objectives to the organization and the community. Third, a strategic plan helps to ensure that the needed resources are available to carry out the initiatives that have been identified as important to the organization. Next, it provides a method to track progress and a mechanism for making changes when needed in the future. Last, a strategic plan allows nurse leaders to select among seemingly equal alternatives based on each alternatives' potential to move the organization toward the desired end goal.
Strategic planning may be conducted for an entire organization, a unit or division, or a major initiative. This chapter will focus on creating a strategic plan to embark on a journey toward high reliability.
Large strategic planning projects benefit from the formation of an advisory board selected from various constituencies what will be affected by the plan. The advisory board does not have formal authority over a program but is instrumental in reviewing the plan and making recommendations and suggestions. Because the advisory board is deliberately selected to reflect representation from various areas, the board will be able to identify potential concerns and provide sound guidance for the plan.
Various strategic planning approaches or models exist. Because they are both based on the scientific method, strategic planning steps are similar to the steps in the nursing process. In strategic planning, the organization analyzes the environment, reviews the literature, formulates goals, develops strategies and action plans, implements the plan, and evaluates the plan. Table 4.5 lists more detailed steps in the strategic planning process.
Table 4.5 Steps in the Strategic Planning Process
| Perform environmental assessmentSWOT analysisStakeholder analysisReview literature for evidence‐based best practicesDetermine congruence with organizational mission, vision, and valuesIdentify planning goals and objectivesDesign strategies or programs to achieve goalsEstimate resources required for the planPrioritize according to available resourcesEstablish action plansIdentify timelines, resources, and responsibilitiesDevelop a marketing planWrite and communicate the business plan/strategic planImplement the strategic planEvaluate the plan |
Source: Patti Ludwig‐Beymer.
Environmental Assessment
An environmental assessment requires a broad view of the organization's current environment. Both the external and the internal environment are carefully appraised. The external environmental assessment is broad based and attempts to view trends and future issues and needs that could impact the organization. The internal assessment seeks to inventory the organization's assets and liabilities.
SWOT Analysis
A SWOT analysis is frequently used to conduct environmental assessments. SWOT is an acronym for strengths, weaknesses, opportunities, and threats. A SWOT analysis identifies strengths and weaknesses in the internal environment and opportunities and threats in the external environment. The SWOT analysis is useful both for initial brainstorming and for a more formal planning document. Table 4.6 provides a hypothetical SWOT analysis focused on creating an HRO in a community hospital.
Table 4.6 SWOT Analysis for a Hypothetical Hospital
| Internal | |
|---|---|
| Strengths | Weaknesses |
| Board of Directors and Physician Leadership Team supportive of HRO Organization has cultivated an open culture and has been recognizing staff for speaking up for 10 years | Variable levels of knowledge about high reliability Competing priorities include patient experience and staff satisfaction Quality improvement department has limited resources |
| Organization has been recognized as a Magnet hospital for 14 years Chief nursing officer and chief medical officer work well together and share a passion for safety | Quality improvement department has limited resources Direct care staff are jaded and ask if this will be the “flavor of the month” |
| External | |
| Opportunities | Threats |
| A state collaborative is focusing on patient safety Several HRO experts are available for consultation at a reasonable cost A local university has a robust aviation program with expertise in high reliability | After years of growth, patient volumes are stable Financial pressures are increasing State and federal quality databases suggest that other area hospitals are outperforming this hospital |
Source: Patti Ludwig‐Beymer.
Stakeholder Assessment
Stakeholder assessment is an important part of an environmental assessment. A stakeholder is any person, group, or organization that has a vested interest in the program or project under review. A stakeholder assessment is a systematic consideration of all potential stakeholders to ensure that the needs of each of these stakeholders are incorporated in the planning phase. For an organization or program to be successful, the involvement of those who will be affected is essential. This is true whether the stakeholders are in the community or are unit staff who will be affected by a proposed strategic plan. When stakeholders are not involved in the project planning, they do not gain a sense of ownership and may not enthusiastically accept a program or strategic goal.
Other Methods of Assessment may be used to support involvement in the strategic planning process. Thoughtful planning is required to determine the method and when to use the method.
Frequently, surveys or questionnaires are used when there are many stakeholders. For example, staff might be polled to see whether they would attend continuing education on safety and high reliability and which days and times would be most desirable.
Focus Groups
Focus groups are small group meetings composed of individuals selected because of a common characteristic. Members are invited to meet in a group and respond to questions about a topic in which they are expected to have an interest or expertise. For example, a group of patients who recently had experiences with childbirth might be asked to come together to discuss their obstetric experiences at the institution in the hope that the discussion will lead to insights or information that could be used for enhancing safety. Focus groups are usually more time consuming and expensive to conduct than questionnaires or surveys. They work best when the topic is broad and qualitative input is being sought by the organization.
Critical Thinking 4.2
Think about a health care organization with which you are familiar.
What is the mission of that organization?
Is it clearly communicated to the stakeholders?
What activities of the organization are reflective of its mission?
Review of the Literature
A review of the literature should be completed early in the strategic planning process. This allows the project team to identify similar organizations or programs, their structures and processes, successes,