadership group.
• Create regional offices with national staff.
• Provide national office support for mergers.
• Develop Best Practices to focus more directly on
  the mission.
• Highlight mission focused activities within Best
  Practices.

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Design Phase -- Recommendations

• R19 Recommendation for Long-Term Action
• Move to strengthen corporate leadership.
• Develop job descriptions for all volunteers and
  define a growth ladder.
• Define a career ladder for employees.
• Fund formal staff training opportunities.
• Align staffing with the Strategic Plan.

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Design Phase -- Recommendations

• R20 The American Lung Association will
• remain a two-level organization.
• R21 We will consist of a National Office, with
• single state and multi-state corporations.
• R22 We will establish measurable
• performance standards for maximum Mission
• impact and alignment.

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Design Phase -- Recommendations

• R23 Fund raising to further the Mission will
• become a prominent, organizational focus.
• R24 The Lung Association family will ensure
• cultural diversity in its staff, volunteers, and
• leadership.

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Design Phase -- Recommendations

• R25 Field restructuring to achieve larger,
• stronger, more efficient, and more effective
• corporations will be guided by criteria,
• timetable, tools, and technical assistance.

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Design Phase -- Recommendations

• R26 Five-Year Plan6/30/06 California and New
  York along with Chicago and Illinois-Iowa will
  become single state corporation.Concurrently,
  States volunteer to serve as pilot sites and
  create larger scale incorporated entities.
• 6/30/10 15 --20 larger incorporated entities
  are created. Budget size from 8 million upward.

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Design Phase -- Recommendations

• R27 National Office location will be reviewed
  with
• a decision timed to the end of the lease 6/30/07
  
• R28 National Office will decentralize certain
• functions to improve service delivery and support
• to the Field.
• R29 Regional Vice Presidents for Field Support
• will help implement the Balanced Scorecard and
• performance standards, to name a few, and
• collaboration among all levels of the
  organization.

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Design Phase -- Recommendations

• R30 Governance structures will be revised to
• direct strategic planning, fund raising, and
• decision-making in the most effective,
• expeditious, and excellent way possible.
• R31 Additional Possible Design Elements
• Creation of a Foundation with a separate Board of
  Directors
• Creation of a National Advisory Board
• Creation of a Research Foundation

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Design Phase -- Recommendations

• R31 Additional Possible Design Elements
• Creation of a Political Action Committee
• Formation of a Peer Technical Advice and Support
  Team to assist the Field
• Training and certification of CEOs and Senior
  Managers as CALL US mentors and coaches who
  provide assistance.
• Creation of a shared services division.

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Design Phase -- Recommendations

• R31 Additional Possible Design Elements
• Develop National Offices senior level staff
  positions for interaction with the RVPs/CEOs.
• Use an existing committee or establish a new body
  to oversee the Balanced Scorecard and performance
  standards process.
• Develop logistics for the RVP positions
• Define the process for a new Charter and
  implement a performance standard system.
• Clarify what local presence means.

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Design Phase -- Recommendations

• R32 Approve and distribute the Human
• Resources Principles
• R33 Approve the Priority Leadership
• Characteristics and Position Responsibilities
• R34 Encourage supervisors to lead their staff
• through the new Staff Learning Needs
• Assessment and Staff Learning Resources.

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Design Phase -- Recommendations

• R36 The Human Resources Management
• Development Work Group will manage the
• creation of a Staff Transition Plan.
• R37 The Human Resources Management
• Development Work Group will manage the
• creation of a Volunteer Transition Plan.

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Pre-implementation, Technical Assistance,
Development Phase

• The process can and should begin now.
• Those who choose to begin the process will be
  assisted, and we can learn and benefit from their
  early efforts.
• The Steering Committee is refocusing various work
  groups to take on new assignments.

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Pre-implementation, Technical Assistance,
Development Phase

• These assignment groups will operate going
  forward under the Steering Committee.
• Organizational Assessment
• Communications
• Balanced Scorecard
• Governance
• Corporate Design
• Human Resources
• Regional Vice Presidents

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Pre-implementation, Technical Assistance,
Development Phase

• Open Items
• Governance
• Regional Vice Presidents
• The Tool Kit
• The new Charter
• Granting and Foundation sources
• Early retirement possibilities
• Balanced Scorecard Development (Field and
  National).

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10 Most Frequently Asked Questions

• Q1 -- Why must ALA restructure and move to a new
  model of operation?
• We are in a declining revenue position versus
  other national health organizations.
• Many local Lung Associations cannot fully serve
  the states where they are located, and many
  cities lack our presence altogether.
• Several Field operations are in deficit
  situations without adequate support or resources
  available either from the Field or the National
  Office to reverse this trend.

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10 Most Frequently Asked Questions

• Q1 -- Why must ALA restructure and move to a new
  model of operation? (continued)
• We must reposition ourselves to grow with a
  deeper commitment to fund raising to support our
  strategic priorities of advocacy, programs,
  research, and education.
• We lack a cohesive nationwide program of work
  that is every association pursues along with work
  that is unique to the associations environment
  and population.

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10 Most Frequently Asked Questions

• Q2 -- Why are CA, NY, and IL being asked to form
  single-state corporations?
• States must be lead and represented by 1 Board
  and 1 CEO and managed through 1 budget in order
  to bring a clear and coordinated nationwide
  effort to statewide advocacy efforts and
  nationally sponsored programs.

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10 Most Frequently Asked Questions

• Q3 -- Why is the Field being asked to merge
  and/or restructure to form multi-state or larger
  regional configurations?
• We lack economies of scale to function
  competitively. Some local Associations lack
  exclusive fund raisers, statewide service
  delivery models, and the capacity to have input
  as advocacy organizations.
• We need Critical Mass within each entity to
  accomplish our mission.

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10 Most Frequently Asked Questions

• Q3 -- Why is the Field being asked to merge
  and/or restructure to form multi-state or larger
  regional configurations? (continued)
• Local Lung Associations are being asked to
  consider new, better, and larger organizational
  models.
• This will enable ALA to marshal its most talented
  people in more effective ways.

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10 Most Frequently Asked Questions

• Q4 -- Whats the Balanced Scorecard, and why is
  the ALA moving to implement this framework?
• The traditional corporate balanced scorecard is
  overly complex for our needs.
• Our balanced scorecard is, in effect, a
  performance review system that allows us to
  measure financial and non-financial results of
  our work based upon standards that are nationally
  agreed-to, quantified and tracked.

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10 Most Frequently Asked Questions

• Q5 -- Has Field restructuring in the ALA been
  historically successful?
• The findings of the Historical Perspective Group
  were positive with clear gains to these
  organizations.
• Local Lung Associations have completed numerous
  Field restructurings which are documented in the
  survey conducted by this group.
• Restructuring has provided the benefits of
  economies of scale in all cases.

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10 Most Frequently Asked Questions

• Q6 -- Will the National Office change as a result
  of this process, and if so, how?
• Yes. It, too, will be held to new performance
  targets as will the Field. The Field will be
  surveyed about its performance.
• The National Office may operate under a new
  governance model still under development.

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10 Most Frequently Asked Questions

• Q6 -- Will the National Office change as a result
  of this process, and if so, how? (continued)
• The National Office will be asked to play new
  roles to ensure stronger Field-National
  relationships and will be asked to service and
  support the Field in new collaborative ways, as
  well as to provide support to volunteer and staff
  transition.

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10 Most Frequently Asked Questions

• Q7 -- What is the purpose/function of the new
  National RVPs?
• Working with the Field CEOs, together they will
• Manage and coordinate the use of Balanced
  Scorecard.
• Provide support and facilitation to field
  restructuring efforts.
• Focus on, highlight, and convene states around
  best practices.

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10 Most Frequently Asked Questions

• Q7 -- What is the purpose/function of the new
  National RVPs? (continued)
• Bring more effective National-Field
  collaboration, and coordination to agreed-upon
  strategic priorities.
• These regionally-based, Nationally staffed
  positions will be hired by and report to the
  National CEO.
• The number and geographic scope of
  responsibilities is being developed.

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10 Most Frequently Asked Questions

• Q8 -- Has a national map and master plan already
  been developed?
• NO. The map of new regional or multi-state
  organization will evolve from all Stakeholders
  continuing to work together to determine the best
  possible nationwide look.
• There is no master plan. You are designing,
  developing, and will implement a unique Strategic
  Alignment Model based upon our collective efforts
  through this process.

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10 Most Frequently Asked Questions

• Q9 -- How much will these recommendation cost to
  implement, and what is the impact of all this
  restructuring effort?
• Volunteer Leadership and National Staff are
  working on models that will estimate
  reorganization costs Return on Investment (ROI)
  Opportunity Costs absent reorganization
  Foundation and other funding sources with the
  goal of authoring a business plan addressing
  these issues.

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10 Most Frequently Asked Questions

• Q10 -- What is there to point to that says that
  this time we will actually follow through and
  implement?
• You! This has been one of the most
  participatory, informative, collaborative, and
  constructive initiatives ever undertaken
• The number of people who have been involved is
  beyond our best expectations and bodes very well
  for implementation of these recommendations.

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10 Most Frequently Asked Questions

• Q10 -- What is there to point to that says that
  this time we will actually follow through and
  implement? (continued)
• The number of states already considering
  alliances is promising.
• The number of professionals seeking to begin
  pilot use of the Balanced Scorecard is very
  encouraging.

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Improving Life, One Breath at a Time
For 100 years, the American Lung Association has
been the lead organization working to prevent
lung disease and promote lung health. Lung
disease death rates continue to increase while
other leading causes of death have declined. The
American Lung Association funds vital research on
the causes of and treatments for lung disease.
With the generous support of the public, the
American Lung Association is Improving life, one
breath at a time. For more information about the
American Lung Association or to support the work
it does, call 1-800-LUNG-USA (1-800-586-4872) or
log on to www.lungusa.org.
www.lungusa.org