Visionary leaders ensure that those around them understand the direction the organization is going (Ibarra & Obodaru, 2009). These visionaries search for a new path through a vigorous dialog with various constituents, both internally and externally, because great visions will not actualize from solitary analysis (Ibarra & Obodaru, 2009). It is also important that futuristic leaders test their vision practically against current resources from the following perspectives: financial, human resources, and the overall organizational capabilities (Ibarra & Obodaru, 2009). True strategists provide an organization with more than a vision statement—they can articulate it and have the organization respond to it (Ibarra & Obodaru, 2009). Although strategic planning is often achieved at the executive level of an organization, staff and managers provide a valuable perspective. In addition, managers and staff may be engaged in a clinical strategic planning process.

Phase 1: Assessment of the External and Internal Environment

External Environmental Assessment

Assessment of the external environment is the initial phase in the strategic-planning process. The economic, demographic, technologic, social-cultural, educational, and political-legal factors are assessed in terms of their impact on opportunities and threats within the environment. Healthcare leaders can assess the effect of competitors on their environment, thus plan and monitor their own operations, and develop other creative and visionary programs as they work within the framework of their institutional mission and goals. Coyne and Horn (2009) suggested that leaders of an organization must anticipate how their competitors might respond to the strategic plan. Once that is known, the response can be incorporated into the plan. An example appears in Box 16-1.

BOX 16-1 An Example of Environmental Assessment

A community-based acute care hospital is undertaking a study to examine accessibility, availability, quality, and effectiveness of developing an Orthopedic Center of Excellence. One of the initial steps is to conduct an environmental scan. The factors considered are the following:

• Economic forces and the escalating rates of healthcare costs

• The numbers and types of health professionals, including board-certified orthopedic physicians who are specializing in innovative joint replacement, operating room (OR) orthopedic nurses and OR orthopedic surgical technicians (certified), orthopedic staff nurses (certified), case managers, social workers, physical and occupational therapists, and pain management specialists

• Cost of orthopedic implants and reimbursement

• The social, political, and regulatory forces, including strategic priorities of the government in health promotion and disease prevention

• The diagnostic services available, including magnetic resonance imaging (MRI) and nuclear diagnostic imaging

• Community Outreach and educational opportunities

Patient Trends

• Demographic and population trends (population, employment, socioeconomic indicators, education, ethnicity, and lifestyle issues, with particular emphasis on minority groups)

• Trends in health care (increased emphasis on wellness programs and enhanced technologies)

• Prospective users’ input about current and future services

Exercise 16-1

What is your opinion about the demographic situation in the city in which you live and work? What is the cultural makeup of the area? What is the gap between the real needs and services provided to patients in your organization?

Internal Environmental Assessment

The internal assessment of the environment relates to the institution of health care and includes a review of the effectiveness of the structure, size, programs, financial resources, human resources, information systems, and research and development capabilities of the organization. In addition, education and training of staff and public demands are reviewed. The management team involves all levels of staff in this process and focuses on the purpose of the organization; the mission and goals; the capabilities, skills, and relationships of various professional and related staff; and the weaknesses and strengths of staff in such areas as leadership, planning, coordination, research, and staff development.

Organizational Environmental Assessment

The organizational environment assessment relates to the hospital administration, service departments, and medical staff. The process is considered an informal evaluation of relationships that define the organizational boundaries to assess for structure and loyalties that may affect the achievement of work. Also, the organizational climate must be assessed because it can shape the strategic direction of the organization.

Phase 2: Review of Mission Statement, Philosophy, Goals, and Objectives

Mission Statement

A mission statement reflects the purpose and direction of the healthcare organization or a department within it. A statement of philosophy provides direction for the organization and/or department within it. The content usually specifies organizational beliefs regarding the rights of individuals, beliefs regarding health and nursing, expectations of practitioners, and commitment of the organization to professionalism, education, evaluation, and research. The importance of the mission statement cannot be overstated, yet it is questionable how many individuals in an organization, when questioned directly, can articulate their mission statement or the philosophy.

Covey (1990) identified that the mission statement is vital to the success of an organization and believes that everyone should participate in the development of the mission statement: “The involvement process is as important as the written product and is the key to its use” (p. 139). “An organizational mission statement, one that truly reflects the deep shared vision and values of everyone within that organization, creates a unity and tremendous commitment” (p. 143).

Exercise 16-2

Select a healthcare organization with which you have been affiliated. How effective is the organizational structure (i.e., is the organization operating effectively and efficiently)? What overall human resources are present (e.g., table of organization, various titles, and numbers of people)? What information systems are used? Critique these questions as they apply to the nursing component only.

An example of a mission statement for a newly developed joint replacement program might be to provide quality, to be integrated, and to use the patient-focused healthcare model.