Strategic plan to achieve waiting time of 4 hour target for Accident and Emergency department

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The purpose of this strategic plan is to provide the framework for the general hospital that I am the newly appointed manager in its plans of meeting the new government targets for the Accident and Emergency (A&E) departments waiting times of <4 hours.  The principal operational plan and other internal management plans will include specific, quantifiable objectives and tactics that are aligned with goals and strategies that are pinpointed in this strategic plan. The timeline for this strategic planning process is from November 2020 to October 2023, which will be two months ahead of the deadline set by the government to have all A&E departments achieve the waiting target of four or less hours. In addition, there will be meeting of no more than 2 hours before each of the following nine stages;

1. Purpose of our strategic planning efforts, timeline for the strategic planning process and resources available for this strategic planning process.

  1. Before building a strong planning team;
  2. Before conducting an analysis of the internal and external environment of our program and analysis of our hospital strengths, weaknesses, opportunities, and threats (SWOTs);
  3. Before creating a prioritised program strategies, an aligned annual work plan, a communication process, an implementation process, and an evaluation process;
  4. Before communicating our strategic plan to stakeholders;
  5. Before evaluation of the strategic plan;
  6. Before developing a timeline for collecting data;
  7.  Before reviewing annual evaluation data to monitor implementation of the strategic plan;
  8. Before developing future work plans;
  9. Before improving program activities.

Each of the above 9 steps represents a 1 strategic meeting which will aid the team to focus and be more productive. Ideally the meeting will be less than 3 months apart, or else the team will lose momentum (Baroto et al., 2014). Further, this plan needs to be completed by 31st October 2020 so that the strategic planning process can begin by 1st November 2020.

The hospital has 500 beds and has a staff of 700 employees in its A&E department. In the year 2019, the hospital received $500 million from the National Institutes of Health. Presently, the hospital is undertaking a $30 million, 30,000-square-foot addition of 5 surgical rooms with ultra-modern robotic services, camera and recording devices that will be completed in July 2021. Additionally, the hospital is currently undertaking a $300 million, 450,000-square-foot, nine-story 150-bed patient tower project to be ready in mid-2022. However, the A&E department is lacking enough radiographers, trauma surgeons and nurses. Further, the number of beds available in the department needs to be increased to about 600 beds. To address the lack of these resources, this strategic plan, through the representative of the United States Department of Health and Human Services on the hospital’s board of directors, targets to get more staff for the department. Furthermore, this strategic plan team will approach the hospital management with the aim of having the A&E department be added at least 50 beds and more floor space in the project that is currently underway.

2. Internal and external environment analysis

2.1 Internal environment analysis

This analysis provides information about factors inside our organization that have effects on service delivery. It is generally agreed that an organization has full ability to transform and change its internal environment (Phadermrod et al., 2016). To analyze our organization internal environment, this strategic plan will focus on aspects below;

  • Resources: a report will be made detailing resources as shown above. Further, organizational resources will be analyzed in detail because lack of doing so often results to waste of resources and failure to achieve full potential for improvement.
  • Regulations: an analysis of the hospital regulation that affects its performance will be conducted.
  • Other power groups within the hospital: an analysis of trade unions and professional associations will be conducted.
  • An analysis of training and research and clinical care will also be conducted. The analysis will be undertaken from the quantity, quality and cost point of view.

2.2 External environment analysis

This analysis provides information about the larger outside environment that in one way or the other affects our organization but the organization has no power to change (Namin, 2015). To analyze our organization external environment, this strategic plan will attend components below;

  • Clients: it is vital that our organization identify our clients (patient) and what they expect from it. These clients should be divided on their appropriate basis (socio economic, demographic), and in case of A&E department, their reason of visiting the hospital.
  • Competitors: it is vital to identify and analyze other organizations in order to understand the features that make them different from our organization. Additionally, this analysis will help to understand what make other organizations better or worse than our organization.
  • Providers: our organization will analyze our suppliers to understand those that provide vital goods and services. This will make us know suppliers that their goods and services influence quality and cost of services we provide. 
  • Owners: this means person, company or government body that has ownership equity on our hospital. It is important to analyze them so that we can understand their objectives and expectations.

Though the 4 four components above compose what is generally referred to as “business sector”, they provide a clear picture of the external environment in which our hospital operate.

2.3 SWOT analysis

After analyzing internal and external environment of our organization. A SWOT analysis will deem necessary in analyzing our organization more deeply. Justina et al. (2014) postulate that Strength and Weakness originate internally while Opportunities and Threats originate externally. Table 1 below shows SWOT analysis diagram of our organization.

Table 1: SWOT analysis diagram

Highly educated and experienced staff.Building of new and renovation of various facilities.Good relationship with trade unions and professional associations.More allocation of funds to undertake research.Staff having jobs in private practice.Some equipment especially in A&E department being outdated.Damaged reputation mostly caused by delays.
Rationing of staff and facilities.Support from NGOs.Availability of new technology.   Adverse changes in regulations.High number of immigrants.Loss of key staff and goods and service providers.Changing in insurance plans.

3. Prioritized program strategies, aligned annual work plan, communication process, implementation process, and an evaluation process

3.1 Prioritized program strategies

Our third strategic meeting will focus on creating a prioritized program strategies, an aligned annual work plan, a communication process, an implementation process, and an evaluation process. One of the major issue that makes it difficult to have an effective strategic plan is having too much things to do and therefore being overwhelmed, making it difficult to achieve all objectives (Elbanna et al.,2016). To avoid this, we created a prioritized program strategy with four objectives as shown in table 2 below.

Table 2: Prioritized program strategies

Priority rankingObjectiveValueTimeline
1.To improve efficiency of Type A emergency department (ED).Very highBy 31st December 2021
2.To improve community-based health services in order to aid in efficient use of ED.HighBy 31st December  2022
3.To improve data collection of ED wait time.MediumBy 30th June 2020
4.To improve patients and general public communication on ED wait times.LowBy 30th October 2023

3.2 Aligned annual work plan

Once we have created our long-term objectives and prioritized them as shown in table 2 above, we will create a framework plan which will be the foundation of our strategic plan. These objectives supported by annual goals will serve as pillar for each member of the strategic team to create short-term goals supporting the strategic plan’ annual goals (Chang et al., 2018). Table 3 below shows how our aligned annual work plan will look like.

Table 3: Aligned annual work plan

S.NO.ObjectiveAnnual GoalsProgress
1.To improve efficiency of Type A emergency department (ED).Ensure optimum scheduling of staff, physical; layout and flow of patients in ED.On track
2.To improve community-based health services in order to aid in efficient use of ED.Ensure more access to family doctorsBehind
3.To improve data collection of ED wait time.Ensure that all data such as “Door to Doc”, length of stay, left without seeing a doctor and patient satisfaction is available in timely manner.Complete
4.To improve patients and general public communication on ED wait times.Ensure that all patients are informed what their wait time will be. They should also be educated on how the urgency of their conditions affect their wait time.Overdue

3.3 Communication process

Having set objectives and goals, the strategic team will send a “message from CEO” to all staff members in the hospital. This communication process will report the formation of this strategic plan and its effects on the whole of the hospital going forward. A summary including the company’s history in the context of A&E department, what caused the need for the strategic plan, and parties involved will be included as an attachment.

3.4 Implementation process

Dyer et al. (2016) explain that implementation process is the act of turning plans on the strategy into action in order to achieve strategic objectives and goals. In order to ensure that our strategies plan is well implemented, we will follow the following implementation process. First, we will ensure that the hospital management understand fully about the strategic plan. The management has to review it and point any element that is not realistic and requiring excess resources in times of money and/or time. These should be kept in mind in order to begin implementation of the strategic plan. Second, we will create a vision for implementation as shown in table 2 and table 3 above in order to have a transparent image of goals and objectives to be achieved, and progress made. Third, we will create a special team to oversee the implementation of the plan. Led by the team leader, the team will help the management to implement the strategies. Fourth, we will organize meetings to address progress reports made by the implementation team. These meetings will also discuss if any changes have to be made. Five, where necessary we will regularly inform the management on the progress of the implementation process. This will make them part of the process and if any difficulty arises, the management will find it easier to find a solution (Percoco, 2016).

3.5 Evaluation process

Our evaluation process will include five steps. Firstly, fixing benchmark for performance; this will be facilitate by table 2 and table 3 above. By fixing timeline (table 2), and by keeping track of the progress (table 2), we will be able to constantly evaluate our plan. Secondly, measurement of performance; using table 2 above, we will be able to measure the performance of our strategic plan. Thirdly, analyzing variance; in the process of measuring actual performance and targeted performance, variance may be found. Consequently, our strategy will have degree of tolerance whereby certain variance may be acceptable. Positive deviation will be welcome while negative deviation will be a source of concern since it will denote that we are underperforming. Lastly, our last evaluation process will be taking corrective action after experiencing negative variance. This scenario will demand carrying out an analysis in order to know the causes of such under performance (Tama, 2015).

4. Communication of strategic plan to program stakeholders

Leskaj (2016) concedes that in order to increase staff engagement and participation, a plan of communication has to communicate in a simple way a description of the strategic plan and goals that staff and the team can align to. Having completed our strategic plan, the next vital step will be to communicate it in an effective manner to program stakeholders. To achieve this end, we will do the following; a) We will begin with a leadership briefing to discuss the communication plan strategy. b) Create a one-sheet summary which will not be linger than two pages. It will include an internal and external analysis of our organization environment, SWOT analysis, direction the organization is headed, resources we have and ones we are lacking, what is expected from the staff members, and goals and objectives outlined in the strategic plan. c) On the strategic plan, we will craft about ten frequently asked questions with the answers. Some of the questions include; who were responsible in creating the strategic plan? How will the plan affect my job and responsibilities? Will the new plan affect my present annual plans? d) We will create a card containing overarching measurable goals that will be distributed to all staff members. e) We will send a “letter from the CEO” to all the staff members that will declare the creation of the new strategic plan. f) We will hold smaller team meanings covering all the 30 departments in the hospital. g) Lastly, we will quarterly update all stakeholders on the progress made on the implementation of the strategic plan. This will mostly be done through our hospital website.

5. Evaluation of the strategic plan

Strategy evaluation is the process of gathering information in order to assess how effective the strategic plan is in achieving the set objectives and thus guide in making changes where deemed necessary (Kumar, 2015). In order to properly evaluate our strategic plan, we came up with three evaluation activities. These are; assessing the underlying bases of our strategy, comparing actual results with targeted results, and analyzing the differences in results (if any) and correcting our strategy where necessary. Our team agreed on evaluating the plan after every 3 months and we will mostly rely on table 2 and 3 above, but table 4 below will help us especially in the evaluation of implementation of SMART goals. The response column will be filled as the implementation process proceed, and it will help in gauging how successful the plan is.

Table 4: Evaluation of the strategic plan

1.What progress have we made towards our goal of reducing the waiting time to ≤ 4 hours? 
2Are our areas of focus still appropriate? 
3Have we completed any objective? Which one if any? 
4Are all the objectives still required? 
5Are our performance indicators still effective? 
6Have we fallen short of our target? Where and what happened? 

6. Data collection timeline and the process for reviewing annual evaluation data to monitor implementation of the strategic plan, develop future work plans, and improve program activities.

The team developed table 5 below to demonstrate the timeline for data collection.

Table 5: Timeline for data collection

1. Preliminary study and write-up (2-3 months)
Researching the problem Goals/ objectives Literature and empirical study reviews Data collection plan Analyzing data Studying reporting plan
2. Hospital management approval (1-2 months)
3. Collection of data (2-3 months)
Pilot data collection if any Initial data collection Revision (s) if any
4. Write up and reporting of findings (1-3 months)

In order to review annual evaluation data to monitor implementation of the strategic plan, we will follow the following steps;

STEP 1: Clarifying what is to be evaluated. This involve noting down the four objectives of the strategic plan and noting down the progress of each objective. The four objectives are; to improve efficiency of Type A emergency department (ED), to improve community-based health services in order to aid in efficient use of ED, to improve data collection of ED wait time, and to improve patients and general public communication on ED wait times.

STEP 2: Engaging stakeholders. The rationale behind this is to get full cooperation for the evaluation process. This involve identifying stakeholders such as the hospital management, goods and services providers and staff.

STEP 3: Assessing resources. Since evaluation is demanding in terms of money and time, we first have to assess whether the management is willing/ able to fund the process and if the rest of the strategic planning team is available.

STEP 4: Determining evaluation questions. The questions in table 4 above will aid in meeting our evaluation goals.

STEP 5: Determining appropriate measurement methods and procedures of how data will be collected.

STEP 6: Identifying evaluation activities, resources allocation and timelines.

STEP 7: Collecting data that is credible in order to answer evaluation questions. We will use data collection methods such as, interviews, questionnaires and surveys, observations, documents and records, and Focus groups.

STEP 8: Processing data and analyzing results. This entails organizing the data in an easy to summarize and interpret way.

STEP 9: Interpreting results and present the outcomes. This involves creating a list of recommendations addressing the outcome of the evaluation process. Presentation can be in form of a report, slide show, video, letters or hospital website updates.

STEP 10: Apply evaluation findings. Review of recommendations should be done with stakeholders in formulate actions and evaluate what has been learned from the evaluation.

All in all after the evaluation process has been carried out successfully, it will highlight future work plans and improve program activities (Bryson et al., 2015).

7. Summary

This strategic plan offers top level guidance to the management of our hospital and staff necessary to achieve the recent government target of less than four hours in the A&E department. The organization will implement the laid down strategies using strategic planning process pointed out above. However, this is not an exhaustive or exclusive list of strategies, and the management may embrace new strategies in response to changes in internal and external factors in the course of the three years duration of planning. This plan in collaboration with associated operating plans will guarantee that our organization maintain a strong focus on complying with the new government directive of lowering A&E department waiting time of <4 hours.


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