Fluent Essays

Peer review references are required for all work in this class. I will not accept websites that are not creditable. I will accept federal and state websites in addition to current peer review journal articles and your textbook and assigned supplemental reading material for the course. I am looking for research to support your arguments and thoughts on our topics. Please let me know if you have any questions about these requirements. Week 9 Assignment 2 - Development Plan Career Activity Use the Basic Internet Search and peer review articles to research how to create a professional career development plan.  Respond to the following: · What are some of the key concepts that should be included in a career plan? · What common mistakes do people make when developing a career plan? Follow all Assignment Instructions Write a one-page paper (not to exceed 250 words). You will be graded on the following: · Quality of your response. · Coherence and organization. · Mechanics. Always do all Work According to The Scoring Guide Week 9 Assignment 2 - Development Plan Career Activity Use the Basic Internet Search and peer review articles to research how to create a professional career development plan. Respond to the following: · What are some of the key concepts that should be included in a career plan? · What common mistakes do people make when developing a career plan? Follow all Assignment Instructions Write a one-page paper (not to exceed 250 words). You will be graded on the following: · Quality of your response. · Coherence and organization. · Mechanics. Always do all Work According to The Scoring Guide Quality of response. 34 \% Did not submit or insufficiently provided an answer to the question prompt. Did not submit or insufficiently answered all parts of the question in detail. Insufficiently provided an answer to the question prompt; answer was incorrect or missing key information. Satisfactorily provided an answer to the question prompt and answered all parts of the question in detail. Thoroughly provided an answer to the question prompt and answered all parts of the question in detail; response was concise and scholarly. Coherence and organization. 33 \% Does not display organization or coherence. Response is either non-existent, lacks expression, or is missing key information. Communicates unevenly and may incorporate other, unrelated topics. Coherence and organization are somewhat visible in the response. Communicates a central idea or point in a coherent manner. Response is, for the most part, easy to understand. Communicates a central idea or point that is well integrated in the response in a coherent and logical manner. Response is easy to understand. Mechanics. 33 \% Response is either non-existent, or contains so many errors related to grammar, spelling, and sentence structure that it cannot be read or understood. Response contains significant errors related to grammar, spelling, sentence structure, and citations, which may distract the reader from the content of the response. Response contains some errors related to grammar, spelling, and sentence structure, but they do not distract the reader from the content of the response. Student properly cites resources (if applicable), per instructor expectations. Response contains very few, if any, minor errors related to grammar, spelling, and sentence structure. Student properly cites resources (if applicable), per instructor expectations. S t r a t e g i c M a n a g e M e n t o f H e a lt H c a r e o r g a n i z a t i o n S e i g H t H e d i t i o n S t r a t e g i c M a n a g e M e n t o f H e a lt H c a r e o r g a n i z a t i o n S P e t e r M . g i n t e r University of alabama at Birmingham W. J a c k d U n c a n University of alabama at Birmingham l i n d a e . S W a y n e University of north carolina at charlotte Cover Design: Wiley Cover Image: © Jamie Grill/Getty Images © 2018 Peter M. Ginter, W. Jack Duncan, Linda E. Swayne. All rights reserved. Published by John Wiley & Sons, Inc., Hoboken, New Jersey. Previous editions published under the Jossey-Bass imprint by John Wiley & Sons, Ltd. Seventh edition published 2013. Published simultaneously in Canada. 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 Section 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, (978) 750–8400, fax (978) 646–8600, or on the Web at www.copyright.com. 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Jack (Walter Jack), author. | Swayne, Linda E., author. Title: Strategic management of health care organizations / by Peter M. Ginter, University of Alabama at Birmingham, W. Jack Duncan, University of Alabama at Birmingham, Linda E. Swayne, University of North Carolina at Charlotte. Description: Eighth edition. | Hoboken, New Jersey : Wiley, [2018] | Includes bibliographical references and index. | Identifiers: LCCN 2017051205 (print) | ISBN 9781119349709 (hbk) Subjects: LCSH: Health facilities—Administration. | Strategic planning. | Mission statements. | BISAC: MEDICAL / Nursing / Management & Leadership. | HEALTH & FITNESS / Health Care Issues. Classification: LCC RA971 .D78 2018 (print) | DDC 362.1068—dc23 LC record available at https://lccn.loc.gov/2017051205 ISBN 978-1-119-34970-9 (hbk) ISBN 978-1-119-34969-3 (ebk) ISBN 978-1-119-34971-6 (ebk) 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 http://booksupport.wiley.com http://www.wiley.com https://lccn.loc.gov/2017051205 v c o n t e n t S Preface xiii Features of the Text xiv Organization of the Text xvi To the Students: Why This Book About Strategic Management Is Important xviii The Author Team xviii Acknowledgments xix Chapters Chapter 1 The Nature of Strategic Management 1 Chapter 2 External Analysis 37 Chapter 3 Service Area Competitor Analysis 79 Chapter 4 Internal Analysis and Competitive Advantage 121 Chapter 5 Directional Strategies 163 Chapter 6 Identifying Strategic Alternatives 205 Chapter 7 Evaluation of Alternatives and Strategic Choice 259 Chapter 8 Value-Adding Service Delivery Strategies 313 Chapter 9 Value-Adding Support Strategies 359 Chapter 10 Communicating Strategy and Developing Action Plans 401 Resources for Strategic Thinkers Resource 1 Analyzing Strategic Health Care Cases 431 Resource 2 Health Care Organization Accounting, Finance, and Performance Analysis 443 Resource 3 Health Care Acronyms 463 Resource 4 Glossary of Strategic Management Terms 471 vi contentS Cases in the Health Care Sector Case 1 Cottage Senior Living Case 2 Asian Health Services: Rediscovering a Blue Ocean Case 3 Community Blood Center of the Carolinas: Building for a Better Community Case 4 Navigating Change at Alaska’s Southcentral Foundation Case 5 LINET Americas: This Bed Is Just Right! Case 6 West Kendall Baptist Hospital: Meeting the Demand of Community- Based Health Care in the New (and Stormy) Regulatory Environment Case 7 Humana’s Bold Goal: 20 Percent Healthier by 2020 Case 8 Pricing the EpiPen: This Is Going to Sting Case 9 Cavalier Hospital Case 10 Pleasant Bluffs Hospital: Launching a Home-Based Hospital Program Case 11 Kaiser Permanente: Creating a No-Wait Emergency Department Case 12 ExAblate Neuro Case 13 Huntington Hospital Case 14 Valley Health Index 495 vii c a S e S For book adopters, the following cases from the health care sector are available on the book’s website, www.wiley.com/go/ginter8e. Case 1 Cottage Senior Living Andrew C. Rucks, PhD School of Public Health, University of Alabama Birmingham Cottage Senior Living (CSL) was a family owned assisted-living company headquartered in Huntsville, Alabama. CSL had developed or acquired nine continuing care retirement communities (CCRCs) in seven locations in Alabama and one each in Mississippi and Tennessee. CSL operated in a highly-controlled environment with regulations stipulating staffing and building requirements. The leadership team of CSL assembled at a strategic planning retreat to move the business “to the next level.” The purpose of the retreat was to answer three questions: (1) How to grow? (2) Where to grow? and (3) Do we have the organi- zational capacity to grow? Case 2 Asian Health Services: Rediscovering a Blue Ocean Ken Chung, PhD and Wendell N. Chin, MBA California State University at Eastbay Asian Health Services (AHS) is a not-for-profit community health care provider that focuses on serving ethnic Asians in Oakland, California. With the advent of the Affordable Care Act (ACA or “Obamacare”), AHS had been preparing vigorously for significant changes. Now that the initial operational systems were in place, AHS’s CEO Sherry Hirota must decide what proposals to include in a coherent blue ocean strategy presentation at the upcoming board meeting that balanced AHS’s dual mission of social benefit against generating more revenues than costs. Looming threats included payments moving from pay-for-service to pay-per-patient or even pay-for-value. As the original founders had identified a blue ocean (i.e. uncontested markets) in the health care environment 40 years ago, now Hirota must find another blue ocean. Case 3 Community Blood Center of the Carolinas: Building for a Better Community Linda E. Swayne, PhD Belk College of Business, The University of North Carolina at Charlotte In early 2010, Martin Grable, President of the Community Blood Center of the Carolinas (CBCC), was ready to move the first community blood center in http://www.wiley.com/go/ginter8e viii caSeS North Carolina to a new level. In a strategic planning retreat, he asked the Board of Directors to evaluate seven strategic options for CBCC. Although all of the alternatives were needed by the community, CBCC did not have unlimited resources. Further, health care reform loomed on the horizon. Clearly, to serve the community, CBCC needed not only to survive, but to thrive in the near term. Which of the alternatives would allow achievement of that goal for the newest FDA-licensed community blood center? Case 4 Navigating Change at Alaska’s Southcentral Foundation Erin E. Sullivan, PhD, and Jessica L. Alpert Center for Primary Care, Harvard Medical School Long-time president and CEO Katherine Gottlieb reflected on a recent meeting of Southcentral Foundation’s (SCF) board of directors where CEO succession planning was discussed as she contemplated retirement. The case provides background information about Alaska, the American Indian and Alaska Native (AIAN) health care system, and reviews SCF’s mission, vision, and key tenets of the organization’s culture: customer-ownership, core concepts, and continuous improvement. SCF’s approach to hiring and developing its workforce and its gov- ernance structure are highlighted as background for Gottlieb’s concerns in choos- ing the next CEO: maintaining SCF’s culture, choosing an internal or external CEO, and identifying the top three qualities that SCF’s next leader must embody. Case 5 LINET Americas: This Bed Is Just Right! Linda E. Swayne, PhD Belk College of Business, The University of North Carolina at Charlotte and Colin Bain, President and CEO, LINET Americas LINET was the leading manufacturer of ICU (intensive care unit) beds in Europe. In 2010 LINET Americas began competing with the two largest U.S. bed manu- facturers, Hill-Rom and Stryker, by marketing to smaller hospitals based on lower prices and better safety features for caregivers. Hill-Rom and Stryker noticed and head-to-head competition began. Hill-Rom lowered its prices and extended its warranty to match two of LINET Americas’ competitive advantages; however, the innovative design was much harder to match. President and CEO Colin Bain needed to determine how he could continue to grow LINET Americas, especially when the company was blocked out of the largest group purchasing organization (GPO) that was offering Hill-Rom or Stryker ICU beds. Case 6 West Kendall Baptist Hospital: Meeting the Demand of Community-Based Health Care in the New (and Stormy) Regulatory Environment Miriam Weismann, PhD, and students Javier Hernandez Lichtl, Heather Pierce, Denise Harris, Lourdes Boue, and Cathy Campbell Florida International University The first three years of operation of the West Kendall Baptist Hospital in Miami provided a “poster child” for efficient and cost-effective health care delivery to ixcaSeS the West Kendall community. The 133-bed facility’s mission was to promote the preservation of life by improving the health and well-being of its constituents. WKBH exceeded every budget prediction and showed a profit in year 3; however, with the passage of the Affordable Care Act, the situation changed almost over- night. By the first quarter 2016, WKBH started to lose money in excess of budget predictions, despite its increased patient admissions, careful financial planning, expense reductions, quality service, and excellence in patient care delivery. A serious financial crisis loomed with little relief in sight; the management team was searching for solutions. Case 7 Humana’s Bold Goal: 20 Percent Healthier by 2020 Nancy M. Kane, DBA with the assistance of Deborah Milstein Harvard T.H. Chan School of Public Health Humana, Inc., headquartered in Louisville, Kentucky, was the fourth largest U.S. health insurance firm with annual revenues of $54.3 billion, membership of 14.2 million, and 50,100 employees in 2015. The company served members in 17 states plus the military. Under the leadership of CEO Bruce Broussard, Humana was attempting to shift its focus from paying claims to improving the health of beneficiaries. Humana set an “aspirational Bold Goal of improving the health of the communities we serve by 20 percent by 2020 because we make it easy for people to achieve their best health.” Dr. Andrew Renda, hired as Director, Bold Goal Measurement, knew that senior leaders understood that it would take time to change population health, yet they wanted to see some results quickly. Case 8 Pricing the EpiPen: This Is Going to Sting Thomas J. Steenburgh, PhD The Darden School of Business, University of Virginia Mylan Inc., a generic drug manufacturer, bought the EpiPen product line from Merck, invested in marketing, and dramatically increased the price from $100 to $600 per two-pack, igniting consumer anger and provoking a media firestorm. Congress was compelled to step in, demanding to know how Heather Bresch, CEO of the company, could justify the high price of EpiPens. Such health care companies face a tension between doing good in the world and making a profit. Is it fair for drug prices to vary so dramatically across countries (as the EpiPen is priced at $85 in France)? How should such a public controversy be resolved? Case 9 Cavalier Hospital Kenan W. Yount, MD MBA under the supervision of Michael J. Schill, PhD The Darden School of Business, University of Virginia A midsize (650-bed) community not-for-profit hospital, located in south central Virginia, chose an expansion strategy in 2008 by bringing all its cardiology under one roof in a new comprehensive care center. Impressive results drew the attention of several insurers who approached Cavalier Hospital, each hoping to include the hospital in its network of physician providers. In preparation for his first board meeting, the physician director wanted to assess the hospital’s overall financial condition to determine which strategies should be pursued next: focusing on acquiring patient volume, expanding investment into integrated care, setting the reimbursement structure for revenue collection, or moving to a capitation-based payment system. The evaluation of revenue models would help him understand which alternatives could best be supported for the business strategy. Case 10 Pleasant Bluffs: Launching a Home-Based Hospital Program Laura Erskine, PhD Ivey Business School, University of Western Ontario Pleasant Bluffs Health System was a Level I Trauma Center with 400+ licensed beds that provided outpatient care, acute and subacute care, biomedical research, and graduate and undergraduate education. Pleasant Bluffs wanted to create a pilot program for home-based hospital care. Graft Salot, as the director of the hospital’s Performance Improvement (PI) department, was asked to recommend the pilot program’s location, duration, eligible population, and possible changes to the intake process. Salot must consider issues related to an educational program about home-based care and an implementation strategy for it as well as a cost/ profit comparison for providing care in the hospital versus home-based care. Case 11 Kaiser Permanente: Creating a No-Wait Emergency Department Edward D. Arnheiter, PhD Ivey Business School, University of Western Ontario Kaiser Permanente, based in California, was a vertically integrated health care system comprised of 38 hospitals, 619 medical offices, and 10.1 million mem- bers in eight western U.S. states. In 2007, the emergency department at South Sacramento was experiencing long patient wait times; it became clear that a better way was needed. Changes were made from 2007 until 2015 by Dr. Karen Murrell, leader of the LEAN program, and her flow group, to significantly improve many key performance measures of the emergency department. In 2016, she was wondering whether there were any additional ways to create capacity in the ED. Case 12 ExAblate Neuro Matthew Thames, MBA/MD under the supervision of Robert E. Spekman, PhD The Darden School of Business, University of Virginia InSightec, a privately-held Israeli company, developed a new medical device, ExAblate. Focused ultrasound provided precise concentration of sound waves to act on a particular part of the body; the guidance of magnetic resonance imaging (MRI) technology allowed for non-invasive, targeted destruction of diseased tis- sue. The company required a marketing strategy, navigating a number of barriers that could impinge on its ability to successfully introduce the new technology. The FDA approved its use for removing uterine fibroids and bone metastases. Yet the holy grail of this technology was the application to the brain. InSightec needed to x caSeS xi develop a go-to-market strategy for ExAblate Neuro, which was intended to treat essential tremor (ET) and other diseases, such as Parkinson’s, for which there was no cure at present. Case 13 Huntington Hospital Davina Drabkin and Sarah Soule, PhD Stanford Business Graduate School, Stanford University Located in Pasadena, California, Huntington Hospital (HH) was a 625-bed not- for-profit organization named among the top-performing hospitals in 2012 by U.S. News & World Report. To further HH’s focus on high-quality, patient-centered care, Jim Noble, Executive VP-COO/CFO, was looking for a change in direction, particularly in the Business Services Office. Accounts Receivable (AR), a key bill- ing metric, could be lower; Noble hired Kim Markey with the mandate to improve performance. Markey’s long-term vision involved re-examining the revenue cycle and the hospital’s processes to ensure that HH would become a stronger performer. She needed to get her metrics under control as a first step before trans- forming the departments she oversaw into truly patient-focused business centers. Case 14 Valley Health S. Hughes Melton, MBA under the supervision of Alexander B. Horniman, PhD The Darden School of Business, University of Virginia Felton Wayne, MD, began his career in private practice with a friend. After ten years of developing the practice, he sold his share and Dr. Wayne joined the much larger practice of Valley Health (VH) that had recently merged with Franklin Memorial Hospital (FMH). He was appointed Chief Medical Officer (CMO) and was responsible for the North Carolina organization. The medical staff was unhappy and many physicians left; two CMOs left before Dr. Wayne took up the position. During a feedback session with John Richmond, from the South Carolina division of VH, Dr. Wayne was stunned to discover that Richmond considered him a “cowboy!” Dr. Wayne personally thought he was doing a good job of developing a better working environment. caSeS xiii P r e f a c e Almost three decades ago, the three of us agreed that health care was experiencing evolutionary, and in some segments, revolutionary change. At that time, we wrote in the Preface for the first edition of this text (1992) that health care organizations have “had difficulty in dealing with a dynamic environment, holding down costs, diversifying wisely, and balancing capacity and demand.” Our conclusion was that only health care organizations with a structured strategic management approach that recognized the value of emergent thinking could make sense of such a rapidly changing environment. Our only surprise has been that the rate of change in the health care system has been far greater than we imagined and now certainly exceeds the magnitude of changes initiated with the passage of Medicare and Medicaid in the 1960s and later in 1983 with the implementation of Medicare’s prospective payment system. Significant change in health care continues as evidenced, first, by the passage of the Patient Protection and Affordable Care Act (ACA) in 2010 and more recently by the election of a new administration focusing once again on changing the health insurance landscape and subsequently the “rules for success” for health care organizations. Such regulatory changes, as well as significant economic, technological, social, political, and competitive changes in health care are likely to continue. To cope with such alterations, by the late 1990s health care organizations had universally embraced strategic management as the primary leadership phi- losophy and process for understanding and addressing change. The widespread adoption of strategic management continues today as health care leaders have found that strategic thinking, planning, and managing strategic momentum are essential for coping with the dynamics of the health care system. We believe that strategic management has become the single clearest manifestation of effective leadership in health care organizations. In the broadest terms, this text is about leadership; more narrowly, it concerns the essential strategic tasks of leading and managing health care organizations. As a result, the eighth edition continues to advocate the importance of strategic think- ing and clearly differentiates strategic thinking, strategic planning, and strategic momentum. These concepts represent the central elements of a complete strategic management process that we believe reflect the realities of conceptualizing, devel- oping, and managing strategies. Specifically, our approach depicts strategic management as the processes of strategic thinking, consensus building and documentation of that thinking into a strategic plan, and maintaining strategic momentum. Through the management of the strategic plan, new insights and perspectives emerge and strategic think- ing, planning, and managing are reinitiated. Therefore, strategic managers must xiv Preface become strategic thinkers with the ability to evaluate a changing industry, ana- lyze data, question assumptions, and develop new ideas. Additionally, through strategic planning, strategic managers must be able to create and document a plan of action. Once a strategic plan is developed, managers maintain the strategic momentum of the organization. As strategic managers attempt to carry out the strategic plan, they evaluate its success, learn more about what works, and incor- porate new strategic thinking. It is our view that strategic control is integral to strategic momentum and can- not be thought of or taught as a separate process. Therefore, traditional strategic control concepts are integrated into the strategy development chapters under the heading of “Strategic Momentum.” We believe that this approach better reflects how strategic control actually works in organizations – as a part of managing the strategy, not as an afterthought. Although we present a structured strategic management process, we believe that strategic management is highly subjective, often requiring significant intui- tion and even well-informed guesswork; however, intuition and the development of well-informed opinions are not easily learned (or taught). Therefore, a major task of the future strategic thinker is to first develop a thorough understanding of analytic strategic management processes and then – through experience – develop the intuition, perspective, and insight to consider previously uncharted strategic issues. Our map and compass metaphor provides a framework for blending rational, analytical planning with learning and responsiveness to new realities. We believe this text provides the foundation for effective strategic thinking, plan- ning, and managing strategic momentum. Features of the Text We have incorporated some new features into this 8th edition of Strategic Management of Health Care Organizations as well as retained features that users of previous editions have said were informative, interesting, and a pedagogically sound foundation for understanding and embracing strategic management of health care organizations. Retained Features ● Retained from the 7th edition, Learning Objectives direct attention to the important points or specific chapter elements that students should know and be able to describe, explain, discuss, clarify, and justify. ● We continue to emphasize analytical models, illustrative examples, and informative exhibits to aid in learning chapter material. ● As in the 7th edition, the Map and Compass provide a useful metaphor for conveying the view that strategic leaders must both plan as best they are able, but also learn, adjust, and establish new direction (develop a new plan) as they progress. xvPreface ● Retained from the 7th edition, The Language of Strategic Management – Key Terms and Concepts, presents a list of the essential vocabulary and terminology relative to the chapter’s material. ● The Questions for Class Discussion focus on key chapter concepts and assist the reader in reviewing the material and thinking about the implications of the ideas presented. ● We have retained our extensive end of chapter Notes, which contain the references used in development of the chapter materials. ● An even more extensive and easy to access Web-based Instructor’s Support site is available to verified course instructors using the text. The support material includes PowerPoint slides for each chapter, chapter lecture notes that include suggestions for effective teaching, answers to the end of chapter questions, example assignments and quizzes, the strategic management case studies, and the instructor’s manual (teaching notes) for the case studies. In addition, the Instructor’s Support contains a true/false, multiple choice, and discussion question test bank and can be found at www.wiley.com/go/ginter8e. New Features ● Each chapter now begins with Why this Chapter Is Important, a brief chapter introduction – a call to action, providing a clear and compelling reason for continuing to read and understand the concepts discussed in the chapter. ● In addition to Learning Objectives, this edition identifies a Strategic Management Competency that describes the overall applied skill that students of strategic management should be able to demonstrate after completing the chapter. ● Each chapter now has a step-by-step process for accomplishing the elements of strategic management discussed in the chapter. Thus, readers are guided through a series of detailed steps for performing external analysis, service area analysis, internal analysis, and so on through strategy implementation. ● Newly introduced in the 8th edition, Essentials for a Strategic Thinker are one-page sidebars that provide summaries of contextual concepts important to understanding health care and the health care system. These “Essentials” do not concern core strategic management concepts per se, but rather provide concise descriptions of terms, institutions, or concepts in the changing health care landscape that every strategic thinker should know. ● New to this edition, Practical Lessons for Health Care Strategic Thinkers provides bullet points (derived from the chapter content) containing practical advice for those undertaking strategic thinking, strategic planning, and managing strategic momentum. ● For this edition we have eliminated the Introductory Incidents, which provided a practical example of the concepts addressed in the chapter, and instead included additional in-text examples more specific to the concepts being discussed. http://www.wiley.com/go/ginter8e ● For this edition, four Resources for Strategic Thinkers are included at the end of the text to assist readers: Resource 1. Analyzing Strategic Health Care Cases Resource 2. Health Care Organization Accounting, Finance, and Performance Analysis Resource 3. Health Care Acronyms Resource 4. Glossary of Strategic Management Terms ● The new Glossary of Strategic Management Terms (presented in alphabetic order with the chapter noted) defines all the terms and concepts presented in The Language of Strategic Management – Key Terms and Concepts section at the end of each chapter as well other terms referenced in the text that students of strategic management should know. ● Strategic Management Case Studies are returning to this edition in response to user requests. These case studies, listed in the Table of Contents, are unique to this edition and are available for download to verified course instructors on the Web-based Instructor’s Support site (see www.wiley.com/ go/ginter8e). In addition, favorite case studies from the sixth edition of this text as well as other selected cases written by the authors are available for download from the support site. Through our own teaching, research, and consulting in the health care field, we have applied the process outlined in this text to physician practices, hospitals, local and state public health departments, long-term care facilities, social service organizations, and physical therapy practices. In addition, we have students who …