Chapter 3 - Goal Alignment PDF

# Chapter 3: Goal Alignment ## 3.1 Introduction Deploying a company's strategy is about: - **Goal alignment:** Aligning teams' goals, down to front-line team level, with the company strategic goals across all departments throughout the company. - **Objectives, measures and targets:** Developing...

# Chapter 3: Goal Alignment ## 3.1 Introduction Deploying a company's strategy is about: - **Goal alignment:** Aligning teams' goals, down to front-line team level, with the company strategic goals across all departments throughout the company. - **Objectives, measures and targets:** Developing and aligning teams' related objectives, measures and targets, down to front-line team level, with the company strategic goals and within a framework of relevant balanced scorecard perspectives of finance, client, process and learning and growth. - **Performance-driven teams:** Introducing the concept of Performance-Driven Teams to enable effective communication, goal alignment and top-down and bottom-up management. - **Visual management:** Managing goals, objectives and related measures visually. ## 3.2 The Goal Alignment Process Goal alignment is the structured process of deploying strategic objectives by cascading them through subsequent levels of management teams until they reach front-line teams. As the strategy cascades down to all levels throughout the company, it should include increasingly specific action plans. ### Example **Strategic Objective Statement:** Reduce the healthcare-associated infection rate by 15% over the next 12 months. Through goal alignment, this objective may be translated by team members to action plans that could include: - Implementing evidence-based practices to reduce different types of infections. - Improving process flows, each with corresponding measures and targets to track progress. ## The Mediclinic Strategy for Goal Alignment Even if the company is working towards its goal, and the goal is communicated from the top to the bottom through each level, it is often difficult to get everyone to cooperate and to be aligned towards that goal. If someone thinks of just attaining his/her own goal, and pushes others aside, the company goal can never be achieved. Meaningful goals are achieved when all employees of the business work towards the accomplishment of their own goals while helping to further the goals of the company and of those around them. This situation exists only when the goals of all employees are in harmony and aligned with the goals of management, and management understands and includes the needs of employees. - **Human Resources Enablement:** The one on the left demonstrates that in a company which has not consciously aligned its goals, everyone is working towards their own goals - some complement the company's goals, some do not, and some unconsciously work against it. The second arrow represents a company where the goals have been communicated in such a way that people could make it their own, buy into it and decide how they can contribute towards it. Both arrows move forward, but the one with the aligned lower-level goals is more streamlined and able to move faster. - **ICT Enablement:** - **Leadership:** ‘General Colin Powell’ “Leadership is the art of accomplishing more than the science of management says is possible." Enhancing the culture of a company to one in which performance is aligned with goals, can only be successful if this enhancement is strongly led by the decision makers of the business that give guidance on: - Why the change is needed - What needs to be done in order to change - How the change will happen - Who will help the company in the change process - When, and according to which timelines, will the change be implemented To effectively reach meaningful goals as a company, it is important for senior management to clearly set the overall strategic direction and to communicate it to all levels. Once this has been done, all line management (from senior managers to team leaders) must translate the company's objectives into relevant measures at each successive level. It is essential to involve employees to ensure a sense of ownership throughout. Only then can everyone work together to ensure a top-down and bottom-up renewal of the organisation. ### Example ### Goal Alignment (Cascading Corporate Strategy to the Front Line) | | | | |--------------|----------------|-----------------| | **Company** | **Company** | **Company** | | Mediclinic Southern Africa | 1 | 2 | 3 | | **Support Departments** | | | | | (Corporate Office) | 1 | 4 | 2 | 3 | | **Operations (Hospitals)** | | | | | Hospital 1 | 1 | 2 | 3 | 1 | 2 | 3 | | | 4 | 4 | 4 | **Company Objective with Associated Measurement (KPI):** 1. Department 1 and all hospitals are aligned to this objective, e.g. a company objective to reduce the healthcare-associated infection rate by 15% over the next 12 months can be cascaded to the Clinical Department and all hospitals. 2. Department 2 and all hospitals are aligned to this objective. 3. Department 3 and all hospitals are aligned to this objective. **Support Department Objective with Associated Measurement** These may be complimentary to the company objectives to improve department operations. 4. All hospitals are aligned to this departmental objective originating from Department 1. **Operations Objective with Associate Measurement** These may be complementary to the company and departmental objectives, and unique to the specific hospital. ## 3.3 Objectives, Measures and Targets Understanding the company's strategy and goals is a major step towards aligning goals and enhancing team performance. This step must be followed by setting detailed objectives and action plans. The best way in which to do this is to take the strategy and to break it down into a series of objectives and action plans applicable to the team. These objectives and action plans must be so specific that when they are achieved throughout the company, the goals of the company are achieved, which, in turn, ensures that the strategy of the company is accomplished. ### Important Information It is important to understand the differences between goals, objectives and actions (or action plans) and to differentiate between these items. These terms are defined and applied in various ways throughout literature and in various organisations. Mediclinic has chosen the definitions described in the following diagram. In the Mediclinic environment, goals are also called ‘strategic themes’. - **Financial** - General guidelines that explain what you want to achieve - Usually long term and visionary in nature - **Client** - Defined outcomes to be achieved to attain the goal - Unlike goals, objectives must adhere to SMART criteria - **Process** - Series of actions (or action plans) to attain the objectives - Actions should also be SMART ### Important Information To set effective objectives and action plans for the team, ensure that they all comply to SMART criteria. Each objective and action must be: - Specific - Measurable - Achievable - Realistic - Time-oriented **Not SMART:** See if Patient Experience can improve next time. **SMART:** Increase the Press Ganey Patient Experience Index Overall Mean Score by 1.5 over the next 12 months. Note that by adding a measure and a target and time-orientation to the description, the objective or action plan became SMART. It easily happens that a company leans towards focusing primarily on one specific thing, typically financial performance, for example achieving a predefined profit margin target. However, it is important that the scorecard remains balanced. This means that, although you are focusing on improving one specific thing, you are also keeping an eye on the rest so that they are not neglected, or that achieving a certain objective is not detrimental to the achievement of other objectives. Another example is that it often happens that while we are driving volume targets that cost and quality fall behind. For this reason, we must ensure that the company strategy and goals are translated by using the perspectives of a balanced scorecard. The typical perspectives of a balanced scorecard and the questions that guide the setting of objectives relative to those perspectives are described in the diagram below. In the Mediclinic environment, the ‘client’ is often the ‘patient’, but it might also be another team or department in the hospital. - **Financial** - 'To satisfy our shareholders, what financial objectives must we accomplish?' - **Client** - 'To satisfy our clients, what client needs must we serve?' - **Process** - ‘To satisfy our clients and shareholders, in which internal business processes must we excel?’ - **People** - ‘To achieve our goals, how must our organisation learn and grow?’ ### Important Information You cannot manage what you do not measure! It is important that the ‘smart’ objectives include a measure (KPI) as well as a target for that measure. There will probably be many more that can be measured, but pick the critical measures in the team that requires special attention. An example of a company goal, and a series of objectives pertaining to that goal plus associated measures, targets and action plans and using balanced scorecard perspectives is depicted in the diagram below: | Strategic Theme / Goal: Improve safe quality clinical care | Objectives | Measures | Targets | Action Plans | |---|---|---|---|---| | **Financial** Negotiate value-based payment model with funders | Defined outcomes to be achieved to attain the goal | How success will be measured and tracked | Level of performance or rate of improvement | Key actions required to achieve target for objective | | **Client** Reduce incidence of healthcare-associated infections | Objective Improve hand hygiene compliance | Measure Cumulative YTD hand hygiene compliance score | Target e.g. 80% | Action plan Implement hand hygiene campaign as per corporate guideline and timeline | | **Process** Implement the new food process at hospitals | | | | | | **People** Train all RNs in IHI model for improvement | | | | | The outcome of goal alignment and the setting of objectives with associated measures and targets will result in something like the following diagram. ### Example | | Financial | Client | Process | People | |----------------------|------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------| | **Financial** | - Achieve budgeted EBITDAR margin for the year to 31 March 20xx of 21.5% - Achieve budgeted salary cost as % of revenue for the year to 31 March 20xx of 39.7% - Achieve Debtors Days as at 31 March 20xx of [20] - Reduce Cost per event for [...] to 1.15 for the year to. 31 March 20xx | - Improve, for the year to 31 March 20xx: - HAI (12-month average) to 1.20 - Mortality Index (12-month average) to 0.60 - Falls (12-month average) to 0.97 - Improve Press Ganey Overall Mean Score (12-month average) to 83.5 for the year to 31 March 20xx | - Implement Surgical Safety Checklist in Theatre by 31 March 20xx - Implement hand hygiene campaign by 31 June 20xx - Improve average door-to-discharge-time for green Emergency Centre patients from 120 min to 95 min by 31 March 20xx | - Improve Gallop grand mean score to 3.73 for the year to 31 March 20xx - Reduce hospital absenteeism to 2.5% by 31 March 20xx - Train all heads of departments and Unit Managers in Cl Modules 1 to 3 by 31 March 20xx | These measures are measured in a balanced scorecard. Currently, in Mediclinic, this is managed by line managers in Excel format and selected measures are eventually displayed on the visual management boards. View an example of a balanced scorecard below. | | Target 18/19 | Stretch Target 18/19 | Apr-18 | May-18 | Jun-18 | Jul-18 | Aug-18 | Sep-18 | Oct-18 | Nov-18 | Dec-18 | Jan-19 | Feb-19 | Mar-19 | |----------------------|--------------|---------------------|--------|--------|--------|--------|--------|--------|--------|--------|--------|--------|--------|--------| | **Financial** | | | | | | | | | | | | | | | | 1. Reduce CPE | 0.00 | 0.98 | | | | | | | | | | | | | | 2. Maximise Revenue (millions) | R.30 648 | R31 648 | | | | | | | | | | | | | | 3. Achieve budget Income per bedday (exc ph | R56 43 | R.57 000 | | | | | | | | | | | | | | 3. Achieve budget REBITDAR (millions) | R6 063 | R.6 000 | | | | | | | | | | | | | | 4. Maintain EBITDAR % YTD | 19.4% | 20.0% | | | | | | | | | | | | | | 5. Optimise theatre utilisation YTD | 50.4% | 60.0% | | | | | | | | | | | | | | 6. Maintain Debtors Days | 25 | 25 | | | | | | | | | | | | | | 7. Cash conversion YTD | 100% | 100% | | | | | | | | | | | | | | 8. Minimise expenses | | | | | | | | | | | | | | | | 8.1 Manage operating cost of sales P/Bd | R21 99 | R2 009 | | | | | | | | | | | | | | 8.2 Manage operating expenses P/Bd | R2 062 | R1 062 | | | | | | | | | | | | | | 9. Ensure Capital Management | | | | | | | | | | | | | | | | 9.1% of items on budget ordered | 50% | 100% | | | | | | | | | | | | | | 9.2 no. of Items ordered not on budget | 20 | 18 | | | | | | | | | | | | | | **Patient Experience** | | | | | | | | | | | | | | | | 18. Improve PX overall Mean score (3 month rolling) | 4 | 45 | | | | | | | | | | | | | | **Dr Partners** | | | | | | | | | | | | | | | | 8.1. Priority index top 6 items | | | | | | | | | | | | | | | | 8.1.1 Attention to special/personal needs | 12 | 0.0 | | | | | | | | | | | | | | 8.1.2 Staff include decisions re treatment | 81 | 0.0 | | | | | | | | | | | | | | 8.1.3 Safety issues and precautions explain | 75 | 70 | | | | | | | | | | | | | | 8.1.4 Nurses kept you informed | 81 | 62 | | | | | | | | | | | | | | 8.1.5 Response to concems/complaints | 79 | 80 | | | | | | | | | | | | | | 8.1.6 Staff addressed emotional needs | 81 | 12 | | | | | | | | | | | | | | 8.1.7 Nurses | 4 | 46 | | | | | | | | | | | | | | 8.1.8 Overall assessment | 66 | 87 | | | | | | | | | | | | | | 8.1.9 Noise level in and around the ward | 73 | 75 | | | | | | | | | | | | | | 19. Enhance Dr Partnerships | | | | | | | | | | | | | | | | 9.1. Specialist Visits Individual | 4 | 1 | | | | | | | | | | | | | | 9.2 Specialists meeting Group | | | | | | | | | | | | | | | | 9.3 Care Expert no of Drs | | | | | | | | | | | | | | | | 10. Improve Facilities | | | | | | | | | | | | | | | | 10.1. Projects | | | | | | | | | | | | | | | | 11. Improve Clinical Outcomes (YTD) | | | | | | | | | | | | | | | | 12. Environment management program | | | | | | | | | | | | | | | | 12.1. Water Badday | 500 | 450 | | | | | | | | | | | | | | 12.2. Electricity Kwh/Bedday | 73 | 70 | | | | | | | | | | | | | | 12.3 Paper shoots/bedday | cancelled | | | | | | | | | | | | | | | 12.4 Medical Waste Kolbedday | 1.30 | 1.28 | | | | | | | | | | | | | | 13. Cl Implementation to expected maturity (external) | | | | | | | | | | | | | | | | 13.1 Module 1 | | | | | | | | | | | | | | | | 13.2 Module 2 | | | | | | | | | | | | | | | | 13.3 Module 3 | | | | | | | | | | | | | | | | 13.4 Module 4 | 2.10 | 2.33 | | | | | | | | | | | | | | 13.5 Module 5 | 2.11 | 1.54 | | | | | | | | | | | | | | 13. Improve Transformation & EE | 45% | 50% | | | | | | | | | | | | | | 14. Improve Employee Engagement | | | | | | | | | | | | | | | | 14.1 Follow through of action Plans | | | | | | | | | | | | | | | | 15 Improve Staff recognition | | | | | | | | | | | | | | | | 15.1 Most Recognised Manager | | | | | | | | | | | | | | | | 15.2 Manager that gives the most recognition | | | | | | | | | | | | | | | | 16. Skills Plan compliance (monthly) | | | | | | | | | | | | | | | | 17. Legaslative training .compliance | | | | | | | | | | | | | | | | 18. Staff turnover | 5% | 6% | | | | | | | | | | | | | | 19. Statuatory Leave | 30.7016 | 31.50% | | | | | | | | | | | | | ## Activity 4 Practice the process of goal and objective alignment by writing down which goals and objectives, with associated measurements (KPIs) and targets, should be achieved in your team or department this year. Remember the SMART criteria. The goals and objectives of your team should depend on the goals and objectives of the company. They may be identical to the company goals and objectives or complementary. | | Financial | Client | Process | People | |-----------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------| | **Financial** | **[List your financial goals and objectives, including KPIs and targets]** - For example, "Reduce operating expenses by 5% by the end of the fiscal year. KPI: Operating Expense per Bed Day. Target: R2000." - You can align the financial goals of your team with the overall company goals, or they can be complementary, such as reducing costs within your specific department which contributes to the overall company's financial goals. | **[List your client-related goals and objectives, including KPIs and targets]** - For example, "Improve patient satisfaction scores by 5% by the end of the year. KPI: Press Ganey Patient Experience Index Overall Mean Score. Target: 85." - The client focus can be the patient directly or other internal or external clients your team interacts with. | **[List your process-related goals and objectives, including KPIs and targets]** - For example, "Reduce the average door-to-discharge-time for green Emergency Centre patients by 10% by the end of the fiscal year. KPI: Door-to-Discharge Time. Target: 100 minutes". - Focus on improving processes within your team or department that relate directly to the overall company's strategic goals, such as improving efficiency or effectiveness. | **[List your people-related goals and objectives, including KPIs and targets]** - For example, "Increase employee engagement scores by 10% by the end of the year. KPI: Employee Engagement Survey Score. Target: 80" - This can focus on training, skill development, recognition, staff satisfaction, and other aspects that impact the team's performance and contribute to the overall company's goals and objectives. | | **Client** | | | | | | **Process** | | | | | | **People** | | | | | 9