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Assignment: Analyze Systems Thinking Approach
Often, individuals take situations at face value and don’t recognize that they are not what they appear. As a healthcare leader, it is important that you remember this anytime you’re dealing with other people. This is the premise of the following assignment.
CASE STUDY Assignment
Clark Memorial Hospital (CMH) is a 254-bed community hospital located in a small, affluent suburb just outside of San Francisco, California. Historically, the hospital has been well-received by the local community, which demographically has a higher concentration of older adults than most other areas in the vicinity. The greater San Francisco Bay Area is densely populated with nearly 890,000 residents (World Population Review, 2018, June 3), and has over 60 hospitals operating in the larger geographic area (HealthGrades, n.d.). CMH has a history of being financially sound and has managed to remain independent, even while most of competitors joined larger health systems.
Within the last year, Clark Memorial Hospital undertook a strategic planning process outlining the next 5 years. At the time, the hospital was doing moderately well financially, but as of late, low patient census and a changing market have forced this organization to access its cash reserves more than the Board of Trustees liked. Furthermore, increased staffing, technology upgrades in several key clinical areas, and resources to improve patient safety and quality (TeamSTEPPS training for all clinical personnel, floor mats to reduce injuries due to falls, pressure-relieving mattresses to prevent decubitus ulcers, etc.) ended up being very costly to the organization. It was decided that CMH needed an ideal strategy to get the hospital back on track operationally and financially in an already competitive market before things get out of control.
As the strategic planner for CMH, Benjamin Santiago reported directly to the CEO, Jason T. Snow. However, Santiago’s immediate boss, was COO Penny Hearst, who had made it very clear to everyone in the room that she had a lot on her plate. CMH did not have a chief nursing officer, and as COO, Hearst was responsible for all of the nursing departments, as well as surgical services, facilities, and information technology (IT). A nurse by background, Hearst spent the majority of her time trying to find different ways to recruit much-needed nursing staff.
During the development of the strategic plan, Santiago called together the usual group of senior executives, Board members, and key physician leaders. He diligently developed the SWOT (strengths, weaknesses, opportunities, and threats) analysis using their input and applying their assumptions. During his market research, Santiago became aware of some patient-centric trends emerging across the country, but he was also aware that CMH had always strategically catered more to physicians due to the notion that physicians were the ones who ultimately referred patients to the hospital. Through the strategic development process, it became clear that executive leadership was stuck in this physician-centric mindset. Santiago, who was ambitious and eager to make a name for himself, found and presented valid information that concurred with the mindset of executive leadership. At the end of the planning process, Snow felt confident that their physician-focused strategy would give CMH a market lead – the plan was to attract more surgeons – and increase operative room (OR) volumes. Hearst was now under intense pressure from Snow to make sure the ORs were as efficient as possible to handle the planned increase in volume, as OR efficiency would be a key recruitment issue for surgeons. The CMH physician recruiter was under pressure as well. The remainder of the executive staff breathed a sigh of relief that their areas were not part of the strategic initiative. Santiago suspected that CMH needed more of a strategy than just attracting new surgeons, but he convinced himself that executive leadership knew best.
After the Board approved the strategic plan, Hearst immediately met with her OR Director and charged her with increasing the efficiency of the ORs. She then turned her focus back to her first love: nursing. The physician recruiter hit the ground running, developing an elaborate plan to increase surgeon recruitment. From all appearances, CMH was on a roll.
Over the next several months, the OR Director was able to reduce the OR’s operating budget by 13%, a result that made Snow very happy. At the same time, Hearst made great strides in increasing CMH’s exposure to and status in the nursing community and was able to decrease the nursing vacancies by over 6%. During the period of nursing shortages, the Board was impressed with Hearst’s results. The physician recruiter was having only moderate success at recruiting surgeons, however, and his targeted volume projections were noticeably under budget. Snow approved the physician recruiter’s request to increase his staff, adding approximately $250,000 to his budget line.
Overall, patient volumes were steadily decreasing at what was becoming an alarming rate, and thus the financial picture for CMH was in critical condition. To this, Snow couldn’t help but wonder aloud, “Why isn’t the CMH strategic plan working” (Buchbinder & Shanks, 2017)?
According to the Waters Foundation (2018), the “Habits of a Systems Thinker” exemplify 14 ways of thinking about how systems work and how certain actions can affect results seen over time. Although the traditional definition of a “habit” is the usual way of doing things, systems thinkers are not limited by routine ways of thinking. Instead, the following “habits” encourage adaptive thinking which, in turn, leads to the system thinker to appreciate new, emerging insights and multiple perspectives:
1. Seeks to understand the big picture
2. Observes how elements within systems change over time, generating patterns and trends
3. Recognizes that a system’s structure generates its behavior
4. Identifies the circular nature of complex cause and effect relationships
5. Makes meaningful connections within and between systems
6. Changes perspectives to increase understanding
7. Surfaces and tests assumptions
8. Considers an issue fully and resists the urge to come to a quick conclusion
9. Considers how mental models affect current reality and the future
10. Uses understanding of system structure to identify possible leverage actions
11. Considers short-term, long-term and unintended consequences of actions
12. Pays attention to accumulations and their rates of change
13. Recognizes the impact of time delays when exploring cause and effect relationships
14. Checks results and changes actions if needed: “successive approximation”
Focusing on the way that a CMH’s constituent parts interrelate and how systems work over time and within the context of the organization as a whole, put yourself in Snow’s shoes and, as a systems thinker, respond to each of the 14 Habits as they apply to this scenario. What is your perspective?
Length: 6–8 pages (excluding title page, references page, and any appendices)
References: Include a minimum of 5 peer-reviewed, scholarly resources.