The Quadruple Aim provides broad categories of goals to pursue to maintain and improve healthcare. Within each goal are many issues that, if addressed successfully, may have a positive impact on outcomes. For example, healthcare leaders are being tasked to shift from an emphasis on disease management often provided in an acute care setting to health promotion and disease prevention delivered in primary care settings. Efforts in this area can have significant positive impacts by reducing the need for primary healthcare and by reducing the stress on the healthcare system.

Changes in the industry only serve to stress what has always been true; namely, that the healthcare field has always faced significant challenges, and that goals to improve healthcare will always involve multiple stakeholders. This should not seem surprising given the circumstances. Indeed, when a growing population needs care, there are factors involved such as the demands of providing that care and the rising costs associated with healthcare. Generally, it is not surprising that the field of healthcare is an industry facing multifaceted issues that evolve over time.

In this module’s Discussion, you reviewed some healthcare issues/stressors and selected one for further review. For this Assignment, you will consider in more detail the healthcare issue/stressor you selected. You will also review research that addresses the issue/stressor and write a white paper to your organization’s leadership that addresses the issue/stressor you selected.

To Prepare:

  • Review the national healthcare issues/stressors presented in the Resources and reflect on the national healthcare issue/stressor you selected for study.
  • Reflect on the feedback you received from your colleagues on your Discussion post for the national healthcare issue/stressor you selected.
  • Identify and review two additional scholarly resources (not included in the Resources for this module) that focus on change strategies implemented by healthcare organizations to address your selected national healthcare issue/stressor.

The Assignment (2-3 Pages):

Analysis of a Pertinent Healthcare Issue

Develop a 2 to 3 page paper, written to your organization’s leadership team, addressing your selected national healthcare issue/stressor and how it is impacting your work setting. Be sure to address the following:

  • Describe the national healthcare issue/stressor you selected and its impact on your organization. Use organizational data to quantify the impact (if necessary, seek assistance from leadership or appropriate stakeholders in your organization).
  • Provide a brief summary of the two articles you reviewed from outside resources on the national healthcare issue/stressor. Explain how the healthcare issue/stressor is being addressed in other organizations.
  • Summarize the strategies used to address the organizational impact of national healthcare issues/stressors presented in the scholarly resources you selected. Explain how they may impact your organization both positively and negatively. Be specific and provide examples.

Looking Ahead

The paper you develop in Module 1 will be revisited and revised in Module 2. Review the Assignment instructions for Module 2 to prepare for your revised paper.

Research Method and Design


Data Analysis




Week I

Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

Week I

Post a description of the national healthcare issue/stressor you selected for analysis, and explain how the healthcare issue/stressor may impact your work setting. Then, describe how your health system work setting has responded to the healthcare issue/stressor, including a description of what changes may have been implemented. Be specific and provide examples.

Health Care Regulation Impact 

Assignment : Health Care Regulation Impact 


Target: Assess the social determinants of health and health policy to optimize the management of health care delivery

Select a state regulation from a state of your choice on one of the below topics. Prepare an annotated copy of the regulation, including the sections you reviewed to answer the questions in the following format:

Prepare a three (3) to four (4) page written response addressing all information in the following table. Text must be double spaced. Also include a cover page and a reference page in APA Format (these do not count toward the page limit). Review the bolded text in the Class Guidelines section of the syllabus above for formatting requirements.

Highlight five (5) notable parts of the regulation. For each of the parts, describe how the patient, provider, product developer, health care organization and/or payer may be impacted. Remember to write in narrative format except for titles. No more than 15% of direct quotes or paraphrasing are permitted in the document. Use citations and attach the notated regulation. In Week Five, you need to sign up for a topic in the Assignment Three Topic Selection folder in LEO. Unless the professor reaches out to you directly, your chosen topic is approved. Note a maximum of five (5) students may select the same topic. The topics are as follows:

Topic: Alcohol and drug treatment varies widely across states.  Select a state and note the specific regulations about drug treatment facilities. (You can use one from the following NY state, California or Florida) If you have a better state you are free to use it.

CLARIFICATION:  You need to select ONE specific state regulation/law from ONE state that addresses your chosen topic. Then highlight/select FIVE notable parts of the regulation. Then, in a paper format (NOT in the table), answer all the inquiries from the table. That includes analyzing all five parts of the regulation and its impact on the noted stakeholders in the table.

HGMT 310 Assignment #3

Student Name:

Type your name here.

Assignment #3 Title:

Provide a unique short name for the paper and the official title of the state regulation.

Agency Responsible:

Identify the state agency and subunit (such as a bureau or office) responsible for oversight of the regulation.

Incentives and Enforcement:

What enforcements and penalties are noted in the regulation?  Is there training for personnel? Is Technical Assistance (funding, training, resources) provided?

Key Aspect of the Regulation #1:

How does this section of the regulation impact payers/insurers/health plans, health care professionals, health provider organizations, or health product developers?

Key Aspect of the Regulation #2:

How does this section of the regulation impact payers/insurers/health plans, health care professionals, health provider organizations, or health product developers?

Key Aspect of the Regulation #3:

How does this section of the regulation impact payers/insurers/health plans, health care professionals, health provider organizations, or health product developers?

Key Aspect of the Regulation #4:

How does this section of the regulation impact payers/insurers/health plans, health care professionals, health provider organizations, or health product developers?

Key Aspect of the Regulation #5:

How does this section of the regulation impact payers/insurers/health plans, health care professionals, health provider organizations, or health product developers?

Notated Copy of the Rules:

Attach a copy of the regulation that you have marked up.  Underline, highlight or note key sections. Mark them (1), (2), (3), etc. You may use technology to mark up in PDF or print, handwrite and scan the regulation. Specifically:

1.  Print out the regulation, write in notes and/or highlight the printed copy, use a scanner to scan in the document in PDF format, and then attach to the back of your paper, or submit as a separate, second file online.


2. Save the regulation in PDF format (you could copy the text and paste into Word, then Save As a PDF file). Open up Adobe Acrobat and add comments and/or highlights via the Comments function.  Then attach to the back of your paper or submit as a separate, second file online.







Health Administration Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. CHAPTER 4 STRATEGIC PLANNING AND SWOT ANALYSIS I skate where the puck is going to be, not where it has been. —Wayne Gretzky Learning Objectives After you have studied this chapter, you should be able to ➤➤ demonstrate the ability to integrate the various disciplines into a comprehensive framework to assess healthcare strategic planning problems; ➤➤ exercise strong individual managerial problem-solving skills through the use of SWOT analysis; ➤➤ formulate strategy and implement change through the use of gap analysis and force field analysis; and ➤➤ discuss multidisciplinary teamwork required within organizations that allows leaders and individual team members to efficiently implement change. 100 EBSCO Publishing : eBook Collection (EBSCOhost) – printed on 11/4/2022 7:33 PM via TRIDENT UNIVERSITY AN: 1843079 ; Jeffrey Harrison.; Essentials of Strategic Planning in Healthcare, Second Edition Account: s3642728.main.ehost 00_Harrison (2302).indb 100 2/18/16 4:12 PM Chapter 4: Strategic Planning and SWOT Analysis 101 Key Terms and Concepts ➤➤ Bundled payment ➤➤ Strengths ➤➤ Churn rate ➤➤ SWOT analysis ➤➤ Downstream value ➤➤ Threats ➤➤ Force field analysis ➤➤ Weaknesses ➤➤ Opportunities I n t r o d u c ti o n Healthcare organizations must continually make adjustments to maintain optimal function. The high rate of change in healthcare is shortening the strategic planning window for healthcare organizations that are adapting to healthcare reform (Zuckerman 2014). Leading organizations believe strategic planning is more important than ever and focus on allocating resources for the short and long term, integrating geographically separated organizations, and developing a team that can focus on a clear strategy. As a result, strategic planning is evolving into a more continuous and integrated process. A number of different techniques can be used to determine where adjustments need to be made. One essential technique involves a discussion of an organization’s strengths, weaknesses, opportunities, and threats, commonly called SWOT analysis. SWOT analysis has been used extensively in other industries but has not yet been widely used in healthcare (Makos 2014). Prior to strategic planning, a panel of experts who can assess the organization from a critical perspective perform a SWOT analysis. This panel could comprise senior leaders, board members, employees, medical staff, patients, community leaders, and technical experts. Panel members base their assessment on utilization rates, outcome measures, patient satisfaction statistics, organizational performance measures, and financial status. While based on data and facts, the conclusions drawn from SWOT analysis are the expert opinion of the panel. The annual strategic planning process should incorporate strategic planning, action planning, and operational oversight into an ongoing cycle (Zuckerman 2014). Many of the elements discussed in SWOT analysis are a part of this process, including environmental factors, organizational structure, capital financing, operational planning, and measurement of financial performance. SWOT analysis Examination of an organization’s internal strengths and weaknesses, its opportunities for growth and improvement, and the threats the external environment presents to its survival. D e fi ni t i o n SWOT analysis is an examination of an organization’s internal strengths and weaknesses, its opportunities for growth and improvement, and the threats the external environment EBSCOhost – printed on 11/4/2022 7:33 PM via TRIDENT UNIVERSITY. All use subject to 00_Harrison (2302).indb 101 2/18/16 4:12 PM 102 Essentials of Strategic Planning in Healthcare presents to its survival. Originally designed for use in other industries, it is gaining increased use in healthcare. S t e p s i n SWOT A nalys i s The primary aim of strategic planning is to bring an organization into balance with the external environment and to maintain that balance over time. Organizations accomplish this balance by evaluating new programs and services with the intent of maximizing organizational performance. SWOT analysis is a preliminary decision-making tool that sets the stage for this work. Step 1 of SWOT analysis involves the collection and evaluation of key data. Depending on the organization, these data might include population demographics, community health status, sources of healthcare funding, and the current status of medical technology in the organization. Once the data have been collected and analyzed, the organization assesses its capabilities in these areas. After the data on the organization are collected, in step 2 it is sorted into four categories: strengths, weaknesses, opportunities, and threats. Strengths and weaknesses generally stem from factors in the organization, whereas opportunities and threats usually arise from external factors. Organizational surveys are an effective means of gathering some of this information, such as data on an organization’s finances, operations, and processes (Makos 2014). Exhibit 4.1 illustrates step 2 of SWOT analysis in a hypothetical example Exhibit 4.1 Sample SWOT Matrix External Origin Internal Origin Helpful to Objective Harmful to Objective Strengths Weaknesses • Worldwide reputation • Focus on patient care • Focus on quality and value • Experience in medical imaging • Location of hospital • High-tech facility and equipment • No capital expenditures • Some increase in staffing • Some dissatisfaction by employees working on Saturdays • Increased workload for radiologists already working at peak performance Opportunities Threats • Local community targeted marketing • Improvements in payer mix • Improvements in integrated care • Local competitors offering Saturday MRIs • Loss of potential market share and revenue to competitors • Unknown implications of healthcare reform EBSCOhost – printed on 11/4/2022 7:33 PM via TRIDENT UNIVERSITY. All use subject to 00_Harrison (2302).indb 102 2/18/16 4:12 PM Chapter 4: Strategic Planning and SWOT Analysis 103 of an outpatient clinic considering the value of adding Saturday MRI (magnetic resonance imaging) appointments in response to increasing demand. Step 3 involves the development of a SWOT matrix for each business alternative under consideration. For example, say a hospital is evaluating the development of an ambulatory surgery center (ASC). It is looking at two options: The first is a wholly owned ASC, and the second is a joint venture with local physicians. The hospital’s expert panel would complete a separate SWOT matrix for each alternative. Step 4 involves incorporating the SWOT analysis into the decision-making process to determine which business alternative best meets the organization’s overall strategic plan. Strengths Traditional SWOT analysis views strengths as current factors that have prompted outstanding organizational performance. Examples include the use of state-of-the-art medical equipment, investments in healthcare informatics, and a focus on community healthcare improvement projects. To draw an example from real life, Mayo Clinic is a nonprofit, integrated, multispecialty medical practice with more than 60,000 employees. Mayo is an outstanding organization because it integrates the provision of healthcare through teamwork, the use of real-time patient healthcare information, and the application of advanced technology to provide high-quality care to the patient at an affordable cost (Berry and Beckham 2014). For example, treatment at an academic medical center during the last two years of life for a patient with at least one of nine chronic conditions might cost $93,000, while similar treatment at Mayo would cost $53,000 (Wennberg et al. 2008). Mayo’s strengths also include investing in structural tools such as comprehensive electronic health records, which connect individual clinicians with the latest clinical information available for treating the patient. Patients at Mayo frequently have complex medical conditions that benefit from the pooling of knowledge inside the organization and among the integrated healthcare team. Mayo fosters a culture that considers teamwork essential to delivering patient-centered care. This attitude translates to a unified focus on shared values to achieve a high level of collaboration across the team. This teamwork enhances learning, inspires confidence, and promotes camaraderie among the clinical team. Research suggests that top-tier organizations nurture teamwork and recruit individuals who are likely to be team players (Beckham 2013). For other healthcare organizations, potential organizational strengths might include highly competent personnel, a clear understanding among employees of the organization’s goals, and a focus on quality improvement. Future strengths include growth through mergers and acquisitions as healthcare organizations consolidate into larger organizations with annual revenues in excess of $2 billion (Zuckerman 2014). These larger organizations have the ability to reach economies of scale and reduce costs in the future by 3–5 percent annually. This reduction in costs combined with improved quality results in greater value for the patient. Strengths Current factors that have prompted outstanding organizational performance. EBSCOhost – printed on 11/4/2022 7:33 PM via TRIDENT UNIVERSITY. All use subject to 00_Harrison (2302).indb 103 2/18/16 4:12 PM 104 Essentials of Strategic Planning in Healthcare Weaknesses Weaknesses Organizational factors that increase healthcare costs or reduce healthcare quality. Bundled payment Single payment made to providers or healthcare facilities (or jointly to both) for all services rendered to treat a given condition or provide a given treatment. Weaknesses are organizational factors that increase healthcare costs or reduce healthcare quality. Under healthcare reform, it is increasingly clear that hospitals that seek to “go it alone” will find it difficult to acquire the financial and human resources necessary to build the infrastructure required for coordinated care. The fundamental Affordable Care Act (ACA) model for integrated care shifts the healthcare system from volume-driven fee-for-service care provision to chronic disease management and value-driven episodes of care (see Highlight 4.1). The shift is occurring piecemeal, one payer and one contract at a time—forcing hospitals to operate in both the volume- and value-driven models at the same time. As a result, hospital mergers have increased in order to find strategic partners that can manage the transition from a volume-driven to a value-driven marketplace. In 2000, 52 percent of hospitals were part of multihospital systems, whereas by the end of 2013, 62 percent of hospitals had joined multihospital systems (AHA 2014). As organizations now position themselves for valuebased reimbursement with shared savings and bundled payments (single payments made to providers or healthcare facilities for all services rendered to treat a given condition or provide a given treatment), freestanding hospitals will increasingly be unable to provide integrated healthcare (Lineen 2014). Other hospital weaknesses include aging facilities and a lack of continuity in clinical processes, which can lead to duplication of efforts. Weaknesses can be broken down further to identify underlying causes. For example, disruption in the continuity of care often results from poor communication. This fragmentation leads to inefficiencies in the entire system—weaknesses also breed other weaknesses. Thus, poor communication disrupts the continuity of care. Inefficiencies, in turn, deplete financial and other resources. The growth in integrated delivery systems allows greater efficiency across the continuum of healthcare. As a result, hospitals will need to develop ambulatory care networks and enhance their relationship with multispecialty physician groups. Failing to market ambulatory services in the face of increasing competition could prove to be a fatal weakness as patient referrals migrate to larger health systems. Other common weaknesses include poor use of healthcare informatics, insufficient management training, lack of financial resources, and an organizational structure that limits collaboration with other healthcare organizations. A payer mix that includes large numbers of uninsured patients or Medicaid patients can also negatively affect an organization’s financial performance, and lack of relevant and timely patient data can increase costs and lower the quality of patient care. Opportunities Significant new business initiatives available to a healthcare organization. O p p o rt u n i t i e s Traditional SWOT analysis views opportunities as significant new business initiatives available to a healthcare organization. For example, healthcare organizations could collaborate through the development of healthcare delivery networks, pursue increased funding for EBSCOhost – printed on 11/4/2022 7:33 PM via TRIDENT UNIVERSITY. All use subject to 00_Harrison (2302).indb 104 2/18/16 4:12 PM Chapter 4: Strategic Planning and SWOT Analysis * 105 HIGHLIGHT 4.1 Value-Driven Episodes of Care The US Department of Health & Human Services (HHS) is testing and expanding new healthcare payment models that can improve healthcare quality and reduce its cost. HHS has adopted a framework that categorizes healthcare payment according to how providers receive payment to provide care: • Category 1—Fee-for-service with no link of payment to quality • Category 2—Fee-for-service with a link of payment to quality • Category 3—Alternative payment models built on fee-for-service architecture • Category 4—Population-based payment Value-based purchasing includes payments made in categories 2–4. Moving from category 1 to category 4 involves two shifts: (1) increasing accountability for both quality and total cost of care and (2) a greater focus on population health management as opposed to payment for specific services. Prior to 2011, many Medicare payments to providers were tied only to volume, rewarding providers based on, for example, how many tests they ran, how many patients they saw, or how many procedures they did, regardless of whether these services helped (or harmed) the patient. But under the ACA and because of other changes, by 2014, an estimated 20 percent of Medicare reimbursements had shifted to categories 3 and 4, directly linking providers’ reimbursement to the health and well-being of their patients (CMS 2015). healthcare informatics, partner with communities to develop new healthcare programs, or introduce clinical protocols to improve quality and efficiency. Additional opportunities include obtaining increased reimbursement; instituting value-based purchasing; increasing patient satisfaction; providing new clinical services aligned with population health needs; and delivering integrated, patient-focused care. Healthcare organizations might also improve patient satisfaction by increasing public involvement and ensuring patient representation on boards and committees. Organizations that are successful at using data to improve clinical processes have lower costs and higher-quality patient care. For example, healthcare organizations with Centers for Medicaid & Medicare Services (CMS) Hospital Compare quality scores above the 90th national percentile are eligible for CMS pay-for-performance incentives (see Chapter 6 for information on CMS Hospital Compare). Pay-for-performance incentive programs vary payment among providers on the basis of quality and efficiency measures EBSCOhost – printed on 11/4/2022 7:33 PM via TRIDENT UNIVERSITY. All use subject to 00_Harrison (2302).indb 105 2/18/16 4:12 PM 106 Essentials of Strategic Planning in Healthcare so that desired outcomes occur through changed behavior. The greater the number of organizations achieving such scores, the greater patients’ access to quality healthcare. Such scores also enhance an organization’s reputation in the community. While there will always be a certain number of hospitals at the 90th percentile, the bar continues to keep getting higher. Even the best have to continue to improve. T h r e at s Threats Factors that could negatively affect organizational performance. Churn rate Ratio indicating the quantity of new patients relative to existing patients. Threats are factors that could negatively affect organizational performance. Examples include political or economic instability, increasing demand by patients and physicians for expensive medical technology that is not cost-effective, increasing state and federal budget deficits, and increasing pressure to reduce healthcare costs. Additional threats include healthcare funding cuts, the increasing cost of technology, and the potential for reduced access to capital. One of the basic threats to a healthcare organization’s survival is churn rate, the quantity of new patients relative to existing patients. Hospital churn rates can vary, but a good target is 15 percent new patients annually. This rate replaces lost business while maintaining significant growth. A high churn rate can be good news. A low churn rate suggests that an organization is losing potential new patients to its competitors and poses a significant threat if the number of existing patients also declines. Such a decrease in the number of existing patients can come from many sources; patients may move out of the area, die, or age into a cohort requiring a different type of provider. Referral patterns among primary physicians may also change. Low churn rates clearly reflect an organization’s inability to attract new patients, possibly driven by low patient satisfaction. SWOT A n a ly si s : I nternal and E xternal P erspect i ve As shown in Exhibit 4.1, SWOT has an internal as well as an external focus. Strengths and weaknesses are primarily internal in origin. Examples of these internal factors include patient satisfaction, cost per procedure, and level of quality. Conversely, opportunities and threats are primarily external in origin. These could include the level of competition in the market, the availability of integrated care, and the economy of scale as measured by an organization’s market share. Strengths and opportunities are helpful to the objective; weaknesses and threats are harmful to the objective. F o r c e F i e l d A n alysi s Healthcare organizations’ responsibility to implement change that is beneficial to the patient, staff, and organization is increasing. The primary drivers of change in healthcare are the push for quality improvement, the need for customer satisfaction, the desire to improve working conditions, and the diversification of the healthcare workforce. EBSCOhost – printed on 11/4/2022 7:33 PM via TRIDENT UNIVERSITY. All use subject to 00_Harrison (2302).indb 106 2/18/16 4:12 PM Chapter 4: Strategic Planning and SWOT Analysis Force field analysis (see Exhibit 4.2) takes SWOT analysis a step further by identifying the forces driving or hindering change—in other words, the forces driving an organization’s strengths, weaknesses, opportunities, and threats. Kurt Lewin’s (1951) force field analysis and force field diagrams are the founding theory for this exercise. Forces that propel an organization toward goal achievement are called helping forces, while those that block progress toward a goal are called hindering forces. After identifying these positive and negative forces, an organization can develop strategies to strengthen the positives and minimize the negatives. For an organization to achieve success, the helping forces must outweigh the hindering forces. When this state is reached, an organization is able to move from its current reality to a preferred future. Effective force field analysis considers not only organizational values but also the needs, goals, ideals, and concerns of individual stakeholders. Individuals who promote change are Probability of Change High +2 +1 0 Force field analysis Examination of the forces helping or hindering organizational change. Exhibit 4.2 Healthcare Model for Force Field Analysis Low –1 107 –2 Transformational Leadership Limited Financial Resources Highly Skilled Personnel Poor Payer Mix with Low Reimbursement Adequate Financial Resources Equilibrium Profitability Marginal Patient Safety Low Healthcare Quality Culture of Innovation Lack of Motivated and Skilled Personnel Patient Perception of Quality Culture Opposed to Change Driving Forces Restraining Forces EBSCOhost – printed on 11/4/2022 7:33 PM via TRIDENT UNIVERSITY. All use subject to 00_Harrison (2302).indb 107 2/18/16 4:12 PM 108 Essentials of Strategic Planning in Healthcare helping forces, whereas those who resist change are hindering forces. As a result, understanding individuals, their attitudes, and the culture of the organization is important. A group performing force field analysis should also identify the key stakeholders in an issue and develop a plan to gain their support. Counteracting organizational inertia (the hindering forces) and creating an environment that proactively supports future change (the helping forces) is vital. Such change is accomplished by modifying current attitudes (“unfreezing” an organization’s perspective on a particular issue), emphasizing the positive aspects of change, and then incorporating the new attitudes in the organization’s processes (“refreezing” the new attitudes so that they and their associated behavior patterns become entrenched in the institution). A participative management style that solicits input from inside the organization is important in implementing change. This approach also fosters the development of consensus within work groups, which helps to refreeze the new behaviors in the organization. G a p A n a ly si s To further refine planning decisions, SWOT analysis can be supplemented by gap analysis, which reveals differences between the organization’s current standing and its target performance. Knowing where to focus efforts improves the efficiency of interventions. Obtaining data that can be used for local benchmarking and improvement is a key step in raising awareness and driving quality improvement. Research shows that while we have seen improvement, there are still gaps of quality care in healthcare practice. For example, in 2010, 287,000 women died worldwide from causes related to pregnancy and childbirth. Also, during the same year, 3.1 million babies died in their first month of life (Dean et al. 2014). These mortality rates clearly show that improvement is needed in the continuum of care for these patients. Preconception care is a solution that would improve the continuum of care by ensuring ongoing health surveillance and early intervention so that women begin pregnancy in the best possible health. Some potential tools include community-based studies to identify need and availability of resources, education programs, women’s support groups, and counseling on topics such as smoking, obesity, nutrition, diabetes, hypertension, and depression. By closing the gap through preconception care, health professionals can enhance the community’s health status and improve clinical outcomes for women, mothers, and infants. Implementing a gap analysis framework to improve quality of care for patients requires an organization to ask and answer a series of tough questions (Dick, Gaudreault, and Shakir 2010; see Exhibit 4.3). Gaps also exist between people’s expectations of high-quality care and situations in which they receive low-quality healthcare. Low-quality healthcare may be the result of providers’ lack of responsiveness, marginal competence, unreliability, weak communication skills, and breaches of confidentiality. Performance variations also result from trade-offs in the allocation of healthcare resources (Kasti 2013). For example, some healthcare organizations EBSCOhost – printed on 11/4/2022 7:33 PM via TRIDENT UNIVERSITY. All use subject to 00_Harrison (2302).indb 108 2/18/16 4:12 PM Chapter 4: Strategic Planning and SWOT Analysis What to Ask What are we trying to accomplish? How to Answer 109 Exhibit 4.3 Performing a Gap Analysis Identify the target population and improvement goal. Pinpoint gaps and who falls through them. What changes can we make that will result in improvement? Identify the causes and barrier behind the gap. Determine what changes would improve care or close the gap. Plan and implement change. Monitor results. How will we know if a change is an improvement? Collect data. Plot or display the data for analysis. may lack the financial resources to purchase new equipment or hire additional staff when experiencing increased demand because they have allocated their resources for another purpose; as a result, patients experience excessive waiting times. Downstream Revenue Understanding downstream value—the revenue captured by the services a patient uses after his initial visit—can provide a hospital with a better foundation for strategic planning and resource allocation. Although hospitals tend to think in terms of transactions, in the rapidly changing healthcare environment, hospitals must increasingly look beyond the dollars spent on the initial transaction and incorporate downstream revenue. Patients generate two to ten times the value of the initial transaction in the two years following that encounter from sources such as subsequent testing or return visits (Sturm 2009). A full-time physician brings in an average of $1.45 million in net revenue every year to the hospital with which she is affiliated, and some specialties bring in almost double that amount. In 2013, primary care physicians brought in more revenue to their hospitals than specialists did. Primary care physicians generated $1.57 million in downstream revenue for their hospitals, compared to $1.42 million from specialists. This figure did not include indirect revenue they may have created from patient referrals to specialists (Herman 2013). Downstream revenue can provide a strong foundation of resources for future strategic planning. Moreover, as changes in reimbursement drive transactional revenue down, positive patient relationships that produce an ongoing revenue stream from repeated and clinically appropriate visits are critical. Downstream value Revenue captured by the services a patient uses after his initial visit, such as subsequent testing or return visits. EBSCOhost – printed on 11/4/2022 7:33 PM via TRIDENT UNIVERSITY. All use subject to 00_Harrison (2302).indb 109 2/18/16 4:12 PM 110 Essentials of Strategic Planning in Healthcare Summary SWOT analysis is performed prior to the strategic planning process. Ideally, SWOT analysis includes a comprehensive review of the healthcare literature, in-depth data analysis, and input from a panel of SWOT analysis experts. Findings from the analysis are sorted into four categories: strengths, weaknesses, opportunities, and threats. Force field analysis supplements SWOT analysis by identifying the forces driving the strengths, weaknesses, opportunities, and threats. To refine these analyses even further, gap analysis may be performed to determine where deficiencies exist in an organization’s delivery of care. Such analyses promote (1) a better understanding of barriers to change, innovation, and the transfer of knowledge to practice; (2) improved outcomes; and (3) more efficient allocation of healthcare resources. A review of service lines allows organizations to identify new promotable products. These promotable products should have a high profit margin and downstream revenue opportunity and should allow for low-cost ease of entry as a reasonable payback period. Other signs of market potential are leading indicators in the geographic area such as housing starts, employment rates, and per capita income, which can be harbingers of future activity in a healthcare service line. Exercises Review Questions 1. How does SWOT analysis set the stage for strategic planning? 2. Discuss the use of force field analysis in promoting change in a healthcare organization. 3. Provide examples of how gap analysis can be used to improve the quality of healthcare services. 4. Provide an example of how a hospital’s strategic plan can affect downstream revenue. C o a s ta l M e d i c a l C e n t e r E x e r c i s e s : SWOT A n a ly s i s a n d H o s p i ta l E m e r g e n c y D e pa rt m e n t E x pa n s i o n Using the four steps of SWOT analysis discussed in Chapter 4, create a panel of experts and perform a SWOT analysis for Coastal Medical Center (CMC). Use SWOT analysis to identify factors that are key to getting CMC back on track and moving forward on a new road to success. CMC CEO Richard Reynolds has met with Dr. John Warren, the chief medical officer, and Dr. Debra Jones, the director of the CMC emergency department (ED). They discussed EBSCOhost – printed on 11/4/2022 7:33 PM via TRIDENT UNIVERSITY. All use subject to 00_Harrison (2302).indb 110 2/18/16 4:12 PM Chapter 4: Strategic Planning and SWOT Analysis 111 the quality-level data included in the following report. They also discussed a workload report of the ED service volume for the past year. The data show a high level of ED utilization. The average charge for a hospital ED visit is $1,000 plus $500 in ancillary charges such as laboratory, radiology, and pharmacy. However, the data also suggest that a percentage of the ED patients are leaving without being seen. Mr. Henderson, Dr. Warren, and Dr. Jones are concerned about lost revenue because hospital data show that, in addition to the ED charges, if admitted to the hospital, patients generate an average of $100 in profit per inpatient day. C o a s ta l M e d i c a l C e n t e r Q u e s t i o n s Use the following report to answer these questions: 1. Based on your evaluation of the ED data, do you see any current problems? 2. Based on the data provided, calculate the potential lost revenue for ED visits over the past year. 3. Based on the data provided, calculate the potential lost downstream hospital revenue from ED admissions who walked out over the past year. 4. Make a recommendation to Mr. Henderson, Dr. Warren, and Dr. Jones for how to deal with the ED problem. CMC Hospital Data Annual discharges 40,720 Average length of stay (days) 5.1 Average daily census 423 Inpatient surgeries 13,000 Outpatient surgeries 14,900 Births 2,400 Outpatient visits 245,000 Emergency department (not admitted) 36,400 Emergency department (admitted) 24,700 Total emergency department patients 61,100 EBSCOhost – printed on 11/4/2022 7:33 PM via TRIDENT UNIVERSITY. All use subject to 00_Harrison (2302).indb 111 2/18/16 4:12 PM 112 Essentials of Strategic Planning in Healthcare ED Quality-Level Comparison Score CMC State Average National Average Average (median) time patients spent in ED before admission 340 minutes 282 minutes 272 minutes Average (median) time patients spent between decision to admit and departing for inpatient room 130 minutes 108 minutes 97 minutes Average time patients spent in ED before being sent home 150 minutes 143 minutes 133 minutes Average time patients spent in ED before being seen by a healthcare professional 36 minutes 23 minutes 24 minutes Average time patients with broken bones waited for pain medication 70 minutes 56 minutes 55 minutes Percentage of patients who left ED ➤ before being seen 4% 2% 2% Percentage of patients who came to ED with stroke symptoms and received brain scan results within 45 minutes 55% 67% 61% Measure References American Hospital Association (AHA). 2014. “Fast Facts on US Hospitals.” Updated January 2015. Beckham, D. 2013. “Building a Team of Teams.” Hospitals & Health Networks. Published February 19. Berry, L. L., and D. Beckham. 2014. “Team-Based Care at Mayo Clinic: A Model for ACOs.” Journal of Healthcare Management 59 (1): 9–13. Centers for Medicare & Medicaid Services (CMS). 2015. “Better Care. Smarter Spending. Healthier People: Paying Providers for Value, Not Volume.” Published January 26. EBSCOhost – printed on 11/4/2022 7:33 PM via TRIDENT UNIVERSITY. All use subject to 00_Harrison (2302).indb 112 2/18/16 4:12 PM Chapter 4: Strategic Planning and SWOT Analysis 113 Dean, S., Z. Lassi, A. Imam, and Z. Bhutta. 2014. “Preconception Care: Closing the Gap in the Continuum of Care to Accelerate Improvements in Maternal, Newborn and Child Health.” Reproductive Health 11 (Suppl. 3): S1. Dick, S., S. Gaudreault, and F. Shakir. 2010. “Implementing a Gap Analysis Framework to Improve Quality of Care for Your Patients.” US Agency for International Development. Accessed August 15, 2015.➤ framework_workbook.14jun10_1.pdf. Herman, B. 2013. “Which Physicians Generate the Most Revenue for Hospitals?” Becker’s Hospital Review. Published May 8. Kasti, M. 2013. “Model for Healthcare Performance: GAP #1—The Strategy Gap.”➤ Mo (blog). Published November 9.➤ performance-gap-1-the-strategy-gap/. Lewin, K. 1951. Field Theory in Social Science: Selected Theoretical Articles. Edited by D. Cartwright. New York: Harper & Row. Lineen, J. 2014. “Hospital Consolidation: ‘Safety in Numbers’ Strategy Prevails in Preparation for a Value-Based Marketplace.” Journal of Healthcare Management 59 (5): 315–17. Makos, J. 2014. “How to Conduct SWOT Analysis in Healthcare Organizations.” Pestle Analysis. Published October 28. Sturm, A. 2009. “Five New Ways to Look at Generating Revenue.” Healthcare Financial Management 63 (11): 68–74. Wennberg, J. E., E. S. Fisher, D. C. Goodman, and J. S. Skinner. 2008. Tracking the Care of Patients with Severe Chronic Illness: The Dartmouth Atlas of Health Care 2008. Dartmouth Institute for Health Policy and Clinical Practice Center for Health Policy Research. Zuckerman, A. 2014. “Successful Strategic Planning for a Reformed Delivery System.” Journal of Healthcare Management 59 (3): 168–72. EBSCOhost – printed on 11/4/2022 7:33 PM via TRIDENT UNIVERSITY. All use subject to 00_Harrison (2302).indb 113 2/18/16 4:12 PM

 Cancer Risk and Prevention Course number: PHC335 CRN: 15772

 Cancer Risk and Prevention Course number: PHC335 CRN: 15772

Write a short essay to discuss risk factors associated with Cancer and prevention methods in Kingdom of Saudi Arabia (Support your answer with evidence and examples) i. What is magnitude of Cancer in KSA? (2 marks) ii. Mention the most types of cancers prevalence in Assignment title or task: KSA. (1 mark) (You can write a question) iii. What are the main causes and contributory factors of Cancer in KSA? (3 marks) iv. What are the interventions applied to prevention these risk factors in KSA? (4 marks) Student name: Student ID: Submission date: Instructor’s name: Dr. Eltagi A. M. Abdalla Grade: …. Out of 10 Instructions for submission: • • • • • • • • Assignment must be submitted with properly filled cover sheet (Name, ID, CRN, Submission date) in word document, Pdf is not accepted. Length of the paper assignment will be 500-1000 words write-up should be 1 to 2 (Minimum one page). Text size 12-Times New Roman with 1.5-line spacing. Heading should be Bold The text color should be Black Do proper paraphrasing to avoid plagiarism with proper references/sources. Minimum 5 references ‘’References must be in APA style’’ Don’t forget the in-text citations

insurance and managed care

 healthcare categories  in the U.S.


Insurance and managed care continue to be an area of concern for consumers, healthcare organizations, and insurance companies as the U.S. healthcare system continue to struggle in meeting healthcare needs. There are various, pressing issues regarding insurance and managed care. This assessment will provide an opportunity to explore one of the issues in greater depth through research and writing an essay.

  1. Utilization and quality
  2. Costs, cost-savings
  3. Reimbursement methodologies and incentives
  • Write a 5 to 7-page paper/essay including the following about the selected healthcare category:
  1. Summary of the current state of the selected category of healthcare in the U.S.
  2. Explanation of at least 2 specific issues the U.S. struggles with within the selected category
  3. Description of 3 potential solutions that would improve the selected category in the U.S. healthcare system
  4. Identification of at least 1 advantage and 1 disadvantage of each solution presented
  5. From the 3 identified solutions, select the preferred solution and provide a rationale for the selection.