Literature Review of Strategic Planning for Health Information Management

Title:  Strategic Planning Literature Review

1.0) INTRODUCTION

Healthcare planning can be complicated and challenging. In order to provide access to high quality, patient-centered healthcare, hospitals need to classify future goals and objectives and convey them into meaningful strategies for the organisation. Attaining this necessitates adaptive thinking, clear priorities, strong management, collaboration from staff, and community involvement (Sadeghifar, Jafari, Tofighi, Ravaghi, & Maleki, 2014) (Taiwo & Idunnu, 2007).

This review of literature examines the relationship between employee

This review of literature looked at a selection of information including grey literature, government policy, accreditation material and reviewed journal articles. The search examined general information about the importance of implementing a strategic plan in a hospital setting, and explored factors that might cause the failure of a strategic plan to be executed. It examined the significance of a SWOT analysis and the part it plays in the planning process. It also looked at who the key stakeholders would be, and identified issues effecting Health Information Management in a hospital setting and ways to address those issues. The research supports the commonly held belief that a strategic plan is paramount to effective project management. However, it is clear from the literature that strategic planning is one of the most neglected aspects of health care delivery.

2.0) WHAT IS THE IMPORTANCE OF A STRATEGIC PLAN?

A strategic plan is a systematic step-by-step approach used to scope out future goals and direction of a business. The overall sentiment from the literature reviewed is an organisation that takes the time to look forward and determine where they want their business to go, and how they aim to achieve this, will have the greatest possibility of success (Norris, 2016). Therefore, planning to ensure that resources are available in future years, to achieve the desired objectives and outcomes will lead to continued growth of the company (Garcia, 2016). The planning process involves establishing the most effective method to allow the organisation to reach its specified vision (Terwindt, & Rajan, 2016). However, it is vital that a strategic plan addresses the goals or outcome required, while encompassing all the factors that need to be considered to reach those goals. Some factors to be addressed would include the length of time available, the budget available, staffing requirements and other resources needed. The strategy is required to ensure the goals can actually be met, because a goal without a plan will not succeed (Lofgren, 2018). Studies show the implementation and continual follow up of the plan is more important than the formulation, otherwise the company has nothing more than a well-documented idea (Sial, Usman, Zufiqar, Satti, & Khursheed, 2013).

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The literature shows a strategic plan should clearly identify the current features specific to the business, this can be done using a SWOT analysis. The strategic plan needs to outline the company’s vision for the future, and it also needs to produce a well-defined long-term roadmap, listing the actions required to achieve the desired future situation (Perera & Peiro, 2012). In addition, Varkey & Bennet (2010) propose when a strategic plan is done correctly, organisations can benefit from its team building power, which in turn will drive enthusiasm for prospective change and action.

Stragic planning is one of the most neglected aspects of health care delivery, often being seen as a daunting task that can redirect critical resources. However, studies done in 20 hospitals in Belgrade, between 2006 & 2007, show evidence that training of hospital management staff in strategic planning methods improved the management team’s skills in developing their vision and mission statements, strategic objectives, and an action plan for the hospital (Terzic-Supic et al., 2015).

3.0) WHAT IS A SWOT ANALYSIS?

The acronym SWOT stands for strengths, weaknesses, opportunities and threats analysis, and is a method to assist managers achieve business objectives, and overcome or minimise obstacles to attain the desired outcomes. The SWOT analysis measures information taken from environmental factors (both internal and external) and separates the data into four categories, strengths and weaknesses, and opportunities and threats. In doing a SWOT analysis Ommani (2011) found that the organisation is able to gauge what its true capacity and capabilities are and what they are not, while also looking at possible opportunities and threats to the business.

A SWOT analysis diagram is laid out in a two-by-two matrix format which illustrates positive and negative, internal and external factors effecting a specific project or business. The formatting of the SWOT matrix allows for quick comparison and analysis of competing factors. It becomes the easy foundation for managers to create growth and retrenchment strategies with a clear understanding (White, 2018) (Wang, 2007).

For the purpose of this review I have outlined some examples of strengths and weaknesses, opportunities available and threats posed to a medical records department, set in the context of a period of expansion for the hospital.

SWOT ANALYSIS DIAGRAM

 

INTERNAL

 (THE ORGANISATION)

STRENGTHS

WEAKNESSES

Specialist expertise

Experience and knowledge in managing health information

Security

Filing system

Staff

Encrypted data systems

Central repository

One place where records are stored

Knowledge all in one place allows for sharing and spreading the load

24-hour availability

Take on tasks outside the direct remit of medical records

Recruitment and rostering issues

Elasticity of demand

Seasonality

Turnover of staff

Backfill of emergent leave

Lack of qualified staff (gaps in capabilities of service areas)

Security

Data integrity

Recovery of files

Data upgrades

Legacy records

Storage

Limited space for storage of records

 

OPPORTUNITIES

THREATS

EXTERNAL

(THE ENVIRONMENT)

Expansion of hospital

Additional medical services

Staff development

Knowledge/skills

Succession planning

Security

Cyber attacks

Information governance

Disruption of service

HELPFUL

(TO THE ORGANISATION)

HARMFUL

(TO THE ORGANISATION)

 

3.1) STRENGTHS OF THE BUSINESS

3.1a) Specialist expertise – In any clinical environment, the importance of recording the detail of patient encounters is implicit and starts at the time of clinical care. Specialist knowledge is grown over time and is essential in the support of clinical activity. The area of Health Information Management has become in its own right a highly specialised field with accuracy, integrity and security being far more important than perhaps in non-medical environments.

 

3.1b) Security – The security of medical information is vital, not only so it is available when required but also to underwrite trust relationships between patients and health care providers. The evolution of medical record keeping, most obvious in the transition from paper to digital records, has led to the development of specialized secure data storage and multilayered security encryption. Staff working in this environment are required, and have been developed to have high degrees of integrity and work to a strict code of conduct.

 

3.1c) Central repository – Allows for better security with information and access points being in one place. This centralization means having your primary core of staff all in one place makes for quicker and easier implementation of policy and security changes.

 

3.1d) 24-hour availability – Any medical records department needs to be able to provide patient information outside of business hours or in emergency situations. This 24-hour operation can also provide supports for other health care administrative roles that do not have an out of hours service but may on occasion need tasks completed.

 

3.2) WEAKNESSES OF THE BUSINESS

3.2a) Recruitment and rostering issues – Unpredictable demand of labor within a medical records department can give rise to issues with rostering and consequently staff retention. Patterns of rostering often provide less than fulltime hours across shift patterns that are perceived as covering anti-social hours which can again cause problems with staff retention and overall recruitment. Recruitment problems manifest as lower applicant levels than for other similar administrative positions, this can lead to an inability to recruit qualified staff leaving gaps in capabilities which then require additional resources to be allocated towards training.

3.2b) Security – The transition from analogue (paper) medical records to digital medical records has led to new sets of security problems based around the comparatively easy illicit transmission or recovery of clinical information. Vulnerability through cyber-attacks or accidental or intentional data breaches can have far more wide-spread implications than for instance the loss of an individual paper file. Constant vigilance and development of digital security measures are essential to keep pace with technology and to maintain trust across stakeholder relationships.

3.2c) Data upgrades – The required evolution of digital records to keep pace with updated requirements for data capture changing security threats and the update of the operating platforms is a continuing expense. Investment is not only limited to software development but also into extending downtime practices and the constant training of staff to deal with changes in systems.

3.2d) Legacy records – In today’s technological climate it can be assumed that paper records have been phased out and data capture using analogue methods is either close to or at an end. However, a Norwegian study published in 2008 showed even though paper-based records had largely been removed from the clinical setting, many of the changes to previous workflow practices still remained, in turn limiting the potential of the digital system (Lium, Tjora, & Faxvaag, 2008). Over a decade later we continue to see an appreciable percentage of clinical encounters still recording results on paper, and archived pre-digital paper charts that may need to remain accessible for the life of the patient.

It is considered that the digitization of legacy paper records is cost prohibitive, and therefore these records need to be kept in a secure and accessible facility. The management of contemporary paper based patient information has led to systems being developed that digitize this information and add it to current digital records. 

3.2e) Storage – Although the requirement for physical storage of legacy paper charts is on the decline, the demand for cloud based digital storage is increasing exponentially, especially when held in the context of the need to capture an ever-increasing number of data streams. Reports by the Australian Government Information Management Office [AGIMO] (2013) confirm that 90% of all data generated was done so in the preceding two years alone, with estimates of this increasing to by 44 times between 2009 and 2020 (Commonwealth of Australia, 2013).

3.3) OPPORTUNITIES FOR THE BUSINESS

 

3.3a) Expansion of hospital – Increasing population and urban growth are putting higher demands on the health care sector. This increased demand can be dealt with in two ways either building more hospitals or increasing the capacity of existing facilities (Carrier, Dowling, & Berenson, 2012). Any increase in patient capacity will have an obvious requirement for growth of patient record keeping.

3.3b) Staff development – Growth in the department provides the opportunity to increase the core of experienced and qualified staff. Any increase in staffing should allow easier transitions to cover staff turnover, a wider variety of resources to help with informal training and the ability of the department to promote internally and consolidate work experience. In this way, Jacobs and Washington (2003) hypothesis that any employee improvement training will understandably be connected to higher organisational performance.

 

3.4) THREATS TO THE BUSINESS

 

3.4a Security – One of the primary issues with digital data storage is the secure transfer of information. The constantly evolving nature of cyber-attacks and digital threats translate into an equal constant requirement of investment and development of digital security measurements. Cybersecurity is essential when collecting, storing and transmitting private patient information. Safeguarding personal information is a complicated task for the health sector with major information data breaches growing in number. For example, the Australian Information Commissioner (OAIC) received 15 notifications of health care privacy data breaches affecting 119 individuals from February to March 2018 (OAIC, 2019).

The second most prevalent security risk sits with operator error, either deceptive or negligent behavior on behalf of administrative staff. To counter this constant training and the enforcement of the organisations code of conduct is required. Also required is a review of implementation in changes of best practice oversight of operational procedure to ensure compliance. The OAIC reported an incident where on 5 September 2016, the Australian Red Cross Blood Service database, which was managed by a contracting firm, inadvertently uploaded to a public-facing web server, around 550,000 potential blood donor’s private data (OAIC, 2017).

 

3.4b) Disruption of service – The literature suggests the negative impact on hospital services is far reaching in times of extreme weather events such as flood and fire, with hospitals taking in a greater number of disaster patients, as well as patients with chronic illnesses who need access to medical care. Electricity is vital to health care services, because most other services rely on it in order to function, loss of power poses a serious patient safety risk. Surprisingly there is little peer reviewed literature on significant public health issue (Klinger, Landeg, & Murray, 2014).

As digitising patient records become more the norm, the side effects of an unplanned system downtime can result in the loss of critical data, will limit access to electronic patient information, cause disruption to clinical workflow, and frustrate both staff and patients alike (Coffey, Postal, Houston, & McKeeby, 2016). 

4.0) FAILURE TO IMPLEMENT A STRATEGIC PLAN

Studies show the primary reason for failure to implement a strategic plan is a disconnect between the strategists and the implementers. The lack of understanding of the company’s mission, vision and targets and an appropriate framework by strategy makers, to guide management and staff towards the desired outcomes of the organisation (Sial et al., 2013). Other significant factors include ineffective leadership and communication between management and staff regarding the formulation of plans, by the upper executive, without a full understanding of how they will be implemented by people further down the workforce. (Chepkoech, & Waiganjo, 2015).  

5.0) CURRENT ISSUES IMPACTING HIM

5.0a) EHR – Key challenges facing HIM today revolve around changes in the capture, storage, and retrieval of clinical data. Health information managers are experiencing an enormous change in the quantity of health care information being generated daily. The most impactful of these being the ongoing transition from analogue paper-based patient record keeping to a partial or full digital record. Of these changes, the most obvious is the national rollout of the Electronic Health Record (Wissman, 2015).

5.0b) Recruitment – Increased demands on HIM units based on the rapid changes and upgrades of systems have in turn led to an increased demand for HIM’s. Even though HIM has a direct career path there are still a shortage of candidates to fill the posts available (Wissman, 2015).

5.0c) Training – The changing face of technology in HIM has led for an increase in the understanding in technology based training of staff and adapting of policy to account for the evolution of health care systems.

 

5.1) STRATEGIC SOLUTIONS TO ADDRESS THESE ISSUES

One of the constants of the contemporary HIM landscape is the constant need to upgrade in response to collection and security requirements. Controlling this change to ensure positive outcomes involves a number of important factors including.

Predicting and responding to changes before they have an impact.

Consulting with stakeholders at all levels of HIM workforce and using their feedback to drive change that is positive and compatible rather than unpredictable.

Raising the profile of careers in HIM, offering incentives to those already employed in HIM to further develop their careers, and encouraging investment in industry comparative salaries for HIM staff.

6.0) STAKEHOLDER INVOLVEMENT IN STRATEGIC PLANNING

6.0a) What is a stakeholder?

A stakeholder is defined as “one who is involved in or affected by a course of action” (Merriam-Webster, 2019).  This can be any individual, organisation or group who can affect or be affected by the outcome or process of the project. Stakeholders can be either internal or external to the organisation. Having both internal and external stakeholders with a vested interest in the project, involved in the development of the strategic plan, will bring with it valuable insight, a greater understanding, and a vision for the organisations future (Posey, 2019). A study by Chepkoech and Waiganjo (2015) found Research has shown that more successful outcomes are genereatedd when stakeholders are involved in all stages of strategic planning. This allows for a greater sense of ownership leading to a more likely acceptance of any change (Chepkoech and Waiganjo, 2015).

6.0b) Stakeholder analysis

Most projects involve a variety of stakeholders with competing interests and expectations. Undertaking a stakeholder analysis during planning and development stage of a project allows for the project managers to engage in conversations with stakeholders. These conversations may assist understanding their intentions, and interest in the project, as well as what influence they could have on the decision-making process. This information will also aid project managers in developing strategies to manage stakeholders. Successfully managing stakeholder expectations will ensure their continued support (Brugha & Varvasovszky, 2000).

Primary stakeholders would be those affected by change and implementation of processes, and those that control the resources that govern the scope of the implementation. Those identified for this exercise would include health care professionals, patients and community, the budgeting authority, HIM team affiliates, and clinical staff.

6.0c) Reasons for resistance

The literature has shown many reasons for stakeholder resistance regarding proposed strategy changes ranging from uncertainty of what the objective of the project is, to lack of conviction because they may not feel the change is necessary. During the time of transition management needs to ensure good communication with all stakeholders to allow for all involved to share their feelings and incorporate their perspectives and opinions regarding any changes to be made in the project implementation (Chepkoech, & Waiganjo, 2015).

7.0) CONCULSION

For a strategic plan to go through the stages of planning, approval, and implementation, it is clear from the literature that involvement and consultation with stakeholder groups at all stages is essential. This process ensures stakeholder ownership, which reduces resistance and underwrites a successful outcome. HIM’s must respond to pressures by evaluating initiatives and ensuring they have a plan in place, and are dynamic enough to adjust to these changes.

 

Resources

 

Biggs, A. (2018). Recent developments in federal government funding for public hospitals: a quick guide. Retrieved from https://parlinfo.aph.gov.au/parlInfo/download/library/prspub/6180516/upload_binary/6180516.pdf

Brugha, R., & Varvasovszky, Z. (2000). Stakeholder analysis: a review. Health Policy and Planning, 15(3), 239-246. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11012397

Carrier, E. R., Dowling, M. & Berenson, R. A. (2012). Hospitals’ geographic expansion in quest of well-insured patients: will the outcome be better care, more cost, or both?. Health Affairs, 31(4), 827-835. Retrieved from https://www.healthaffairs.org/doi/10.1377/hlthaff.2011.1085

Chepkoech, C. & Waiganjo, E. W. (2015). Role of stakeholders in the implementation of strategic change in commercial banks in Kenya: A case study of National Bank of Kenya Limited. International Academic Journal of Human Resource and Business Administration, 1 (5), 55-82. Retrieved from http://www.iajournals.org/articles/iajhrba_v1_i5_55_82.pdf

Coffey, P. S., Postal, S., Houston, S. M., & McKeeby, J. W. (2016). Lessons Learned from an Electronic Health Record Downtime. Retrieved from https://perspectives.ahima.org/lessons-learned-from-an-electronic-health-record-downtime/

Commonwealth of Australia. (2013). The Australian public service big data strategy: improved understanding through enhanced data analytics capability. Canberra: Commonwealth of Australia. Retrieved from https://www.finance.gov.au/sites/default/files/Big-Data-Strategy.pdf

Department of Health. (2016). WA Health Information Management Strategy 2017–2021. Retrieved from https://ww2.health.wa.gov.au/~/media/Files/Corporate/Reports%20and%20publications/Information%20management%20strategy/WA_Health_Information_Management_Strategy_2017-2021.pdf

Department of Health and Human Services. (2017). Strategic planning guidelines for Victorian health services. Retrieved from https://www2.health.vic.gov.au/hospitals-and-health-services/funding-performance- accountability/planning

Fenton, S. H., Low, S., Abrams, K. J., & Butler-Henderson, K. (2017). Health Information Management: Changing with Time. Yearbook of medical informatics, 26(1), 72–77. doi:10.15265/IY-2017-021

Garcia E. V. (2016). Strategic planning: a tool for personal and career growth. Heart Asia, 8(1), 36–39. doi:10.1136/heartasia-2015-010684

Godiwalla, Y., & Godiwalla, S. (1991). Strategic management in hospitals. Journal of Health and Human Resources Administration, 13(3), 336-351. Retrieved from http://www.jstor.org/stable/25780452

Hinkelmann, J., Hasebrook, J. P., Volkert, T., & Hahnenkamp, K. (2017). Growing Pains at Hospitals: Opportunities and Issues of Service Expansion in Maximum Care. Frontiers in medicine, 4, 90. doi:10.3389/fmed.2017.00090

Houser, S. H., & Johnson, L. A. (2008). Perceptions regarding electronic health record implementation among health information management professionals in Alabama: a statewide survey and analysis. Perspectives in health information management, 5, 6.

Houser, S. H., Tesch, L., Hart-Hester, S., & Dixon-Lee, C. (2009). Roles and challenges of the health information management educator: a national HIM faculty survey. Perspectives in health information management, 6, 4.

Jacobs, R. L., & Washington, C. (2003). Employee development and organizational performance: a review of literature and directions for future research. Human Resource Development International, 6(3), 343-354. Doi: 10.1080/13678860110096211

Klinger, C., Landeg, O., & Murray, V. (2014). Power outages, extreme events and health: a systematic review of the literature from 2011-2012. PLoS currents, 6, ecurrents.dis.04eb1dc5e73dd1377e05a10e9edde673. doi:10.1371/currents.dis.04eb1dc5e73dd1377e05a10e9edde673

Lium, J. T., Tjora, A., & Faxvaag, A. (2008). No paper, but the same routines: a qualitative exploration of experiences in two Norwegian hospitals deprived of the paper based medical record. BMC medical informatics and decision making, 8, 2. doi:10.1186/1472-6947-8-2

Lofgren, J. (2018, February 28). How to improve your strategic plan. Retrieved from https://www.forbes.com/sites/forbescoachescouncil/2018/02/28/how-to-immediately-improve-your-strategic-plan/#2682a9d625c2

Menachemi, N., & Collum, T. H. (2011). Benefits and drawbacks of electronic health record systems. Risk management and healthcare policy, 4, 47–55. doi:10.2147/RMHP.S12985

Nardi, E. A., Lentz, L. K., Winckworth-Prejsnar, K., Abernethy, A. P., & Carlson, R. W. (2016). Emerging Issues and opportunities in health information technology. Journal of the National Comprehensive Cancer Network, 14(10), 1226-1233. Retrieved from https://jnccn.org/abstract/journals/jnccn/14/10/article-p1226.pdf

Norris, T. (2016, February 25). Why is strategic planning so important?. Retrieved from https://www.healthcaremgmt.com/why-is-strategic-planning-so-important/

Office of the Australian Information Commissioner. (2017). Donate Blood.com.au data breach (Austalian Red Cross Blood Service). Retrieved from https://www.oaic.gov.au/resources/privacy-law/commissioner-initiated-investigation-reports/donateblood-com-au-data-breach-australian-red-cross-blood-service.pdf

Office of the Australian Information Commissioner. (2019). Clarification regarding health data breaches. Retrieved from https://www.oaic.gov.au/media-and-speeches/statements/clarification-regarding-health-data-breaches

Perera, F. de P. R., & Peiro, M. (2012). Strategic planning healthcare organisations. Rev Esp Cardiol, 65(8), 749-754. Retrieved from https://www.revespcardiol.org/en-pdf-S188558571200182X

Posey, P. A. (2019). Stakeholder engagement for strategic planning. Retrieved from http://www.everettcc.edu/ccec/enewsletters/stakeholder-engagement-strategic-planning/

Sadeghifar, J., Jafari, M., Tofighi, S., Ravaghi, H., & Maleki, M. R. (2014). Strategic planning, implementation, and evaluation processes in hospital systems: a survey from Iran. Global journal of health science, 7(2), 56–65. doi:10.5539/gjhs.v7n2p56

Sial, A., Usman, M. K., Zufiqar, S., Satti, A. M., & Khursheed, I. (2013). Why do public sector organisations fail in implementation of strategic plan in Pakistan?. Public Policy and Adminstrative Research, 3(1), 33-41. Retrieved from https://pdfs.semanticscholar.org/c767/0a986195df3610fe95e36845f3bb35f9c016.pdf

Sittig, D. F., Wright, A., Coiera, E., Magrabi, F., Ratwani, R., Bates, D. W., & Singh, H. (2018). Current challenges in health information technology–related patient safety. Health Informatics Journal. https://doi.org/10.1177/1460458218814893

Smith, J. (1995). The strategic planning of health management information systems. Australian Health Review, 18(4), 26-42. Retrieved from http://www.publish.csiro.au/AH/pdf/AH950026

Speziale, G. (2015). Strategic management of a healthcare organization: engagement, behavioural indicators, and clinical performance, European Heart Journal Supplements, 17(A), 3–7. Retrieved from https://doi.org/10.1093/eurheartj/suv003

Stakeholder. 2019. In Merriam-Webster.com. Retrieved August 29, 2019, from https://www.merriam-webster.com/dictionary/stakeholder

Strategic Planning: Why It Makes a Difference, and How to Do It. (2009). Journal of oncology practice, 5(3), 139–143. doi:10.1200/JOP.0936501

Stausberg, J., Koch, D., Ingenerf, J., & Betzler, M. (2003). Comparing paper-based with electronic patient records: lessons learned during a study on diagnosis and procedure codes. Journal of the American Medical Informatics Association : JAMIA, 10(5), 470–477. doi:10.1197/jamia.M1290

Taiwo, A. S., & Idunnu, F. O. (2007). Impact of strategic planning on organizational performance and survival. Research Journal of Business Management, 1(1), 62-71. DOI: 10.3923/rjbm.2007.62.71 

Terwindt, F., & Rajan, D. (2016). Strategic planning: transforming priorities into plans. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/250221/9789241549745-chapter5-eng.pdf;jsessionid=9B7A173BE80F4D3B31BDD399A74CF360?sequence=17

Terzic-Supic, Z., Bjegovic-Mikanovic, V., Vukovic, D., Santric-Milicevic, M., Marinkovic, J., Vasic, V., & Laaser, U. (2015). Training hospital managers for strategic planning and management: a prospective study. BMC medical education, 15(25). doi:10.1186/s12909-015-0310-9

Varkey, P., & Bennet, K. E. (2010). Practical techniques for Strategic planning in health care organisations. PEJ, 36(2), 46-48. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/20411847

Wang, K. (2007). A process view of SWOT analysis (Doctoral dissertation, Tatung University, Taipei, Taiwan). Retrieved from http://journals.isss.org/index.php/proceedings51st/article/viewFile/470/242..

Washington, L. (2017). Strategic alignment: the driving force for information governance. Journal of AHIMA 88, 1, 40-43.

White, S. K. (2018). What is SWOT analysis? A strategic tool for achieving objectives. Retrieved from https://www.cio.com/article/3328853/swot-analysis-defined.html

Wissmann, S. (2015). Addressing challenges to the health information management profession: an Australian perspective. Retrieved from https://perspectives.ahima.org/addressing-challenges-to-the-health-information-management-profession-an-australian-perspective/

Zeps, A., & Ribickis, L. (2015). Strategy development and implementation – process and factors influencing the result: case study of Latvian organisations. Procedia Social and Behavioral Sciences, 231, 931-937. doi: 10.1016/j.sbspro.2015.11.507