UCSF Clinical Enterprise
Strategic Plan
Presentation to Faculty Council
Prepared for
October 16, 2008
Strategic Plan: Timeline
Today
MONTHS
DEC
JAN
FEB
MAR
STAGE 1 – CHARTING THE LAY OF THE
LAND: 2015 MARKET
Confirm process, work plan, and roles
Understand UCSF’s DNA (Acuity model)
Set the stage: In 2015, we believe…
Create a shared understanding
Organize to address the challenges
STAGE 2 – UCSF READINESS AND
RESPONSES TO CHALLENGES
Readiness vs. 2015, Identify Issues
Responses, implications, & requirements
Sub-Committee Reports
STAGE 3: BRINGING IT ALL TOGETHER:
UCSF’S ROADMAP TO THE FUTURE
Sub-Comm. Outputs and Implications
Draft UCSF Strategic Roadmap
Shared strategies for a shared vision
Consensus on strategic plan
Modification of 10-year financial plan
Submission of final report
MEETINGS
Steering Committee
Strategic Oversight Committee
Sub-Committees
Town Halls*
Stakeholder Interviews
**
Strategic Retreats
1
APR
MAY
JUN
JUL
AUG
SEPT
OCT
Clinical Enterprise Strategic Plan
2002 Strategic Plan
2008 Strategic Plan
Previous Context
Current Challenges
 Significant growth imperative
 Capacity constrained
 Increased capacity
 Challenging FY08 budget
 Improved financial & operating
 Increased competition
performance
 Continued shift in insurance
 Increased customer
dynamic
service/satisfaction
 SB1953 seismic requirements
– Mission Bay cost
 Created Mission, Vision, and
Values
 Planned Mission Bay
2
Clinical Enterprise Strategic Plan
Foundational Statements
Values: Embodied in the acronym
PRIDE:
Mission:
Caring, Healing, Teaching and
Discovering.
P
R
Vision:
I
To be the best provider of health
care services, the best place to work
and the best environment for
teaching and research.
D
E
3
for Professionalism, how we conduct
ourselves and our business
for Respect for our patients, families,
ourselves and each other
for Integrity, always doing the
honest, right thing
for Diversity, understanding and
embracing the diverse beliefs, needs
and expectations of our patients,
community and employees
for Excellence, what we strive
for in everything we do
Strategic Plan: Direction
This 2008-2015 Clinical Enterprise Strategic Plan defines the next
evolution of UCSF, building on existing strengths and focusing on
opportunities for improvement
Three key goals serve as the foundation for this Strategic Plan
Clinical Growth
Best Care
Shared Accountability
Financial Performance
4
Strategic Plan: Themes
CLINICAL GROWTH
1. Maximize the Potential of the UCSF Inpatient Facilities
2. Match Patient Mix to UCSF’s Mission and Program Capability
3. Expand Functional Ambulatory and Office Capacity
4. Achieve a More Effective UCSF Referral Outreach
BEST CARE
5. Create the Next Generation UCSF Care Delivery Model
6. Provide the Highest Value Care to Patients
7. Educate, Recruit and Retain the Best Talent
SHARED ACCOUNTABILITY
8. Define a Stronger Culture of Shared Accountability and Action
9. Achieve the Operating and Clinical Cost Improvements Necessary to
Sustain a 6% Operating Margin (language still being reviewed)
5
Strategic Plan: CLINICAL GROWTH
Theme #1: Maximize the Potential of the UCSF Inpatient Facilities
Recommendation 1.1: Increase functional bed capacity by 60+ beds across
both major campuses
Strategy 1.1.A: Complete 16 ICU-bed addition on Parnassus, to be
operational by end-2008
Strategy 1.1.B: Decrease risk-adjusted inpatient ALOS to the average UHC
benchmark or better
Strategy 1.1.C: Improve average bed occupancy at Mt. Zion to 75% (from
less than 60% today), adding an additional 15-20 beds to functional inpatient
capacity
6
Strategic Plan: CLINICAL GROWTH
Theme #2: Match Patient Mix to UCSF’s Mission and Program Capability
Recommendation 2.1: Focus adult incremental growth in high and
moderate complexity care
Recommendation 2.2: Ensure that programmatic growth occurs in a
rational and controlled fashion
Recommendation 2.3: Ensure future patient mix supports UCSF’s
educational and research requirements
Recommendation 2.4: Encourage Departments to commit to a set of
institutional policies that are intended to stabilize UCSF’s sponsor mix to
ensure financial viability
7
Strategic Plan: CLINICAL GROWTH
Theme #3: Expand Functional Ambulatory and Office Capacity
Recommendation 3.1: Improve exam room utilization (visits/room/day) to
allow a 10%-15% growth in ambulatory visits within existing infrastructure
Recommendation 3.2: Ensure that there is sufficient office space available
to support projected growth of the clinical enterprise
Recommendation 3.3: Focus the development of any ambulatory growth
(exam room or outpatient ancillary capacity) off the main campus
8
Strategic Plan: CLINICAL GROWTH
Theme #4: Achieve a More Effective UCSF Referral Outreach
Recommendation 4.1: Create and implement an Institutional Outreach
Oversight Committee that will act on behalf of the enterprise and be
responsible for prioritizing and coordinating future UCSF outreach initiatives
Recommendation 4.2: Work closely with the School of Medicine, translational
research scientists and others to ensure linkages and appropriate volumes
for teaching requirements and clinical trials through outreach initiatives
Recommendation 4.3: Focus on building and enhancing relationships with
community providers in Northern California to ensure patients are cared for in
the appropriate care settings
Recommendation 4.4: Focus UCSF marketing strategies on increasing
awareness of the UCSF brand regionally
9
Strategic Plan: BEST CARE
Theme #5: Create the Next Generation UCSF Care Delivery Model
Recommendation 5.1: Increase the number of non-resident (mid-level providers) and
mixed (both mid-level providers and house staff) services to reduce reliance on the
resident model
Recommendation 5.2: Explore residency expansion initiatives in select departments,
if aligned with institutional clinical priorities without affecting the quality of the
training programs
Recommendation 5.3: Develop core teaching and non-resident staffing models for
inpatient units as needed by service
Recommendation 5.4: Restructure workflow on inpatient units to allow all clinical
providers to spend more time with the patient
Recommendation 5.5: Ensure the care delivery model supports a consistent standard
of clinical care regardless of time of day or day of the week
10
Strategic Plan: BEST CARE
Theme #6: Provide the Highest Value Care to Patients
Recommendation 6.1: Create an organization and infrastructure that allows
the UCSF clinical enterprise to tie its value proposition to superior quality,
patient safety and clinical outcomes
Recommendation 6.2: Communicate UCSF’s results in clinical quality,
patient safety and clinical outcomes to a broad external audience
Recommendation 6.3: Enhance service standards for the UCSF clinical
enterprise so that it is competitive in the Bay Area market
11
Strategic Plan: BEST CARE
Theme #7: Educate, Recruit and Retain the Best Talent
Recommendation 7.1: Develop recruitment initiatives that enable UCSF to
meet its goals around clinical growth and patient mix
Recommendation 7.2: Create retention initiatives that allow UCSF to
identify and develop the next generation of UCSF leadership
Recommendation 7.3: Strengthen the relationship between UCSF and its
employees
12
Strategic Plan: SHARED ACCOUNTABILITY
Theme #8: Define a Stronger Culture of Shared Accountability and Action
Summary Assessment of Today’s Model:
 High level of patient service variability, financial result
 High level of decentralization, local discretion
 Low level of shared success definition, expectations
 Low level of transparency across the enterprise
 High level of frustration, sense of lost potential
13
Strategic Plan: SHARED ACCOUNTABILITY
Expectations – Defining Success (per KSA)
1. Define clinical service credo distinct from academic freedoms

Service to patients the priority in clinical enterprise work
2. Clear service standards expected across all clinical participants
3. Operating leadership roles aligned with demonstrable expertise
4. Participation a major institutional value, i.e. not discretionary
14
Strategic Plan: SHARED ACCOUNTABILITY
Transparency – Reporting Progress (per KSA)
1. Reporting vs. (just) approving clinical enterprise aims

Current clinical enterprise strategic plan the starting basis
2. Use of comprehensive dashboards and scorecards
3. Broad, disciplined disclosure of progress and lack thereof, good
and bad
4. Scheduled use of advisory boards, open faculty sessions to vet
status
15
Strategic Plan: SHARED ACCOUNTABILITY
Incentives – Reinforcing Success (per KSA)
1. Recognize patient service acumen by the clinical faculty

Leadership roles, governance participation, compensation
2. Align institutional clinical support with results and plan aims
3. Align career opportunity pathway with proven clinical excellence
16
Strategic Plan: SHARED ACCOUNTABILITY
Theme #9: Achieve the Operating and Clinical Cost Improvements
Necessary to Sustain a 6% Operating Margin
Ten Year Financial Plan Assumes Several Key Assumptions:
 Reduced Length of Stay to UHC Benchmarks (6.3 to 5.85 in select
services)
 Decrease in FTEs/Adjusted Occupied Bed (8.08 to 7.76)
 Increase in Case Mix Index (1.98 to 2.08)
 Flat Volume in MediCal
17
Financial Implications
UCSF Finanical Forecast
Net Income - Scenario Analysis
Dollars ( in thousands)
160,000
120,000
80,000
40,000
0
F Y2008
Base Scenario
Scenario 3 - Payor M ix
F Y2009
F Y 2 0 10
F Y 2 0 11
F Y 2 0 12
Scenario 1 - ALOS
Scenario 4 - Combined Revenue
18
F Y 2 0 13
F Y 2 0 14
Scenario 2 - CM I
Scenario 5 - FTE per AOB (8.08)
Strategic Plan: Next Steps
Next steps include:

SOM Faculty Council, Clinical Affairs Committee, Academic Planning and Budget,
Senate Coordinating Committee, DOM Chiefs Meeting

Please advise if you would like us to present at one of your Department
meetings

Two Town Halls Led by Interim Dean Hawgood and Mark Laret in mid October

Formal approval from:


Chancellor’s Office

Faculty Senate
Dissemination to the Public

On-line postings – official Summary of the Plan

Public Relations and Marketing (articles, brochures)

Create Detailed Implementation Plan (see next page)

Address Issue of Shared Accountability
19
Implementation Plan: Metrics and Measures
Themes
Measures of Success
Detailed Reports
Strategic Plan Dashboard
(Compare Current to 2015 Target)
(Compare Current to 2015 Target)
Maximize Potential of the
Current UCSF Inpatient
Facilities
• Decrease number of days each
inpatient unit exceeds 100% capacity
• Decrease % of patients being held in
the ED or PACU while waiting for a bed
• Decrease in adult and pediatric ALOS
• Decrease in inappropriate one day
admissions (Define – Reece?)
• Increase in transfers to post-acute
facilities – decline in ALOS
• Quarterly reports by product line
(Adult / Peds and PRN/ Mt.Zion)
 CMI
 Inpatient discharges
 Outpatient visits
 % Medi-Cal
• Current ALOS compared to UHC riskadjusted average by product line
• ADC by unit (10:00am, 2:00pm and
midnight)
• Percent occupancy for the adult
(split Parnassus and Mt Zion)
and children’s inpatient chassis
(Target Occupancy = X)
• Target ALOS = X
• Target OR utilization = X
Match Patient Mix to
UCSF’s Mission and
Program Capability
• Increase in institutional CMI
• Growth of volume in targeted product
lines or services
• Decrease the % of inpatient Medi-Cal
patients to the lower of 2002 or 2006
percentages in each service
• Departmental adherence to Outpatient
Referral Guidelines
• Exceed minimum volumes needed to
ensure teaching accreditation in each
program
• Quarterly reports by product line
(Adult / Peds and PRN/Mt.Zion)
 CMI
 Inpatient discharges
 Outpatient visits
 % Medi-Cal
• Annual review of recruitment plans by
department
• Secret shopper for Outpatient
Referral Guidelines
• Annual review of teaching Risk
Registrar
•
•
•
•
Expand Functional
Ambulatory Capacity
• Growth in ambulatory visit volume by
department
• Volume growth in imaging by modality,
and in OP surgery/procedures (why are
these combined)
• Increase in % of ambulatory activity
occurring off- the Parnassus campus
• Decline in % of faculty without an office
• Ambulatory visits by department
• Number of designated exam rooms
by department
• Ambulatory visits/room/day by
department
• Assigned offices (and associated
square footage) by department
• Professional revenue per sf of clinic
space by department
• Target Ambulatory Visits = X
• Target visits/room/day = X
• No. of Faculty w/out offices = X
20
Target CMI = X
Target Volumes = X
Target Medi-Cal = X
Programs at risk for losing
teaching credentials