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Schober Global Healthcare Consulting, Indianapolis, IN, USA
Keywords
PolicyPolicy theoryPolicy processStrategyStrategic planningConsideration of advanced nursing practice (ANP) and the integration of advanced practice nursing (APN) roles as part of the healthcare workforce require policy development supportive of this emerging concept. Developing strategies and policy that promote the optimal scope of practice for APNs is a dynamic and complex process that operates within a political, cultural, and historical context. The process is sensitive to the country in which nursing, professional development, and policymaking take place. In turn, the country milieu is comprised of representatives of government, healthcare institutions, employers, medicine, and consumer cultures where a variety of opinions arise and diverse policy decisions occur.
In this chapter, based on evidence and noted positive outcomes for ANP in the literature, strategic planning is introduced as an approach that could facilitate not only the introduction of APNs but also contribute to the sustainability of an ANP initiative. The complexities to consider with a strategic approach are discussed. In addition, the chapter proposes that a variety of viewpoints affect the identification of strategies that influence the integration of APN in the healthcare workforce. Definitions and descriptions of strategy, strategic planning, policy, policy theory, policy process, and the significance of a strategic approach are introduced. Critical points to consider for strategic planning and a Conceptual Policy Framework for Advanced Nursing Practice can be found in Chap. 2. Further in-depth discussion of the policy process, evidence-based policy decisions, and theories applicable to social policy are discussed in Chap. 3.
1.1 Defining Strategy and Strategic Planning
Strategic planning is, by definition, about integration, long-term thinking, and a disciplined approach to decision-making (Mintzberg et al. 2003). It can be viewed as a process of defining a strategy or direction and making decisions in pursuit of a strategy that includes diverse mechanisms and methods to guide implementation. A strategy usually involves setting goals and objectives, determining actions to achieve the goals along with describing the human and financial resources needed to achieve the intended purpose (see Chap. 7 for discussion of the use of evaluation and indicators in planning).
A strategic approach may be formal or informal, typically involving repetitive rounds of analysis including discussion and feedback loops throughout the process. Some elements may be continuous and others may be executed as discrete entities with a definitive start and ending. The objective is to reach an identified decision or outcome.
Strategic planning can also be seen as an effort to systematize strategic thinking. However, it can be argued that strategic thinking involves creative activities that involve synthesis or “connecting the dots” and key intention of the ideas and concepts. Therefore, strategic planning assists in coordinating planning and measuring progress on key objectives, occurring as a result of strategic thinking (Mintzberg and Quinn 1996).
Formulation and implementation of strategies are intertwined as complex interactive processes in which politics, values, organizational culture, and leadership styles determine or constrain particular strategic decisions and influence outcomes (Mintzberg et al. 2003). Although the reader may insist on a singular definition for strategy as a concept, it is acknowledged that the term strategy has multiple definitions. Multiple meanings are provided to assist the reader to maneuver through the field of strategy formulation. Definitions of strategy are presented in Table 1.1 followed by some of their interrelationships.
Table 1.1
Definitions of strategy
Type of strategy | Strategy definition |
|---|---|
Strategy as a plan | Some sort of consciously intended course of action, a guideline or set of guidelines to deal with a situation. By this definition, strategies are made in advance of the actions to which they apply and are developed consciously and purposively. They can be general or specific and can be labeled as an intended strategy or deliberate strategy where previous intentions are realized. This definition deals with how leaders try to establish direction |
Strategy as a pattern | Encompassing resultant behavior, strategy can be viewed as a pattern in a stream of actions (e.g., successful approaches merge into a pattern of action that becomes a strategy). This perspective can be viewed as emergent strategies where patterns are developed in the absence of or despite intentions. Focuses on action-taking behavior into account |
Strategy as position | A means of identifying an entity/organization in an environment. By this definition strategy becomes a mediating influence between organization and environment or between internal and external context. Collective strategy can then be seen as strategy to promote cooperation between organizations and decision-making entities. Such strategies can range from informal discussions to formal directives or ventures and can be identified at times as political strategies |
Strategy as perspective | Strategy is viewed as an innate way of perceiving the world and represents an ideology or culture, e.g., government, healthcare, nursing, and consumer. This can also be seen as a worldview or collective perception about how the world works. In this definition, a perspective is shared with individuals united by common thinking and/or behavior. It focuses on intention and behavior in a collective context |
The definitions of strategy as a plan or as a pattern can be viewed independently. Plans may go unrealized, while patterns may appear without preconception. Strategies, rather than being totally planned or totally unintended, sit on a continuum that exists, portraying deliberate action along with emergent aspects of strategy formulation. Strategy defined as position and/or perspective can be compatible with strategy as plan/or pattern. Realistically, the interrelationships are complicated when developing an in-depth understanding of strategy in the face of reality (Mintzberg et al. 2003).
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