Assesses - the internal and external driving forces and barriers to strategic planning. Demonstrates -innovation, vision, creativity within the organizational unit planning,

inspiring proactive rather than reactive planning. Influences and inspires -group members to be actively involved in long term planning Clarifies -the leaders recognition of the employees value ,to increase self

awareness Encourages - employees to be involved in policy formation, developing and

implementing company philosophies, goals, objectives, policies, procedures and rules.

Communicates - and clarifies organizational goals and values Receptive - to new and varied ideas Role models - proactive planning to employees

Knowledgeable -regarding all the factors that effect healthcare planning, political, economic and

social. Demonstrates -appropriate planning techniques Organizes -opportunities for participation from employees, peers, competitors, regulatory

agencies, and the general public in planning. Coordinates -unit level planning to be congruent with organizational goals Assesses - the units constraints assets and resources for planning Develops and articulates -the Unit goals and objectives that reflect, philosophy, unit policies, procedures, and

rules. Reviews - if the goals are being met and if not, what changes need to be made. Participates -actively participates in all areas of unit planning and operations.

Reactive -planners respond to a crisis which can lead to hasty

decision and mistakes. Inactivism -these planners do not like change and put all of their

efforts into maintaining conformity and the status quo. Preactivism -these planners are unsatified with the past or present,

believing the future is always preferable. Interactive or proactive - these planners are dynamic, considering the past,

present, and future. Leaders and managers must be adaptive in order to promote growth within their organization.

Mission Philosophy Goals Objectives Policies Procedures Rules

Mission statement -Is a brief statement outlining the reason an

organizations exists, and addresses its position regarding ethics, principles, and standards of practice. It is the highest priority in the hierarchy of planning because it influences all the other planning components in the pyramid

Vision statement -Is are always future oriented while mission

statements provide the foundation for organizational planning, an example of a vision statement would be “To become an exemplar for healthcare in the region”

Organizational◦ Flows from the mission statement and defines the set of

values and beliefs that guide all actions of the organization, it is the basic foundation that directs all further planning toward the mission, a philosophy statement can usual be found in policy manuals and are available upon request

Nursing -The concepts of holistic care, education, and

research, as well as the quality, quantity, and scope of nursing services

Societal -Sets of beliefs that guide their behavior, called

values. Some strongly held american values are individualism, the pursuit of self-interest, and competition, we will be discussing the effect of these values on our healthcare system later on.

Individual -Shaped by the socialization processes

experienced by that person. Value criteria

◦ 1. It must be freely chosen from among alternatives only after due reflection

◦ 2. It must be prized and cherished◦ 3. It is consciously and consistently repeated (part of

a pattern)◦ 4. It is positively affirmed and enacted

Each nurse-leader should encourage self-awareness in their employees through examination of their value system and understanding the role that it plays in decision making and resolving conflict.

Goal◦ The ends toward which the organization is

working, it is the aim of the philosophy, it is what makes the philosophy operational

◦ The desired result toward which effort is directed◦ Measurable and ambitious, but realistic, just like

the criteria we use in our nursing care plans to identify pt. outcomes

Objectives◦ Identify how and when the goal is to be accomplished,

they are more specific and measurable than goals in this regard

Process objectives◦ Are written in terms of the method to be used, an

example of a process objective might be “100% of nurses will teach their pts how to use the callbell within 30 mins of admission, and request return demonstration”

Result-focused objectives◦ Specify the desired outcome, an example of this would be

“ All post-op pts will perceive a decrease in their pain after the administration of pain medicine”

Policies◦ Plans reduced to statements or instructions that direct

organizations in their decision making; it is a statement of expectations that sets boundaries for action taking and decision making

◦ Many policies come from JCAHO (Joint Commission Accreditation of Healthcare Organizations)

Implied policies◦ Not written or verbally expressed, and usually developed over

time and follow a precedent; for example a hospital may have a policy that employees should be encouraged and supported in their activity in regional, community, and national healthcare organizations

Expressed policies◦ Delineated verbally or in writing◦ May include a formal dress-code, a policy for sick leave or

vacation time, and disciplinary procedures

Procedures◦ Plans that establish customary or acceptable

ways to accomplishing a specific task and outline a sequence of steps of required actions.

◦ For example, the unit manager must provide a clearly written procedural statement regarding how to request vacation time

Rules and Regulations◦ Plans that define specific action or non-action◦ Describe situations that only allow one choice of

action◦ Least flexible◦ Because rules are the least flexible type of

planning, there should be as few rules as possible, however existing rules should be enforced to keep morale from breaking down

Omitting Goals or Objectives◦ The organization can be more effective if movement

within it is directed at specified goals and objectives◦ Goals and plans keep managers focused on the bigger

picture and keeps them from getting lost in the minute details

◦ Similar to our care plans, we establish patient goals before we make interventions

Lack of Flexibility◦ The plan must be flexible to reach a goal, and allow for

readjustment as unexpected events occur◦ “Those who are flexible will not break” – Ms. Mancer

Lack of Communication & Buy-in◦ Manager should include in the planning process people

and units that could be affected by the course of action◦ Although everyone will not want to contribute, they

should all be invited

Unrealistic Expectations◦ Plans should be specific, simple, and reasonable◦ A plan that is vague or too global can be difficult or

impossible to implement Over- & Under-Planning

◦ Know when and when not to plan◦ The over planner has “paralysis by analysis”◦ The under planner is makes false assumptions that

people and events will naturally fall into place and has difficulty prioritizing against real needs

Failure to Execute the Plan◦ Have built-in evaluation checkpoints◦ If goals are not met, the manager must determine why

and what needs to be changed

Strategic planning as a management process includes the following steps:

1. Clearly define the purpose of the organization2. Establish realistic goals and objectives consistent with

the mission of the organization3. Identify the organization’s external constituencies or

stakeholders, then determine their assessment of the organization’s purposed and operations

4. Clearly communicate the goals and objectives5. Develop a sense of ownership of the plan6. Develop strategies to achieve the goals7. Ensure the most effective use of resources is made8. Provide a base from which progress can be measured9. Provide a mechanism for informed change as needed10. Build a consensus about where the organization is going

A manager has to be willing to take risks

Changes in the future of the healthcare organization◦ Change in information technology

Will result in elimination of duplication and provide immediate access of information

◦ Change in patient demographics The increasing number of seniors (baby boomers) will

create enormous demands on the healthcare system◦ Change in economics

US ranks 21st in life expectancy and 27th in infant mortality

Cost of drugs is highest in the world◦ Changes in providers

Nurses will continue to decrease in supply and some physician specialties will increase in supply

Leader-Manager must be skilled in determining, implementing, documenting, and evaluating all types of planning in hierarchy

The leader should demonstrate a proactive rather than a reactive management style to employees

Manager draws on the philosophy and goals established to implement planning Manager appropriately assesses the constraints, assets, and resources available for

planning Manager draws on leadership skills in creativity, innovation, and futuristic thinking to

translate philosophies into goals, goals into objectives, and so on down the planning hierarchy

Leader-Manager will develop the interpersonal skills necessary for inspiration of employees

Leader-Manager must be receptive to new and varied ideas The Leader-Manager’s final step in the process involved articulating identified goals

and objectives clearly If the unit manager lacks management or leadership skills, the planning hierarchy

fails Managers who are uninformed about the legal, political, economic, and social factors

effecting healthcare make planning errors that may have disastrous implication for the organization

Considering the societal philosophies and values of the US today -- individualism, the pursuit of self-interest and competition…◦ Do you agree or disagree that the US healthcare

system represents these societal values?◦ This is a topic that effects managers and leaders

planning and decision-making Would you be willing to have fewer

healthcare choices if access could be granted to all?

Do you believe the cost of universal coverage should be picked up by the consumer or by the employer?

You are a nurse chosen to be on the board of a major county hospital, the board has begun the strategic planning process for the year…

Quality◦Sample Objective/Goal: “To reduce

medication administration errors by 10%” Information Technology

Consider implementation of electronic charting/drug administration system

Staff Levels Analyze staff to patient ratios Are nurses overworked?

Baylor of Garland case study Baylor of Garland still uses paper charting -- because of this

many medication errors may occur For example, a patient received the incorrect dosage of an anti-

seizure medication for 2 days because the pharmacy scanned the incorrect doctors order due to the disorganization of the paper chart. Because of this, the patient experienced an unnecessary seizure before the error was found

Access◦Sample Objective/Goal: “Provide care to 15% more patients than we did last year” Assess resources to available to achieve the

objective How much additional staff will be needed? How much additional space will we need?

Will we need new construction? New wing or modular building? How will we pay for the addition – seek funding,

charity or debt financing (taking out a loan)?

Cost◦Sample Objective/Goal: “Decrease the unnecessary waste of supplies by 5%” Implement incentive-based motivation for staff to

decrease wasted supplies Consider implementing a competition for the least amount

of supplies wasted, winner gets first right on holiday scheduling decisions

Consider implementing additional policies for supply uses? (Example: Mandatory workshops or refresher courses on proper patient assessment)

Many times supplies will be wasted because the patient was not properly assessed prior to getting the supplies – for example grabbing a male-sized catheter for a female and not realizing it until the procedure.