case study

The paper needs to at least 3 pages double spaced. Please utilize peer reviewed sources. Paper must be in APA style. Case Study, Part IReview Chapter 3 in the textbook.Prepare an analysis of Steps 1 through 3 of the MAPP Strategic Plan initiativesApply at least three quality and/or risk management concepts, measures, and tools in your paper.Your paper must be at least 3 double-spaced pages (excluding the title and reference pages). In addition to the text, utilize a minimum of two scholarly and/or peer-reviewed sources that were published within the last five years. Your paper and all sources must be formatted according to APA style.Please include the url/website.MAPP Process – 3 steps1.Organizing for Success: This step involves organizing the planning process and developing partnerships.2.Visioning: The visioning step engages stakeholders in a collaborative, creative process of developing a shared community vision with common values.3.Conducting Community Assessments: Four community assessments provide information about internal and external environmental trends relevant to the community:Community Themes and Strengths Assessment: Identifies local community interests, perceptions about quality of life, and assets.Local Public Health System Assessment: Appraises the capacity of the local public health system to conduct essential public health services.Community Health Status Assessment: Analyzes data about health status, quality of life, and risk factors.Forces of Change Assessment: Identifies changing external forces and dynamics of the community and the local public health system.Textbook: Fallon, F. L., Begun, J. W., & Riley, W. (2013). Managing health organizations for quality and performance. Burlington, MA: Jones & Bartlett Learning


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Strategic planning is a discipline that is well understood and used in many businesses and c
ompetitive health care organizations. However,strategic planning is not as widely used in
many nonprofit and public health organizations. This is unfortunate because nonprofit and
publichealth organizations, like other health organizations, can benefit significantly from th
e strategic planning process. All health organizationsface competition for limited resources,
and all have the capability to make better use of those resources and produce more quality
and valuefor consumers and the public.
Strategic planning helps an organization develop an overall sense of direction for the fut
ure. This is essential because an organization thatdoes not identify and make strategic choi
ces loses opportunities to learn about its market and its capabilities to serve and endangers
fulfillment of its organizational mission. Strategic planning is an important competency for
managers because it stimulates new ideas andemphasizes continuous improvement in qual
ity and value relative to alternative or competing organizations.
Two definitions are necessary to understand strategic planning. Strategy addresses the que
stion of how to position an organization in itsenvironment. A strategy is a major course of a
ction an organization uses to pursue its mission and vision. Strategic planning is the proces
s ofdeveloping strategies. As a result of conducting a strategic planning process, an organiz
ation will make significant, nonrecurring decisionsabout its nature and the directions it will
take in the future. As a first step, an organization must first clearly articulate its mission.
An organization’s mission statement delineates its purpose and reason for existence. It esta
blishes boundaries for the organization’s activities,programs, and services. It creates focus,
assuring that the organization does not attempt to be all things to all people. Mission state
ments areas important for what they exclude as for what they include.
A mission statement is typically brief, usually not exceeding two or three sentences. It c
ommunicates the current intentions of theorganization. Mission statements are often acco
mpanied by statements of vision and values.
Vision and Values
Decision makers in many organizations develop a targeted description of the future outcom
es expected if the organization is successful. Thisdescription is called a vision. Visions are so
mewhat idealistic because they are intended to motivate people and enroll the hearts, as w
ell asthe minds, of organizational stakeholders. Many organizations also produce a written
statement of the values upon which an organization isbuilt. This is especially true in organiz
ations with a religious affiliation or foundation. They may rely on explicit values to a greate
r degreethan their secular counterparts. Strategic planning activities are based on the missi
on, vision, and values of the organization.
Guiding statements (the mission, vision, and values documents) from two different orga
nizations provide useful examples. FairviewHealth Services (FHS) is a large, nonprofit integ
rated health delivery system in Minnesota. FHS is comprised of 7 hospitals, has over 2000e
mployed and affiliated physicians, and is supported by more than 21,000 staff. The mission
of FHS is to improve the health of the communityand support research and education effort
s (Fairview Health Services 2010). The vision of FHS is to be the best health care delivery sy
stem inAmerica. The values of FHS—dignity, integrity, service, and compassion—
reflect beliefs regarding ways to serve individuals.
A second example of a guiding statement comes from Healthy People 2020, which lists s
trategic priorities for national health promotionand disease prevention efforts to improve t
he health of people in the United States by 2020. It is used as a tool for strategic planning b
y alllevels of government and the health system to prioritize targets and to measure progre
ss for health issues in specific populations (USDepartment of Health and Human Services 2
010). The mission of Healthy People 2020 is to identify priorities for improving healthnatio
nwide and engage multiple sectors to take health actions based on scientific evidence. The
vision of Healthy People 2020 is to helppromote a society in which all people live long, heal
thy lives. The values of Healthy People 2020 are embedded in its overarching goals—
thevalues emphasize a desire to improve community health, nurture healthy behaviors, an
d eliminate health disparities.
Both guiding statements (FHS and Healthy People 2020) set stretch goals—
becoming the best health care delivery system in America(FHS) and creating a society wher
e all people live long, healthy lives (Healthy People 2020). Stretch goals are important to th
e improvementprocess because they challenge employees and stakeholders to perform at e
ven higher levels. The mission, vision, and values of eachorganization create the foundation
for aspirations and strategic plans of the organization.
Strategic Planning Steps
The strategic planning process is depicted in Figure 3–
1 and consists of six steps that proceed from the mission, vision, and values. Note thatthe m
ission, vision, and values have two roles in the strategic planning process. First, they form t
he foundation of the planning efforts. Second,the results of the planning effort should serve
to validate the continuation of the mission. The mission of the organization (and more rarel
y,the vision or values) is occasionally changed as a result of the strategic planning process,
as shown by the feedback loop in Figure 3–
1.Although not a common occurrence, it is important for an organization to alter its mission
when the environment, the people, or thecommunity it serves changes, or when it undergo
es a major transformation.
The six steps of strategic planning include the following:
Analyze the internal organization
Analyze the external environment
Analyze internal strengths and weaknesses
Analyze external opportunities and threats
Identify and evaluate strategic issues and options
Select strategic priorities
FIGURE 3–1 The Strategic Planning Process
Although the steps in the process are presented in a linear fashion for simplicity, in realit
y, they are interdependent. Identification of keystrategic issues can result in a reassessmen
t of external opportunities and threats, for example. A selection of priorities can mean chan
ges ininternal operations that alter the internal strengths and weaknesses of the organizati
on. The strategic planning process is more realisticallydescribed as an interdependent cycl
e than a series of discrete steps (Begun and Heatwole 1999).
Steps 1a and 1b: Analyze the Internal Organization and the External Environment
Strategic planning begins with an analysis of the internal environment of the organization a
nd the external environment in which theorganization operates. Because the internal and e
xternal environments of organizations are constantly changing, regular review is essential i
norder to identify and assess the impact of changes and how they affect an organization. Fa
ctors that typically are reviewed to assess changesinclude laws, regulations, payment mech
anisms, competitors, workforce supply, trends in quality and safety, demography of the ser
vice area,and customer or client satisfaction.
An internal organizational analysis consists of a review of the health organization’s reso
urces and performance. An internal analysistypically includes measures of productivity, sta
ffing ratios compared to industry standards, key financial ratios, patient and client satisfact
ionrates, employee morale, and other performance measures.
An external environmental analysis looks at the key factors outside the organization suc
h as economic, political, and legal trends that affectthe service area and the health care orga
nization. It is also important to examine the demographics and disease risks in the commun
itycarefully. Conducting an external environmental analysis is an extensive activity underta
ken to gain a complete understanding of relevantexternal forces affecting the organization.
At a minimum, this component of the environmental audit should include key demographic
trends,employment data, poverty data, workforce supply, and health status of the commun
ity. It also should include characteristics of the client orcustomer populations served by the
organization, where they come from, and market penetration trends.
Steps 2a and 2b: Analyze Internal Strengths and Weaknesses and External Opportuni
ties and Threats (SWOT Analysis)
The analysis of the internal and external environments forms the basis for determining the
organization’s internal strengths and weaknessesas well as external threats and opportunit
ies. Taken together, these two steps are often referred to as SWOT analysis. This acronym re
fers tothe Strengths and Weaknesses inside the organization and the Opportunities and Th
reats outside the organization.
A SWOT analysis uses the findings from the environmental audit to perform a critical se
lfassessment of the organization. Step 2a analyzesthe list of factors identified in the internal
organizational assessment performed in Step 1a, identifying those factors that represent str
engthsof the organization (what the organization does well) or weaknesses of the organizati
on (what the organization does not do well). Forexample, strengths of a health organization
may include the high quality of services it delivers to its constituents, a highly committed s
taff,and low staff turnover. In contrast, weaknesses may include productivity problems, fina
ncial difficulties, falling client base, and aging physicalplant.
Step 2b analyzes the list of factors identified in the external environmental assessment,
identifying those factors that represent opportunities for the organization (favorable trends
outside the organization) and threats to the organization (unfavorable trends outside theo
rganization). For example, opportunities for a health organization may include improving c
ommunity economic growth, increasedgovernmental funding, and grant opportunities. In c
ontrast, threats may include potential funding decreases, the opening of a neworganization
that serves the same needs and may encroach on the organization’s activities, or deteriorati
ng socioeconomic trends in theconstituent group.
Step 3: Identify and Evaluate Strategic Issues and Options
Analyzing the internal and external environments of a health care organization in terms of t
he strengths, weaknesses, opportunities, andthreats (SWOT) enables the organization to re
cognize specific areas where improvement is necessary and development is possible. The fi
fthcomponent of the strategic planning model (Step 3) is to identify and evaluate major stra
tegic issues and choices. Managers of healthorganizations have the responsibility to unders
tand all the issues facing their organization completely in order to prioritize their importan
ceand make decisions to address the priority issues adequately. This process of prioritizing
is essential for health organizations, which oftenhave limited resources to meet the seemin
gly unlimited needs of their stakeholders. The strategic issues must be monitored continual
ly andchoices must be identified so that the organization stays responsive to the patients a
nd population it serves. An organization that tries to doeverything will end up doing nothin
Once the most important issues facing a health organization are identified, strategic cho
ices must be made to guide the organization’sattempts to address them adequately. First, th
e SWOT analysis can be used to identify strategies to (1) take advantage of strengths and to
maximize opportunities (maxmax strategies); (2) take advantage of strengths to reduce vulnerability to threats (maxmin strategies); (3)minimize weaknesses by taking advantage of opportunities (minmax strategies); and (4) minimize weaknesses and avoid threats (minminor defensive strategies). Strategies in the first category, which draw on strengths and o
pportunities, are ideal and usually involve growth andexpansion. Strategies in the last categ
ory, which address weaknesses and threats, often involve downsizing and retrenching.
Two other techniques assist in the process of making strategic choices: key issue analys
is and forecasting. These techniques help anorganization analyze its priorities in the contex
t of the changing external environment to make useful strategic choices for the future.
Key Issue Analysis A key issue is an event that, if it occurs or does not occur, will have an im
portant impact on the organization. In a strategicplanning process, it is important to identif
y and prioritize all key issues in the context of the internal and external environment of the
organization, which is constantly changing. For example, emergency preparedness is often i
dentified as a key issue for public healthdepartments. Until September 11, 2001, however, c
oncerns regarding emergency preparedness would normally have received a low priorityin
an issue analysis. Today, it receives a much higher priority. Among hospitals, implementati
on of the Affordable Care Act of 2010 is a keycurrent issue.
Assumptions are often made when identifying key issues. An assumption is an estimate
of an important future event over which anorganization has little or no control. For exampl
e, as a result of the economic downturn that began in 2008, state and local governments fac
esubstantial problems in balancing governmental budgets. Assumptions need to be made b
y publicly funded health organizations regardingthe impact of these budget reductions on h
ealth programming.
Identifying how changing external circumstances and events will influence or alter the
priority issues of health organizations in the futureis an important component of key issue
Forecasting Forecasting consists of predicting or estimating future events in the environm
ent. Forecasting is usually based on extrapolationof past or present trends into the future.
Many trends in public health are readily subject to forecasting techniques. This includes for
ecasts ofpopulation trends, death rates and their causes, health behaviors and risk factors,
and economic predictors.
However, forecasting trends can also be inexact and elusive. Some events are the result
of discontinuities or turbulent developments in theenvironment and may not be identified t
hrough a forecast of past trends. For example, the outbreak of an epidemic or an unexplain
ed plantclosure of a major employer in a community is an event not likely to be anticipated
or included in a forecasting exercise.
Step 4: Selecting Strategic Priorities
The last activity of the strategic planning model (Step 4) is selecting strategic priorities, in
which managers decide what an organization mustdo in order to capitalize on strengths an
d opportunities, improve areas of weakness, and respond to threats. As a result of the envir
onmentalaudit, the SWOT analysis, and evaluating major strategic issues, the organization
makes strategic choices. Building on the priority issuesidentified in step 3 of the strategic pl
anning process, decision makers select strategies to address these priorities and provide a f
ocus for theorganization. The resulting strategic priorities should answer three essential qu
1. Where is the health organization at present?
2. Where does it want to go?
3. What actions must take place to achieve the goal from the previous question?
As shown in Figure 3–
1, the strategic planning process is followed by planning at the operational level of the orga
nization. Operationalplanning requires setting goals and objectives at the tactical level, usu
ally the departmental and subunit levels, for carrying out theorganization’s strategies. Plan
s of the operating units of the organization then form the basis of the goals and objectives o
f the operating unitsand the workforce of the operating units. Operational plans typically ar
e revised annually, whereas strategic plans have a longer shelf life,usually 2 to 5 years.
A business plan is a common type of operational plan. Business plans describe new servi
ces, products, or programs and their markets andmake projections concerning the personn
el and other resources needed to implement the new items. A key element is the financial a
nalysis,which often includes projected expenditures and revenues and a breakeven analysi
s (analysis of volume required so that the new servicedoes not lose money for the organizat
Ideally, departmental goals and objectives are also translated into individual employee
objectives by managers and workers as part of theemployee performance evaluation proce
ss. With evaluation of results and continuous feedback to the strategic planning process, in
dividualand departmental goals and objectives may be incrementally adjusted but still are
expected to maintain consistency with the organization’sstrategy.
Finally, as depicted in Figure 3–
1, operational plans require funding. Budget plans, in the form of a capital budget for major
purchases, anoperating budget for annual revenues and expenses, and a cash budget to pre
dict the inflow and outflow of cash, are common planningmechanisms in organizations. Bu
dgeting is covered in more detail later in this book.
Mobilizing for Action through Planning and Partnerships (MAPP) is a strategic planning process for
improving public health services and outcomes in local communities. Similar to the organizational
strategic planning model in Figure 3–1, MAPP is a community-wide strategic planning tool developed
specifically for public health by the National Association of County and City Health Officials (NACCHO)
and the Centers for Disease Control and Prevention (CDC). A work group of local health officials, CDC
representatives, community representatives, and public health experts developed MAPP between 1997
and 2000. MAPP “helps communities improve health and quality of life by identifying and using their
resources wisely, taking into account their unique circumstances and needs, and forming effective
partnerships for strategic action” (NACCHO 2010).
The MAPP process assesses all levels of organizations, including public, private, and voluntary
organizations, as well as individuals, involved in public health activities in the community. This
assessment creates a complete picture of the resources available to the local public system. MAPP is
based on a community-driven and community-owned approach designed to assess and enhance a
community’s strengths, needs, and desires, which will in turn drive the strategic process (NACCHO
Compared to the strategic planning steps outlined in this chapter, the MAPP model places a greater
emphasis on the external environmental assessment in order to identify opportunities for public health
organizations to more effectively secure resources, align needs and assets, respond to external
circumstances, anticipate and manage change, and establish a long-term direction for improving the
health of the community. MAPP uses assessment tools to determine the health status and community
perceptions of health needs.
MAPP Process
The MAPP process includes six steps (NACCHO 2010):
1. Organizing for Success: This step involves organizing the planning process and developing
2. Visioning: The visioning step engages stakeholders in a collaborative, creative process of developing
a shared community vision with common values.
3. Conducting Community Assessments: Four community assessments provide information about
internal and external environmental trends releva …
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