CREATING YOUR PREFERRED FUTURE

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CREATING YOUR PREFERRED FUTURE

• Reginald Carter, PhD
• Past President/CEO
• Health Care Association of Michigan
• Orgpro Learning Fest
• Michigan Society of Association Executives
• Frankenmuth, Michigan
• July 18, 2007
• 130-300 PM

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PREFERRED FUTURE

• Lions, antelopes and chipmunks
• Define your antelopes and do not get distracted
  by the chipmunks
• Plan back from victory rather than forward from
  the present
• Transformational Change and Strategic Planning
  Newt Gingrich (2002)

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PREFERRED FUTURING

• Preferred futuring initiates a large paradigm
  shift, taking us from being powerless victims to
  being empowered and connected to our deep
  passions and motivated to work together to create
  a future we want. It means we are responsible and
  cannot blame others. But there is a tendency to
  resist this reality. For many of us, feeling
  helpless or victimized has been a way of coping
  with our sense of powerlessness.
• Lawrence Lippitt, Preferred Futuring (1998) pg.67

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GETTING TO NO

• Defining your preferred future helps to clarify
  competing agendas and better use of scarce
  resources. It provides a critical reason for
  saying no to many opportunities to spend your
  resources helping others attain their preferred
  futures.
• The larger the association the greater the
  requests to use your resources for other
  preferred futures.

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AGENDA

• Member versus association futures
• Five lessons for creating the future
• Exercise to help define your preferred future
• Five examples of HCAMs implementation of their
  preferred future
• Lessons learned
• Resources

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• I GO WHERE THE PUCK IS GOING, NOT WHERE IT WAS.
• Wayne Gretsky, hockey player

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DIFFERENT FUTURES

• The future of members is different from the
  future of an association of those members.
• It is almost impossible from within an industry
  to perceive of a future that eliminates their
  major capital investment. IBM would have found it
  impossible to envision a world without
  typewriters. Nursing home owners have great
  difficulty in envisioning a world without
  nursing homes.

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ORIGINS OF CHANGE

• Almost all significant change is initiated
  outside a given industry.
• It is just too painful to gain voluntary support
  among current vested interest members for a big
  change which places them at high risk.
• Doing nothing also has its own risks.
• The reason why members have a difficult time
  agreeing to a preferred future is that they have
  different expectations about the future. These
  expectations vary according to their business
  plan. Different segments of the same industry
  have very different expectations for the future.

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GETTING TO YES

• Any proposed preferred future can impact members
  positively or negatively based on their business
  plan.
• That is why it is so hard to get to yes.
• Some members who are negatively impacted by the
  adoption by an association of a preferred future
  may reassess their continuing in membership.

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FIVE LESSONS FOR CREATING THE FUTURE

• Imagination is the master of great strategy,
  implementation its servant
• When it comes to creating value, imagination wins
  over forecasting and prediction
• Ambitious goals act as catalysts.
• Put a car in every garage (Henry Ford)
• Rock- bottom prices to rural Americans (Sam
  Walton)

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FIVE LESSONS FOR CREATING THE FUTURE

• Do not listen to naysayers.
• Create a compelling future which captures the
  dream, defines benefits to consumers, identifies
  core competencies and defines interface between
  company and consumer.
• Gary Hamel and C.K. Prahalad, Competing for the
  Future (1994).

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EXERCISE IN DEFINING YOUR PREFERRED FUTURE

• I dream of a world where our members can
• Our association will have to strengthen its
  competencies in
• And forge partnerships with
• To attract and retain members, our association
  will have to interact with and serve members in
  the following manner

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HCAMs PREFERRED FUTURE

• I dream of a world where HCAM members can be
  respected by the majority of the public, receive
  adequate payments and be judged on customer
  satisfaction and patient outcomes.
• For this world to become a reality, HCAM will
  have to strengthen its competencies in defining
  quality, negotiating the necessary resources and
  communicating our successes and our legitimate
  role in providing high quality care.

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HCAMs PREFERRED FUTURE

• And forge partnerships with consumers,
  regulators, media, legislators, other provider
  organizations, payers, financial institutions,
  advocacy groups and physicians (basically
  everyone).
• To attract and retain members HCAM will have to
  interact with and serve members with continuous,
  cutting-edge education, real results in the
  regulatory and legislative arenas and efficient
  ways of communicating with members.

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IMPLEMENTING HCAMs PREFERRED FUTURE

• New CEO (1996)
• Ten Guiding Principles (1996)
• Defining the Preferred Future (1998)
• Implementing the Preferred Future
• Consumer Guide (1996-2006)
• Clinical Practice Guidelines (2000-2007)
• Provider Tax (2000-2007)
• New Physical Plant Model (2002-2007)

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CONSUMER GUIDE

• Family satisfaction (high)
• Web-site and printed copies
• Neutral third party research
• All homes invited to participate
• All homes listed
• Detail on Medicaid and Medicare eligibility
• Recommendations on choosing a nursing home
• Updated every two years

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AARP-BEYOND 50(2002)

• Consumers perceptions of health care quality
  stand in stark contrast to the views of technical
  experts who warn of deficiencies. For example,
  although it is known that many people, including
  Medicare beneficiaries, do not receive
  appropriate care, the vast majority of consumers
  across all the age groups are very satisfied with
  the health care they receive. (page 105)

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CLINICAL PRACTICE GUIDELINES

• Broad coalition
• Timetable and process to implement American
  Medical Directors clinical practice guidelines
• Joint training of regulators and providers
• Decrease in survey citations and improvements in
  clinical quality in the short run with recent
  reversal of this trend

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NEW PHYSICAL PLANT INCENTIVE

• Governor Granholm initiative (2002)
• 5 more to Medicaid rate paid to nursing home for
  creating predominately single room and bath. This
  provides an additional 182,500 for a 100 bed
  Medicaid home to be used for new physical plant
  expenses.
• Change law to allow revisions
• New model now available at Tendercare at Suttons
  Bay.

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TEN GUIDING PRINCIPLES

• One year to get to yes
• Used to review proposed regulations, legislation
  and practices
• Good public policy is necessary to get buy in
  from broad coalition necessary to create change
  in the best interest of consumer, not necessarily
  the provider members

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PRINCIPLES

• Substandard care shall not be tolerated.
• Customer satisfaction is the most important basis
  for defining quality.
• Customer satisfaction driven criteria should
  replace the current government regulatory model.
• The consumers need for services should be
  assesses and the necessary resources committed to
  meeting their needs.

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PRINCIPLES

• Competition among providers should be encouraged.
• Customers need to know the costs and outcomes of
  services in order to make informed choices.
• Customers have the right to select their most
  appropriate services.
• Legislation to address isolated problems is
  inappropriate.

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PRINCIPLES

• Legislation and public policies should be
  initiated only if based on outcome evidence
  information that enhances quality care.
• Uniform standards should be promoted.

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PROVIDER TAX

• Governor Engler initiative in 2000
• 440 million in 2006 from enhanced federal
  Medicaid funding for nursing homes and other
  state services.

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LESSONS LEARNED

1. Implementation of a specific initiative always
   results in members who are winners and losers
   even though the project helps movement to a
   preferred future.
2. The first Consumer Guide embarrassed some low
   performing homes but encouraged transparency,
   improved care and provided an alternative
   definition of quality outside the regulatory
   framework.

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LESSONS LEARNED

• Members have different strategies for achieving
  success. An associations preferred future can
  conflict with individual members strategies.
  Leadership needs to be aware of these likely
  conflicts before and during the process of
  defining and implementing a preferred future.
• The new physical plant proposed model and the
  Provider Tax split HCAM members on ideological
  and financial basis. It was probably inevitable
  that some members would be unhappy.
• There is strong member and staff resistance to
  the risk of defining a preferred future and much
  uncertainty regarding the future. It takes
  courage to define a preferred future. Most
  members are more comfortable allowing other
  forces to define their future.

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LESSONS LEARNED

• Members may perceive an associations commitment
  to a preferred future as not in their best
  interest and decide to leave the associations
  membership. Three large chains did leave HCAM
  membership in 2005 and one has subsequently
  returned. None chose to belong to another
  competitor association.
• HCAM did gain a whole new membership category
  (County Medical Care Facilities) because HCAM was
  perceived to be proactive and aggressive
  especially in the political arena.

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LESSONS LEARNED

• Be careful what you wish for you may attain it
  with a smaller but a more cohesive membership.
  Members join associations to achieve goals they
  could not attain individually.
• Associations need to establish preferred futures
  which allow all members to envision what success
  would look like. It may be necessary to be less
  ambitious in establishing preferred futures in
  order to retain membership levels. HCAM, I
  believe, is a stronger association as a result of
  articulating a preferred future even with a
  smaller membership base.
• Strong volunteer leadership is necessary to
  preserve a preferred future when it may cause
  association membership declines.

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RESOURCES

• Roger Fisher and William Ury, Getting to Yes,
  Penquin Books, 1981.
• GARY Hamel and C.K. Prahalad, Competing for the
  Future, Harvard Business School Press, 1994.
• Allen Liff, Learning How to Create the Future.
  Association Management, August 1997 (Pages
  54-62).
• George Lakaff, Dont Think of an Elephant,
  Chelsea Green Publishing Company, 2004.

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CONTACTING REGINALD CARTER

• By mail at 1777 Colorado Drive, East Lansing,
  Michigan 48823
• By phone at [phone]
• By e-mail at reginaldkcarter_at_aol.com