New Jerseys volatile and ever-changing hospital environment is putting the spotlight on the need for insightful short- and long-term strategic planning. Plans that prepare for the future and ready hospitals to react to the unexpected begin from the hospitals mission, vision, and values, says Nelson Tuazon, MAEd, MSN, MBA, CNAA, FACHE, senior vice president and CNO, East Orange General Hospital, East Orange, N.J.
When I do strategic planning with my management team every year, we begin with what our vision of the hospital is and where we think were going. We take into consideration the values that we hold in nursing, including our nursing philosophy, where we think nursing is going, and where the hospital is heading, Tuazon says.
Address the issues
There are several overriding issues in health care that affect hospitals. Tuazon says todays number one issue for many hospitals is decreasing reimbursement, which is driving some hospitals vulnerability and other hospitals ability.
In addition to the financial stress hospitals feel, patient safety is a driver in todays strategic planning. With those competing priorities, strategic planning is the key to our success, Tuazon adds.
About needs and resources
When he plans for the future, Tuazon makes priorities based on the community needs, hospital strengths and opportunities, and available hospital resources. In addition to East Orange General Hospitals core ED, Med/Surg and Critical Care Services, the hospital has developed niches in response to community outcry for dialysis and behavioral health. Those areas, he says, will be higher priorities than ones like trauma care, which are being met successfully by other community hospitals.
Looking at how the hospital can meet the communitys needs, Tuazon and other leaders must consider the workforce mix and numbers not only in nursing but in services that affect patient care, such as PT, social work, and pharmacy. For staffing purposes, Tuazon and his team consider patient acuity, performance improvement outcomes, and the staff experience mix.
He believes that nursing managers need to integrate administrative and clinical responsibilities. I think the trend in recent years is that managers are expected to multitask. Its not uncommon for one manager or director to have more than one unit, Tuazon says.
That evolved management role requires support from higher-ups, according to Tuazon, who says that his team has created a clinical coordinator position to support managers who manage two units, as well as their staffs. He has empowered management through education, and as a result, there are unit-based educators. You also support the managers by providing the structure for performance improvement; we have created a shared governance model, he says.
Today, nursing managers must be fiscally knowledgeable to plan for the future. Tuazon says nursing managers have become multimillion-dollar managers who understand the clinical and operational aspects as well as the financial aspects of their units.
Nursing morale has to be part of strategic planning, experts agree. Making commitments to involve and recognize nurses for good work are not only morale boosters but recruitment and retention tools. Recognition, Tuazon says, provides a strong foundation for workforce morale. Recognition doesnt just mean celebration but also includes, for example, shared governance, when you involve staff in the decision-making process, he says.
Short- and long-term plans
Tuazon says East Orange has a short-range, or fiscal-year plan, as well as three- and five-year and longer-range plans. Because of the nature of health care, I think its wise to do short- and long-range planning. If you plan for too short at a time, you lose the big picture. But if you only rely on a 10-year plan, for example, there are dynamics going on now that may radically change next years plan, Tuazon says.
Next, Tuazon and his team plan to implement a shared governance in nursing; launch the hospitals clinical ladder program to strengthen the hospitals recruitment and retention efforts; and enhance staff quality in the core services that the hospital offers.
Strategic planning allows every nurse leader to be on the same page, Tuazon says. The plan you have for nursing must be in concert with the mission, vision, and values of the hospital, or its not going to work.