Organizational Planning in Health Care
Fundamentals of Organizational Planning
Definition of Planning: Planning is the act of deciding in advance what work is to be done, who is responsible for doing it, how the tasks will be performed, and the specific timeline for completion.
Nature of the Process: Planning is a proactive and deliberate process that is a fundamental requirement for all managers.
Flexibility: As a plan serves as a guide toward a goal, it must remain flexible to allow for necessary readjustments when unexpected events occur.
Management Priority: Planning is critically important and acts as the foundation that precedes all other management functions.
Consequences of Inadequate Planning: Without sufficient planning, the entire management process fails, making it impossible to meet organizational needs and objectives.
Failures in Planning
Common Reasons for Strategic Failure: * Sound strategies are not utilized. * There is an inadequate delegation of authority. * A failure to recognize specific organizational goals and needs. * Planning is too narrow in scope, often failing to recognize community, legal, and licensing requirements. * Making false assumptions. * Not knowing the overall goal of the organization. * Lack of sufficient alternatives. * Inadequate time or other necessary resources. * Low motivation levels among planners or staff.
Managerial Errors: Managers who are uninformed about legal, political, economic, and social factors affecting health care are prone to planning errors. These errors can have disastrous implications for professional development and the financial viability of the organization.
Planning Modes and Proactive Strategies
Four Modes of Planning: * Reactive: Planning that occurs after a problem or event has already taken place. * Inactive: Maintaining the status quo and resisting change. * Preactive: Utilizing technology to accelerate change; future-oriented. * Proactive: Designing a desired future and finding ways to make it happen. This is always the goal for organizations and planners.
Supply Chain Management as Proactive Planning: * Defined as managing the flow of products and services to maximize quality, delivery, customer experience, and profitability. * Steps in Supply Chain Management: 1. Determine the resources required to meet customer demand for products or services. 2. Choose suppliers to provide the necessary goods and services. 3. Organize the activities required to accept or receive products. 4. Pay for the products and charge system users to cover costs.
Factors Influencing the Future of Health Care
Institutional Shifts: Further consolidation of hospitals/systems, medical groups, ancillary services, health plans, and post-acute care providers.
Value vs. Volume: The growing tension between "value" and "volume," leading to stronger linkages between expected quality outcomes and reimbursement.
Financial Transformation: A shift from revenue management to cost management.
Integration and Science: Increasing physician integration and scientific breakthroughs in precision diagnostics, precision medicine, patient monitoring, and drug discovery for targeted therapies.
Technology and Robotics: * Technology facilitating mobility and portability of operational processes. * The introduction and use of robotic pharmacists. * Advances in biomechatronics and robotic technology. * Use of biometrics and smart cards. * Expansion of telehealth, the internet, and point-of-care testing.
Economic Pressures: Rising pharmaceutical costs and ongoing drug shortages.
Population Health Models: * Movement toward managing populations rather than individuals. * Shift from illness care to wellness care and disease management programs. * Use of complementary and alternative medicine.
Workforce Dynamics: * The need for interprofessional collaboration over professional autonomy. * Persistent nursing shortages in acute care hospitals. * The impact of a growing older adult population.
Principles and Strategies for Successful Planning
Core Principles: * All plans must flow from other plans; short-range plans must be congruent with long-range plans. * Planning in all areas must align with the overall mission, philosophy, and goals of the organization. * The planning process remains consistent regardless of the time period involved. * The length of a plan is determined by the actions necessary to make it successful. * All planning requires an evaluation step, periodic reevaluation, and prioritization. * All people and organizational units affected by a plan should be included in the planning process.
Strategies for Success: * Start planning at the top of the organization. * Keep planning organized, clear, and definite. * Do not bypass levels of people; include those at all levels. * Maintain both short-range and long-range goals. * Know when it is appropriate to plan and when it is not. * Keep target dates realistic. * Gather data appropriately and ensure objectives are clear. * Maintain an awareness of the importance of interpersonal relationships.
Strategic Planning
Timeframe: Typically involves complex organizational plans spanning a long period, usually to years.
Scope: Strategic planning examines an organization's purpose, mission, philosophy, and goals within the context of its external environment.
Modern Limitations: While strategic plans in the 1960s and 1970s often looked years ahead, modern planners find it difficult to look even years into the future.
The Management Process in Strategic Planning: * The delineation of strategic goals and objectives, typically for a to year plan. * The development of strategies to achieve these goals.
Steps in Strategic Planning: 1. Clearly define the organization's purpose. 2. Establish realistic goals and objectives. 3. Identify external constituencies and determine their assessment of the organization’s purposes. 4. Clearly communicate the goals to constituents. 5. Develop a sense of ownership of the plan among stakeholders. 6. Develop strategies to achieve the goals. 7. Ensure effective use of resources. 8. Provide a base from which progress can be measured.
Subordinate Input: There is increasing recognition that input from subordinates at all levels is vital to give strategic plans meaning and increase the likelihood of successful implementation.
Analytical Tools: SWOT and Balanced Scorecard
SWOT Analysis Definitions: * Strengths: Internal attributes that help an organization achieve its objectives. * Weaknesses: Internal attributes that challenge an organization in achieving its objectives. * Opportunities: External conditions that promote the achievement of organizational objectives. * Threats: External conditions that challenge or threaten the achievement of organizational objectives.
Rules for SWOT Analysis: * Be realistic about internal strengths and weaknesses. * Be clear about the difference between the present organization and future possibilities. * Be specific about goals. * Always apply SWOT in relation to competitors. * Keep the analysis short and simple. * Recognize that SWOT is subjective.
Balanced Scorecard: Analyzes data from four organizational perspectives: 1. Financial 2. Customers 3. Business processes 4. Learning and growth
Planning Components and Hierarchy
Forecasting: The use of available historical patterns and projected statistics to assist in planning and determining future needs.
The Planning Hierarchy (Top to Bottom): 1. Mission 2. Philosophy 3. Goals 4. Objectives 5. Policies 6. Procedures 7. Rules
Hierarchy Implementation: A person should be able to identify how an organization implements its philosophy by observing nursing staff, reviewing budgetary priorities, and talking to patients.
Definitions within the Hierarchy: * Goals: The desired result toward which effort is directed. * Objectives: Specific, measurable targets describing how a goal will be achieved, including a timeframe. * Policies: Plans reduced to formal statements that direct decision-making. * Procedures: Descriptive, step-by-step processes. * Rules: Plans that specifically define acceptable choices of action.
The Role of Rules: Rules are the least flexible type of planning. Consequently, there should be as few rules as possible. However, existing rules must be enforced to prevent morale breakdown and to maintain organizational structure.