MBA6271 Capella Strategic Management Plan For Healthcare Organizations

attachment_2External Environment Report

Institution Affiliation

Instructor’s Name

Student’s Name

Course Code

Date

External Environment Report

Community Hospital Health Care Systems: St Catherine Hospital

Introduction

Due to increased demand for quality health care, hospitals have been changing their internal management systems by incorporating the goals that suit the current market standard however it has been a significant challenge to manage and cope with the external environment for St. Catherine Hospital. The facility has been known for continuous improvement in the service delivery services in Chicago. The administrators and the medical staff members play a vital role in helping the implementation of the strategic plan process that aims to align the organization service quality with the current market demand and an increase the staff members. This paper will discuss some of the external market trends that have an impact on the strategic plan. Also, the report will address some of the roles played by key external stakeholders in the strategic plan and the barriers to achieving this plan. Lastly, the solutions for the uncertainties or the obstacles to plan success will be discussed.

Market trends that affect strategic plan

External environment factors that affect the plan to align the organization service quality with market demand and the increase of staff members include one, Competition- In the United States, many private and public community health centers are offering better and affordable health services compared to St Catherine Hospital. Therefore, increased competition reduces the revenue and number of customer’s visiting the facility. The plan to hire more workers has faced challenges as the compensation of medical and non-medical staff demands is very high, as the competitors are willing to pay more wages to the workers (Barney, 2009). Secondly, technological factors- due to continuous improvement in technology, demand for better services has increased. But the cost of purchasing these surgical machines is very high. The management may decide to suspend plan implementation so that it can acquire some of the modern medical equipment. Lastly, demographic changes- over the years, the East Chicago population has increased by 25% for the last five years (Bryson, 2018). Therefore, there has been an increase in patients visiting the facility, but the number of workforces is inadequate. At the same time, social and cultural background changes affect the implementation of the hiring process and service quality of the new workers. This is because, individuals, beliefs, values, and practices differ hence the need to have training programs for evidence-based practices.

The role played by Key External Stakeholders

External stakeholders are the groups outside the business that play significant roles in the success of the company, they can influence decision-making, but also they are affected by the business activities. Arguably, one should note that these groups hold the most influence on the long-term operation of the hospital. Some of the stakeholders and the critical roles they play in the strategic plan success include Government agencies- The State, the federal and local government want the business to offer quality services to the society and contribute in the national building through tax payment. The taxes collected through different avenues add to the support of government operations. Therefore, the need for quality service improvement and the hiring of more workers will be supported by the government. Hence the plan will have a strong background to help its suggestions. Secondly, Customers- these are the clients visiting the hospital; they expect the facility to produce quality service at reasonable prices.

Further, the availability of resources for such staff members and modern equipment affect their decision. Therefore, the strategic plan will be faced with a challenging situation since clients will demand better services. Thirdly, the Shareholders- these are individuals or corporates that have invested in the facility as they ensure the firm continues to run correctly to maximize their wealth. Due to their interests, they may opt not to support an increase in the workforce if they suspect that the income will reduce.

Another Stakeholder is the creditors; some provide financial capital, raw materials, and services to the hospital. Therefore, they influence the firm’s decision based on the demands that they make. In the event the loan interest increases, it will affect the firm’s cost (Coulter, 2002). Also, request for payment, once they fall due, can reduce the chances for the managers to consider funding the plan to hire more workers and buy new equipment’s. Another group is the Suppliers- This group expects the hospital to continue buying their products such as medicine, laboratory equipment’s, surgical machines, and computer software and hand wares among others.  Once they make a proposal to the management on the need to make essential orders due to possible changes in market prices, the strategic plan can be affected, and its implementation might be suspended.

Lastly, the Society as a whole or local community impact the decisions made. That is, they expect most of the workers to be hired from the locality; since they are the immediate possible clients and have the best interest of the firm. The firm is expected to consider their demands; hence the strategic plan can be affected positively.

Barriers to achieving the objectives

Despite the efforts put in the meeting the goals, some barriers affect its success, some of these uncertainties include one, changing strategies: The hospital’s constant changes to its policy limits the success of the plan. This is because the administrators are continually assessing performance to keep pace with today’s business environment which leads to the changes in priorities of the hospital. Secondly, lack of adequate resources; accomplishing any objective in business is dependents on three key factors- people, time and money (Bryson, 2018). Since there is a demand for quality the funds to hire more workers are inadequate.

Similarly, the time set for the plan is not favoring the objectives of the firm. Lastly, the perceived priority: Achieving goals needs to be continuously discussed in the weekly meetings; however, the management perceives that the objectives are no longer a priority for the business and disregards them. On the other hand, these barriers can be overcome by constant communication with the hospital authority to request funds and people to help in the implementation. Also, the management can develop policies that will ensure the approved plans are implemented within the set period. MBA6271 Capella Strategic Management Plan For Healthcare Organizations

Reference

Barney, J. B., & Hesterly, W. S. (2009). Strategic management and competitive advantage. Upper Saddle River, NJ: Pearson Education.

Bryson, J. M. (2018). Strategic planning for public and nonprofit organizations: A guide to strengthening and sustaining organizational achievement. John Wiley & Sons.

Coulter, M. K., & Coulter, M. K. (2002). Strategic management in action (p. 7). Upper Saddle River, NJ: Prentice Hall.

attachment_3Strategic Management Plan

Francesca Wilder

MBA-FP6271

Table of content

Plan Overview…………………………………. 3

External Environment Review…………………. 4-6

Internal Environmental Analysis……………… 6- 8

Organizational Direction………………………. 8-11

Strategy Formation……………………………. 12- 15

Reference page………………………………… 16-17

Strategic Management Plan

Plan Overview

Due to increased demand for quality health care, hospitals have been changing their internal, external as well as formation systems by incorporating the goals that suit the current market standard however it has been a significant challenge to manage and cope with the external environment for St. Catherine Hospital. The facility has been known for continuous improvement in the service delivery services in Chicago. The administrators and the medical staff members play a vital role in helping the implementation of the strategic plan process that aims to align the organization service quality with the current market demand and an increase the staff members. This paper will discuss some of the external market trends that have an impact on the strategic plan. Also, the report will address some of the roles played by key external stakeholders in the strategic plan and the barriers to achieving this plan. Additionally, the solutions for the uncertainties or the obstacles to plan success will be discussed. Moreover, this report will discuss some of the roles played by the significant internal stakeholders of the firm in the strategic plan. Secondly, the report will discuss internal trends and uncertainties against the project and the analysis of the financial performance of the facility and how it enhances the hospital service delivery. Furthermore, this paper will discuss some of the strategic planning outcomes, critical components of the planning the process and schedules of the plan. Additionally, the paper will analyze the direction which the organization will implement to ensure that there is a smooth running and meeting the needs of the customers. Lastly, the paper will analyze some for the past strategies taken by the hospital to determine the reasons for its success and failures. MBA6271 Capella Strategic Management Plan For Healthcare Organizations

External Environment Review

Due to increased demand for quality health care, hospitals have been changing their internal management systems by incorporating the goals that suit the current market standard however it has been a significant challenge to manage and cope with the external environment for St. Catherine Hospital. External environment factors that affect the plan to align the organization service quality with market demand and the increase of staff members include one, Competition- In the United States, many private and public community health centers are offering better and affordable health services compared to St Catherine Hospital. Therefore, increased competition reduces the revenue and number of customer’s visiting the facility. The plan to hire more workers has faced challenges as the compensation of medical and non-medical staff demands is very high, as the competitors are willing to pay more wages to the workers (Barney, 2009). Secondly, technological factors- due to continuous improvement in technology, demand for better services has increased. But the cost of purchasing these surgical machines is very high. The management may decide to suspend plan implementation so that it can acquire some of the modern medical equipment. Lastly, demographic changes- over the years, the East Chicago population has increased by 25% for the last five years (Bryson, 2018). Therefore, there has been an increase in patients visiting the facility, but the number of workforces is inadequate. At the same time, social and cultural background changes affect the implementation of the hiring process and service quality of the new workers. This is because, individuals, beliefs, values, and practices differ hence the need to have training programs for evidence-based practices.

External stakeholders are the groups outside the business that play significant roles in the success of the company, they can influence decision-making, but also they are affected by the business activities. Arguably, one should note that these groups hold the most influence on the long-term operation of the hospital. Some of the stakeholders and the critical roles they play in the strategic plan success include Government agencies- The State, the federal and local government want the business to offer quality services to the society and contribute in the national building through tax payment. The taxes collected through different avenues add to the support of government operations. Therefore, the need for quality service improvement and the hiring of more workers will be supported by the government. Hence the plan will have a strong background to help its suggestions. Secondly, Customers- these are the clients visiting the hospital; they expect the facility to produce quality service at reasonable prices.

Further, the availability of resources for such staff members and modern equipment affect their decision. Therefore, the strategic plan will be faced with a challenging situation since clients will demand better services. Thirdly, the Shareholders- these are individuals or corporates that have invested in the facility as they ensure the firm continues to run correctly to maximize their wealth. Due to their interests, they may opt not to support an increase in the workforce if they suspect that the income will reduce.

Another Stakeholder is the creditors; some provide financial capital, raw materials, and services to the hospital. Therefore, they influence the firm’s decision based on the demands that they make. In the event the loan interest increases, it will affect the firm’s cost (Coulter, 2002). Also, request for payment, once they fall due, can reduce the chances for the managers to consider funding the plan to hire more workers and buy new equipment’s. Another group is the Suppliers- This group expects the hospital to continue buying their products such as medicine, laboratory equipment’s, surgical machines, and computer software and hand wares among others.  Once they make a proposal to the management on the need to make essential orders due to possible changes in market prices, the strategic plan can be affected, and its implementation might be suspended.

Despite the efforts put in the meeting the goals, some barriers affect its success, some of these uncertainties include one, changing strategies: The hospital’s constant changes to its policy limits the success of the plan. This is because the administrators are continually assessing performance to keep pace with today’s business environment which leads to the changes in priorities of the hospital. Secondly, lack of adequate resources; accomplishing any objective in business is dependents on three key factors- people, time and money (Bryson, 2018). Since there is a demand for quality the funds to hire more workers are inadequate. MBA6271 Capella Strategic Management Plan For Healthcare Organizations

Similarly, the time set for the plan is not favoring the objectives of the firm. Lastly, the perceived priority: Achieving goals needs to be continuously discussed in the weekly meetings; however, the management perceives that the objectives are no longer a priority for the business and disregards them. On the other hand, these barriers can be overcome by constant communication with the hospital authority to request funds and people to help in the implementation. Also, the management can develop policies that will ensure the approved plans are implemented within the set period.

Internal Environment Analysis

Internal stakeholders in business play a significant role in the running of the firm. These groups or individuals are within the firm, and their influence can be managed or controlled. Some of the roles played by each stakeholder in this firm include Managers- Managers are responsible for organizing, planning, coordinating and monitoring the hospital’s resources. These individuals decide the projects that need to be undertaken for every department, the workers, time and funds. Therefore, the strategic plan relies on its final decision. They can approve funds, human resources and time for the plan implementation. Constant discussion with the managers about the plan help in tabling the needs, reasons and the facts based on the current market forces (Morris, 2017).

Secondly, Employees- These are significant stakeholders in the Healthcare, some of the employees found in this facility include, doctors, Physicians, engineers, Informational technology workers, Nurses, administrators, cooks, security guards, among others. They play significant roles in the implementation of the plan. In the event they are not included in the process, they may decide not to support the strategy. Further, the remunerations and other compensation programs need to be observed to ensure they run the facility efficiently. The last group of internal stakeholders found in this hospital is the investors and the board of directors. Any major implementation plan requires their approval; however, in this case, the hiring process and the purchase of service equipment need manager’s approval; thus their influence cannot entirely affect the plan.

Some of the emerging trends are employee turnover; competitors have been taking the best workers from St. Catherine by proposing better employment terms. Again, the technology changes and demand for healthier diets has forced many of the public to visit the hospital for a medical check, hence increasing demand for more workers. Another common trend is the change in management where the policies and procedures are regularly amended. Such issues have affected the strategic plan process due to lack of adequate support and resources. Some of the qualitative research methods that can be used to uncover the trends in individual thoughts and opinions about the plan include group discussions, one-on-one interviews, and observations. On the other hand, quantitative research approach can be undertaken where the study can be carried out using surveys (questionnaires), random sampling, and correlational research. The best method would be to use survey research and individual interviews (Morris, 2017). MBA6271 Capella Strategic Management Plan For Healthcare Organizations

A barrier is an obstacle that affects or prevents a given policy from taking effect or being implemented or limits how it is supposed to be implemented. Increased changes in management decisions limit the plan to purchase modern types of equipment for improved quality and hiring more staff at St. Catherine. Managers have been setting different agendas for the program to ensure that other projects are implemented. Also, Lack of adequate funds- the finance department seems to have been directed not to channel funds, hence limiting the hiring process of new staff members. Another barrier is the approach that managers think the plan is too impractical: They feel that it looks good on paper, but it is way too lofty for the firm.

Another barrier that affects the plan is the increased distractions; the managers are preoccupied with immediate plans and urgent needs; hence, lose sight of the strategic plan. Also, employees may find it unnecessary for the firm to hire more workers as some may be insecure about losing their position and benefits (Carroll, 2016).  The fear of the unknown by employees can lead to failed implementations process. Lastly, the managers may think the plan is too cumbersome and costly for the hospital thus making it difficult to implement.

Organization Direction

Every organization is expected to undertake strategic planning activities to ensure that it meets the expected market demands as well as adapt to new technology changes. Some of the direction that St. Catherine Community hospital focuses on are quality service delivery and increased staff members. The Hospital reports indicate that the facility has been in operation for decades; its reputation for quality service has continually grown, but the management needs to continue advancing and improving on the same (Abell, 2010). The focus is on the strategic differentiation plan and Aligning the organization with the current market standards and requirement. These outcomes can be measured by identifying the number of patients served and their reviews of services.  The specific target is to promote quality service delivery and increase staff members.

The organization direction of St Catherine Community hospital provides a comprehensive view of the key components that facilitate the organization’s services delivery. Some of these elements include the external environment factors including competition, economic and political issues in the health industry. Secondly, the mission statement- the hospital is committed to providing high-quality care in the country at an affordable cost by respecting cultural behaviors, religion and race as well as observing the wellness of the people. The third component is the vision statement; the hospital targets to capitalize and on opportunities to increase the operating efficiency and overall service delivery for patients, employees, and physicians.

Planning process components that are part of the firm’s objectives are its values; being compassionate, serving the community and valuing human dignity in the hospital. Lastly, the firm focuses on internal factors such as the medical staff, nurses, administrators, and health care management (Bryson, 2018). The employees of the organization help in establishing a reliable strategy that enhances the quality of the service in the hospital; therefore, the health professionals provide exceptional care for the patients. Hence, the planning process is to ensure that the responsibilities of the administrators are performed as well as avail adequate resources for better services. As a non-profit organization, the health care center offers numerous free programs and support for the community members. The visions statement enables the firm to continue serving and providing special events to improve the quality of life in Chicago (Bryson, 2018).

The Health care system management prioritizes some of the key components in planning and preparing the organization for quality service delivery. The schedule begins by clarifying the organization vision, that is, the purpose of setting the goals as both the short- and long-term objectives are defined in this stage. The goals are expected to be realistic and match the values of the company. Secondly, gathering and analyzing information about the firm and the planned changes enable efficient utilization of the data. The schedule is established by setting the available number of workers, daily patient’s reports, and the number of non-medical staff members. Therefore, the plan initiatives are expected to support the mission of the hospital and provide the information on the expected threats and opportunities by the organization. Thirdly, the schedule allows the developed alternatives and approaches to improve the formulation of the defined goals and objectives at each step of the plan. Lastly, the program involves implementations and evaluation of the plan to ensure the overall work and expected outcome is obtained. St Catherine Hospital management and employees remain committed to serving and managing the resources available (Bryson, 2018).  MBA6271 Capella Strategic Management Plan For Healthcare Organizations

The success of an organization is determined by the level of commitment and planning that is put by the management. Therefore, this facility has been in operation for many years, which means that the experience and the efforts that have put by each staff member in the past has contributed to the current successes.  Some of the strategies that were used in the past include Structuralism- this approach involved arraigning the hospital resources and operations to fit the existing market demands and conditions. The firm structured the ordering process for medical equipment using the supply chain method; this process ensured that quality, standardized equipment, and medicine were supplied to the firm. The model was more rigid as it was used for over five decades before changes were done. Another strategy used was cost leadership (Goldstein, 2015). This approach targeted cost of offering services by establishing the business networks. Lastly, the firm focused on the methods that either served cost leadership or service differentiation to facilitate competition in the market.

Some of the factors that contributed to the success of the facility include highly trained workers; the employees working for the hospital had important qualification as their service delivery was tremendous. Also, the firm used the aids funds and government loans to fund some of its operations which enhanced its efficiency and reliability in the market. Besides, the firm’s location contributed to its success at was easily accessible and the population of the residence was very high; hence the demand for the service increased.

This information can be useful in improving the planning process as it provides an essential background that shows the factors that contributed to the success of the firm. Further, strategizing on the ways to hire more workers, it will be necessary to refer the cost leadership and the differentiation approach taken by the management when managing the available resources in the company. Also, past information will help to avoid possible mistakes that might cause damages for the firm. It will be useful to incorporate some of the quality standards that the firm was offering in the 1980s into the future. This is because the reputation of the firm during those years was very positive, as the customer opinions and reviews provide an insight on what can be done for patients.

Strategy Formation

Obtaining the best steps for the success of the healthcare is achieved by creating the best strategies that fit in the objectives of the firm. Therefore, the public and private health sectors are providing the most efficient service to the clients. Consequently, St Catherine Hospital has established the most appropriate strategic plan to ensure that service delivery and quality is improved. This paper intends to discuss and establish a strategic management plan that will ensure successful implementation of the plan. It will discuss some of the external and external environment strategies that can be implements, the objectives and the financial plan to establish the plan in the business. MBA6271 Capella Strategic Management Plan For Healthcare Organizations

Over the years, quality health care services have been the objective of various hospitals, home cares and the providers. Doctors, nurses and physicians have been focusing on improving the quality of the service in the sector. It is the responsibility of every care provider to ensure that patients receive the best medical care without undergoing prejudices or discrimination. Further, affordability is an important aspect as the economic condition of the residents in Chicago does not enable majority of the population to pay for expensive and quality medical services. The strategies that the hospital management is expected to implement are on the improved quality of health care and increased workers to ensure efficient and effective service delivery. Quality services can be improved by having more workers since therefore skills will be used to operate the new equipment’s. Therefore, the objective of the firm is to establish the best methods to convince the internal stakeholders involved in decision making to support the plan.

The changes that are expected to be taken in the facility presented both challenges and opportunities, however, the best approaches and key methods targets the ideas of the possible changes that can be done.  The mission and vision statement of the organization helps in managing and improving the services of the firm; employees provide wide range of quality services to the clients. The main objective for St Catherine Hospital is to acquire new equipment’s that will enhance adequate service delivery within the facility, the approach will enable the firm to hire new workers to increase the number of medics and non-medical staff in the facility. By aligning the organization with the current market standards, the changes can be managed and measured by identifying the number of patients visiting the hospital to facilitate the best strategic plan. The initiatives put in place focus on mobilizing the external stakeholders to support the plan; this can be achieved by sharing the need to have the best standards and manage the cost. Lastly, the internal stakeholders such the managers, employees and the board members are expected to provide adequate resources and support the organization objectives (Abell, 2010).

St Catherine Hospital managers provide a wide and sustainable approach that enhances the skills of workers to support new standards. Some of the methods put in place by the organization to achieve these objectives include, connecting the plan with the firm’s mission; to reinvest capital upgrades and technologies to ensure quality services is offered by the firm. Secondly, to bring the top management on board; it can be achieved by preparing a comprehensive plan on the need and the set standards that will facilitate growth and service delivery in the organization (Dent, 2017).  The top managers are essential key individuals in the implementation of the strategy in the organization. Also, it would be appropriate to inform the employees on the impending changes. This would ensure that constant resistance is eliminated since the primary objective is to diversify the operation of the facility and technology (Klein, 2016). MBA6271 Capella Strategic Management Plan For Healthcare Organizations

These methods are appropriate for the success of the firm and its objectives as they ensure the resources allocated by the management to implement the strategy are fully utilized and supplied. Every stakeholder in the organization plays a key role in ensuring that resources are diversified and utilized appropriately. At the same time, the Health care system management prioritizes some of the key components in organization service delivery. The goals set are realistic and achievable since the plan presents the number of works expected to be hired with roles that they are expected to play in the hospital (Johns Hopkins, 2013). The Plan schedule is established by identifying the number of workers available for the facility. Finally, by analyzing the past strategies, planning of the firm’s resources is maintained and fully established; hiring qualified staff members helps the firm to utilize resources without wastage.

Regardless of the efforts put in place there are barriers and constraints that affects the support of the objectives towards the implementation and management of the resources in the organization. The healthcare center provides adequate resources for the workers and the patients. However, the government regulatory policies have been demanding for constant implementation of various polices that are costly to the organization.  Another constraint that affects the firm is the increased cost of management and supply of the resources. Purchase of new equipment’s requires money, however the creditors are demanding for higher interest charges and short repayment period for the funds. Thirdly, there are inadequate skills in the facility to run the operations and training for the new workers. The current staffs members are use traditional systems of operations which do not meet the expected demand for the firm. Lastly, increased cost of living has resulted to inflation due to price increase. Such factors limit the number of patients visiting the facility hence reducing the amount of revenue creation

The management has put in place efficient mechanisms that ensure that the resource utilization and supply is undertaken appropriately. Some of the solutions that are put in place in this organization to support the objectives and implementation process include debt financing from financial institution charging lower interests; this approach allows the firm to undertake the best practices and needs in the paying low charges for a long term loan. Secondly, the firm needs to adjust the charges to ensure that changes in economic standard do not limit patients from accessing the medical service. Lastly, engaging stakeholders tasked with the firm’s project implementations (Niles, 2010). This approach will ensure that every party is brought on board about the expected changes in the firm to ensure that they understand and provide resources and time for the implementation of the goals.

The hospital management expects every stakeholder to supply and support the diversity in service delivery and resource management. Some of the recommendation that would support these objectives includes training and development of the workers; employees play a major role in the success of the health care center hence they need to be trained and supported on the best approaches to serve clients appropriately. Secondly, the strategic plan should incorporate the society by requesting application from the qualified personnel within the firm’s location (Howard, 2015). Lastly, ensuring equal distribution of resources to all departments responsible for the organization objectives is important.

Some of the financial requirements expected to meet the objectives include short term budgeting of the resources and identifying the organizations external environment factors. This approach will ensure that the funding of these services is established by the finance manager. Again, the plan requires income projections to be made to allow the hospital manger to understand the need for change. Lastly the need for an expense budget and the expected cash flows for the organization will facilitate service delivery in the hospital through plan implementation (Bryson, 2018).

The best recommendation that will make the firm to improve its current position in the industry and the serve the customers appropriately is by acquiring new modern equipment’s and hiring new skilled workforce. The objectives of the plan support the firm strategies and service delivery. Further, the implementation plan provides the factors that support the changes in the firm. Managing the available resources in the company will enhance and facilitate workers service delivery (Mead, 2018). MBA6271 Capella Strategic Management Plan For Healthcare Organizations

In Summary, the strategic management plan focuses on using the hospitals mission, vision and values to evaluate the steps that can be put to address the external stakeholders and internal stakeholder in supporting the objectives. Every stakeholder in the organization provides a significant support for the success of the firm. It is the responsibility of the managers to ensure every person responsible in the implementation of the plan is provided with adequate resources (Noe, 2016).  However, the best practice to evaluate the organizations financial status is by using the annual reports of cash flows and income statements which enable one to plan on resource distribution.

Reference

Abell, D. F. (2010). Defining the business: The starting point of strategic planning (pp. 3-26). Englewood Cliffs, NJ: Prentice-Hall.

Barney, J. B., & Hesterly, W. S. (2009). Strategic management and competitive advantage. Upper Saddle River, NJ: Pearson Education.

Bryson, J. M. (2018). Strategic planning for public and nonprofit organizations: A guide to strengthening and sustaining organizational achievement. John Wiley & Sons.

Carroll, A. B., & Buchholtz, A. K. (2016). Ethics and stakeholder management. Cincinnati: South-Western.

Coulter, M. K., & Coulter, M. K. (2002). Strategic management in action (p. 7). Upper Saddle River, NJ: Prentice Hall.

Dent, E. B., & Goldberg, S. G. (2017). Challenging “resistance to change”. The Journal of applied behavioral science, 35(1), 25-41.

Goldstein, R. E., Beiser, G. D., Stampfer, M., & Epstein, S. E. (1975). Impairment of autonomically mediated heart rate control in patients with cardiac dysfunction. Circulation Research, 36(5), 571-578.

Goldstein, R. E., Beiser, G. D., Stampfer, M., & Epstein, S. E. (1975). Impairment of autonomically mediated heart rate control in patients with cardiac dysfunction. Circulation Research, 36(5), 571-578.

Howard, B. (2015). St. Michael’s Hospital strategic plan 2015–2018 [Video]. Retrieved from

Johns Hopkins. (2013). Johns Hopkins Medicine strategic plan. Retrieved from http://www.hopkinsmedicine.org/strategic_plan/_doc…

Klein, S. M. (2016). A management communication strategy for change. Journal of Organizational Change Management, 9(2), 32-46.

Mead, R. (2018). Cross-cultural management communication(p. 273). New York: Wiley.

Measham, T. G., Preston, B. L., Smith, T. F., Brooke, C., Gorddard, R., Withycombe, G., & Morrison, C. (2018). Adapting to climate change through local municipal planning: barriers and challenges. Mitigation and adaptation strategies for global change, 16(8), 889-909.

Morris, S. A. (2017). Internal effects of stakeholder management devices. Journal of Business Ethics, 16(4), 413-424.

Niles, N. J. (2010). A case study in strategic financial planning in health service organizations. Journal of Business Case Studies, 6(5), 23–29.

Noe, R. A., Hollenbeck, J. R., Gerhart, B., & Wright, P. M. (2016). Human resource management: Gaining a competitive advantage.