Our Services and Areas of Expertise include:
Financial Turnaround and High-Impact Performance Improvement
How many consultants can guarantee success?
In the past eight years, we have helped over 50 clients achieve rapid turnarounds in financial performance. Success. Every time.
Galloway combines a proven methodology for financial turnaround with seasoned executives who have done it in real life. Our model for improvement is based on three basic premises:
- First, the changing business of healthcare requires performance improvement interventions that are faster, broader and more strategic than those of the past.
- Second, most health systems are organized and structured in a foundationally similar manner; consequently, they share similar, predictable operational challenges.
- Third, most performance improvements initiatives fall short of expectations not from a lack of skills, effort, structure or tools but from an absence of prioritization and alignment.
Our methodology includes collaborative teams – our consultants working with your executives and managers – to seek out those opportunities that exist in your cost structure. We then look at each item and provide an assessment of the likelihood of that opportunity being successfully implemented; finally, we design a strategy to overcome the risk of implementation failure and an action plan to ensure success.
The Galloway methodology was recently captured in a new book published by Health Administration Press, authored by Gary Auton, a Galloway consultant, entitled 18 Levers for High Impact Performance Improvement.
The result has been an average increase of five points in bottom-line profitability. In most cases, clients generated 10 to 20 times their investment within the first year. Typical sustained improvement averages 30 times their investment.
This innovative solution recognizes that regardless of the political environment and economic cycles, the pressures of the healthcare environment will continue to test traditional hospital and provider business models. Consolidation, consumerism, cost structures that need to, at a minimum, break even at current Medicare rates and disruptive competition all challenge the landscape.
Organization Transformation is about moving strategy from aspiration to sustained success, in a way that permeates the company, drives the culture and overcomes the Corporate Immune System that lurks in every organization, inhibiting change and transformation. AHT – Accelerated Healthcare Transformation – is the methodology with which Galloway Consulting designs patient-centered systems that deliver high-quality care and an excellent experience at significantly lower cost.
AHT is proprietary to Galloway and was originally designed by Dr. Robert Miles to lead large scale corporate transformations at industries as diverse as manufacturing, retail, technology and professional services. Dr. Miles and the Galloway team have customized the methodology for health care and it has been used over the past 12 years with extraordinary results across dozens of health care organizations.
AHT is both top down and bottom up, focusing on creating alignment across the organization and speed in implementation. And while we design your new organizational model and the structures to support it, we also create a glide path that eases your transition and put into play some “Quick Starts” that can generate early returns to reinforce the transformation effort, even before its plans are cemented.
The AHT process has been designed to quickly focus and engage the full organization and then thoroughly follow through for implementation (as shown in the figure above). By design, AHT moves from Launch Phase so that the entire organization can quickly get into Execution and accelerate the process of learning from performing.
A Corporate Immune Response (CIR) is frequently triggered when there is a lack of buy-in among the organization’s stakeholders to implement an innovation, a new organizational strategy or significant operational change. AHT and other Galloway interventions are designed to resolve this corporate level inhibition.
Organization Design and Strategy Implementation
Most organizations are perfectly designed …… to achieve their previous strategy.
This common misfit shows up in dissonance between current elements structure, systems, skills, character, human capital and competencies and what is required for the new strategy.
Organization design is more than just the boxes on the chart. Galloway’s method for assessing organization design combines our Accelerated Healthcare Transformation methodology with a broad view of organization design that considers the interaction of all core elements: culture, structure, organization infrastructure, strategy, people, competencies and vision. We understand that impacting one of these factors potentially has a corresponding impact on others. And that each much be harmonized for proper organization design to take hold.
Organization design and strategy implementation are linked – as any organization changes that impact core elements will have a corresponding change on strategic initiatives – which ones are prioritized and resourced and who is accountable for achieving them. Governance plays a critical role as well as organization design changes impact decision rights – or stated in a simple way, who gets to decide what.
Galloway uses numerous techniques to assess organization constructs. Our library of High Performing Practices allows comparisons across numerous high achievement providers and in multiple dimensions. Organizational Network Analysis (ONA) is a survey-based tool that uncovers the natural communications networks across organizations and how efficient (or not) those networks work in running your business. Organizational network analysis can provide an x-ray into the inner workings of an organization — often serving as a powerful means of making invisible patterns of information flow and collaboration in strategically important groups visible.
We’ve found that when leaders can’t identify the cause of an implementation failure they have most likely triggered what we call the Corporate Immune System (CIS). The Corporate Immune System lurks in every organization, including yours. There are no exceptions. A Corporate Immune Response (CIR) is frequently triggered when there is a lack of buy-in among the organization’s stakeholders to implement an innovation, a new organizational strategy or significant operational change.
Recent successful projects in this domain include:
- Helping a national cancer research institute restructure their organization and clarify decision rights to bring better balance to their ambulatory business and research mission.
- Leading a combination MSO and Population Health company through a multi-month process to redefine the company vision and strategy and turn around the financial performance in ways that provided over a 20:1 return on their consulting fees.
- Helping a large regional system reorganize its acute care hospitals and its top management team reporting to provide clarity of decision rights and drive a cultural change toward increased accountability.
The Galloway method and AHT lead organizations through a multi-step process for addressing the core issues, decision rights clarity and governance forum changes – all designed to ensure accountability is clear, strategy is fully supported, and the CIS is eliminated.
Analyzing and Managing Total Administrative Costs and Corporate Services
Consolidation has created large systems and pooled corporate services. These consolidations should theoretically lead to economies of scale, drive value and reduce cost throughout the system. Many health systems have not only failed to achieve the economies of scale from combined administrative functions, but many find their total administrative expense is higher after consolidation. System offices must understand the combined total administrative expense of inhouse corporate services, regional offices and local organizations in the field. Our national experience confirms that Corporate offices are better at managing hospitals/operating units than they are at managing themselves. Adding to the complexity is the legacy of local administrative costs that come along with acquisitions and consolidations. How are local administrative expenses adjusted down as Operating Companies fulfill requirements that used to be supported locally?
Who in your organization is responsible for managing total administrative costs? What is the right level, structure and focus for driving the efficiencies in operating units while maintaining an effectual corporate structure? What is the appropriate level of decision rights at each level? What governance structures are in place to achieve that efficiency and manage the decision rights?
We find these issues are frequently poorly addressed. The lack of clarity creates extra expense, slows down decision making and cycle time, and wastes energy that could be applied to more productive and strategically important topics. Typical span of span of control thinking addresses the size of the management team, but usually does not address the effectiveness of decision making that is affected by these muddled decision rights. Dyad and other matrix structures add even more complexity.
Galloway’s process for addressing these issues includes developing an understanding of an organization’s total administrative cost, a structural analysis, assessment of services against high performing practices and the governance structures to effectively manage the decision rights and achieve the desired efficiencies.
Dramatic Margin Improvement
All industry’s change – but few change with the pace and intensity of healthcare.
Moving forward, reputation and access will no longer guarantee a strong book of business (except for geographic monopolies). Providers that have been surviving based on their location and / or an undeserved reputation will lose business as payers direct patients to higher value locations. Ongoing quality and cost performance enable larger and faster swings in market share. Providers will need to work hard to stay ahead of the competition’s ability to deliver demonstrably better quality and cost. Managers and boards will need to pay closer attention to a provider’s competitive positioning.
To win business, providers must deliver true value: Demonstrably higher quality at significantly lower cost. Quality will move from a minimum standard (e.g., Do No Harm) to a true source of competitive advantage (e.g., Best Possible Outcome) that will win business and enable lower costs.
New “unthinkable” cost structures will be required to compete: Make margin on Medicare rates? Medicare minus 5%? Medicare minus 10%. That used to be crazy talk. But now providers will need to move beyond improving execution in areas like productivity, supply chain, and revenue cycle. They will need to eliminate needless variation, address structural costs, and focus their portfolios to deliver the high quality that will be required at market-leading prices. A new reality will require that we address changes in strategic and structural ways – not merely through improved execution.
Galloway’s combines a proven methodology for rebasing your organization’s fundamental cost structure with seasoned executives who have done it in real life. Our approach to developing momentum – collaborative teams – is our secret sauce for turning the concepts into a movement that engages large numbers of people. We follow up collaborative teams with a small number of senior level “boots on the ground” to ensure that the momentum isn’t lost.
What will your new reality look like?
Growth & Strategic Positioning
In today’s climate of declining patient volume, growth is more than ever a key imperative for healthcare organizations.
The Galloway Growth Product combines short term tactical solutions along with long term strategic positioning. It is a comprehensive, data driven approach encompassing all options – everything from physician segmentation (an analysis of the physicians most key to organizational financial and cultural success) to portfolio analysis (which service lines improve brand positioning and contribute to contribution margin) to strategic market assessments (to include partnerships, acquisitions, innovative start-ups or disruptive combinations). Our solution consists of a combination of both short term and long-term growth objectives, linked to your vision and informed by market conditions.
There must be interventions designed to bolster the organization with enough short-term growth to allow it the time necessary to build the longer-term growth strategy. We will guide you through an analysis of potential partners and partnership structures. This includes an evaluation of why a partnership at all including the trade-offs of building scale, protecting and growing market strength versus growing the organization as it is today and the what-ifs of standing alone. We know how to do this.
Most Growth & Strategic Positioning Assignments start by conducting an assessment of your short and long-term growth capabilities. These can be accomplished in two to four weeks with a small, senior consulting footprint, with minimal disruption to your organization.
Population Health and Fee for Value Strategies
Nearly every day our consultants across the country have conversations about population health. As the discussions begin, it’s clear that the first challenge is that everyone seems to have a different definition of “population health”. This is because population health covers a wide spectrum of activities.
What does the range of population activities entail? It depends on who you are and your vantage point:
Managing the uninsured population that comes to your organization for care
- Reducing unnecessary ER use
- Avoiding expensive acute episodes of chronic conditions
- Managing the cost when they are admitted – utilization, LOS, and preventing re-admissions
Managing the patient panels in your primary practice group to achieve quality incentives
- Upside fee for value (FFV) incentives from payers or employers
- MIPS/MACRA “mainstream” approaches
Managing Medicare Shared Savings Programs (MSSP)
- MSSP track 1,2 and 3
- Next Generation Advanced Payment Program
Managing cost of employee health benefits
- Your own self-insured employee benefits costs
- Direct to employer to help manage employed populations
Managing populations of patients with full risk
We also know, like it or not, that Systems are destined to be pushed towards adopting population health strategies and tactics. Not for profits struggling to manage uninsured and under-insured populations will have to find better ways to match patients with appropriate resource use. Hospitals trying to break even (or better) on Medicare will need to manage resource use within a fixed DRG payment. Employers that have shifted all the cost they can to employees will soon arrive at your door asking how you are going to provide relief from their ever-escalating health care cost. CMS will continue to push Fee for Value and population health models into the market to find relief from the Government’s own ever escalating cost of Medicare and Medicaid.
The good news? As the markets shifts there is opportunity for increased profits, better employer relationships, better community optics and solving the problems of frequent flyers/over utilizers. Galloway consultants have “inside views” having worked in population health from multiple perspectives; hospital, health plan, physician group, ACO, PHO and PO. Our consultants are fluent in the multiple languages and cultures of population health. We can provide practical, tested solutions and speed up your organization’s inevitable journey into population health.
Clinical Utilization, Quality Optimization and Length of Stay Improvement
The advent of population health and accountable care models are requiring hospitals to dramatically improve acute care cost performance. While many healthcare organizations team with medical staffs and clinicians to identify and pursue clinical utilization improvement opportunities, these initiatives frequently fall short of producing tangible results.
Our Clinical Utilization, Quality Improvement and Length of Stay processes provide a streamlined, data-driven approach to clinical utilization and quality optimization. Our process engages clinicians and provides focus on the key variables that yields the greatest benefit for the organization and the patients served.
Galloway facilitates multi-disciplinary collaborative teams to quickly evaluate hypotheses, identify solutions and develop implementation strategies. Clinical collaborative teams include physicians and representatives from nursing, pharmacy, imaging, laboratory, rehab services, surgery, and case management. Galloway consultants facilitate with a point of view, understanding those paths and processes that have worked in dozens of comparable organizations. We share this experience with your team and help guide them, particularly when the teams are challenged on a topic or problem.
At the conclusion, the teams develop specific recommendations that focus on:
- Reducing the cost per case
- Accelerating throughput and lowering Length-of-Stay
- Reducing the cost and incidence of off-quality events
- Improving clinical outcomes and patient experience
Most teams are completed in as few as four, two-hour meetings. We help teams quantify opportunities in terms of the expected annual savings and risk-rate each based on the level of difficulty anticipated during implementation. Following approval from system leadership, we work with physicians and clinical leaders to implement and operationalize these changes.
Frequently employing Lean Kaizan design principals by some of the most experienced consultants in the market, we work with team members to move quickly through the design process. Today a great many health systems have demonstrated the value of Lean as they have applied Lean tools and techniques to some of the most vexing problems of patient flow, deployment of resources, clinical utilization, and quality of care.
Transformational Adoption® – Galloway’s methodology that combines lean principles and deep data analytics – allows your organization to embrace new work processes, technology, and behaviors within the framework of the lean performance model. We facilitate this proven method, deploying best-practices and leveraging shared knowledge across 10 success factors to hard wire transformational improvement.
Physician Enterprise Alignment
Physician Enterprise Alignment is the degree to which physicians, both owned and independents, are organizationally aligned and act consistently with an organization’s key tactical and strategic objectives. Physician alignment normally requires a fundamental cultural change that must have commitment at all levels in the organization.
Many different types of organizations need to strengthen alignment with physicians; Health Systems, hospitals, ACOs, population health companies and organizations that share risk for medical utilization.
Galloway Consulting has a deep understanding of physician/organization relationships and uses this insight to assess, improve and maximize alignment. Our goal is to move alignment from a typical intuition-based relationship alignment to the highest level of alignment that is driven by fact-based data and integration.
Our architecture, process, and tools have proven to move an organization to a highly integrated relationship with physicians resulting in consistent growth and cost management. We understand the tenants of a highlight aligned system and have a method for assessing the “best” physicians across four dimensions – quality, throughput, growth and cost management.
We would be happy to talk to you about your specific questions or your organizational need.
CEO Transition Success
Each year, about one-fifth of the CEOs in American hospitals resign and by most accounts, most of this turnover is involuntary. CEO turnover in healthcare is more pronounced than in other industries; the Conference Board reports that average corporate CEO tenure is 8.1 years while many recent studies including Becker’s has put healthcare CEO tenure at less than half of that, or 3.5 years.
In some organizations, consistent CEO turnover seems to be part of the fabric of the institution. An ACHE study reports that 57% of hospitals have had more than two or more CEOs in the past five years; amazingly 25% have had three or more.
These statistics tell us three things.
- First and perhaps obvious, that getting a CEO transition right – picking the right person and having that person achieve notable and meaningful success, is critical to an organization.
- Second, the ripple effects of a poor selection will be profound.
- And third and not so well understood, CEOs have a limited amount of time to show results before Boards become restless and an organization dynamic starts to change. Even with the implied mandate a new CEO has, achieving change is difficult.
The idea of a honeymoon period for a new CEO is an idea for romantics. Time is ticking from the first day, whether you are a new CEO from the outside or promoted from within. Even a CEO who inherits a stable and financially well performing organization, has an implied obligation to articulate the organization’s next vision, priorities and future path. Failure to do so quickly, will ensure the CEO loses credibility internally, with the Board and forfeits its window to achieve impact.
New CEO’s typically face many or all these inhibitors when establishing their vision and organizational change:
- Cautious Management Culture
- Business-as-Usual Management Process
- Initiative Gridlock
- Recalcitrant Executives
- Disengaged Employees
- Loss of Focus during Execution
Our process has identified six “accelerators” that will speed the transition and overcome the inhibitors. Our proven process drives progress and tackles the main challenges you will need to overcome. It allows CEO’s to get traction immediately with their new team, onboarding themselves and their vision at the same time. And creates an organizational sense of urgency that drives meaningful transformation deep.
As consolidations continue at an increasing pace the importance of creating effective marketing strategies also increases.
This is not about advertising!
Remember your four “P”s from your marketing courses in business school? Health care companies almost always focus on the “P” in Promotion, but not enough attention to the Product, Place, and Price. At Galloway we take a comprehensive look at the entire marketing mix. We surround ourselves, and you, with the objective information to formulate the very best Go-To-Market strategies that align with your overall vision and strategic intent.
What’s in a name anyway?
A lot as it turns out. We start with your Brand. We specialize in integrating brands due to mergers, acquisitions, (even divestitures). Sometimes re-positioning the brand is necessary to align with the long-term vision of your company. An effective brand position will become the foundation of all your communications, product development and even distribution strategies for years. It’s not about just the names, but also the refinement of the teams. Our ability to thoroughly understand the skills and personnel needed to achieve your growth goals is significant.
Galloway Consultants have been involved in the creation or re-crafting of some of the worlds most esteemed brands, and their strategic and tactical approach to multiple geographic markets. From brand positioning, to brand architecture, from marketing and sales strategies to creating best in class marketing and communications teams, we have been there.
So, whether you are in the pure B2B world or B2C let us help you to get it right, and then do it right. After all it is your name.
Cultural Assessment and Employee Engagement
We are at a unique time in the provision of healthcare in America with changes taxing fundamental structures that have been built to meet client and community needs over the past fifty years. Staff and physicians’ ability to respond to change in meaningful and timely ways to address their environment have markedly impacted health systems’ ability to operate in an effective manner.
The key to organizational success in the future will be based on how an entity is able to create and manage a focused, nimble, forward thinking and accountable culture. For culture serves as the foundation to achieve the organization’s mission, vision and strategic goals.
Those health systems that have prospered have learned that the journey transitioning from one culture state to another is as important as defining the changes needing to be made and the introduction of programs to achieve corporate goals. As the saying goes, culture eats strategy for breakfast.
Our approach at Galloway allows the organization to assess its culture and readiness for change, establish a model of what the future success culture should look like, and evaluate the extent of the gaps between the two states. We work with your senior leadership team to determine the organization’s willingness to embrace a cultural shift and the skill sets necessary to affect a positive transition.
Galloway utilizes a methodology for bringing about change at a grass roots level over a short period of time. One that can be left with your leadership to insure continued success in the development of the culture in the future. We help you identify key staff who will serve as “culture champions” and who will have the opportunity to grow into future leaders. Communication tools are introduced that will reinforce the importance and visibility of the program, create momentum and recognize the building of this “new improved” culture.
We will help you put into place metrics that can be used to measure the impact of change in culture. These metrics will supplement those that the senior team already uses to determine the system’s success in meeting quality, engagement, human resources and financial scores.
There is a direct correlation to improvements made in the culture to those of how the system operates on a day to day basis. Our approach helps you improve the organization’s performance, at a cost that you can afford with results that you can proudly share with your Board, your community, your physicians, staff and leadership.
Talent Development and Coaching
In our view, sustainability of any transformational change begins and ends at the top of healthcare organizations.
Our senior team comes from a variety of backgrounds and experiences, both inside healthcare and in other private and public-sector industries. This allows us to give you a unique perspective on the issues you face and incorporate successful lessons from areas outside healthcare. We employ a variety of techniques to assist organization leaders at understanding themselves and their organizations better to make the change sustainable and long lasting. These include organizational network analysis, self and peer surveys, interpersonal exercises and other heuristic models proven to work in a variety of settings.
All our projects are grounded in three basic premises:
- A session that confronts reality – a realistic, no holds barred look at the current state strengths and weakness
- A philosophy of crucial conversations – being unafraid to address directly address the issues that are holding people or organizations from realizing their true potential
- A realization that each executive is different and despite a proliferation of articles and books that suggest a “1-2-3” approach to leadership, each person is different and there are many ways, techniques and styles that can be effective, provided they are grounded in core values and skills.
Typical recent engagements have included:
- Working with a new CEO on how to establish his vision, how to think through and execute difficult senior personal decisions, and how to organize his top team for future success.
- Helping a newly promoted executive move from tactical level leadership of running a single hospital to strategic level leadership needed to lead a multi-hospital operation
- Helping a technically gifted existing C Suite leader gain more self-awareness as it relates to her work with her peers and inside her department
- Working with a top C Suite team to design governance structures and improve team work between the members.
- Facilitating senior level Board and C Suite retreats and strategic level decision forums
- Board level coaching designed to help the Board understand their role as it relates to the CEO and top management
Our leadership and team building product provides analysis of your leadership team’s strength and gaps.
One of our tools, the Leadership Wheel, is used for a real-world look to explore the leadership competencies across the organization, allowing us to explore the natural tension between the polarity of “vision” and “reality” on one axis and the polarity of “taking care of business” and “taking care of people” on the other axis. Another tool is the Strategic Leader Matrix which analyzes 16 different dimensions of strategic leadership.
Galloway consultants have a variety of backgrounds – academic, health care, Fortune 500, military and nonprofit and combined with these tools and methods – we can provide one on one coaching of executives at any level, as well as broader team-based events designed to link to specific operational initiatives.
Some organizations will hire Galloway to provide an Executive Extender. Sometimes do you wish you had 48 hours in a day? Or maybe two of you to go around? How about an extra COO to drive change and initiatives? The pace of healthcare, the changes impacting your organization and the need to drive cost initiatives or other strategic initiatives never stops.
Our Executive Extenders allow you expand your organizational bandwidth – to address crucial short and medium-term issues without diverting energy and resources from ongoing strategic objectives. They provide experience, efficiency, and skilled leadership, all tuned to your strategic initiatives and within a specified time frame. Minimal time to get up to speed and achieve fast results. Hands on.
With this flexible assistance, your organization can tackle time-sensitive projects while executives, senior managers, and staff members maintain their focus on stakeholders’ goals and long-term strategic imperatives. This “coaching while doing” model is particularly effective in providing implementation experts who can instantly grasp the strategic aspects of your business and market conditions.