INTRODUCTION

SWOT
Situation Analysis
CPM

USG
HANLON
Priority of the problem
CARL
MCUA

Fishbone Diagram
Cause of the problem Problem Tree
Blum

FGD
Alternative Solutions NGT
Brainstorming
 SWOT Analysis

S W O T
 What is SWOT Analysis?
• SWOT analysis is an examination of an organization’s internal
strengths and weaknesses, its opportunities for growth and
improvement, and the threats the external environment
presents to its survival. Originally designed for use in other
industries, it is gaining increased use in healthcare.

• SWOT is a business or strategic planning technique used to

summarise the key components of your strategic
environments.

• Acronym for Strengths, Weaknesses, Opportunities, and

Threats.
 Cont’d….

• SWOT analysis (strengths, weaknesses, opportunities, and

threats analysis) is a framework for identifying and analyzing
the internal and external factors that can have an impact on
the viability of a project, product, place or person.

SWOT is a summary of your

Strengths Internal
Weaknesses
Opportunities
External
Threats
 Internal vs. External
• Strengths and Weaknesses are considered internal
factors---meaning you as the business owner can
control them. How you manage or market the
business controls whether it is a strength or
weakness

• Opportunities and Threats are considered external

factors---meaning you have little control over them.
It is your job as a business owner to respond
appropriately
 STRENGTHS

Current factors that have prompted outstanding

organizational performance

Characteristics of the business or a team that give it an

advantage over others in the industry.

Positive tangible and intangible attributes, internal to

an organization.

Some examples include the use of state-of-the-art

medical equipment, investments in healthcare
informatics, and a focus on community healthcare
improvement projects.

Other strengths might include highly competent

personnel, a clear understanding among employees of
the organization’s goals, and a focus on quality
improvement.
 WEAKNESSES

Organizational factors that will increase healthcare costs

or reduce healthcare quality.

Characteristics that place the firm at a disadvantage

relative to others.

Detract the organization from its ability to attain the core

goal and influence its growth.

Weaknesses are the factors which do not meet the

standards we feel they should meet. However,
sometimes weaknesses are controllable. They must be
minimized and eliminated.

Examples : aging healthcare facilities , poor

communication, poor use of healthcare informatics,
insufficient management training, a lack of financial
resources, and an organizational structure that limits
collaboration with other healthcare organizations.
 OPPORTUNITIES

Significant new business initiatives available to a

healthcare organization.
Chances to make greater profits in the environment -
External attractive factors that represent the reason for an
organization to exist & develop.

Arise when an organization can take benefit of conditions

in its environment to plan and execute strategies that
enable it to become more profitable.

Organization should be careful and recognize the

opportunities and grasp them whenever they arise.
Opportunities may arise from market, competition,
industry/government and technology.

Examples : collaboration among healthcare organizations

through the development of healthcare delivery networks,
increased funding for healthcare informatics, community
partnering to develop new healthcare programs, and the
introduction of clinical protocols to improve quality and
efficiency
 THREATS

Factors that could negatively affect organizational

performance.

External elements in the environment that could cause

trouble for the business - External factors, beyond an
organization’s control, which could place the
organization’s mission or operation at risk.

Arise when conditions in external environment

jeopardize the reliability and profitability of the
organization’s business.

Examples : political or economic instability; increasing

demand by patients and physicians for expensive
medical technology that is not cost-effective; increasing
state and federal budget deficits; a growing uninsured
population; and increasing pressure to reduce
healthcare costs.
 Identifying Strategic Options
• SWOT analysis helps you get a better understanding of the strategic
choices that you face. (Remember that "strategy" is the art of determining
how you'll "win" in business and life.) It helps you ask, and answer, the
following questions: How do you:
– Make the most of your strengths?
– Circumvent your weaknesses?
– Capitalize on your opportunities?
– Manage your threats?

• A next step of analysis, usually associated with the externally-focused

SWOT Matrix, helps you think about the options that you could pursue.
 SWOT Strategic Alternatives Matrix
STRENGTHS WEAKNESSES
1. 1.
2. 2.
3. 3.
4. 4.
OPPORTUNITIES Strength-Opportunity (SO) Weakness-Opportunity
1. Strategies (WO) Strategies
2. Use strengths to take Overcome weaknesses by
3. advantage of opportunities taking advantage of
4. 1. opportunities
2. 1.
2.
THREATS Strength-Threat (ST) Weakness-Threat (WT)
1. Strategies Strategies
2. Use strengths to avoid Minimize weaknesses and
3. threats avoid threats
4. 1. 1.
2. 2.
 Example of a SWOT analysis
Positive Negative

Internal Strengths Weaknesses

Environment Willingness of staff to Staff lack of motivation
change Space constraints
Perception of quality of Bureaucracy
services Cultural differences
with users

External Opportunities Threats

Environment Support of district Poor communities
management Bad roads
Availability of women’s Lack of budget
groups
 Compiling a SWOT Matrix
Opportunities – O
List most important external
opportunities, e. g. traditional
midwives attend to home births of
rural women who has limited
access to transport
Threats – T
List most important external
threats, e. g.
Pregnant rural women book late for
antenatal care or go unbooked due
to lack of money and transport
Strengths –S
List most important internal
strengths e. g.
skilled training department
SO Strategies
Match internal strengths with
relevant external opportunities
and record the possible strategies,
e. g. teach Infection prevention and
control practices to traditional
midwives in rural areas
ST Strategies
Match internal strengths with
relevant external threats and
report possible strategies, e. g. get
traditional midwives on board of
MNCH program to promote early
antenatal booking
Weaknesses – W
List most important internal
weaknesses, e. g Lack of health
promotion interventions in rural
communities
Lack of outreach support to rural
areas
WO strategies
Match internal weaknesses with
relevant external opportunities e.g.
health promotion in rural areas
through NGO outreach
WT Strategies
Match internal weakness with
relevant threat and report possible
strategy, e. g. DCST establishes
monthly outreach visits to rural
areas.
SWOT Analysis Strategy
 Quadrant I : The organization is in the current situation. The organization
has opportunities and strengths that can be used. Growth oriented strategy
should be applied in this condition.

Quadrant II : Although facing some threats the company still has internal
strengths. Diversification strategy (product or market) should be applied
because the organization has internal strengths that can be used on long
period opportunities.

Quadrant III : The organization is facing a great market opportunity, but on

the other hand they also face some internal weaknesses. A business
condition in Quadrant III is similar with a question mark in the BCG-Matrix.
They must focus to minimize internal company problems in order to reach
market opportunities.

Quadrant IV : The organization is in a poor condition because they face

some threats and deal with internal weaknesses.
M3 (Handover) Weight Rating Weight x Formula
Rating
IFAS
Strength
1. Head of room leads handover activities 0,2 3 0,6
every morning
2. Handover done every shift change 0,2 3 0,6 S-W =
3. Handover time is less than 5 minutes / 0,25 2 0,5 2,5 – 2 =
patient + 0,5
4. There is a special book for handover 0,25 2 0,5
reporting
5. Handover is already a routine activity 0,1 3 0,3
that has been implemented in the room
Total 1 2,5
Weakness
1. Handover times are uncertain often 0,4 2 0,8
changeable and there is still a late nurse
2. The content of the handover is still not 0,3 2 0,6
focused on nursing issues
3. Handover implementation is still not 0,3 2 0,6
optimal
Total 1 2
M3 (Handover) Weight Rating Weight x Formula
Rating
EFAS
Opportunity
1. There are nursing students who practice 0,6 4 2,4
nursing practice
2. The existence of good cooperation 0,5 3 1,5 O-T =
between nursing students who practice 3,9 – 2 =
with nurses in the room + 1,9
Total 1 3,9

Threatened
1. The existence of higher demands from 0,5 2 1
patients to obtain professional nursing
services
2. Increased awareness of the patient 0,5 2 1
about the nurse's responsibilities as a
nursing care provider
Total 1 2
 Aggressive Area

M3 (0,5; 1,9)

0,5

1,9
 POA (Planning of Action)

No. Data Problems Goals Activities Indicator Time PIC

Implementation & Evaluation

No. Problems Strategic Implementation Implementation Current Long term
Planning Constraint Solution Solution
Fishbone Diagram
 What is it?
• An analysis tool that provides a
systematic way of looking at
effects and their respective
causes

• Developed by Dr. Kaoru Ishikawa

of Japan in 1943 and is sometimes
referred to as an Ishikawa
Diagram or a Fishbone Diagram
because of its shape
 Why implement this?
• It helps determine the root causes
of a problem using a structured
approach.

• It encourages group participation

and utilizes group knowledge of the
process.

• It uses an orderly, easy-to-read

format to diagram cause-and-
effect Relationships

• It indicates possible causes of

variation in a process.
Why implement this?
• It increases knowledge of the
process by helping everyone to learn
more about the factors at work and
how they relate.

• It identifies areas where data should

be collected for further study.
 Submission of Billing to Client
Receive update of Locate included
newly issued billings clients’ file folders

File folders

Find and update clients’

billing statements

Locate included clients’ Buyers’

Buyers’ Information Sheet Information Sheet

Call each client Send Billing Statements

on update
STEP 1:
Identify and clearly define the
outcome or EFFECT to be analyzed.
• Decide on the effect to be
examined.
• An effect may be positive (an
objective) or negative (a problem),
depending upon the issue that is
being discussed.
STEP 1:
Identify and clearly define the
outcome or EFFECT to be analyzed.
>POSITIVE
– pride and ownership over productive areas
– upbeat atmosphere that encourages the participation of the
group
> NEGATIVE
– justifying why the problem occurred and placing blame
– easier for a team to focus on what causes a problem than what
causes an excellent outcome
– concentrate on things that can go wrong may foster a more
relaxed atmosphere which sometimes enhances group
participation
STEP 2:
Draw the SPINE and create
the EFFECT box.
• Draw a horizontal arrow pointing to the
right. This is the spine.
• To the right of the arrow, write a brief
description of the effect or outcome
which results from the process.
• Draw a box around the description of the
effect.
Spine

Inaccurate
Submission of
Billing to Client

Effect Box
STEP 3:
Identify the main CAUSES contributing
to the effect being studied.
• Establish main causes, or categories, under
which other possible causes will be listed.
– 3Ms and P – Methods, Materials,
Machinery, and People
– 4Ps – Policies, Procedures, People, and
Plant
– Environment
STEP 3:
Identify the main CAUSES contributing
to the effect being studied.

• Write the main categories your team has

selected to the left of the effect box.
Draw some above and below the spine.
• Draw a box around each category label
and use a diagonal line to form a
branch from the box to the spine.
Methods People

Inaccurate
Submission of
Billing to Client

Main Causes

Machinery Materials
STEP 4:
For each major branch, identify other
specific factors which may be the
CAUSES of the EFFECT.

• Identify as many factors or causes

possible and attach them as sub-
branches of the major branches.
• Fill in detail for each cause.
 Methods People

Erroneous
sorting People fail to inform
of billing client thru call/e-mail
Invalid statements
list of
updates Ignorance
Inaccurate
Submission of
Erroneous Billing to Client
Information
Unreliable in BIS
mail system No file for
Phone line record of billing
disconnected statements
in clients’
folders

Machinery Materials
STEP 5:
Identify more detailed levels of
causes and continue organizing them
under related causes or categories.

• You can do this by asking a

series of WHY questions.
STEP 5:
Identify more detailed levels of
causes and continue organizing them
under related causes or categories.
FROM GIVEN EXAMPLE:
Q: Why is there an invalid list of updates?
A: Because the data was mixed up.
Q: Why was the data mixed up?
A: There was a problem with the manual organization of the files.
Q: Why is there a problem with the manual organization
of the files?
A: Because there are no back-up files and since it was
manually prearranged, inaccuracy is inevitable.
 Methods People Inaccuracy in
sorting data
Manual file
Erroneous Wrong phone number/ organization
Mixed up sorting e-mail information Erroneous info
Inaccuracy data of billing
Poor in BIS
in statements People fail to inform
Inaccuracy training client thru
sorting
data In sorting call/e-mail
Mixed data No training
up data Ignorance
Invalid Ignorance
Manual file list of
organization updates Manual file Inaccurate
organization
Submission of
Erroneous Billing to Client
Information in BIS
Skipping paying
monthly bills Inaccuracy in
Poor sorting data
Mixed
training No Unreliable up data
money
Phone line mail system
Assorted records
disconnected of billing
Manual file system
statements
Inaccuracy in sorting Manual file in clients’ folders
and giving out mail organization Inaccuracy in
sorting data
Mixed
Manual file
Machinery Materials up data
organization
STEP 6:
Analyze the diagram.
• It helps identify causes that warrant
further investigation.
• Use a pareto chart to determine the
cause to focus on first.
• See the “balance” of your diagram,
checking for comparable levels of
detail for most of the categories.
STEP 6:
Analyze the diagram.
– A thick cluster of items in one area may
indicate a need for further study.
– A main category having only a few specific
causes may indicate a need for further
identification of causes.
– If several major branches have only a few
sub-branches, you may need to combine
them under a single category.
STEP 6:
Analyze the diagram.
•Look for causes that appear repeatedly.
These may represent root causes.
•Look for what you can measure in each
cause so you can quantify the effects of
any changes you make.
•Most importantly, identify and circle the
causes that you can take action on.
 Methods People Inaccuracy in
sorting data
Manual
Manual file
file
Erroneous Wrong phone number/ organization
organization
Mixed up sorting e-mail information Erroneous info
Inaccuracy data of billing Poor
Poor
in BIS
in statements training
training People fail to inform
sorting Inaccuracy client thru
data In sorting call/e-mail No training
Mixed data No training
up data Ignorance
Invalid Ignorance
Manual file list of
Manual file
organization
organization updates
Manual file
Manual file Inaccurate
organization
organization
Submission of
Erroneous Billing to Client
Information in BIS
Skipping paying
monthly bills Inaccuracy in
Poor
Poor sorting data
training Mixed
training No Unreliable up data
money
Phone line mail system
Assorted records
disconnected of billing
Manual
Manual filefile system
system
statements
Inaccuracy in sorting Manualfilefile
Manual in clients’ folders
and giving out mail organization
organization
Inaccuracy in
sorting data
Mixed
Machinery Materials up data Manual
Manual file file
organization
organization
 ANALYSIS
–The level of detail is well-balanced.
–The causes poor/no training and
manual file organization/system are
repeated several times.
–These causes stated above are the
ones that should be attended to and
given action on ASAP.
 RECOMMENDED SOLUTIONS:
–Poor/No Training -> Give tutorials and
seminars to new and old employees alike.
Have people check employees’
performances every once in a while.
–Manual File System -> Have a computer-
based information system to maintain the
organization. It will not only give you back-
up files but make the system work faster.
Make sure it is maintained and updated at
all times.