Tag Archives: culture

Strategic Planning: Strategies & Tactics

Seattle Children’s Hospital (2011, n.d.) was the first pediatric specialty care hospital founded west of the Mississippi River. Seattle Children’s Hospital, supported by the philanthropic efforts of the community, performs at the cutting-edge of pediatric medicine and research. With nearly 60 pediatric specialties and award-winning research faculty, Seattle Children’s Hospital presents expertise in the field of pediatric medicine.


Seattle Children’s Hospital (n.d.) is a pediatric specialty care center associated with the University of Washington to provide medical and surgical residents with the hands-on practical experience and education needed to succeed in the medical profession.

The hospital (Seattle Children’s Hospital, n.d.) has many specialized programs, or sub-specialties, within its pediatric specialty, including urgent and emergency care, oncology and hematology, craniofacial, orthopedic and sports medicine, a heart and transplant center, neonatology, neurosurgery, and general and thoracic surgery.

Seattle Children’s Hospital (n.d.) also boasts an award-winning research facility dedicated to treating and eliminating pediatric disease.

Strategic Planning

The strategic plan of Seattle Children’s Hospital (2011) focuses on the hospital’s vision and four specific goals:

  1. provide the safest, most effective care possible,

  2. control and reduce the cost of providing care,

  3. find cures and educate clinicians and researchers, and

  4. grow responsibly and provide access to every child who needs us (p. 2).

In order to succeed in reaching these goals, the hospital’s plan must have directives that outline the strategies and tactics useful in attaining the goals.


Strategy is the broad means directed towards attaining strategic goals. As Seattle Children’s Hospital’s (2011) strategic plan demonstrates, in order to achieve the means of providing the safest, most effective care possible, “[the hospital] will standardize our care processes and strengthen our systems to prevent and respond rapidly to medical errors” (p. 5). This strategy is broadly stated, provides direction, and acknowledges that failures may still occur, which allows for the provision of a secondary, or backup, strategy for response to these failures.


Tactics are the individual steps made within a strategy towards attaining a specific goal. Tactics should be moral, safe, efficient and effective towards the strategic goals. For instance, the strategy of “[standardizing] our care processes and [strengthening] our systems to prevent and respond rapidly to medical errors” (Seattle Children’s Hospital, 2011, p. 5) is well-stated, yet broad. In order to employ this strategy, tactics must be employed that are specific to meeting the described goal. In this case, Seattle Children’s Hospital (2011) has identified that “[completing] the transition to an electronic medical record system” (p. 5) is a specific means that can be used to help fulfill this particular strategy and meet the described goal.

Another tactic not presented in Seattle Children’s Hospital’s (2011) strategic plan but helpful in attaining the goal of improved patient safety and drawn from the strategy of “[standardizing] … care processes and [strengthening] … systems” (p. 5) would be the formation of an anonymous, voluntary self-reporting system in which a nurse or physician submits a card detailing a medical or surgical error in the spirit of identifying processes and systems in need of improvement.


Strategic plans are guided by strategic goals, and strategic goals can have many strategies that are employed and useful in meeting the stated goals. It is also true that a plethora of tactics can be employed for each strategy.

Strategic plans are often based on lofty, yet attainable, goals. In order to meet these goals, one must only ask a simple question: How? With each broad answer, a continuous and recursive series of How? can be used to work the strategy into a number of manageable tactics to use to reach that lofty goal.


Seattle Children’s Hospital. (2011). Shaping the future of pediatric healthcare: Strategic plan 2012 to 2016. Retrieved from http://www.seattlechildrens.org/pdf/strategic-plan-2012-2016.pdf

Seattle Children’s Hospital. (n.d.). About Seattle Children’s. Retrieved from http://www.seattlechildrens.org/about/

SWOT Analysis: Day Kimball Healthcare

Day Kimball Healthcare (DKH) is a non-profit health care organization serving the northeastern Connecticut, southcentral Massachusetts and northwestern Rhode Island communities. The mission of DKH (2011) is “to meet the health needs of our community through our core values of clinical quality, customer service, fiscal responsibility and local control” (para. 4). A comprehensive health care system, DKH offers primary care and a multitude of medical and surgical specialties along with sophisticated diagnostics by offering a comprehensive network of more than 1,000 employees including more than 200 physicians, surgeons and specialists. DKH is comprised of Day Kimball Hospital, four community health care centers, Day Kimball HomeCare, Day Kimball Hospice & Palliative Care of Northeastern Connecticut, Day Kimball HomeMakers, and Physician Services of Northeast CT, LLC.


DKH provides a host of services to the community, including:

  • primary medical care,

  • emergency medical care,

  • surgical care,

  • palliative and hospice care,

  • home health care, and

  • social services

DKH appears to strive towards providing a comprehensive health care solution to the community that is robust, yet limited in specialty, especially critical care, trauma, and pediatric services.



The primary catchment area for DKH includes the Connecticut towns of Brooklyn, Canterbury, Eastford, Killingly, Plainfield, Pomfret, Putnam, Sterling, Thompson, and Woodstock, and the Rhode Island towns of Foster and Glocester. According to the available U.S. Census data (2010), the population served is nearly 92,000 with average growth in the last ten years of nearly 9%. The median age of the catchment population (37.8) is merely 3 months older than the median age of the Connecticut population (37.4). The median household income is $66,422 (CT: $67,034).


DKH is the primary health care provider within the defined catchment area. Some of the population, however, rely on three other community-level hospitals, Backus Hospital (Norwich, CT), Southbridge Hospital (Southbridge, MA), and Windham Hospital (Windham, CT). Additionally, some of the population with advanced disease processes rely strictly on the primary and emergency care services of the nearest urban centers (Worcester, MA, Hartford, CT, and Providence, RI), with many of DKH’s emergency patients transferred to these tertiary care centers for trauma, critical care, and pediatric specialties.


DKH, as a health care organization, can be adversely affected by patterns of infectious diseases within the community. As each season mounts, the health care system becomes overwhelmed and requires coordination between other health care facilities in the area.

Additionally, a large disaster would strain the resources of DKH; however, this would be a temporary issue, resolving as the disaster winds down. There is ample opportunity within the catchment area for a disaster to unfold, including traffic on the major highway that divides the catchment area as well as the number of large manufacturing entities in the area.


Strengths. DKH provides comprehensive long-term health care to community members. DKH enjoys a strong and comprehensive relationship with a large network of physicians and other primary care providers.

Weaknesses. DKH has no intensivists, physicians with expertise in critical care, and provides very limited critical care service. As a result, DKH must transfer many cases to other facilities to rule in or rule out critical illnesses or injuries, which negatively affects earnings.

Another weakness lies in DKH’s reliance on electronic patient care reporting. DKH uses a number of patient care reporting platforms that do not integrate with each other. This creates a need for over-redundancy and opportunities for patient care errors. Further, a fully integrated system would allow for health care partners to access up-to-date patient care information without delay.

Opportunities. Opportunities exist for DKH to expand their services by further decentralizing the current services offered and concentrating on which scopes of service to expand or improve upon. By improving laboratory reporting standards and facilitating full integration of patient reporting, patients of DKH will be able to obtain a more standardized level of care throughout the health care continuum.

DKH should cultivate their relationship with the public by being more active and visible within the community performing screenings, vaccinations, blood drives, as well as other public relations endeavors.

Another opportunity exists with the patient population who suffer from critical illness or injury that is yet to be determined. These patients face risk in transport to tertiary care centers when, often times, the transfer is unwarranted by later findings. By cultivating relationships with specialties in the tertiary care centers, these patients could be more fully determined to need (or, not need) transfer to tertiary care centers, keeping the financial reward of caring for patients in-house while obtaining specialist coordination.

Threats. The largest threat to DKH, as with any organization, is its reputation within the community. Funding, which is largely based on governmental and private insurance providers, is also a considerable threat that must be managed continuously. However, other threats are significant and can be actively managed.

Pandemics are unlikely to occur but present catastrophic scenarios if they do, indeed, occur. Pandemic influenza, as well as other pandemic diseases, presents a situation of an increasing need for awareness and preparation.

Unpredictable weather in the northeastern Connecticut presents a likely and significant threat to the provision of health care. Recent and historical storms have proven to impede access and egress to and from patients both out in the community and at the hospital.


This SWOT analysis is limited by the a posteriori knowledge and perceptions of the author, a paramedic who is active within the health care system, and it is limited in the scope of an academic exercise to practice SWOT analyses.

However, DKH has overcome many adversities in the past and continues to grow, but seemingly without proper direction. The efforts thus far seem disjointed and without a clear structure or coherent path into the future. DKH would benefit from an internal SWOT analysis that could be performed without the limitations inherent herein.


Day Kimball Healthcare. (2011). Day Kimball Healthcare. Retrieved from http://www.daykimball.org

U.S. Census Bureau. (2010). 2010 census data. Retrieved from http://www.census.gov/

Messaging as an Ongoing Process

Just after midnight on March 24, 1989, the Exxon Valdez ran aground in the Prince William Sound off of the Alaskan coast causing the 36th largest oil spill in history (Baker, n.d.; Fearn-Banks, 2011; Holusha, 1989; Moss, 2010). Though the initial ecological insult was severe, Exxon’s poor response to the emergency is noted as having the most significance (Baker, n.d.; Holusha, 1989). According to Fearn-Banks (2011), the initial public relations response was swift, but the public perception, especially with the obvious absence of CEO Lawrence G. Rawl from the public spotlight, was that the company did not view the incident with the importance that it deserved (Holusha, 1989). “The biggest mistake was that Exxon’s chairman … sent a succession of lower-ranking executives to Alaska to deal with the spill instead of going there himself and taking control of the situation in a forceful, highly visible way” (Holusha, 1989, para. 6). Rawl made comments about being technologically obsolete as a reason for not responding to the incident personally, and in a later television interview, Rawl explained that it was not the responsibility of the CEO to read specific response plans, then he went on to blame the media for the crisis (Baker, n.d.; Fearn-Banks, 2011).

According to Fearn-Banks (2011), Don Cornet, Exxon’s Alaska public relations coordinator, rushed to the scene and instituted a plan focused on the clean-up upon hearing of the incident; however, resources were scarce and the plan was slow to implement. Alaskan oil industry regulations held that the Alyeska Pipeline Service Company, an oil company consortium, was ultimately responsible for the initial response, which was soon taken over by Exxon. It was Alyeska’s involvement in the incident that introduced George Mason, an experienced crisis communications public relations expert for the company that represented Alyeska, into the spotlight. Mason worked with Cornet to streamline the media response and did much to limit the impact of Exxon’s poor media relations, even in light of Rawl’s disastrous commentary. Without the efforts of Mason, Cornet, and a few others, it appears that Exxon’s reputation would have suffered much more.

The primary issues identified in Exxon’s response to the Valdez incident, according to Baker (n.d.), are 1) a lack of resources and preparedness for a crisis of this magnitude, 2) failing to commit to prevention efforts in the future, and 3) the perceived indifference to the ecological shock.

According to Holusha (1989), Exxon’s response to the Alaskan spill was immediately identified as highlighting what not to do in responding to a crisis. Holusha compared Rawl’s messaging and response with that of the Ashland Oil spill and the Union Carbide incident in Bhopal, India, in which both CEOs responded immediately, availing themselves to the media to answer questions and respond to scrutiny.

The Exxon Valdez spill was significant, large, costly, and affected many industries and lifestyles in Alaska. Rawl’s response should have been immediate, and he should have taken responsibility to be apprised of all efforts being undertaken to rectify the situation. Legitimizing Rawl’s concerns of being a distraction to local efforts, he could have held frequent press conferences in the mainland United States, which would have limited the media’s need to send so many representatives directly to Alaska. This would have helped to show cooperation with the media as well as allow Rawl to address any concerns that the public might have. The messaging should have been that Exxon will do everything needed to return Alaska back to pre-spill status no matter the cost or manpower required.

Today, social media presents a unique opportunity for companies to address their public. Recently, Connecticut Light and Power utilized Facebook and Twitter, two popular social media programs, to provide real-time updates to their affected customers during a freak early snowstorm that put most of Connecticut without power for weeks (Singer, 2011; State of Connecticut, Department of Emergency Services and Public Protection, 2011). Though there are still concerns that Connecticut Light and Power were unprepared for such a crisis, without the deliberate effort to maintain communication with customers, the corporate image would have been much worse, as Exxon experienced.

It is a common precept in crisis communications that crises will occur and hopes can only be made to minimize their effect (Fearn-Banks, 2011). While preparing for such a crisis, a focus on communication and messaging should be paramount. The more the public trusts that the company will respond to the emergency effectively, the more apt they will be to acknowledge the difficulties involved in such a response. Messaging should be open, honest, and realistic. Every effort to use a multitude of media (e.g. radio, television, print, internet, telephone, et al.) to maintain a sense of transparency should be used to promote messages that accept responsibility and sets realistic goals. These communications, however, should not be unidirectional. A conversation needs to take place where the public can have their concerns and curiosity addressed in a fair and open environment.

By addressing the concerns of all stakeholders in a timely, open manner, corporate images will fare much better even in light of the worst crisis imaginable.


Baker, M. (n.d.). Companies in crisis – What not to do when it all goes wrong: Exxon Mobil and the Exxon Valdez. Retrieved from http://www.mallenbaker.net/csr/crisis03.html

Coombs, W. T. (2012). Ongoing crisis communication: Planning managing, and responding (3rd ed.). Thousand Oaks, CA: Sage.

Fearn-Banks, K. (2011). “Textbook” crises. Crisis communications: a casebook approach (4th ed; pp. 90-109). New York, NY: Routledge.

Holusha, J. (1989, April 21). Exxon’s public-relations problem. New York Times. Retrieved from http://www.nytimes.com/1989/04/21/business/exxon-s-public-relations-problem.html

Moss, L. (2010, July 16). The 13 largest oil spills in history. Mother Nature Network. Retrieved from http://www.mnn.com/earth-matters/wilderness-resources/stories/the-13-largest-oil-spills-in-history

Singer, S. (2011, November 4). CT utility takes heat over winter storm response. News 8 WTNH. Retrieved from http://www.wtnh.com/dpp/weather/winter_weather/ct-utility-takes-heat-over-winter-storm-response-

State of Connecticut, Department of Emergency Services and Public Protection. (2011, November 8). Winter storm October 29, 2011 (Situation Report #49). Retrieved from http://advocacy.ccm-ct.org/Resources.ashx?id=802e4723-2e4a-4a61-896e-f51eafbbd4c0

The Importance of Planning

To borrow from the motto of the Boy Scouts of America (2011), “Be prepared!” There is no possible way to fully predict with perfect accuracy when and where a crisis will develop. However, with some foresight, the adoption of a comprehensive crisis communication plan will allow an immediate response to any emergency, disaster, or other crisis that might arise. Gray (2008) discusses how JetBlue might have benefited from such a plan. JetBlue, if they had focused on developing a crisis communication plan, might have uncovered the not unlikely possibility of a major storm grounding many of its passengers. In this case, JetBlue would have been in a more proactive position to mitigate the effects such a storm might produce on passengers and their east coast operations. According to Fearn-Banks (2011), the impending storm prediction would have been a warning sign, or prodrome, that JetBlue could have responded to in order to prevent the crisis. Had JetBlue contacted the passengers prior to their arrival at the airports, they might have been able to secure better and more comfortable accommodations than the airports had to offer. Additionally, the company would have presented themselves proactively instead of taking the defensive posture noted by Gray.

In December 1984, Union Carbide, a pesticide production company, was the subject of the worst industrial accident in history. At their plant in Bhopal, India, an employee purposefully allowed water into large tanks of a chemical called methyl isocyanate (MICN) which caused a chemical reaction (according to Union Carbide management), bursting the tanks and releasing MICN gas into the environment killing more than 3,000 people (some estimates exceed 25,000 dead) and injuring 100 times that amount (Venkatasubramanian, 2011). According to Muller (2001), MICN was stored in large above ground tanks, a water valve was connected to the tanks, and employees had largely unrestricted access to these tanks and valves. When liquid MICN and water are mixed, MICN rapidly expands to a gaseous state and can quickly overwhelm holding tanks. Had Union Carbide conducted an investigation of potential crises while constructing a crisis communication plan, these circumstances might have been uncovered and considered prior to the accident, allowing company officials the opportunity to mitigate the potentially deadly situation and avoid the catastrophe in 1984. Additionally, had this crisis occurred regardless of mitigation, the company would have been poised to provide helpful instructions and recommendations to public safety officials and the public to minimize the loss of life. Union Carbide was eventually sued for billions of dollars, which it has never paid.

Another incident that might have benefited from a crisis communication plan is the Massey Energy Upper Big Branch mine explosion that occurred in West Virginia on April 5, 2010. Venkatasubramanian (2011) describes this explosion as the worst mining accident in four decades, killing 29 people. Like the Union Carbide example above, Massey Energy initially tried passing the blame to employees and single system failures, but eventually the company closed its Kentucky Freedom Energy Mine #1, and the CEO, Don Blankenship, stepped down. This after being confronted with the over 600 safety violations in 2009 and 2010. Again, the implementation of a crisis communication plan would have focused on potential accidents and allowed a window for mitigation and prevention. Upon completion of the effort, when the accident occurred, there would have been clear directives on how to proceed, which might have helped to save the company’s reputation; although, in this case, that is unclear.

Only when a company’s management realizes that safety is important and that crises do occur can they set forth means of mitigating their risk. One important way to mitigate risk is to consider that no matter the attempts at prevention, errors and failures can always occur and it is best to be prepared for the worst-case scenarios in hopes that they never do occur. By being prepared for the worst case scenarios, mainly by having drafted crisis communication plans along with incident action plans, the company representative has focus and direction on how to proceed with response efforts both publicly and internally. The benefits are appearing with a unified message of adequately responding and recovering from the crisis, and bringing a sense of strength and direction to that effort that the public, employees, and shareholders alike can appreciate and find faith. It is always best to be prepared.


Boy Scouts of America. (2011, March). Overview of Boy Scouts of America. Retrieved from http://www.scouting.org/About/FactSheets/OverviewofBSA.aspx

Fearn-Banks, K. (2011). Crisis communications: a casebook approach (4th ed.). New York, NY: Routledge.

Gray, S. (2008). Without crisis plan, your reputation could be at risk. Las Vegas Business Press, 25(8), 22. Retrieved from http://www.ebscohost.com/academic/regional-business-news

Muller, R. (2001). A significant toxic event: The Union Carbide pesticide plant disaster in Bhopal, India, 1984. Rural and Remote Environmental Health, 1(10). Retrieved from http://www.tropmed.org/rreh/vol1_10.htm

Venkatasubramanian, V. (2011). Systemic failures: Challenges and opportunities in risk management in complex systems. AIChE Journal, 57(1), 2-9. doi:10.1002/aic.12495

Defining Crisis

A crisis is any problem that has a significant impact. Most simply, a crisis is a decision-point of change, for better or worse. For example, a new father seeing his child for the first time might have a crisis of faith. A beautiful and healthy child may trigger thoughts of awe and trigger a divine revelation; whereas, a seriously ill child may bring feelings of doubt and religious contempt. In the field of crisis management, Coombs (2012) defines crisis as “the perception of an unpredictable event that threatens important expectancies of stakeholders and can seriously impact an organization’s performance and generate negative outcomes” (p. 2). In this definition, Coombs suggests that crises are both negative and unpredictable events that effect others. While I agree with the scope of the definition, as I stated above, crises do not necessarily have to be negative events, and frequently, they can be predicted. Predictable negative crises are usually caused by negligent management, such as economic crises (Berg & Pattillo, 1998; Compagnon, 2011; Feldstein, 2010; Roubini, 2010).

A crisis usually develops from a less significant issue and, if understood and contemplated, can be mitigated early (Coombs, 2012). A crisis stemming from an issue finds a causal relationship with risk. Risk can be categorized by human, systematic, and process or random (Youndt, Snell, Dean, & Lepak, 1996). Human and systematic risk can be mitigated easily; however, process risk is inherent and requires substantial process change to minimize.

The British Petroleum Deepwater Horizon event, which occurred on April 20, 2010, was said to have been fraught with risk of all three types. A New York Times article by Barstow, Rohde, and Saul (2010) describes the event and attempts to elucidate what went wrong. Initially, according to the article, there was a blowout of the Macondo Prospect well, a risk that is inherent to drilling, especially in deep water. Next, every single “formidable and redundant defenses against even the worst blowout” (para. 10) failed. This was certainly a failure of process errors (geological “bursts” causing the well blowout), systematic errors (“One emergency system alone was controlled by 30 buttons” [para. 18]), and human errors (“members of the crew hesitated and did not take the decisive steps needed. Communications fell apart, warning signs were missed and crew members in critical areas failed to coordinate a response” [para. 15]).

On a micro-organizational level (the rig), these failures are evident and allowed risk to develop into an issue, which developed into a crisis. On a macro-organizational level, however, the response seemed to be swift, but the focal response to the incident and the public relations response appeared very disjointed, which was compounded by both the media and the federal government, that is, until the U.S. Coast Guard took control. It was apparent very early that both British Petroleum and the federal government were concerned with reputation over response and recovery from the focal incident. This translated to poor support for both by the public. I believe the U.S. Coast Guard is the only managing entity involved in the response to have managed to maintain dignity throughout the effort.

Crisis management is promoted as a multifaceted approach to mitigate, alleviate, respond to, and recover from crises of different types and scope. Although there are many aspects to organizations that require attention during these efforts, it needs to be understood that some have higher priorities than others, and reputation is a culmination of all of these.


Barstow, D., Rohde, D., & Saul, S. (2010, December 25). Deepwater Horizon’s final hours. New York Times. Retrieved from http://www.nytimes.com/2010/12/26/us/26spill.html

Berg, A. & Pattillo, C. (1998). Are currency crises predictable: a test (Working paper #98/154). International Monetary Fund. Retrieved from http://books.google.com/

Compagnon, D. (2011). A predictable tragedy: Robert Mugabe and the collapse of Zimbabwe. Philadelphia, PA: University of Pennsylvania Press.

Coombs, W. T. (2012). Ongoing crisis communications: planning, managing, and responding (3rd ed.). Thousand Oaks, CA: Sage.

Feldstein, M. (2010, June 14). A predictable crisis: Europe’s single currency was bound to break down. The Weekly Standard, 15(37), 1-3. Retrieved from http://www.weeklystandard.com/articles/predictable-crisis

Roubini, N. (2010, May 17). All crises are predictable: Contrary to beliefs, history shows there’s nothing new in debt or inflation. Gulf News. Retrieved from http://gulfnews.com/business/features/all-crises-are-predictable-1.627708

Youndt, M. A., Snell, S. A., Dean, J. W., & Lepak, D. P. (1996). Human resources management, manufacturing strategy, and firm performance. The Academy of Management Journal, 39(4), 836-866. doi:10.2307/256714

Human Resources & Challenges in Health Care

The function of human resources is not without its challenges and difficulties. No matter the industry or organization, acquiring and managing a pool of employees can be overwhelming (Thompson, 2012). Human resources managers in health care organizations seem to face more challenges than most. From nursing and physician shortages to attracting innovative and contemporary researchers, health care organizations seem to search within thinning pools of prospective employees, yet still demand the best and brightest (Keenan, 2003; Lewis, 2010; Thompson, 2012).

One of the most challenging issues to health care over the last few decades has been a significant nationwide nursing shortage (Keenan, 2003; Lewis, 2010). Thompson (2012) outlines both a declining skilled workforce and an increasing population contributing to the problem. Both Keenan (2003) and Lewis (2010) cite the aging babyboomer population adding to the increased need for nurses through 2020 and beyond. Novel human resources strategies can result in an augmented workforce designed to meet the continually growing impact these forces have on health care organizations, specifically those with emergency departments.

One novel strategy includes consideration of other highly-skilled clinicians that do not traditionally work in hospitals. As Oglesby (2007) considers the possibility, paramedics are, by far, one of the best examples. By introducing paramedics into the emergency department, a hospital can redistribute the nurses to clinical areas more suited towards their training, decrease the patient-to-nurse ratios (thereby increasing patient safety and maximizing outcomes), and tap into a new pool of prospective employees that are well-suited to rise to the stressful demands of the emergency department (Keenan, 2003; Swain, Hoyle, & Long, 2010). Additionally, organizations employing paramedics can augment both their emergency department operations and home health care operations by sending paramedics to certain patients to mitigate their complaints and minimize the number of inappropriate patient transports to the emergency department (Swain, Hoyle, & Long, 2010). This alone would decrease emergency department overcrowding and maximize revenue and efficiency in the delivery of care. Additionally, turn-over rates should be significantly lower with a more productive work environment where stress is managed, outcomes are met, and patients are care for more effectively.

In conclusion, intelligent and novel planning of the workforce can, itself, lead to increases in recruitment and retention; however, efforts still need to focus on each individually in order to attract, maintain, and develop a first-class workforce (Thompson, 2012).


Keenan, P. (2003). The nursing workforce shortage: causes, consequences, proposed solutions (Issue brief #619). The Commonwealth Fund. Retrieved from http://mobile.commonwealthfund.org/

Lewis, L. (2010). Oregon takes the lead in addressing the nursing shortage: A collaborative effort to recruit and educate nurses. American Journal of Nursing, 110(3), 51-54. doi:10.1097/01.NAJ.0000368955.26377.e1

Oglesby, R. (2007). Recruitment and retention benefits of EMT—Paramedic utilization during ED nursing shortages. Journal of Emergency Nursing, 33(1), 21-25. doi:10.1016/j.jen.2006.10.009

Swain, A. H., Hoyle, S. R., & Long, A. W. (2010). The changing face of prehospital care in New Zealand: the role of extended care paramedics. Journal of the New Zealand Medical Association, 123(1309), 11-14. Retrieved from http://journal.nzma.org.nz/

Thompson, J. M. (2012). The strategic management of human resources. In S. B. Buckbinder & N. H. Shanks, Introduction to Healthcare Management (Custom ed.; pp. 81-118). Sudbury, MA: Jones & Bartlett.

Prior Proper Planning …

… Prevents Poor Performance

I am in the midst of planning an ad hoc merger of a number of local emergency medical service agencies into a single regional provider to reduce overall costs while maximizing revenue, improve training and the delivery of care, and to streamline the operational processes that support our providers in the field. Unfortunately, I have found that there are many obstacles that need to be dealt with at every step before moving on to the next. My research has certainly opened my eyes to developing a useful approach to these problems.

Planning “[provides] the appropriate focus and direction for … organizations” (Zuckerman, 2006, p. 3). Without planning, organizations risk stagnation and obsolescence. For any organization to succeed (and continue to do so), the strategy needs to focus both on the contemporary traditional needs as well as those anticipated in the future, but this focus needs to be comprehensive. Bartling (1997) writes of 25 different pitfalls any health care organization might face when considering strategic planning. These 25 pitfalls are just some of the issues I hope to avoid.

One of the largest difficulties in planning for emergency medical systems, however, is the sense of ‘fiefdom’, or an assertion of organizational ownership — in a truly feudal sense. A fiefdom is a literal power trip. In this area, there are 10 towns with an average of two ambulances each, and each department’s administration will fight tooth and nail to keep the organization from outgrowing them. What is interesting about the area is that many of the members of one department work for at least two of the other departments, also. This is because the pay is so meager they have to work as many hours as possible, and there is no chance of working more than 32 hours at any one service in any given week. The pay is low as is the quality of care. This needs to change, but how do I create an amalgumated organization from the bits and pieces that I have to work with? Add to that my lack of formal authority in this process. My vision is to reduce the number of ambulances by staffing eight ambulances at all times and tactically positioning them around the region. This alone would create 48 well-paid jobs, using the same 40 people who currently job share across organizational lines.

In reviewing the available resources, I have learned that there is no particular process or flow-chart pathway to effective planning (Bartling, 1997; Begun & Kaissi, 2005; Zuckerman, 2006). Critical forward thinking is needed, instead. Some of the particular issues that Bartling (1997) discusses and I foresee might be particular to my planning process are: inadequate planning, short-sightedness, underestimating the complexity of the process, post-merger angst, analysis paralysis, and lack of evaluative criteria, to name a few. Politics plays a large role in many of these issues I mention.

Inadequate planning, short-sightedness, and a lack of evaluative criteria are closely related. I see in the present that the system does not work as well as it should (short-sightedness), and I want to develop a plan that can be implemented immediately (probably suffering inadequate planning). This would leave me with a fragmented system devoid of vision and, therefore, crippled from improving (lacking that evaluative criteria). These are pitfalls that I need to avoid. These issues would give rise to the others dooming my effort to failure and, possibly, leaving the system in even worse shape than it began.

Perhaps, my only chance of fulfilling this process is to first perform a limited situational assessment by identifying the mission, vision, and values of all of the stakeholders and show how a streamlined process can better fulfill their visions (Casciani, 2012). By gaining stakeholder support, I might better leverage my idea against those who fear change.


Bartling, A. (1997). 25 pitfalls of strategic planning. Healthcare Executive, 12(5), 20–23.

Begun, J. & Kaissi, A. (2005). An exploratory study of healthcare strategic planning in two metropolitan areas. Journal of Healthcare Management, 50(4), 264–274.

Casciani, S. J. (2012). Strategic planning. In S. B. Buckbinder & N. H. Shanks (Eds.), Introduction to healthcare management (Custom ed.; pp. 3-23). Sudbury, MA: Jones & Bartlett.

Zuckerman, A. (2006). Advancing the state of the art in healthcare strategic planning. Frontiers of Health Services Management, 23(2), 3–15.

Leadership: Determining the Best Approach

 The true value of leadership is empowerment, or the ability to promote those traits through the chain of command for subordinates to use to effectively make decisions that are in the spirit of the vision of the leader (Buchbinder, Shanks, & McConnell, 2012; Kirkpatrick & Locke, 1991; Wieck, Prydun, & Walsh, 2002). When leaders make decisions, the focus is not on the myopic view of the here and now but reflects the nature of ethics and vision promoting the endeavor (Kirkpatrick & Locke, 1991).

Buchbinder, Shanks, and McConnell (2012), discuss various strategies and attitudes employed to both lead and manage the health care workforce. Though each of the styles presented are effectively used in certain scenarios, many managers and ineffective leaders misuse these styles due to misplaced attitudes, trust, and motives. These styles are authoritarian, bureaucratic, participative, theory Z, laissez-faire, and situational. The authoritarian and bureaucratic styles are closely related as dictatorial and at risk for involving micromanagement; however, authoritarians tend to be motivated by their responsibilities, whereas bureaucrats tend to disregard their responsibilities. The participative and theory Z styles are more democratic and egalitarian describing the usefulness of a majority opinion or consensus before moving forward. Though these styles could result in indecision, they are best implemented when a leader has ultimate decision-making capabilities and relies on his or her subordinates for input. Laissez-faire leadership is typically characterized as the hands off approach. Laissez-faire leadership, when used correctly, relies on the specialized training or focused scope of the work of the subordinates and lends guidance only when necessary. Laissez-faire leadership, however, can provide refuge for a lazy manager. Situational leadership is the use of all or some of the styles described above depending on the specific circumstances of a given situation. For instance, providing guidance to a new employee might benefit from an authoritarian approach; however, deciding on the best approach to implementing a new process might benefit from a participative style of leadership.

In the emergency medical services, a move has been made over the last decade to separate from the authoritarian leadership of the fire service. In my opinion (due to the gross lack of research within both the fire and emergency medical services), the attitudes of the fire service leadership do not correspond well with the manner in which paramedics wish to be led. As paramedics are formally educated and expected to perform as skilled clinicians in the field, they tend to operate independently and view their supervisors more as a resource tool than as tactical or clinical decision-makers. Combination departments, or those that operate both fire and emergency medical services, would do well with developing situational leadership skills to guide both operations (Mujtaba & Sungkhawan, 2009). Though paramedics may utilize an authoritarian style of leadership during an emergency call (and, do well to follow such styles in these environments), during normal day-to-day operations, paramedics respond much better towards a laissez-faire, or indirect, style of leadership that allows for independent critical thinking (Buchbinder, Shanks, & McConnell, 2012; Freshman & Rubino, 2002). For example, during a call, I expect that when I direct my crew to perform a certain task that it is completed immediately; however, between calls when I might say that in a particular scenario a certain intervention is necessary, I expect some discussion to aid in the learning of my crews and to help develop and hone their critical thinking skills.

True leadership has its own rewards, primarily, empowering those who follow to synthesize the traits of their leaders and evolve into leaders, themselves. This, in addition to watching your own visions take root and flourish.


Buchbinder, S. B., Shanks, N. H., & McConnell, C. R. (2012). Introduction to healthcare management (Laureate Education, Inc., Custom ed.). Sudbury, MA: Jones and Bartlett.

Freshman, B. & Rubino, L. (2002). Emotional intelligence: a core competency for health care administrators. Health Care Manager, 20(4), 1-9. Retrieved from http://ezp.waldenulibrary.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=12083173&site=ehost-live&scope=site

Kirkpatrick, S. A. & Locke, E. A. (1991). Leadership: Do traits matter? Academy of Management Executive, 5(2), 48-60. doi:10.5465/AME.1991.4274679

Mujtaba, B. G. & Sungkhawan, J. (2009). Situational leadership and diversity management coaching skills. Journal of Diversity Management, 4(1), 1-55. Retrieved from http://journals.cluteonline.com/

Wieck, K. L., Prydun, M., & Walsh, T. (2002). What the emerging workforce wants in its leaders. Journal of Nursing Scholarship, 34(3), 283-288. doi:10.1111/j.1547-5069.2002.00283.x

Fear of Terrorism

As terrorism becomes more prevalent within a society, concerns about the psychological effects are brought to the forefront. The psychological effects of terrorism, in general, should have an impact on the ability of law enforcement and the public to interface appropriately. A recent study by Bleich, Gelkopf, and Solomon (2003) of the psychological effects of terrorism on the public in Israel showed surprisingly low levels of post-traumatic stress disorder symptoms despite high incidences of direct exposure to terror events. This study demonstrated that, although up to a third of the respondents acknowledged a “limited sense of safety and substantial distress [they] reported adapting to the situation without substantial mental health symptoms and impairment, and most sought various ways of coping with terrorism and its ongoing threats [, possibly linked to] processes of adaptation and accommodation” (p. 619). The study found that the most effective and widely used coping mechanism was checking on the well-being of friends and family. As people tend to cope well with trauma, attitudes towards protective measures seem to acquiesce for the common good, and this can be assistive to law enforcement.

One of the protective measures people tend to adopt that would help law enforcement is a sense of hypervigilance (Bleich, Gelkopf, & Solomon, 2003). Hypervigilance allows the people to be more attentive to things out of the ordinary (e.g. unattended packages, suspicious loitering, anxious mannerisms of others, et al.). This promotes a line of communication with law enforcement not only regarding terrorism but for other criminal activity, also.

Another protective measure, which goes towards acquiescence, is the ability of the people, in general, to accept an increased presence of law enforcement in their daily lives. When faced with a proximal event, the bulk of the citizenship contend that it is, indeed, a function of government to protect the masses from further harm, and these citizens tend to accept limits on personal liberty for perceived increases in security (Klein, 2007). This is a double-edged sword, however. People tend to want to return to a normal state of affairs (Bleich, Gelkopf, & Solomon, 2003). Though an increased police presence is initially welcomed and embraced, the people will eventually resent the loss of liberty and require law enforcement presence to recede. How this occurs will either enhance or detract from the ongoing relationship with law enforcement. An example of this is easy to see when considering both local law enforcement and the federal effort of the Transportation Security Administration (TSA). Local law enforcement seems to have decreased their presence, at least in my area, and are respectfully viewed as helpful, whereas the TSA, an agency that continues to irrationally impede on liberty, is viewed negatively by the traveling public.

Law enforcement is a service-based industry where the public is the customer. Police need to understand both the rights and the fears of the people in order to maintain the appropriate level of service, which waxes and wanes.


Bleich, A., Gelkopf, M, & Solomon, Z. (2003). Exposure to terrorism, stress-related mental health symptoms, and coping behaviors among a nationally representative sample in Israel. Journal of the American Medical Association, 290(5), 612-620.

Klein, L. (2007). Civil liberties and national security in the post 9-11 era: State power and the impact of the USA Patriot Act. Conference Papers – American Sociological Association, 1-8.

Expansion of Law Enforcement Post-9/11

Prior to 1993, federal law enforcement agencies, specifically the Federal Bureau of Investigation (FBI), felt more than adequate in investigating and preventing terrorism on U.S. soil (Smith & Hung, 2010). On September 11, 2001, as has been done on numerous emergent occassions, the U.S. government all but suspended Article III, Sec. 2 and Amendments II, IV, V, VI, IX, X, XIII, XIV of the U.S. Constitution in the name of protecting liberty; a premise I find sadly ironic.

According to an article by Abramson and Godoy (2006), the passage of the USA PATRIOT Act (2001) promotes intelligence sharing among the intelligence community, utilization of technological tools to combat tech-savvy terrorists, allows easier access to the business records of suspected terror supporters, allows search warrants to be affected without undermining other concomitant investigations, and allows wiretaps to be dynamic in order to follow the target suspect more easily. Detractors of the USA PATRIOT Act, however, argue that these measures undermine certain liberties that Americans are right to enjoy. These detractors warn of information cataloging that could lead to massive data stores of private information of regular citizens, unwarranted investigations, searches, and seizures of casual contacts of someone under investigation, and general use of “sneak and peek” warrants for the investigation of petty crimes.

One particular part of the USA PATRIOT Act, the usage of letters of national security that demand secrecy of government involvement from the recipient, was struck down by a federal judge based on Constitutional freedom of speech issues (Liptak, 2007). This is no surprise. Passing 357 to 66 in the House of Representatives and 98 to 1 in the Senate just six weeks after 9/11 and with little debate, this knee-jerk legislation was destined for failure, at least where public relations is concerned (Weigel, 2005).

The USA PATRIOT Act (2001) grants immeasurable power to law enforcement to investigate and prevent terrorism, this is a good thing; however, most of the provisions seem to fail whenever exercised against a U.S. citizen or lawful resident (Weigel, 2005). We need to rethink our approach to terrorism and ask the question of ourselves: is our safety worth every ounce of our liberty?


Abramson, L. & Godoy, M. (2006, February). The Patriot Act: Key controversies. Retrieved from http://www.npr.org/news/specials/patriotact/patriotactprovisions.html

Liptak, A. (2007, September 7). Judge voids F.B.I. tool granted by Patriot Act. The New York Times, pp. A18. Retrieved from http://www.nytimes.com

Smith, C. S. & Hung, L. (2010). The Patriot Act: issues and controversies. Springfield, IL: Thomas Books.

USA PATRIOT Act. P. L. 107-56 Stat. 115 Stat. 272. (2001).

Weigel, D. (2005, November). When patriots dissent. Reason, 37(6). Retrieved from http://www.reason.com/news/show/33167.html