Measurement and Analysis Case Study:
Boston Children’s Hospital; Boston, Massachusetts
Warbird develops custom data measurement tool to help world-renowned children’s hospital increase international market share
The Opportunity
Recognized as one of the most prestigious and high quality tertiary and quaternary care centers for children in the world, Boston Children’s Hospital sought to increase its share of the global market for children’s healthcare services. According to CFO David Kirshner, although Children’s is renowned for several areas of clinical expertise, there was growing concern about overseas competitors. “We needed to get our arms around how to best measure our international business information flow and ability to process our patients in a timely and effective manner.”
David knew that hospital decision-makers would need concise and timely data about the strengths and weaknesses of the international business and patient flow process within the Children’s system in order to grow international market share. He engaged Warbird Consulting Partners, a professional services firm specializing in value-driven organizational solutions, to develop a measurement and analysis tool designed specifically for hospital executives and physician leaders.
The Solution
David and Steve Nichol, Children’s lead director of the measurement effort, worked with Doug Fenstermaker, Warbird Consulting Partners’ managing director and leader of the company’s healthcare practice. A former healthcare executive with 18 years’ experience as a hospital CFO, Doug helped David and Steve develop a detailed measurement device that identified core indicators, process-oriented performance indicators and data elements that would need to be captured. The data would be provided in an easy-to-use dashboard interface that both meshed with and reflected progress on Children’s newly-developed international business strategic plan.
The project was completed in approximately 90 days and results were presented to the internal board that governs international business, chaired by Alan B. Retik, M.D. During this time, project managers also partnered with Huron Consulting Group’s higher education practice to assist in the creation of a long-range strategic plan for international business development at Boston Children’s Hospital. The hospital embarked on a multi-phase effort to implement the measurement system. Some key performance indicators – such as those related to revenue – were put into operation immediately while other, more complex indicators continued to be developed and refined.
The Boston Children’s Hospital international patient data measurement tool shows how Warbird can add value by custom-designing a solution to meet discreet organizational needs. The selected data indicators provide hospital executives, managers and physician leaders important information about the timeliness and effectiveness of information flow. The data also provides insight into communications and processes in managing a patient at Children’s – from the point of inquiry to the point of returning the patient to the country of origin. By being able to easily access critical indicator data about patient processing, hospital leaders are able to identify points where added efficiency will make Children’s a more attractive choice for patients coming from overseas.
Results: Measuring turn-around time and key economic indicators
The following is an excerpt of the table prepared for Boston Children’s Hospital that shows the nature of the custom-designed measurement tool and the types of indicators to be measured. Each indictor helps hospital leaders and Children’s international oversight board understand where the process is effective and efficient and where it can be improved. This indicator system was integrated with the hospital’s international business strategy to give management and others insight into the effectiveness of Children’s overall international business approach, including timeliness, communications, information flow and actual patient care delivery. The hospital populated the table with indicators from its data systems and uses the table as a dashboard for performance reporting to Boston Children’s Hospital senior leaders and international board of directors.
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Interim Chief Financial Officer Case Study:
Trinity Mother Frances Health System: Tyler, Texas
Warbird provides customized healthcare finance team, including an interim CFO, to help leading health system move forward with key financial initiatives
The Opportunity
Recognized as a leader in quality and rated as the number one hospital in the state of Texas for patient safety, Trinity Mother Frances Health System in Tyler was in need of financial leadership after the retirement of its long-time CFO. Trinity had embarked on the construction of a heart hospital and the installation of the EPIC electronic information system yet days of cash-on-hand was strained and the organization was not prepared to enter the bond market for financing.
The Solution
Lindsey Bradley, president and CEO of Trinity, turned to Warbird Consulting Partners. Working with Warbird, Trinity was able to engage a customized team of healthcare finance experts that included an interim chief financial officer through Warbird’s Healthcare CFO Consulting Network, as well as key financial staff through Warbird’s On-Demand Services. In addition to interim CFO Pamela Vukovich, a healthcare finance expert with more than 29 years’ professional experience, including 11 years as a chief financial officer, Warbird also provided seasoned interim professionals to serve as internal audit director, tax manager and director of physician services, as well as several financial analysts.
Working onsite with the Trinity executive leadership team three-to-four days a week, Pam and the Warbird team collaborated with the hospital’s finance department to devise a detailed plan of action to put the organization on financial track. With her expertise, Pam spearheaded the development of a long-range financial plan that included a return-on-investment analysis for the EPIC and heart hospital projects, and helped define the need for bond financing for expected capital outlays in the next three years.
After the long-range plan was approved by the Trinity finance committee and executive leadership team, Pam prepared the organization for review by Fitch and Moody’s. Trinity’s current ratings were confirmed and Pam led the combined finance team in working with investment bankers to execute a successful bond issue.
In addition to addressing the immediate financial challenges facing Trinity, Pam worked with CEO Lindsey Bradley to restructure the finance department and its functions for long-term improvement, including instituting a department of internal audit, and defining its responsibilities, staffing models and detailed audit programs. She also reviewed Trinity’s investment practices and policies and recommended key changes in cash management and investment allocations to Trinity’s finance committee. All of these changes were implemented and have resulted in a more robust finance function with greater returns and lower risk.
Finally, Pam worked with Lindsey and Trinity COO Ray Thompson to rewrite the CFO job description and provided expert input during the selection process for a permanent CFO. Trinity selected Joyce Hester, an internal candidate, and Pam has continued to consult with Trinity as a mentor for the new CFO with regular update calls to provide counsel in the areas of bond financing, investments and more.
Results
Warbird’s expertise in healthcare finance management and its ability to build a customized On-Demand team to meet the hospital’s specific needs provided the following results for Trinity Mother Frances Health System:
• New Chief Financial Officer
• New bond financing at attractive rates
• Established department of internal audit
• Robust investment policies, including new asset allocations for corporate and retirement funds, and an improved cash management system
• Completed reviews of ratings, which were confirmed
• Restructured bond portfolio with reduced interest expense and lower risk
• Process to review and standardize physician incentive compensation programs
• New record keeping and investment management firm for the system’s 403(b) pension plan, which resulted in significant annual savings to participants
• Long-range financial plan and model, which could be updated by Trinity staff in the future
• Standardized financial analysis and capital analysis
Process Improvement and Resource Restructuring Case Study:
Tufts Medical Center; Boston, Massachusetts
Warbird enhances process outcomes in month-end reporting to help Tufts Medical Center provide more timely information and increase operating performance
The Opportunity
A world-class academic medical institution operating in the highly competitive Boston healthcare market, Tufts Medical Center wanted to improve the quality and timeliness of its financial reporting without the cost of adding new staff resources. Although Tufts Chief Financial Officer Okey Agba believed the needed process improvements and staff realignment were feasible, his busy schedule prevented him from devoting the time necessary to designing and implementing the changes.
The Solution
In order to devise and execute a process and realignment strategy, Okey and Tufts Controller Kathy Davis engaged Warbird Consulting Partners’ Healthcare CFO Network. Jim Fox, a former CFO with 35 years of healthcare experience and a senior consultant at Warbird, worked with Okey and Kathy along with a small group of Tufts Medical Center employees. With Jim’s expertise and guidance, the Tufts CFO and controller were able to develop a strategic process map to improve the timely production of month-end financial statements through more effective utilization of resources.
The overall strategy/plan and the first phase of implementation were completed in 60 days, and the Tufts team continued to improve upon the process under Kathy’s direction. Jim continued to be involved over the next few months with ongoing consultation and periodic check-ins to ensure the plan remained on track. The new process flow has been sustained and further refined over the last 12 months.
Results
The Tufts Medical Center project demonstrates how Warbird Consulting Partners can assist an established finance team in developing and executing a new process plan, while also enhancing existing capabilities to achieve superior outcomes. The process improvements and resource restructuring allowed Tufts Medical Center to refocus on strategic operational priorities aimed at maintaining its competitive position in the Boston market. Other benefits of the Warbird engagement included:
• Decreasing unnecessary steps in the production of month-end financial statements
• Reducing by one-third the amount of time required to produce month-end financial reports
• Lowering the number of FTEs within the finance department
• Reducing special-request reports that diverted staff resources from essential finance functions