3
Irish Goudie
How do APNs lay the groundwork
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analysis, a strategic plan, and the development of a time frame to com- plete the process. Strategic planning involves several steps:
1. Planning the process
2. Developing the mission statement 3. Conducting the external assessment 4. Conducting the internal assessment 5. Setting goals and priorities
6. Developing strategies to achieve the goals 7. Developing the implementation plan 8. Evaluating the outcomes
Planning the Process
First, decide who is going to do which tasks in the planning process, the way data will be collected, the time frame for each task, the schedule for meetings, and the timeline for completing the strategic planning process.
Developing the Mission Statement
The mission statement serves as the guide for an APN practice. It includes the philosophy, values, goals, and priorities of the business. If a mission statement for the practice already exists, then review it for accuracy and relevancy. If no mission statement exists, then create one.
Answering the following questions can assist you in this process:
• What is the philosophy of the business (values/beliefs)?
• What is the purpose of the practice (reason for existence)?
• What are the objectives? What will be accomplished by the prac- tice? (State specific measurable outcomes.)
Some practices opt to have a philosophy statement as a separate sec- tion. The example outlined here provides a separate section in the mis- sion statement for the philosophy, purpose, and objectives.
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Mission Statement Example
Philosophy. We believe that all women are entitled to health care that will result in the best possible outcomes during the provision of maternal/newborn nursing care.
Purpose. The purpose of the practice is to provide compassionate, evidence-based nursing care to women throughout the perinatal period.
Objectives. To decrease the incidence of failure to progress in first- stage labor by 10%.
Conducting the External Assessment
This step of the process requires considerable time and effort to effec- tively research the environmental factors that have an impact on the practice. This step is sometimes referred to as an environmental scan.
Proposed elements of the external assessment include the following:
• Economic factors. Although it might seem unlikely that a prac- tice in Anytown, USA, would be affected by global trends, it is essential that both a micro- and macroanalysis of economic fac- tors be conducted. The macroanalysis should include both domestic and worldwide economic influences, and their effects on health care providers and consumers, the workforce, and the pay- ers (private, public, and government). The microanalysis should include an examination of state and local government and busi- ness climates, unemployment rates, gains/losses of local busi- nesses, and payer coverage of the target population (public, private, and government).
• Political factors. The regulatory environment can change according to the political party in power; therefore, it is essential to be aware that national, state, and local elections can directly affect health care delivery. Some health care issues are highly politicized (e.g., abortion, sex education, contraceptive services, and assisted suicide), which will influence the long-term planning for a health care practice. Be aware of how national and local political factors will affect an APN practice.
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Market trends. These should be examined at the national, state, and local level. Some parts of the country have been more readily accepting of alternative care delivery models, which can provide important data for a new practice seeking to address local needs. The following should be included in the analysis:
>• Payer marketing. Promoting services and fee structures to business groups
>• Packaged services marketing. Packaging all services in one center (e.g., a primary care clinic, WIC clinic, or well child clinic)
> Program-focused marketing. Addressing broader concepts such as women's hospitals and health services and health pro- motion centers
Technology trends. The joke is that the latest technical toy pur- chased is obsolete before it leaves the store. Health care technol- ogy is constantly changing, and the savvy strategic planner will be up-to-date on the latest advances in biomedical and informa- tion systems that affect health care delivery.
Social/lifestyle trends. The changing demographics of Ameri- can society have had an impact on the delivery of health care in this country. As the baby boomers age, health care options and delivery are altered to fit their needs. What are the current trends?
Be sure to examine local as well as national statistics, and how they may affect the APN practice.
Regulatory factors. The following factors are essential:
>• State agency regulating the APN (most often, it is the state board of nursing)
>• Statutes/rules relating to nursing practice
>* State agency regulating prescriptive authority, if applicable
>* Occupational Safety and Health Administration (OSHA) rules
>• Environmental Protection Agency (EPA) rules for hazardous waste and water, and air/soil pollution
>• Food and Drug Administration (FDA) control of diagnostic and treatment procedures and substances
>• State laws/rules regarding laboratory testing
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>* State laws affecting reimbursement
>• State agency(ies) regulating health care facilities
• Competition/institution image. Who is the competition? How is the competition similar to the APN practice? How is it differ- ent? Is there a niche that the APN practice fills? How are APNs viewed in the health care community? To appraise the competi- tion, research hospital utilization data (such as the number of patient-days and percent of occupancy), and look at the health care provider mix. Your practice image may be assessed by qual- itative measures such as patient satisfaction, employee satisfac- tion, and community satisfaction surveys. The stability of health care provider practices or the retention rates and the Joint Com- mission on the Accreditation of Healthcare Organizations (JCAHO) are useful quantitative measures (Simms, Price, &
Ervin, 2000).
• Workforce trends. This analysis includes information about local, state, and national workforce trends. What is the supply and demand of health care providers? How are providers distributed?
Are there unfilled vacancies, or is there oversaturation? What is the status of the pipeline for providers, that is, students enrolled in health care provider education programs? Information is avail- able from governmental agencies (e.g., the state board of nurs- ing), professional organizations, and educational institutions (Simms et al., 2000).
Conducting the Internal Assessment
The internal assessment looks at the strengths and limitations of the business. This step should include an examination of the organizational culture, communication, and demographics of the business. For the independent practitioner, include any volunteers (unpaid assistance) and community contacts that work closely with the business.
Setting Goals and Priorities
Goals are determined by matching the strengths and weaknesses of the business with environmental threats and opportunities (Simms et al.,
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2000). Goals must be written down, measurable, and specific as to when they will be attained.
Developing Strategies to Achieve the Goals
This step involves the development of the strategies (decisions made to implement the mission statement) needed to achieve the goals and objectives of the plan. Some strategies are easily determined, whereas others require sequential development or radical change. At this point, the aim is to have a list of realistic strategies for each goal. Select the strategies and alternatives that best fit your practice's mission statement and philosophy. The end result will be a realistic plan for the comple- tion of each goal.
Developing the Implementation Plan
This final step is where the tactics (actions to implement the strategy) are determined for each goal and a specific completion date is set. Some goals may be incremental, requiring checkpoints along the timeline to assess progress.
Evaluating the Outcomes
Evaluation is an ongoing process. The plan should be constantly eval- uated to assess the effectiveness of the strategies. Additionally, the mis- sion statement (philosophy, purpose, and objectives) should be evaluated annually and revised as needed. A modified external analysis should be conducted according to the needs of the practice (at least yearly), and changes to the plan should be made as a result of relevant findings.