HCO 7020 Module 4 Strategic Plan Final Project Example

From Scan to Scorecard: A Strategic Plan, Four Action Plans and the Measures That Will Show Whether a Rural Hospital's Refocus Works

Student Name

MBA in Healthcare Management, Thomas Edison State University

HCO-7020: Strategic Management within a Healthcare Organization

Mentor Name

Month Day, Year

From Scan to Scorecard: A Strategic Plan, Four Action Plans and the Measures That Will Show Whether a Rural Hospital's Refocus Works

Introduction

This final project completes the strategic analysis of Skylands Community Hospital, the composite rural nonprofit hospital in northwest New Jersey that the earlier modules analyzed. Earlier modules examined the hospital's strategic environment, scanned its external forces and chose a strategy. This paper summarizes those findings, develops the value-adding strategies that will carry out the chosen direction, sets out action plans with owners, budgets and dates, and defines how the board will judge success, following the strategic management model of Ginter et al. (2018).

Situational Analysis in Brief

Skylands faces four urgent issues. Federal Medicaid changes enacted in 2025 are likely to raise the share of uninsured patients over the coming years. Two larger systems are capturing outpatient and specialty volume in the county. Births have fallen to 410 a year and the maternity unit runs a loss of roughly $3.1 million a year, part of a national decline in rural obstetric services (Hung et al., 2017). And an older county population is driving up demand for chronic disease care, rehabilitation and mental health services. On the inside, Skylands can count on its round-the-clock emergency department, deep community trust and a respected orthopedic and rehabilitation service, while its size and shortage of specialists hold it back.

The Strategy

After generating alternatives with a TOWS matrix and scoring them on five weighted criteria, the board chose to remain independent while refocusing: closing inpatient obstetrics with a careful transition, expanding senior care, rehabilitation and behavioral health, and partnering with a university hospital for cardiology, telestroke and remote specialist visits. The revised vision states that Skylands will be the trusted place in Sussex County for emergency care, care for older adults and mental health, connected to specialist expertise wherever patients need it.

Value-Adding Service Delivery Strategies

Ginter et al. (2018) describe the value chain of a healthcare organization as service delivery activities, before, during and after care, supported by strategies for culture, structure and resources. Each part should add value consistent with the strategy.

Pre-service: Skylands will build a community outreach program for older adults, including fall-risk screening and medication reviews at senior centers, and a behavioral health access line that schedules assessments within 48 hours. These activities generate appropriate referrals and strengthen community ties.

Point of service: the hospital will open a 12-bed inpatient geriatric behavioral health unit in space freed by closing obstetrics, expand outpatient rehabilitation with a falls-prevention clinic, and add telehealth consultations with the affiliated academic center for cardiology and neurology in the emergency department.

After service: a transitional care program with nurse calls and home visits for high-risk patients discharged to home will reduce readmissions, and a partnership with community behavioral health providers will ensure follow-up after psychiatric discharge. For obstetric patients, a coordinator will manage prenatal care locally and arrange deliveries at regional hospitals, with transport protocols and emergency readiness for unexpected births.

Support Strategies

Culture: leaders will present the refocus as a commitment to the community's changing needs, not a retreat, and involve staff from obstetrics in redesigning services, offering retraining for roles in behavioral health, rehabilitation and transitional care. Structure: service lines for senior care and behavioral health will each have a physician and administrative co-leader accountable for results. Strategic resources: the hospital will apply for state funds under the federal rural health transformation program for behavioral health and telehealth, negotiate the affiliation agreement, and recruit two psychiatric nurse practitioners and a geriatrician.

Action Plans

Each strategy is carried out through an action plan with an objective, an owner, a budget and a deadline.

Evaluating Success: A Balanced Scorecard

Ginter et al. (2018) stress that managing strategic momentum depends on measures that tell leaders whether the strategy is working. Kaplan and Norton (1996) designed the balanced scorecard so that a strategy is tracked through four sets of measures, so that financial results are read alongside the drivers that produce them. Skylands' scorecard includes, from the financial perspective, operating margin rising from minus 1.8 percent to break-even by year three; from the patient and community perspective, behavioral health assessment within 48 hours for 90 percent of callers and prenatal visits maintained at current levels; from the internal process perspective, emergency telestroke consultation within 20 minutes and readmissions down 20 percent among targeted patients; and from the learning and growth perspective, retention of 80 percent of obstetric staff in new roles and recruitment of the planned clinicians.

The board will review the scorecard quarterly. Two triggers will prompt reconsideration of the strategy: two straight years of operating losses deeper than 2 percent of revenue, which would reopen a merger with a larger system, and evidence that pregnant women in the county are delaying care or experiencing worse outcomes after the obstetric closure, which would require changes to the transition plan.

Where the Plan Is Vulnerable

Recruitment is the first vulnerability: the geriatric behavioral health unit depends on psychiatric nurse practitioners and a geriatrician who are scarce in rural areas, so the plan includes a contingency of contracted telepsychiatry coverage while hiring continues, and the unit's opening date will move if staffing cannot be assured safely. The second is community reaction to the obstetric closure. The hospital will hold public meetings before the decision takes effect, publish the transition plan and report quarterly on prenatal visits and transport times, so that residents can see whether care has been preserved. The third is financial: if state rural funds do not arrive, the behavioral health unit will open in two phases, with six beds first, to limit capital at risk. Naming these risks in advance, with a response for each, is part of managing strategic momentum, because it tells the board what to watch and what it has already agreed to do if conditions change.

Conclusion

Skylands' strategy concentrates its limited resources where it can add the most value for an aging rural county, emergency care, senior care and behavioral health, while closing a service it cannot sustain safely and borrowing specialist depth through an affiliation. Value-adding service and support strategies, four action plans with owners and budgets, and a balanced scorecard with explicit triggers turn the strategy into commitments the board can monitor. The plan's success will depend less on the document than on managing its momentum, the lesson at the heart of strategic management.

References

Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2018). Strategic management of health care organizations (8th ed.). Wiley.

Hung, P., Henning-Smith, C. E., Casey, M. M., & Kozhimannil, K. B. (2017). Access to obstetric services in rural counties still declining, with 9 percent losing services, 2004-14. Health Affairs, 36(9), 1663-1671. https://doi.org/10.1377/hlthaff.2017.0338

Kaplan, R. S., & Norton, D. P. (1996). Using the balanced scorecard as a strategic management system. Harvard Business Review, 74(1), 75-85.