STRATEGIC LEADERSHIP

Chapter 2

STRATEGIC LEADERSHIP

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Chapter 2

STRATEGIC LEADERSHIP
Leadership concepts 3
1 Definitions 3
2 Characteristics of leaders 3
3 Styles of leadership 5
4 Quality champions 6
5 Role of HC quality professional 7
6 Organizational infrastructure 8
7 - Governance 8
8 - Management 9
9 - Licensed Independent Practitioner (LIP) 10
10 Organization ethics 11
11 Organization-wide functions 13
12 Strategic planning 15
13 Traditional strategic planning process 16
14 Strategic quality planning process 20
15 The balanced scorecard 21
16 Lean-six sigma 22
17 The organization plan for patient care service 23

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LEADERSHIP CONCEPTS

 Leadership is an action, not a position. (Donald H. McGannon)

 If you want to go fast, go alone. If you want to go far, go together. (African Proverb)
 Definitions;
 Influencing people to make changes necessary to achieve results.
 Direction, guidance and example given to others to get quality work done.
 The creation of a vision and environment which inspire people to contribute to
organizational goals.
 Strategic leadership; direction that is essential to meet the stated objectives or
successfully implement a plan of action.
 Difference between leadership and management;
 Leadership and management are distinct functions.
 Kotter notes that management involves coping with complexity through planning and
budgeting; setting goals; organizing, staffing, and creating a structure to foster goal
attainment; setting up mechanisms for monitoring; and controlling results. In
contrast, leadership involves coping with change by developing a vision and aligning
the subsystems of the organization.
 Leadership is the ability to influence an individual or group toward achievement of
goals and includes determining the correct direction or path. Management involves
doing the correct things to stay on that path.
 Both strong leadership and skilled management are necessary for high reliability
performance. Some individuals are great leaders but poor managers, while others are
great managers and poor leaders. In some cases, an individual may be successful in
both roles.
 Characteristics of leaders;
1) Integrity or consistency
2) Understand the concept of equity
3) See the broad picture
4) Lead through serving
5) Open to contrary opinions
6) Communicate easily
7) Self-confidence
8) Tell why rather than how
9) Motivate others to produce
10) Keep learning and teaching

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11) Participative management
 Framework for leadership for improvement:
 The Framework for leadership for improvement of the Institute for Healthcare
Improvement (IHI, 2006) provides a roadmap for organizational leaders to achieve
organization-level results from improvement efforts. This framework consists of five
steps:
1) Set direction: mission, vision, and strategy.
2) Establish the foundation.
3) Build will.
4) Generate ideas.
5) Execute changes.
 Effectiveness of leadership;
 Leaders are effective because of their impact on others' motivation and on others'
ability to perform effectively and with satisfaction.
 The role of leadership in PI:
1) Focus on value to the customer.
2) Promote constancy of purpose:
- Shared vision with the organization and all involved
- Common interest and commitment to quality
- Power with rather than power through
3) Develop cross-functional organizational networks:
- Creative-minded
- Empowered employees
- Constant, incremental improvement
 Effective leaders combine the following leadership components;
1) Togetherness
2) Empowerment
3) Communication
4) Visibility
5) Feedback system
6) Rewards and recognition
 Our rule as leaders is not to catch people doing things wrong, but to create an
environment in which people can become heroes.

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STYLES OF LEADERSHIP

- It is not what leadership style you think you have, but what others think you have.
- The goal of any style is to achieve the optimal productivity.
( 1 ) classic styles;
1) Autocratic or bureaucratic;
 Leaders make decisions with little or no subordinate participation.
 Rules are strictly enforced.
 It is most effective in immediate crisis situations or when a very strict control is
necessary e.g., data confidentiality, budget cut.
 Productivity may increases, but morals markedly suffer.
2) Diplomatic or consultative;
 Leaders sell the decisions and invite questions.
 It is effective when employees’ acceptance is important for already made decisions
e.g., redesigning QI process as a result of a merge.
3) Democratic;
 Leaders detail problems, define limits, and ask others for a decision.
 It is effective when employees are self-directed, decisions are made for methods
and procedures, and when employees' participation is important.
4) Participative (The TQM leadership style);
 Leaders present a tentative decision, draft of an idea, or a problem to staff, receive
suggestions, and then make the decision, based on what is deemed best to the
organization.
 A powerful motivator for employees whose expertise is considered valuable to the
decision-making process.
 It is the preferred style for;
- Change
- Motivation
- QM/PI
- Innovation and creativity
 Problems;
- It is more time-consuming.
- Staff may participate only at less important levels.
5) Laissez-faire ( free rein);
 Leader is a figurehead with no decisions made or limits set.
 Both productivity and morals suffer.

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 It can work satisfactorily if the individuals in the group are very self-motivated,
good-oriented, and innovative.
( 2 ) Crisis leadership;
 Crisis; an extended period of disequilibrium.
 When written in Chinese, it is composed of 2 characters which are danger and
opportunity.
 The focus of leadership is to strengthen the cohesive bonds that can hold people
together.
 It is a behavior and an activity, rather than a position.
 It is a participative style.
 Characteristics:
1) Maintains absolute integrity.
2) Remains cool: calm behavior is an important tool.
3) Knowledgeable about the crisis events.
4) Shows commitment and expresses passion to succeed.
5) Generates ideas.
6) Sees the vision, holds the vision, and articulates the vision.
7) Plans for a crisis; creates a sound strategic plan which allows for
contingencies (plan B).

QUALITY CHAMPIONS

 Definition; any person in the organization, regardless of position on the organizational

chart, who believes in striving for excellence, supports quality and believes in the vision,
mission, and values.
 Clinical quality champions must be known within the organization and community as both
delivering and promoting best practices with their patients.
 The quality professional must be viewed as a champion to be effective and he must has
ability to get others commit.
 Quality champions:
1) Make a personal commitment to walk and talk the quality path.
2) Are well respected as delivering best practice in their professional arena.
3) Believe in the principals of quality and actively participate in quality activities.
4) Are positive communicators of the quality strategy and its outcomes.
5) Actively participate in quality activities.

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THE ROLE OF THE HC QUALITY PROFESSIONAL
( 1 ) Responsibilities:
1) Promotion and support of all systems and processes to achieve a high quality, safe and
cost-effective HC in;
- QM/PI
- UM
- Case management
- Patient safety
- Risk management
- Infection control
- Information management
2) One who has the needed knowledge, effective leadership, and skills to design, develop,
implement and evaluate these systems and processes.
3) Coordination of all QM activities implemented by all members of the organization.

( 2 ) Contributions to QM/PI;
1) Facilitating leadership commitment to culture of excellence, quality, and patient safety.
2) Facilitating the identification of the organizational specific QM/PI needs and
opportunities.
3) Differentiating between needs of patients, processes and systems.
4) Determining all possible and available information resources for quality activities.
5) Developing systems and processes to assure reliability, accuracy and confidentiality of
this information.
6) Facilitating documentation and reporting.
7) Processing for approval of the written plans and documents.

( 3 ) Gaining and giving support for HC quality activities by accessing and informing the right
people(key players);
1) Who are the key players? Leaders, quality champions and internal customers.
2) Quality professional must understand their needs and responsibilities.
3) He must be sensitive to the best time to approach them and listen to their concerns.
4) He must be available, patient, supportive, persistent, credible and knowledgeable.

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ORGANIZATIONAL INFRASTRUCTURE
( 1 ) GOVERNANCE
( 2 ) MANAGEMENT
( 3 ) LICENSED INDEPENDENT PRACTITIONERS (LIPS)

( 1 ) GOVERNANCE = GOVERNING BODY (GB)

 Definition; the legal authority that carries the ultimate responsibility for all patients care
rendered by all practitioners.
 A governing body may be responsible for one or more facilities or HC organizations.
 Names;
1) Governing Board
2) Board of Governance
3) Board of Trustees
4) Board of Directors
 Functions;
1) Delivery of an appropriate quality HC in a cost-effective manner at a minimal risk.
2) Responsible for organizing itself effectively, for selecting a qualified chief executive
officer (CEO), and for ensuring that the medical staff is appropriately organized.
3) Accommodation of needs and expectations of all stakeholders.
4) Appropriate response to changes in HC e.g., increased competition, financial
constraints and corporate liability.
5) Provides for conflict resolution.
6) Responsible for and has the authority to develop a strategic plan.
7) Provides for compliance with applicable laws and regulations.
8) Provides for necessary resources; approves the budget.
9) Adopt the corporate bylaws.
10) Review of performance of GB.
 QM/PI roles;
1) Commitment to HC quality and patient safety.
2) Provision of sufficient support and resources; budget, staffing, approval of the plans,
and involvement.
3) Ensuring access to educational and research programs that support the
organization's mission.
4) Final approval of credentialing criteria of LIPs and final decisions on individual
credentials, privileges, staff appointments, and reappointments.
5) Receipt and review of periodic summary reports related to care, safety, PI, patient

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satisfaction.
6) Review and documentation of their own roles and performance in quality strategy.
7) Oversight of the processes supporting public reporting.

 Corporate bylaws;
 It defines the formal GB, administrative structure, and lines of authority, responsibility,
accountability, and communications.
 It specifies;
1) The role and purpose of the organization.
2) The process and criteria for selecting the GB members.
3) The duties and responsibilities of the GB.
4) The responsibilities and relationships between GB, chief executive officer (CEO),
staff, and LIPs.
5) Officers and committees, including selection process, responsibilities, and
meeting procedures.
6) The authority and responsibility of each level of the organization.
7) Definition of conflict of interest.
8) Mechanisms to review and revise these bylaws.

( 2 ) MANAGEMENT
 General management functions;
1) A chief executive officer (CEO)=administrator=president=executive director:
 Appointed or approved by the GB.
 Is responsible for the daily operation and management of the organization
including recruitment and retention of staff, physical and financial assets, and
information and support system.
2) A management and administrative staff;
 Develop organizational goals and objectives.
 Implement appropriate functions and lines of responsibility and accountability.
 Establish necessary departments and services.
3) Provisions for all necessary Ps & Ps, financial practice, and communication
mechanisms.
4) The successful management team must achieve goals and objectives with the best
possible allocation of human and material resources.

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 Management with a future; these emerging themes for management survival are
consistent with system thinking, concepts of customer and reengineering, and the value of
people to the organization:
1) Envision the future by building scenarios of what might be and plausible responses
for strategic planning.
2) Responses to reengineering/restructuring.
3) Managing for growth: seeking out emerging markets and planning organizational
services and processes to accommodate growth.
4) Innovation.
5) Quality: making it a business strategy.
 Management roles in QM;
1) Commit to lead in the QI/PI mission.
2) Continuous education of the GB, practitioners, management, and all staff continually.
3) Empower staff to effect positive change.
4) Provides training and support for all quality activities.
5) Confirm compliance with QM/PI strategy and plan.
6) Participate in monitoring the effectiveness of QM/PI activities.
7) Develop effective communication systems for QM/PI activities.
8) Ensure annual evaluation of all QM/PI processes.

( 3 ) LICENSED INDEPENDENT PRACTITIONERS (LIPS)

 Definition;
 Any individual who is professionally licensed by the state (U.S) and permitted by the
organization to provide patient care services without direct supervision and within
the scope of his license.
 LIPs include;
 Physicians, dentists, podiatrists, as well as other practitioners as determined by the
state.
 leadership role;
 LIPs leaders and administrative medical directors provide governance and
management leadership within the organization as well as Clinical leadership related
to the quality of care provided.
 Role in hospitals;
 Officers of the medical staff, key-departments, and committees chair who represent
the medical staff on quality council, GB, and committees.
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 Duties of the chief of staff (CMO);
1) Presiding officer at all medical staff meetings.
2) Chair of the medical executive committee.
3) Member of the GB.
4) Represents the medical staff concerning policies, needs, views, and grievances to
administration and the GB.
5) Participates as a key organizational leader in decision making.
6) Appoints medical staff committee members and chairpersons not elected by their
peers.
7) Enforces medical staff bylaws, rules, and regulations.
 Duties of department leader;
1) Continuing surveillance of the professional performance.
2) Recommending relevant criteria for clinical privileges.
3) Integrating the department into the organization’s functions.
4) Developing and implements Ps & Ps.
5) Recommending sufficient number of qualified, competent persons and other
resources needed to provide patient care.
6) Assuring orientation and continuing education.
7) Continuous assessment and improvement of the quality of care, treatment, and
services.

ORGANIZATIONAL ETHICS
 Definitions;
 The personal value system that affects every decision depending on goodness or
badness of every person’s character and behavior.
 The system or code of moral standards or values.
 The system or code of morals of a particular person, religion, group, profession, etc.
 It refers to;
1) Management of relationships with patients and the public under a set of principles
and right conduct.
2) Recognition of the patients’ right to receive care, respecting cultural, spiritual, and
psychological values.
3) Conduct of business with patients and the public with respect and honesty.
4) Recognition and acceptance of responsibilities under law.
5) Accountability to the public.
6) Appropriate disclosure of information.

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 All HC organizations are expected to have a written code of ethics or a policy statement
regarding the organizational ethics.
 Deming’s quality values applied to ethics;
 In Deming’s 14 points, 5 are process-oriented and 9 affect human conduct.
 The nine points can be considered in three concepts; skill, empowerment, and absence
of fearing.
1) Adopt a philosophy of high quality and training.
2) Institute training.
3) Institute leadership.
4) Drive out fear.
5) Break down barriers between staff areas.
6) Eliminate numerical quotas and goals.
7) Remove barriers to pride of work.
8) Institute vigorous education and self-improvement.
9) Involve everyone in the transformation.
 E-HC ethics;
1) Honesty: no deception in content or claims.
2) Quality: accurate, up-to-date, and easy-to-understand.
3) Privacy: user protection against unauthorized access/use.
4) Informed consent: respect for users’ personal data collection, use, and sharing.
5) Professionalism: fundamental ethical obligations and full disclosure.
6) Candor: full disclosure of ownership, purpose, and relationships.
7) Accountability: opportunity for user feedback to site.
 The HC quality professional’s role; He is a leader and a facilitator in helping to ensure that;
1) The organization has in place:
- An approved core set of values and guiding principles.
- A code of ethical behavior and/or ethics policy.
- Inclusion of ethics in all staff orientation and annual educational sessions.
- A formal mechanism to support ethical decision making in specific patient
care situations and reporting concerns.
- A formal, confidential mechanism for reporting concerns, including ethical.
2) The organization adheres to its own ethics policy in decision making concerning
quality, cost, and risk issues.
3) Those involved in QI/PI activities adhere to the organizational ethics policy.

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 Ethical checklist; the HC quality professional and all leaders can ask three questions when
making a managerial decision.
1) Is it legal? Based on policies, regulations, and laws.
2) Is it fair and balanced? All individuals are treated fairly.
3) How will I feel when it’s done? Good, proud.

ORGANIZATIONWIDE FUNCTIONS

 Definition;
- Goal directed interrelated series of processes. (JC)
- A term used to identify a key area of responsibility and activity of HC organizations
as leadership and PI.
 Thinking in terms of functions rather than departments facilitates integration of the HC
services.
 Functions are useful to;
1) Describe the organizational scope of services.
2) Describe the patient flow through the organization.
3) Prioritize quality and safety activities.
4) Focus activities on patient-centered issues.
5) Breakdown barriers between departments.
6) Organize cross-functional teams.
 Types;
1) Clinical (Patient Care); e.g.,:
- Clinical assessment, testing, diagnosis
- Surgical/invasive procedures
- Medication usage
- Blood/blood component usage
- Anesthesia care
- Emergency care
- Critical care
- Care of specific patient conditions or complex chronic conditions, e.g., patients
with hypertension.
2) Support; e.g.,:
- Preadmission/admission process
- Case management
- Demand management

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- Patient/family education
- Transportation
- Infection control
3) Management; e.g.,:
- Quality planning, control, and improvement
- Patient safety
- RM
- UM
- Budgeting
- HR management
- IM
4) Governance; e.g.,:
- Strategic planning
- QM oversight
- Bylaws
- Budget approval
 Organization functions are identified and prioritized by review and analysis of the;
1) Patient flow through the organization e.g., use of tracer methodology.
2) Knowledge of services provided.
3) JC standards chapters.
4) Findings of performance measures (process and outcome)
5) DRG, LOS, and cost data.
6) Claims data.

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STRATEGIC PLANNING

 Definition; an organization-wide/system-wide, ongoing look into the future. It is a process

based on objective internal and external assessments that focuses on current reality and
the foreseeable future, and is driven by vision, needs, priorities, resources, and
capabilities.
 Strategy; the plans and activities developed by an organization in pursuit of its goals and
objectives, particularly in regard to positioning itself to meet external demands relative to
its competition.
 The goals of strategic management
1) Provide a framework for thinking about the “business”
2) Create a fit between the organization and its external environment
3) Provide a process for coping with change and organizational renewal
4) Foster anticipation, innovation, and excellence
5) Facilitate consistent decision making
6) Create organizational focus

 Former master planning differs from strategic planning;

FORMER MASTER PLANNING STRATEGIC PLANNING

 Producing services first, then
marketing customers.
 Mission statement is the start of
planning.
 Planning is a technical exercise.
 Plans developed for specific products
and departments.
 Planning is a separate entity.
 Developing and marketing services based on
customer needs, expectations, and purchasing
power.
 External and internal assessments then issue
analysis.
 A social and political one influenced by social
needs, culture, customers, and publics.
 Organization is viewed as a system.
 Planning is an integral part of management.

 Time frames; strategic planning may incorporate both short-term and long-term goals. A
year-long Operational Plan may be generated annually to support strategic plan
implementation.
 Short-term focus of 2-3 years or up to 4 years with an annual review and update of an
accompanying year-long Operational Plan..

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 Longer-range planning for 5-10 years may be included as well.
 Both types are needed now, 10 years vision and strategic direction then formulating 2-3
years objectives, and setting annual Operational Plans to accomplish strategic initiatives.

TRADITIONAL STRATEGIC PLANNING PROCESS

( 1 ) External analysis;
 Includes; environmental, community, and cultural assessment.
 Purposes;
1) Set the tone for organizational culture and commitment to excellence.
2) Define the community for services goals.
3) Define and assess actual and potential markets and customers.
4) Provide a basis for benchmarking.
5) Identify opportunities and constraints.
 Data to be collected and assessed (identification/review/analysis);
1) Regulatory environment.
2) Competition.
3) Customer; needs, expectations, and groups.
4) Demographic forecasting: characteristics of customer groups to be served.
( 2 ) Internal analysis;
 Purpose; to develop a picture of the organization’s current assets, scope of services,
patients served, quality and safety issues, and resources.
 Data to be assessed (identification/review/analysis);
1) Types and utilization of services.
2) Important organization functions.
3) Patient mix.
4) QM/PI findings.
5) Practitioner characteristics and performance.
6) Financial performance.
7) Organizational assessment (evaluation of the current effectiveness of
infrastructure and culture).
( 3 ) Issue analysis;
 It often takes the form of a “S.W.O.T” analysis using the external and internal data
collected and analyzed in step 1 and 2.
(a) Strengths;
1) What do we do well?
2) Competitive advantages.

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3) High value points.
4) High quality services.
(b) Weaknesses;
1) Where do we not compete well?
2) Gaps in competition and resources.
3) Personal resistance to change.
4) Employees’ skills needs.
(c) Opportunities;
1) Where are new customers?
2) New markets.
3) New systems, processes, services, and technologies.
(d) Threats;
1) Competitors.
2) Shifting demographics.
3) Economic and financial factors.
( 4 ) Development and review of Mission, Vision, and Values;
- Mission, vision, and value statements should reflect commitment to services and quality
culture, and be operationalized in Ps & Ps. The mission, vision, and values must be
communicated routinely and continuously by leaders to every individual in the organization.
(a) Mission Statement (who/what the organization is):
 It declares the overall and broad purpose and role of the organization related to
desired services, permitted services, resources, and commitment to meeting
community needs.
 It should address commitment to quality, patient care, professional growth of
employees, and serving community.
 E.g.,:
- To enhance the quality of life for the served and the server in a safe and
compassionate environment. “a hospital”
- Google’s mission is to organize the world’s information and make it universally
accessible and useful. “Google”
- To be one of the world’s leading producers and providers of entertainment and
information, using its portfolio of brands to differentiate its content, services and
consumer products. “Walt Disney corporation”
- To continuously improve health care for the public, in collaboration with other
stakeholders, by evaluating health care organizations and inspiring them to excel
in providing safe and effective care of the highest quality and value. "TJC"

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(b) Vision Statement (what the organization strives to be):
 It declares the organization intent and aspiration for the future.
 The vision statement is the commitment that the organization is making to its
stakeholders.
 The vision statement outlines future goals, rather than focusing on what has
already been achieved.
 E.g.,:
- To be the number one athletic company in the world. “Nike”
- To make people happy. “Walt Disney Corporation”
- To be a creative leader in the development and delivery of services that will
improve the physical, mental, and spiritual health of our community. “a hospital”
(c) Core Values (how the organization will achieve);
 Core values, value statements, or guiding principles are a listing of values that
support the mission and vision statements and guide strategic planning, decision
making, and provision of all services.
 Core values can relate to;
- Respect for persons
- Quality of care
- Professional competence
- Patient-centered care
- Accessibility of care
- Continuity of care
- Employee’s satisfaction
- Safety
- Management of information and technology
( 5 ) Goals, Critical Success Factors, and Objectives;
 Purpose: to reflect and operationalize the mission and vision.
 Critical success factors: those things the organization must do to achieve the goals and
vision, e.g., defining roles; improving quality, technical expertise, or customer satisfaction;
securing recognition of value; growing market share; training, and retaining staff. Once
identified, they are incorporated into the strategic plan as strategies, objectives, or
strategic initiatives.
 Goals are general statements specifying a purpose or defined outcome while objectives
are more specific and action oriented.
 Goals and objectives must undergo ongoing periodic evaluation and revision to ensure
their relevance and fulfillment.
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(a) Goals;
 Articulate specific strategic end points to accomplish the mission and vision.
 They should be focused on improving performance not short-term financial gain.
 It must be prioritized based on important functions and processes that most critical to
achieve effective patient outcome.
(b) Objectives;
 Must :
1) Be measurable and explicit.
2) Specify a time of completion.
3) Identify the person(s) responsible for completion.
4) Linked to a specific goal, and offering more detail about how to reach this goal.
 In some strategic plan formats, objectives are called “strategies.”
 Strategic quality initiatives;
 Definition; a statement of intent and a strategy to improve care and services in a
specific way. It is a high-level, leadership-driven, organizationwide decision.
 Description;
- Each initiative is linked to one or more strategic goals.
- Are executive-level priorities based on strategic goals and performance data.
- Are developed and/or reviewed at least annually or as necessary.
- Include team development for specific measurable outcome objectives and
associated performance measures for each initiative.
 Criteria for selection;
1) Has organization-wide impact.
2) Links to one or more strategic goals.
3) Focused on the improvement of systems and processes.
4) The primary way to prioritize for organization-wide PI.
5) The primary way to prioritize for performance improvement.
6) Is approved by GB, QI/PI council, administration, and staff.
 Sample initiative topics by organization-wide function category;
1) Clinical; antibiotic utilization, immunization access, treatment of patients with
asthma.
2) Support; outpatient registration or clinical appointments wait time.
3) Management; QI training and education, timely performance evaluation, and
information management training and education.
4) Governance; board self-evaluation and financial performance measures.

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 Strategic planning process;
(1) Strategic plan
1) Mission: why we exist?
2) Vision: what we want to be?
3) Goals: what we must do to be successful?
(2) Action plans
1) Objectives: specific outcomes in measurable elements.
2) Initiatives: planned actions to achieve objectives.
(3) Evaluation
1) Measures: indicators and monitors of success.
2) Targets: desired levels of performance and timelines.

STRATEGIC QUALITY PLANNING PROCESS

1) Quality definition; in the process of developing the mission and vision statements, quality
must be defined for the organization.
 Sample organizational definitions of quality:
- Quality is providing services that are based on the best available knowledge
and practice in a manner that is safe and results in highly satisfied
participants.
- Quality is meeting or exceeding expectations at a cost that represents value
to the customer.
2) Quality planning; it is performed at the process level by teams and as a component of
strategic planning, where it involves;
 Developing a definition of quality.
 Developing a clear vision, mission, and values.
 Identifying customers and their needs and expectations.
 Identifying important organization-wide functions.
 Developing quality goals and objectives.
 Planning for the design and redesign of services depending on customer needs
and prioritized functions and linked to strategic goals.
 Developing and modifying measures for organizational performance.

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2) Documenting the strategic quality planning process:
 Attach the current list of objectives, including all quality objectives, to both
the organizationwide plan for patient care services and the quality
management plan.
 Prepare an action plan to meet the objectives.
 Address the strategic quality initiatives as organizationwide priorities for
performance improvement.
3) Ongoing evaluation of progress:
 Toward meeting strategic quality initiatives and other organizational
objectives.
 Teams must know that leaders are involved in assessing their effectiveness
usually through reports generated at least quarterly.

Integrating TQM with strategic planning

 The most common methods that can be used to integrate TQM and strategic planning
are;
1) Hoshin planning
2) Juran triology
3) Visionary planning
 Hoshin planning (policy deployment); an approach for integration of TQM with strategic
planning and to ensure that all plans and strategies are being carried out.
- It ensures that the organization vision is translated into objectives and actions.
- It is performed at three levels of management; general (senior), intermediate
(middle), and detailed (implementation).

THE BALANCED SCORECARD

 It is a strategic measurement system.
 It is a translation of mission, vision, and strategy into a set of top-level-approved
performance measures (indicators).
 It reflects the priorities of both the organization and its customers.
 It answers the questions, how are we doing? Are we there yet?
 The key is to select measures that truly predictive of the leaders’ ability to achieve the
organization’s vision and goals.

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 STRATEGIC LEADERSHIP
 Perspectives;
1) Customer perspective; patients, employees, and others.
2) Financial perspective; profit, revenue growth, productivity.
3) Operations/internal perspectives; those processes directly impacting
performance for customers.
4) Clinical outcomes.
5) Innovation and growth;
 Human capital (employee skills, training, retention, etc.)
 Informational capital(access)
 Organizational capital(culture, teamwork, accountability)
6) Community perspective.
7) Research and teaching.

LEAN-SIX SIGMA

 Lean-Six Sigma is considered as the major organizationwide strategic weapon.

 The lean quality improvement concept focuses on eliminating waste in processes.
 It is more effective when linked with the six sigma DMAIC approach of Define, Measure,
Analyze, Improve, and Control.
 Characteristics of lean-six sigma;
1) Strategy deployment; three-year and one-year “stretch” goals for quality,
patient safety, satisfaction, and productivity.
2) A belief system; setting a new order of performance.
3) Statistical calculation; as quality increases, costs decrease:
 Process costs (67%): as processes become lean, costs decrease.
 Cost of quality (13%): costs incurred to ensure that quality is maintained
at an acceptable level e.g., inspection.
 Cost of poor quality (20%): to correct processes e.g., rework, malpractice,
risk management, etc.
4) A suite of improvement methods;
 DMAIC; the six sigma method.
 PDCA; problem-solving approach of Plan-Do-Check-Act.

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 STRATEGIC LEADERSHIP
Cost area Cost of conformance Cost of non-conformance

Sub-category Prevention costs Appraisal costs Internal failure External failure

Costs Costs
Description Arise from efforts Arise from Arise from defects Arise from defects
to keep defects detecting defects caught internally that actually
from occurring. via tests, audit, and dealt with by reach the final
inspection. discarding or customer.
repairing the
affected items.
Examples Quality planning Testing Scrap Warranty costs

Quality training Audit Rework costs Product recall

Market research Inspection Management of Product liability

rework systems Claims

THE ORGANIZATION PLAN FOR PATIENT CARE SERVICES

 The requirement;
 HC organizations are required to have a written plan for the provision of patient care
services.
 The plan describes the full scope of services and practitioners.
 The plan must:
- Be based on identified patient needs.
- Be consistent with the mission.
- Include the goals for services provided.
- Provide for patient assessment and planning.
 Organization plan content;
 It includes policies, mechanisms, charts, and other documentation tools related to the
provision of patient care.
 All policies concerning the patient should be organization-wide.
 Content;
1) Introduction and planning;
- Leadership commitment
- Mission, vision, and values
- Quality definition

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- Ethics policy
- Patient safety commitment
- Community culture assessment
2) Organizational structure and information flow(organization charts);
- Administration
- Medical staff
- Nursing
- Other clinical services
- QM/PI information flowcharts
3) Patient assessment, reassessment, treatment policies;
- Levels of care
- patient/family education
- Mechanisms for timely entry, access, and continuity of care.
4) Assessment of patient needs and satisfaction;
- Policies, plans, and tools.
5) Scope of services and staffing;
- Types of clinical and support services
- Types of patients served and levels of care provided
- Types of HC practitioners providing patient care
- Types of staff providing support services to patients
6) Patient care budgeting.

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