Children's Hospital of Michigan Strategic Plan
Children's Hospital of Michigan Strategic PlanTeam 2:Chanelle ChristieCynthia FaustMilton GriffinPhillip HinsonJacqueline HoekemaChristine LewandowskiA project submitted in partial fulfillmentof the requirement for the degreeMaster of Arts Dr. John FickStrategic Leadership (OB)Siena Heights UniversitySouthfield, Michigan5/22/2015Children’s Hospital of Michigan Strategic PlanBackground and Overview of Children's Hospital of Michigan (CHM) - ChristineChildren’s Hospital of MI has come a long way from its inception in 1886. It began as a small area of the Harper Hospital to treat “children regardless of race, religion, or ability to pay” (About Children’s, n.d, para. 2). Dr. Devendorf established this to care for children so that their parents wouldn’t have to go into poverty staying home to care for them. He said, “We will take the most hopeless cases. All the children who are suffering from want of care or illness in Detroit will be nursed and made well if we can do it” (About Children’s, n.d., para 4). This has remained the core mission of the current Children’s Hospital of Michigan. “Its current mission is to meet the physical and emotional needs of youngsters with common childhood illnesses, as well as the diagnosis and treatment of rare and unusual diseases” (About Children’s, n.d., para 4).Since, the hospital has grown and developed to be a premier center for pediatric care. “It was Hiram Walker, however, who was responsible for taking Children's Hospital from a series of rented houses and barns to an admirable facility” (About DMC, n.d, para 1). Among his own tragedy with his daughter, he donated a new building to the hospital in 1896 (About DMC, n.d., para 1).Many developments have led to achieving many accomplishments in the way of pediatric medicine. “As Children's grew into a state-of-the art hospital, it served both as a pioneer and advocate by leading the way in researching Sudden Infant Death Syndrome, genetically caused childhood diseases, and nutrition needed to improve maternal and child health, and lobbying state legislature to write laws that would identify and protect abused and battered children” (About DMC, n.d., para 6). DMC Children’s Hospital of Michigan has more than 40 clinical specialties and is an international leader in pediatric and adolescent medicine. Surgical services include general, neurosurgery, orthopedics, and cardiovascular. Imaging technology designed especially for children provides advanced diagnostic services such as Positron Emission Tomography (PET) and MRI. The Children’s Hospital of Michigan’s Emergency Department is a verified Level 1 Trauma Center dedicated exclusively to children. Experts in pediatric critical care, rehabilitation, neonatal and perinatal medicine provide care for thousands of children every year (About DMC, n.d., para 5).“The hospital offers outpatient specialty and rehabilitation centers serving children in Birmingham, Bloomfield Hills, Canton, Clinton Township, Dearborn, Detroit, Novi, Southfield and West Bloomfield” (About Children’s, n.d., para 5). The hospital has won much recognition and awards for its contribution to pediatric medicine. It is affiliated with Wayne State University and Michigan State University (Services, n.d., para 2). Directional Strategies - CindyAccording to Ginter et al, (2008), “mission, vision, values, and strategic goals are appropriately called directional strategies because they guide strategists when they make key organizational decisions” (p. 161). Together, the directional strategies provide a basis for an organization in which they conduct their day to day operations which highlights the importance in developing well-conceived directional strategies (Ginter et al., 2008). More importantly, a successful business will communicate their written mission, vision, values, and strategic goals to their entire organization.The mission statement describes the purpose of a business. “An organizational mission is a broadly defined and enduring statement of purpose that distinguishes a healthcare organization from other organizations of its type and identifies the scope of its operations in product, service, and market (competitive) terms” (Ginter et al., 2008, p.162). The mission of an organization will capture their distinctive character (Ginter et al., 2008). A mission is a general statement about an organization, but it is more specific than a vision. Children's Hospital of Michigan mission states: Mission"Children's Hospital of Michigan (CHM) will improve the health and well-being of all children and their communities by advancing the science and practice of pediatric health care and through advocacy efforts" (CHM, 2015, para. 1).The proposed mission statement is as follows per team two’s analysis: Children’s Hospital of Michigan will be the premier leader in pediatric services in Southeastern Michigan serving the community regardless of their financial ability. Children’s Hospital of Michigan will be a leader in research, technology, and differentiate from competitors by improving quality, safety, and cost leadership. An organization's vision is a statement of hope for the future. This vision is the inspiration of the business leadership and the dream of what they strive for their organization to become (Swayne et al., 2008). Some important factors for an effective vision are to have originality and clarity (O'Hair, Friedich, & Dixon, 2011). A vision that is readily understood by all members of an organization makes this easier to follow. CHM's vision states:VisionChildren's Hospital of Michigan will fulfill its mission by being an outstanding provider of child health services within the Detroit area and throughout Michigan to patients around the region, nation and globe. We will establish a national, regional and statewide child health system, promote a family-centered system of care and prevention, engage in the generation of new knowledge relevant to child health and well-being, educate physicians and other health professionals in the provision of care to children, and advocate for programs which will benefit children, families and communities (Children's Hospital of Michigan, 2015, para.2). The proposed vision statement is as follows: Children’s Hospital of Michigan will be an innovator in pediatric medicine research and technology implementation. CHM will strive to be a market leader by developing its competencies and achieving cost leadership in order to continue to serve its communities in alignment with its mission. CHM will treat each and every patient and family member with dignity, respect, and empathy while providing access to care regardless of financial ability. The values of an organization "are the fundamental principles" that they stand for (Ginter et al., 2008, p.179). They also define the uniqueness of the organization. "Values are the principles and ideas that organizations strongly believe in and consider important" (O'Hair et al., 2011, p. 26). A successful organization will have these shared values among all employees. CHM's values are stated as:Values"Children's Hospital of Michigan's values are: accountability, compassion, excellence, innovation, integrity, partnership, respect, and unselfishness" (Children's Hospital of Michigan, 2015, para. 3). Accountability refers to the organization living up to their end of providing premiere healthcare services to children. Compassion is about taking into consideration the nature of the illness and the impact on the child, family, and psychological needs of them both. Excellence will be achieved by continuing to implement the newest and most advanced technology and research in the care of children. Innovation is described as discovering new ways to tackle new problems in ways that are not applicable from previous medical practices. Integrity will be maintained by treating each customer with the highest ethical standards. Partnership refers to the collaboration with child, parent(s), and healthcare provider to treat and sustain health. Respect will be given in all interactions taking into account the diverse nature of the demographics and respect for cultural differences in treating patients. Unselfishness refers to not withholding any of these values for financial gains. The strategic goals of an organization will be developed after the mission, vision, and values are established. "Goal setting should be focused on those areas that are critical to mission accomplishment" (Ginter et al., 2008, p. 181). These areas are called the critical success factors and they are what is necessary for an organization to achieve if they are going to reach their vision (Swayne et al., 2008). CHM's strategic goals are stated as:Strategic GoalsChildren’s Hospital goal is to select a vendor that is very well known in dealing with its competitors, such as, Beaumont Hospital, Oakwood, Botsford, St John Providence Hospital, and Henry Ford Health System and many other hospitals in Michigan (Christie, 2015). However, the goal is to utilize Press Ganey to monitor and improve patient satisfaction. “To improve the patient experience, health care providers must first be able to see and understand the complex relationships between satisfaction, clinical, safety and financial measures” (Press Ganey, 2015).Another strategic goal that CHM are implementing is called GEMBA. GEMBA is a Japanese word which means, at the site. When?GEMBA?is used in conjunction with?process?improvement methodologies, it refers "to the act of making observations of the?process?in action” (google, 2015). Each day the leaders of Children's Hospital, such as, managers and directors form teams and go to each department site within the hospital to view each department's boards that has ratio performance and graphs of performance (Christie, 2015). Each department must set a goal. These goals are aligned with the corporate metrics utilized by Tenet Healthcare Corporation, its parent company. An example of a goal is quick patient admission into a department such as the emergency department. The leader would make sure that goals are met and to speak to the departments to encourage what they can do better. Monitoring the metrics enables leadership to make proactive corrections the current process. The CHM implements GEMBA and KAIZEN to align the strategy of managing visibly and implementing Lean management (Expert Resource, 2015). This is a participative style of leadership. External Environmental Analysis - Chanelle & ChristineGeneralPolitical To highlight some political changes, funding of healthcare, prison systems, education, and infrastructure repair are of need of immediate attention. According to The National State of State Budgeters, "Much of the additional spending in governors’ budget proposals is targeted towards making greater investments in areas such as education, economic development and infrastructure" (Summaries of fiscal, 2014, para. 3). Tax policies will affect the public and increase costs of services. As mentioned in Congress, “Senate Majority Leader McConnell also identified reform of an “insanely complex tax code that is driving jobs overseas” as a priority for the 114th Congress if not corrected” (Opportunities and Challenges, n.d., para 2). Higher business taxes will send jobs overseas and decrease American spending abilities. Immigration will have an impact on costs in healthcare and public spending related to the economy. Immigrants are important to the social fiber of our society in contributing to economic stability and growth. “Since 2000, the immigrant population has increased by 30% to a record 41.3 million” (Immigrants, n.d., para. 2). The amount of unauthorized immigration has decreased (Immigrants, n.d.). The 2016 election will prove to be a challenge to the healthcare environment; in addition, to the general environment in how these issues are handled. “Immigrants to the United States represent a sizable and rapidly growing group that totaled approximately thirty-six million people, or 12 percent of the U.S. population, in 2005”(Derose, 2015). Reform to the structure of social security will also need to be considered in the political arena as the population ages and the increases strain on the costs associated with caring for this demographic. Simply, there will not be enough employed Americans to support the rising costs of the vast elderly population who is also living longer due to increased technology in life sustaining medicine. Public funding will decrease as the deficient is worked on decreasing. In addition, employee-based insurance may be diminished (Ginter et al., 2013, pp.36-37). Enders (2013) stated, “An aging population, federal and state budget deficits and the potential addition of 16 million lives to cover are among the trends coming together to drive major Medicaid reform.” The increase in the cost of fuel has a domino effect at raising the costs of transporting and manufacturing goods and so on. This also changes how populations reorganize to survive the economic strain. Changes in a seemingly small part of the external environment can have a domino effect elsewhere. According to Bloomberg News, the US has decreased its spending in defense while other countries, such as, China and Russia have increased their spending in defense (Yoon, 2015). The cost of water is another issue. In addition to the shortage of water supply, there is a demand for replacement of the old system that has increased costs that were not previously budgeted by politicians. These costs will now be passed onto the public. These replacements could end up costing over $2 trillion over the next 25 years, according to Tom Curtis from the AWWA (American Water Works Association) (Sustainability, n.d.). This shortage of supply is forcing states to look for new sources of water in distant areas. This will have an economic impact on the public and government as the situation worsens. Social changesThe baby boomer population will double in size and consume more than the fair share of resources related to social services. As the lifespan improves, there will be more pressure on healthcare organizations and government funding. According to the Social Security website, Americans are living longer and are having fewer children. These two factors result in the aging of the U.S. population and a subsequent strain on the Social Security System. Additionally, aging of America has created a situation in which fewer workers will be tasked with supporting a growing retired population. The baby-boom generation will soon reach the early eligibility age for retirement under Social Security. The U.S. will then find themselves at a crossroads where which the older population have grown at a rate that far outpaces that of the working-age population. With an increase in immigration and predicted birth rates, "Whites will become a minority (47%) by 2050” (Passell& Cohn, 2008, para.5). The Hispanic population will continue to flourish. This will impact communication with language barriers becoming more prevalent. Ginter et al. (2013) stated, “Tiered access to health care is anticipated, with the division between the tiers becoming more extreme. An increase in income disparity is expected and a more ethnically diverse population will continue to develop” (p.47).With an increase in population predicted, the amount of raw resources is depleting at an alarming rate. This will also force the costs associated with demand higher or force innovative ways to make do. The prevalence of the ecological impact of businesses will be more important to business’ success and branding. It will be an important market driver in how "green" a company is perceived as. Ethical and responsible will be an indicator of success. However, due to a rise in different ethnic backgrounds and cultures within Michigan’s health organizations, strategic planning will be necessary to expand their organization to handle larger productivity.Industry Specific AnalysisTechnological Technology will continue to evolve and advance. It will be essential for healthcare providers to keep up with their industry specific advances ahead of the competition. Technology that brings the virtual world of medicine to the customer will be needed to embrace before the competitors in unrelated industries beat healthcare providers to it. Telemedicine is projected to grow six times to avoid Medicare penalties and reduce readmission rates by monitoring the patient remotely (Telehealth to grow, 2013). An increase in technology will improve the health of people extending their lives, which was not possible a decade ago. New advances in imaging, drug design, minimal invasive surgery, genetic mapping, and testing, gene therapy, vaccines, and artificial blood will emerge in these areas (Ginter et al., 2013). The electronic health record implementation and telemedicine will improve quality patient care and standardization of care. The research of the today will be the surgical procedures of tomorrow. Technology changes will include high costs in equipment, an updated electronic health record database, medical information, drugs, imaging, surgeries, and vaccines. Technology within health organizations such as Children’s Hospital of Michigan has grown and will constantly continue to grow as patient data will need to be transferred. Electronic medical records are a popular way to for technology to constantly keep advancing within health organizations. RegulatoryWith advances in technology comes the necessity for regulatory measures that healthcare providers will have to contend with to remain within ethical and moral boundaries. As medicine reaches far into sustaining life beyond normative measures, regulations will come into place regarding research and development of new advanced treatments. Research and development will proceed with monumental progressions that will alter the mortality and morbidity rates of disease pattern. There will also be the second phase of meaningful use implementation that will be regulated more heavily in order for providers to comply with the incentives of EMR implementation. There will also be a catalyst for regulatory measures to ensure Public Health Information (PHI) is protected and who is responsible in the event of a security breach. The second phase of the implementation of ICD 10 billing is expected to pose a challenge for healthcare providers not prepared. “Although many of these regulations were designed to improve care and efficiency, many providers see them as burdensome and impractical” (Beckers Hospital Review, Regulatory demands, 2014, para. 1). Additionally, the EPA has proposed that states reduce carbon emissions over the next fifteen years. The healthcare industry will have to focus on the public’s changing perspective on value. This will include going “green” and being ecologically and socially responsible, in addition, to providing quality over volume healthcare. “Green industry methods are on the rise because they’re increasingly demanded by consumers, sought after by shareholders, and required by governments” (Green Industry, n.d., para. 13). Specific to the healthcare industry, political issues affecting the reform of the current ACA model and possible repeal could pose major challenges for healthcare organizations. Changes to the funding of CHIP (Children's health insurance program) could also decrease accessible care for those most vulnerable. “The year is likely to see a down-to-the-wire debate over federal funding for the Children’s Health Insurance Program. A decision in Congress not to continue funding the program would leave last-minute holes in state budgets while stripping millions of children of health coverage”(The top ten, n.d.,para. 3).Therefore, it is expected for health insurance percentages to be on the rise for the adult population and small business as some smaller businesses in the near future may be facing lots of penalties because of the rising insurance costs and the mandating of health coverage and for children’s insurance plan to possibly be a thing of the past in the near future due to budget cuts. Also, health expenses have increased and will continue to do so.”health-related expenditures are now rising faster with increasing co-payments and deductibles, and a much larger percentage of the population is without health insurance”(Campbell, 2008, para. 2). The political arena is taking away services, such as, insurance that is needed to ensure children are getting the quality of care that they deserve in the counties that Children’s hospital is serving. However, due to the Children’s health insurance expiring in September there are states that are required to budget finances for medical coverage and without prompt action there will be a lot of children uninsured. (LA Times, para 3, 2015). It is predicted that children under 18 and under coverage will be cut in half and from the years of 1997 to 2012 there already been some declining medical coverage for our children(LA Times, 2015,para 3). The children who need to see specialist would have a much harder time because of not having all procedures covered to get the quality of care that they need because of the cutbacks. Each state would have to strategically plan for the insurance of the children of ways to still care for the children without proper funding that the federal government was once giving. Service Area Competitor Analysis - Jackie & PhillipService AreaChildren’s Hospital of Michigan, along with its closest competitor’s span two of the seven counties that help make up what is referred to as the “Region” of Southeast Michigan. Two of the closest competitors are Beaumont Children’s Hospital in Royal Oak, Michigan, and Botsford Hospital in Farmington Hills, Michigan; both located in Oakland County. The third is Oakwood Hospital, which shares Wayne County with Children’s Hospital of Michigan. All competitors are within a twenty-mile geographic service area.According to the Southeast Michigan Council of Governments (SEMCOG), during the 2000s both Oakland and Wayne counties were greatly impacted by the statewide recession for the greater part of a decade, before the nationwide Great Recession of 2007. During this period, Oakland and Wayne counties were particularly hard hit. Loss of considerable number of jobs and people plagued these counties adding to the demographic, social, and economic changes experienced. Review of recent statistics from the Census American show that both Oakland and Wayne counties are currently on a slow path to recovery. In 2012, Southeast Michigan experienced an increase in population for the first time since 2003, after experiencing population loss for eight years consecutively. However, the region remains three percent below its 2000 population, while the growth experienced between 2011 and 2012 was a considerable amount smaller than the losses that occurred during the recession years. While the region continues to experience more births than deaths, natural increase fell 38 percent during the four year period of 2008-2012. Domestic migration is the lowest it has been since 2001. While this is encouraging, more people are continuing to move out than in, evidenced by the region’s loss of 6,000 people between the years 2011-2012, due to out-migration.According to the most recent census statistics, the regional unemployment rate dropped between 2010 and 2012, from 16.3 to 11.8 percent. While these rates remain higher than the national rates, they are closer than ever before. This narrowing gap indicates that recovery is occurring faster in the region than nationwide. With unemployment rates still high, the region’s median household income has been negatively impacted by 22 percent over the course of a twelve year period of 2000-2012. When compared nationally, this decline in household income fell well below the national average. Although Southeast Michigan’s per capita income slightly increased in 2012, when compared to 2000, individual income declined by 14 percent, while the nationwide rate was 8 percent.According to the most recent Census, “wide income disparities continue to exist among households in Southeast Michigan” (SEMCOG, November 2013, p.6-7). The recession affected the lower-income households disproportionally. Between 2000 and 2012, some of these incomes dropped by 30 percent, thereby adding to the poverty levels of the region. Census statistics indicate the percentage of people in the region living in poverty “declined from 17.8 percent in 2011 to 17.3 percent in 2012” (SEMCOG, November 2013, p.7-8). Today, the region’s poverty rate remains higher than the nation’s. While poverty rates for children under 18 declined slightly by 2012, the rate is back on the rise placing one in every four children in Southeast Michigan in poverty.While the recession is over and the region is showing signs of slow recovery, the downturn of 2007 continues to affect the social and economic well-being of Southeast Michigan residents. With the substantial, regional loss of population over the past ten years, along with a decrease in natural increase; increased migration into the region continues to be a critical success factor for future population growth. According to SEMCOG, 2014 population estimates indicate that Wayne County will lose 3.7% of its population, while Oakland County is trended to increase its population by 3.9%. Due to the geographic location of its competitors in the service area, the burden is placed on Children’s Hospital of Michigan to create additional value in order to persuade customers to travel for pediatric services that are offered by a closer competitor.Population Change by Community, Southeast Michigan, 2010-2014CountyCensusApr. 1, 2010EstimateDec. 31, 2014VariancePercentOakland1,202,3621,249,14946,787 3.9Wayne1,820,6501,752,56668,084-3.7Source: SEMCOG, Population and Household Estimates for Southeast Michigan, December 2014, p.1, table 1.While unemployment rates continue to decrease slowly, the per capita and median household income, continue to decrease. This continued decrease has devastating effects on households in the lower income brackets, resulting in poverty rate increases. With poverty rates on the rise in Southeast Michigan, the dramatic increase in poverty among children is of particular concern. “Poverty in early childhood often carries over into adulthood, thereby negatively affecting the productivity and earning power of these individuals later in life,” (SEMCOG, November 2013, p.7-8). Although the region is on the slow path to recovery, it continues to lag behind the national averages in several indicators to include; unemployment rates, incomes, and poverty. Closing these gaps is imperative for Southeast Michigan to make a strong, sustainable petitor AnalysisA competitor analysis was conducted using three similar organizations within the operating vicinity of Children’s Hospital of Michigan. These direct competitors are as follows, Beaumont Hospital, Botsford Hospital, and Oakwood Hospital. All three competitors operate within the same metropolitan areas as that of Children’s Hospital of Michigan, and offer similar services.A chart was created (figure 1.) to show a comparison of 4 major areas, the number of staff, number of physicians, number of beds, and number of pediatric services offered. As we take into account these areas, we also review each hospitals strengths and weaknesses.Beaumont HospitalThis 141 bed children’s facility has many strengths that lend them to be a major competitor within the aspect of children’s care. Their biggest strength is the more than 80 sub-specialty pediatric treatments that they provide which include gastroenterology, neurology, oncology, pulmonary, and vast surgeries (Beaumont Children’s Hospital, 2015). What adds to the value of these treatments is that they are offered at more than one location, Troy, and Royal Oak. Another strength for Beaumont is they are rated as a Level 1 Trauma facility for pediatric patients, of which there is staff on hand 24/7 (Beaumont Children’s Hospital, 2015). This gives great comfort to those who seek excellent emergent care for their children. They also offer an after-hours pediatric clinic, which accepts walk-in appointments (Beaumont, 2015).Some of Beaumont’s weaknesses include a drastic difference in their Emergency Room waiting time, as to that of which they advertise. Some people choose Beaumont’s ER over others simply based on the radio and TV advertisements stating that they have a short ER waiting time. However, if you read patient reviews, many of them are a reflection of long waits upon arrival at their ER. Another weakness may be that of not enough staffing. With so many sub-specialty services offered, the difficulty becomes having the appropriate staff that are trained in said sub-specialties, and are also available to work.Botsford HospitalBotsford Hospital is a 330 bed facility (16 pediatric bed) that when compared to their local competition, are not as prevalent in the pediatric services field. However, for being a smaller provider of pediatric services, they do have strengths that benefit those who utilize them. One strength is the pediatricians staffed with Botsford Hospital are on-call and available 24/7 to their patients (Botsford, 2015). Another strength is they are highly rated by the Leapfrog Group, a group that conducts safety and quality surveys amongst hospitals nationwide (Botsford, 2015). When patients can review survey information, and that information is positive, it will help strengthen the patient’s confidence. Botsford’s weaknesses when compared to their competition in terms of services offered in pediatrics are many. In comparison, Botsford does not seem to find it necessary to expand upon their pediatrics program with specialty services. They seem to stick to the basics when it comes to pediatric services.Oakwood HospitalThis 632 bed (combined within the system, 30 pediatric beds) Oakwood Hospital offers many services that are great strengths to pediatric patients. Oakwood Hospital operates with a Level III Neonatal Intensive Care Unit which is staffed 24/7 (Oakwood, 2015), a strength that will always attract customers, Oakwood offers same day or next day pediatric appointments (Oakwood, 2015). They also offer after hours, and weekend pediatric care (Oakwood, 2015). This security will help parents feel more at ease that their child will soon be seen, and hopefully feel better. Other strengths within Oakwood are the numerous pediatric services provided which include oncology, gastroenterology, cardiology, and neurology (Oakwood, 2015). They also offer behavioral and therapeutic services to include occupational, physical, and speech therapy (Oakwood, 2015). These vast amounts of services provided make Oakwood a top competitor for pediatric services.A weakness that may affect Oakwood Hospital from receiving return customers is that of their emergency room admissions operations. There are numerous complaints on record of decreased satisfaction with the emergency wait times, this is a weakness for Oakwood Hospital. Figure 1 Internal Environmental Analysis - Chanelle & MiltonPoint of ServiceStrengths WeaknessesThe largest healthcare system in MichiganLarge operational expensesMultiple clinical servicesAbundant capital needsMultiple surgical specialist Extended wait time EMR pioneersPhysicians and employee dissatisfaction as early adaptersCompetitive RelevanceStrengthsIs the value of the strength high/low?(H/L)Is the strength rare?(Y/N)Is the strength easy or difficult to imitate? (E/D)Can the strength be sustained?(Y/N)ImplicationAbundance of technologyHNDYCompetitive advantage most other competitors do not have the capital to invest in new technologyInpatient servicesHNDYCompetitive advantage most other competitors do not have the operational revenue to sustain the expense to offer the depth of servicesLevel one pediatric trauma centerHYDYCompetitive advantage the hospital receive federal funding as designated trauma center and the medical center is the only level one (pediatric) trauma facility in the areaOrganizational StructureStrengthsIs the value of the Strength High or Low?(H/L)Is the Strength Rare?(Y/N)Is the Strength Easy or Difficult to Imitate?(E/D)Can the Strength be sustained?(Y/N)ImplicationsCommitment to research pathologyHNEYNo Competitive AdvantageDiversityHNEYNo CompetitiveAdvantageEmployee EngagementHNDYNo Competitive AdvantageGrowth Strategy based on internal developmentHNDYNo CompetitiveAdvantageOrganizational StructureOrganizational Structure: Functional PediatricsStrengthsWeaknessesLargest freestanding Children Hospital in the State of Michigan, International reputation in pediatric medicineLong Patient wait timesGrowth Strategy based on internal development and acquisitionStaff nursing shortagesExperienced management team and TechnologyTechnology Machines over a decade old, technology down time due to needing repairs.Resources: The organizations commitment to pathology resource is considered as a high value within the organization. With over 100 residents in training, CHM offers a diversity of pediatric experiences, including urban and suburban clinical rotations, a track in international medicine and opportunities for child advocacy (Children’s Hospital Of Michigan, 2015). Competency: Knowledgeable of having diversity in the workplace to ensure creative strategic planning is very sustainable within the organization. Also the organizations competency to engage its employees leads to better production results and better patient care and quality outcomes.Capabilities: The organization is capable of expanding and introducing by proving new department within the organization. The capability to fund research programs by finding grants to keep a high capital of the organization or add on the capital. CHM also is capable and known for branching out to different regional areas. The newest addition to Children's Hospital of Michigan is the new pediatric children's hospital that is was built in Troy, Michigan.?The strength of CHM is that the hospital understands their point of service. The structural point of service is being able to grow in production by accepting new patients because of the CHIP and Medicaid program being on the rise. The organization structure also creates new opportunities in the internal environment by being able to support and have technology and equipment as needed. The organizational strength is also recognizing and implementing a strategy of “expanding patient volume, the second is to specialize in particular service lines and the third is to integrate with other health systems (Gamble, 2013).Strategy Formulation and Evaluation – Christine and CynthiaOverview Based on the evaluation and analysis of the service and competitor market area, internal, and external environments, CHM is leading the market in pediatric services. CHM exhibits a competitive advantage over most other competitors by maintaining operational revenue to sustain the expenses incurred offering the depth and diversity of pediatric services. In addition, due to the Level One pediatric trauma designation, CHM receives federal funding that aids the facility in the replacement of capital equipment, while their competitors do not have access to this additional governmental funding. Given all previous information regarding internal resources, competencies, and capabilities, it would be in the best interest of CHM to maintain the scope of their outpatient pediatric specialties.Adaptive Strategy The adaptive strategy most currently suitable for CHM is a maintenance strategy of enhancement by means of internal development of all outpatient pediatric specialties. The strategy of enhancement will further utilize the organization's strengths to add value to already existing pediatric services. Through internal development and special focus on enhancement of quality, efficiency, speed, flexibility, and innovation of existing services and market area, CHM will be equipped with the necessary ammunition to sustain the competitive advantage they hold today. Service development would provide a sustainable competitive advantage in providing unique specialty services to serve the demographic health disparities, while promoting the organization’s current strengths and services within the market. Further analysis of the current state of the organization, utilizing the TOWS and SPACE Matrix analyses, recognizes the need for maintenance of scope for the organization to remain a front runner in the service market. Some of the identified threats to CHM include; Beaumont Hospital merger to increase presence and achieve economies of scale, financial strain affecting reimbursements, a decrease in available caregivers and providers; not enough to meet the projected needs of the community, a decrease in funding of Medicaid and CHIP, and a steady decline of pediatric population in the service area. Additionally, these threats bring opportunities such as increased need for services as demographics change, improving economy, ACA to insure many who were not previously insured, reduced spending due to regulations and changes in reimbursement, and maintaining the current strong market presence that CHM realizes today.1064895333375 STRENGTHSWEAKNESSES00 STRENGTHSWEAKNESSESTOWS Matrix419100259080-1270121920THREATS OPPORTUNITIES00THREATS OPPORTUNITIESSPACE AnalysisFactors Determining Environmental StabilityTechnological changes-3Rate of inflation-5Demand variability-3Price range of competing products/services-3Barriers to entry into market-5Competitive pressure-1Price elasticity of demand-4Average - 6-3.42Critical factors: There is intense competition for the pediatric services, especially in specialty services. Many technological factors play into these services and revenues. Competition for market share is highly ments: It is necessary to obtain more market share within the competitor's service area to increase competition and produce revenue. Demand for services will increase as population demographics change and new research is developed to improve pediatric medicine.Factors Determining Service Category StrengthGrowth potential4Profit potential4Financial stability5Technological know-how4Resource utilization2Capital intensity3Ease of entry into market1Productivity, capacity utilization2Other: Flexibility and adaptability2Average3.11Critical factors: The demand for pediatric services is growing as more and more research is needed for rare and new diseases affecting pediatric patients. Specialty services will continue to grow providing potential for profits in a competitor's ments: The adaptability of services that can provide more patient satisfaction and improved safety measures will maintain the competitive advantage.Factors Determining Competitive AdvantageMarket share-6Product quality-5Product life cycle-3Product replacement cycle-3Customer/patient loyalty-5Technological know-how-5Vertical integration-5Average - 6-4.57Critical factors: The market share is high but quality of product needs improvement to maintain market share. Comments: Rapidly increasing competitors requires enhancement of internal environment to maintain competitive edge. Factors Determining Financial StrengthReturn on investment4Leverage4Liquidity3Capital required/capital available6Cash flow4Ease of exit from market3Risk involved in business4Other: Inventory turnover3Average3.88Critical factors: Changes to Medicaid and CHIP reimbursement are expected to decrease reimbursements for services and decrease the insured population. Risk is moderate. Comments: Investing in internal development to improve quality and safety measures will enable higher reimbursements and reduce the risk of fines. The Lean management structure will reduce costs and improve those measures which make CHM a strong competitor in this market. SPACE Matrix 32575504733925Environmental Stability00Environmental StabilityEvaluation of the selected adaptive strategy of maintenance of scope, using the TOWS and SPACE analysis methods, indicated and confirmed the that organizational enhancement was the best adaptive strategy, that would utilize the existing CHM organization to further develop pediatric specialties, enhance quality and safety, while internal conditions at CHM already demonstrate an ability to reduce costs and increase profitability. This can be accomplished by reducing the wasted resources, decreasing turnaround time, and increasing efficiency, which directly contributes to patient satisfaction, thus, quality. Decreasing inefficiencies will also contribute to lowering costs and becoming a cost leader. Market-Entry StrategyMaintenance of scope can be accomplished by way of the market entry cooperation strategy of internal development. Specific to CHM, enhancement of existing service lines for additional value is mandatory to maintain placement as market leader. Continued strong relations with Wayne State University will potentially give way to increased technology through enhanced research and development. Additionally, Wayne State also brings the medical education component that the competitors do not have. The medical residency program trains new physicians in pediatric medicine at the CHM campus. The existing alliance between CHM and Wayne State University must continue to be fostered. Evaluating the surrounding service area for further penetration of the market for pediatric medicine and specialties is at the forefront of CHM strategic goals. A new service facility for pediatric specialties will soon be available in the Oakland County market, specifically in Troy where Beaumont is a strong competitor. Analysis of the external conditions supports the need for internal development to maximize economies of scale, improve profitability, and to take advantage of increased capital available since the merger with Tenet. These newly penetrated facilities also address CHM’s weakness of providing disproportionally high amounts of uncompensated care by expanding services into a county with a more favorable payer mix. Oakland County outpatient centers will enhance the market presence outside Wayne County, and present an image of growth for CHM. Providing convenient locations to customers living outside Wayne County will increase market share as well as provide additional third-party payer reimbursements for outpatient services. This facility will help mitigate several internal weaknesses identified during TOWS and SPACE analysis, specific to reimbursement, payer mix, and increased market share.CHM’s goals of focusing on areas of cost, growth, quality, service and people will be continued with the internal development of services in Oakland County. CHM’s ability to utilize capital resources, provided by Tenet, to build new facilities and add new technology allows CHM to expand the outpatient service footprint into Oakland County, while better serving existing patients with enhanced technology, and maintaining its high level of service. CHM should focus on entering a presence in Oakland County to contend with competitors in a more influential demographic since Wayne County is decreasing in population size. This can help the payer mix and reach those in the community who require specialty pediatric care that the competitors cannot provide. By expanding market presence outside of Wayne County, CHM will compete with Beaumont Health. New outpatient facilities will bring CHM’s pioneering electronic medical records (EMR), decreased patient turn-around time, and ability to reduce costs while maintaining profitability. The EMR will improve the patients of Oakland County’s quality of care, patient health and safety, and provide them with continuum of care service with advanced access to information throughout the entire CHM petitive StrategiesStrategic PostureStrategic posture has an important impact on long-term performance for an organization. It is a response to external demands. “Organizations are able to change their strategic posture to match the demands of their environmental context and improve their performance” (Ginter et al, 2013, p. 240). While the CHM states innovation as a part of its vision, based on its actions, it is clear that they have a prospector strategic posture. The prospector is always on the lookout for new market opportunities and utilizes experimentation and innovation. Prospector posture is further confirmed by CHM’s continued cooperation with Wayne State University, innovating development of new services, in addition to and improving existing products and services, thereby adding value. Additionally, CHM is looking to better serve current markets with current services through enhancement utilizing internal resources, competencies, and capabilities. Penetration into the adjacent Oakland County with current outpatient services will attempt to increase market share, in response to the external conditions of increased presence of competition. Strategic Position The most appropriate strategic positioning strategy for CHM would be a focus on service value leadership and service differentiation. Achievement of this strategy would provide value to the customer above the competition. Through further development and utilization of the Lean management philosophies, CHM will be able to reduce the costs associated with delivering care and provide better value as well as further developed services. Establishing a price advantage will be essential in such a hard hit economic service area. Service development will be beneficial to reducing wasted resources and strengthening the internal culture to support a competitive advantage. With waste reduced, CHM will be better positioned financially to reduce cost of services to patients. This will, in turn, will increase productivity, patient satisfaction, efficiency, flexibility, and profitability. Reduction in costs to patients and insurance companies will drive increased market share, in addition to setting CHM apart from the competition through achievement of service value leadership. Furthermore, upon achievement of service leadership, service differentiation is within reach for CHM. Entrance into adjacent Oakland County with existing (low cost) services, not currently offered by the competition, will increase market share and place CHM closer to the goal of cost and service differentiation, thereby setting them apart from their largest competitor. Penetration into a new demographic will also present the image of growth and help CHM maintain a high level of control as the market leader. This small expansion of the CHM services is evidence that their target is particular market segment as opposed to the entire market, focusing specifically on outpatient services market share. These competitive strategies will be achieved through use of existing organizational internal resources, competencies, and capabilities and strategically position CHM at the forefront of their competition.Conclusion - Chanelle & PhillipChildren's Hospital of Michigan has been proven by research to be successful in the area of pediatric services. Children’s Hospital of Michigan is in a great location within the south east region of Michigan and has started to expand in other regions within Michigan. The organization has value created in its mission statement “to meet the physical and emotional needs of youngsters with common childhood illnesses, as well as the diagnosis and treatment of rare and unusual diseases” (About Children’s, n.d., para 4). Children‘s Hospital of Michigan is unique because it is a for profit organization that constantly seeks opportunity for improvement. In spite of the external and internal environmental factors, CHM is recognized as one of the leading hospitals in Michigan that has the technology and service excellence to meet the needs of the patients and their families. As a directional strategy, CHM uses a lean management to improve processes, safety, and quality by reducing wastes. Against all competitors, Children’s Hospital of Michigan has its own unique market brand and will be in the healthcare market for years to come because of the specialties and technology that it employs the competitive advantage that others in the market have difficulty imitating. ReferencesAbout Children's Hospital - Children's Hospital of Michigan. (n.d.). Retrieved from DMC. (n.d.). Retrieved from , M. (2010). The Future of the U.S. Economy: 2050. In Joel Kotkin predicts how recent economic and demographic trends may play out over the next few decade. Retrieved from website: , S., Gamble, M., Punke, H., Rappleye, E., Rizzo, E., & Rosin, T. (2014, December 30). 10 challenges and opportunities for hospitals in 2015. Retrieved from Hospital pediatric information (n.d.). Retrieved from Hospital pediatric information (n.d.). Retrieved from 's Hospital of Michigan. (2015). Children's hospital of Michigan: Mission, vision, and values. Retrieved from ’s Hospital of Michigan pediatric information (n.d.). Retrieved from , C. (2015). Children Hospital of Michigan “Hourly rounding”. Retrieved by internship service excellence meeting Drose, K. (2015, January 1). Immigrants and health care: Sources of vulnerability. Retrieved from , W. J., Ginter, P., & Swayne, L. 2013). In Strategic management of health care organizations (7th ed.). Jossey-Boss, San Francisco, California.?Enders, T. (2013). 10 megatrends shaping healthcare’s next 10 years. Retrieved from Expert Resource. (2015). Lean manufacturing. Retrieved from Ginter, P., Duncan, W., &Swayne, L. (2013). Strategic management of health care organizations. Ann Arbor, MI: Malloy Lithography.Google. (2015). GEMBA. Retrieved from Green Industry Analysis 2015 - Cost & Trends. (n.d.). Retrieved from , M. (2015, March 11). Will Congress play politics by killing healthcare for 2 million children? Retrieved from of Children's Hospital of Michigan. (n.d.). Retrieved from . (2012, December 12). Retrieved from healthcare provider in southeast Michigan uses citrix access platform for secure on-demand access to medical information. (2005, Sep 27). Business Wire Retrieved from 2014 CHIP Fact sheet. (n.d.). Retrieved?from wired hospitals wield tools of technology. (2007, Jul 23). PR Newswire Retrieved from of the Detroit Child: 2010. (2010). Retrieved?from and Excellence | DMC Children's Hospital of Michigan. (n.d.). Retrieved?from 'Hair, D., Friedich, G. W., and Dixon, L. D. (2011). Strategic communication in business and the professions. Boston, MA: Allyn& Bacon.Opportunities and challenges ahead 2015 Tax Policy Outlook. (n.d.). Retrieved from Hospital pediatric information (n.d.). Retrieved from , J., & Cohn, D. (2008, February 11). U.S. Population Projections: 2005-2050. Retrieved from Ganey. (2015). Driving targeted performance improvement. Retrieved from SEMCOG | Southeast Michigan Council of Governments. (n.d.). Retrieved from? & Specialties - Children's Hospital of Michigan. (n.d.). Retrieved from of Fiscal Year 2015 Proposed Executive Budgets. (n.d.). Retrieved from of FY15 Proposed Executive Budgets_0.pdfSustainability. (n.d.). Retrieved from to Grow Six-Fold by 2017 - InformationWeek. (2013). Retrieved from Top 10 Legislative Issues to Watch in 2015. (n.d.). Retrieved from , S. (2015).China, Russia, Saudi Arabia Boosted Defense Most as U.S. Cut. (n.d.). Retrieved from ................
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