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Strategic Plan – Rehabilitation ServicesRoger Anderson, Leslie Burgy, Kathryn Petrilli, Margaret Pokorski, and Carolyn SucaetLDR 660 – Strategic Planning and ImplementationSiena Heights UniversityMay 20, 2013?Strategic Plan – Rehabilitation ServicesThe strategic plan chosen for development will focus on St. John Providence Health System’s (SJPHS) Physical Rehabilitation Services. St. John Providence Health System is a non-profit system within the Ascension Health Care System. Currently the system is made up of five hospitals and over 125 medical facilities. Based on the health system’s structure and management, this will be further restricted to the East Region and include the following service components:Acute Care at St. John Hospital and Medical Center in Detroit, St. John Macomb - Oakland Hospital, Macomb in Warren, and St. John Macomb – Oakland Hospital in Madison Heights. Acute therapies focus on hospitalized patients with a variety of diagnoses and function to prepare the patient for discharge to the next level of care in the continuum.Inpatient Rehabilitation (IPR) units at St. John Hospital and Medical Center and St. John Macomb-Oakland Hospital, Macomb Campus. These units are both focused on adult rehabilitation for those patients who require intensive physical, occupational, and/or speech-language therapies totaling three hours per day, meet diagnostic criteria, and demonstrate medical necessity for admission. In addition, patients need a plan for discharge that will allow a return to the community at or near their prior level of function.Outpatient rehabilitation at ten ambulatory sites throughout the East Region. These sites provide therapies for orthopedic, neurological, and sports injuries as well as offering a post-therapy functional independent training (FIT) program.Sports medicine offering athletic training services in nine area high schools.These choices were made to represent the rehabilitation services continuum of care in a specific region of SJPHS. Attempting to move beyond this into a system-wide plan would dilute its effectiveness due to the large geographic area. In such a wide area, there would be too many differences in competitors, payer mix, patient mix, and similar factors to make one plan useful or sustainable. Directional Strategies: Mission, Vision, Values, and GoalsThe mission of St. John Providence Health System is “St. John Providence Health, as a Catholic health ministry, is committed to providing spiritually centered, holistic care which sustains and improves the health of individuals in the communities we serve, with special attention to the poor and vulnerable” (Our Mission, Vision and Values, 2013, para. 1). The mission of St. John Rehabilitation Services is: To be consistent with the gospel imperative and the spirit of Ascension Health’s values. We will promote physical, mental, social, and spiritual health for all those seeking rehabilitation services, including the poor and those with special needs. Our concern for the value of all human life and the dignity of each person leads St. John Rehabilitation Services towards the achievement of excellence in the treatment of all those we service and in enhancing the quality of the environment for those who provide and receive rehabilitation services. (Anderson, 2012)The vision statement of St John Providence Health System is “our passion for healing calls us to cultivate trust, advocate wellness and transform healthcare” (Our Mission, Vision and Values, 2013, para. 2). The vision statement of the rehabilitation department is “St. John Hospital and Medical Center’s Rehabilitation Services Department will be the market leader in providing the highest quality physical, occupational, and speech therapy services in southeastern Michigan. This will be accomplished through the development of multiple clinical specialties within the service line, making us the destination department for those patients who require rehabilitation. These specialties will support the vision of St. John Hospital and Medical Center becoming a ‘Tertiary Plus’ level institution and provide exemplary care to all those in need.The values of St. John Providence Health System are service of the poor, reverence, integrity, wisdom, creativity and dedication. Service of the poor consists of generosity of spirit, especially for persons most in need. Reverence is the respect and compassion for the dignity and diversity of life. Integrity is inspiring trust through personal leadership. Wisdom is integrating excellence and stewardship. Creativity is courageous innovation and dedication is affirming the hope and joy of the health ministry (Our Mission, Vision and Values, 2013, para. 3). St. John Providence Health System follows the goals set forth by Ascension Health which include “an outward promise to those we serve to deliver Healthcare That Works, Healthcare That Is Safe, and Healthcare That Leaves No One Behind, for Life, by the year 2020” (About Ascension Health, 2013, para. 2). Healthcare That Works means “healthcare that achieves absolute satisfaction for those we serve and those who serve with us. From the moment a patient walks through our door to the minute he or she leaves and beyond, we want to create a consistent, exceptional experience” (Goals, 2013, para. 1). Healthcare that is safe focuses on eliminating preventable injuries and deaths throughout the organization. This goal focuses on falls and fall injuries, pressure ulcers, perinatal safety, nosocomial infections, perioperative safety, Joint Commission national patient safety goals, and adverse drug events. Because of the Affordable Care Act, many Americans will continue to be without medical insurance coverage. Ascension Health has set a goal of “Healthcare That Leaves No One Behind” to ensure access to physicians, testing, and treatment is available to all patients in need regardless of their medical insurance coverage.Service AreaThe service area for these units was determined using a number of factors including the location of the units, types of patients admitted and programs that support them, recent population and census data, and data obtained regarding market share from the strategic planning and decision support areas. These sources, in addition to our own internal tracking of referrals, have determined our service area to include Macomb County, Northern/Central Wayne County, Eastern Oakland County, and Southern St. Clair County. Figure 1.0 demonstrates the location of both units relative to each other as well as the areas as described. The population of the region totals approximately 2,436,211 if one uses 50% figures for each of the partial counties noted and 100% for Macomb County based on 2010 census data.Figure 1.0Change in Population by Community, 2010-2012 Southeast Michigan, St. John Providence Health System East Region IPR Sites NotedPopulation Map from Southeast Michigan Council of Governments (SEMCOG). (2010, November 29). SEMCOG Quick Facts. Retrieved April 24, 2013, from : In Table 1, the population age and ethnic demographics are listed for Grosse Pointe, Harper Woods and Detroit. Although these three cities are located in Wayne County within a five mile radius, the demographic characteristics are very different. Persons age 65 years and over are the highest in the Grosse Pointe area. Age 5 and under are the highest in the Detroit region. The high population of persons age 65 years and over would identify a need for health services for senior citizens. Identifying the ethnic backgrounds of an area also assists in identifying medical diagnoses that are common to that group and implicate development of health services geared to that need. In an investment in the Grosse Pointe area it is important to identify the characteristics of the primary service area and the adjacent communities which are significantly different.Table 1.0Comparison of age and ethnic demographics in Grosse Pointe, Harper Woods and Detroit Population, 2011 estimate Grosse Pointe5,365Harper Woods14,092Detroit706,855Population, 2010 (April 1) estimates base 5,42114,236713,777Population, percent change, April 1, 2010 to July 1, 2011 -1.0%-1.00%-1.00%Population, 2010 5,42114,236713,777Persons under 5 years, percent, 2010 4.2%6.10%7.00%Persons under 18 years, percent, 2010 26.4%25.90%26.70%Persons 65 years and over, percent, 2010 16.1%12.80%11.50%Female persons, percent, 2010 53.6%53.80%52.70%White persons, percent, 2010 (a) 93.2%49.60% 10.60%Black persons, percent, 2010 (a) 3.3%45.60%82.70%American Indian and Alaska Native persons, percent, 2010 (a) 0.1%0.20%0.40%Asian persons, percent, 2010 (a) 1.6%1.50%1.10%Native Hawaiian and Other Pacific Islander, percent, 2010 (a) 0.1%ZZPersons reporting two or more races, percent, 2010 1.5%2.70%2.20%Persons of Hispanic or Latino origin, percent, 2010 (b) 1.8%2.00%6.80%White persons not Hispanic, percent, 2010 91.7%48.50%7.80%(SEMCOG, n.d.)External EnvironmentIt is important for an organization to be able to identify influential trends in the external environment because “changes in the general environment are always “breaking through” to the health care environment” (Swayne, Duncan, & Ginter, 2008, p. 51). The primary goal of environmental analysis is to identify and evaluate the degree of relevance and importance of general and health care industry issues which occur outside the organization (p. 68). This is achieved through scanning the environment, monitoring issues, forecasting based on knowledge obtained, and assessing the impact on the organization. This activity is necessary in order to develop visions and strategies to align the organization within its environment. Two external factors that will affect rehabilitation services involve the competitive and regulatory environments. In regards to the competitive environment, Beaumont Health System and Henry Ford Health System are considered the two main external competitors to St. John Providence Health System in relation to the rehabilitation services. This year they announced plans to merge their health systems and as a result will have a significant presence in the metro Detroit market and the SJPHS market. The proposed merger “would create the largest health care system in Southeast Michigan with $6.4 billion in annual revenue and 42,000 employees” (Beaumont-Henry Ford merger, 2012). Although, the effects of this proposed merger are unknown, this is cited as a strong external environmental factor as both systems are identified as the main competitors for St. John rehabilitation and the potential for a significant market share exists should these systems combine. This is an issue that SJPHS needs to monitor closely and continue to evaluate as it plays out in the market.The second type of environmental issue that significantly affects rehabilitation services are government and regulatory standards. There are regulatory standards used to qualify a patient for inpatient rehabilitation services. The Centers for Medicare and Medicaid Services (CMS), state the following in CMS manual:Inpatient Rehabilitation Facility (IRF) benefit is designed to provide intensive rehabilitation therapy in a resource intensive inpatient environment for patients who, due to the complexity of their nursing, medical management and rehabilitation needs require and can reasonably benefit from an inpatient stay and an interdisciplinary team approach to the delivery of rehabilitation care. (CMS Manual, January 15, 2010)Patients must require active and ongoing therapeutic intervention from multiple therapy disciplines whether that is physical therapy, occupational therapy, speech language therapy, or prosthetics/orthotics and one of the therapies has to be either physical or occupational therapy. The patient must be able to participate in three hours of therapy per day for a minimum of five days per week. The CMS guidelines also indicate that it is reasonable that the patient at the time of admission must be able to actively participate and significantly benefit from an IRF program and upon discharge the patient should be able to return home or to a community based environment (CMS Manual, January 15th, 2010). These are some of the basic guidelines followed by the hospitals that participate in the Medicare program but the same criteria are applied to all patients regardless of their insurance or lack of insurance.The outpatient rehabilitation services also submit to the same regulatory agent as the inpatient rehabilitation program, CMS. There have been some recent changes in the regulatory environment which include the mandate from the Centers for Medicare and Medicaid (CMS) requiring therapy providers to submit levels of patient functioning with billing and the implementation of a therapy cap to the total benefit payable for outpatient rehab services. As of July 2013, in the rehabilitation setting, CMS has implemented the mandatory reporting of a patient’s functional disability levels pre and post therapy intervention. This change will allow CMS to begin trending data regarding levels of disability, levels of improvement achieved through therapy intervention, and the associated cost of this care (U. S. Department of Health & Human Services, 2012). This is important to the rehabilitation practices as ultimately this may result in pre-determined levels of payment for identified diagnostic groups in an outpatient setting. Additionally, CMS has capped the total reimbursement for combined outpatient physical and speech therapy services at $3700 annually. In the past when this cap was met, the therapy provider could submit documentation to justify the need for continued treatment and following review, may have received further authorization from CMS to continue patient treatment. This is no longer the case. Services will be capped at a total benefit amount. The impact for patients who rely on CMS for the health care benefits is now limited by payment versus a continued need by the patient. This also becomes a challenge and responsibility for the treating therapist to educate the patient and patient family members or caregivers and provide the most efficient care so that medically necessary treatment is not impacted by the cost of petitor AnalysisThe primary competitors for inpatient rehabilitation services in this market were identified using a couple of methods. First, the 10-mile radius was checked to determine which other health systems had inpatient rehabilitation beds active in the area. Recognizing that the two SJPHS units do overlap in this type of assessment, they are treated as a region and viewed both individually and for their net totals in terms of capacity and census. This does allow for a higher degree of flexibility and fluidity in staffing and admissions that will be discussed later as part of the assessment of strengths. In addition to this, market share data from a recent analysis done by the system’s strategic planning department was available from a recent project that gave historical data and trends for capture on IPR admissions. Aggregation of this data is shown in tables 2.0 and 3.0.Table 2.0 Inpatient Rehabilitation Admissions – Market Share By FacilityMarket Share????HospitalFY10FY11FY12Net ChangeChange FY11->FY12Beaumont - Royal Oak13.4%15.9%19.5%6.1%3.6%St. John Macomb-Oakland19.9%18.3%18.6%-1.3%0.3%Rehab Institute of MI12.4%12.8%16.5%4.1%3.7%Henry Ford Macomb-Clinton10.9%10.5%10.9%0.0%0.4%Henry Ford Macomb - Warren10.4%12.9%10.5%0.1%-2.4%St. John Hospital and Medical Ctr.0.0%4.6%7.1%7.1%2.5%Sinai-Grace 5.3%5.0%4.4%-0.9%-0.6%Straith Hospital4.7%3.4%3.4%-1.3%0.0%Oakland Regional Hospital3.3%3.3%3.2%-0.1%-0.1%Providence Hospital3.4%3.7%2.1%-1.3%-1.6%All Other16.3%9.7%6.5%?-9.8%?-3.2%Table 3.0 Inpatient Rehabilitation Admissions – Market Share By System Market Share????SystemFY10FY11FY12Net ChangeChange FY11->FY12Beaumont - Royal Oak13.4%15.9%19.5%6.1%3.6%SJPHS23.3%26.6%27.8%4.5%1.2%HFHS21.3%23.4%21.4%0.1%-2.0%DMC17.7%17.8%20.9%3.2%3.1%All others24.3%16.4%13.1%?-11.2%?-3.3%Note: Beaumont Troy IPR Unit opened December 2012.Based on this data and geographic assessment, the identified competitors for this analysis are Henry Ford Health System (Ford) and William Beaumont Health System (Beaumont). Ironically, at the time of this analysis, these systems are in the process of a potential merger, which would give them a large share of IPR beds in the market. Currently, similar to SJPHS, each of these competitors has two facilities in the identified market area. Henry Ford has facilities in Warren and northern Clinton Township, which are both located in Macomb County, while Beaumont has beds in Royal Oak and Troy, both of which are in eastern Oakland County. Calls placed to each facility to gather information have confirmed the bed allocations as follows:Table 4.0 Competitor Inpatient Rehab Bed CapacitiesHospitalBedsHenry Ford Clinton Township42Henry Ford Warren12Beaumont Troy12Beaumont Royal Oak33Based on this data, as well as total bed compliment (SJPHS 68 beds, Ford 54 beds, Beaumont 45 beds); these competitors constitute the three predominant forces for inpatient rehabilitation services for this service area.Service Delivery – Strengths and WeaknessesOutpatient competitor differentiation strategy is noted in the placement of outpatient sites from Beaumont Health System and Henry Ford Health System in fitness centers, therapy for professional sports teams, and targeting specific patient populations. The strengths and weaknesses of St. John outpatient centers and its competitors have some similarities as noted in Table 5.0. The weaknesses are similar due to the external environment influences of regulatory agencies such as the government and medicare. The strengths of being part of a major health system are common to all three sites. The strengths and weaknesses of the competitors are limited to information obtained from websites and may not reflect a comprehensive internal analysis. A relevant weaknesses of Beaumont and Henry Ford is the ongoing merger of these two hospitals. The uncertainty of whether or not programs will be closed or expanded creates an unstable environment for staff satisfaction and creates potential conflicts within their organization. Table 5.0Strengths and weaknesses of St. John Providence Health System outpatient and competitors Beaumont Health System and Henry Ford Health SystemStrengths of Outpatient BeaumontWeaknesses of Outpatient BeaumontPhysician relationshipsMajor Health System, large networkLocations / Coverage of areaEquipmentCommunity InvolvementSocial Media – Facebook/Twitter Ambulatory NetworkSpecialty Programs Strategically positioned in Health Fitness Centers within community.Athletic trainers in “several local high schools”Health Care ReformUnclear financial status Unclear identity and future of programs due to merging with Henry Ford Health SystemInsurance rules changing i.e. Medicare CAPStrengths of Outpatient Henry Ford Weaknesses of Outpatient Henry FordMajor Health System large networkStrategically positioned in Health Fitness Centers within community.Emphasis on Sports Medicine within community, i.e. Professional sportsSpecialty ProgramsContinuing Education opportunities for staffHealth Alliance Plan insurance Athletic trainers contracted for services at 15 local high schools and 4 collegesHealth Care Reform Unclear financial status Lack of brand identificationUnclear identity and future of programs due to merging with Beaumont HospitalInsurance rules changing i.e. Medicare CAPStrengths of St. John OutpatientWeaknesses of St. John Outpatient Major Health System large networkNiche Specialty ProgramsATC’s in High SchoolsCenters of Excellence participationSite best practices, evidence basedCommunity involvementSocial Media – Facebook, TwitterAmbulatory networkPhysician relationshipsRegulatory complianceHigh satisfaction scoresOutcomes toolsAthletic training contracts at 11 local high schoolsHealth Care ReformInconsistent brand identificationInsurance rules changing i.e. Medicare CAPInconsistent physician supportIt is also necessary to assess the relative strengths and weaknesses of the IRF program of St John Providence Health System, Beaumont Health System and Henry Ford Health System (table 6.0). As noted above, information was obtained from published information about each company from their parent system, review of marketing materials on the companies websites, and practice guidelines for operations of an inpatient rehabilitation unit in compliance with the current CMS regulations. As of November 2012, Crain’s list (figure 2.0) of the largest Michigan hospitals and hospital companies showed that the parent companies of all three identified systems were in the top ten for the state of Michigan (Reilly, 2012). Table 6.0 Strengths and weaknesses of inpatient rehabilitation St. John Providence Health System and competitors Beaumont Health System and Henry Ford Health SystemStrengths of IPR BeaumontStrengths of IPR BeaumontWeaknesses of IPR BeaumontWeaknesses of IPR BeaumontThe Joint Commission Accreditation Receive the majority of their patients from referrals from their acute care hospitals.Physician relationships “Do you have a Beaumont doctor?”Major Health System, large networkLocations / Coverage of areaSupport of outpatient services- care continuum Community InvolvementDrivers Rehabilitation Program Promotion of geriatric rehabilitation programAffordable Care Act (ACA) Unclear financial status Unclear identity and future of programs due to merging with Henry Ford Health System Marketing did not provide data regarding patient satisfactionStrengths of IPR Henry Ford Weaknesses of IPR Henry FordCertified with Commission on Accreditation of Rehabilitation Services (CARF)CARF certification for stroke specialty program The Joint Commission Accreditation Will take patients as young as 14 years of ageMajor Health System; large networkSupport of outpatient programs- care continuumHeavily research based institution Specialty ProgramsContinuing Education opportunities for staffHealth Alliance Plan insurance Affordable Care Act Unclear financial status Lack of brand identificationUnclear identity and future of programs due to merging with Beaumont HospitalHenry Ford Warren is a free standing facilityLists on webpage criteria for admission that conflicts with CMS diagnosis standards i.e. joint replacements and debility diagnosisLacks specific references to research related to rehabilitation Strengths of IPR St. John ProvidenceWeaknesses of IPR St John ProvidenceStrengths of IPR St. John ProvidenceWeaknesses of IPR St John Providence The Joint Commission Accreditation Major Health System large networkState of the art gait trainingDriver’s Rehabilitation program Neurovestibular programCenters of Excellence participationSite best practices, evidence basedCommunity involvement and support groupsPhysician relationshipsMarketing of high patient satisfaction scoresSupport of the outpatient services- care continuumHealing without Harm strategyHolistic care is weaved into the programAmputee walking school, which is free to all amputees regardless of their physician. Program development and promotion of neurorehabilitation with Bioness devices in lieu of traditional braces. Affordable Care Act Inconsistent brand identificationInsurance rules changing Inconsistent physician supportFigure 2.0 Top Health Systems by Net RevenueAdaptive StrategyIt is very common for large, complex organizations to utilize combination strategies since often no single method can adequately provide sufficient market leverage (Swayne et al., 2008, p. 235). The primary adaptive strategy for SJPHS Rehabilitation Services, based on evaluation of the location of its current cadre of ambulatory outpatient sites in relation to hospitals, inpatient rehab units, physician offices, and desired markets is market development. More specifically, this called for the development of an ambulatory center within Grosse Pointe that would include outpatient rehabilitation among a mix of other services to include diagnostics, urgent care, physician offices, and retail space. With this geographic area being a present market, the definition of market development remains relevant given the goal of developing a new segment within said market (p. 217). The payer mix of the Grosse Pointe demographic continues to be desirable in relation to the adjacent regions, making this area financially advantageous to capture. Furthermore, SJPHS is able to compliment this initiative at a time when a competitor, Henry Ford Health System, lost the referral source of having the Sports Medicine contract at Grosse Pointe North High School (GPN). This provided for a complimentary strategy to move into play giving SJPHS a differentiation within the market as the sole provider of athletic training for all of the Grosse Pointe School System. Venture capital investment, to be further discussed later, will also be required as a requisite component of this strategy.This adaptive strategy for the rehabilitation department, focusing on sports medicine, is an expansion of scope defined as market penetration. St. John Providence Health System’s Sports Medicine and Rehabilitation Program is thriving as both a primary care program for student athletes at nine area schools, and as a referral source for the system and its physicians in the areas of family medicine, orthopedic surgery, rehabilitation services, emergency services, and urgent care. This program has capitalized by adding two additional schools this year, one of which being GPN. The presence of this program in the same market as planned expansion of the ambulatory OP program will serve to support the program with referrals and related revenue. This downstream revenue is quantified by direct referrals to the health system from athletic trainers. This market penetration strategy allows the rehabilitation department to increase both value and market share. The ongoing presence at practices and games within the market area provides marketing opportunities at hundreds of events throughout all sports seasons, and the preventative services protect the youth of the communities we serve from sudden cardiac death, concussion, and other injuries for which they are at risk (Anderson, 2012, p. 6). In 2012, there were 63 referrals to the emergency department, 4 referrals to surgery and 35 referrals to therapy. As an adjunct to the additional penetration in this portion of the market, the Sports Medicine program also added to its market share by gaining the Chippewa Valley High School contract starting in 2014-2015 school years. Located in North-Central Macomb County, this location’s referrals will support the newly developed Ambulatory Center at 23 Mile Road and Romeo Plank in Macomb Township as well as OP Physical Therapy locations in Macomb, Clinton, and Harrison Townships. This volume will supplement existing market share as well as increasing responsiveness for athletes who, previously, had to travel outside of their local zip codes for urgent care related to their previous provider. By providing a higher level of service, the strategy is also to improve satisfaction and gain loyalty and foot traffic from these players and their families. Market Entry Strategy “The adaptive and market strategies work in combination” (Swayne et al., 2008, p. 227). The market entry strategy provides the “means to achieve the scope” (p. 227). The adaptive strategy of market development to add an outpatient clinic in the Grosse Pointe area requires the venture capital investment strategy. This strategy is a financial investment in an outpatient site in order to participate in growth and expansion of the rehab services product line. The investment of an outpatient site in this area is part of St. John Providence Health’s system investment strategy to have a presence in the Grosse Pointe area. St. John Providence Health System had presented a proposal to the Grosse Pointe City Council on May 13, 2013 to “buy a building in Grosse Pointe, renovate and put about $5.4 million into it” (Martin, 2013). Part of that plan included approximately 4,200 square feet for outpatient physical rehabilitation services. The internal resources will be provided by the current physical rehabilitation services product line to provide comprehensive therapy. Competencies and capabilities are supported by the internal line of core services provided through the continuum of care. The Health System’s strategic plans and mission to provide health services in neighboring communities support the venture capital investment strategy.The adaptive strategy of market penetration through the expansion of the sports medicine program requires the market entry strategy of internal development. Both the rehab services product line and the scope of sports medicine will be enhanced via internal development. The internal development market entry strategy “presents image of developing (growth)” (p. 228). This strategy is supported by the external conditions of the market share and locations of the high school contracts. The high schools are located in the same geographical areas of the St. John outpatient clinics and hospitals. The athletic trainers work part time in the outpatient clinics and provide patient referrals from the High Schools. Continuity of care is provided from the High School point of entry to the neighboring outpatient therapy sites. The access points may include the emergency room or physician visit. Referrals are generated to the next level of care within the system. The competencies and capabilities have been established through existing resources in programs of physical therapy, occupational therapy, and speech therapy at each of the sites. The sports medicine athletic trainers provide expertise and competencies which include staff instruction in CPR, cardiopulmonary resuscitation training, high school physical evaluations, and community education. The organizational goal of providing the highest quality of care to the patient throughout the continuum is reinforced through this market entry strategy beginning in the high schools. The Sports Medicine internal development strategy leverages our resources into the community and strengthens the rehab product line. Strategic Posture St John Providence Health System’s strategic posture is a competitive posture. According to Swayne et al. (2008), a competitive posture is “typical in an attractive service category” (p.259). SJPHS has achieved and sustained a competitive advantage in a relatively unstable environment. The goal to maintain this strategic posture within the current market would be to continue demonstrating financial strength and use these resources to increase marketing and to extend and improve the current product line. Such improvements could include clinical advancements as well as enhancing the patient experience or ease of access for customers. To maintain the appropriate strategic posture within the current market, SJPHS needs to ensure proper analysis of the external conditions, internal conditions, resources, competencies and capabilities. Such analyses must be done periodically and considered as fluid, dynamic processes rather than one-time or static occurrences. This is largely due to the rate of change in healthcare today as well as changes in the composition of the competitors.In reviewing the external conditions that affect the current strategic posture of SJPHS, the behavior that most influences the strategic posture can be identified. The three categories are defender, prospector, and analyzer (Swayne et al., 2008, p. 276). The prospector behavior represents SJPHS the most accurately. The prospector operates in rapidly changing environment especially in relations to technology, regulatory and economic changes (Swayne et al., 2008, p. 278). It is important that successful utilization of technology is incorporated into the strategic plan and the key is that there are numerous market and product opportunities with low barriers to the market entry. There are a wide variety of internal conditions, competencies, and capabilities necessary within SJPHS to maintain the current strategic posture. Primary among these are the ability to adjust the program based on the organization’s external forces, the ability to develop and use new technologies, the ability to deploy and coordinate resources among numerous decentralized units, decentralized planning and control, and a flexible structure (Swayne et al., 2008, p. 279). The leadership within SJPHS rehabilitation services division are constantly reviewing and updating the current practices to ensure compliance with regulatory standards. A very recent example would be the new coding necessary in the outpatient area that also affects acute care operations for patients in observation or same-day surgery units. The rehabilitation service department is also currently sharing resources not only within the East region but also across the entire system. The overall goal is to systematize the current policies, procedures, and associate competencies so that personnel can move seamlessly throughout the system. Strategic PositionThere are two types of positioning strategies that an organization may utilize. These are “cost leadership and differentiation, both of which can be applied as market wide strategies or focus strategies (a market segment strategy)” (Swayne et al., 2008, p. 238). In outpatient rehabilitation, the positioning strategy is a focus-differentiation strategy, defined as the development of a unique product or service directed toward a particular market segment. Advantages of this strategy include customization of the product or service to the needs of the particular market segment. As a result, the service line develops a close relationship with the market segment. In doing so, it becomes easier to identify market needs, customer feedback, and develop an appropriate response. Disadvantages include a relatively small market share (p. 234).The internal resources, competencies, and capabilities of the outpatient rehab services support this strategy position. The rehab product line has a strong reputation for quality and development of niche programs, which align with the characteristics of the differentiation strategy. The therapists have advanced training that enhances the care delivery of these niche services. The rehab product line as a whole demonstrates strong cohesiveness that is recognized and supported by administration. This is evidenced via the subjective measurements from consistently high patient satisfaction scores which rehabilitation services receive. These organizational capabilities support the focus-differentiation strategy as outlined in Swayne et al. (p. 281).External risks for this positioning strategy include the customer’s need for the differentiating factors or niche programs may diminish or the niche programs may eventually be duplicated by other health systems in the market focus area (p. 280). Outpatient rehab has situated itself in the Grosse Pointe market via the sports medicine program’s high school affiliations with the community’s two main high schools, North and South. The rehab position can be further solidified through the focus strategy and a St. John location for outpatient rehab services positioned in the community boundaries. This location will allow for the penetration of the all specialty programs into the market where before only the sports niche was dominant. Programs that were developed based on customer demand and need such as the FIT program or oncology rehab will now be closer to the market that drove their development, and marketing will be supported by the ongoing presence in the wider community sporting events. Summary and ConclusionsThe Rehabilitation Services division of SJPHS is, along with many of its counterparts in the region, challenged with a rapidly changing landscape in terms of reimbursement, referral sourcing, competition, and regulatory criteria. The overall response until recently had been to focus on growth where possible, quality at all times, and the ongoing efficiency of our core processes. Over the past five years, however, the approach has become decidedly more strategic with an emphasis on development only in response to the voice of the customer and programs that worked in tandem with each other. The global principle of “Healing Without Harm”, part of a system safety initiative, drove leadership to address any gaps in the continuum of care in order to better serve patients. As this strategic plan has outlined, the rehabilitation service line has exemplified this by providing comprehensive care throughout all points where a patient may have need of our services. The Inpatient Rehabilitation area has moved to a regional model in order to leverage its strong market share and leverage resources in order to capitalize on its advantages. The expertise and clinical strengths identified in the SWOT analysis are supported by unique equipment on the cutting edge of research-validated care. By focusing only on patients who require the unique skills of this setting (neurological cases for example) instead of diluting the case mix to gain volume that can go to a lesser setting, our clinicians are achieving outcomes above the national benchmarks. This differentiation allows area physicians to refer cases from non-SJPHS facilities on an increasing basis, validating this strategy in addition to the market share. These patients then connect into our outpatient ambulatory component for a seamless transition to OP care close to home. The outpatient centers, a highly competitive arena, coordinate care with acute, IPR and home care points in the continuum. While this is not unique to SJPHS, one strategy that we have leveraged was the Sports Medicine program. The addition of two local high schools within our existing market will provide many downstream referrals to physicians, urgent care, emergency departments, and rehabilitation. By including assigned team physicians, athletes have immediate professional care and access to specialists within days or hours instead of weeks or months. The built-in marketing value of this positive service promotion is difficult to measure, especially to the parent of an injured child. Working in tandem with the OP Ambulatory leadership, one of these new schools was intentionally chosen to be Grosse Pointe North, securing the entire Grosse Pointe School System for additional market penetration at the same time plans are moving forward for an ambulatory center in the same area. Not only will our programs continue to differentiate us as providers, our strategies will work in tandem to support each other to sustain market share and enhance penetration. Addendum AMission: The mission of St. John Rehabilitation Services is to be consistent with the gospel imperative and the spirit of Ascension Health’s values. We will promote physical, mental, social, and spiritual health for all those seeking rehabilitation services, including the poor and those with special needs. Our concern for the value of all human life and the dignity of each person leads St. John Rehabilitation Services towards the achievement of excellence in the treatment of all those we service and in enhancing the quality of the environment for those who provide and receive rehabilitation services.Vision: St. John Hospital and Medical Center’s Rehabilitation Services Department will be the market leader in providing the highest quality physical, occupational and speech therapy services in southeastern Michigan. This will be accomplished through the development of multiple clinical specialties within the service line, making us the destination department for those patients who require rehabilitation. These specialties will support the vision of St. John Hospital and Medical Center becoming a ‘Tertiary Plus’ level institution and provide exemplary care to all those in need.Service Line: Rehabilitation ServicesParent (Hospital) Strategic GoalService line Critical Success FactorService Line StrategyMeasure/TargetTactical/Action PlanStrategic Market Growth in Ambulatory Services and other Service LinesIncreased ambulatory market shareAdaptive- Market Development, supported by increased Market PenetrationDevelopment of additional OP Ambulatory Site; expansion of Sports MedicineInvestigate real estate opportunitiesSecure capital fundingSecure community support/ investigate alternate sites as neededOperationalizeOngoing assessmentContinue to assess Sports Medicine opportunities in areaReferencesAnderson, R. C. (2012). Rehabilitation services mission, vision, and values. Policy and Procedure Manual. Detroit: NP.Anderson, R. C. (2012). Hospital based rehabilitation services 2012 annual report. St. John Providence Health System, Rehabilitation Services. Detroit: NP.CMS Manual System, Transmittal 119 Medicare Benefit Policy § 110-2 (January 15th, 2010).Beaumont-Henry Ford merger. (n.d.). Retrieved from Crain's Detroit: Retrieved from: Martin, S. E. (2013, May 14). City of Grosse Pointe council denies variance for St. John proposal on former borders. Retrieved from club (2013). Retrieved from Beaumont Health System: Therapy. (2013). Retrieved from Henry Ford: Retrieved from: Reilly, B. (2012, November 12). Crain's List: Largest Michigan Hospitals and Hospital Companies. Crain's Detroit Business.Southeast Michigan Council of Governments (SEMCOG). (2010, November 29). SEMCOG Quick Facts. Retrieved April 24, 2013, from : , L. E., Duncan, W. J., & Ginter, P. M. (2008). Strategic Management of Healthcare Organizations (6th ed.). San Francisco, CA, USA: Jossey-Bass.U. S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. (2012). CMS Manual System (Pub 100-02 Medicare Benefit Policy, Transmittal 165). Retrieved from ................
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