Health_and_Human_Services

Strategic Planning and Quality Health Care August 10, 2009 Strategic planning is a way to move toward desired management goals. It is the process of developing and implementing plans to reach goals and objectives. Strategic planning, more than anything else, is what gives direction to an organization. A strategic plan helps in dealing with the suppliers, advertisers, investors and business consultants. There are systems and strategies out there improving the way health care is. Strategic planning is the process of identifying a desired future state for an organization and a means to achieve.” Health care mainly used the planning for new buildings and expanding funding services with population growth." Health care managers of all levels should understand the process, purpose, benefits and challenges, of strategic planning for their success. (Buchbinder & Shanks pg59-60) In order for an organization to succeed it must plan for the future and market appropriately. Strategic planning in health care has been implemented as recently as the 1970's. It consisted mainly of planning for new buildings and funding expanded services in response to population growth (Buchbinder & Shanks pg. 59-60).  Strategic planning for healthcare organizations now is much more complicated then buildings and expanding services. With the many market forces in today’s society, the strategic planning process must incorporate all of the market forces in order to succeed. The purpose of strategic planning is to identify market forces and how they may affect the organization, and determine an appropriate strategic direction to take that will counter act those forces, and/or tap their potential (Buchbinder & Shanks 2009 pg. 60). The way to identify market forces is by following the steps of strategic planning. Strategic planning is a dynamic rather than linear process and as such should optimally be no distinct beginning or end.( Buchbinder & Shanks pg69) A good process of strategic planning is: 1. Missions and objectives: company’s vision and goals. 2. Environmental scanning: internal and external analysis for the company/firm, strategy formulation: matching strengths to opportunities, while examining weaknesses. 3. Strategy implementation: programs, budgets and procedures the firm/ company may look into to motivate their employees to reach goals. 4. Evaluation and control: the implementations of the strategy should be monitored and adjusted as needed. (quick mba) Even while being executed the plan is still in motion. Market forces are constantly changing, and healthcare in general is constantly being reviewed. Because of this, the strategic plan must remain flexible to flow with the direction of all that can change in the organization and surrounding elements. Once the plan has been implemented, it must periodically be reviewed, thus starting the process over again and again throughout the life of the business. In order for the organization to remain flexible with this process it must have followed the steps of development for the strategic plan; taking into consideration all that can affect the business, putting in place plans for which direction the company will go if an unforeseen event take place. Health Care strategic planning is a very important part of an organization. There is planning and strategies needed to keep things in order. Different plans and strategies are: Leadership Strategies are needed for an organization’s strengths and weaknesses. You have to have a good leadership team to make things run smoothly. Services include: organizational design of multihospital systems, post-merger integration and revitalization, facilitation and execution of complex projects, organizational culture and leadership strategies, governing board assessment and development, executive team assessment and development, executive and board leadership coaching, and succession planning. Program Planning helps to expand clinical service offerings, improve quality, increase market share and revenues, and enhance image. Different organizations and facilities such as, neuroscience, orthopedic, musculoskeletal, women and children's, emergency, surgery, to just name a few. Services that can be service line planning and development, physician-hospital partnerships, facility/equipment requirements. Physician Strategies are needed to make sure that physicians are giving the correct quality to their patients and working together in a facility to improve patient satisfaction. They need to make sure that they are doing their jobs correctly and to the standards of healthcare regulations. Physician and hospital alliances together improve in Physician-hospital partnerships and joint ventures, hospital-medical staff alignment, physician recruitment and retention, financial performance improvement, compensation and compliance review, medical staff development and planning. Facility planning and development requires a lot of organization. They have inpatient and outpatient services, new programs and technology always developing, and the need to run the facility smoothly. This in itself requires strategy. Ways to do this is to Functional and space programming, capital prioritization and planning, market and financial feasibility assessments, and demand forecasting and capacity requirements. ( Health Care Strategy and Consulting Services) The steps of strategic planning development are situational assessment, strategy and selection, and strategy tactical plans. After the plan is developed then it needs to be executed. This is called strategy execution. The steps to strategy execution are strategy identification and selection, strategy tactical plans, rollout and implementation and monitoring and control. Situational assessment is referred to as a strengths, weaknesses, opportunities and threat analysis (SWOT). It finds the internal strengths and weaknesses of the organization and marketing opportunities. The three components of SWOT are the market assessment, mission, vision and values of the organization and the internal assessment. Strategy identification and selection begins by analyzing and challenging the planning assumptions, further exploring any future scenarios developed earlier and incorporating any desired financial targets as determined by leadership (Buchbinder & Shanks pg.61). This points the organization into many potential different directions to go in to obtain the goal that it desires. Strategy tactical plan is the final step in the actual development of the strategic planning process. This puts in place tactical plans for each strategy. Tactical plans answer the who, what, when, where and how questions of strategy implementation. Leadership is a process by which a person influences others to accomplish an objective and directs the organization in a way that makes it more cohesive and coherent. Different types are Inspirational, which inspires people by giving them what they need. There is diversity, to help healthcare leaders to address matters easier, whether with patients or their employees. Servant, applies to top administrator’s ability to lead by motivation to help and serve others. (Buchbinder & Shanks pg8-9) The National Academies’ Institute of Medicine (IOM) provides the most widely accepted definition of healthcare quality as the “degree to which health services for individuals or populations increase the likelihood of desired health outcomes and are consistent with the current professional knowledge” (Buchbinder & Shanks 2007 pg. 82-83). This has many aspects to it. The first aspect is high quality health services should not only achieve desired health outcomes for individuals, but it should also match their preference for a variety of services. Next, high quality health services should achieve desired health outcomes for populations and match society’s preference for efficiency. Finally, high quality health services should coincide with professional standards and scientific evidence to ensure effectiveness. Different styles are based on certain healthcare workers and their education, training, competence, motivation, experience and their person needs. The coercive leadership style used inappropriately to get a desired response from a follower. Not exactly one of the best to use, to fix problems you should always use styles with participative, pacesetting, and coaching values. Being a leader is a big responsibility, with all that will be looking up to you and relying on your guidance.(Buchbinder & Shanks pg10-14) Avedis Donabedian introduced the idea that quality should be viewed from a system perspective as structures, processes and outcomes. He was, in the 20th Century, a physician and a leading advocate for improving health care. The structure elements of quality are basically the setting and the people of the organization. Processes are the services provided to the patient, and the interaction between patients and providers. Outcomes are the health status results of the patient after care has been provided. Donabedian, was not only a physician but a leading advocate for quality care, championed the development of “best practices,” to achieve better care. This linked structures, processes and outcomes with a feedback loop. He defined quality as having at least four components: 1. The technical management of health is the clinical performance of healthcare providers. 2. The management of interpersonal relationships focuses on the patient-provider encounter, and the clinical and non clinical aspects of care. 3. The amenities of care constitute the variety of health services, and promote individual well being. 4. The ethical principles that govern the conduct of care guide the providers to ensure effectiveness of the organization and care for society. (Buchbinder & Shanks pg. 83). The four components represent two fundamentals of quality in health services, efficiency and effectiveness. Efficiency is defined as avoiding waste, in particular waste of equipment, supplies, ideas, and energy. Effectiveness is defined as providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (Buchbinder & Shanks pg.84). Misuse, underuse and overuse all pose health care improvement challenges. One of the key issues in healthcare quality and performance is the appropriate use of scarce resources to improve the health of both individuals and the entire population (Buchbinder & Shanks pg. 84). The Institute for Healthcare Improvement (IHI) is a Boston-based, independent, non-profit organization established in 1991. They help with improvements healthcare systems in the United States, Canada, and Europe. They are recognized as an organization that hosts seminars and has a shared approach to reducing healthcare error , and contributes to improving patient safety. (Continuous Health care Improvement) The Joint Commission on Accreditation of Healthcare (JCAH), was developed in 1951, by the American College of Physicians, the American Hospital Association, the American Medical Association, the Canadian Medical Association , and the American College of Surgeon. It was a non-profit organization to provide voluntary accreditation for hospitals. In 1965, it grew importance with the passage of legislation of Medicare and Medicaid. This helped insure hospitals followed minimal standards for quality assurance approach on achievable standards. In 1966, it began long-term facilities, such as psychiatric, and substance abuse programs, community mental health programs in 1970, hospice organizations in 1983, and plenty others though out the years. Leading to, in 1987, they changed their name to Joint Commission on Accreditation of Healthcare Organization(JCAHO). ( Buchbinder & Shanks pg. 88-89) National Association for Healthcare Quality (NAHQ) is one of the leading organizations for healthcare quality professionals. It was founded in 1976, and holds more than 5,000 individual members and 100 institutional members. The goals of the company are to inspire healthcare professionals in all fields by providing research, education, networking, certification and professional practice resources, and a strong voice for healthcare quality. They have 5 core values. They are: 1. Excellence: They hire people, with high professional standards, to exceptional provide the best services to their members. 2. Integrity: They are honest, ethical and responsible with their customers and members. 3. Innovation: They encourage change, creativity, continuous learning and personal growth, to improve the services that they provide. 4. Collaboration: They encourage individual and group achievements, and join with colleagues across organizational boundaries to improve the services we provide. 5. Stewardship: They are resourceful, resilient, and always have a “can do” attitude, to get the jobs done. And are very good with time management. (nahq.org) Quality health care is defined as the degree to which health services increase the likelihood of desired health outcomes and are consistent with the current professional knowledge. In order for the organization to maintain performance improvement, it must achieve desired outcomes in the clinical and non clinical aspects of the organization. Efficiency and effectiveness must exist in all aspects of health care. With new information technology in health care there is more opportunity for efficiency and effectiveness not only in record keeping but in every aspect of health care services. In the health care industry there are new developments every day. There is always need for good record keeping as well. In technologies there are multiple systems such as Electronic Health Record and Electronic Medical Record. The first major problem with information technology is that for every system created to ensure security of health data and information, there is always someone who can find their way around it, and break into the system (Buchbinder & Shanks 2007 p. 150). New confidentiality laws have created more complications in trying to keep patient information private. Financial costs are also a major barrier for health organizations to adopt information systems. Many perceive hospitals and providers as financially secure or wealthy, the truth is that many health organizations are struggling with little or no profit margins (Buchbinder & Shanks 2007 p. 151). The two final challenges are standards and interoperability. These are vital not only within the organization itself but across other organizations as well. Having data collection, data standards and storage promote quality and efficiency, however, data standards and software interoperability among outside health providers and organizations can easily allow movement of the information and transfer of the records between hospitals, pharmacies, and other providers in the cases of travel, emergency or relocation. “The Electronic Health Record (EHR) is a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting.” EHR includes a lot of information including: patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. (himss.org) It is important to note that an EHR is generated and maintained within an institution, such as a hospital, integrated delivery network, clinic, or physician office. Electrical Medical Records (EMR) provides access to everything from patient specific information to expert care knowledge. This system is not simply an automated form of the paper record (Buchbinder & Shanks 2007 p. 141). The traditional EMR is a closed system, for use within a single healthcare organization only.(Issdata.com) EMR incorporates far more then patient notes. It gives providers immediate access to decision support, expert knowledge, care prompts, alerts, connectivity to the internet, and other real time tools(Buchbinder & Shanks 2007 p. 41). The purpose of implementing information technology is to improve effectiveness as well as efficiency. EMR is not the only technology to enhance the quality, efficiency, and productivity of health care (Buchbinder & Shanks 2007 p. 143). Other systems such as Computerized Physician Order Entry (CPOE), Bar Coding, Tele-health, and Enterprise Resource Planning System (ERP), are all powerful tools in healthcare today. Though both systems help out the health care system, these are two completely different concepts, both of which are crucial to the success of local, regional, and national goals to improve patient safety, improve the quality and efficiency of patient care, and reduce healthcare delivery costs.(himssanalytics.org) ” The EMR is the legal record created in hospitals and ambulatory environments that is the source of data for the EHR. The EHR represents the ability to easily share medical information among stake holders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual. Stakeholders are composed of patients/consumers, healthcare providers, employers, and/or payers/insurers, including the government.”( himssanalytics.org) An organization that has a well structured course of action in place for every move will be able to achieve desired outcomes when delivering quality health care. In order for performance improvement to take place it must come from clinical and non clinical aspects including education of health care providers and new information technology. For an organization to know where it wants to go, it has to have a plan to get there. The plan can’t be just one road to achieve that certain goal. The plan has to have many different strategies to be flexible in case of unpredicted outcomes. Strategic plan can be a roadway, which will allow for this dynamic process to take place. Because strategic planning is a dynamic process that never ends, it is important to continue strong improvement within the organization. References 1. Sharon B. Buchbinder and Nancy H Shanks, Introduction to health Care Management, 2007, Jones and Bartlett Publishers, Inc. 2. http://www.quickmba.com/strategy/strategic-planning/ - The strategic Planning process 3. Health Care Strategy and Consulting Services, http://www.healthstrategiesandsolutions.com/ 4. Continuous Quality Improvement - Healthcare Quality and Patient Safety http://sph2.umdnj.edu/omcweb/2000/Continuous%20Quality%20Improvement%20-%20Healthcare%20Quality%20and%20Patient%20Safety.html 5. http://www.himss.org/ASP/index.asp 6. http://www.himssanalytics.org/docs/WP_EMR_EHR.pdf electronic heath record vs. electronic medical record 7. http://www.gao.gov/new.items/d09895t.pdf 8. http://www.lssdata.com/products/EMRvsEHR.php - Electronic Medical Records and Electronic Health Records 9. http://www.nahq.org/