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Rural Hospital Flexibility Program Tracking Project
Appendix D4
Strategic and Financial
Information Collected During Hospital Site Visits
Strategic Information to be Collected
on Behalf of UNC at the Hospital Level
Desired Respondent(s): The hospital CEO.
Major Goals: The major goals of the hospital strategy study are to identify:
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If the organization has a formal strategic plan.
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The hospital's major problems and strategic initiatives. Specifically, in regard to their strategic initiatives we are interested in:
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What they were
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If they are concentrated in one area or if they are spread across the main categories of the Balanced Scorecard: financial, stakeholder, business processes, and infrastructure and innovation
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If they tend to concentrate on one or more of the following areas: finance, clinical services, staffing, external relations or management practices
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Estimates of the size ($) of the impact during the first year of implementation and forecasted over five years.
Some of the information we need will have been collected on the
pre-sitevisit survey. Section B-2 identifies whether or not they have a strategic plan, and if so, its composition. Section B-1 of the
pre-sitevisit survey asks the CAHs to identify their major strengths and problem areas as well as where major initiatives are taking place. Hopefully this later information will be useful in answering the questions on the site survey instrument.
Our primary area of interest in the site survey is to identify the hospital's major problems and strategic initiatives, and related information. We used the term "major" instead of strategic because in our pretests we found too much confusion over the term "strategic" and found that "major" was a reasonable substitute. In regard to their strategic initiatives we are interested in:
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What they were
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If they are concentrated in one area or if they are spread across the main categories of the Balanced Scorecard: financial, stakeholder, business processes, and infrastructure and innovation
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If they tend to concentrate on one or more of the following areas: finance, clinical services, staffing, external relations or management practices
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Estimates of the size ($) of the impact during the first year of implementation and forecasted over five years. [Part III, 2].
Related information, which is of primary interest to other
centers, will help us understand the context of their strategic efforts. These questions are:
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What were the major factors that made conversion to CAH seem like one of the more logical strategies for the hospital [II.1.]
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What were the strategic issues which had to be faced and addressed before deciding to convert to a CAH? [II. 2]
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What internal changes have occurred as a result of conversion? [III. 1]
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What external dynamics have changed as a result of participation in the Flex Program? [III 3]
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How have the CAH's accomplishments in developing affiliation and network relationships created opportunities that may not have otherwise been available without them?) [III.4]
Financial Information to be Collected on Behalf of UNC at the Hospital Level
Desired Respondent(s): The hospital CFO or, if necessary, the CEO
Major Goals:
Our main goal in the financial portion of the study is to answer the following two questions:
In particular, our objective in the financial study is to estimate the effect of conversion on the CAH's:
Some of the information we need might have been collected on the pre-site visit data collection instrument and in the telephone survey. Section D of the pre-site visit data collection instrument identifies the composition of some of its payer sources and expense items. The telephone survey should have collected some of the information related to the financial estimates of feasibility studies. Hopefully these sources of information will be useful in answering the questions on the site survey instrument.
Our primary area of interest in the site survey is to identify the hospital's major profitability and cash flow problems and how these areas have been affected by CAH conversion. In regard to their financial initiatives we are interested in:
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What their financial initiatives are/were
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Whether they were aimed at revenue enhancement, cost reduction, or cash flow management
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What budgetary category the fall into (e.g., physician labor expense; non-physician labor expense; supplies; inventory; property, plant and equipment; discounts on charges; and managed care premium revenue)
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Estimates of the size ($) of the impact during the first year of implementation and forecasted over five years.
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Projected and, if available, actual change in CAH's profits and cash flow post conversion.
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