The health care industry can be thought of as a chaotic, constant changing business. It was once stated that chaos cannot be controlled. Perhaps that is the truth, yet there are several techniques that can be used when bringing order to this multi-trillion dollar industry while keeping the quality in health care services in tact. Health care services are measured by cost, quality and access.
In order to provide efficient care and maintain an operable business, it is important to understand how sufficient strategic planning, performance improvement, and information systems interrelate to one another and benefit the delivery of health care while ensuring quality in the delivery of health care services. This paper is intended to provide how these three fundamental elements correlate with one another and play an important role in operating a successful health care facility and business.
Perhaps one of the most crucial component of running and maintaining a health care facility is the process of strategic planning. This building block acts as a guide in which course the business will take. Whether the organization is for-profit or not-for-profit, the long term goals and effects can act as a deciding factor in the survival of the business. The purpose of implementing a strategic plan is to prepare for future goals and possible issues. An organization must prepare itself for forces that are both controllable and uncontrollable and implement strategies in order to adapt to the situations.
The development of the strategic plan and the execution of the organization’s strategy are two interrelated activities that are a part of the dynamic strategic planning process, (Buchbinder & Shanks, 2007). “The development of the plan usually spans a multi-year time horizon…and is updated annually,” (Buchbinder & Shanks, 2007). Strategic planning is a glimpse as to how the organization is currently working with market factors and possible threats or opportunities that the organization may wish to address.
It is important to have the involvement of physicians in strategic planning, as stated in the article, The Necessity for Physician Involvement in Strategic Planning in Healthcare Organizations from the American Journal of Surgery, which does an impeccable job of summarizing the significance of strategic planning. Its position is that, “strategic planning is necessary in health care organizations to meet the constraints of a lean economy, rapidly changing technologies, and an unprecedented need to provide quality services at affordable prices.
It offers a structure for assessing core strengths and environmental conditions and an innovative approach to enhance revenue and minimize costs. During the planning process, organizations define their mission, identify direction, develop a unified approach, prioritize long- and short-term goals, assign accountability, and allocate financial resources. Effective strategic planning is a continuous process and becomes an integral part of an organization’s culture.
Implementation is a part of strategy formulation, because future insights arise from current operating experiences. Success depends on buy-in from stakeholders, including physicians, nurses, and managers. The invested effort can offer the rewards of management that is proactive rather than crisis driven,” (Schwartz & Cohn, 2002). A SWOT Analysis (strengths, weaknesses, opportunities, and threats) is a situational assessment used to recognize a company’s internal strengths and weaknesses.
To put the meaning of strategic planning into better perspective, think of it as arranging, preparing, implementing, and managing your goals in life. You plan to attend school, graduate high school, enroll in college, graduate, start a career, marry a person you love, start a family, then retire. Yet, what about all the little road bumps along the way? Maybe the order of the events get rearranged. Perhaps you don’t attend college because you can’t afford to or you have no interest in remaining in school. Maybe you work several dead end jobs before starting your career.
These can be considered the outside forces that cannot be controlled. Financial instability, rocky marriage, lack of education, are your weaknesses. But what about the factors you can control and the strengths you possess? A SWOT Analysis works not only for health care organizations, but for just about any long term goal to be had. Along with strategic planning, the quality of care and improvement in performance is equally imperative. In today’s society, expectations become greater with each innovation and new research outcomes.
The need for specialized care according to preferences and standards is desirable and professional care adhering to current legislation and personal values is a must. “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” (Institute of Medicine, 1990),” (Buchbinder & Shanks, 2007).
According to the Performance Measurement and Management of Healthcare Professionals: Some Topical Issues, “Healthcare professionals are increasingly held accountable for standards of care that they provide…The science of performance measurement and performance management of professional activity is a new and rapidly expanding one. Advocates of an actively managed approach to quality improvement often underestimate the tensions associated with promoting change amongst traditionally autonomous professionals who work in complex organizations,” (Marshall & Davies, 2000).
The “End Result System”, introduced in 1910 by Ernest Codman, a Harvard Medical School Surgeon, “advocates that hospitals should examine whether the services provided to patients were beneficial and address the reasons for failure…and articulated three core principles of quality assurance:
1) examining quality measures to determine if problems are patient-, system-, or clinician-related; 2) assessing the frequency and prevalence of quality deficiencies; and 3) evaluating and correcting deficiencies so that they do not reoccur (Cooper, 1999),” (Buchbinder & Shanks, 2007). This program established “minimum standards” that focused on the quality of care within hospitals, including the 1) organizing of hospital medical staffs; 2)restricting of medical staff membership to well-trained, competent, and licensed physicians; 3)framing of policies and procedures to ensure regular staff meetings and clinical reviews; 4)recording of medical histories, physical exams, and laboratory tests; and 5) developing diagnostic and treatment facilities under physician oversight (Luce, Bindman, & Lee, 1994),” (Buchbinder & Shanks, 2007).
The “End Result System” has sense thus evolved into Quality Assurance (QA). Essentially, QA involves the development of standards, and the measurement of individual, group, or organizational performance against such standards,” (Buchbinder & Shanks, 2007). One study shows that taking a look at a new work design “permits healthcare managers to address the two biggest problems they face: reducing costs of service and attracting and retaining highly dedicated and competent patient care and support employees…High Involvement Work Systems (HIWS) represent a holistic work design that includes interrelated core features such as involvement, empowerment, development, trust, openness, teamwork, and performance-based rewards.
HIWS have been linked to higher productivity, quality, employee and customer satisfaction, and market and financial performance…The research found that HIWS were associated with both greater employee satisfaction and lower patient service costs in 146 Veterans Health Administration centers…This suggests that managers implementing HIWS will incur real expenses that are likely to be more than offset by more satisfied employees, less organizational turmoil, and lower service delivery costs, which in this study, amounted to over $1. 2 million in savings for an average VHA facility,” (Scotti, Behson, Farias, Petzel, Neumam, Keashly, et. Al. 2003).
Now that the goals for performance improvement are understood, it is necessary to discuss what approach and steps are required to take in order to achieve a higher productivity and quality of performance and employee satisfaction. Peer reviews and surveys are a great tool as long as they are done in a safe, confidential, professional manner. However, the effectiveness of these tools can only aid so much when assessing an employee’s performance. The money and time surveys take, results in the commitment of actually doing something about the results. Lack of change can result in employee mistrust and unsatisfaction towards management.
Employee and organization incentives and rewards are a great way to promote productivity and quality. Creating goals and programs allows the employees to feel valued and the need to work towards something for in return a reward or bonus. It is important to share these goals though so that staff is able to understand the direction and achievements in which the facility is trying to take. The article, Competing Values in Healthcare: Balancing the (Un)Balanced Scorecard, from the Journal of Healthcare Management mentions the use of Balanced Scorecards (BSC) to evaluate performance.
However, “…it has three conceptual limitations that are especially problematic for evaluating healthcare organizations: (1) it underemphasizes the employee perspective, (2) it is founded on a control-based management philosophy, and (3) it emphasizes making trade-offs. To address these limitations, we propose using the Competing Values Framework (CVF), a theoretically grounded, comprehensive approach to understanding and improving organizational and managerial performance by focusing on four action imperatives: competing, controlling, collaborating, and creating.
The CVF pays particular attention to the employee perspective…Rather than focusing on customer satisfaction or employee satisfaction, the CVF looks for ways to satisfy customers and employees while still addressing the financial constraints and growth opportunities. The CVF also can be used to assess both the culture of the organization and the competencies of individual managers, thereby providing a clear link between strategy and implementation,” (Wicks & St. Clair, 2007). So far, the importance of strategic planning and performance improvement have been discussed.
Yet, there is another aspect to consider when looking at quality in the delivery of health care services. “Information technology (IT) impacts every area, function, caregiver, organization, and patient…,” (Buchbinder & Shanks, 2007). Computers and technology today is different than it was even five years ago. The development of information and technology advances everyday and bigger and better equipment is produced. Technology in the health care world benefits both the patient and organization as well as clinical professionals and administrative staff.
EMR, electronic medical records, poses solutions to hand written paper medical records. Issues with paper records include: “illegible handwriting; incomplete, inaccurate, or late documentation and/ or notes; the physical record only being in one place at any given time; the limited access available to off-site providers; the fact that storage space for paper files often requires entire rooms and/or buildings; the passive, non-interactive nature of the paper record; and the difficulty in collecting and aggregating information across patients, providers, and the organization. (Buchbinder & Shanks, 2007).
CPOE, Computerized Physician Order Entry is an excellent tool when it comes to physician orders for doctors, resulting in the minimizing life and death situations. The hand-held device allows for physicians to document exams, record prescriptions, reducing human errors. In the article, Electronic Health Records: Their Time Has Come, the effort of the United States government has committed broad use of electronic health records (EHR’s) by 2014 and provides $36 billion to the usage of EHR’s in clinical settings. Detmer, 2009) Technology will always be a part of the health care industry, whether it be computers, EMR, CPOE or equipment used in treating and diagnosing patients. Improvements and new innovative technology are always advancing, which is why it is important for health care professionals and staff to remain up-to-date on procedures and tools.
Strategic planning, performance improvement, and information technologies all interrelate within one another because of their magnitude in role in the health care production. Strategic planning is essential in making sure long and short-term goals are made and met and include the ever changing, quick pace of technology. It is important for staff performance and ability to be top-notch so that it may effectively and accurately operate at society’s standards using new invasive equipment and technology.
Information Technology aides in the quality of healthcare in that it can help lower costs over the long run and minimize patient injury and mistakes by producing fewer human errors, including those that can be fatal. After reading this paper, it should be clear as to how these fundamental elements correlate with one another and play a vital part in operating a successful health care facility while ensuring patient and employee happiness. By understanding these three focal key sections, cost, access, and quality can be achieved.