Dr.
Naglaa Abd EL Aziz Mahmoud
Associte professor
Nursing administration Dep.
2020
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The learner will:
• Identify planning process
•Differentiate between planning modes
• Describe the steps necessary for successful strategic planning
•Describe who should be involved in strategic planning
•Discuss the relationship between an organizational mission statement,
philosophy, goals, objectives, policies, procedures, and rules
•Identify contemporary paradigm shifts and trends impacting healthcare
organizations
•Analyze social, political, and cultural forces that may affect the ability
of 21st century healthcare organizations to forecast accurately in
strategic planning
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• Identify barriers to planning as well as actions the
leader–manager can take to reduce or eliminate these
barriers
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Planning
Is the process of deciding in advance
What should be done
How should be done
When should be done
where should be done
By whom it will be done
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Planning modes
Reactive planning
Inactivisim
Preactivism
Interactive or proactive planning
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Planning modes
• Reactive planning occurs after a problem exists. Because
there is dissatisfaction with the current situation,
• planning efforts are directed at returning the organization to
a previous, more comfortable state.
• Frequently, in reactive planning, problems are dealt with
separately without integration with the whole organization.
In addition, because it is done in response to a crisis, this
type of planning can lead to hasty decisions and mistakes..
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Planning modes
• Inactivism is another type of conventional planning.
Inactivists seek the status quo,
• And they spend their energy preventing change and
maintaining conformity.
• When changes do occur, they occur slowly and
incrementally.
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Planning modes
• Preactivism. Preactive planners utilize technology to
accelerate change and are future oriented.
• Unsatisfied with the past or present,
• preactivists do not value experience and believe that the
future is always preferable to the present.
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Planning modes
• Interactive or proactive planning
• Planners who fall into this category consider the past,
present, and future and attempt to plan the future of their
organization rather than react to it.
• Because the organizational setting changes often,
adaptability is a key requirement for proactive planning.
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• Proactive planning occurs, then, in anticipation of
changing needs or to promote growth within an
organization and is required of all leader managers
so that personal as well as organizational needs
and objectives are met.
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Forecasting
• Forecasting involves trying to estimate how a condition
will be in the future. Forecasting takes advantage of input
from others, gives sequence in activity, and protects an
organization against undesirable changes.
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• A mistake common to novice managers is a failure to
complete adequate proactive planning.
• Instead, many managers operate in a crisis mode and fail to
use available historical patterns to assist them in planning.
Nor do they examine present clues and projected statistics to
determine future needs. In other words, they fail to forecast
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STRATEGIC PLANNING
• Planning also has many dimensions. Two of these dimensions
are time span and complexity or comprehensiveness.
• Generally, complex organizational plans that involve a long
period (usually 3–10 years) are referred to as long-range or
strategic plans
• Involves projecting the organization goals and activities into
the future usually 2 to 5 years a head.
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STRATEGIC PLANNING
• However, strategic planning may be done once or twice a
year in an organization that changes rapidly. At the unit
level, any planning that is at least 6 months in the future
may be considered long-range planning.
• Strategic planning focuses on purpose, mission, philosophy,
and goals related to the external organizational
environment.
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STRATEGIC PLANNING
• Strategic planning then forecasts the future success of an
organization by matching and aligning an organization’s
capabilities with its external opportunities. For instance, an
organization could develop a strategic plan for dealing with
a nursing shortage, preparing succession managers in the
organization, developing a marketing plan, redesigning
workload, developing partnerships, or simply planning for
organizational success.
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SWOT Definitions
• Strengths are those internal attributes that help an
organization to achieve its objectives.
• Weaknesses are those internal attributes that challenge an
organization in achieving its objectives.
• Opportunities are external conditions that promote
achievement of organizational objectives.
• Threats are external conditions that challenge or threaten
the achievement of organizational objectives..
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Simple Rules for SWOT Analysis
• Be realistic about the strengths and weaknesses of your
organization.
• Be clear about how the present organization differs from
what might be possible in the future.
• Be specific about what you want to accomplish.
• Always apply SWOT in relation to your competitors.
• Keep SWOT short and simple.
• Remember that SWOT is subjective.
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strategic planning as a management
process generally includes the following
steps:
1. Clearly define the purpose of the organization.
2. Establish realistic goals and objectives consistent with the
mission of the organization.
3. Identify the organization’s external constituencies or
stakeholders and then determine their assessment of the
organization’s purposes and operations.
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strategic planning as a management
process generally includes the following
steps:
4. Clearly communicate the goals and objectives to the
organization’s constituents.
5. Develop a sense of ownership of the plan.
6. Develop strategies to achieve the goals.
7. Ensure that the most effective use is made of the
organization’s resources.
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strategic planning as a management
process generally includes the following
steps:
8. Provide a base from which progress can be measured.
9. Provide a mechanism for informed change as needed.
10. Build a consensus about where the organization is going.
•It should be noted, though, that some critics argue that
strategic planning is rarely this linear. Nor is it static.
•Strategic planning instead involves various actions and
reactions that are partially planned and partially unplanned.
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Who Should Be Involved in
Strategic Planning?
• Long-range planning for healthcare organizations
historically has been accomplished by top level
managers and the board of directors, with limited
input from middle-level managers.
• To give the strategic plan meaning and to implement
it successfully, input from subordinates from all
organizational levels may be solicited.
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Who Should Be Involved in
Strategic Planning?
• There is increasing recognition, however, of the
importance of subordinate input from all levels of the
organization to give the strategic plan meaning and to
increase the likelihood of its successful implementation.
• The first-level manager is generally more involved in
long-range planning at the unit level. However, because
the organization’s strategic plans affect unit planning,
managers at all levels must be informed of organizational
long-range plans so that all planning is coordinated.
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Who Should Be Involved in
Strategic Planning?
• Top level executives and board of directors
• For successful implementation, it is important to involve
subordinates from all organizational levels.
• All organizations should establish annual strategic planning
conferences, involving all departments and levels of the
hierarchy; this action should promote increased effectiveness
of nursing staff, better communication between all levels of
personnel,
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Strategic planning as
a management process
• Define the purpose of the organization clearly
• Establish realistic goals and objectives consistent
with the mission
• Identify external stakeholders
• Communicate the goals and objectives
• Develop a sense of ownership of the plan
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Strategic planning as
a management process
• Develop strategies to achieve the goals
• Ensure effective use of resources
• Provide a base to measure progress
• Apply informed change as needed
• Build a consensus about where the organization is
going
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Organizational Planning
The plans form a hierarchy, where the top plan affects
all plans that follow.
Planning components at the top are more general, and
lower components are more specific
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The planning hierarchy
Mission
Philosophy
Goal
s
Objectives
Policies
Procedures
Rules
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Vision and mission statement
• Vision - a description of the future aims to which an
organization aspire
Ex- …… will be the leading center for trauma care in the
region
• Mission is a brief statement of the purpose / reason of
an organization to exist. Ex- p.147
• Philosophy the set of values and beliefs based
on the mission and guides all actions of the
organization
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Goals and objectives
• Goals are statements of desired end product
Organization has long- and short-term goals
• Objectives are statements specific and measurable
that identify how and when the goal is to be
accomplished
• Strategies are actions by which objectives are to be
achieved
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Policies and procedures
Policies
Are instructions that direct organizations in their
decision making
Procedures
Are written actions outlined in a sequence of steps
needed to implement a policy or a specific task.
The manager has a responsibility to review and
revise policies and procedures to ensure currency
and applicability
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• Implied policies, neither written nor expressed
• verbally, have usually developed over time and follow
a precedent.
• Expressed policies are delineated verbally or in
writing. Most organizations have many written policies
that are readily available to all people and promote
consistency of action. Expressed policies may include a
formal dress code, policy for sick leave or vacation
time, and disciplinary procedures.
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Rules
• Rules and regulations
are plans that define
specific action or
nonaction
• It describes situations
that allow only one
choice of action
• Rules are fairly
inflexible
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The levels of Planning in Nursing
Top- level management Strategic Planning
CEO (Chief Executive Officer 3 to 10 years
•Vice President of Nursing
•Division heads
Middle-level management
•Supervisor Intermediate Planning
•Case manager 6 months to 2 years
•Clinical specialist
Lower-level of management
Managers of nursing units NM, HN Operational Planning
Primary care nurse 1 week to 1 year
Team leader
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Examples of the data that need to be collected
and analyzed for planning purposes are:
Daily average patient census
Bed capacity and occupancy rate
Average length of stay
Number of births
Number of operations
Trends in patient populations (diagnosis, age,
acuity)
Trends in technology (diagnostic, therapeutic)
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The role of First-level managers
• They are responsible for the work
of others, and often participate in
the work itself
• They accomplish the objectives
designed by strategic planners, and
they may or may not participate in
strategic planning
• They are involved in unit planning
that is directly related to patient
care
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The role of First-level managers
• Coordinate all patient care activities
• Implement policies and procedures
• Develop annual budgets for their departments
• Determine staffing needs and pattern of nursing
• Engage in supervising personnel and evaluating
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Factors emerging in the rapidly changing healthcare
system that must be incorporated in planning for a
healthcare organization’s future
● There is a need to build different work relationships
because the way we manage systems is changing. For
example, healthcare continues to move toward
managing populations rather than individuals.
● The healthcare industry continues to move away from
illness care to wellness care to reduce the demand for
expensive, acute care services.
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● The use of complementary and alternative medicine is
increasing as public acceptance and demand for these
services increases.
● The transformation from revenue management to cost
management will continue as declining reimbursement
forces providers to focus on how to maximize limited
resources and provide care at less cost.
● A move is underway to interdependence of
professionals rather than professional autonomy. With
the movement toward managed care, autonomy has
decreased for all healthcare professionals, including
managers.
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factors emerging in the rapidly changing healthcare
system that must be incorporated in planning for a
healthcare organization’s future
● There continues to be a shift in framework to the patient as a
consumer of cost and quality information. Historically, many
providers assumed that consumers, both payers and patients,
had minimal interest in or knowledge about the services that they
received. Currently, a change in the balance of power among
payers, patients, and providers has occurred, and providers are
increasingly held accountable for the quality of outcomes that their
patients experience.
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factors emerging in the rapidly changing healthcare
system that must be incorporated in planning for a
healthcare organization’s future
● A transition from continuity of provider to continuity of
information is occurring. Historically, continuity of care was
maintained by continuity of provider. In the future, however, the
meaning and operationalizing of continuity will become
predicated on having complete, accurate, and timely information
that moves with the patient. For example, electronic health
records (EHR) provide promise for such real-time, point of
care information, and clinicians everywhere will soon have a
longitudinal medical record with full information about each
patient (Huston, 2008).
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factors emerging in the rapidly changing healthcare
system that must be incorporated in planning for a
healthcare organization’s future
● Technology, which facilitates mobility and portability of
relationships, interactions, and operational processes, will
increasingly be a part of high functioning organizations.
EHRs and clinical decision support are examples of such
technology, since both impact not only what healthcare data is
collected, but how it is used, communicated, and stored
(Huston, 2008).
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factors emerging in the rapidly changing healthcare
system that must be incorporated in planning for a
healthcare organization’s future
● Commercially purchased expert networks (communities of top
thinkers, managers, and scientists) will increasingly be used to
address “wicked problems” (problems with innumerable
causes, that are tough to describe, and for which there is no right
answer) and improve the quality of their decision making (Saint-
Amand, 2008; Camillus, 2008). Such network panels are typically
made up of researchers, healthcare professionals, attorneys,
and industry executives.
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factors emerging in the rapidly changing healthcare
system that must be incorporated in planning for a
healthcare organization’s future
● The healthcare team will be characterized by highly
educated, multidisciplinary experts (Huston, 2008).
While this would appear to ease the leadership
challenges of managing such a team, Gratton and
Erickson (2007, p. 102) suggest that such challenges
actually increase, since the greater the proportion of
experts a team has, the more likely it is to disintegrate
into a nonproductive conflict
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factors emerging in the future healthcare system that
must be incorporated in planning for a healthcare
● Robotic technology and the use of prototype nurse robots called
nursebots will increasingly serve as an adjunct to scarce human
resources in the provision of healthcare.
● Biometrics, the science of identifying people through physical
characteristics such as fingerprints, handprints, retinal scans, voice
recognition, and facial structure, will be used to assure targeted
and appropriate access to client records.
● A growing elderly population, medical advances that increase
the need for well-educated nurses, consumerism, the increased
acuity of hospitalized patients, and a ballooning healthcare system
will continue to increase the demand for RNs.
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factors emerging healthcare system in the future that
must be incorporated in planning for a healthcare
organization’s future
● An aging workforce, improving economy, inadequate
enrollment in nursing schools to meet projected demand, increased
employment of nurses in outpatient or ambulatory care settings,
high turnover due to worker dissatisfaction, and inadequate long-
term pay incentives will exacerbate the current nursing shortage in
acute care hospitals.
● The Internet and electronic access to healthcare information will
continue to change how providers interact with patients, with
consumers increasingly adopting the role of expert patient.
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OVERCOMING BARRIERS TO
PLANNING
• The organization can be more effective if movement
within it is directed at specified goals and objectives.
• Because a plan is a guide to reach a goal, it must be
flexible and allow for readjustment as unexpected
events occur
• The manager should include in the planning process all
people and units that could be affected by a plan.
Although time-consuming, employee involvement in
how things are done and by whom increases
commitment to goal
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OVERCOMING BARRIERS TO
PLANNING
• Plans should be specific, simple, and realistic. A vague
plan is impossible to implement. A plan that is too global
or unrealistic discourages rather than motivates employees.
• Know when to plan and when not to plan. It is possible to
over plan and under plan. For example, one who overplans
may devote excessive time to arranging details that might
be better left to those who will carry out the plan.
• Good plans have built-in evaluation checkpoints so that
there can be a midcourse correction if unexpected events
occur.
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