Care Setting Environmental Analysis Scoring GuideCRITERIA .docx

Care Setting Environmental Analysis Scoring Guide
CRITERIA NON-PERFORMANCE BASIC PROFICIENT
DISTINGUISHED
Synthesize stories and
evidence about times when
a care setting performed at
its best with regard to
quality and safety goals.
Does not list stories and
evidence about times
when a care setting
performed at its best with
regard to quality and
safety goals.
Lists but does not synthesize
stories and evidence, or fails to
clearly relate stories and
evidence to quality and safety
goals.
Synthesizes stories and
evidence about times when
a care setting performed at
its best with regard to
quality and safety goals.
Synthesizes stories and evidence
about times when a care setting

performed at its best with regard to
quality and safety goals. Identifies
knowledge gaps, unknowns, missing
information, unanswered questions,
or areas of uncertainty (where
further information could improve the
synthesis).
Propose positive, attainable
quality and safety
improvement goals for a
care setting.
Does not propose positive
goals for a care setting.
Proposed goals are positive
but not attainable, or will not
lead to ethical and culturally
sensitive improvement of
organizational quality and
safety, or are not clearly
aligned with the care setting’s
mission, vision, and values.
Proposes positive,
attainable quality and
safety improvement goals
for a care setting.
Proposes positive, attainable quality
and safety improvement goals for a
care setting, and identifies
assumptions on which proposed
goals are based.

Conduct a SWOT analysis
of a care setting, with
respect to quality and safety
goals.
Does not present the
findings of a SWOT
analysis of a care setting.
Conducts a SWOT analysis of
a care setting that is not clearly
focused on quality and safety
goals.
Conducts a SWOT analysis
of a care setting, with
respect to quality and
safety goals.
Conducts a SWOT analysis of a care
setting, with respect to quality and
safety goals, and impartially
considers conflicting data and other
perspectives.
Describe an area of concern
identified in a SWOT
analysis—relevant to a care
setting's mission, vision,
and values—that should be
improved.
Does not describe an
area of concern identified
in a SWOT analysis that
should be improved.

Describes an area of concern
identified in a SWOT analysis,
but does not show its relevance
to a care setting's mission,
vision, and values.
Describes an area of
concern identified in a
SWOT analysis—relevant
to a care setting's mission,
vision, and values—that
should be improved.
Describes an area of concern
identified in a SWOT analysis—
relevant to a care setting's mission,
vision, and values—that should be
improved. Identifies criteria that
could be used to evaluate such an
improvement.
Compare the AI and SWOT
approaches to analysis with
regard to data gathering and
interactions with others.
Does not describe data
gathering and interactions
with others.
Describes data gathering and
interactions with others, but
does not compare these
activities using an AI and
SWOT approach to analysis.

Compares the AI and
SWOT approaches to
analysis with regard to data
gathering and interactions
with others.
Compares the AI and SWOT
approaches to analysis with regard
to data gathering and interactions
with others, and acknowledges one’s
own assumptions and biases.
Analyze the leadership
characteristics and skills
most desired in the person
leading potential
Does not analyze
leadership characteristics
and skills most desired in
the person leading
Analyzes leadership
characteristics and skills most
desired in the person leading
potential performance
Analyzes the leadership
characteristics and skills
most desired in the person
leading potential
Analyzes the leadership
characteristics and skills most
desired in the person leading

potential performance improvement
CRITERIA NON-PERFORMANCE BASIC PROFICIENT
DISTINGUISHED
performance improvement
projects, taking both an AI
and SWOT approach.
potential performance
improvement projects.
improvement projects, but does
not clearly distinguish between
an AI and SWOT approach.
performance improvement
projects, taking both an AI
and SWOT approach.
projects, taking both an AI and
SWOT approach. Identifies areas of
uncertainty or knowledge gaps.
Communicate analyses
clearly and in a way that
demonstrates
professionalism and respect
for stakeholders and
colleagues.
Does not communicate
analyses clearly and in a
way that demonstrates
professionalism and

respect for stakeholders
and colleagues.
Communication is not
consistently clear and
professional; errors in grammar
or mechanics distract from the
message, or communication
lacks respect for stakeholders
or colleagues.
Communicates analyses
clearly and in a way that
demonstrates
professionalism and
respect for stakeholders
and colleagues.
Communicates analyses clearly,
logically, and persuasively,
demonstrating professionalism and
respect for stakeholders and
colleagues. Grammar and
mechanics are virtually error-free.
Integrate relevant and
credible sources of
evidence to support
assertions, correctly
formatting citations and
references using APA style.
Does not integrate
relevant and credible
sources of evidence to
support assertions; does

not correctly format
citations and references
using APA style.
Sources lack relevance or
credibility, are poorly
integrated, or are incorrectly
formatted.
Integrates relevant and
credible sources of
evidence to support
assertions, correctly
formatting citations and
references using APA style.
Integrates relevant and credible
sources of evidence to support
assertions, correctly formatting
citations and references using APA
style. Citations are error-free.
Case Study: Mr. Roth
Teacher: Mr. Roth
Teacher Experience: 4 Years
Grade: 11
Subject: U.S. History
You arrive at Mr. Roth’s classroom 3 minutes before the bell
rings. You observe Mr. Roth in the doorway of the classroom
greeting students by name as they come in. You hear him
talking with students about non-curricular topics such as how
the game went last night and asking about their weekend plans.
Students spoke freely with Mr. Roth and seemed genuinely

engaged in their short conversations with him. While waiting
for the bell to ring you noticed posters on the wall regarding
historical figures and events as well as a small area with student
created political cartoons depicting the different freedoms
outlined in the Bill of Rights.
When the bell rang, most students were seated at their desks.
Mr. Roth put up a bell ringer question of the day that asked
students to summarize the power of the Judicial Branch in their
own words and to react to the following statement: “The
Judicial Branch is the most powerful branch of government.”
Most students took out a blank sheet of paper and began to
work. Two students were slow to get started. Mr. Roth moved
over to each student individually and softly reminded them of
the expectations. After being addressed by Mr. Roth, both
students immediately got their materials out and began working.
As the students were working, Mr. Roth took attendance, and
met with a student that was absent the day before regarding
make-up assignments. He then moved throughout the room and
looked over students’ shoulders as they were responding. After
approximately seven minutes, he asked the class for volunteers
that wanted to share what they had written. Several students
raised their hands and shared their responses. Mr. Roth
commented briefly on each response and called on two students
randomly as well to share what they had written. He then asked
students to clear their desks and take out a pen.
Mr. Roth announced to the students that although they had
already learned that the Judicial Branch interprets the
Constitution, it is important to know where and how the
Supreme Court actually acquired this power. He then distributed
a summary and guiding questions on the case, Marbury vs.
Madison (1789). Mr. Roth shared the day’s objective: Students
will be able to explain the concept of Judicial Review and how
the case of Marbury v. Madison established this power of the
Supreme Court. Prior to reading, he asked students to skim the
summary and look for key words, titles, etc. that would give
them an indication of what the case was about. This activity

lasted 3 minutes. He then asked them to share their predictions
with their neighbor. As the students did this, Mr. Roth moved
through the class and listened in on the conversations. Next, he
chose a few vocabulary words from the summary that he thought
many of the students would need clarified and were essential to
fully understanding the reading. He briefly went over those with
the class and checked for understanding by asking students to
provide synonyms for the words, first individually and then
sharing their words with the class.
Next, he broke the class into small groups of 3-4 students per
group based on their proximity to each other. Students moved
quickly into their groups with little loss of instructional time.
When the groups were formed, he told the students they had 10
minutes to read the summary and answer the guiding questions.
During the independent reading portion, he moved around the
room to answer any questions about the reading and check to
see how students were progressing through the questions. Two
of the groups started to get off-task and chatty, but when
redirected by Mr. Roth they returned to their work quickly.
After all of the students had completed the reading and were
working on the questions, Mr. Roth told the class they could
now talk about the questions in their small groups. Students
could either choose to write down the answers that were
discussed in the group, or their own answers if they were not in
agreement with their group's answers.
After the students had answered the questions collaboratively,
Mr. Roth got the students attention at the front of the room, by
stating, “let’s come together and discuss your answers.” He
assigned each group one or two questions they would need to
share with the class. As each group shared their answers, he
asked if the entire group agreed with the answer and called on
other groups randomly to share whether they agreed or
disagreed and how the answer given differed from their group's
answer. During this activity, Mr. Roth also reinforced key
concepts.
To conclude the lesson, Mr. Roth asked students to go back to

their bell ringer question and see if they still felt the same about
their answer regarding whether the Judicial Branch, specifically
the Supreme Court was the most powerful branch of
government. As a ticket out the door, he asked each student to
predict what our government or the U.S. as a whole might look
like if Marbury v. Madison was decided the other way and if
Judicial Review did not exist. Mr. Roth collected these
responses as the students exited the classroom.
© 2019. Grand Canyon University. All Rights Reserved.
image1.jpeg
1
Care Setting Environmental Analysis: Wound Center
Alexandra Sanders
Capella University
NURS-FPX6210 Leadership and Management for Nurse
Executives
Dr. Mary Ellen Cockerham
October 11, 2021
2
Care Setting Environmental Analysis: Wound Center

The Wound Center (WC) at Regional Medical Center (RMC) in
Orangeburg, SC, was
one of the departments with the highest retention and
satisfaction rates in the entire hospital.
Although it was one of the smaller departments in the hospital,
it treated over 60 patients a day
in the clins=c and at least 2o inpatients a day. The WC staff
was comprised of an infectious
disease/certified wound specialty physician, a certified wound,
ostomy, continence nurse
practitioner, seven registered nurses all certified in would care
with two also certified in ostomy
care, a physical therapist with two assists, a medical office
assistant and front desk staff. The
clinic had long wait times and long hours, but the clinic had
little to no team turnover. This paper
will analyze how the clinic kept its staff retention high by
looking at the discovery and dream
phases of Appreciative Inquiry and conducting a strengths,
weakness, opportunity, and threats
(SWOT) analysis.
Synthesizing Stories
The center was an ambulatory care setting that saw patients
from the community,

local nursing facilities, and transfers from other hospitals in the
outpatient setting. The staff was
also responsible for treating any inpatient with a wound or
needing specialized care from the
WOCN. With such a heavy patient load, there were times that
the staff would work upwards of
14 hours a day, five days a week, and patients would leave
without being seen due to the long
wait times in the clinic. A patient's experience at a clinic can
determine their perspective on their
treatment and experience overall (Le et al., 2019). Although the
days were long and hard, the
staff retention in this department was 100%. How did a
department that saw nearly as many
patients as emergency departments, work long hours, and rarely
get breaks, manage to keep
3
100% retention? A survey was conducted that asked several
questions regarding retention and
what made this clinic run so smoothly. Many of the employees
stated that they stayed because of
the teamwork. When rooms got backed up, other staff would

pitch in and lend a hand. The front
desk staff said that they would keep the patients in the waiting
room updated on the progress in
the back and let them know how long their wait would be; they
felt this helped to keep the
waiting room satisfied with their wait time if they knew how
much longer they would be waiting.
One staff member decided that instead of having patients have
their vital signs and questions
asked about updates in medicines and medical history done in
the room with a nurse, she would
begin the process in an alcove in the clinic. She would check
vital signs and blood sugars and
update medications and new problems before taking patients to
rooms. This made the patient feel
like their visit had started, and they were one step closer to
seeing the doctor or nurse
practitioner. It broke up the wait time and made it seem shorter
since they had already had
contact with a staff member. Identifying these patient
bottlenecks helps with workflow and
patient and staff satisfaction. By maximizing efficiency, health
care systems have taken
principles f the LEAN Sigma Six strategies and adapted them to

their setting (Amerine et al.,
2017). This method worked well in the clinic setting at RMC.
The team members stated that they felt like a family. They had
all been working together
for about five years, and there was a genuine camaraderie
among them. Their retention was so
high because they knew each other's work ethic, and each
member had their particular skill that
kept the team moving forward. They were all high achievers and
hard workers. They thrived in
the chaos and business of the clinic. One staff member shared
that the staff that works in the
clinic were handpicked. When inpatient rounds were made, the
nurses would watch the floor
staff and see who made an effort to assist the clinic nurses, who
would ask them questions about
4
the wound and ostomy care, how did the patients present: were
they clean and dry, was their
dressing changed, was their room neat, little things that would
tell the clinic nurses a little insight
in the floor nurses care. By handpicking the staff, they knew

that they would get a high-caliber
team to work with, and by watching and interacting with staff,
they got a feel for if the potential
staff would make a good fit in the clinic and if they would stay
for years. Retention is dependent
on factors like workload, effective collaboration, professional
solid practice roles, and a healthy
work environment (Susan Trossman, n.d.) RMC is having a
significant nursing turnover and
issue with retention. They have requested an evaluation of how
the WC could keep their nursing
staff and reduce turnover. The goal is to increase nursing
retention on the units and increase staff
satisfaction. To effectively evaluate the possibility for the
facility to increase nurse retention, the
use of Appreciative Inquiry (AI) and SWOT analysis will be
used to review nursing turnover
rates and facilitate ways to improve nurse retention and
recruitment. Upon completion of the
analysis documentation, the results will be submitted to upper
management for review and
presentation to the board.
Appreciative Inquiry Discovery and Dream

What is Appreciative Inquiry (AI)? AI creates change by asking
intentional questions
focusing on discovery, dream, design, and destiny (MacCoy,
2014). AI looks for the best in
people, the organization, and the strengths (AI Commons,
2015). The first two phases of AI were
used in assessing the WC. During the discovery phase, it was
found that the WC had high
retention rates of their staff. The staff cared for more than 60
patients a day that included
inpatients and outpatients. All the clinical team is board-
certified, and ancillary staff all had
previous experience in a clinic setting. Patient care safety is a
number one goal for all health
care facilities. Having a high nurse retention rate shows that the
staff you have The WC is
5
known for its excellent care, and the only advertisement it
receives is word of mouth from
present and former patients. Hospital Consumer Assessment of
Healthcare Providers and
Systems (HCAHPS) data, provided by facility management,
shows this department, clinic, has

been in the top percentile for patient and staff satisfaction for
the past ten years. As mentioned
above, staff find that their teamwork and innovative ideas keep
them at the clinic and keep
patients happy. The team has the skill of engagement; they are
compassionate, energetic, and
love their job. They are fully vested in their work. The WC
staff reported the following positive
engagement experiences: 1) I understand what is expected of me
from my supervisor; 2) We
deliver high-quality care and are rewarded for such;3) the
employees in this department have
mutual respect for one another and their opinions and protect
one another, and the patients;4) the
physician and nurse practitioner value my opinion and are ever
ready to teach and give
constructive criticism; 5) I enjoy working with my team; 6) I am
encouraged to grow
professionally through education, research, and publications.
Nursing managememt at RMC must formulate an action plan to
promote nursing
retention throughout the hospital and use the WC as a model.
All nursing staff needs to make an

effort to stay informed and express their ideas and desires to
help with retention. This can be
done by attending and contributing to monthly staff meetings,
attend council meetings, read
nursing bulletin boards, and participate in upcoming continuing
education, to name a few.
All healthcare institutions have similar missions, to care for
their community, but the WC
also has a mission related to their staff. Their mission is to
make everyday fun while working
together as a team and teach something new every day, whether
to staff or patients. The dream
phase of the AI approach leads to several opportunities to create
a mission for the RMC staff as a
whole and increase nurse retention at the facility. Nurse
retention is a current problem for RMC,
6
even before COVID. The dream phase includes bonuses for
nurses who have been at the facility
for five or more years, in-house continuing education to meet
state education requirements,
tuition reimbursement, and merit/ Press Gainey raise increases
every year. Using AI, the facility

will identify what is working well, define why it is working
well, and clarify how to continue it
(Halm & Crusoe, 2018).
Strengths, Weakness, Opportunities, and
Threats(SWOT)Analysis
There are four elements to the SWOT analysis approach:
strengths, weaknesses,
opportunities, and threats (Hollingsworth & Reynolds, 2020).
Strengths and opportunities are
internal factors that help the WC achieve the goal of 100%
retention. Weaknesses and threats are
external factors that prevent goals from being completed.
Leadership should conduct a SWOT analysis on a yearly or even
as-needed basis. It
should occur when nurse retention and recruiting, patient
satisfaction, or safety issues are
identified ( Hollingworth & Reynolds, 2020). The assessment
usually includes managers and
other stakeholders, like nursing, physicians, and clerical
assistants in this setting who have a
vested interest in the organization. A SWOT analysis can ensure
a valuable and correct
connection between management and the internal and external

environment of the healthcare
setting (Swysen et al., 2012).
Leadership wants nurse retention to improve and has seen that
high retention is possible
at RMC, as evidenced by the 100% retention rate of the WC. A
SWOT analysis was conducted
during a strategic planning meeting to decide if this was a
workable plan. The strengths were
noted as 1) the WC has been around since 1998 and has only
added staff, 2) the community
needs RMC as it is the closest hospital 3) the hospital has an
affiliation with the local technical
school and therefore has access to new nurse graduates, and 4)
the WC traits can easily be
7
reproduced to assist with nurse retention. The weaknesses
identified by the team include 1)
RMC does not have the best reputation for patient care due to
nursing shortage, 2)there are no
competitive wages to keep nurses, 3) the benefits program does
not include an appealing
retirement process, 4) there is little promotion from within to

keep nurses from wanted to climb
the ladder. Even though these weaknesses are significant, the
opportunities are ample. The
identified opportunities are 1) use the new graduates to fill
nursing positions as they have done
their clinicals here and are familiar with the culture, 2) add a
sign-on bonus plan and competitive
wage program and referral bonuses to entice staff to come and
stay, 3) include state retirement as
the hospital is affiliated with the county and state government,
and 4) implement a program to
teach staff about the management positions in the hospital and
promote from within the hospital.
Lastly, the threats that may impede this plan are as follows: 1)
larger hospitals are 30 minutes
from RMC and already offer higher wages and bonuses, 2)
Fewer students are applying for
nursing school at the local college, 3) the new CEO and CNO
are not from this area and have not
learned the RMC way, and 4) former employees are getting
bonuses to get new hires to the other
hospitals and taking staff from RMC.
It is essential to focus on the positives of this analysis and
consider the implications for

safety and quality. Patient safety is the most prominent area of
concern. Having issues with nurse
retention comes the risk of patient safety, staff burnout, and
increased nurse-to-patient ratios that
are not attractive to potential employees. Leadership must
decide if it is fiscally and financially
possible to give raises and sign-on bonuses. If these areas
cannot be implemented, nurses will go
elsewhere, mainly because low staffing means higher ratios.
AI and SWOT Comparison
8
Both AI and SWOT work to create improvements in processes
and outcomes. AI focuses
on positivity and increased value. It can be used to promote
workforce engagement and learning
within the organization and promote positive change in a health
care context (Trajkovski et al.,
2013). Focusing on what is working can help promote positive
change. AI involves interviewing
the involved persons and collecting data using open-ended
questions (MacCoy, 2014). SWOT

analysis is a systematic way of thinking and exploring areas for
development in your field,
resource usage (including physical, personal, and intellectual
resources), and areas of
vulnerability needing improvement or expansion ("Strengths,
Weaknesses, Opportunities, and
Threats," 2008). While both tools use specific and relevant
components for data collection, AI
focuses on positivity. SWOT only looks at factors at a certain
point in time and times change the
SWOT analysis does not allow for the changes.
Leadership Skills
Transformational leadership is one of the most used styles in
healthcare (The University
of Alabama Huntsville, n.d.). Transformational leadership can
be defined as "an ethically-based
leadership model that integrates a commitment to values and
outcomes by optimizing the long-
term interests of stakeholders and society and honoring the
moral duties owed by organizations
to their stakeholders (Caldwell, 2012). Transformational
leaders are proactive, seeking mutually
beneficial opportunities for both the organization and the
individual team members. They seek to

promote success in the workplace by making changes.
Transformational leaders are excellent at
influencing others, which makes it easy for people to
manipulate a situation, and since they
spend a lot of time helping team members, they can be seen as
showing favoritism, also
transformational leaders focus on long term goals and may lose
sight of the details along the way
(Indeed Editorial Team, n.d).
9
The AI approach, which focuses on positive and affective
aspects of a project, and the
transformational leadership style that focuses on an individual's
knowledge and expertise are
both supportive and innate combinations. The transformational
approach looks at the group as a
whole while also giving attention to individuals as needed.
Transformational leaders engage the
group
For the SWOT approach, transformational leaders can be
influential as they look at

strengths and weaknesses, opportunities and threats for a project
that requires open
communication. With a mutual goal of satisfying the
stakeholders, SWOT analysis and
transformational leaders work well.
Conclusion
While AI and SWOT analysis are different assessment tools,
they share the common goal
of pursuing growth opportunities. Both assessments are sources
of truth during the strategic
planning process; however, over-emphasis for either evaluation
may lead to a skewed prediction.
A skilled transformational leader can evaluate existing or
planned programs using analytical
tools and effectively design a financially viable plan and
supportive of high-quality outcomes.
Using the WC as a model for nurse retention, RMC should
recruit nurses and retain those nurses
for years to come.
10

11
References
AI Commons. (2015). Appreciative inquiry commons - the
appreciative inquiry commons. The
Appreciative Inquiry Commons.
https://appreciativeinquiry.champlain.edu/
Amerine, J. P., Khan, T., & Crisp, B. (2017). Improvement of
patient wait times in an outpatient
pharmacy. American Journal of Health-System Pharmacy,
74(13), 958–961.
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Caldwell, C. (2012). Moral leadership: A transformative model
for tomorrow's leaders (strategic
management collection). Business Expert Press.
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al-leadership-
transformative-model-tomorrows-leaders/
Halm, M. A., & Crusoe, K. (2018). Keeping the magnet flame
alive with appreciative inquiry.
JONA: The Journal of Nursing Administration, 48(6), 323–328.
https://doi.org/doi:
10.1097/NNA.0000000000000622

Hollingsworth, A., & Reynolds, M. (2020). The ED nurse
manager's guide to utilizing SWOT
analysis for performance improvement. Journal of Emergency
Nursing, 46(3), 368–372.
https://doi.org/10.1016/j.jen.2020.02.006
Indeed Editorial Team. (n.d.). Common weaknesses of
transformational leadership and how to
avoid them. https://www.indeed.com. Common Weaknesses of
Transformational
Leadership and How To Avoid Them
Le, V., Wagar, E. A., Phipps, R. A., Del Guidice, R. E., Le, H.,
& Middleton, L. P. (2019).
Improving patient experience of wait times and courtesy
through electronic sign-in and
notification in the phlebotomy clinic. Archives of Pathology &
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leadership.aspx
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https://doi.org/10.3138/cjpe.29.2.104Synthesizing
StoriesAppreciative Inquiry Discovery and DreamStrengths,
Weakness, Opportunities, and Threats(SWOT)AnalysisAI and
SWOT ComparisonLeadership SkillsConclusionReferences

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