Importance of Building a Strategy - Case Study Example

Build strategy Introduction Health care s with low staffing levels tend to have higher levels of poor patient outcomes (Swayne et al, 2008). Raising the level of staff is a challenging task. Some of the main reasons for lower staffing level are: the gap between available positions and the number of qualified medical professionals, rising needs of care, reorganization and spending cuts by the government (Greener, 2009). Low staffing levels has a direct influence on the quality of care offered by an institution and patient safety because overstretched staff can experience burn out and cannot meet the demands of all patients (Swayne et al, 2008). Milton Keynes hospital is one if the healthcare institutions faced with shortages of staff especially the nurses. Several strategies can be undertaken by this institution to solve this challenge of staff shortages. Importance of building a strategy Strategic planning is vital to any business in order to realize success. A strategic plan incorporates the mission, vision, and creative thinking. It mainly gives a description of the where the company is headed to by giving the details of achieving it. Strategic plans are the expressions of the visions and dreams of successful outcomes (Kaplan & Norton, 2008). It serves as the design of how a company can achieve its strategic objectives. Strategic planning can be focused on the whole organization or a department (Williams, 2006). For a hospital such as Milton Keynes, the strategy of solving the problem of understaffing will be focused on the entre institution. Objective The objective of this assignment is to build a strategy that can be implemented by Milton Keynes hospital in order to solve the issues related to understaffing. The strategy that will be developed will help the organization solve its immediate staffing problems and ensure that it is sustainable in the long-run. The strategy must put into consideration the implications of the implementation on the hospital. Such implications include: effect on patient care, increased costs and the ability of the institution to meet nursing needs in the future. Description of the problem The problem of understaffing in hospitals in the United Kingdom is rampant with the nation hospital services naming 26 healthcare institutions as operating below the safe staffing levels. This problem is further highlighted by the failure of sixteen percent of these institutions to come up to the required levels (Swayne et al, 2008). One of the main contributions of those staffing shortages especially in the nursing profession is due to the aging of the nursing population and the unwillingness of the younger generation to join the nursing profession. Despite in increase of foreign-born professionals in the medical profession, this group cannot meet the rising demand for medical care. The demand for higher pay, a weakening economy and increased medical demand is straining the thin available labor force (Mireille, 2007). Analysis of the problem Difficulties associated with understaffing are worsened by changes in medical care for example novel medical technologies and a reducing average stay in hospital that have contributed to increase in the level of care demanded by patients while they are in medical institutions. Novel medical technologies facilitate less seriously sick patients to receive medical care in out patient environments instead of inpatient environments. Furthermore, patients who would have spent the early days of recovery in hospitals are being released to nursing institutions or to their homes. The result of these changes in hospitals is that healthcare institutions are experiencing an influx of more patients who require more care. Staffing of healthcare institutions is an issue of concern because of its effects on quality of care and patient safety (Greener, 2009). Sensitive outcomes, especially those attributable to nursing are one signs of quality of care. It can be defined as the changeable patient or caregiver situation, condition or sensitivity receptive to a nursing intervention. Various adverse patient results are increasingly sensitive to nursing care. These are: pneumonia, urinary tract infections, longer hospital stays, shock, and failure to rescue, upper gastrointestinal bleeding and thirty-day mortality (Stegenga et al, 2002). Several research studies on the topic have linked lower staffing levels in hospitals to elevated adverse outcomes rates. Lower staffing levels are also closely linked to workload and job dissatisfaction. Rising cases of chronic illnesses in most countries including the United Kingdom has increased patient acuity (Vicca et al, 2000). The rising workload contributes to burnout, which influences patient safety and the quality of care. Strategic plan for solving understaffing The strategy developed must meet the hospitals mission statement “committed to treating you well” (Milton Keynes Hospital, 2013). The strategy developed incorporates the hospital’s goals of growth and offering quality services to meet the needs of its patients. The problem of understaffing at Milton Keynes hospital can be solved by developing short-tern and long-tern strategies. Short-term strategies are aimed at responding to immediate staffing needs and are usually not sustainable in the long-term. Long-tern strategies take a longer period to implement and are aimed at addressing the factors that cause the shortages over a longer period of time (Darwin et al, 2002). Short-term strategies Hiring temporary staff Travelling nurses and per diem nurses can be used by Milton Keynes hospital to solve its problem of understaffing. These nurses will sign shorter contracts that will aim at filling short-term nursing requirements caused by medical leaves or staff vacations and personal shifts. Relying on temporary staff has two disadvantages that can influence the hospital in the long-term. The first one is the rising costs of sustaining this strategy and the other is quality concerns. Quality issues arise because the hospital cannot ascertain the level professionalism of the staff. To alleviate the challenges associated with temporary staff, the hospital can use internal staffing agencies or float pools (Needleman, 2005). The hospital can realize cost saving through internal staffing agencies because internal-agency staff are paid premium salaries, which are lower than salaries paid to external-nurses. Internal nurses can also help the hospital manage quality issues because they are current employees who are seeing additional sources of income or previously employed staff who need lesser hours or more flexibility in their working schedules. The hospital can develop a system where employees interested in extra shifts can bid for unoccupied shifts within a range that is higher than staff nurses rates but lesser than external nurse’s rate (Loeb, et al, 2004). This system will function via an online shift auction similar to eBay for nursing shifts. Remuneration and economic benefits High demand for healthcare employees makes competitive salaries and benefits an important strategy is hiring and retaining employees. The hospital can increase s the salaries of all healthcare employees, not just raises that aim at new employees. This strategy has the short-term advantage of attracting new employees, especially in a market where competitors are slow to regulate their remuneration in response. This strategy will involve an analysis of the market salaries offered to nurses and increasing salaries offered by the hospital. It will also entail analyzing the financial position of the hospital to determine if it is affordable and that the increases do not compromise the provision of other services. The hospital can also use referral, sign-on and retention bonuses or a combination to attract more recruits and retain them. Despite financial incentives being a key motivating factor, they are not sufficient to attract new employees or retain them if the work environment is not conducive. The hospital can make its work environment pleasant and attractive by introducing flexible schedules (Kavaler & Spiegel, 2003). Employees to balance professional and home life found this on the rising demand. Flexible schedules can be achieved by offering a range of shift types and personal scheduling (Amaravadi et al, 2000). Introducing parent shifts for employees with responsibilities that limit their availability for longer hours will attract more employees during busy shifts make the working environment more pleasant for employees who have parenting responsibilities. Long-term strategies Nurse education Large hospitals such as Milton Keynes can invest in nursing education a way of alleviating the problem of understaffing. The institution can expend its training program or open new nursing schools. Through this strategy, the hospital can grow its own employees by managing nursing schools. Other mechanism of ensuring that this strategy works is by paying for student’s fees in exchange for a work commitment with the hospital (Pasqual, 2009). The hospital can also provide a flexible working schedule for existing employees to allow them enhance their education and training. Most of the students who receive financial aid from hospitals for their education become hospital employees. The hospital can offer training to maintenance and housekeeping staff to be certified nurses, who can then enter degree programs to further their education. Offering orientation programs for new employees is another educational strategy that can be used by the hospital. This will involve lengthening and redesigning orientation programs to meet the ever-increasing intricacy in patient care and enhance satisfaction and retention among employees. If the orientation is increased to 20 weeks, new employees can be excluded from normal staffing plans or can be rotated via different hospital units to find where they are best suited (Clarke et al, 2002). Another related strategy to this is by using preceptor programs where new nurses are paired individually with experienced nurse during the orientation period. Giving specialized training in specific clinical settings is another strategy that the hospital can use to attract new employees and retain them. Milton Keynes hospital can enter into partnerships with nursing schools, which in turn serve as sites for clinical rotations, and providing other educational benefits such as paying for further education and certification and providing specialized career paths. Furthermore, hospital such as Milton Keynes can help in mitigating the problem of limited nursing school capacity and insufficient nurse faculty by subsiding nurse faculty remunerations, loaning its employees to serve as nurse faculty or aiding nursing schools in looking for faculty members. Investing in nursing education is an expensive venture by the hospital, but is a sustainable strategy that will be cheap in the log-term. Providing a conducive work environment Considering that, financial incentives are not sufficient to enhance recruitment and retention of hospital employees, the hospital can initiate changes to the working environment of its employees. The changes can help the hospital develop a reputation as having a positive working environment (Hickman et al, 2003). Although this strategy requites commitment and sustained investment, it has long-term positive impacts. The most effective strategy that is related to other strategies aimed at raising the level of staff is hiring more staff. This will lower employee workload and enhance patient care. Restructuring of the employees’ roles and responsibilities is another strategy that can be used by the hospital to attract and retain employees. Creation of specialized teams of nurses such as rapid response teams to handle critically ill patients, support staff to manage the personal needs of patients and employing older employees to manage administrative tasks and paperwork. Other strategies aimed at making the work place conducive include physical alterations to the physical set up to the hospital. This involves redesigning workstations to make them more comfortable and decentralization of some units such as pharmacies. Investing in modern medical technologies for handling and treating patients and imitating electronic medical registrars can help the hospital improve the working conditions in the hospital (Ginter et al, 2013). An example of this strategy is investing in lifting and bathing equipment that can help in lifting overweight employees. Automation will simplify the work of nurses; therefore, it lowers burnout and job dissatisfaction. The above strategies aimed at mitigating the shortages of nurses at Milton Keynes hospital will benefit the institution in three ways. First, it will alleviate the problem of staff shortages in the short and long-term. Secondly, the strategies will help in lowering hospital costs. Although short-term strategies are expensive, long-term strategies are expensive in the initial stages, but will benefit the hospital in the long-term. This is because it will lower future dependence on short-terms strategies and increase in economic benefits. The long-term strategies will also aid in lowering nurse turnover, which will result in cost savings. Lastly, the strategies will promote access and quality of care offered by the hospital. Limited staffing lowers patient capacity, while reliance on temporary and inexperienced employees impacted the quality of patient care. Vision of the strategy The vision of the above strategy is to make Milton Keynes Hospital a competitive healthcare institution that offers quality services for all. Considering that staffing levels impacts the quality of care of the institution, investment in the long-term strategies of solving this challenge will ensure that the institution gets a return on investments in the end. Change management plan The change management plan will begin with a provision of the background of the need to increase staffing levels at the hospital through an evaluation of the quality of its services that are affected by staffing levels. This will involve linking the strategic goal of the organization to the proposed changes. Increasing staffing is directly linked to provision of quality healthcare, which is one of the strategic goals of the hospital. The next step will be defining the lead change project sponsor, which in this case is the human resource manager at the hospital. The next step will be providing project objectives, which in this case are raising staffing levels, ensuring quality of care, cost reduction and sustainability in staffing. Next is outlining the principles and change objectives. This will involve outlining the step that the hospital will take to realize required staffing levels such as increasing salaries, training nurses and improving working conditions. Cost reduction will be a long-term objective of strategies such as training nurses and collaborating with nursing schools. (Hambrick & Fredrickson, 2005). The next step is outlining the rationale for change, which comprises the drivers of change, constraints for change and the risks involved in the change process. The rational for change is to increase staffing to enhance quality healthcare. Change drivers will be enhancing the work environment, communicating the strategic plan to hospital stakeholders and competition in the healthcare sector. Constraints to the change management plan are time, costs and resistance from current employees. Risks include long-term sustainability and adoption of the plan by competitors. This is then followed by an analysis of stakeholders who will be affected by the change process. The stakeholders in this case will be staff, management, students, unions, and patients. The analysis will focus on their responses to the proposed changes, change management needs and their preferred mode of communication concerning the changes. Evaluation of readiness to changes is the next process that determines the willingness to participate in the change process. This is the most important aspect of the strategic plan because stakeholders usually resist changes. This is followed by identifying change messages that will convey the gains and losses caused by the proposed changes. The gains will be reduction in work load, increased competiveness and increase in salaries and benefits. It is noteworthy that the next step will be identification of the change elements, which will comprise the structures, resources, processes, timeframes and performance measures (Aaker, 2001). Developing a change is the next step and it will involve the actions by whom and when, and the performance measures. The main performance measure of this strategy is evaluating patient satisfaction because it is directly linked to sufficient staffing. Another measure is evaluating the attractiveness of the hospital to employees. The next step is the consolidation of the changes, and involves continued collaboration with nursing schools, expanding nursing training programs, establishing nursing schools, and offering competitive salaries and benefits (Hambrick & Fredrickson, 2005). The last step is the evaluation of the change process to determine if it meets the objectives of solving understaffing, promoting quality of care and reduction of cost. Conclusion For a hospital such as Milton Keynes, understaffing is a problem that can be solved by developing a strategy that aims at solving the problem in the long-term and short-term. Strategies such as increasing salaries and benefits, collaborating with nursing schools, establishing nursing schools and providing an appropriate working environment will solve understaffing challenges and help the hospital to realize its strategic objective of providing exceptional healthcare. Considerations such as cost, sustainability, obstacles to changes must be considered before initiating the strategic plan. Evaluation against set objectives or lowering costs and patient satisfaction will aid it determining the success of te strategic pan. References Aaker, D. A. (2001). Developing business strategies. New York, NY [u.a.: Wiley. Aiken, L.H., Clarke, S.P. & Sloane, D.M. (2002). Hospital staffing, organization, and quality of care: Cross-national findings. Nursing Outlook, 187-194. Amaravadi, R.K., Jacobson, B.C., Solomon, D.H. & Fischer, M.A. (2000). ICU nurse-to-patient ratio is associated with complications and resource use after esophagectomy. Intensive Care Medicine, 1857-1862. Clarke, S.P., Sloane, D.M. & Aiken, L.H. (2002). Effects of hospital staffing and organizational climate on needlestick injuries to nurses. American journal of public health. Vol 92:1115-1119 Darwin, J., Johnson, P., & McAuley, J. (2002). Developing strategies for change. Harlow [u.a.:Financial Times/Prentice Hall. Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2013). Strategic management of health care organizations. San Francisco, CA: John Wiley & Sons/Jossey-Bass. Greener, I. (2009). Healthcare in the UK: Understanding continuity and change. Bristol: Policy Press. Hambrick, D.C. & Fredrickson, J.W. (2005). Are you sure you have a strategy? Academy of Management Executive, Vol 19(4), pp 51-62. Hickman, D., Severance, S. & Feldstein, A (2003). The effect of health care working conditions on patient safety. Rep.74. Agency for Healthcare Research and Quality. Isgur, B. (2010). Healing the Health Care Staffing Shortage. Hospitals & Health Networks Kaplan, S.R & Norton, D.P. (2008). Developing the Strategy: Vision, Value Gaps, and Analysis.  Balanced Scorecard Report. Kavaler, F., & Spiegel, A. D. (2003). Risk management in health care institutions. Sudbury, Mass: Jones and Bartlett Publishers. Loeb, M., McGeer, A., Henry, B., Ofner, M., Rose, D. & Hylwka, T. (2004). SARS among critical care nurses, Toronto. Emerging infectious diseases, 251-255. Milton Keynes hospital NHS Foundation Trust. Retrieved from http://www.nhs.uk/Services/Trusts/Overview/DefaultView.aspx?id=732 on 13th march 2013 Mireille, K. (2007). Nurses on the Move: A Global Overview. Health Services Research, 1281-1298. Needleman J. B. (2005). Trends in nurse overtime, 1995-2002. Policy, politics & nursing practice, 183-190. Pasqual, L. (2009). How nurse agencies can mitigate understaffing dangers. Retrieved from http://www.apihealthcare.com/blog/how-nurse-agencies-can-mitigate-understaffing- dangers/ Stegenga, J., Bell, E. & Matlow, A. (2002). The role of nurse understaffing in nosocomial viral gastrointestinal infections on a general pediatrics ward. Infection control and hospital epidemiology, 133-136. Swayne, L. E., Duncan, W. J., & Ginter, P. M. (2008). Strategic management of health care organizations. San Francisco, CA: Jossey-Bass. Vicca, A.F. (1999). Nursing staff workload as a determinant of methicillin-resistant Staphylococcus aureus spread in an adult intensive therapy unit. The Journal of hospital infection, 109-113. Williams, A. (2006). Developing strategies for the modern international airport: East Asia and beyond. Aldershot, England: Ashgate Pub. Co. Read More