Operating unit has an OFI that requires capital. Unit develops OFI in to a proposal with forecast improvements to operating scorecard. Unit's OFI and PIT processes identify many ideas. The most promising are developed into a proposal that identifies operational scorecard improvements. EXHIBIT 14.9 Programmatic Capital Review Process Unit rank-orders all its proposals. Service line or activity ranks all its unit's proposals. Several levels of review conclude with a list rank-ordered for the whole HCO. Senior leadership and medical staff rank the lists from all service lines and activities. Board planning committee compares rank- ordered list with annual goals and recommends adoption or deferral. Governing board approves capital budget. The governing board planning committee takes three actions: 1. Compares the rank-ordered list to the annual financial goals. 2. Recommends highest-ranked projects to expend the capital allocation. 3. Reviews the list above and below the acceptance point, and recommends increase or decrease In capital allocation if desirable. The committee may reorder the list, but doing so is potentially dangerous. Changes should be negotiated with senior management and units Involved. Operating unit, internal consulting, and finance coordinate implementation. Operating unit includes operational scorecard goals in its next goal setting. Implementation includes scheduling installation, revising processes, and retraining. The unit's operating goals will incorporate changes included in the proposal.