INTRODUCTION:

Strategic planning is a means by which an organization defines its future. The planning process involves strategies that provide direction for an organization’s future as well as an operational plan for the business. Planning affords the opportunity to determine how capital and human resources are allocated. Mission (purpose), vision, values, philosophy (belief) and objectives are powerful tools in the planning process and they are the basic tools of management.¹

The challenges that health institutions currently face are complex and changing, they include the need to improve access to and quality of health services and reform standard processes. Institutions must also respond to emerging diseases, the lack of resources or new resource streams, and new donor priorities, among other challenges. To address these challenges, managers and their teams must be fully aware of the fact that their organization’s future depends to a large extent on the provisions they make for that future and the decisions they make to place their organization in the best possible situation considering the prevailing circumstances. To achieve this, organizations need a planning process based on strategic thinking.²

What is planning?

Planning is a continuous process, beginning with the setting of goals and objectives and then laying out a plan of action to accomplish them, put them into play, review the process and the outcomes, provide feedback to personnel and modify as needed. As planning is put into action, the management functions of organizing, leading and evaluating are implemented, making all management functions interdependent.³

There are two major types of organizational planning:

• Long – range, or strategic planning

• Short – range or operational planning

Strategic planning extends 3 – 5 years into the future.

Operational Planning is short range planning that deals with day-to-day maintenance activities.⁴

What is Strategic Planning:

Drucker defines Strategic planning is a continuous process of making risk – taking decisions today with the greatest knowledge of their effects on the future; organizing efforts are necessary to carry out these decisions and evaluating results of these decisions against expected outcomes through reliable feedback mechanisms.⁵

Nursing administrators can increase effectiveness through strategic planning, which can promote professional nursing practice and the long – term goals of the organization and the division of nursing. Clear, complete plans are developed in seven areas of key result.

• Client satisfaction

• Productivity

• Innovation

• Staff development

• Budget Goals

• Quality

• Organizational climate

Strategic planning in nursing is concerned with what nursing should be doing. Its purpose is to improve allocation of scarce resources, including time and money, and to manage the agency for performance.⁶

Purpose of Strategic Planning

The purpose of strategic planning is to set overall goals for your business and to develop a plan to achieve them. It involves stepping back from your day-to-day operations and asking where your business is headed and what its priorities should be.⁷

Executives using the strategic planning process give direction to the organization to:

• Improve efficiency

• Weed out poor or underused programs

• Eliminate duplication of efforts

• Concentrate resources on important services

• Communications and coordination of activities

• Provide a mind –expanding opportunity

• Allow adaptation to the changing environment

• Set realistic and attainable yet challenging goals

• Help to ensure goal achievement.

• Leaders need vision that is realistic and feasible.

• The strategic vision should be clear, cohesive, consistent and flexible.⁶

Aims of Strategic Planning:

Strategic planning is to bring an organization into balance with the external environment and to maintain that balance by over time (Sackett, Jones, and Erdley2005).⁸

Phases of Strategic Planning Process:

Phase 1: The Mission and the Creed:

Develop statements that define the work, the aims, and the character of the division of nursing. These include idea statements of shared values and beliefs. They are called mission (purpose) and creed (philosophy) statements and relate to personnel, patients, community and all other potential customers.

Phase 2: Data collection and Analysis:

• Collect and analyze the data about the health care industry and nursing.

• Such data should include internal forces that define the work and affect the employees, clients, stakeholders and creditors; technological advances; threats; opportunities to improve growth and productivity;

• External forces such as competition, communities, governmental tand political issues, and legal requirements; marketing and public relations or image; trends in the physical and social work environment; and communication.

• Use simple and complex forecasting techniques.

Phase 3: Assess Strengths and Weaknesses:

• Define those factors from the data analysis that influence management of the division of nursing.

• List them as strengths / opportunities and achievement of goals and objectives or as weaknesses / threats that impede achieving goals and objectives.

• Define the current position and strength of the unit.

Phase 4: Goals and Objectives:

• Write realistic and general statements of goals.

• Break the goals down into concrete written statements of objectives the division of nursing intends to accomplish in the next 3 to 5 years.

Phase 5: Strategies:

• Identify untoward conditions that could develop in achieving each objective.

• Note administrative actions to avoid or manage them.

• Use this information to modify goals and objectives, making contingency plans for alternative actions.

• Define the organization needed for implementing strategic plans.

Phase 6: Time Table:

• Develop a timetable for accomplishing each objective. This phase produces or becomes part of the plans.

Phase 7: Operational and Functional Plans:

• Provide guidelines or general instructions that lead functional and operational nurse managers to develop action plans to implement the goals and objectives.

• These include detailed actions, policies, practices, communication and feedback, controlling and evaluation plans, budgets, time tables, and persons to be held accountable.

• Phase 8: Implementation

• Put the plans to work.

Phase 8: Implementation:

Put the plans to work

Phase 9: Evaluation:

• Provide for formative evaluation reports before, during, and after the implementation of operational plan.

• Provide for summative evaluation that is quantified. Report actual vs. expected results.

• Evaluate the strategic mission, and plan frequently.

• Provide continuous feedback that can be used to modify and update the plan.

• Use people who implement the plan to evaluate it.⁶

SWOT Analysis:

• Health care organizations must continually make adjustments to maintain optimal function (Christiansen 2002).

• A number of different techniques can be used to determine where adjustments need to be made.

• One essential technique involves a discussion of an organizations strengths, weaknesses, opportunities, and threats, commonly called SWOT analysis (Kahveci and Meada 2008).

• SWOT analysis is a precursor to strategic planning and is performed by a panel of experts who can assess the organization from a critical perspective (Gibis et al. 2001).

• This panel could comprise senior leaders, board members, employees, medical staff, patients, community leaders, and technical experts.⁸

Definition:

SWOT analysis is an examination of an organizations internal strength and weaknesses, its opportunities for growth and improvement, and the threats the external environment presents to its survival.⁸

Steps in SWOT Analysis

STEP 1:

• SWOT analysis involves the collection and evaluation of key data.

• Depending on the organization, these data might include population demographics, community health status, source of health care funding, and /or the current status of medical technology.

• Once the data have been collected and analyzed, the organization’s capabilities in these areas are assessed.

STEP 2:

• Data on the organization are collected and sorted into four categories: strengths, weakness, opportunities, and threats.

• Strengths and weaknesses generally stem from factors within the organization, whereas opportunities and threats usually arise from external factors.

STEP 3:

Involves the development of a SWOT matrix for each business alternatives under consideration.

For example,

• Say a hospital is evaluating the development of an ambulatory surgery centre (ASC).

• They are looking at two options; the first is a wholly owned ASC, and the second is a joint venture with local physicians.

The hospital’s expert panel would complete a separate SWOT matrix for each alternative

STEP 4:

Involves incorporating the SWOT analysis into the decision-making process to determine which business alternative best meets the organizations overall strategic plan.⁹

STRENGTHS:

SWOT analysis views strengths as current factors that have prompted outstanding organizational performance. Examples

• Use of state -of-the-art medical equipment

• Investments in health care informatics

• Focus on community health care improvement projects

• Highly competent personnel

• Clear understanding among employees of the organization’s goals

• Focus on quality improvement.

WEAKNESSES:

Weaknesses are organizational factors that will increase health care costs or reduce health care quality.

Examples include aging health care facilities and lack of continuity in clinical processes, which can lead to duplication of efforts.

Weaknesses can be broken down further to identify underlying causes.

• For example, disruption in the continuity of care often results from poor communication. Weaknesses also breed other weaknesses.

• Poor communication disrupts the continuity of care, and then this fragmentation leads to inefficiencies in the entire system.

• Inefficiencies, in turn, deplete financial and other resources.

• For example, disruption in the continuity of care often results from poor communication. Weaknesses also breed other weaknesses.

• Poor communication disrupts the continuity of care, and then this fragmentation leads to inefficiencies in the entire system.

• Inefficiencies, in turn, deplete financial and other resources.

OPPORTUNITIES:

SWOT analysis views opportunities as significant new business initiatives available to a health care organization.

Examples

• Collaboration among health care organizations through the development of health care delivery networks

• Increased funding for health care informatics

• Community partnering to develop new health care programmes

• Introduction of clinical protocols to improve quality and efficiency.

THREATS:

Threats are factors that could negatively affect organizational performance.

Examples

• Political or economic instability

• Increasing demand by patient and physician for expansive medical technology that is not cost effective

• Increasing state and federal budget deficits

• Growing uninsured population

• Increasing pressure to reduce health care costs.¹⁰

FORCE FIELD ANALYSIS:

• Force field analysis takes SWOT analysis a step further by identifying the forces driving or hindering change in other words, the forces driving its strengths, weaknesses, opportunities, and threats.⁷

• Force field analysis is a valuable change-management tool. This management technique was developed by Kurt Lewin, an expert in experiential learning, group dynamics and action research. Although Kurt Lewin contributed greatly to the field of social science, he is best-known for his development of the Force field analysis model in 1947.

• Lewin’s force field analysis is evaluates the net impact of all forces that influence change. These forces can be divided into two groups: driving forces and restraining forces. Driving forces are all forces that push for and promote change. These change drivers promote and encourage the change process.

• Some examples of driving forces are executive mandate, customer demands, and increased efficiency. Restraining forces are forces that make change more difficult. These forces counteract driving forces and lead to the avoidance or resistance of change. Some examples of restraining forces are fear, lack of training, and the lack of incentives. When these two sets of forces are equal change is in a static state of equilibrium meaning that no movement towards or away from change is happening.¹¹

• Effective force field analysis considers not only organization values but also the needs, goals, ideas, and concern of individual stakeholders. A case can be made that individuals who promote change are driving force, where as those resists change are restraining forces.¹²

GAP ANALYSIS:

• To further refine decisions, SWOT analysis can be supplemented by gap analysis.

• Research shows there are significant gaps in health care practice and that these gaps cause provider to make inaccurate assessment of patient`s conditions and provide the wrong types of care.

• The result is poor clinical outcomes.

• Gaps in the health care include lack of knowledge, lack of motivation, poor access to information, variations in patient culture and education, lack of resources and system barriers that limit team work

• In one study Robert Fleet croft honorary senior lecturer in primary care for the school of medicine at the University of East Anglia and his colleagues used gap analysis to measure the quality of health care services at 8407 medical practices in England.

• There research found significant gap in clinical practice, quality indicator and patient satisfaction across a wide range outcome measures.

• Gaps also exist between the public’s expectation of high-quality care and situations in which they receive low-quality healthcare.¹²

How Strategic Planning Can Be Used To Improve Nursing Management

• To provide accountability and monitoring of performance.

• To set up more formal planning programs

• To integrate strategic plans with operational and financial plans.

• To think and concentrate more on strategic issues.

• To improve knowledge of and training in strategic planning.

• To increase top management involvement and commitment.

• To improve focus on competition, market segments, and external factors.

• To improve communication from top administration and nursing management.

• To allow better execution of plans.

• To be more realistic and rationalize.

• To improve the development of nursing management strategies.

• To improve the development and communication of nursing management goals.

• To anticipate the future and plan for it.

• To develop the annual budget.

• To focus on quality output that will improve nurses performances and productivity, decrease losses, and increase return on equity.¹³

CONCLUSION:

Strategic planning is often considered to be a goal-setting that is largely carried out by top management. Operating nurse managers need to be trained in the strategic planning process. Strategic planning has many benefits. It provides for objective consideration of strategic choices or options that are better matched with organizational goals and objectives. With strategic planning, the outlook becomes future oriented, resources are allocated systematically and rapid change is accommodated. Strategic Plans must be dynamic. Strategic plans are the blue prints that are to be updated as the environment changes.¹⁴

REFERENCES:

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4. Nursing Management and Leadership, Ann Marriner Tomey, 8^th edition, Mosby Publication, Page Number 220-225.

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12. Strategic management mgt 521, diploma in business administration, dbm kings university, hawaii, honolulu, united states of america. Page Number: 85-86 [Available from http://www.kingsuniversityusa.org/pdf/Strategic%20management%20MGT%20521.pdf].

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Received on 09.11.2017 Modified on 19.01.2018

Int. J. of Advances in Nur. Management. 2018; 6(1): 67-71.

DOI: 10.5958/2454-2652.2018.00015.X