14Jones Leadership(F)-ch 14 228 1/14/07 3:45 PM Page 228 Skills for Being an Effective Manager plan for more than years Strategic plans in certain organizations may be drafted for 10 or more years The strategic plan, just like the project or operational plan, should be simple and easily understood by the participants The way a strategic plan is developed depends on the nature of the organization’s leadership, culture of the organization, complexity of the organization’s environment, size, and the expertise of the planners Strategic planning models can be issue-based, goal-based, and scenariobased Issue-based strategic planning utilizes a very focused approach as is used in manufacturing businesses (Hiam, 1990) to improve productivity over a specified period Scenario-based strategic planning is used frequently in human resources or marketing operations (Hiam, 1990) to improve decision making and sales forecasting The goal-based model is the most widely used in organizations Its key elements include: the organization’s assessment of the environment, mission statement, vision, development of goals and objectives, strategies to accomplish the goals and objectives, and outcomes (Table 14-4) Unlike project planning or operational planning, strategic planning requires a multidisciplinary approach Every single department or unit in an organization must be involved in the plan to ensure that staff members comply with goals and objectives and that strategies are implemented Managers may initiate the strategic planning process by communicating the initiative in their monthly meetings They may invite an expert to provide a seminar to inform all the employees about the process Once the employees are oriented to the strategic plan, they volunteer to work with specific sections Without this involvement, employees may not buy into the organization’s goals and objectives and may hinder the plan’s success One benefit of strategic planning is that it helps managers make current decisions in light of future consequences For example, if your unit plans for expansion from 16 to 32 beds within months, you need to start planning for staffing now Planning helps managers develop a comprehensive basis for decision making and exercise maximum direction in organizational control In addition, strategic planning assists managers to: ■ Resolve organizational problems goals; they are shared with the entire organization TABLE 14-4 Strategic Planning Process External assessment Opportunities and threats Internal assessment Strengths and weaknesses Mission Vision Goals Strategic Organization Operational Department Unit Objectives Strategies Implementation Outcomes Evaluation ■ ■ Improve performance strategies; they are accepted by all staff Build teamwork expertise; staff must work together to identify goals and objectives and determine strategies Strategic Planning Process Strategic planning is a step-by-step process that delineates ongoing group activity Table 14-4 demonstrates the steps of the process ASSESSMENT OF THE ENVIRONMENT The first step of any planning process is assessing the environment At any level, the assessment conducted is both external and internal (Table 14-5) At the unit level, an environmental assessment includes assessment of employees, for example The manager needs to examine how the staff is likely to feel and react to the contents of the project, operational, or strategic plan Even at an organizational 14Jones Leadership(F)-ch 14 1/14/07 3:45 PM Page 229 Planning and Marketing for a Healthy Organization level, a nursing executive needs to know the staff in the departments he/she oversees Because staff plays a crucial role in strategic planning, some key questions that a manager should ask before any type of planning occurs include: ■ ■ ■ ■ ■ ■ ■ Who are the best, most interested staff members in your unit/department? What is the emotional or financial interest they have invested in the organization? What motivates them? Are there staff members who are not ambitious, who minimal work? What staff members think about administration? Who are the informal leaders who influence the unit/department? How can everyone be engaged in the planning process? Once they have answered these questions, managers need to inform all staff members about the necessity of planning, answer the “what’s in it for me” questions, and guide the staff toward the realization of the plan Managers must talk to staff directly if they perceive a lack of interest or a lack of understanding of the process Most people are willing to share their views, and asking their opinions will make them feel like they are contributing to the organization’s plans When creating a project or operational plan, it is important to assess the department’s/unit’s immediate physical environment as well When develop- TABLE 14-5 Environmental Assessment ASSESSMENT OF EXTERNAL ENVIRONMENT ASSESSMENT OF INTERNAL ENVIRONMENT Competition Patient care Markets Financial resources Health-care trends Human resources Economic factors Information systems PEST: Political, Educational, Social, Technology factors Research capabilities Staff development Educational systems 229 ing a staffing plan at the unit level, for example, you must determine future patient census on the unit based on past data When does the patient census peak? When does it drop? In which months of the year does a particular disease become prevalent? What kind of financial resources will be required? Based on these data, you can make projections and continue in the planning process When preparing a strategic plan, the assessment becomes a bit more expansive The manager must assess the internal and external environment of the organization thoroughly The external assessment should include the competition for services in the community For example, determine which hospitals are around the area and what kind of specialized care they offer and compare it with yours Take a look at the markets, and identify your customers Health-care trends also influence planning If the elderly population in your community indicates an upward trend, your organization may choose to accommodate the elder’s needs by planning a skill care unit or expanding the cardiac care unit In order to assess the internal environment, strategic planners must identify a variety of systems within the organization Important to assess are patient care standards, not only to comply with accrediting organizations but also to improve the care offered Other assessments include financial resources, information systems, research capabilities, staff development, and educational systems In any health-care organization, nursing is the largest human resource group Thus, it is imperative that this segment of employees be taken into consideration as the organization conducts strategic planning The quantity and quality of staff development and educational systems need to be assessed, especially when considering expansion of services Environmental Assessment Techniques One technique used to assess the environment is the PEST, which stands for political, educational, social, and technology factors that affect an environment In the political realm, managers analyze factors such as legislative activities, antitrust regulations, and environmental protection laws that may affect the organization In the economic environment, analysis includes trends, events, and economic indicators specific to the marketplace in 14Jones Leadership(F)-ch 14 230 1/14/07 3:45 PM Page 230 Skills for Being an Effective Manager which the organization operates The PEST also assesses areas and services of potential growth and monitors trends in industry, global economy, interest rates, and energy availability In the societal environment, it analyzes population growth, age distribution, regional changes, health status of the population (death rates, communicable diseases, Medicare/Medicaid resources), and safety issues In the technological environment, it helps managers focus on what the organization has or lacks in terms of current technology as well as on what is available The SWOT technique is another tool to help managers conduct a thorough environmental assessment The acronym stands for the strengths, weaknesses, opportunities, and threats in an organization SWOT requires analysis of multiple factors related to the health-care industry: human resources, the physical facility, the population, and the economic stability of the organization, for example Table 14-6 presents a brief example of a SWOT analysis The risk analysis, another environmental assessment technique, helps the manager spot project risks, weaknesses in the organization, and external risks For example, suppose an organization discovers that a group of physicians plans to build a neurology center and recruit nursing staff from your TABLE 14-6 SWOT Technique STRENGTHS WEAKNESSES 10-year- old facility Nursing staff turnover at 36% Experienced senior staff Lack of staff development Strong information system High nurse/patient ratio Quality of clinical resources OPPORTUNITIES THREATS Increase in the aging population Construction of three specialty hospitals Partnerships with diverse groups Urban population declining Develop mentor programs High unemployment rate Develop student preceptorship programs Salary competition between hospitals units This has the potential for affecting not only the finances of the hospital but also the patient care offered Conducting a risk analysis helps the manager to make additional plans to neutralize some risks MISSION AND VISION STATEMENTS Mission statements identify why the organization exists (see Chapter 4) They encapsulate the overriding purpose of the organization Vision statements identify the future of the organization They provide the ultimate level the organization aims for Mission and vision statements can be one sentence, a number of phrases, or multiple sentences When creating a mission statement, it is imperative that all individuals in the organization understand the purpose of the content For example, the mission statement at a hospital in Ashland, Kentucky, reads: “To Care To Serve To Heal.” These phrases summarize why the hospital exists Such statements are generally simple so that employees can identify with and remember them A children’s hospital’s mission statement in Virginia reads: “To provide the highest level and quality of pediatric care available in our community.” This statement is concise and easy to interpret St George’s Hospital Medical School University of London has a mission statement that reads: “To promote by excellence in teaching, clinical practice, and research the prevention and understanding of disease.” This statement lets you know that this is a teaching hospital with a medical school where research is a priority The vision statement accompanies the mission statement but is more future-oriented It states where the organization is going, the ultimate position that the organization plans to achieve: “To achieve a local, regional and national reputation as leader in health care.” This could be a vision statement of an organization that has been operating only at the local level A hospital could have a vision statement that reads: “To provide world-class care in our communities.” This is a very clear, self-explanatory statement GOAL SETTING Goals, in general, are global statements that help an individual or an organization plan for the future in a constructive way Goals should delineate clearly 14Jones Leadership(F)-ch 14 1/14/07 3:45 PM Page 231 Planning and Marketing for a Healthy Organization the desired end product Goals may be short-term, to be accomplished within a week, a month, or a year Or they may be long-term, indicating what the organization aspires to become to 10 years from now For planning purposes in organizations, goals are written for the operational plan and the strategic plan Operational goals at the unit or department level are statements that indicate future directions Goals are more specific statements of the organization’s vision, enumerating the accomplishments to be achieved if the vision is to become real Strategic plan goals are institutional goals often written by executives or upper-level administration members who oversee the organization’s activities and are able to conduct environmental assessments A current trend encourages all individuals in the organization to participate in the goal-setting process, but involvement depends on the size of the organization For large companies, involving all employees may be next to impossible Operational plan goals are congruent with strategic plan goals (Table 14-7) OBJECTIVES Objectives are descriptions of performances or activities They are statements that make goals more specific and measurable and give managers the ability to evaluate goal achievement For this reason, over the last two decades organizations have included objectives in their operational and strate- TABLE 14-7 TABLE 14-8 231 Objectives OBJECTIVES STRATEGIES By 2007, provide wellqualified College of Medicine faculty in all departments Recruit board-certified physicians a Partner with university to offer curriculum on site By 2009, all nursing staff at the Medical Center will be pursuing or have a baccalaureate degree b Negotiate tuition reimbursement gic plans When incorporating objectives into plans, keep asking yourself, “Are you sure we can this?” Objectives are the specific, measurable results produced while implementing strategies (Table 14-8) As you work with objectives, state them separately, and show related information that is linked to strategies This means that if you listed a number under objectives, make sure you have a number in the strategies Objectives are written in a logical sequence, preferably in numeric order For example, all objectives related to human resources (individuals), staff development, or clinical practice should be grouped under those sections Be sure that the period for the objective is clear and realistic The time line ensures achievement of the outcome by the target date If there is no time line stated in an objective, that objective is assumed to be bound by the fiscal year covered by the plan Strategic and Operational Goals STRATEGIES STRATEGIC GOALS OPERATIONAL GOALS MEDICINE UNIT Optimize the a Increase nursing visibility resources of the medical center Emphasize clinical excellence within the medical center and the community b Assure cost containment at the unit level Evaluate the performance of all employees in a manner that produces growth in the employee and upgrades service standards Strategies are a series of actions or behaviors that assist planners in achieving the objectives Strategies link to a particular objective and intended outcomes Well-planned strategies provide specific directions to achieve objectives (see Table 14-8; 149) Strategies are not static They can change and be modified during the implementation of the plan Strategies may be clustered under a common objective For example, if the Human Resources department has an objective to increase the diversity of the staff, the strategy may be to (a) travel to the South to recruit minority physicians, and (b) advertise nursing positions in minority nursing journals Strate- 14Jones Leadership(F)-ch 14 232 1/14/07 3:45 PM Page 232 Skills for Being an Effective Manager TABLE 14-9 Outcomes DEPARTMENT GOAL: OPTIMIZE TECHNOLOGY RESOURCES OBJECTIVE STRATEGY OUTCOME Within years, provide a Solicit input from vendors a Within months, at least six state-of-the-art computer enhancement in the department Nursing staff vacancy rate will decrease below the national standard of 12% b Assess staff’s knowledge of b computers c Purchase wireless computers c a Plan recruitment and retention a activities b Address workplace issues such as mandatory overtime, staffing, and quality care c Address compensation and benefit packages b gies must be resource driven and sequential Being resource driven means that the constraints of people, equipment, operating systems, money, and other resources are considered when developing a strategy Strategies must be designed after the desired outcomes are written Managers must assess whether the strategies produced the desired outcomes c vendors will visit the hospital and demonstrate their products Within a year, at least 50% of the staff will receive computer training Purchase seven computers by the end of the fiscal year Within months, recruitment activities will be conducted in 19 adjacent counties Within a year, RN staff:patient ratio will be 1:6 Annual RN salary will increase to $52,000 the effectiveness in meeting the expectations of the planners It is important to select benchmarks, measures that compare the organization with others For example, if your objective reads that the nursing turnover rate in your facility will decrease below the national standard, then your outcome would be measured by comparing your rate with the national average as a benchmark IMPLEMENTATION In the implementation phase of the strategic plan, all the strategies planned are carried out The success in the implementation of the strategies depends on the involvement of managers who must monitor all the activities to ensure accomplishment of the objectives OUTCOMES Outcomes are the results that you plan to accomplish Outcomes must be realistic and achievable If the vision is an expansive one, such as “to offer the best service in the world,” managers need to determine how to write goals and objectives to assure outcomes are achieved Otherwise, outcomes may fall short of expectations Outcomes are indicators against which you measure the success in meeting your objectives (see Table 14-9) Outcomes reflect EVALUATION The evaluation determines the organization’s progress toward attaining the identified outcomes How did the organization respond to the implementation of the plan? How was productivity achieved? To what level? Was the budget sufficient? The evaluation compares outcomes or results with objectives Dashboards and scorecards (Table 14-10) are tools that help organizations to achieve strategic outcomes These software application tools have been used extensively in the last few years because of their ability to amass large volumes of information, making it easy to monitor trends and to respond to time-sensitive events Dashboards and scorecards can promote performance visibility and effectiveness The purpose of the dashboards is to foster better communication between managers and staff The ... (a) travel to the South to recruit minority physicians, and (b) advertise nursing positions in minority nursing journals Strate- 14Jones Leadership( F)-ch 14 232 1/14/07 3:45 PM Page 232 Skills... b Address workplace issues such as mandatory overtime, staffing, and quality care c Address compensation and benefit packages b gies must be resource driven and sequential Being resource driven... 14Jones Leadership( F)-ch 14 230 1/14/07 3:45 PM Page 230 Skills for Being an Effective Manager which the organization operates The PEST also assesses areas and services of potential growth and monitors