Because they are a blueprint for decisions, plans are preferable to making decisions in a vacuum, which usually results in worst kind of decisions. Plans provide an opportunity for the institution to be proactive rather than reactive.
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The need to improve medical care services, and the rapid technological and socioeconomic changes call for short-range planning dovetailed into long-range planning.
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1. Plans should be based on a thorough study of the end results desired
2. Planning should involve participation of the medical staff, other concerned service representatives
3. Plans should be comprehensive
4. Plans should be flexible
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5. Plans should be continually updated
6. Plans should be realistic
7. Plans should be time phased.
1. Step by Step Approach to Planning:
Planning involves the following steps.
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1. Analysis of the situation
2. Identifying priority problem
3. Formulating objectives
4. Setting goals
5. Reviewing limitations/constraints
6. Laying down operational policy and systems
7. Writing down the plan.
2. Analysis of the Situation:
Whether it is strategic planning with wide perspective at the highest organisational level or operational planning which translates the strategic plan into practice, and whether it is planning a new hospital, planning an expansion, planning for a new service, or planning to bring in new technology, the planners do have some idea of the problem they want to solve.
Nevertheless, an analysis of the situation connected with the broader problem must be carried out. The analysis aims at addressing the questions as to what is the core problem, and what opportunities does it present.
Participation of all those who are concerned with the problem can lead to a wider and better understanding of the problem as well as their commitment to the plan.
What are the specific patient care services provided by the hospital? What is the quality of each of these services? What is the volume of each service? Is the volume sufficient to achieve economy of scale? Does the present equipment meet the requirements?
Should any of the service be scrapped because of low volume or inadequate resources? Does major equipment in the hospital need replacement? Is there necessity for adding on new technology?
Are the hospital’s financial resources capable of supporting its functioning? Are there any problems with the medical, nursing, paramedical staff?
These are only some of the innumerable problem situations which give impetus to the planning process and to overcome them.
Analysis of the situation leads us to all the facets of an institution’s functions and resources. The problems which are highlighted may relate to the following.
1. Personnel
2. Physical facilities
3. Equipment
4. Finance
5. Information
6. Extramural factors.
One of the pitfalls in problem identification is to miss the woods for the trees. Causes or effects of the core problem are likely to be mistaken for the problem itself.
3. Identifying Priority Problems:
It is impossible to plan for all the problems at all times simultaneously. After the general analysis of problems, the focus should shift to the important ones.
What opportunities are essentially attractive? At what cost?
For example, a hospital may have to correct X-ray department deficiencies to check unfavourable demand trend. Or it may have to institute cost controls.
Or it may find necessary to prune the unskilled work force due to establishing a mechanical laundry.
In ranking the relative importance of each of the problem, certain factors need to be taken into consideration, listed below in the form of questions.
1. Is the problem situation in question really the one to be solved, or is it simply a part of a still larger problem which requires study?
2. Is there a good chance of achieving success, and what may be the extent and nature of the benefits to be achieved?
3. What are the attitudes of personnel towards the exiting situation or procedure? How much employee resistance or resentment may be anticipated?
4. Are there any management policies or professional requirements that might influence this planning?
4. Formulating Objectives:
Traditionally, hospitals operate on a set of implicit assumptions and beliefs, and loosely bound interrelationships. Having selected the problem, the next step is to formulate objectives.
The hospital’s mission sets the direction for all other objectives. Long range objectives usually have a span of achievement of usually five years or more, and short range objective two to three years.
Short range objectives generally have a greater degree of specificity than long range objectives.
A hospital achieves its objectives through the various service departments. Therefore, each departmental head must establish his own departmental objectives, consistent with the institutional objectives.
An understanding of the relationship between departmental objectives and individual objectives is essential to assess departmental accomplishments and shortcomings.
In any organisation, objectives form a hierarchy, as shown.
Objectives must be:
i. Relevant and realistic
ii. Feasible and achievable
iii. Observable and measurable.
In everything one does, one must ask oneself: is what I am doing or about to do getting us closer to the objective? Finding answers to this question may save us of a lot of useless activity.
There are three criteria for the attainment of objectives.
1. The first criteria for the achievement of objectives are that the person responsible for achieving the desired results understands and accepts the responsibility.
He should feel that they are attainable, given the time and resources required.
2. The second criteria have to do with the achievement of results. Objectives should clearly state the results to be achieved or outcome to be anticipated.
Therefore, in this context, it is also necessary to specify the measure by which it can be said that the objective has been achieved.
3. The third criteria are the time-frame in which objectives have to be achieved. Time constraint helps establish work priorities and enforce accountability.
Linking department objectives to institutional objectives for departmental objectives, institutional objectives provide the overriding direction.
Each departmental head establishes departmental objectives, with the process pushed down the chain in the organisation from department, to sub department, to a section, to individual objectives.
The most important aspect of this process is linking the institutional and departmental objectives.
5. Setting of Goals:
Whereas objectives specify and operationalise strategies, goals articulate a specific strategy. The management team now prepares statements of goals, both short-term and medium-term. Some of the goals may be as follows:
1. Achieving recognition of the hospital’s residency programme by a university.
2. Operationalise the computerisation programme fully, by integrating nursing management system in it.
3. Generation of 5 per cent additional revenue by the end of next financial year.
4. Completion of the new building for housing the CT scanner by end of the year.
5. Physical facility modification to phase out old X-ray machine and installation of the new one in its place.
6. Completion of a feasibility study for installation of mechanical laundry/glove processing unit in CSSD.
7. Orderly transition into new building upon its construction.
8. Increased bed occupancy to 93 per cent from present 86 per cent.
9. A 5 per cent reduction in operating costs in XYZ department.
6. Reviewing Limitation/Constraints:
No goal setting can be accomplished without anticipating and giving adequate considerations to the obstacles which may be encountered in meeting objectives and goals.
The constraints and limitations can be in the form of personnel, equipment, finance, information, time, government policy, geographical and others.
The full range of external forces affecting a particular plan need to be identified, and the potential impact of these forces needs to be assessed.
This external assessment involves detailed examination of much critical relationship between goals and objectives and the environment. However, as important as external analysis is the internal analysis.
A realistic internal assessment leads to identification of internal organisational weaknesses and shortcomings, and develop a balanced picture of the hospital’s limitations, strengths and opportunities for corrective action. Organisational assessment is an essential element of internal analysis.
7. Laying Down Operational Policy and Operational Systems:
Operational policy:
It is a statement of objective and principle functions for each department. Basically an outline of the operational system, it provides the organisation ample choice as to how each department will eventually run.
Operational policy and strategies lead to operational plans and system at each level untill the institution gets down to “nuts and bolts” of its operations.
Operational systems:
Once the operational policy and strategies are laid down, operational systems are designed to fit in the constraints set up earlier by the policy.
The main purpose of operational system is to determine the way the institution will ultimately operate. Operational system will determine the equipment to be obtained, forms to be printed, and how different staff members will be deployed, among many others.
It is a way of laying down the intended use of each department until every detail becomes clear.
Action plans reflect operational programmes and decisions. If they are not made to reflect desired departmental objectives and strategies, only vague hopes or useless statements of operating systems result.
8. Writing down the Plan:
A plan has no value if it remains only in the mind of the planner. There are many others in the organisation that will have to be associated in putting the plan into practice and understanding the rationale behind objectives, goals, limitations and resources in operational sing plans. Therefore, the plan must be written down and copies passed on to all concerned.