Lawrence E. McManus, general partner of Integrity Management Advisors, LLC, has partnered with hospitals to develop Bridge PlanTM to improve financial performance since 2005. Bridge Plans help establish organizational goals, organize managers and directors to achieve individual and organizational targets, and redesign operations to encourage efficiency and change management. A well-established Bridge PlanTM can affect an organizational shift in responsibility and change management from the “C suite” to qualified managers and directors across the clinical and business operations. The bridge plan concept involves the empowerment of staff to develop and impement plans across the organization in a team-oriented approach. 

Bridge PlansTM have been successfully developed and implemented across entire organizations: Health care systems implementing the bridge plan process has included Northwestern Memorial HealthCare, Chicago, IL and Eastern Maine Health System, Brewer, ME - including related hospitals and medical groups included below. Hospitals participating in the Bridge PlanTM include - Central DuPage Hospital, Winfield, IL, Delnor Hospital, Geneva, IL, Kishwaukee Hospital, DeKalb, IL, McHenry Hospital, McHenry, IL, Huntley Hospital, Huntley, IL, Woodstock Hospital, Woodstock, IL, Lake Forest Hospital, Lake Forest, IL, St. Josephs Hospital, Phoenix, AZ,  St. Raphael Hospital, New Haven, CT, Eastern Maine Medical Center, Bangor, ME, Inland Hospital, Waterville, ME, Maine Coast Hospital, Ellsworth, ME, Blue Hill Hospital, Blue Hill, ME. Medical Groups supporting the hospitals have been included as an integral part of the bridge plans developed.

The bridge plan process has also been used to target specific aspects of an organization such as its revenue cycle: UMass Memorial Health Care, Worcester, MA.

The bridge plans are housed on a shared drive, with acess across the management group. Sharing initiatives and worksteps is encouraged to facilitate 'best practice' across the system and maximize financial impact. Completed initiatives that represent annuities are included in the subsequent years budget, while ititiatives in process are rolled into the subsequent years bridge plan. 

A finance group improves internal control and fiscal impact by implementing a Bridge PlanTM process following completion of the budget. The process is implemented throughout the year with a target of 'beating budget' by 3 - 5% - thus developing a financial 'cushion' throughout the year. This 'cushion' - at year end - either covers budget variances or results in additional profits above budget. Staff have generally adopted the bridge plan process with enthusiasm due to their empowerment and support by senior management in this 'team-oriented' process.

Technology developed to support the Bridge PlanTM process includes the bridge plan template housed on the shared drive, as well as a bridge plan mobile app for monitoring by management.

Click here to read the bridge plan case study.

Each year, hospital leadership develops a capital budget and cash flow in conjunction with the Operating Budget. The sophistication of the planning process for capital varies across hospitals. Funding is increasingly challenging and the need for capital is never ending. Merger and acquisition activity is often fueled by an inability to “keep up” with capital needs. In some cases “well off” not- for-profit hospitals are joint venturing with for-profit hospitals with greater access to capital just to hedge their capital need into the future.

Clinical business planning is a process that is frequently overlooked in hospital management – often due to the pressures of everyday operations. Certain clinical service lines are known, and frequently capital is allocated to those areas – and growth opportunities such as primary care and ambulatory services. This certainly makes sense, but critical planning decisions are often made without a comprehensive clinical business planning process. Such a process inventories current resources by clinical area, involves the key physicians (employed and private), considers future changes in medical practice and involves clinical, finance and information technology staff to project service line profitability over the next three years.

In a recent Clinical business planning process we created a “workgroup” of physician leaders and senior management, and chose approximately ten clinical areas to look at the following:

- List of referring physicians
- Evaluation of current market share
- Evaluation of contribution margin of service
- Inventory of services capital
- Established needs – operating and capital
- Projected the contribution margin over three years of acting on the “needs” – individually and in the aggregate

The clinical business planning process began in November and concluded in April, timely for a September 30th year end and capital planning process from May – September for the following year. A good clinical business process is open to collaboration, with an understanding from the start that though capital may be limited and financial returns are important, quality and patient safety come first, and community needs must be evaluated.

A good clinical business planning process will be ongoing with the previous year’s plan updated annually. In the process that Mr. McManus was overseeing at St. Raphael Hospital, approximately six new services were added in year two. Experience demonstrated that some of the plans were more successful than others, and this had an impact on capital decision making.

Hospitals and hospital systems are encouraged to implement a clinical business planning initiative and individuals at Integrity Management Advisors may be helpful in the planning, oversight and participation in such a process.