Health Care SWOT ANALYSIS

Health CareSWOT ANALYSISBy: Shelli Chernesky, Kelly Ewing, Kenneth Longbrake, Susan Mateo, & Sharna Young

1IntroductionSWOT analysisStrengthsWeaknessesOpportunities ThreatsStrategic plan

Nurse leaders need to develop skills to evaluate their organization and the current health care market. Once leaders have completed the evaluation, they need to develop a plan to guide the hospital in the future. The SWOT (strengths, weaknesses, opportunities, threats) analysis is one tool the nurse leaders can use to evaluate the organization and the current health care market. The tool assesses both external and internal capabilities. External developments are identified as either opportunities or threats for the organization; internal capabilities are described as strong or weak points of the organization (van Wijngaarden, Scholten, & van Wijk, 2012, p. 34). Based on these finding, leaders develop a strategic plan to provide direction for the organization. Strategic planning examines the internal and external environments of an organization and provides a guide for future development. The strategic plan "determines the direction of the organization, allocates resources, assigns responsibilities, and determines time frames" (Whitten & Cameron, 2004, p. 220).

2Organizational Strengths Excellent reputationNurse residency program Robust research department< 2% vacancy rate for registered nurse positionsHigh employee/patient satisfaction scoresElectronic health record

The SWOT analysis revealed multiple organizational strengths of the hospital. The hospital has an excellent reputation locally and nationally. Its cardiac and oncology programs have been ranked among the best within the nation. This reputation has allowed the hospital to attract patients to the hospital from across the country. The hospital has an established nurse residency program that attracts high-quality nurses from around the nation. Nurse residency programs have been shown to improve patient care and retain new nurses (Varner & Leeds, 2012). Research plays an important role in delivering the highest quality care and developing best practices. The hospital has a robust research department that participates in multiple clinical trials and nursing research. The organizations current vacancy rate for registered nurses is less than 2% enabling the hospital to effectively staff nursing units. The hospital has both high employee and patient satisfaction scores. A recent survey conducted by Press Ganey indicated that the hospital is in the top 5% for employee satisfaction. Another significant strength is the electronic health record. The organization has fully implemented an electronic health record across the organization and physician offices. The implementation has improved patient care and access to needed information. 3Organizational WeaknessesPhysician recruitment of specialistsDecreased reimbursements Current facility lack of spaceLack of succession plan for leadersLong emergency department wait timesKey quality indicators below national average

The SWOT analysis revealed weaknesses of the organization. The hospital has not been able to recruit specialists in psychiatry and emergency medicine. The lack of physicians has created staffing shortages in the emergency department and inadequate call coverage for psychiatrists. The Association of American Medical Colleges projected a shortage of 30,000 primary care physicians by 2015, and 66,000 by 2025 (Chen, Mehrotra, & Auerbach, 2014, p. 95). Decreased reimbursements have led to a reduced capital budget. The hospital has been forced to make difficult decisions and construction plans for a new patient tower have been placed on hold. The new tower was anticipated to house a new emergency department and additional inpatient beds. The lack of physicians and space has led to long wait times in the emergecny department. Because of the long wait times the left without being seen rate in the emergency department is over 5%, which is higher than the national average. Over the last two years, the hospital has lost several managers and senior leaders. The lack of a succession plan has forced the hospital to hire candidates from outside the hospital. The hospital has high patient satisfaction scores, but the hospital does have key quality indicators that are below the national average. The hospital must address these areas to ensure they continue to have the publics support, and reimbursement rates are not affected. 4

External Environmental FactorsAnnual analysis of External FactorsTechnologicalPoliticalCompetitiveRegulatorySocial

The importance of annually gathering and analyzing the external factors of the health care market data propels decision-making for the administrative team. A focused direction either maintains actions and processes of the opportunities or looks at the factors relating to the external threats. These factors include technology, political, competition, regulatory elements, and social components (Whitten & Cameron, 2004). This undertaking provides a focus and new business strategy for success of the organization. External factors include influences that cannot be controlled by the organization. However, the organization can have a strategy in place to maintain success and profits for these moving parts. The importance of taking advantage of the opportunities and planning for treats is most profitable for the organization.5OpportunitiesExternal Environmental FactorsIncrease in National Population

SocialConstant Demand for HealthcareNecessity/Life Saving ServiceEssential Need for Healthy Living 2020Affordable Health Care ActDecrease Leading Causes of Death

Today, the United States Census Bureau (USCB) announces the nation's population is 320,143,776, an increase of 2,218,622, or 0.7%, from New Year's Day 2013 (USCB, 2014). Our countrys population is growing, with community demands for health care and prevention. Services for health care are essential needs for the living. Health care is a service of necessity, for life-saving needs within the community (Smith, 2014). Projection of plans for a healthy community include health care availability, along with programs available for healthy living (Healthy People 2020, 2014). Moving towards health care availability accessible to all citizens is present with the Affordable Health Care Act. Overall aim to reduce the leading causes of death within the nation is essential for a healthy nation. Therefore, opportunities to assist these needs and goals are readily available for healthcare organizations to make a mark in the health care market as a social factor influence.6ThreatsExternal Environmental FactorsCompetitive MarketNeed a Leading Edge100 Top HospitalsAccreditation/CertificationSpecialties of ServicesAttract Skilled EmployeesTalent & ExpertiseService ExcellencePatient Centered---CaringFaster with a SMILE!LocationConvenientTechnologyComfort

The health care industry is competitive. The ultimate goal is to attract customers and make a profit. With all the industry competition, medical professionals are looking for ways to enhance their competition and give themselves a leading edge. These goals are reached by advertisement and media coverage, obtaining accreditations and certifications as a top hospital or specialty of health care service. Recruiting skilled employees that hold talent and expertise to help the sick is critical to raising the bar with health care delivery, including adding service excellence Adding service excellence benefits how customers feel. Customers want to come back or recommend a hospital because of the type of care that they received. Employees, who sincerely cared and listened to patients, are ranked high in surveys (Smith, 2014). Therefore, organizations must be frugal, yet provide a location that is convenient, comfortable, and include technology tools to do the job effectively and efficiently.7Initiatives for Strategic PlanNursing Sensitive indicator (NSI) performance data Magnet designationImprove reimbursementBuild nursing leadershipIncrease job satisfaction Maintain and improve nursing retention Initiatives set within the strategic plan of the hospital include nurse sensitive performance data that is below the national average and the urgent need of physicians in the emergency department. Nursing Sensitive indicator (NSI) performance data reflects a "below average" score which indicates hospital deficiencies in the area of the structure, process, and outcomes of nursing. The structure of nursing care is affected by the level of education of the nursing staff, supply of nurses, and an efficient nursing leadership team. The NSI performance data is the reflection of care provided by nurses that are indicative of patient outcomes, such as pressure ulcers, falls, and infections. Medicare Value-Based Purchasing (VBP) Program has transformed organization's reimbursement from Medicare. In 2013-2014, the VBP score was based on 70% of the clinical care processes and outcomes (Bakker & Keithley, 2013). These processes and outcomes determine the money amount of reimbursement to individual hospitals and organizations. NSI performance is necessary for our hospital because of the financial reimbursement implications.The American Nurses Credentialing Center Magnet Recognition Program (Magnet) has conveyed much attention in NSI performance and excellence in patient care. Hospitals are carefully monitored on their observed patient outcomes to gain Magnet status (Bakker & Keithley, 2013). Magnet hospitals are acknowledged for their unified work environments, empowerment of staff, and excellence in patient care. Hospital Magnet initiatives have resulted in substantial increases in performance improvements and NSI performance measures with a 4% increase overall. These types of results will support our hospital's efforts to improve reimbursement, build nursing leadership, increase job satisfaction, raise nursing retention rates, and achieve Magnet designation. The hospital decision to pursue and acquire Magnet status brings us to the cost versus benefits standpoint. The hospital initiative will take approximately four and a half years. The estimating cost of the Magnet program initiative can be in the range 100,000 to 600,000 dollars (Smith, 2014). The hospital must consider the financial commitment and consideration along with the program initiative benefits. Research shows us that Magnet hospitals attract and retain the top talented nursing staff and leaders, increase safety and satisfaction of patients, and improve patient care. This magnet initiative will foster a culture of collaboration among health care staff, advance the standards and practice of nursing, and expand the hospital for the future of financial success (Parsons, 2011).Commitment, to become a Magnet hospital, will need well-supported nursing leadership by the hospital administrators. Our hospital's pursuit of Magnet designation and redesignation will continually face external challenges with the ever-changing reimbursement policies and regulatory demands. Other external influences are health care reform legislation, public transparency, and the demand for high-quality outcomes. Internal challenges will be the needs of the nursing staff productivity and our aging workforce. Support will be needed in the way of research to keep the health care staff consistently practicing to the most current best-practice standards. The Magnet initiative will benefit the hospital by promoting quality care for patients in our community and supporting our hospital's professional nursing practice.8Initiatives for Strategic PlanModel of clinical alignment and collaboration with physicians and physician service lines with the hospitalModel: Physician directors, develop and execute sustaining lease agreements, metrics and goal setting, and sustainabilityCommit to the improvement of efficiencyQualityCoordination of patient careCost effectivenessOur hospital is facing a shortage of emergency room physicians along with a lack of twenty-four hours psychiatric staff. This deficit is coupled with the need to improve the quality of care provided to patients, community expectations, and hospital financial outcomes. As the leadership team of the hospital, we must share the urgency to achieve greater access, improve care, and prepare for lower costs. The strategic initiative within the next five years is to integrate a model of clinical alignment and collaboration with physicians and physician service lines. Clinical alignment integration is the pledge from the physician leader to commit to the improvement of efficiency, quality, and coordination of patient care while considering cost effectiveness (Salas-Lopez, Weiss, Nester, Whalen & Fulton, 2014).The model has four agreements between the physician or service lines and the hospital. The first is to appoint physicians to serve as medical directors of the service line with clear roles and responsibilities. The responsibility of the director is the framework of the hospital which includes the people, service, quality care, costs, and continued growth (Salas-Lopez et al., 2014). Physician directors will work closely with nursing staff, researchers, clinical nurse leaders, suppliers, community physicians, and hospital administrators to provide the best care practices with cost-effective strategies. These physician directors will meet in their respective areas monthly to track progress or challenges.The second part of the model initiative is to develop and execute sustaining lease agreements between the hired physicians and the hospital (Salas-Lopez et al., 2014). Lease agreements would be determined by hospital needs such as, community physicians working as emergency room staff for times of shortage and weekend coverage. Specialty physician lease agreements will be developed by the physician director group for service lines and specialty areas, such as psychiatry. Physician leadership will ensure lease agreements and monthly meetings payments are fair and appropriate.The third initiative of the model is to develop metrics and focus on goal setting as a high priority and responsibility of the physician directors and hospital leadership. Successful alignment and integration of the physicians and the hospital requires planning, mutual objectives, and a collaborative approach to delivering high-quality care. The fourth part of the model is the sustainability which is an ongoing commitment of physician directors to lead their service lines, communicate the hospital vision and goals, and remove barriers. The initiative, to properly structure the hospital infrastructure, will contribute to external opportunities such as support from community physicians and meet the challenges of predicting shortages to certain physician specialty service lines. Active internal development will be in the collaboration of all disciplines working toward the same goals with physician leadership to remove existing barriers. Examples of these goals are decreasing patient readmissions and wait times in the emergency department. Internal challenges will be the cost of new programs and process and salaries for physician directors (Salas-Lopez, et al., 2014).9Justification of Resource Allocation for Strategic InitiativesBenefits of Seeking Magnet Recognition:Increased quality of careDecreased staff turnover and increased retentionRecruitment of highly qualified nursesIncreased financial success

Benefits of Adopting Clinical Alignment and Collaboration with Physicians and Physician Services:Increased quality of careCost effectivePhysician satisfaction

The value and advantage of having Magnet Recognition are astronomical for any healthcare facility. Research has proven that organizations with Magnet status demonstrate positive nursing, patient and organizational outcomes (Mueller, 2002). The high cost cannot be omitted but can be justified. According to the Robert Wood Johnson Foundation (2014) the average cost of magnet status is $500,000 annually, for an average total investment of $2,125,000. Researchers calculate that hospitals should begin to see the payback in two to three years with revenues of $1,229,770 to $1,263,926 annually (Robert Wood Johnson Foundation, 2014). From a financial standpoint, these figures illustrate the potential financial gain that the hospital could realize long-term, which could later be used to complete structural project that had been put on hold.The hospital have seen below average national scores on quality indicators progressively, and loss of managers and senior leaders, which have led to external recruitment. This has been an aspect of increased spending for the facility and could be combated by seeking magnet status. On a research of facilities with Magnet Status it has shown that these hospitals have more positive work environments that have boosted nurse retention due to nurse satisfaction (Renter, Allen,Thallas& Foley, 2014). It then can be deduced that quality of care will be increased. Magnet status is given to facilities that show nursing excellence (Monroe & Lash, 2005). According to Daley (2011) "Better work environment supports better patient outcome and reduces mortality rate by 4.6% when compared to non-Magnet hospitals" (p. 44). All benefits from this initiative are justifiable for allocation of resources for the problems faced by this organization.Clinical alignment and collaboration with physicians and physician services are regarded as a way for facilities to give doctors more independence while making them partners with the facility. This comes at a time when healthcare costs are high, and reimbursement is based on patient outcomes. There is also competition between facilities and physicians. Alignment and collaboration are a good way to improve the quality of care and be cost effective. The problems facing this facility presently where physicians are scarce and quality scores are lacking, implementing a strategy that makes it positions desirable to doctors and therefore increasing the quality is a priority. This initiative, therefore, becomes a sound decision for the facility. The alignment of physician medical staff that shares the same goal will support high-quality care (Salas-Lopez, et al., 2014).Collaboration of physicians is cost effective when everyone shares responsibility instead of each independently. Physicians are also more satisfied with their interdependence to provide services with some control, which implies that they will be less likely to want to leave. The goal of this initiative is to improve patient health, patient experience and reduce cost at the same time making it justifiable for allocation of resources.

10Effect of External Environment on Strategic ManagementCompetition

Economy

Environmental Complexity

Community Resources

The external environment can impact the strategic plan in two ways. It can push organizational leaders to seek out innovation as well as it can affect the direction in which a strategic plan is aimed. Competition can affect how organization organize and distribute services. The external environment is always changing, and plans should be an ongoing action done to keep ahead and apart from competitors. It can be a good thing for consumers, and in these case patients because organizations seeking improvements continuously means improved services and quality of care.The economy is a changing factor in the external environment and stands to dictate how many hospitals and other businesses can risk in terms of capital. The rate of investment (ROI) should always be a factor in any endeavor and how long these investments will come to fruition. Implementing any initiative can be costly and when an economy is facing recession spending is diminished or slowed. The economy, therefore, can have effects on strategic management. Strategic management is used in response to changes in the external environment and linking strategy and analysis with action (Jasper, 2012).Based on a study done by Powers and Sauders (2013) on environmental and organizational influences on Magnet Hospital Recognition, they concluded that environmental influences such as environmental complexity and community resources were shown to promote innovations. Environmental complexity refers to environments that are composed of complex compositions. These could include federal and state legislation and policies, third party payers, consumer expectations, and financial aspects, just to name a few. "The greater the degree of environmental complexity, the greater the need for more flexible and adaptive organizational forms and practices (Powers & Sauders, 2013, p. 356). Community resources provide an extra incentive that influences implementation of initiatives, especially when there are limited resources internally.

11Role of Leadership in Strategic ManagementLeadership focus and tasks: Clarify beliefs and values of the organization Develop a strategic visionDevelop a mission statementAnalyze the external and internal situationDevelop a business planImplement the plan

Strategic management includes multiple steps and levels of planning. Leaders use strategic planning to provide direction to the organization, improve efficiency, identify and remove ineffective or under used programs, eliminate redundancy of efforts, focus resources on priority services, improve communications and coordination of services, set and ensure achievement of challenging goals that are both realistic and attainable. Strategic planning provides opportunities to broaden perceptions of possibilities and to adapt to the changes in the organizations environment (Marriner Tomey, 2009).Top-level managers focus on strategic planning for the upcoming 3 to 5 years. This level includes chief executive officers, chief nurse officers, and chief financial officers. They are accountable for the entire organization and consider the impact of external influences on the organization. Middle-level managers focus on intermediate planning looking at the next 6 months to 2 years. They include directors, department heads, unit supervisors, and clinical specialists. They are responsible for aligning and merging the organizational plan with unit planning. Lower-level managers focus on operational planning activities that occur daily, weekly, and monthly in support of the other levels of plans. Leaders at this level include nursing unit managers, patient care coordinators, case managers, charge nurses, team leaders, and primary care nurses providing direct patient care (Marriner Tomey, 2009).12ConclusionStrategic PlanningSWOT analysis

Initiatives

External environment impact

Role of leadershipStrategic planning examines the internal and external environments of an organization and provides a guide for future development. The SWOT (strengths, weaknesses, opportunities, threats) analysis is one tool the nurse leaders can use to evaluate the organization and the current health care market. Several strengths were identified, for example, the nurse residency, research program, and EMR. Identified weaknesses included decreased reimbursements, low quality indicator averages and no succession plan for leadership positions, among others. Opportunities included an increasing national population with a constant demand for healthcare both for lifesaving measures and increasing longevity. Threats included the competitive market that requires certification/accreditation with service excellence that are dependent on attracting skilled and qualified staff.Part of strategic management includes setting initiatives to achieve the end vision and mission of the organization. Magnet designation and development of a model of alignment and collaboration among the physician, nurses and other services provided by the hospital. The benefits of both increased market share and reimbursements justify the costs associated with these initiatives. Managing the impact of external environmental factors such as competition, the economy, and community resources is crucial when implementing any new initiatives. Effective strategic management involves leadership at all levels of the organization. The values, beliefs, vision and mission of the organization must filter down through all levels. When this occurs, the ability to see new possibilities and to adapt to changes becomes an integral part of the organizations culture.

13References Bakker, Denise and Keithley, Joyce (2013). Implementing a Centralized Nurse-Sensitive Indicator Management Initiative in a Community Hospital. Journal of Nursing Care Quality, 28(3) 241249. DOI: 10.1097/NCQ.0b013e31827c6c80

Chen, P., Mehrotra, A., & Auerbach, D. (2014). Do we really need more physicians? Responses to predicted primary care physician shortages. Medical Care, 52(2), 95-96. DOI:10.1097/MLR.0000000000000046

Daley, K. (2011). 2012 Magnet highlights: Recognizing nursing excellence. American Nurse Today, 7(1). Retrieved fromwww.americannursetoday.com/assets/o/434/436/440/8612/8614/8630/8676/80b7e58d-848_44bf-98a5-090a8f7c8d26.pdf

14ReferencesHealthy People 2020. (2014). Leading health indicators. Retrieved from https://www.healthypeople.gov/2020/Leading-Health-Indicators

Jasper, M. & Crossan, F. (2012). What is strategic management? Journal of Nursing Management, 20(7), 838-846. doi: 10.1111/jonim.12001

Marriner Tomey, A. (2009). Guide to nursing management and leadership (8th ed.). St. Louis, MO. Mosby Elsevier

Monroe, D.J. & Lash, A.A. (2005). Achieving magnet recognition: The process. MEDSURG Nursing, 15-20. Retrieved from web.a.ebscohost.com.ezproxy.appollolibrary.com

Mueller, C. (2002). Demonstrating excellence. Nursing, 8(2): 7. Retrieved from academic search complete, EBSCohost web.a.ebscohost.com.ezproxy.appollolibrary.com

ReferencesParsons, M. L., & Cornett, P. A. (2011). Sustaining the pivotal organizational outcome: magnet recognition. Journal Of Nursing Management, 19(2), 277-286. doi:10.1111/j.1365-2834.2011.01224.x

Powers, T.L. & Saunders, T.J. (2013). Environmental and organizational influences on magnet hospital recognition. Journal of Healthcare Management, 58(5)m 353-366.Retrieved fromweb.a.ebscohost.com.ezproxy.appollolibrary.com

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Renter, M., Allen, A., Thallas, A. & Foley, L. (2014). How magnet designation affects nurse retention: An evidence-based research project. American Nurse Today, 9(3). Retrieved fromwww.americannursetoday.com/how-magnet-designation-affects-nurse-retention-an-evidence-based-research-project/

ReferencesRobert Wood Johnson Foundation (2014). Becoming a magnet hospital can increase revenue, offset costs and achieving magnet status: New study finds magnet status increases hospital revenue by an average of more than $1.2 million annually. Retrieved from www.rwjf.org.en/about.rwjf/newsroom/newsroom-content/2014/05/becoming-a-magnet-hospital-can-increase-revenue--offset-costs-of.html

Salas-Lopez, D., Weiss, S. J., J.D., Nester, B., D.O., Whalen, T., M.D., & Fulton, M. S., F.A.C.H.E. (2014). Physician clinical alignment and integration: A community academic approach/practitioner application. Journal of Healthcare Management, 59(3), 195-208. Retrieved from http://search.proquest.com/docview/1534475434?accountid=458

Smith, S, (2014). Magnet hospitals: Higher rates of patient satisfaction. Policy, Politics, & Nursing Practice. 15 (1) 30-41. DOI: 10.1177/152715441453810217ReferencesUnited States Census Bureau. (2014). Population of the United States. Retrieved from http://www.census.gov/

van Wijngaarden, J. H., Scholten, G. M., & van Wijk, K. P. (2012). Strategic analysis for health care organizations: The suitability of the SWOT-analysis. The International Journal Of Health Planning And Management, 27(1), 34-49. DOI:10.1002/hpm.1032

Varner, K., & Leeds, R. (2012). Transition within a graduate nurse residency program. The Journal of Continuing Education in Nursing, 43(11), 491-499. DOI:http://dx.doi.org/10.3928/00220124-20121001-28

Whitten, D., & Cameron, K. (2004). Developing management skills (6th ed.). Upper Saddle River, NJ: Prentice Hall.

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