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Running head: STRATEGIC PLANNING FOR SHARP HEALTHCARE 1

Strategic Planning for Sharp HealthCare

Charisse Lyn Tabotabo

University of San Diego

STRATEGIC PLANNING 2

Strategic Planning for Sharp HealthCare

Sharp HealthCare (Sharp) is a health care organization that serves San Diego

County with four acute-care hospitals, three specialty hospitals, three affiliated medical

groups, a health plan, and over 18,000 employees. (Sharp HealthCare [Sharp], n.d.-c).

Sharp (n.d.-c) was created to meaningfully honor the sacrifice of San Diego pilot Donald

Sharp who gave his life for his country in World War II. The core of Sharp is The Sharp

Experience, a performance-improvement initiative designed to provide patients with

exceptional care accomplished with excellence, commitment, and compassion (n.d.-c).

The organizational structure and decision makers of Sharp consist of Sharp’s

leads, supervisors, managers, directors, vice presidents, senior vice president, entity

CEOs, executive vice president, and the system CEO/president (Sharp, n.d.-a). Sharp is

governed by a 25-member board, including two ex-officio members and seven

“Designated Directors,” who are on boards of Sharp entities or are physicians designed

by the three Sharp-affiliated medical groups; physicians comprise up to one-third of

board membership (Sharp, n.d.-a). Sharp’s (n.d.-a) board members range from “audit,

compliance, executive, finance, IT, marking and communication to construction, quality,

and nominating”. According to Sharp (n.d.-a), the Board is also tasked with electing the

150 members of the eight Sharp entity boards, which oversee executive management

teams responsible for operations and strategic initiatives of the respective entities.

According to Sharp (n.d.-b), its mission is "to improve the health of those we

serve with a commitment to excellence in all that we do" with a goal of offering "quality

care and services that set community standards, exceed patients' expectations and are

provided in a caring, convenient, cost-effective and accessible manner." It describes its


vision of "[transforming] the health care experience through a culture of caring, quality,

safety, service, innovation and excellence, and be recognized by employees, physicians,

patients and families, volunteers and the community as: the best place to work, the best

place to practice medicine, and the best place to receive care." Sharp (n.d.-b) adds to its

vision of being "known as an excellent community citizen embodying an organization of

people working together to do the right thing every day to improve the health of those we

serve [to] become the best health system in the universe."

Step One: Set the Stage

The Sharp strategic planning team consists of system and entity management,

physicians, and Board leadership (Sharp, 2007). Along with these organizational leaders,

at least one representative from SMBHWN Quality Council, Collaborative Governance

Councils, Unit Practice Councils, and staff from each unit should be involved.

During the planning process, the strategic planning team will have to assume any

research presented at meetings is credible and peer reviewed. The team can also mandate

that any study used during the planning process meets certain criteria that can be agreed

upon in the initial strategic planning meeting. It can also be assumed that those in higher

positions, such as the executive team or board of directors will take charge and may

overpower strategic planning meetings. Therefore, it can be mandated that during

meetings, everyone has equal say so no one is intimidated during meetings, participation

amongst members is high, and a free flow of ideas can occur.

Step Two: Do Your Homework

According to Ebener & Smith (2015), the second step in the strategic planning

process is conducting an environmental assessment utilizing data and perspectives from


both inside and outside the organization. The authors discuss how this step is best

conducted with literature reviews, guest speakers, surveys, and even focus groups to

gauge how those in the strategic planning committee and stakeholders view key issues in

the strategic planning process. Once data has been gathered, a Strengths, Weaknesses,

Opportunities, and Threats (SWOT) analysis can be created.

Sharp is a health care organization that has served the San Diego community for

over 65 years (n.d.-c). It appears to be well known and carries an excellent reputation in

the community. Patient-centered care is its focus, as seen by the development of

the Sharp Experience. Stakeholders for Sharp were identified and outlined in a

stakeholder map to showcase the reciprocal relationship various organizations, entities,

and groups have that impact the organization (see Appendix B for stakeholder map).

While treating people, not patients, is at the heart of the Sharp Experience, there are many

facets involved to make this possible. For example, competing health systems can push

the organization to make improvements over the competition, accrediting agencies push

for further excellence, the health care providers who see and treat patients are at the front

lines of the Sharp Experience, and every employee matters and has a role to play.

The Sharp Experience is arguably Sharp's greatest strength. It has been ingrained

in the company's culture since 2001 and transforming the health care experience for its

community is its philosophy of care (n.d.-d). It is a culture that encourages every single

Sharp employee to be passionate and dedicated to the patient experience (n.d.-d). Another

of Sharp's strengths is its large presence in the community. With four acute-care

hospitals, three specialty hospitals, three affiliated medical groups, and a health plan,

many San Diego residents go to a Sharp entity because it is in close proximity to their


homes (n.d.-c). Sharp is also frequently recognized for its commitment to clinical

excellence and high-quality patient care by local and national accrediting agencies (n.d.-

c). Sharp Memorial and Sharp Grossmont achieved Magnet designation for nursing

excellence, Sharp Healthcare was ranked one of the best employers for diversity by

Forbes, SMBHWN was recognized by The Leapfrog Group, Sharp Community Medical

and Sharp Rees-Stealy Medical Groups were honored with the Elite Status Designation

from the California Association of Physician groups, and many more (n.d.-c).

Some of the weaknesses Sharp (2007) has identified are capacity issues and

patient access, operational costs, aging infrastructure, and workforce shortages. One of

the ways in which Sharp can improve is to work on the identified weaknesses. For

capacity issues and patient access, Sharp can continue to build its network through a new

hospital, new clinics or expanding existing facilities, depending on where capacity issues

exist and what the budget allows. For operational costs, Sharp can reduce supply

expenses either by making deals with current suppliers, or shopping around for those with

more reasonable costs. Sharp can also lower financial expenditures, use efficient time

management strategies, and take more advantage of technology in marketing. In terms of

aging infrastructure, renovations can be made if budgets allow and the community

environment requires it. Workforce shortages can be addressed by hiring new staff, either

new graduates or experienced individuals, by creating a referral program, or offering

hire-on incentives. While Sharp has many opportunities to improve, it does not appear as

if the organization should stop doing anything at the time this analysis was conducted.

In terms of growth, Sharp has the opportunity to expand its technology through

the advancement of medical devices and electronic medical records. Sharp can also begin


conducting more research studies and clinical trials. In 2017, the Neonatal Research

Institute at SMBHWN received a $2.9 million research grant from the National Institutes

of Health to extend its research on umbilical cord milking and delayed cord clamping

(Sharp, n.d.-c). Another opportunity for growth is through San Diego Health Connect, a

health information exchange (HIE) program that securely connects health care providers

and patients to private HIEs to access a patient's information across many of San Diego's

health systems (San Diego Health Connect, n.d.). This includes Scripps Health, UC San

Diego Health System, Kaiser Permanente, VA San Diego Healthcare System, Rady

Children's Hospital, as well as 14 community clinics (SDHC, n.d.). By participating in

this service, Sharp is adapting to the new environment of electronic health records

through many diverse systems and ensuring patient charts are complete and up-to-date,

resulting in improved patient care.

Since Sharp is growing and becoming a larger health care network, it faces many

potential threats. One of its threats is the increased competition it faces from other health

care systems such as UC San Diego Health, Scripps, and Kaiser Permanente. With a

population of over 3.3 million, San Diego County is a highly competitive marketplace for

quality health care (United States Census Bureau, 2017). While Sharp is the largest

integrated health care delivery system in the county, serving 27 percent of the market

share, Scripps Health is not far behind it, serving 22 percent (Wong, 2012).

Moving forward, Sharp can continue to build upon its reputation of being a

trusted health care network in the community. With 65 years of history within the

community and a commitment to excellence through awards from accrediting agencies

and the Sharp Experience culture, the patient experience and patient satisfaction at Sharp


will likely continue. Sharp can also adopt the Institute of Medicine's six aims for the

health care system, which is to provide safe, effective, patient-centered, timely, efficient,

and equitable care (Agency for Healthcare Research and Quality, 2016).

The second step of the strategic planning process, conducting an environmental

assessment, was a challenge to complete due to the nature of looking deep into the frames

of the organization. However, the constructed SWOT analysis has provided an excellent

starting point for the next step in the process, describing the culture of Sharp (see

Appendix A for SWOT Analysis).

Step Three: Describe Your Culture

An organization’s mission statement sets the stage for its purpose, business plan,

primary market, geographical region of operation, and values. Sharp's (n.d.-b) mission

statement is as follows:

It is our mission to improve the health of those we serve with a

commitment to excellence in all that we do. Our goal is to offer quality

care and services that set community standards, exceed patients'

expectations and are provided in a caring, convenient, cost-effective and

accessible manner.

Sharp's institutional business plan can be seen in the fragment of serving the

market by providing health care in a "convenient, cost-effective, and accessible manner

(Sharp, n.d.-b)." The mission statement shows that Sharp’s business plan is dependent on

how the community views the organizations and uses its services. By providing care that

accomplishes these three goals, Sharp can position itself as the dominant health care

organization in the San Diego area.


The purpose of Sharp is clear in its statement to "improve the health of those we

serve with a commitment to excellence in all that we do (Sharp, n.d-b)." This statement

makes clear that Sharp’s market is health care whose aim is to provide excellent care for

its consumers. Another underlying theme from Sharp is its commitment to its vision to do

the right thing every day to improve the health of its patients.

Sharp (Sharp, n.d.-d) has translated its core values of excellence, integrity, caring,

and innovation into the Six Pillars of Excellence - quality, service, people, finance,

growth, and community. The organization explains that by establishing the Pillars, a

balanced focus for patients, employees, physicians, volunteers, supplier partners, and

public are ensured. Sharp (n.d.-d) demonstrates quality by improving clinical excellence

to set industry standards and exceed customer expectations. Safety keeps patients,

employees, and physicians safe from harm (Sharp, n.d.-d). Sharp (n.d.-d) demonstrates its

commitment to service by providing an excellent experience and service to its

customers. People are of huge value to the organization, and this pillar demonstrates

Sharp's (n.d.-d) "commitment to create a values-drive culture that attracts, retains, and

promotes the best and brightest people, who are committed to Sharp's mission and

vision”. Sharp (n.d.-d) describes its finance pillar as its commitment to achieve financial

results to ensure the organization's ability to provide quality health care services, new

technology, and investment in the organization. According to Sharp (n.d.-d), the growth

pillar demonstrates commitment to achieve consistent net revenue growth to enhance

market dominance, sustain infrastructure improvements, and support innovative

development. Finally, Sharp (n.d.-d) describes the community pillar as its commitment to

be an exemplary public citizen by making a difference in the community and supporting


the stewardship of its environment. Sharp (n.d.-d) expects these values to be exemplified

by all employees, volunteers, and business partners.

Step Four: Frame the Question

Step four of the strategic planning process is framing the question, or the

identification of an organization's strategic areas of concern (Ebener & Smith, 2015). The

top three strategic areas for Sharp are its capacity issues and patient access, expansion of

innovation and technology, and increased competition from other health care systems.

1. The strategic area of capacity issues and patient access is comprehensive

because it covers all of Sharp's consumers, or patients. This is a critical part of the

strategic area because if patients are not seen in a timely manner due to capacity

issues, they may choose to go to providers in other health care organizations,

leaving Sharp with a loss in market and finances. This area is changeable if Sharp

can figure out a way to decrease capacity issues such as building its network

through a new hospital, new clinics, or expanding existing facilities. Sharp can

control this strategic area by conducting marketing research to decide where a

new clinic or expansion will be most beneficial, depending on their target market.

By improving these capacity issues, Sharp can increase patient access and

satisfaction.

2. Expansion of innovation and technology is a strategic area that is of concern for

any health care organization. This strategic area is comprehensive because it

covers every organization's need to adapt to the new environment of electronic

health records. This is critical because in 2009, all public and private health care

providers and other eligible professionals were required to adopt electronic


medical records (EMR) by January 1, 2014 to maintain their existing Medicaid

and Medicare reimbursement levels (USF Health, n.d.). Sharp has already adopted

EMRs in all of its entities, however with the rapid advancement of technology,

there is always room for growth. Sharp has the opportunity to expand its

technology through the advancement of medical devices and EMR updates and

innovations. This strategic area is controllable by the organization due to its

ability to roll out updates to its current EMR to stay up to date with technology.

3. Increased competition from other health care systems is another strategic area

for Sharp. It is comprehensive because competition affects the entire organization.

This potential threat is a critical strategic area because if competing hospital

systems gain a significant advantage over Sharp, it could mean a huge financial

loss, putting Sharp at a serious competitive disadvantage. This strategic area is

controllable if Sharp continuously does competitor analyses to determine the

competition's strengths and weaknesses. This strategic area is changeable if the

organization responds in a timely, efficient, and cost-effective manner in response

to the results of their competitor analysis.

Steps Five and Six: Answer the Questions and Get Specific

According to Ebener and Smith (2015), step five of the strategic planning process

involves responding to the strategic issues identified in step four. This creates a cascade

that evolves into the specific action steps of step six, which helps an organization go from

general to specific action steps per strategy. The authors argue that without specificity

and an action plan, the strategic plan will likely be unsuccessful.

Strategic Area #1: Capacity issues and patient access


Sharp’s strategy for this area will be to decrease capacity issues and increase

patient access depending on where these issues exist and what budgets allow. Sharp will

review the number of patients seen after implementation compared to the previous year.

Action Step #1: Sharp will conduct market research in the San Diego community

over a period of 12 months to identify communities that have unmet needs and determine

where expansion will be most beneficial.

Action Step #2: Sharp will hold four community meetings over a period of four

months to determine community needs to decrease capacity issues and increase patient

access. After each community meeting, participants will be asked to complete a survey to

determine their current satisfaction levels with the organization.

Action Step #3: Sharp will conduct an internal review over a period of six months

to determine where capacity issues and patient access can be improved without the need

to expand or build new facilities. The organization will track changes on a monthly basis

to determine if they are having a positive or negative effect on patient access.

Strategic Area #2: Expansion of innovation and technology

Sharp’s strategy to expand innovation and technology throughout all Sharp

entities will be completed through the advancement of medical devices and electronic

medical records (EMRs). Patient and employee satisfaction scores, as well as comparison

of costs of care will determine if this strategy is successful or not.

Action Step #1: The Sharp information technology (IT) team will release

Cerner EMR updates no longer than one week after release to allow the IT team to learn

the new updates for themselves and educate appropriate staff of expected changes. The IT


department will allow employees to review if the updates were beneficial, easy to learn,

and easy to use.

Action Step #2: Sharp’s purchasing group will complete internal

equipment evaluations over 3 months to determine which equipment can be updated with

more advanced technology. To determine effectiveness, Sharp’s financial team will

measure success via cost of providing the service – was the cost reduced associated with

providing care from the new and advanced equipment?

Action Step #3: Sharp’s financial and research team will invest money

into research by conducting a market analysis over 6 months to determine best practices

for medical care. To determine effectiveness, Sharp’s financial team will measure success

by ascertaining if the innovative care practices lead to improved patient satisfaction and

reduced cost of care.

Strategic Area #3: Increased competition from other health care systems

For the strategic area regarding increased competition from other health care

systems, Sharp’s strategy is to gain a competitive advantage over the competition. This

area will be measured by Sharp’s increased financial success over its competition.

Action Step #1: The Sharp analytics team will complete a competitive

analysis of other hospital systems serving the San Diego area over a period of one year to

determine current and future marketing strategies, such as TV, radio, and billboard ads.

The Sharp marketing team will decide which marketing strategy will be more effective to

increase the number of new patients and continue with patient retention over competing

hospital systems.


Action Step #2: The Sharp IT department will track search engine clicks

and ad words over a period of one month to determine which hospital system in the San

Diego area comes up most often. Based on this data, the Sharp marketing team will

implement marketing strategies from action step #1, as well as community outreach, and

volunteering projects to grow the Sharp brand even more in the community. After 6

months, Sharp will then see if the organization shows up first in search engines, and if

there has been an increase in new patients.

Action Step #3: The analytics team at Sharp will conduct a competitor

analysis of other hospital systems in the San Diego area over a period of one year to

compare the average cost of services provided. Sharp leadership will implement changes

based on competitor analysis to reduce costs to its target market while maintaining a high

level of care, and compare financial statements from the prior year.

Step Seven: Discover the Vision

Step seven of the strategic planning process involves the development of a vision

statement to clearly state where the organization is headed and provide insight on how to

get there (Ebener & Smith, 2015).

For over sixty years, Sharp has been the leader of health care in San Diego

because we remain focused on the most important element of the health care experience:

the people. Over the next five years, we envision a revitalized health care experience that

will be advanced by a culture of caring, quality, safety, service, innovation, and

excellence. Challenges for the upcoming years have been identified and outlined in the

strategic plan to turn them into opportunities for success. We envision being recognized

by employees, physicians, patients and families, volunteers, and the community as the


best place to work, the best place to practice medicine, and the best place to receive

care. In doing so, we can improve care for patients, access to health care, and efficiency.

We will become the best place to work by attracting and retaining highly skilled

and motivated staff that are dedicated to providing quality health care. As members of

Sharp who will convey The Sharp Experience to patients and the community, these

individuals will build a culture of teamwork, recognition, and professional growth.

To become the best place to practice medicine, we will create an environment in

which physicians enjoy positive, collaborative relationships with every member of the

care team. These physicians will be treated as valued members of Sharp, have access to

state-of-the-art equipment and cutting-edge technology, and enjoy the camaraderie of the

highest-caliber medical staff in the San Diego area.

In order to become the best place to receive care, we will provide a new standard

of service in health care. We will employ service-oriented individuals who see it as their

privilege to exceed the expectations of every patient, treating them with the utmost care,

compassion, and respect. We will create healing environments that are soothing, safe,

immaculate, and easy to access and navigate.

It is our vision to be known as an excellent community citizen embodying an

organization of people working together to do the right thing every day to improve the

health of those we serve. This commitment to serving patients and supporting one another

will make Sharp the best health care system in the universe.

Step Eight: Hold Yourself Accountable

According to Ebener & Smith (2015), step eight of the strategic planning process

involves the development of action steps for the organization. The authors explain that


these action steps should clearly define how the organization will implement their

strategy and later evaluate it. The authors add that this plan will become the focus for

leaders throughout the organization.

Sharp's objectives are to decrease capacity issues to increase patient access,

expand innovation and technology throughout all Sharp entities, and gain a competitive

advantage from increased competition from other health care systems. To accomplish

these objectives, Sharp will need to unify every Sharp entity at the organizational level,

while also working with each individual entity to help them achieve these objectives

within their respective facilities.

Based on the action steps identified in Steps Five and Six, Sharp will be

successful in its objective of decreasing capacity issues to increase patient access by first

conducting market research in the San Diego community over a period of 12 months to

identify communities that have unmet needs and determine where expansion will be most

beneficial. Next, Sharp’s community outreach team will hold at least four community

meetings over a period of four months to determine community needs. After each

community meeting, participants will be asked to complete a survey to determine their

current satisfaction levels with Sharp. Finally, Sharp leadership will conduct an internal

review over a period of six months to determine where capacity issues and patient access

can be improved without the need to expand or build new facilities. The organization will

track changes on a monthly basis to determine if they are having a positive or negative

effect on patient access. The analytics team will then review the number of patients seen

after implementation compared to the previous year to determine if these action plans

have been successful and helped the organization reach its objective.


To achieve the objective of expanding innovation and technology within the

organization, Sharp's IT team will release Cerner EMR updates no longer than one week

after release so appropriate personnel can learn about the expected changes. One week

after successful release, the IT department will allow employees to review if the updates

were beneficial, easy to learn, and easy to use. Next, Sharp's purchasing group will

complete internal equipment evaluations over 3 months to determine which equipment

can be updated with more advanced technology. To determine effectiveness, Sharp's

financial team will measure success via cost of providing the service - was the cost

reduced associated with providing care from the new and advanced equipment? Finally,

Sharp's financial and research team will invest money into research by conducting a

market analysis over 6 months to determine best practices for medical care. To determine

effectiveness, Sharp's financial team will measure success by determining if the

innovative care practices lead to improved patient satisfaction and reduced cost of care.

For the objective regarding increased competition from other health care systems,

Sharp's financial team will measure Sharp's increased financial success over its

competition to determine if this objective was met. Per the action plan, Sharp's analytics

team will complete a competitive analysis of other hospital systems serving the San

Diego area over a period of one year to determine current and future marketing strategies.

Based off this analysis, the marketing team will decide which marketing strategy will be

the most effective in increasing the number of new patients and maintaining patient

retention over competing hospital systems. The Sharp IT department will then track

search engine clicks and ad words over a period of one month to determine which

hospital system in the San Diego area comes up most often. Based on this data, the


marketing team will implement marketing strategies, as well as community outreach and

volunteering projects to grow the Sharp brand in the community. After 6 months, the IT

department will determine if the organization shows up first in search engines, and if

there has been an increase in new patients. Finally, the analytics team will conduct a

competitor analysis of other hospital systems in the San Diego area over a period of one

year to compare the average cost of services provided. Sharp leadership will implement

changes based on competitor analysis to reduce costs to its target market while

maintaining a high level of care, and compare financial statements from the prior year.

By meeting the above objectives based on the drawn out action plans, Sharp's

vision of being the best place to work, the best place to practice medicine, and the best

place to receive care can be realized. In doing so, Sharp will improve care for patients,

access to health care, and efficiency and will make Sharp the best health care system in

the universe.


Appendix ASWOT Analysis

Internal ExternalPositive Strengths Opportunities

Multiple locations across San Diego County

Expansion of innovation and technology

Sharp Experience Culture Clinical trialsRecognized commitment to excellence from accrediting agencies

San Diego Health Connect

65+ years of history within the community

Adopt IOM’s six aims for health care system

Negative Weaknesses ThreatsNurse-to-patient ratios /Workforce shortages

Increased competition from other health care systems

Capacity issues and patient access Reduced government reimbursementOperational costsAging infrastructure


Appendix BStakeholder Map


References

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safety/talkingquality/create/sixdomains.html

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Leaders. Mahwah, NJ: Paulist Press.

San Diego Health Connect. (n.d.). San Diego health connect. Retrieved from

http://www.sdhealthconnect.org/

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https://www.sharp.com/about/leadership/

Sharp HealthCare. (n.d.-b). Mission and vision. Retrieved from

https://www.sharp.com/about/our-story/mission-vision-values.cfm

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story/

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https://www.sharp.com/about/sharp-experience/

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United States Census Bureau. (2017). QuickFacts: San Diego County, California;

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