Classmate 1:       The case of Enron is one that seems like it was only one company at first, but it takes many moving parts to move so smoothly. As a trading company, they wanted to stay ahead of every curve predicting what could happen. Even when bad occurred the company made it seem as though they gained. This happens to many of the deal they took part in. When the time came again to where they needed to make their number, every single time they met them with extra. With all of this success, coming back from a never-ending tunnel into the light, no one really asked why. This is ironic because their slogan was “ask why”. As long as the people were getting their money some how where it had come from was never really thought of. Some people got curious but could not pinpoint what it was. They could see that something was going on or the numbers just did not make sense. As an accounting major, there was a lot of ethical decisions that as an accountant you would have to think about.             When hiring someone outside of the company you would usually think that you will get an unbiased opinion but that is not close to what they did. A big example shown in the movie was how they handled California. They had just used the people to get their money and when they did Enron wanted more by manipulating the power plants to get prices to increase. These traders never really wanted to help the people besides the words the company said to help the people. This was just for themselves this is not a good method of treating people, in their position they should have been stewards to the people with energy. With a reasonable price and not shifting the energy around that did not make sense when you have a surplus amount that could be supplied to the people with little mishaps.              Another is a work environment, they had said it plenty of times if I have to step on your throat to get ahead I will trample you. This type of environment does not promote good work cooperation it is just a stressful situation. This would be a good time to promote the common good, the method is not just used outside but also in the workplace. You would want good for all of your coworkers when they do good you do as well. You wouldn’t want someone to crush all over you to get to a position or use your work to get what they want eventually getting you fired from the job since it looks like you have not been contributing.             There is so much to this company and everyone else that you could talk about trying to analyze their behavior. A big one to me is, in the end, knowing full well what they have done they stuck to an ID conscience, all just for the money. Lower-level people felt as if they were doing good because they are not high enough to know the rest of the information or maybe some knew because they contributed in the wrong. For many who didn’t know they lose everything to this company and because of the name of the company, it would follow them because the ...

1. Classmate 1:
The case of Enron is one that seems like it was only one
company at first, but it takes many moving parts to move so
smoothly. As a trading company, they wanted to stay ahead of
every curve predicting what could happen. Even when bad
occurred the company made it seem as though they gained. This
happens to many of the deal they took part in. When the time
came again to where they needed to make their number, every
single time they met them with extra. With all of this success,
coming back from a never-ending tunnel into the light, no one
really asked why. This is ironic because their slogan was “ask
why”. As long as the people were getting their money some how
where it had come from was never really thought of. Some
people got curious but could not pinpoint what it was. They
could see that something was going on or the numbers just did
not make sense. As an accounting major, there was a lot of
ethical decisions that as an accountant you would have to think
about.
When hiring someone outside of the company you
would usually think that you will get an unbiased opinion but
that is not close to what they did. A big example shown in the
movie was how they handled California. They had just used the
people to get their money and when they did Enron wanted more
by manipulating the power plants to get prices to increase.
These traders never really wanted to help the people besides the
words the company said to help the people. This was just for
themselves this is not a good method of treating people, in their
position they should have been stewards to the people with
energy. With a reasonable price and not shifting the energy
around that did not make sense when you have a surplus amount
that could be supplied to the people with little mishaps.
Another is a work environment, they had said it plenty
of times if I have to step on your throat to get ahead I will
trample you. This type of environment does not promote good

2. work cooperation it is just a stressful situation. This would be a
good time to promote the common good, the method is not just
used outside but also in the workplace. You would want good
for all of your coworkers when they do good you do as well.
You wouldn’t want someone to crush all over you to get to a
position or use your work to get what they want eventually
getting you fired from the job since it looks like you have not
been contributing.
There is so much to this company and everyone else
that you could talk about trying to analyze their behavior. A big
one to me is, in the end, knowing full well what they have done
they stuck to an ID conscience, all just for the money. Lower-
level people felt as if they were doing good because they are not
high enough to know the rest of the information or maybe some
knew because they contributed in the wrong. For many who
didn’t know they lose everything to this company and because
of the name of the company, it would follow them because they
worked for Enron. Enron did not think of their employees
making sure they would be taken care of and in turn, they take
care of you.
Classmate 2:
“Enron: The Smartest Guy in the Room” is a true story based on
the year 2005. The ethics within this true story and film will
have you question this companies morality. The impression is
that Enron was simply a good company that went bad. It was
known as “the best energy companies in the world” but along
there pathway to fame there was something happening under the
wraps. This film showed how it happened and how it unraveled.
Enron created fake quarterly returns, showing they made more
money than they actually did. It was claiming that future
potential income, is what there income had been at the time.

3. This tactic used deceived people of actual returns from
predicted returns. So if the company is predicted to make 80
million in 10 years, it would show that is what it made now.
This film includes shocking real footage and information from
the scandal at hand. For example the fact that Enron knowingly
created the fake California energy crisis. There was actually
never any energy crisis there at all. As the film progresses the
company starts to fail and does an employee cut. Cutting over
20,000 employees because of its unethical practices, and their
stock becoming worthless. Only because of unethical practices,
and lying executives.
In this film we can analyze the ethical theory of rights and
responsibilities. In the business world, we are required to tell
the truth and nothing but the truth. Encouraging employees and
citizens to invest in Enron stock when they knew the lack of
value in that stock is simply unethical and does not apply to the
theory of rights and responsibilities. The responsibility to take
care of their employees was broken, along with actually lying to
them for company profit. Secondly the investors and employees
have the right to know the companies actual value and
intentions. Enron had placed a smoke screen of who they
actually were, and directly violated this human right and
business right.
The only thing Enron could have done in this case is to have
simply stopped there unethical practices long before this
happened. This would allow for shareholders to find the true
value in the company and the employees to know where they
actually stand. This would’ve hopefully prevented the massive
employee cut, and demolish of the entire company. Giving them
the right to know these past problems, and letting them know
they are going to fix it could have helped the company service,
or at least try to make things right before this happened.
Essentials of strategic Planning in Healthcare

4. Introduction Healthcare spending in the United States in 2006
rose 6.7 percent from the previous year, to $2.1 trillion. This
figure equates to an expenditure of $7,026 per person and 16
percent of the gross domestic product. During this same period,
prescription drug spending increased 8.5 percent (Catlin et al.
2008). Healthcare costs are increasing at a significant rate, and
the industry needs leaders who can allocate resources more ef-
ficiently. Research shows that hospitals are one of the largest
employers in the country and are critical to attracting new
business to a geographic area. The healthcare industry also
contributes to the United States’ economic and social well-
being; the Bureau of Labor Statistics (2007) reported 13.6
million Americans were employed in the health-care industry in
2006. As noted in Exhibit 1.1, the U.S. hospital industry
comprises a wide range of hospitals of varying size. Growth is
important to an organization’s future success. It helps the
organization recruit physicians and provides for greater
economies of scale(see Highlight 1.1), which can result in
increased profitability. To grow, organizations need effective
infrastructures, high-performance work processes, and skilled
personnel, and they must provide their employees with
appropriate incentives. Most important to growth is good
strategy development, which is a product of excellent leadership
and diversity of individuals and expertise (Goldman and Dubow
2007). Strategic planning is an effective way for organizations
to improve their allocation of resources(see Highlight 1.2).
Resources need to be allocated in a way that allows
organizations to provide healthcare services as efficiently as
possible. Research has shown that the efficient allocation of
healthcare resources in the production process is linked to
improved quality (Harrison and Cop-pola 2007). The following
section discusses the role of hospital leaders, particularly their
function in strategic planning.
Defintion of leadership

5. The most basic level, leadership is the ability to guide,
influence, and inspire individuals to meet goals (for purposes of
this book, organizational goals). Competency models that focus
on leadership in the healthcare industry have been developed by
many organiza-tions, including the Healthcare Leadership
Alliance and the National Center for Healthcare Leadership (see
Highlight 1.3). Based on the most current research, these
models identify behaviors and technical skills (competencies)
that characterize outstanding leadership performance.
In this rapidly changing healthcare industry, strategic planning
is becoming in-creasingly important to overall organizational
success. Strategic planning involves the de-velopment of
organizational objectives (i.e., what the organization wants to
accomplish), the management of action plans, and the
measurement of ongoing performance. Key to strategic planning
is the development of relationships with key stakeholders, such
as patients, physicians, employers, insurers, community groups,
and government agencies (Griffith and White 2005).In
healthcare organizations, the board of directors and the chief
executive officer (CEO) are at the top of the leadership
structure. The board of directors is the governing body
appointed to hold fiduciary responsibility for the organization.
(An example of Pied-mont Healthcare’s (Atlanta, Georgia)
board of directors is illustrated in Exhibit 1.2.) As part of this
responsibility, the board makes policy decisions, which guide
the future of the organization. An essential area of the board of
directors’ responsibility is the development of a strategic plan
consistent with the organization’s mission and vision.Many
believe that an organizational culture that embraces continuous
quality im-provement is necessary for long-term success and
that the board of di-rectors should focus on measuring
performance to ensure healthcare quality. The Institute of
Medicine (IOM) (see Highlight 1.5) believes that improving the
healthcare industry will require changes to the structure and
processes of the delivery system, as well as a focus on

6. coordination of care across all services (IOM 2001). In addition,
successful delivery of healthcare in the future will depend on
the use of health information technology, such as electronic
medical records.The CEO is the highest ranking executive in an
organization and is responsible for strategic planning, hiring
senior leadership, and managing operations. The CEO is often a
member of the board of directors and is a key interface between
the board and opera-tions. The CEO also represents the
organization to key stakeholders, including regulatory
authorities and community groups. A competent CEO
emphasizes organizational transformation by envisioning,
energizing, and fostering change. Analytical thinking, a
community orientation, innovative thinking, and strategic
planning are essential to this focus. At the execution level,
CEOs must demonstrate an ability to manage change,
communicate, influence staff, and measure performance. They
also need to dem-onstrate excellent people skills; they must
build relationships, uphold professional ethics, develop talent,
and lead teams (Calhoun et al. 2008). Most important, CEOs
should focus on organizational values, direction, and
performance expectations.
MLA (Modern Language Assoc.)
Harrison, Jeffrey, and Association of University Programs in
Health Administration. Essentials of Strategic Planning in
Healthcare. Health Administration Press, 2010.
APA (American Psychological Assoc.)
Harrison, J., & Association of University Programs in Health
Administration. (2010). Essentials of Strategic Planning in
Healthcare. Chicago, Ill: Health Administration Press.
Strategic Management in Healthcare
Evidence-Based Care Sheet

7. By: Hillary Mennella, DNP, ANCC-BC
Cinahl Information Systems, Glendale, CA
Nathalie Smith, RN, MSN, CNP
Cinahl Information Systems, Glendale, CA
Edited by: Diane Pravikoff, RN, PhD, FAAN
Cinahl Information Systems, Glendale, CA
What We Know
· The concept of strategicmanagement was introduced in the
1950s in the business sector of certain industries (e.g., the
automotive industry) as a result of long-term planning to
forecast operating budgets. Healthcare organizations did not
utilize strategicmanagement because they were independent
entities that were reimbursed on a cost-plus basis. As the
healthcare industry became more complex in the 1980s and
1990s, traditional methods of management were no longer
appropriate. Although strategicmanagement in healthcare is a
concept that was adopted during the last 30–35 years, a gold-
standard definition for the concept is lacking in the literature. It
is generally believed that strategicmanagement in the healthcare
industry continues to be underutilized in both private and public
healthcare sectors(3,5,7,8,9,10)
· Strategicmanagement is specific to each organization and is
influenced by the unique culture of staff members,
organizational needs, and the external environment.
Strategicmanagement should be flexible and evident in all
levels of the organization. In general, strategicmanagement can
be defined as a framework or a philosophy that(3,5,7,8,9,10)
· unites the organization with a common sense of purpose and
shared values(10)
· encourages innovation and change
· provides the organization with a clearly defined self-concept,
goals, and the ability to recognize the need for change based on
external dynamic factors (e.g., economic factors)
· provides an organization with external information for
planning of activities regarding the organization’s direction and
changes that should be made

8. · enhances overall coordination in the organization
· assists healthcare organizations in responding to state and
federal health policies and legislative initiatives to improve
quality of care and provide cost-effective care
· The three elements of strategicmanagement are strategic
thinking, strategicplanning, and management of strategic
momentum. Incorporating these elements in the process of
strategicmanagement is critical to remaining competitive with
social, technologic, political, and economic forces in the rapidly
changing healthcare industry(5,10)
· Strategic thinking is an individual and intellectual process that
involves generating new ideas, analyzing current assumptions
and activities, envisioning the future and assessing the need for
change, and forecasting the organization’s fit with external
forces(8)
· Strategicplanning is a key function of the management process
and involves developing activities that will enable the
achievement of the organization’s mission and vision. (For more
information on strategicplanning, see Evidence-Based Care
Sheet...Strategic Planning). Strategicplanning involves the
following:(10)
· Defining the purpose of the organization and its focus
· Establishing realistic goals and objectives that are in
alignment with the mission statement of the organization
· Goals are measurable, obtainable, and retrievable. Objectives
are more specific than goals and are designed to identify how
and when goals will be achieved
· Identifying external stakeholders and evaluating their
assessment of the organization’s purposes and operations
· Communicating goals and objectives to the organization’s
constituents
· Creating a sense of ownership of the strategic plan
· Developing specific, simple, flexible, and realistic strategic
action plans to obtain goals
· Utilizing the organization’s resources in the most effective
manner

9. · Measuring progress
· Devising and initiating strategies for change based on
information, as necessary
· Developing a consensus regarding the future of the
organization
· Managing strategic momentum involves monitoring the
performance of daily activities and tasks that are identified in
each strategy as being necessary to reach the organization’s
goals and objectives; this is usually the most challenging aspect
of strategicmanagement. Strategic momentum involves the
actual work to be accomplished and evaluation of performance.
Effective strategic momentum involves a learning process that
relies on new strategic thinking and periodically performing
new strategicplanning
· All members of the healthcare organization, not just upper-
level management and executives, should be involved in
strategic thinking, strategicplanning, and managing of strategic
momentum for successful strategicmanagement(5)
· Healthcare organizations often utilize separate processes for
developing goals related to patient satisfaction, financial
budgeting, and organizational planning. Although challenging,
strategicmanagement can be used to identify patient
expectations as a first step in unifying the organization’s
budgeting and planning processes by balancing patient value
and cost (e.g., patient loyalty, cost of services). Effective
strategicmanagement necessitates that upper-level management
understand patient concerns and perspectives at the
departmental level, and the department managers should have a
clear understanding of the organization’s mission and vision
created by upper-level management. Strategicmanagement
involves participation in the following overlapping concepts:(8)
· Planning for what the organization wishes to accomplish by
organizing and controlling assets; this step includes assessment
of organizational goals and resources as they relate to the needs
of the community
· Identifying areas of patient satisfaction and values to produce

10. customer-valued goods and services; the organization should
consider what patients want and what patients need
· Budgeting to tie future resource utilization with the work
performed; resource allocation plans should be financially
stable
· Healthcare systems are moving away from acquisition or
management of physical assets to capital planning. Capital
planning is a strategicmanagement tool that augments existing
patient services by developing additional services or expanding
to wider geographic markets. Capital planning requires review
of the health system’s long-term goals, projected needs (e.g.,
equipment), debt, and current and potential financial resources,
and the projected time frame for spending(11)
· Misidentification of organizational goals by improper data
analysis can hamper strategicmanagement and adversely impact
quality of care. Researchers have proposed using specially-
designed analytic methods to evaluate “big data” (i.e., very
large data sets) to identify clinical trends and future goals in
healthcare organizations while conserving resources to achieve
maximum strategic impact(4)
· Nurse managers should be more involved in the process of
strategicmanagement. Investigators in a focus group study
regarding nurse managers’ perceptions of implementing a health
information technology (HIT) system found that nurse managers
are often overburdened as a result of having only a fragmented
concept of strategicmanagement. The following five categories
were identified by nurse managers to describe issues related to
strategicmanagement of the implementation of a HIT system:(9)
· HIT should be made an emphasis of strategy, and nurse
managers should be trained in the HIT system; the nurse
managers felt they had a duty to use the HIT system
· There was a lack of strategicmanagement of information
systems (e.g., underutilization of information systems in the
organization)
· Problems in privacy protection and confidentiality were
identified in HIT systems

11. · Although nursing manager roles were strengthened,
implementation of the HIT system required strong management
skills. For example, some nursing managers had to convince
staff members that the HIT system was necessary
· Problems of cost in HIT were identified. For example, the
nurse managers thought that the HIT system was expensive
compared to its benefits
· In a review of the literature, authors concluded that the
concept of strategicmanagement is unclear to nurse managers,
who have little control over strategies that drive the
organization. Many healthcare organizations utilize a
strategicmanagement framework that focuses on profit-making
as a goal; nurse managers should review the evidence in the
literature regarding strategicmanagement in order to understand
how profit-making goals can be implemented using a patient-
focused approach(7)
· A balanced scorecard (BSC), introduced to the health sector in
1992, is a performance measurement tool to assist organizations
in implementing a strategicmanagement plan into operation;
BSCs can be customized to specific healthcare organizations’
goals and missions. Key performance indicators (KPIs; e.g.,
patient wait times) are developed to monitor organizational
performance, improvement, and strategic alignment. Large
organizations with numerous departments may require larger
sets of KPIs to evaluate all strategic objectives(2)
· Healthcare organizations can implement flexible work
schedules as a strategicmanagement decision to retain and
engage employees(1,6)
· As a result of the aging global population, there is a nursing
shortage; there are substantial costs involved in training and
replacing experienced nurses who leave the profession. Nurse
executives should implement strategies to retain older nurses ≥
45 years of age with high skill sets to successfully manage
nursing workforce shortages. Strategies might include offering
fewer or shorter shifts per week, minimizing physical labor,
providing workplace exercise programs, and communicating

12. value to the nursing profession and within the healthcare
organization(6)
· In a multisample study of 695 employees in 12 departments of
9 large organizations, investigators found that organizations
that provided flexibility for their employees’ work and non-
work life demands (e.g., extra unpaid vacation days, input
regarding overtime hours, flexible work schedules) achieved
positive outcomes related to employee engagement and job
performance(1)
What We Can Do
· Learn about strategicmanagement in healthcare so you can
better understand your organization’s mission, vision, goals,
and objectives; share this information with your colleagues
· Collaborate with your organization’s managers to
· review your organization’s mission, vision, goals, and
objectives to verify they are up to date and aligned with the
changing external forces of the healthcare industry and with
nursing management
· develop a framework for strategicplanning and management in
accordance with evidence-based research
· identify strategicmanagement strategies that involve a patient-
focused approach for change and improvement
· implement and manage activities to maintain strategic
momentum
· periodically review strategic thinking and strategic plans and
revise, as appropriate
References
1. Bal, P. M., & De Lange, A. H. (2015). From flexibility
human resources management to employee engagement and
perceived job performance across the lifespan: A multisample
study. Journal of Occupational & Organizational Psychology,
88(1), 126-154. doi:10.1111/joop.12082 (R)
2. Behrouzi, F., Shaharoun, A. M., & Ma'aram, A. (2014).
Applications of the balanced scorecard for strategicmanagement
and performance measurement in the health sector. Australian
Health Review, 38(2), 208-217. doi:10.1071/AH13170 (RV)

13. 3. Carney, M. (2009). Enhancing the nurses’ role in healthcare
delivery through strategicmanagement: Recognizing its
importance or not? Journal of Nursing Management, 17(6), 707-
717. doi:10.1111/j.1365-2834.2009.01018.x (RV)
4. Desai, S. S., Wilkerson, J., & Roberts, T. (2016). Improving
the success of strategicmanagement using big data. World
Hospitals and Health Services, 52(1), 49-51. (R)