Lukacs, RN, asserts (Lukacs, 1984, p. 11). So, with those issues clearly on the table (as they are today in many hospitals), strategic planning in hospitals offers nursing directors a direct path to increased effectiveness, Lukacs explains. The way for nurses to get in on the strategic planning movement and increase their clout and effectiveness within the hospital structure, Lukacs explains, is to do the research necessary that matches patient / client needs and preferences "with specific provider strengths and competencies" (p. 12). Doing that research and making certain that those data and narrative get into the strategic plan is paramount to upgrading their departments, Lukacs goes on. "Knowledge of user needs must be accompanied by free and direct communication with the public," Lukacs reminds. She goes on, insisting that nurse executives "…carefully review and contribute to information upon which institutional plans are based…in order to identify implications for nursing practice and develop needed channels of communication with the public" (p. 13). That is cogent advice for today's nurse executives albeit the advice was offered twenty-six years ago. Ronald L. Zallocco has participated in another scholarly article, this one published in 1991 in which he researches how many hospitals had engaged in strategic market planning up to that point in time. In a survey that 127 hospitals responded to -- the researchers had sent questionnaires to 500 hospitals -- data indicates that 63% of respondents reflected that they were "satisfied or very satisfied" with their strategic market planning processes, Zallocco writes (p. 8). The hospitals that were not satisfied with their strategic planning processes tended to be smaller "…and have just begun to understand what marketing planning can contribute" (Zallocco, 1991, p. 8).

What Zallocco emphasized those years ago is today just as pertinent to the economic health of hospitals: a) consultants can indeed play a useful part as "change agents" when it comes to marketing planning and defining the process, however the administrators should not relinquish the strategic planning process to outsiders; and b) completion to a thoughtful strategic planning process should be followed up with a performance evaluation and "reward system."

Hospital libraries should not be left out of the mix when it comes to strategic planning processes, according to Judith a. Siess (Siess, 2005, p. 37). Indeed, in order to participate in the planning, the library personnel need to: a) analyze the present situation; b) examine the library's mission statement and unspoken vision to determine the "preferred [future] scenario" prior to developing objectives and goals; c) write an "action plan" in concert with other hospital departments (as alluded to earlier in this paper); and d) implement the plan, carefully evaluating it to be certain it meets the objectives and goals (Siess, 2005, p. 37).

One of the reasons Siess published this piece is that "…many librarians are afraid of strategic planning" likely because they don't understand it, she says (p. 37). People often do get "caught up in the moment, fighting fires and keeping their heads above water" and hence they put the future aside and forget about it. However, Siess goes on, hospital library leadership must assure staff that by preparing a strategic plan, there will be "…intangible benefits" in addition to the practical functionality of simply laying out what the library needs to be relevant to staff and clients (p. 39).

One intangible benefit, Siess explains on page 39, is that after preparing the strategic plan staff will gain a "greater understanding of each job in the library, its importance, and the ways each related to the library's mission." Also, library personnel will have a greater appreciation for and understanding of the library's clientele and the information needs those patients have. Moreover, Siess continues (p. 39), the librarian provides "evidence of an ongoing assessment of the knowledge-based information needs" of the hospital; after all, libraries are expected to be fully up-to-date with technological advances and equipped to find solutions to information management problems. Siess (pp. 41-44) offers "Four Cornerstones of Planning": a) predict the future; b) decide what you want your future to look like; c) decide how you will get there; and d) implement the plan. These are appropriate not just for libraries, but also for any component of any hospital wishing to embrace the future with strategic planning today.

Francois Champagne and colleagues writing in the journal Long-Range Planning take the position that a hospital should not follow traditional business models when developing strategic plans for their future. Because hospitals are "professional...

77). The suggestion is that yes, management and board members must be involved, but the biggest strategy-making thrust must come from doctors. Moreover, the strategic planning of health services "…rests on the consideration of the health needs of the population," Champagne asserts, not just on what the hospital believes its needs are in order to meet its mission statement.
Champagne (78-81) offers a strategic planning model that worked successfully in three Canadian hospitals (Ottawa General; Valleyfield Hospital; and Institut de Cardiologie de Montreal). He calls it the ARA Planning Model, and it would appear to be applicable to any hospital in the U.S., UK, or elsewhere. It is based on "active-reactive-adaptive" (ARA) dynamics and has two main components (the need for "epidemiological focus" and "the necessity of using a participative process") that are broken down into four parts, Champagne explains.

Those four parts: a) Internal analysis; b) analysis of the clientele; c) analysis of the population; and d) a macro-environmental analysis (Champagne, 1987). In the case of the Institut de Cardiologie de Montreal, this hospital went through the ARA model and through the epidemiological process they determined the hospital didn't need more beds but rather it needed enhanced research and promotional activities instead.

Methodology

There are many ways to launch a strategic planning process at a hospital. But when it comes to strategic planning the literature does not thoroughly report the specifics of hospital operations strategy -- the methodology of how it comes together -- according to Timothy W. Butler and associates (Butler, et al., 1996, p. 137). In fact operations strategy is an area that is "largely neglected in the literature," Butler explains. Hence, the article is presented as a way to fill in some of the blanks that other scholarly articles do not offer.

Butler uses Grace Hospital in Detroit as an example of how operations evolved based on strategic planning that embraced all components and departments of the hospital. The author complains that research approaches in healthcare operations are "…mostly disjointed and autonomous" in the sense of where and how operations issues are developed and analyzed (p. 138). Butler says the strategic planning by hospitals is often conducted without considering "how they relate to a hospital's strategy, mission or other operational programs" (p. 138).

Ken Fisher is the CFO for Grace Hospital, and he is obviously a good listener as an executive. During the strategic planning process he agreed to the staff recommendation -- to promote the development and utilization of "performance measures for feedback in the strategic planning process," Butler explains (p. 138). The Senior VP, Jeff Dawkins, agreed with the need to "coordinate the functional strategies" during the strategic planning phase. Because the two executives had their ears and minds open, it led to the formation of the "Medical, Administrative, Leadership Group," whose mission included: the coordination of finance, operations and human resource planning into one cohesive strategy concept.

Marketing for Grace Hospital is handled at the corporate level but the leadership group alluded to in the above paragraph is making waves to bring marketing into the operations functions as well. This is a textbook example of solid methodology, e.g., how to design an integrative approach to strategic planning. As a result of the cooperation between staff and executives during the strategic planning work, the 500-bed Grace Hospital has a new approach to staffing nurses. The "Grace Contingent Staffing Model" addressed cost containment, flexibility, and delivery of services, and certainly Grace needs to maintain a high quality nurse workforce, so they implemented cost containment and flexibility by putting in place an "In-House Contingent Nurse Pool" (IHP). What this means is the 30 RNs in the IHP "work on an as-needed basis without benefits" but they receive a "higher rate of pay than a full or regular part-time RN," Butler explains (p. 138).

The data gleaned from financial analysis shows a savings of $216,000 annually by implementing IHP. The savings is due in large part due to the fact that no benefits are paid to the 30 pool nurses, who work enough hours to make good money, enough money to purchase their own insurance. Another cost containment policy resulting from the integrative approach to strategic planning was the reduction of inpatient stay for chemotherapy patients -- from an average of 3.7 days to…