Strategic Planning Insights #2

Committing to the formation of strategy, developing that strategy and communicating it are significant responsibilities of any board.

How best can the developed strategy be measured, reviewed, and managed?

I will leave the measurement of strategy performance for the third in this series of short essays.  This short essay focuses on the board’s management of its strategy through the Chief Executive (howsoever titled).

There is nothing that quite replaces the annual board get-away for deep, focused strategic thinking about its role, its responsibilities, and the organisation in which its fiscal duties and fiduciary responsibilities are invested.  These can be richly rewarding times, and if well facilitated, can bring long term, positive momentum to the board and senior management, with a renewed focus on organisationally important things to be achieved.  But if your board’s last strategic thinking and planning session was, say, in November 2019, you know now that the world has almost completely changed within one calendar quarter.

Your board no doubt meets several times each year.  But do you meet to drive an Agenda to get the business done or are you meeting to drive a transformational and winning organisational culture?  There is a world of difference between these two outcomes.  Without detracting from the value of still getting away for an annual, thorough review of strategy, there are useful alternatives that make more frequently inclusive focus on strategy at regular “any time”[1] board meetings, and more formally on a periodic basis throughout any given year.  Whether conscious or unconscious, you and your board drive the culture of the organisation in how you use the opportunities of your governance meetings.

Essentially there can be three types of meetings in which strategy can be given a dedicated place on your board agenda for its appropriate diligent review:

  1. The any time, or monthly meeting;
  2. A bi-monthly, or quarterly meeting; and
  3. The annual review.
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Strategic Planning Insights #1

The Greek word σκέφτομαι (skéftomai – thinking) has the sense of contemplation, that is, more than just thinking as in this familiar image below.[1]  More like thinking with care or weighing up the impact of thoughts.  From this word we get the word skéfto.

Over the years I have been on boards where strategy, its measurement and monitoring have been left to the CEO to lead; and where strategy was not a matter that was on the board agenda in regular (monthly) meetings.

I encourage us all to seriously think about how we can amend agendas to include strategy as a priority item on each board meeting.

Boards can learn how to ask questions of the executive team and management around matters rolled into their Strategic Plan.  For example, if you have ten overarching objectives in your current strategic planning document, and your board meets ten or eleven times each year, you could consider a well thought out sixty minutes of discussion around each of these high level objectives at each Board meeting, and the entire Plan would be discussed throughout the year.  To provide time for input from the CEO and executive team, even if the Board were to conduct that review of each item in the Plan over a two month period, the entire plan could be thoroughly discussed and re-invigorated every two years.  This does not detract of course from the value of a formal annual Strategic Planning review.

However, too often we lay responsibility (blame) at the feet of the CEO and executive team if strategy is not achieved or seems to waver along the path the organisation sets.  This is most unfair if the board itself is not taking care of the primary responsibilities of monitoring and oversight of the organisation’s strategy and strategic plan for which it is responsible.

In his well-known text on governance, Tricker describes the basic board functions[2] working through management as:

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Human Rights for the Elderly in Australia

Just the other day on 15 June 2020 we honoured World Elder Abuse Awareness Day, a day that highlights elder abuse in all of the forms it manifests itself.

Australia has had its own recent and continuing struggles with prevention of spread of COVID-19, and I feel proud to be both an Australian and supporter of most of our aged care providers in how they have managed well in these complex times.  As we know, our experience has not been shared with numerous other western nations.

Just one week ago, the Kaiser Family Foundation (“KFF”) released the following summary of data around prevalence and mortality rates due to COVID-19 in USA long term care facilities – for ease of discussion, let’s call them all nursing homes.  Remembering that the population of the United States of America is about 13 times that of Australia:

  • As at 11 June 2020, 44 States reported 9,192 current cases of COVID-19 infection in nursing homes;
  • Collectively, 43 States have reported a total of 230,776 COVID-19 cases in nursing homes;
  • From 40 States, there has been a combined total of 45,833 COVID-19 related deaths reported in nursing homes;
  • From 43 States, nursing home facility COVID-19 cases represent an average 15% of the States’ total cases reported;
  • From 41 States, COVID-19 related deaths represent 45% of total States’ deaths.[1]
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A Simple Plan – and a Request to Support an Australian Icon

14 June 2020

At the start of May 2020, I proposed a way in which the (residential) aged care sector might reconsider its apparent very widespread lockdown of facilities and prevention of family members visiting with loved ones in care.  Various alternates of “window visits” etc had been quite successfully trialled by some providers, but they fail, for example, where a residential care facility is in a multi storey complex, with all residential living contained at above ground floor level.

There is no doubt that aged care providers have been caught in a bind with the onset of the COVID-19 pandemic.  Can they have visitors at all, or on a very strict basis?  What is the best guidance?  Hospitals have become focused on well controlled prevention strategies – so much so that emergency department traffic has significantly slowed during this pandemic, and only now beginning to return to normal frenetic activity.

Both in hospitals, and in longer term care settings the notion of visits – human touch – in these pandemic times has been a much debated phenomenon.  As a species, humanity craves touch contact with those dear to us – particularly when we are ill and so frail that we are facing death, no matter how imminent.  This certainly affects the older person in care, as well as family and friends who wish to provide the touch of comfort as much as the words of caring love, concern, and, in a final sense, farewell to this life.

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How Is Your Organisational Strategy Shaping Up for the 2020-21 Year and Beyond?

I am not sure how you have been managing your time during these past seven weeks.  Because I am now “semi-retired”, I have taken the opportunity to read and refresh my earlier learnings over the past almost forty years on leadership, management, and strategy, while focusing on completing some studies in executive and leadership coaching.

What has struck me is that in this time of turbulent change, particularly in human services delivery right now where the impact of COVID-19 is taking its toll, is that many theories about leadership, management, strategy, and human resources management, actually have not changed, and likely do not need to.  Sometimes the “old” fundamentals are as reliable as granite …

In his now famous, and dated article, Henry Mintzberg defined as a plan, ploy, pattern, position or perspective (Mintzberg, 1987, The Strategy Concept I: Five Ps For Strategy). Mintzberg described:

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COVID-19 – What more needs to be done in our aged care system?

Stop the world – I want to get off  is the title of a musical created in the 1960s.

Some 55 years later as we become globally enmeshed in a pandemic the like of which none of us has experienced before, one could be forgiven for wanting to shout those words from the roof tops.

I don’t need to remind you of the enormity of the task ahead of every organisation in every industry sector – particularly those in a sector I am so fond of and have given over half of my career to.  I won’t belabour the size of the task ahead of you.  But I do want to ask the rhetorical questions in this group – are we doing enough in our aged care sector to make an impact?

For providers – if you could get hold of adequate supplies of personal protective clothing and equipment, are you considering gloving, gowning, and masking all your front-line care staff?  Are you having a skilled Registered Nurse meet and greet every visitor and taking a temperature prior to allowing a visitor, contractor, family member, Aged Care Quality and Safety Commission staff member enter the facility?

For the Australian government – Department of Health and Aged Care Quality and Safety Commission – have you increased the ACFI rate per resident per day, or introduced a coronavirus supplement to cover the cost of additional medical supplies, staffing supplies, and loss of revenue when facilities empty due to untimely death of residents?  Have you considered the financial risk and impact of failure of the RAD scheme?

Why these specific questions?

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Six Attributes of “Leadership”

This is likely a longer piece than usual, but I think important as we all consider the place of leadership mid-way through the term of appointment of the Royal Commission into Aged Care Quality and Safety.

I have been asked many times over the years I have served as a CEO, to define leadership.  There are of course quotes such as “It is an art, rather than a science”.  Or “You can tell if you are a leader when there is someone following behind you”.  What seems to be true is that you are not born to be a leader, and leadership is not achieved from a one day development training session.  However, we can grow as leaders every day – and indeed we must.  And leadership is about people, whilst management is about tasks and things.

But even those small truisms above do not do justice to this thing called leadership.  Most of us can likely recall our own examples of where we have experienced poor, or ineffective leadership.  We may even now be wincing as we read, recognising our own lack of skills in a leadership role at some time in the past.  We can also likely recall and acknowledge some fine experience of leadership that was such a joy to be party to.

Good leadership is a thing of beauty to experience.  Much like a diamond.  A diamond has so many qualities and when cut well, is a thing of beauty to behold.  It is hardly surprising that “diamonds are a girl’s best friend”.  As the following picture shows, even a so called six sided diamond has much more to offer than the “simple” six sided cuts.

So it is with leadership.

I provide below just six sides, or attributes, of leadership that I believe if practiced (well) every day will not only assist us to be better performing leaders but will drive better performance in our organisations.  I am certain we can all accept that leadership is more complex than these six, but these are a sound foundation.  The attributes are provided in alphabetical order only for convenience:

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Welcome to 2020

6 January 2020

No matter where and how we are involved in our Australian aged care sector, 2019 was a tough year.  The sector ended 2019 with one word ringing in our ears – Neglect – being the title of the Interim Report from the Royal Commission into Aged Care Quality and Safety.  What a tough end to 2019!

How do we emerge from 2019 into a brighter and stronger 2020 given that the Royal Commission continues to march on?  How do we turn Neglect into respect and rise above the negative views of all that 2019 revealed about our sector?

I suggest that we should at least consider the following seven factors:

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Submission to Royal Commission

The following link points to the substantive comments I made in a recent submission to the Royal Commission on Aged Care Quality and Safety.  As a very recently retired Chief Executive in the aged care sector, with some 37 years of continual involvement in aged care related matters, I feel I can comfortably comment upon my own research into matters around minimum levels of staff. Additionally, and importantly how, I believe, the aged care sector has been left in a quandary as to how best to navigate through these troubled times due to funding constraints placed on (at least) the residential aged care.

You can read the entire Submission here.

Nice chatting

Staff Ratios – Royal Commission Research Paper

I have read with interest late last week the very freshly released Royal Commission research paper (1) into aged care staffing requirements, and the shortfall in funding needed to raise the staffing mix and levels to appropriately care for the average residential aged care service consumer.  

The following excerpt from the recommendations paints a picture of what residents, families, advocates, and indeed some providers have been saying for some time – the level of service provision (staffing) in residential aged care in Australia is substandard.  

My conclusion is that because that level of provision is so strongly associated with the operating funding mechanism, the funding mechanism for care is equally substandard:

“more than half (57.6%) of Australian residents receive care in aged care homes that have unacceptable levels of staffing (1 and 2 stars).

To bring staffing levels up to 3 stars would require an increase of 37.3% more staff hours in those facilities. This translates into an additional of 20% in total care staff hours across Australia.

We have not limited our analysis to determining the additional resources required to bring facilities up to an acceptable level. We have also provided an indication of the additional resource requirements that are required to deliver staffing levels consistent with good practice and best practice care.

For all residents to receive at least 4 stars (what we consider good practice) requires an overall increase of 37.2% in total care staffing while 5 stars (best practice) care would require an overall increase of 49.4% in total care staffing.” (2)

As you are probably well aware, I am the CEO of Braemar Presbyterian Care (“Braemar”). To put our services into perspective, since I joined Braemar in March 2017 we have been increasing hours per resident per day to a level that is close to the current national average as recorded by the StewartBrown benchmarking service (3) reporting.  And, as far as is reasonable, we have been improving our subsidy income to match the staffing.  But that recurrent income is not enough.  

According to this research paper, prepared for the Royal Commission into Aged Care Quality and Safety, less than 3 star level of staffing is unacceptable, while a 4 star staffing is good practice, and 5 star staffing is best practice.  Yet 57.6% of residents receive less than 3 star (unacceptable) staffing and only 1.4% receive best practice staffing.

How is this translated into the care of our elders? 

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