CREATING YOUR PREFERRED FUTURE

1. 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 1:30-3:00 PM

2. 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)

3. 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

4. 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.

5. AGENDA • Member versus association futures • Five lessons for creating the future • Exercise to help define your preferred future • Five examples of HCAM’s implementation of their preferred future • Lessons learned • Resources

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

7. 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.

8. 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.

9. 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.

10. 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)

11. 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).

12. 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 …

13. HCAM’s 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”.

14. HCAM’s 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”.

15. IMPLEMENTING HCAM’s 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)

16. 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

17. 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)

18. 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

19. 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.

20. 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

21. 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 consumer’s need for services should be assesses and the necessary resources committed to meeting their needs.

22. 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.

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

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

25. LESSONS LEARNED • Implementation of a specific initiative always results in members who are winners and losers even though the project helps movement to a preferred future. • 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.

26. LESSONS LEARNED • Members have different strategies for achieving success. An association’s preferred future can conflict with individual member’s 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.

27. LESSONS LEARNED • Members may perceive an association’s commitment to a preferred future as not in their best interest and decide to leave the association’s 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.

28. 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.

29. 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, Don’t Think of an Elephant, Chelsea Green Publishing Company, 2004.

30. CONTACTING REGINALD CARTER • By mail at 1777 Colorado Drive, East Lansing, Michigan 48823 • By phone at (517) 337-2266 • By e-mail at reginaldkcarter@aol.com