Strategizing and Business Development for State Offices of Rural Health and Affiliated Functions

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Strategizing and Business Development for State
Offices of Rural Health and Affiliated Functions
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Design of SORH Planning Systems

• Introduction
• All State Offices of Rural Health (SORH) are
  engaged in planning.
• In most cases the foci of SORH planning are
  health care services, access, relationship
  building, workforce development (particularly
  physician needs) and organizational/systems
  development, e.g., Critical Access Hospitals,
  Certified Rural Health Centers, and provider
  networks

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Design of SORH Planning Systems

• The primary vehicle for SORH planning is
  sometimes the crafting of a rural health plan
• Changing FLEX expectations
• Annual grant requests
• Office Budget

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Design of SORH Planning Systems

• While all SORHs engage in many forms of planning,
  many lack substantive experience in planning for
  themselves as business entities
• Until recently, most SORHs did not plan for
  themselves.

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What You Can Expect

• SORHs can achieve better results with systematic,
  thoughtful processes, applied to anticipating the
  future, setting goals, and identifying
  strategies. Thinking like a business adds an
  important dimension. The return on this
  investment will almost always outweigh the costs

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Planning processes and resulting plans can be
extremely useful tools to

• Stimulate discussion and build organizational
  vision and staff cohesion
• Create a better sense of purpose and direction,
  and a flexible framework for action
• Communicate programs, needs, strategies,
  opportunities, and value to higher level
  administrators and to various funding entities
• Identify and clearly document priorities

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Planning processes and resulting plans can be
extremely useful tools to

• Define and communicate the basis of decisions
• Clarify the alignment of resource commitments and
  staffing
• Build relationships and improved communications,
  with other organizations and individuals

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No One Planning Model

• While most SORHs share some issues, any planning
  process has to be specific to the state or
  local conditions. Many of each Offices issues
  will be similar to those of other Offices, but
  the process has to be customized to
  state-specific parameters
• size
• organizational complexity (SORH only or a cluster
  of activities)
• organizational setting (state government,
  university, free-standing)
• the preferences of the director
• Need for outside planning support

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Variability of State Offices

• It is critical to note that the extensive
  variability among State Offices needs to be
  recognized.

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Context of Planning Process

• All of planning occurs in the context of the
  significant demands of other activities, many of
  which are related to meeting the Federal
  expectations for SORH program participation and
  funding.

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SORH Program Expectations

• Technical Assistance (core function.)
• Information Clearinghouse (core function.)
• Coordination of Rural Health Activities Statewide
  (core function.)
• Support for Rural Recruitment and Retention
  Initiatives (supplemental function)
• Participation in Collaborative Relationships That
  Foster State-Federal Partnerships (supplemental
  function.) And,

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SORH Program Expectations

• In addition, although not specifically stated in
  the legislation, Demonstration of Leadership
  That Impacts State and Federal Policy
  Initiatives.

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Design of SORH Planning Systems

• To make the challenges to planning all the more
  complex, SORH have
• Variable roles in FLEX Program management
• Variable roles in primary care development
• Variable expectations of state governments
• Sometimes multiple funding sources, each with its
  own set of expectations-for-its-money
• In most SORH particularly in the complex
  multi-function offices, the issue of planning
  goes well beyond just the basic federally
  defined, SORH role.

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Design of SORH Planning Systems

• The situation for many SORH parallels the
  reality for many small and rural hospitals
  (particularly Critical Access Hospitals) and
  other small provider organizations
• Operational demands and program obligations
  force a focus on immediacy!

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Scope of Planning Process

• In most cases, the planning process needs to be
  extended beyond the strict Federal, legislative
  requirements of the SORH Grant Program
• Key variable is the decision as to scope of
  constituent engagement

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Defining Constituencies

• Define constituencies and think about serving
  clients.
• Are we here to serve rural residents? Or is it
  State government, a university, other funding
  sources or other parties?
• For example, does the SORH think of its clients
  and ask What can we do for them?
• Consider programmatic, financial, and political
  constituency needs.

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Working with Others

• Consider the plans of other organizations in the
  State and the current and anticipated-to-be-neede
  d relationships.
• Evaluate the possibilities for shared strategies.

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Partnering as a Strategy

• Partner entities might include
• PCO and/or PCA
• Rural Development Councils
• Economic Development Corporations
• Extension Services
• Hospital, Medical, Nursing, Public Health, and
  other special interest Associations
• AHECs, and,
• Other agencies and legislative representatives of
  State Government.

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Working with Others

• Ask, On which issues do we lead? On which do we
  follow? Which issues do we own or want to own?
  What are our niches?
• AND
• How do we say no?

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Organizational Goals and Objectives

• Ask
• What are the most significant strengths
• What are the challenges
• What are the opinions of our constituents and
  what are their perceived needs
• What would we like this SORH to look like in
  two-three years? (Note a SORH may find it very
  helpful to consider what other Offices have
  achieved and the approaches that they have used
  for growth.)

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Organizational Goals and Objectives

• What would our goals and objectives be if there
  were to be no Federal funding or other
  significant funding changes?
• What do we think are the Offices core issues and
  expectations?

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Organizational Goals and Objectives

• Consider current and craft future organizational
  goals and objectives.
• These may be clinical in nature (e.g., supporting
  the development of direct clinical services, such
  as primary care, mammograms, preventive services,
  quality studies, etc.) and non-clinical (e.g.,
  CAH development and reimbursement, State Medicaid
  policy development, and any relevant political
  expectations of the Office.)
• How do we make the biggest difference in our
  state?

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Scope of Services Assessment

• Review current core elements of the SORH,
  relationships to Federal expectations,
  strengths and weakness of existing initiatives,
  and opportunities.
• Identify future needs and value-building
  activities.
• Define short-term expectations and phases for
  two years of development.
• Set priorities

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Building Critical Mass

• Consider what it might take to build critical
  mass for a sustainable, high-performance SORH or
  cluster of activities with SORH functions
  imbedded. (This is undefined to date. However,
  in general, size begets size!)

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Securing Resources

• Consider multifaceted funding options and
  alternatives for securing resources.
• State funding What is the current climate and
  our options? How do we present our case?
• What might be salable, income-producing services
  (technical assistance, specific educational
  programs, etc.?) Could we do this in our
  organizational setting?

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Securing Resources

• How can we best obtain grants? What are the
  sources? Do we need an alternative organizational
  structure in order to receive grants?
• Are there other sources to funding to be
  considered?
• How can we gain resources through partnerships?
  Do we need an alternative organizational
  structure?

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Consider Infrastructure

• Staffing
• Systems
• Advisory Structure
• Governance
• Technology

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In Conclusion