5 Establishing Organizational Objectives
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Ah, but a man’s reach should exceed his grasp,
Or what’s a heaven for?
—Robert Browning
Learning Objectives
After reading this chapter, you should be able to do the following:
• Describe the nature of objectives and the important role of—and management by—objectives in an HCO.
• Discuss the characteristics of good objectives.
• Delineate the types of objectives that are included in a strategic plan, and include examples of objectives for
key result areas.
• Provide an example of how to use data from an internal and external environmental analysis to set good
objectives.
• Explain how to perform a periodic review of objectives for measuring progress and making updates
as needed.
Section 5.1The Nature and Role of Objectives
Introduction
An HCO cannot achieve goals if none exist for the organization. Although this idea is quite
simple, many people overlook it. To accomplish anything, an organization must have a clear
understanding of what is to be accomplished. Strategic objectives are the tool by which
organizations define their goals and sketch out a specific road map for achieving them. If we
fail to set specific objectives, we simply waste our time and energy by going in circles. Later,
we look back at what we accomplished and wonder where the time went. Just being busy and
involved in activities does not mean that we are accomplishing what we need to accomplish.
This chapter focuses on the need to establish objectives, the characteristics of good objec-
tives, and the process of writing objectives. After the vision and mission of the HCO have been
defined, and the internal and external analyses completed, relevant objectives are developed
for the strategic plan.
5.1 The Nature and Role of Objectives
Objectives can be defined as clear, concise written statements outlining what is to be accom-
plished in key result areas in a certain time period, in measurable terms. Peter Drucker argues
that “objectives are not fate; they are direction. They are not commands, but they are com-
mitments. They do not determine the future, but they are the means by which the resources
and energies of the operation can be mobilized for the making of the future” (Drucker, 1954,
p. 102).
As noted in Chapter 2, the words key results, goals, and targets often are used synonymously
when talking about short- and long-term objectives. Whatever the label used, the idea is to
focus on a specific set of target activities and outcomes to be accomplished. Think of the anal-
ogy of the archer used in Chapter 2. An HCO administrator wants the whole organization
aimed at a single target, just as an archer wants every arrow aimed at the bull’s-eye. People
get confused and disorganized if they do not know where they are going. In large measure,
the success or failure of an HCO is based on its ability to set goals, as well as on tools with
which to measure progress toward those.
This wonderful and helpful
A company description is an overview of the company's plan, vision, and relationships. These documents typically include the company's name, business structure, mission statement, and an overview of the target mark
Communicate the story of your business and why you started it. Describe the customers or the cause that your business serves. Explain your business model or how your products are made. Put a face to your business, featuring the founders or the people on your team.
This wonderful and helpful
A company description is an overview of the company's plan, vision, and relationships. These documents typically include the company's name, business structure, mission statement, and an overview of the target mark
Communicate the story of your business and why you started it. Describe the customers or the cause that your business serves. Explain your business model or how your products are made. Put a face to your business, featuring the founders or the people on your team.
Ashford 5: - Week 4 - Assignment
Human Resource Planning and Organizational Strategy
In a four- to five-page paper (excluding the title and references pages), discuss the relationship between human resource planning activities and the organization’s strategic development and implementation. Describe the eight elements of the staffing process. Examine the relationship between the eight elements of the staffing process and the four activities related to human resource planning.
Based on the information presented in Figure 10.5, review the human resource planning process and the previous readings from Chapters 4 and 8. Explain the relationship between the four activities of human resource planning and the organization’s strategic planning, development, and implementation.
Your paper should include in-text citations and references for at least three scholarly sources, in addition to the text, and be formatted according to APA style as outlined in the
Ashford Writing Center
.
Carefully review the
Grading Rubric
for the criteria that will be used to evaluate your assignment.
FIGURE 10.5 Human resource planning process
(Plunkett 330-331)
Plunkett, Warren R., Gemmy Allen, Raymond Attner. Management. Cengage Learning, 01/2012. VitalBook file.
CHAPTER 4 PLANNING AND STRATEGY
LEARNING OBJECTIVES
After studying this chapter, you should be able to:
1 Explain the importance of planning
2 Differentiate between strategic, tactical, operational, and contingency plans
3 List and explain the steps in a basic planning process
4 Discuss various ways to make plans effective
5 Distinguish between strategic planning, strategic management, strategy formulation, and strategy implementation
6 Explain the steps involved in the strategic planning process
7 Explain the formulation of corporate-level strategy, business-level strategy, and functional-level strategy
SELF-MANAGEMENT
Strategic Thinking
What do you want to accomplish with your life? To be successful, you need to be proactive, look ahead, anticipate change, and analyze opportunities. In other words, you need to plan and think strategically. This will help you to determine the potential impact of your actions on other individuals. As a result you will make better decisions.
Strategic thinking involves the gathering and use of data to make significant long-term decisions that will affect future business performance. This process requires examination of the mission, core functions and current performance of a business, the industry in which it operates, and the external environment. An important step in becoming a manager is to think strategically. For each of the following statements, circle the number which indicates your level of agreement. Rate your agreement as it is, not what you think it should be. Objectivity will enable you to determine your management skill strengths and weaknesses.
Almost Always
Often
Sometimes
Rarely
Almost Never
I set clear goals for myself.
.
Research SMART goals and other goal setting strategies in the Univ.docxbrittneyj3
Research
SMART goals and other goal setting strategies in the University Library and
review
the "Making SMART Goals Smarter" article located in the
Week 5 Electronic Reserve Readings
.
Refer
to the stages of coaching and mentoring found on pg. 18 of
Student-Centered Coaching
.
Design
a professional learning opportunity for coaches of teachers who need to implement effective instruction in order to meet their students' needs.
Create
an 8- to 10-slide presentation for your professional learning opportunity, in which you address the following:
Identify three possible target areas in which growth may be warranted and provide justification for each area selected.
Write three goals for each target area--two SMART goals and one goal using another goal setting strategy that you discovered.
List strategies for fostering awareness, modeling, and providing motivation during the stages of coaching and mentoring.
Discuss professional learning communities and explain how you might incorporate them as a coach or mentor.
Include
speaker notes, APA-formatted in-text citations, and a reference slide.
Week 5 - readings
Making SMART Goals Smarter Goal-setting In this article… Study the differences between goals and objectives and get some valuable insights on how to use SMART goals in a health care organization. A critical role of leadership is goal setting.1 As our health care system continues to evolve, physician executives will be called upon to play increasingly proactive roles in formulating appropriate goals for their respective health care organizations (HCOs). With what looks like a major perspective shift from provider-driven volume to consumer-driven value,2-4 physician leaders will be entrusted with the responsibility of ensuring high standards of care throughout the extended process of resource realignment. How well they are able to formulate effective goals will have, no doubt, a major influence on the future success of their respective HCOs. In times of system turbulence, goal initiation is usually a far better alternative than goal response. It should be noted initially that, as popular as the concept of SMART goals has become in recent years, it is also somewhat of a misnomer. The terms goals, sub-goals, and objectives are often used interchangeably, which has often been the source of unnecessary confusion, and as goal-setting theory continues to develop as a useful body of knowledge, related application benefits can be markedly improved when their differences are more clearly understood. Together with an HCO’s mission, vision, strategies and tactics, goals and objectives serve as the foundation elements for most major programmatic initiatives. An organization’s mission is basically its reason for being. Its vision describes where it wants to be in the future, and its values are a statement of the principles that form its moral foundation.5 Collectively, they are the basis for devising the supporting goals and object.
is exactly what the name implies. It’s the overall management of a healthcare facility, such as a clinic or hospital. A healthcare manager is in charge of ensuring a healthcare facility is running as it should in terms of budget, the goals of the facility’s practitioners, and the needs of the community. A person in charge of healthcare management oversees the day-to-day operations of the facility.his individual also acts as a spokesperson when providing information to the media. The person in charge of healthcare management also collaborates with medical staff leaders on issues such as medical equipment, department budgets, planning ways to ensure the facility meets their goals, and maintaining a good relationship with doctors, nurses, and all department heads. The healthcare manager also makes decisions about performance evaluations, staff expectations, budgeting, social media updates, and billing. The objective of the Program in Healthcare Management is to train professionals, according to the needs of the healthcare sector, that are committed to basic principles and values of the sector, have knowledge of managerial procedures and practices, and are competent in inpatient/customer relations and communication
Planning - Meaning and Definition – Nature – Objectives – Advantages and Disa...Jumanul Haque
Planning - Meaning and Definition – Nature – Objectives – Advantages and Disadvantages –
Process – Types - Decision Making – Traditional and Modern Techniques – Steps involved in
Decision Making
5 to 8 sentence each 1. Declining marriage rates have led many .docxdomenicacullison
5 to 8 sentence each
1. Declining marriage rates have led many to conclude that Americans no longer place a high value on marriage. Use data and arguments to advocate for and against this conclusion.
2. Discuss the varied causes and ramifications of cohabitation among couples who choose it as a living arrangement before marriage, instead of marriage, or after divorce.
.
5-7 PagesYou will craft individual essays in response to the pro.docxdomenicacullison
5-7 Pages
You will craft individual essays in response to the provided prompts. You must use the current Turabian style with default margins and 12-pt Times New Roman font. For each essay, include a title page and reference page, also in current Turabian format. You must include citations to a sufficient number of appropriate scholarly sources to fully support your assertions and conclusions (which will likely require more than the minimum number of citations). Each paper must contain at least 5 7 scholarly sources
original to this paper
,
The UN— “A More Perfect Union?”
Considering the readings, video presentations, and your own research, draft a quality 6–7-page research paper on the role, legitimacy, and authority of the UN according to the following prompts, answering in a separate or integrated manner as you wish.
Identify at least 3reasons that states might defend the intrinsic legitimacy of the UN as a governing authority. In reverse, identify at least 3reasons that states might criticize its legitimacy and authority.
In short, make an argument for the limits and possibilities of the UN as a legitimate governing authority in a world of sovereign states.
What is the relationship of the UN to the current international system of states?
Considering the reasons for the creation of the UN after WWII, does it seem driven by political necessity or the political utility? In plainer English, do states need the UN more than the UN needs the states? Or do states both large and small find the UN a useful tool for improving their relative power and legitimacy vis-à-vis other states and global institutions? Is there some position in-between?
Using other sources and extra-Scholar sources (The commentaries, teachings, other writings, etc.) to inform your own reasoning, comment on the compatibility with the idea of
World Government
. [
Attention
: The Instructor does not view the question as rhetorical, nor the answer self-evident. So, reason carefully.] For example, if the logic of collective action under the
Articles of Confederation
—the logic of state sovereignty—failed to secure American liberties as well as the ‘more perfect union’, the new Constitution established by the Framers in 1787 to replace it, effectively requiring states to cede sovereignty to a larger collective authority, why would the same logic of collective action not justify the UN as a ‘more perfect union’ to replace an anarchic system of sovereign states putting the world at risk in a nuclear age?
.
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Ashford 5: - Week 4 - Assignment
Human Resource Planning and Organizational Strategy
In a four- to five-page paper (excluding the title and references pages), discuss the relationship between human resource planning activities and the organization’s strategic development and implementation. Describe the eight elements of the staffing process. Examine the relationship between the eight elements of the staffing process and the four activities related to human resource planning.
Based on the information presented in Figure 10.5, review the human resource planning process and the previous readings from Chapters 4 and 8. Explain the relationship between the four activities of human resource planning and the organization’s strategic planning, development, and implementation.
Your paper should include in-text citations and references for at least three scholarly sources, in addition to the text, and be formatted according to APA style as outlined in the
Ashford Writing Center
.
Carefully review the
Grading Rubric
for the criteria that will be used to evaluate your assignment.
FIGURE 10.5 Human resource planning process
(Plunkett 330-331)
Plunkett, Warren R., Gemmy Allen, Raymond Attner. Management. Cengage Learning, 01/2012. VitalBook file.
CHAPTER 4 PLANNING AND STRATEGY
LEARNING OBJECTIVES
After studying this chapter, you should be able to:
1 Explain the importance of planning
2 Differentiate between strategic, tactical, operational, and contingency plans
3 List and explain the steps in a basic planning process
4 Discuss various ways to make plans effective
5 Distinguish between strategic planning, strategic management, strategy formulation, and strategy implementation
6 Explain the steps involved in the strategic planning process
7 Explain the formulation of corporate-level strategy, business-level strategy, and functional-level strategy
SELF-MANAGEMENT
Strategic Thinking
What do you want to accomplish with your life? To be successful, you need to be proactive, look ahead, anticipate change, and analyze opportunities. In other words, you need to plan and think strategically. This will help you to determine the potential impact of your actions on other individuals. As a result you will make better decisions.
Strategic thinking involves the gathering and use of data to make significant long-term decisions that will affect future business performance. This process requires examination of the mission, core functions and current performance of a business, the industry in which it operates, and the external environment. An important step in becoming a manager is to think strategically. For each of the following statements, circle the number which indicates your level of agreement. Rate your agreement as it is, not what you think it should be. Objectivity will enable you to determine your management skill strengths and weaknesses.
Almost Always
Often
Sometimes
Rarely
Almost Never
I set clear goals for myself.
.
Research SMART goals and other goal setting strategies in the Univ.docxbrittneyj3
Research
SMART goals and other goal setting strategies in the University Library and
review
the "Making SMART Goals Smarter" article located in the
Week 5 Electronic Reserve Readings
.
Refer
to the stages of coaching and mentoring found on pg. 18 of
Student-Centered Coaching
.
Design
a professional learning opportunity for coaches of teachers who need to implement effective instruction in order to meet their students' needs.
Create
an 8- to 10-slide presentation for your professional learning opportunity, in which you address the following:
Identify three possible target areas in which growth may be warranted and provide justification for each area selected.
Write three goals for each target area--two SMART goals and one goal using another goal setting strategy that you discovered.
List strategies for fostering awareness, modeling, and providing motivation during the stages of coaching and mentoring.
Discuss professional learning communities and explain how you might incorporate them as a coach or mentor.
Include
speaker notes, APA-formatted in-text citations, and a reference slide.
Week 5 - readings
Making SMART Goals Smarter Goal-setting In this article… Study the differences between goals and objectives and get some valuable insights on how to use SMART goals in a health care organization. A critical role of leadership is goal setting.1 As our health care system continues to evolve, physician executives will be called upon to play increasingly proactive roles in formulating appropriate goals for their respective health care organizations (HCOs). With what looks like a major perspective shift from provider-driven volume to consumer-driven value,2-4 physician leaders will be entrusted with the responsibility of ensuring high standards of care throughout the extended process of resource realignment. How well they are able to formulate effective goals will have, no doubt, a major influence on the future success of their respective HCOs. In times of system turbulence, goal initiation is usually a far better alternative than goal response. It should be noted initially that, as popular as the concept of SMART goals has become in recent years, it is also somewhat of a misnomer. The terms goals, sub-goals, and objectives are often used interchangeably, which has often been the source of unnecessary confusion, and as goal-setting theory continues to develop as a useful body of knowledge, related application benefits can be markedly improved when their differences are more clearly understood. Together with an HCO’s mission, vision, strategies and tactics, goals and objectives serve as the foundation elements for most major programmatic initiatives. An organization’s mission is basically its reason for being. Its vision describes where it wants to be in the future, and its values are a statement of the principles that form its moral foundation.5 Collectively, they are the basis for devising the supporting goals and object.
is exactly what the name implies. It’s the overall management of a healthcare facility, such as a clinic or hospital. A healthcare manager is in charge of ensuring a healthcare facility is running as it should in terms of budget, the goals of the facility’s practitioners, and the needs of the community. A person in charge of healthcare management oversees the day-to-day operations of the facility.his individual also acts as a spokesperson when providing information to the media. The person in charge of healthcare management also collaborates with medical staff leaders on issues such as medical equipment, department budgets, planning ways to ensure the facility meets their goals, and maintaining a good relationship with doctors, nurses, and all department heads. The healthcare manager also makes decisions about performance evaluations, staff expectations, budgeting, social media updates, and billing. The objective of the Program in Healthcare Management is to train professionals, according to the needs of the healthcare sector, that are committed to basic principles and values of the sector, have knowledge of managerial procedures and practices, and are competent in inpatient/customer relations and communication
Planning - Meaning and Definition – Nature – Objectives – Advantages and Disa...Jumanul Haque
Planning - Meaning and Definition – Nature – Objectives – Advantages and Disadvantages –
Process – Types - Decision Making – Traditional and Modern Techniques – Steps involved in
Decision Making
5 to 8 sentence each 1. Declining marriage rates have led many .docxdomenicacullison
5 to 8 sentence each
1. Declining marriage rates have led many to conclude that Americans no longer place a high value on marriage. Use data and arguments to advocate for and against this conclusion.
2. Discuss the varied causes and ramifications of cohabitation among couples who choose it as a living arrangement before marriage, instead of marriage, or after divorce.
.
5-7 PagesYou will craft individual essays in response to the pro.docxdomenicacullison
5-7 Pages
You will craft individual essays in response to the provided prompts. You must use the current Turabian style with default margins and 12-pt Times New Roman font. For each essay, include a title page and reference page, also in current Turabian format. You must include citations to a sufficient number of appropriate scholarly sources to fully support your assertions and conclusions (which will likely require more than the minimum number of citations). Each paper must contain at least 5 7 scholarly sources
original to this paper
,
The UN— “A More Perfect Union?”
Considering the readings, video presentations, and your own research, draft a quality 6–7-page research paper on the role, legitimacy, and authority of the UN according to the following prompts, answering in a separate or integrated manner as you wish.
Identify at least 3reasons that states might defend the intrinsic legitimacy of the UN as a governing authority. In reverse, identify at least 3reasons that states might criticize its legitimacy and authority.
In short, make an argument for the limits and possibilities of the UN as a legitimate governing authority in a world of sovereign states.
What is the relationship of the UN to the current international system of states?
Considering the reasons for the creation of the UN after WWII, does it seem driven by political necessity or the political utility? In plainer English, do states need the UN more than the UN needs the states? Or do states both large and small find the UN a useful tool for improving their relative power and legitimacy vis-à-vis other states and global institutions? Is there some position in-between?
Using other sources and extra-Scholar sources (The commentaries, teachings, other writings, etc.) to inform your own reasoning, comment on the compatibility with the idea of
World Government
. [
Attention
: The Instructor does not view the question as rhetorical, nor the answer self-evident. So, reason carefully.] For example, if the logic of collective action under the
Articles of Confederation
—the logic of state sovereignty—failed to secure American liberties as well as the ‘more perfect union’, the new Constitution established by the Framers in 1787 to replace it, effectively requiring states to cede sovereignty to a larger collective authority, why would the same logic of collective action not justify the UN as a ‘more perfect union’ to replace an anarchic system of sovereign states putting the world at risk in a nuclear age?
.
5.1 Assignment Reading and RemediationGetting Start.docxdomenicacullison
5.1 Assignment: Reading and Remediation
Getting Started
Viewing the videos and practicing using the practice Excel file with its video can prepare you for the work needed on the research report.
In order to successfully complete this exercise, you should be able to:
Review videos about statistics fundamentals.
Practice with the Excel file provided.
Resources
File: WS5Practice
File: WS5Homework
Video: Chi-Square
Video: Chi-Square Testing
Textbook:
OpenIntro Statistics
File: Chi-Square_10by10.xlsx
Background Information
Providing background and descriptive statistics is like a literature review section of a dissertation. You review and communicate the analysis on the raw data. You present visual representations of the data to give meaning to the raw data.
Instructions
Watch the following video on chi-square:
Watch the Excel remediation videos on chi-square testing:
Chi-Square Testing
using the
Chi-Square_10by10.xlsx
file.
An optional supplementary textbook is
OpenIntro Statistics
, and you can read the concepts there.
Use the lab file
WS5Practice
to practice the Excel skills (includes an Excel hands-on video inside the spreadsheet as a link).
Use the file
WS5Homework
to demonstrate the Excel skills. Each of the three problems is worth 20 points, for a total of 60 points possible for this assignment.
When you have completed your assignment, save a copy for yourself and submit a copy to your instructor by the end of the workshop.
=================================================
5.2 Assignment: Summarizing Raw Data
Getting Started
Being able to summarize data using pivot tables is a crucial skill to develop in business and research. Excel provides a powerful pivot table tool that is heavily used in finance, accounting, information technology, and other business areas. In this course, the skill is used to support a chi-square analysis.
In order to successfully complete this assignment, you should be able to:
Summarize data into a contingency table from raw data using pivot tables.
Resources
File: WS5-2_PivotTables
File: WS5-2_PivotAssignment
Instructions
Review the rubric to make sure you understand the criteria for earning your grade.
Read the file
WS5-2_PivotTables
.
After reading the Word document, open the file
WS5-2_PivotAssignment
.
Create the appropriate summary tables called contingency tables.
Turn in an Excel file showing the pivot table you have created.
When you have completed your assignment, save a copy for yourself and submit a copy to your instructor by the end of the workshop.
===============================================
5.4 Assignment: Create Categorical Hypothesis
Getting Started
After the prior activities, the analysis section can be written for the research report. Since there are three analyses to perform, this is a partial assignment for the analysis section.
In order to successfully complete this assignment, you should be able to:
Wri.
4TH EDITIONManaging and UsingInformation Systems.docxdomenicacullison
4TH EDITION
Managing and Using
Information Systems
A Strategic Approach
KERI E. PEARLSON
KP Partners
CAROL S. SAUNDERS
University of Central Florida
JOHN WILEY & SONS, INC.
To Yale & Hana
To Rusty, Russell &Kristin
VICE PRESIDENT & EXECUTIVE PUBLISHER Don Fowley
EXECUTIVE EDITOR Beth Lang Golub
EDITORIAL ASSISTANT Lyle Curry
MARKETING MANAGER Carly DeCandia
DESIGN DIRECTOR Harry Nolan
SENIOR DESIGNER Kevin Murphy
SENIOR PRODUCTION EDITOR Patricia McFadden
SENIOR MEDIA EDITOR Lauren Sapira
PRODUCTION MANAGEMENT SERVICES Pine Tree Composition
This book is printed on acid-free paper.
Copyright ! 2010 John Wiley & Sons, Inc. All rights reserved. No part of this publication
may be reproduced, stored in a retrieval system or transmitted in any form or by any
means, electronic, mechanical, photocopying, recording, scanning or otherwise, except as
permitted under Sections 107 or 108 of the 1976 United States Copyright Act, without
either the prior written permission of the Publisher, or authorization through payment of
the appropriate per-copy fee to the Copyright Clearance Center, Inc. 222 Rosewood
Drive, Danvers, MA 01923, website www.copyright.com. Requests to the Publisher for
permission should be addressed to the Permissions Department, John Wiley & Sons, Inc.,
111 River Street, Hoboken, NJ 07030-5774, (201) 748-6011, fax (201) 748-6008, website
www.wiley.com/go/permissions.
To order books or for customer service please, call 1-800-CALL WILEY (225-5945).
ISBN 978-0-470-34381-4
Printed in the United States of America
10 9 8 7 6 5 4 3 2 1
http://www.copyright.com
http://www.wiley.com/go/permissions
!Preface
Information technology and business are becoming inextricably interwoven. I
don’t think anybody can talk meaningfully about one without the talking about the
other.1
Bill Gates
Microsoft
I’m not hiring MBA students for the technology you learn while in school, but for
your ability to learn about, use and subsequently manage new technologies when
you get out.
IT Executive
Federal Express
Give me a fish and I eat for a day; teach me to fish and I eat for a lifetime.
Proverb
Managers do not have the luxury of abdicating participation in information
systems decisions. Managers who choose to do so risk limiting their future business
options. Information systems are at the heart of virtually every business interaction,
process, and decision, especially when one considers the vast penetration of the
Web in the last few years. Managers who let someone else make decisions about
their information systems are letting someone else make decisions about the
very foundation of their business. This is a textbook about managing and using
information, written for current and future managers as a way of introducing the
broader implications of the impact of information systems.
The goal of this book is to assist managers in becoming knowledgeable par-
ticipants in information systems decisions. Becoming a knowledgeable participant
means lear.
5. The Holy Trinity is central to Catholic beliefs about God. We acc.docxdomenicacullison
5. The Holy Trinity is central to Catholic beliefs about God. We accept it as both a reality and a great mystery. Throughout history there have been many artists who have tried to represent this belief in their artworks. Choose one of the images from the following pages and explain, in the space that follows, why it best symbolises our central Catholic belief about the relationship between God, Jesus and the Holy Spirit.
.
5.1 Provide a brief definition of network access control.5.2 W.docxdomenicacullison
5.1 Provide a brief definition of network access control.
5.2 What is an EAP?
5.3 List and briefly define four EAP authentication methods.
5.4 What is EAPOL?
5.5 What is the function of IEEE 802.1X?
5.6 Define cloud computing.
5.7 List and briefly define three cloud service models.
5.8 What is the cloud computing reference architecture?
5.9 Describe some of the main cloud-specific security threats.
Complete your answers on a WORD Document,
.
4Discussion 6 Review of Four Indiana State Policies.docxdomenicacullison
4
Discussion 6: Review of Four Indiana State Policies
Author’s Name
Institutional Affiliation
Course Name
Instructor
Due Date
Discussion 6: Review of Four Indiana State Policies
In Chapter 9, St. John, Daun-Barnett, and Moronski-Chapman (2013) discuss four state policies in Indiana, which ensure low-income students have better chances of getting higher education opportunities. These state policies are the 21st Century Scholars (TFCS) program, Core 40, Indiana Project on Academic Success (IPAS), and the DREAM Act Bill. The State of Indiana and tuition facilitates the financing of these policies. Specifically, funding is attained through need-based student aid and public tuition charges. This coordination ensures that neither the parents nor the state is overwhelmed with funding the learners. Higher education institutions play a limited role in supporting these four state policies. These policies rely on financial incentives for students, colleges, and schools. Higher education systems play a tiny part in offering support services to students in this regard. Nevertheless, they have tried to implement retention projects through policies such as IPAS.
Regarding the outcome of these policies, for starters, they have improved academic preparation among students in high school. These students are better prepared to succeed in higher learning institutions. However, despite the academic preparation facilitated by the policies, there have been no notable improvements in high school graduation rates among the different racial/ethnic groups. Nevertheless, the SAT scores in Indiana have been considerably better compared to other states in the country (St. John, Daun-Barnett, & Moronski-Chapman, 2013). Also, degree completion, college access, and diversity have been remarkably good in Indiana due to these policies. Out of the four policies, the one that I feel has had the greatest success in eradicating inequalities, supporting students’ progress, and enhancing learners’ access to higher education is the TFCS program. This program not only funds needy students but also prepares them from an early age to be model citizens who do not engage in vices such as drug abuse. It guides both parents and students to take practices that will facilitate good learning outcomes.
Reference
St. John, E. P. S., Daun-Barnett, N., & Moronski-Chapman, K. M. (2013). Public policy and higher education: Reframing strategies for preparation, access, and college success. Routledge.
Vera Discussion:
Hello all,
In higher education financing a student’s tuition is a critical part of enrollment and admissions. The principal component of the funding for state colleges and universities comes from the state government, and ultimately tax dollars. Federal money is available through loans and grants to students, but the schools are primarily depending on state support. Our textbook presented four different higher education plans from California, Indiana, M.
4pagesone is assginmentthe other 3 essays are related wo.docxdomenicacullison
4pages
one is assginment
the other 3 essays are related work for this English class.
The main themes of the course are the ethics of land (proposed by Leopold), the climate crisis, the ecological crisis, the carbon footprint, and the path of sustainable development.
.
4To Replace with name Comment by Sharon Rose Use down ar.docxdomenicacullison
4
To: Replace with name Comment by Sharon Rose: Use down arrow to expand all comments below.
Remove all comments in paper before submitting to earn a better grade. One way to do this, right click on each comment, select ‘Delete Comment’.
All Papers will be checked using SafeAssign. Please focus on keeping the SafeAssign percentage to approximately 20%. Comment by James Manning: From: Replace with nameDate: Replace with dateSubject: Replace with subject of memo Introduction Comment by Sharon Rose: The CEO challenge is for an internal employee provide recommendation of new IT system to remove or bring the Shadow IT projects under the IT department.
Include how this assignment will communicate how your project proposal satisfied the CEO's concern.
Remember Shadow IT from the Week 1 Discussion. The Shadow IT has to either be adopted by the organization, or it has to be removed by the organization. Comment by James Manning:
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Vestibulum et nisl ante. Etiam pulvinar fringilla ipsum facilisis efficitur. Maecenas volutpat risus dignissim dui euismod auctor. Nulla facilisi. Mauris euismod tellus malesuada dolor egestas, ac vulputate odio suscipit. Comment by Sharon Rose: Replace Latin text with your writing for this assignment. Enter your content where the Latin text appears.
The Introduction is a short overview of your memo.
Comment by James Manning:
Sed pellentesque sagittis diam, sit amet faucibus diam lobortis quis. Sed mattis turpis ligula, in accumsan ante pellentesque eu. Quisque ut nisl leo. Nullam ipsum odio, eleifend non orcinon, volutpat sollicitudin lacus. (Beetle Baily Cartoon) Proposed Information System Comment by Sharon Rose: Identify the main functions of your proposed information system and why they are important to the business.
To earn an ‘A’ in this section you must (From Grading Rubric):
Proposed an original information system. Identified the main functions of the system. Explained the importance of each function to the business.
Explained the stylistic choices for architecture of information system. Connected main functions of system to business needs and shadow IT.
Donec tincidunt ligula eget sollicitudin vehicula. Proin pharetra tellus id lectus mollis sollicitudin. Etiam auctor ligula a nulla posuere, consequat feugiat ex lobortis. Duis eu cursus arcu, congue luctus turpis. Sed dapibus turpis ac diam viverra consectetur. Aliquam placerat molestie eros vel posuere.
Comment by Sharon Rose: Add diagrams when applicable.
If a diagram is added, it should show the proposed information system. Comment by James Manning:
This Photo by Unknown Author is licensed under CC BY-SA
Figure 1. Title (Source: www.source-of-graphic.edu ) Comment by Sharon Rose: Include source if applicable, remove when diagram is original) Comment by James Manning: Functions Important to Business Comment by James Manning:
To earn an “A” in this section (From Grading Rubric):
Exp.
5 pages in length (not including title page or references)This.docxdomenicacullison
5 pages in length (not including title page or references)
This week’s journal article focuses on attribution theory and how it influences the implementation of innovation technologies. Two types of employee attributions are noted in the article (intentionality and deceptive intentionality), please review these concepts and answer the following questions:
1. Provide a high-level overview/ summary of the case study
2. Note how constructive intentionality impacts innovation implementations
3. Find another article that adds to the overall findings of the case and note how attribution-based perspective enhances successful innovation implementations. Please be explicit and detailed in answering this question.
4. Discuss what ethical leadership is and how it impacts the organizational culture.
5. What are the various dimensions of ethical leadership?
6. Note some failures in ethical leadership, please find an example, explain the failure and note possible solutions to fix the issue with leadership.
(Question 1, 2 and 3 below Journals):
Journal Article 3.1: Lucas, J.W. and Baxter, A.R. (2012) ‘Power, influence, and diversity in organizations’, The ANNALS of the American Academy of Political and Social Science, 639(1): 49–70.
Journal Article 3.2: Martinez, A.D., Kane, R.E., Ferris, G.R. and Brooks, C.D. (2012) ‘Power in leader–follower work relationships’, Journal of Leadership & Organizational Studies, 19(2): 142–151.
Journal Article 4.1: Petty, M.M., Beadles, N.A., Chapman, D.F., Lowery, C.M. and Connell, D.W. (1995) ‘Relationships between organizational culture and organizational performance,’ Psychological Reports, 76(2): 483–492.
Journal Article 4.2: Bonavia, T. (2006) ‘Preliminary organizational culture scale focused on artifacts’, Psychological Reports, 99(3): 671–674.
Journal Article 4.3: Walker, R.C. and Aritz, J. (2015) ‘Women doing leadership: leadership styles and organizational culture,’ International Journal of Business Communication, 52(4): 452–478.
(Question 4, 5 and 6 below Journals):
Journal Article 5.1:Bormann, K.C. and Rowold, J. (2016) ‘Ethical leadership’s potential and boundaries in organizational change: a moderated mediation model of employee silence,’ German Journal of Human Resource Management, 30(3–4): 225–245.
Journal Article 5.2:Haney, A.B., Pope, J. and Arden, Z. (2018) ‘Making it personal: developing sustainability leaders in business,’ Organization & Environment. DOI: 10.1177/1086026618806201
Please be sure that journal articles are peer-reviewed and are published within the last five years.
The paper should meet the following requirements:
• 5 pages in length (not including title page or references)
• APA guidelines must be followed. The paper must include a cover page, an introduction, a body with fully developed content, and a conclusion.
.
5 to 7 DAY EXERCISE LOG Exercise Log Name___Hejin Lin__.docxdomenicacullison
5 to 7 DAY EXERCISE LOG
Exercise Log
Name___Hejin Lin__________________________ Section # __2____ Start Date _4/7_________ End Date _4/12_______
I. Cardio Respiratory Endurance
Day
Type of Exercise
Duration
(Time)
Intensity (Peak Target Heart rate or Rate of Perceived Exertion)
Cardio Comments for the week- a short descriptive comment for each workout or one long comment summarizing the week on how you felt after each workout
1
Running
25 mins
175
I felt tired, and end up fast walking
2
Running
25 mins
170
kind of tired
3
Running
30 mins
168
Feeling better, also gain more times
4
Running
30 mins
172
much better
5
Swimming
25 mins
176
I felt tired at first, and then gets better
II. Muscular Strength/Endurance
Number of Sets ___2__
Rest Period __3 mins___
Exercise
Sunday Wt/Reps
Monday Wt/Reps
Tuesday Wt/Reps
Wednesday Wt/Reps
Thursday Wt/Reps
Friday Wt/Reps
Saturday Wt/Reps
Push up
/20
/
/
/25
/25
/
/30
Arm curl
25/10
/
/
25/12
30/8
/
30/10
Crunches
/25
/
/
/30
/30
/
/30
Heel raise
/
/
95/12
/
/
100/15
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
Descriptive Strength Comments for the week (Mandatory) on how you felt after each workout
I felt my stomach muscles working when I am doing the exercise, and my muscles were sore, I think I am going get used to it.
III. Flexibility
Number of Sets ___1_____
Reps ____10____
Duration ___35 sec_____
Check each exercise performed
Exercise
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Shoulder rolls
10
10
10
10
Lateral abdominal
10
10
10
10
Hamstring stretch
10
10
Descriptive Flexibility Comments for the week: (Mandatory) on how you felt after each workout
Feels great that after stretching, my muscles still felt a little bit sore, but much better.
5 to 7 DAY EXERCISE LOG
Exercise Log
Name________Hejin Lin__________________Section # __3____ Start Date ____4/15_______ End Date ____4/20____
I. Cardio Respiratory Endurance
Day
Type of Exercise
Duration
(Time)
Intensity (Peak Target Heart rate or Rate of Perceived Exertion)
Cardio Comments for the week- a short descriptive comment for each workout or one long comment summarizing the week on how you felt after each workout
1
Running
30 mins
Not very tired, almost get used to it
2
Running
35 mins
Gains 5 more mins, feels good
3
Running
35 mins
Woke up in the morning, had more energy
4
Running
40 mins
Gains 5 more mins to 40 mins, felt a little bit tired
5
Running
40 mins
Much better
II. Muscular Strength/Endurance
Number of Sets ___2 to 3_
Rest Period __2 mins___
Exercise
Sunday Wt/Reps
Monday Wt/Reps
Tuesday Wt/Reps
Wednesday Wt/Reps
Thursday Wt/Reps
Friday Wt/Reps
Saturday Wt/Reps
Crunches
/35
/35
/
/35
/
/35
/
Push up
/25
/25
/
/25
/
/25
/
Triceps
30/10
30/10
/
30/10
/
30/10
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
/
.
5 Pages 1. Should nonprofit organizations be viewed principally .docxdomenicacullison
5 Pages
1. Should nonprofit organizations be viewed principally as businesses with a social purpose or are they inherently different from for-profit companies? Compare and contrast in your explanation.
2. What are the five general and complementary approaches to judging the effectiveness of nonprofit organizations?
Identify which of these you might find more challenging as a nonprofit leader and explain why.
3. Provide a brief summary of the legal accountability, roles, and responsibilities of nonprofit leadership.
.
5 pagesResearch either a wildfire and mass movement (one tha.docxdomenicacullison
5 pages
Research either a wildfire and mass movement (one that has actually occurred and been reported on).
Instructions:
essay between 1,250 and 1,750 words (5 pages in length) identifying:
· the type and origin of the natural disaster,
· the magnitude of the damage, including structural damage and harm to humans and the environment,
· agency response (governmental or private agencies) and ethical dimension,
· lessons learned and any resulting changes in regulations related to building code modifications, siting requirements, procedural changes, etc.,
· your opinion as to the effectiveness of any corrective actions taken to minimize the chance of recurrence.
· APA Format, place citations for work in the body and provide reference page
.
450+ WordsDiscussion Questions What are the main tenants of.docxdomenicacullison
450+ Words
Discussion Questions
: What are the main tenants of U.S. cyber policy from a civilian and military sector perspective? What are the strengths and weaknesses? This is your opportunity to take a critical look at current US cyber policy and assess it for its positive aspects as well as the negative. How does US policy stand up in light of everything we have learned so far?
.
459- Provide a substantive response to at least two of your pe.docxdomenicacullison
459-
Provide a substantive response to at least two of your peers who presented an example that was not in your response. What did you learn from the examples they presented? Are you now more aware of the challenge of change in health care?
Peer 1.Keneisha
- In health care, the consistency of handling change is constant. Change is an effect of snowball within a healthcare facility. Improvement in one area may or may not impact another establishment area irrespective of the correlations. Eventually, change affects the whole organization.
Electronic health records (EHR) and the Health Insurance Probability and Accountability Act (HIPPA) are two indicators of the healthcare industry. Although many resisted the change within the medical records and implemented EHR, the change made life much easier to navigate through with medical records. The move saved money and didn't have to use as many paper products. EHR made chart access and legibility much faster and easier to navigate through.
Within the change, HIPAA was a little more complex. HIPPA has been introduced to allow an individual to change jobs and not to complicate the coverage of the modified work transaction. HIPAA is meant to protect the protection of patient information and not to be widely distributed. This also included training in patient privacy and security issues for each health care staff members.
Reflecting on these two improvements show that once change is introduced, it can result in substantial change for the better and development of both staff and patients. Both need an open attitude and training, but implement a productive workflow.
Peer 2. Qiana
- Change is not always easy for anyone, and those in the healthcare field. Though change can be good because it can change or make the healthcare delivery systems better and meet those needs of their area. The healthcare environment continues to change and can be a challenge. With changing trends and concerns within healthcare settings, they can show the stages of life cycles within the organization and survival strategies. When rends change, there are changes that occur in case of patients and administrative support. (Liebler & McConnell, 2017). To ensure the survival of any organization change is essential to have a competitive edge in the healthcare environment. Often, for staff managers must be leaders during this process and try to make these changes go smoothly, because it can be difficult for employees.
Healthcare managers must be able to manage change, even though it may be complicated. Being able to manage change can be difficult but all involved must be able to adapt, and it is the job of the manager to inform employees as well as constituents and help them to understand why the change is a necessity and their roles even though it may be difficult.
The two examples of successful change I have chosen are Change as Opportunity: Y2K and A Study in Proactive Change: Electronic Health Records. The trn of the year 2.
4th Grade Science-A Discussion of how Students Learn to Self Assess.docxdomenicacullison
4th Grade Science-A Discussion of how Students' Learn to Self Assess Science
For this assignment, candidate will work alone to research and observe selected videos in their discipline (area of study). Candidate will observe a total of 5 hours of videos.
Candidates will provide a written analysis and/or reflection that responds to the video and selected writing prompt.
.
430 Chapter 17 Death and DyingCase 17-1When Parents Refu.docxdomenicacullison
430 Chapter 17 Death and Dying
Case 17-1
When Parents Refuse to Give Up1
Nine-year-old Yusef Camp began experiencing symptoms soon after eating a pickle bought
from a street vendor. He felt dizzy and fell down, he could not use his legs, and he began
to scream. By 10:00 p.m., he was hallucinating and was transported to the DC General
Hospital by ambulance. He went into convulsions. His stomach was pumped, and they
found traces of marijuana and possibly PCP. He soon stopped breathing, and by the next
morning, brain scans showed no activity.
Four months later, Yusef’s condition had not changed. The physicians believed his brain
was not functioning and wanted to pronounce him dead based on brain criteria. Several
difficulties were encountered, however. First, there was some disagreement among the
medical personnel over whether his brain function had ceased completely. Second, at that
time the District of Columbia had no law authorizing death pronouncement based on
brain criteria. It was not clear that physicians could use death as grounds for stopping
treatment. Most important, Ronald Camp, the boy’s father, protested vigorously any sug-
gestion that treatment be stopped. A devout Muslim, he said, “I could walk up and say
unplug him; but for the rest of my life I would be thinking, was I too hasty? Could he have
recovered if I had given it another 6 months or a year? I’m leaving it in Almighty God’s
hand to let it take whatever flow it will.”
The nurses involved in Yusef’s care faced several problems. Maggots were found
growing in Yusef’s lungs and nasal passages. His right foot and ankle became gangre-
nous. He showed no response to noises or painful stimuli. The nurses had the responsi-
bility not only for maintaining the respiratory tract and the gangrenous limb, but also for
providing the intensive nursing care needed to maintain Yusef in debilitated condition
on life support systems. Had the aggressive care been serving any purpose, they would
have been willing to provide it no matter how repulsive the boy’s condition was and in
spite of there being many other patients desperately needing their attention. However,
some of the nurses caring for Yusef were convinced that they were doing no good what-
soever for the boy. They believed they were only consuming enormous amounts of time
and hospital resources in what appeared to be a futile effort. In the process, other
patients were not getting as much care as would certainly be of benefit to them. Could
the nurses or the physicians argue that care should be stopped because he was dead?
Could they overrule the parents’ judgment about the usefulness of the treatment even
if he were not dead? Could they legitimately take into account the welfare of the other
patients and the enormous costs involved when deciding whether to limit their atten-
tion to Yusef?
1Weiser, B. (1980, September 5). Boy, 9, may not be “brain dead,” new medical examiner
shows. Washington Post, .
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
1. 5 Establishing Organizational Objectives
iStock/Thinkstock
Ah, but a man’s reach should exceed his grasp,
Or what’s a heaven for?
—Robert Browning
Learning Objectives
After reading this chapter, you should be able to do the
following:
• Describe the nature of objectives and the important role
of—and management by—objectives in an HCO.
• Discuss the characteristics of good objectives.
• Delineate the types of objectives that are included in a
strategic plan, and include examples of objectives for
key result areas.
• Provide an example of how to use data from an internal
and external environmental analysis to set good
objectives.
• Explain how to perform a periodic review of objectives
for measuring progress and making updates
as needed.
2. Section 5.1The Nature and Role of Objectives
Introduction
An HCO cannot achieve goals if none exist for the organization.
Although this idea is quite
simple, many people overlook it. To accomplish anything, an
organization must have a clear
understanding of what is to be accomplished. Strategic
objectives are the tool by which
organizations define their goals and sketch out a specific road
map for achieving them. If we
fail to set specific objectives, we simply waste our time and
energy by going in circles. Later,
we look back at what we accomplished and wonder where the
time went. Just being busy and
involved in activities does not mean that we are accomplishing
what we need to accomplish.
This chapter focuses on the need to establish objectives, the
characteristics of good objec-
tives, and the process of writing objectives. After the vision and
mission of the HCO have been
defined, and the internal and external analyses completed,
relevant objectives are developed
for the strategic plan.
5.1 The Nature and Role of Objectives
Objectives can be defined as clear, concise written statements
outlining what is to be accom-
plished in key result areas in a certain time period, in
measurable terms. Peter Drucker argues
that “objectives are not fate; they are direction. They are not
commands, but they are com-
mitments. They do not determine the future, but they are the
means by which the resources
3. and energies of the operation can be mobilized for the making
of the future” (Drucker, 1954,
p. 102).
As noted in Chapter 2, the words key results, goals, and targets
often are used synonymously
when talking about short- and long-term objectives. Whatever
the label used, the idea is to
focus on a specific set of target activities and outcomes to be
accomplished. Think of the anal-
ogy of the archer used in Chapter 2. An HCO administrator
wants the whole organization
aimed at a single target, just as an archer wants every arrow
aimed at the bull’s-eye. People
get confused and disorganized if they do not know where they
are going. In large measure,
the success or failure of an HCO is based on its ability to set
goals, as well as on tools with
which to measure progress toward those goals. Objectives can
be set at upper organizational
levels in key result areas, such as range of service offerings,
productivity, level of client satis-
faction, market share, profitability, financial resources, physical
resources, staff development
and attitudes, and commitment to social responsibilities as an
organization. Every healthcare
administrator should consider long-range objectives in each of
these areas.
Objectives are also needed in subunits, departments, or
divisions of an organization. Objec-
tives can be classified in various ways, such as by their nature,
which includes routine, prob-
lem-solving, and innovative, or by their function, which
includes team, personal, and budget
performance. Most important, all organizational objectives must
4. be consistent. In this way, a
department’s objectives should lead to accomplishing the
overall organization’s goals.
Objectives serve two fundamental purposes. First, they serve as
a road map. Objectives are
the results desired upon completion of the planning period. In
the absence of objectives, no
sense of direction can be attained in decision making. In
planning, objectives answer one of
Section 5.1The Nature and Role of Objectives
the basic questions posed in the planning process: Where do we
want to go? These objectives
become the focal point for strategy decisions.
Another basic purpose served by objectives is in the evaluation
of performance. The objec-
tives in the strategic plan become the yardsticks for evaluating
performance. It is impossi-
ble to evaluate performance without some standard by which
results can be measured. The
objectives become the standards for evaluating performance
because they are the statement
of results desired by the planner.
Management by Objectives
Objectives have sometimes been called the neglected area of
management. In many situa-
tions, the objectives that are set forth are unsound and therefore
lose much of their effective-
ness. Often, organizations fail to set any objectives at all. This
happens for at least six reasons:
5. 1. Many HCO managers fear accountability.
2. Many projects continue even when they no longer serve an
organization’s goals.
3. HCOs often undertake any activity for which money is
available.
4. Some HCO managers fear that a hard-nosed evaluation may
undermine humanitar-
ian instincts.
5. HCO managers must spend a great deal of time on activities
that do not immediately
further their goals (meeting with donors, fundraising, explaining
programs, and so
forth).
6. HCOs may have few, if any, financial report cards to tell
them how they are doing
(Thompson & Strickland, 1986).
Once the process of setting objectives has actually begun within
an organization, some of
these six goal-making deterrents may no longer be applicable.
Unfortunately, however, many
of these listed deterrents are applicable in many types of
organizational settings.
To counteract the failure to define organizational objectives, a
management tool called man-
agement by objectives (MBO) was developed by Peter Drucker.
This tool emphasizes the
need for setting objectives as a basic managerial process,
providing coordination of activities
at all levels of the organization.
6. For the HCO administrator, MBO translates into four basic steps
(Lumsdon, 1994). First, the
administrator and individual staff work out mutual objectives
that each staff member will
pursue in his or her area of responsibility. These objectives
should support the overall objec-
tives established by the HCO. Each staff member with
supervisory responsibilities, in turn,
holds similar meetings with his or her staff or volunteers. These
meetings should be held at
each management level so that objectives are fully coordinated.
Second, in addition to setting objectives at these meetings,
strategies or descriptions of actions
to be taken to accomplish each objective should be laid out.
Third, follow-up meetings should
be held periodically to monitor progress toward reaching
objectives, identify problems, and
mutually determine methods to correct any difficulties. The
final step involves an overall eval-
uation of goal accomplishment for individuals and units at
year’s end or the end of the plan-
ning period. From this, new objectives for the upcoming
planning period can be determined.
Section 5.2The Characteristics of Good Objectives
Alternatives to Management by Objectives
MBO may be best understood by contrasting it with the
following four alternative approaches
to management that all lack a sense of direction (Wayne State
University, 2013).
Management by extrapolation—This approach relies on the
7. principle, “If it ain’t broke,
don’t fix it.” The basic idea is to keep on doing about the same
things in about the same ways
because what we are doing (1) works well enough and (2) has
gotten us where we are. The
basic assumption is that, for whatever reason, “Our act is
together, so why worry? The future
will take care of itself and things will work out all right.”
Management by crisis—This approach to administration is
based on the idea that the
strength of any really good manager is an aptitude for solving
problems. Because there are
plenty of crises around—enough to keep everyone occupied—
managers ought to focus their
time and energy on solving the most pressing problems of
today. Management by crisis is,
essentially, reactive rather than proactive, and it is the events
that already have occurred that
dictate management decisions.
Management by subjectives—The subjectives approach to
management occurs when no
organization-wide consensus or clear-cut directives exist on
which way to head and what to
do. Each manager translates this to mean “do your best to
accomplish what you think should
be done.” This is a “do your own thing the best way you know
how” approach. This is also
referred to as “the mystery approach.” Managers are left on
their own with no clear direction
ever articulated by senior management.
Management by hope—In this approach, decisions are
predicated on the hope that they will
work out and that good times are just around the corner. They
8. are based on the belief that if
you try hard enough and long enough, then things are bound to
get better. Poor performance
is attributed to unexpected events and the fact that decisions
always have uncertainties and
surprises. Much time, therefore, is spent hoping and wishing
things will get better.
All four of these approaches represent variations of managerial
muddling through. Absent is
any effort to calculate what effort is needed to influence where
an organization is headed and
what its activities should be to reach specific objectives. In
contrast, MBO is much more likely
to achieve targeted results and show a sense of direction.
5.2 The Characteristics of Good Objectives
For objectives to accomplish the purpose of providing direction
and a standard for evaluation,
they must possess certain characteristics. The more these
attributes are possessed by a given
objective, the more likely the objective will achieve its basic
purpose. Sound internal objec-
tives (as opposed to external objectives for public consumption,
which may have to be more
generalized) should have the following characteristics:
• Objectives should be clear and concise: Objectives should
be clear to everyone in the
organization. There should not be any room for
misunderstanding what results
are sought in a given objective. The use of long statements with
words or phrases
9. Section 5.2The Characteristics of Good Objectives
that may be defined or interpreted in different ways by different
people should be
avoided.
• Objectives should be in written form: This helps solve two
problems: unclear, inef-
fective communication and the altering of unwritten objectives
over time. Everyone
who has played the game “gossip” realizes that oral statements
can be altered unin-
tentionally in the act of being spoken. Written statements avoid
this problem and
permit ease of communication. Written statements also obviate
the human tendency
to want or appear to “look good,” which is often at the expense
of actual perfor-
mance. Unwritten objectives can be altered to fit current
circumstances.
• Objectives should name specific results in key areas: The
key areas of an organization
for which objectives are needed can include the range of service
offerings, productiv-
ity, level of client satisfaction, market share, profitability,
financial resources, physi-
cal resources, staff development and attitudes, and commitment
to social respon-
sibilities as an organization. Specific results, such as “5,000
patients treated for the
next year” rather than “a high level of patients served” or “an
acceptable level of
patient services,” should be used to avoid doubt about what
result is sought.
10. • Objectives should be stated for a specific time period:
Objectives should be stated for
specific time periods. Objectives can be set for a short-run,
nearly immediate time
period, such as six months to one year. Building on longer and
longer time frames,
the accomplishment of short-term objectives should lead to the
successful comple-
tion of longer-run objectives. The time period specified
becomes a deadline for
producing results and also sets up the final evaluation of the
success of a strategy.
• Objectives should be stated in measurable terms:
Objectives must be measurable. Con-
cepts that defy precise definition and qualification should be
avoided. Patient satis-
faction is an example of a concept that is important, but which
in itself is difficult to
define and measure. If a planner felt patient satisfaction was a
concept that needed
to be measured, a measure or measures (possibly indirect in
nature) would have to
be developed. An objective related to patient satisfaction that
would be capable of
quantification might be stated as follows: To have at least 85%
of our constituents
rate our HCO as the best organization in the area in our annual
survey. A phrase such
as improve staffing is not only unclear and nonspecific, it
cannot be measured. What
does improve mean? Increase the number of staff by 5%? By
40%? In what areas? If
the statement is quantified as “increase the number of full-time
physical therapists
by 10% within the next 18 months,” then it can be objectively
11. measured. The accom-
plishment or failure of such a stated objective can be readily
evaluated.
• Objectives at each administrative level must be consistent
with overall organizational
objectives and purpose: The objectives developed for each unit
of the organization
must be consistent with the overall objectives of the HCO. This
idea has been previ-
ously stated, but it must be continually reemphasized because of
the need for orga-
nizational unity.
• Objectives should be attainable, but of sufficient
challenge to stimulate effort: Objec-
tives need to be attainable but also challenging. Two problems
can be avoided if this
characteristic is achieved. The first problem that can be avoided
is the frustration
produced by objectives that cannot be attained at all or cannot
be attained within
the specified time period. For example, large-percentage
increases in patients served
at home can be unrealistic, as goals, if the home healthcare
agency already has an
unusually large patient load. The desirability and likelihood of
substantial increases
become doubtful. The other problem is that setting easily
attainable objectives that
require only minimum effort results in positive performance
evaluations because
Section 5.2The Characteristics of Good Objectives
12. goals are too easily accomplished. In reality, the evaluations
only camouflage lacklus-
ter performance that is well short of potential. Easily attainable
goals fail to maxi-
mize the contribution of a given strategic plan.
SMART Objectives
One approach to writing objectives is to use the SMART
philosophy (Wayne State University,
2013). SMART is an acronym for guiding the development of
measurable goals. As indicated
by the following list, each written objective should be
• Specific
• Measurable
• Achievable
• Relevant
• Time-oriented
Specific
Specific answers two questions: What is to be done? and How
will you know it is done? It
also describes the results (end product) of the work to be done.
The description is written in
such a way that anyone reading the objective will most likely
interpret it the same way. For
example, Reduce dosage errors to less than 1% is a specifically
stated goal.
Measurable
Measurable answers this question: How will you know it meets
expectations? Measureable
also defines the objective, using assessable terms (quantity,
quality, frequency, costs, dead-
lines, and so forth). Measurable refers to the extent to which
13. something can be evaluated
against a standard. An objective with a quantity measurement
uses terms of amount, percent-
ages, and so forth. For example, measurable could mean the
percent of errors, compared to
the objective, of less than 1%. A measurement also could be a
daily or weekly consideration.
Achievable
Achievable answers these three questions: Can it be done? Can
the measurable objective be
achieved by the organization? Can it be done given the time
frame, opportunity, and resources?
These considerations should be included as part of the written
objective if they will be a factor
in the achievement of the objective. For example, if an error
rate is currently at 5%, decreasing
that rate to less than 1% may not be achievable during a given
time period because of the size
of the decrease specified.
Relevant
Relevant answers these four questions: Should it be done? Why
should it be done? What
will be the impact, if it is done? Is the objective aligned with
the organization’s mission? For
Section 5.2The Characteristics of Good Objectives
example, Dosage error rates are extremely important to
providing quality care is a relevantly
stated goal.
Time-oriented
14. Time-oriented answers this question: When will it be done? It
refers to the fact that an objec-
tive has end points and check points built into it. Sometimes a
task may only have an end
point or due date. Sometimes an objective has several
milestones or check points to help you
or others assess how well something is going before it is
finished so that corrections or modi-
fications can be made as needed to ensure that the end result
meets expectations. This means
including a time frame in the stated objective, such as Reducing
the dosage error rate to less
than 1% by the end of 2019.
Objectives that meet such criteria are much more likely to serve
their intended purpose. The
resulting statements can then serve as the directing force in the
development of strategy.
Examples of Effective Objectives
Table 5.1 provides examples of poorly presented, or weak,
objectives, which are contrasted
with examples of these same core objectives now strengthened,
or better presented, with the
inclusion of more precise information to effectively
communicate measured goals and the
organization’s desired results.
Table 5.1: Contrasting presentations of the same objective
Weaker presentation of
objectives
Remarks to transform the weaker
presentations of objectives into stronger
15. presentations of objectives
Stronger presentation of
objectives
Our objective is to lower
the rate of medication
errors.
How much is lower? The statement is not
subject to measurement. What criterion or
yardstick will be used to determine if and
when actual error rates are equal to those
desired? In addition, no deadline is specified.
Our objective is to lower
our medication error rate
by 10% within 12 months.
Our objective is to increase
our occupancy rates.
How much? A single patient-per-day increase
will meet that objective, but is that really the
desired target?
Our objective this calendar
year is to increase occu-
pancy rates by 5%.
Our objective is to boost
advertising expenditures
by 15%.
Advertising is an activity, not a result. The
16. advertising objective should be stated in
terms of what result the extra advertising is
intended to produce.
Our objective is to boost
patient revenues by 10%
in each of the next five
years with the help of a
15% annual increase in
advertising expenditures.
Our objective is to be the
best HCO of its type in our
area.
Not specific enough; what measures of best
are to be used? Number of patients served?
Level of reimbursement? Number of new
programs started? Services offered? Number
of professional staff ?
We will strive to become
the number one HCO of its
kind in the metropolitan
area within five years in
terms of the number of
patients served.
Section 5.3The Types of Objectives Included in a Strategic Plan
Seven Rules for Writing Effective Strategic Objectives
What follows are seven rules for writing effective strategic
objectives.
17. 1. Objectives should include an action verb, because the
achievement of an objective
must come as a result of specific action.
2. Each objective should specify one major result to be
accomplished.
3. An objective should have a target date for accomplishment.
4. An objective should relate directly to the mission statement
of the group or orga-
nization. For example, a local facility of a national nursing
home chain should not
write an objective outside the scope of its own mission
statement or one that per-
tains more to the mission statement of the parent organization.
This may seem obvi-
ous, but groups often commit themselves to projects for which
they have neither
responsibility nor authority.
5. An objective must be understandable to those who will be
working to achieve the
desired results.
6. An objective must be possible to achieve.
7. An objective should be consistent with a parent
organization’s policies and practices.
Refer to Chapter 3, Table 3.2, which lists sample HCO mission
statements. Imagine that you
have been asked by the CEO of a small, rural hospital to
evaluate its strategic objectives. The
hospital’s mission statement, as stated in Table 3.2, is “To
improve the quality of life of all we
serve through excellence in healthcare delivery emphasizing
compassionate, personal care.”
18. The CEO and his or her planning team have come up with the
following three objectives.
Evaluate the effectiveness of each of these objectives in relation
to the guidelines presented
in the preceding list of seven rules for writing effective
strategic objectives.
• Objective 1: We intend to improve the quality of the
healthcare we provide.
• Objective 2: We intend to expand the scope of our
services to include a birthing cen-
ter, neonatal intensive care, and a children’s orthopedic unit.
• Objective 3: We intend to control costs by automating our
phone system, eliminating
the need for several patient service representatives.
5.3 The Types of Objectives Included in a Strategic Plan
Strategic plans for HCOs usually focus on at least four types of
objectives: (1) services offered;
(2) staffing; (3) services reimbursement, donations, and
funding; and (4) constituents served.
However, objectives should be established in all key result
areas of the HCO’s operations. Key
result areas are those activities that are most likely to impact
the performance of the organi-
zation. They are the few things that must go right if the HCO is
to be effective and thrive. For
example, key result areas for a hospital or clinic could include
the following:
• Percentage of doctors who are board-certified
• Number and quality of services offered
• Number of patients treated by inpatient/outpatient
19. services
• Successful surgery and treatment rates
• Financial condition/budget status/surplus
Section 5.3The Types of Objectives Included in a Strategic Plan
• Status of physical facilities
• Quality
• Productivity
• Patient satisfaction
• Innovation
• Percent occupancy rate
• Number of physicians by specialty
• Level of professional staffing
The preceding list of key result areas is lengthy, and it may lead
to an HCO’s establishment of,
ultimately, an unmanageable number of strategic objectives.
One author therefore suggests
using only five strategic objectives so as to have a more limited
and manageable number of
key result areas to work with. The idea is to reduce the number
of strategic objectives, which
leads to fewer key result areas on which to focus. Based on this
suggestion, each of five key
result areas is linked with a strategic objective that provides
direction by naming a specific
result for the identified key result area of an HCO, as shown in
the following example:
1. Safety: Decrease the number of never-should-happen events
to zero.
2. Quality: Decrease inpatient mortality to zero.
3. Satisfaction: Increase patient satisfaction to 99th percentile.
20. 4. People: Decrease turnover rate to zero.
5. Finance: Increase net margin to 20% (Regan, 2012).
The reasoning for the use of only five strategic objectives is as
follows: First, a powerful vision
can be created through five strategic objectives, and this vision
will serve as a rallying point
for the entire organization. Second, the organization is afforded
tremendous flexibility in
changing the strategies and tactics each year to achieve the
stated objectives. Third, everyone
in the organization will easily know in what way what they do
each day helps achieve the
organization’s objectives. Finally, the consistency in objectives
from year to year will drive the
organization to the relentless pursuit of perfection, and this
consistency becomes immersed
in the organizational culture (Regan, 2012).
In addition to overall objectives that are to be accomplished in
the long term, a set of short-
term objectives will need to be developed. Short-term objectives
support the attainment of
long-term objectives. For example, to have a 1% decrease in
supply-cost each year supports
a long-term objective of decreasing supply cost by 5% over the
next five years. Short-term
objectives are stated only for the operating period, normally one
year, whereas long-term
objectives often span five to ten years. For example, five-year
objectives can be set in areas
such as clients served, programs offered, fundraising, services
offered, and so forth. While
the definition of long term varies, HCOs should be planning at
least as far into the future as
present-day obligations commit them. For example, the planned
21. construction of a new build-
ing with a 45-year life means that the organization should be
looking 45 to 50 years into the
future with regard to the effective use of the facility.
In setting objectives, we first state them in terms of what we
want to accomplish, but as we
develop the strategy we may discover that we cannot afford
what we want. The available
resources committed to a given program or service may not be
sufficient to achieve a stated
objective; if the planning process is resource controlled, then
the objective must be altered.
It must be remembered, as Peter Drucker has argued, that
“objectives are not fate;” but “they
Section 5.3The Types of Objectives Included in a Strategic Plan
are direction”; objectives “are not commands,” but they do
become commitments (Drucker,
1954, p. 102). Planners should avoid falling into the trap of
thinking that objectives, once they
are set, cannot or should not be altered.
Examples of objectives for key result areas, including
productivity, funding, and patient/
client, are presented in the following three subheadings.
Productivity Objectives
Increasing levels of productivity and cost-effectiveness are
essential to the vitality of HCOs,
such as home HCOs in managed-care environments. New
staffing patterns, the use of teams
to improve care plans, and new information systems are often
22. critical to achieving improved
productivity (Regan, 2012). Objectives for improvements in
productivity may be stated
numerically or as a percentage of the total number. If the
objectives are stated in percentages,
they also need to be converted to numbers for budgeting. The
way objectives are stated must
reflect what the organization can realistically expect to attain
under a given plan.
Productivity objectives may resemble the following:
• Patient care services: Reduce the average number of home
visits per patient by 10%
for the coming 12 months over last year’s level.
• Business office operations: Reduce paperwork expenses
by 15% within the next 24
months when compared with the most recent 24-month period.
Funding Objectives
Funding and reimbursement for services rendered are vital
aspects of any HCO’s operations,
especially in an era when financial sources are drying up. While
seeking increased revenues
simply for the sake of revenues should not be the only end
pursued, the need to increase rev-
enues is an inescapable fact of life for an HCO to deliver its
services. The issue of continued
survival offers a very practical reason for developing a specific
statement about funding tar-
gets. Getting specific about desirable end results forces the
planner to estimate the resources
needed to underwrite specific programs and services.
The U.S. healthcare cost crisis is due to the present-day
23. structure of the healthcare system,
the fact that third parties rather than patients pay the bill, and
the longstanding convention
that most reimbursement plans pay for procedures rather than
results. Michael Porter and
Thomas Lee (2013) believe that the goal of HCOs needs to be
this: to deliver better value
rather than to reduce costs and increase profits. Value is defined
as the “health outcomes
achieved that matter to patients relative to the cost of achieving
those outcomes” (Porter &
Lee, 2013, p. 52). The complexity of the problem is beyond the
scope of this textbook. Whether
it is Porter and Lee’s value proposition or a traditional
reduction of cost, the debate over the
nation’s healthcare costs will likely continue.
A statement of whether resources will be available cannot be
made without a break-even
analysis of the revenue versus the cost of providing …
4 Environmental Analysis
Charles Dharapak/Associated Press
Organisations don’t exist in a vacuum. They are intricately
connected to an
outside world with a constantly changing landscape.
—The Happy Manager
Learning Objectives
After reading this chapter, you should be able to do the
24. following:
• Describe the environmental forces that create change and
can influence an HCO’s strategic planning.
• Discuss the impact of legislation on HCO operations and
strategic planning.
• Identify the main forces referred to in the five forces
model of industry analysis.
• Explain why an HCO should continue to assess external
opportunities and threats.
• List different benchmarks that can identify an HCO’s
internal strengths and weaknesses.
• Explain the connections between an HCO’s strengths,
weaknesses, and distinctive competencies.
• Name the advantages of the Integrated Practice Unit (IPU)
as a healthcare delivery method.
Section 4.1External Analysis of Dominant Environmental
Driving Forces
Introduction
This chapter discusses the importance and the components of an
environmental analysis as
part of the strategic planning process for an HCO. This chapter
introduces an external analysis
that uses a PESTLE framework for identifying the elements of
the external environment. This
chapter then reviews legislation and governmental initiatives,
25. which have a dramatic impact
on HCOs. Next, “Porter’s five forces” model, which also is
known as the five forces model of
industry analysis, is explained and applied to an HCO. Finally,
this chapter discusses internal
and external analyses and the use of a SWOT analysis, followed
by an examination of how
resources, costs, and distinctive competencies affect strategic
planning efforts.
4.1 External Analysis of Dominant
Environmental Driving Forces
It is vital for an HCO to gauge the external environment within
which it operates. This, in fact,
should be standard practice for all organizations. Virtually
anything that can happen prob-
ably will happen, eventually. We truly have no certainty about
what things will be like in the
future, in spite of our attempts to make predictions or forecasts.
Still, an HCO cannot afford to
let generalized eventualities and uncertainties keep it from
being active in strategic planning,
and changing in response to environmental demands.
PESTLE is an acronym to describe the elements of the external
environment that impact
an HCO’s planning process. These elements require specific
analysis about their current or
potential impact on the organization’s planning and operations.
PESTLE stands for politi-
cal, economic, sociocultural, technological, legal and eco-
environmental forces, which exert
strong influences on how an HCO crafts and executes strategic
plans. Figure 4.1 shows the
elements of PESTLE.
26. These elements also interact with each other to create additional
ramifications. Consider
medical waste. Medical waste first came to the attention of the
general public, years ago,
when it washed up on New Jersey beaches. Because of the
media exposure of this and other
events pertaining to undesirable disposal practices, as well as
the fear of AIDS, public hysteria
resulted and regulatory officials were under pressure to develop
comprehensive regulations
to prohibit such occurrences. The Medical Waste Tracking Act
of 1988 was passed, requiring
the federal Environmental Protection Agency (EPA) to begin an
investigation to determine
whether federal legislation was necessary. In 1991 the EPA
provided their findings, which led
to federal regulations on medical waste disposal.
The Occupational Safety & Health Administration (OSHA)
began to fine waste generators for
improper disposal practices within their facilities, and most
states have adopted some type
of regulation pertaining to infectious-waste disposal
requirements. This, in turn, led to an
examination of waste-disposal methods technology, such as
autoclave and incineration, and
the documentation needed to show that wastes were being
disposed of properly. This also
created the need for state-of-the art incineration techniques and
facilities. At any given time,
some or several of the forces may be driving change in the
healthcare industry. It is important
to determine which force is the driving force in creating a
change in the environment.
27. Section 4.1External Analysis of Dominant Environmental
Driving Forces
Figure 4.1: PESTLE framework for external analysis
Several external forces influence how an HCO crafts and
executes a strategic plan. The forces are grouped
by category.
f04.01_MHA 626.ai
Sociocultural:
demographics,
education, health
perspectives, etc.
Technological:
New discoveries,
research,
obsolescence, etc.
Legal: Healthcare
legislation,
consumer
protection, etc.
Eco-environmental:
Waste disposal,
energy consumption,
sustainability, etc.
28. Economic:
Economic cycles,
unemployment,
inflation, etc.
Political:
Governmental
policies, spending,
etc.
HCO’s
Planning
Process
The only way we can manage change is to constantly monitor
the environment within which
an organization operates. Other examples of PESTLE forces for
an HCO include trends in
Medicare or Medicaid funding; the Affordable Care Act;
governmental regulations on funding
retirement programs; the labor supply for healthcare
professionals; interest rates for capital
improvements; better-educated clients/patients, who expect to
be included in decisions on
their healthcare; greater emphasis on the marketing of
healthcare services; the fast pace of
technological change; and so forth.
The external analysis is where we look at past and current
developments external to an HCO’s
operations. From this analysis, we identify trends and, in effect,
take the pulse of the environ-
29. ment in which the HCO operates. An HCO must be aware of
characteristics of environmental
conditions affecting it, and be vigilant about changes that may
occur in this environment.
Section 4.1External Analysis of Dominant Environmental
Driving Forces
Numerous possible shifts can occur to affect the organization in
categories such as patients/
clients; the general economy; governmental regulations at
federal, state, and local levels; and
sociocultural trends in demographics and lifestyles, among
others. Many HCO administrators
have discovered their failure to understand and heed the
implications of the environment on
their organization’s actions, even when those implications were
obvious, such as a shift in
population and businesses from the organization’s current urban
location to suburban areas.
Even without a formal organizational system to monitor the
environment and the changes
happening within it, HCO executives must exercise vigilance to
detect and use information
from the environment in formulating strategy.
Many of the environmental factors influencing the organization
and its administration will
change. This is a given. Few factors stand still for long, so
constant study of the environment
is necessary. Thus, the HCO administrator should expect change
and be receptive to it. Many
other driving forces are present. Various industries will have
different forces that help deter-
30. mine the direction of the industry and these forces will have
different magnitudes of impor-
tance from one industry to another. Table 4.1 provides a sample
environmental analysis as it
might apply within an HCO.
Table 4.1: Sample PESTLE impact analysis for an HCO
Political Economic
Medicare/Medicaid reimbursement—eligibility and
reimbursement amounts
Economic trends—increased or decreased employ-
ment and increased or decreased insurance
coverage
Zoning regulations—the types of businesses located
near the HCO
Taxation—changes in tax structures and changing
disposable income for elective procedures
Governmental relations—the lobbying effects of
various healthcare groups
Market and distribution trends—increased avail-
ability of urgent care centers and satellite units
Sociocultural Technological
Lifestyle trends—healthier lifestyles with more
emphasis on prevention
Electronic health records—increased need for train-
ing and record keeping
31. Aging population—increase in geriatric patients
and greater dependence on Medicare/Medicaid
reimbursements
Value-enhancing IT platform—more and better
technology availability and increased cost
Patient education—better-educated patients asking
more pertinent questions and doing research on
treatment options
New diagnostic devices—better patient care and
increased usage cost
Legal and Healthcare Legislation Eco-Environmental
Affordable Care Act—new mandates and informa-
tion requirements
Waste disposal—verification of hazardous waste
disposal
Health Insurance Portability and Accountability Act
(HIPAA)—patients’ ability to keep current coverage
Energy consumption—higher energy consumption
leading to higher operating costs
State Children’s Health Insurance Program (CHIP)—
eligibility and reimbursement schedules
Sustainability—ability to maintain existing and
future operations
32. Section 4.2Legislative Processes and Implementation Issues
4.2 Legislative Processes and Implementation Issues
How legislation affects both planning and operations is an
external factor that requires con-
tinuous monitoring. Federal and state processes may vary,
depending on individual state
rules and regulations concerning legislation.
The Federal Legislative Process
At the national level, the legislative process typically involves
the following steps and
policymakers:
1. A bill is introduced by a congress member.
2. The bill goes to the appropriate committee for review and
hearings. The major com-
mittees with jurisdiction over health issues are the following:
i. Senate Finance: Medicare, Medicaid, and the Children’s
Health Insurance
Program (CHIP)
ii. Senate Health, Education, Labor, & Pensions: Most agencies
in HHS; public
health and health insurance statutes
iii. House Ways and Means: Medicare
iv. House Energy and Commerce: Medicare (Parts B, C, D),
Medicaid, CHIP, public
health
3. Once the committee approves the bill it is sent to the floor of
the House and Senate
33. for a vote, and it must pass in both chambers to become law.
4. If the bill passes both chambers, the President has 10 days to
sign the bill or veto it.
If the President does nothing, it becomes law.
Federal regulations, also known as rules, are issued by agencies
and these regulations have
the force of law. Agencies issue a notice of a proposed rule to
add, change, or delete regulatory
text, which is followed by several stages of review, including a
public comment period. The
final revised rule based on public comment must allow 60 days
to pass before the rule takes
effect (Aetna, 2013).
Landmark Health Legislation in the United States
Legislation pertaining to healthcare has a long history in the
United States (The Associated
Press, 2010). Federal involvement in healthcare began with “An
Act for the Relief of Sick and
Disabled Seamen” in 1798. Since then, healthcare legislation
has been passed at the federal
level, providing care for Native Americans, maternal and child
services, and veterans. The
most notable of these acts and the ones that have the most effect
on healthcare planning
include the following:
• Medicare and Medicaid (1965) Medicare is a federal
program that provides health
insurance for those over age 65. Medicare is one of the largest
purchasers of health-
care in the United States. The coverage and reimbursement
decisions made by
Medicare affect the ways providers operate and have a major
34. impact on the health
Section 4.2Legislative Processes and Implementation Issues
services industry. Some Medicare coverage and reimbursement
decisions (such as
diagnosis-related groups, or DRGs) have been adopted by the
private sector.
Medicaid is a program run jointly by the federal and state
governments to provide
health insurance for low-income individuals who meet
eligibility requirements.
A recent trend in Medicaid is for the federal government to turn
all authority and
responsibility for the program to the states.
• Consolidated Omnibus Budget Reconciliation Act of 1985
(COBRA). This act gives
employees the right to continue the health insurance coverage
their employer pro-
vides after leaving the job. It also made hospice care a
permanent part of Medicare
and Medicaid.
• Health Insurance Portability and Accountability Act of
1996 (HIPAA). This law
strengthened the portability of health insurance that was first
authorized under
COBRA. This law also encouraged the use of medical savings
accounts, improved
access to long-term medical care, and strengthened privacy laws
concerning
health records.
35. • State Children’s Health Insurance Program of 1997
(CHIP). This program helps
provide medical care to children in low-income families that are
not eligible for
Medicaid.
• Patient Protection and Affordable Care Act of 2010.
Known as the Affordable Care
Act, this law provides an array of changes in healthcare,
including coverage man-
dates, acceptance for insurance regardless of medical history,
reduction in spending
on Medicare, and more restrictions on health insurance
providers. However, many
parts of the act are being challenged and delays in
implementation have been given
to some organizations. This act will have a major impact on who
receives healthcare
and how it is administered for years to come. The changes being
brought about by
this act are profound and occurring rapidly with respect to the
method by which
providers will be paid and the imperative to improve the value
of services provided.
The Effects of Reform on HCO Strategy
HCOs must become familiar with the following four key
concepts of current healthcare reform
that will affect strategic planning:
1. Value-based payment
2. Accountable care organizations (ACOs)
3. Bundled payment
4. Bending the cost curve
36. Value-based Payment
Historically, the model of reimbursement for the provision of
healthcare services has been
fee-for-service: a health provider (an organization or individual)
is paid by the volume of
procedures or services provided. This payment mechanism tends
to incent providers to order
more tests, procedures, and hospitalizations than may be
necessary to appropriately care
for patients. The fee-for-service model has been blamed for the
rapid increases in health-
care costs without a concomitant improvement in quality of
care. A key component of health
reform is replacing the fee-for-service model of payment with
value-based payment.
Section 4.2Legislative Processes and Implementation Issues
Under value-based payment, which also is known as pay-for-
performance (P4P), provid-
ers receive payment for service based on their performance or
the potential outcomes of the
service. Tying payment to measurable outcomes in reducing
costs and improving quality is
the “value” proposition sought by healthcare reform. Those
providers who can lower costs
and improve quality of outcomes, resulting in improved
community health, will be distin-
guished as value-based providers. In some payer arrangements,
beneficiaries will experience
higher out-of-pocket costs if they receive care from a provider
that is not designated as value-
based. There will also be penalties for failure to meet
performance targets; for example, the
37. withholding of payments to acute-care hospitals that readmit a
patient within 30 days with
the same complaint.
As value-based payment methods evolve, every provider type
will likely be affected by some
form of value-based payment. Understanding the plans of local,
state, and federal payer orga-
nizations to implement some form of value-based payment and
analyzing how those plans
will affect the HCO will be critical in the strategic planning
process (Health Care Incentives
Improvement Institute, 2012).
Accountable Care Organizations
Although ACOs take many forms and involve many different
providers, all are based on a
group of providers that work together to integrate, coordinate,
and deliver a full continuum of
care to a defined population of patients. These providers are
accountable to both the patients
and the payer organization for delivering quality care in a cost-
effective manner.
Key features of an ACO are the aggressive use of primary care
physicians to distribute preven-
tive care; care planning; and patient management practices that
minimize high-cost hospital
stays through better coordination of community and outpatient
settings. This is an important
development in the drive to cut healthcare costs and creates
more emphasis on prevention.
Although an ACO can receive payment through a variety of
methods, payment for most will
be linked to quality improvements that also reduce overall
costs. Payment will be based on
38. reliable and progressively more sophisticated performance
measures that support improve-
ment and savings.
A significant consideration by an HCO in the strategic planning
process will be participa-
tion in ACOs and other collaborative arrangements that improve
quality and reduce costs,
whether these arrangements are developed by that HCO, a
competing HCO, a collection of
physicians, or a payer organization. Providers across the
continuum must maintain a degree
of flexibility to remain viable and competitive (Centers for
Medicare & Medicaid Services,
March 2013).
Bundled Payment
Bundled payment (also known as an episodic or episode-based
payment) is a method
of payment in which a single lump sum is paid for all services
related to a particular treat-
ment or condition (episode of care), such as a hip replacement
or a coronary arterial bypass.
Services included in the single payment may encompass
physician charges, hospital charges,
ancillary charges, outpatient, and even pre- and post-acute
services.
Section 4.2Legislative Processes and Implementation Issues
Bundled payment is an alternative to capitation and fee-for-
service payment models, as it
is designed to reduce the lack of coordination among healthcare
providers and the dupli-
39. cation of care prevalent with fee-for-service and capitation
arrangements. Under a bundled
payment method, the organization that receives the payment
must negotiate fees and costs
with the respective participants and services in the bundle. This
results in an increased
emphasis on improved coordination, reduction of redundant
services, and reduction of costs
because the organization may be at financial risk for amounts
that exceed the bundled pay-
ment. Quality measures will pay an important role in
determining the value of the bundled
payment program.
Bundled payment is seen by the Centers for Medicare and
Medicaid Services (CMS) as the
most effective payment method to reduce overall healthcare
spending. Preparing for bundled
payment will be essential as an HCO develops a strategic plan.
Bundled payment represents
a fundamental shift in payments because this method transfers a
great deal of risk directly
to the HCO. This method will challenge an HCO to examine its
internal operations, identify
cost-effective behaviors, embrace evidence-based medicine, and
work collaboratively with
physicians and other HCOs to reduce redundancy and improve
patient outcomes (Centers for
Medicare & Medicaid Services, 2013).
Bending the Cost Curve
For the last 20 years, healthcare costs have risen at a fairly
steady rate of 9% per year—
an unsustainable ascent (The Washington Post, 2012). The
object of the bending-the-cost-
curve payment methodology is to alter the current trajectory of
40. healthcare costs nationwide.
Changes in payment methodologies such as value-based
reimbursement, bundled payment,
and care delivery methods encompassing better coordination
and preventive strategies will
be essential in controlling costs over the long term.
No matter where a provider falls along the healthcare
continuum, each will be expected to
deliver value. For acute-care hospitals, that could mean
decreasing readmissions and reduc-
ing duplicate and unnecessary tests and procedures. For skilled
nursing facilities or home
healthcare agencies, that might mean better management of
unnecessary hospital admis-
sions or collaborating with acute-care hospitals to address their
readmission and redundant
services issue. For patients, it may mean fewer contacts with a
physician but greater contact
with a team of healthcare professionals that work under a
physician’s supervision. Teams
may be made up of physician assistants, RNs, pharmacists,
nutritionists, physical therapists,
and mental health professionals. Providers will place greater
emphasis on preventive care,
and care navigators (also referred to as patient care managers or
care coordinators) will be
in regular contact with patients to advise and encourage
preventive care and healthier life-
styles. The result of these efforts will ultimately be measured in
terms of outcomes because
outcomes will inevitably dictate payment.
Value will not be achieved in isolation. Improving quality and
reducing costs will require
cooperation and collaboration that has been largely absent from
41. this industry. The historical
practice of discharging from one venue to the next with little
regard for outcomes or perfor-
mance of the admitting organization will, inevitably, be
replaced by care management via an
integrated continuum (Antos, et al., 2013).
Section 4.3The Five Forces Model of Industry Analysis
As you begin your strategic planning process, it will be
important for you to know what the
providers on either side of you, along the continuum, from low
acuity to high acuity, are doing
(Promise Healthcare, 2012). What reform initiatives are being
explored in your community
and by your state? What collaborations will be necessary for
your HCO to improve internal
capacity and be financially rewarded under value-based
payment? As every HCO is unique and
no cookie-cutter approach will work for everyone, putting
Band-Aids on existing procedures
will not be enough. The voyage for every healthcare provider
will be toward greater value.
4.3 The Five Forces Model of Industry Analysis
The forces of competition greatly influence the strategy
formation and market-opportunity
decisions of an organization. Although each industry has its
own unique characteristics, five
main forces are representative of the actual driving mechanisms
of any given industry and
are often referred to as the five forces model of industry
analysis. These five forces, shown in
Figure 4.2, include the following:
42. 1. The industry itself and the competitive decisions and
activities engaged in by each
company
2. Consumer/buyer composition
3. Supplier composition
4. The possibility of new entrants
5. Availability of good product substitutes
Figure 4.2: The five forces model of industry analysis
Though there are unique characteristics in any industry, five
main forces drive all industries.
f04.02_MHA 626.ai
Dynamic
activity of the
industry
Consumer/buyer
composition
Availability of
substitutes
Competitive
rivalry
Possibility of new
entrants
Supplier
composition
43. Source: Adapted from Michael E. Porter, How competitive
forces shape strategy. Harvard Business Review, 57, No. 2
(March–April 1979), p. 141.
Section 4.4Assessing Environmental Opportunities and Threats
The industry itself and the individual companies within the
industry are constantly involved in
dynamic interplay in an attempt to build a successful
competitive edge over one another. The
success of one organization’s strategy in accomplishing this is
based in large measure on the
strategies of the other organizations. Constant monitoring of
these interdependent strategic
maneuvers is required to make the adjustments necessary to
improve competitive position
and achieve market success. Multiple views of the industry are
necessary.
Consumer/buyer composition can range from a few, high-
volume purchasers to a large num-
ber of low-volume purchasers. In one instance, losing a few
customers can be the difference
between success and failure, while, at the other extreme, losing
the same number of custom-
ers has essentially no impact. Most firms try to minimize the
number of customers who can
exert an adverse effect on their business.
Supplier composition also has an important influence on the
competing position of individual
organizations. The relative importance of the goods or services
they supply will determine
44. the strength of their competitive influence over firms in the
industry. They can have a positive
or negative impact on profit margins, inventory levels, product
quality, and prices.
The possibility of new entrants into the market is a constant
threat to altering market share,
production capacity, and supply distribution within the industry.
This threat can be minimal
when there are strong barriers to entry, such as strong customer
loyalty, large capital require-
ments, difficulty in establishing distribution channels, and
strong response of current mar-
ket participants. When entry barriers are weak or the expected
response of existing firms is
weak, then the possibility of entry is stronger.
The fifth force in the model is the availability of good product
substitutes. This is a major threat
to existing firms when high-quality substitutes exist in ample
quantity at competitive or com-
parable prices. An example of such a substitute in healthcare
might be acupuncture for more
traditional medical treatments.
4.4 Assessing Environmental Opportunities and Threats
Recall, from Chapter 2, that a SWOT analysis involves
analyzing internal strengths and weak-
nesses and external opportunities and threats. Opportunities and
threats related to the exter-
nal environment are analyzed to determine if any action
(strategy) is needed to deal with
them. For example, a nursing center may notice the move
toward hospice programs for the
terminally ill. While the hospice philosophy encourages a stay-
at-home approach for the
45. dying, there are often needs for short-term interim institutional
care to manage complicated
medication regimens. The nursing center, recognizing an
opportunity in this area, could offer
such institutional services at lower costs than the traditional
inpatient, acute-care hospital.
The patients benefit from the lower charges and the nursing
center, from increased usage.
Alternatively, the nursing center may decide it does not have
the staffing expertise or phar-
maceutical services to extend the service, even though the
opportunity exists. In either case,
opportunities cannot be pursued if they are not recognized and
analyzed.
The same is true for threats. An HCO already in trouble from
inadequate funding and in
heavy debt would face even greater risks if it lost a key leader
to illness or death without any
Section 4.5Conducting an Internal Analysis
preparation for a replacement. The ripple effect of bad publicity
regarding the management
and expenses of other HCOs may also be a threat to the
existence or at least the effectiveness
of an HCO. Upon recognizing such threats, and analyzing the
possible ramifications of events,
an HCO can avoid many crises by developing the contingency
plans for dealing effectively
with such situations. Some have referred to this process as the
what if and what then analysis.
In other words, asking the questions What if this happens? and
What do we do if this happens?
46. helps an HCO deal better with major events that might be
detrimental to the organization.
The more you know about the people being served, the better
you can meet their needs. Thus,
the HCO’s patient/client base should be a prime element for
study. Here, building a database
is useful. Many successful businesses, such as Wal-Mart, are
continually doing research to
learn more about their customers. An HCO should do the same
thing. Information can be
gathered on such factors as marital status, family size, age of
family members, occupations,
housing, means of transportation, healthcare needs, reasons for
using the HCO’s services, and
length of time using the HCO’s services. All of these are good
subjects to gather information
about by asking questions.
Scanning the environment of an HCO’s operation for significant
trends, especially in chang-
ing times, is an ongoing effort. This stage in the planning
process is not about gathering data,
reporting that data, and then forgetting about the data. The
environment must be constantly
monitored to help ensure that the HCO survives and grows.
4.5 Conducting an Internal Analysis
After identifying an HCO’s vision and mission and having
considered the environment in
which the HCO operates, strategy planners must objectively
assess the strengths and weak-
nesses of the organization’s internal operations. HCO
administrators can learn from athletic
coaches in this area. Coaches constantly assess the strengths
and weaknesses of their own
47. team as well as the opponent. The coaches try to maximize their
teams’ strengths on game
day, and, during practice, remedy their teams’ weaknesses.
Organizations have certain strengths that make them uniquely
suited to carry out their tasks.
Conversely, they have certain weaknesses that inhibit their
abilities to fulfill their purposes.
HCOs that seek …