about a health care organization with which you are familiar.
What is the mission of that organization?
Is it clearly communicated to the stakeholders?
What activities of the organization are reflective of its mission?
Review of the Literature
A review of the literature should be completed early in the strategic planning process. This allows the project team to identify similar organizations or programs, their structures and processes, successes, and potential problems and challenges. It helps to make the plan evidence‐based. The literature review is an ongoing process that includes tentatively identifying programs, searching the literature for successes and issues, and then refining the program ideas. Identifying best practices or evidence‐based innovations that have been adopted with success by other organizations can facilitate strategic planning. Nurse leaders need to carefully examine the existing evidence and practices prior to beginning planning.
Determining the Congruence of the Project or Program
Determining the congruence of the project or program with the organizational mission is another step in the strategic planning process. Early in the planning process, the project or program must be considered within the context of the organizational mission to ensure that the project or program is congruent with organization's main mission. Typically, the overall mission and vision of the organization is reviewed as part of strategic planning. At times, the mission of the organization needs to be modified. For example, to become an HRO, the central theme of safety needs to be a part of the organization's mission.
Goals and Objectives
Next, the Strategic Planning team next identifies goals and objectives.
Strategies or Programs
Then the Strategiv Planning team designs strategies or programs to achieve their goals and objectives. After the goals, objectives, and strategies have been identified, they are prioritized according to strategic importance, resources required, and time and effort involved.
Action Plans
Action plans are established based on this prioritization. Action plans identify timelines, financial resources, and individuals responsible for the implementation. A realistic timeline allows an organization to evaluate each goal and objective and the degree to which each can be implemented in the specified time frame and with the available resources. Setting a timeline for completing a strategic plan is similar to the prioritization process in that the strategic importance, resources, and effort required are major considerations. Realistic timelines and individual responsibilities must be developed, specified, clarified, and communicated to all stakeholders. This will help to avoid misunderstandings and unmet expectations.
Marketing Plan
A plan for communicating the strategic plan, often called a marketing plan, is required for all strategic plans. This holds true whether the strategic planning involves new programming for external audiences or only internal redesign or restructuring. All constituents need to understand the strategic plan, goals, and objectives. This communication is essential when building a culture of high reliability. Designing, implementing, and evaluating new safety strategies will require substantive changes in work flow and in the way that nurses and other staff members carry out their day‐to‐day work processes. Clearly communicating education requirements will help to ensure proper preparation for nurses, physicians, and other staff members. Without adequate thought to communication across the organization about the project, there is less chance of success and a greater risk of poor cooperation. A marketing plan ensures that all stakeholders have the needed information.
Implementation and Evaluation
Implementation and evaluation of the strategic plan are the final two steps in the process. The action plans must be put into place, and outcomes associated with the plan need to be evaluated. For organizations on the journey toward high reliability, it is expected that safety events will initially rise as nurses and other staff begin to feel more comfortable reporting errors. However, over time, those safety events decrease as the organization begins to practice in new and safer ways.
When implementing a strategic plan with a focus on creating an HRO, nurse leaders must make their commitment to safety clear. This may be achieved by including safety stories at each meeting. A safety story can review a tool for preventing error, provide an example of using the tool, explain why safety is important, summarize a harmful event, or thank a staff member for being committed to patient or employee safety. Many hospitals use safety stories to keep safety at the top of everyone's mind.
Fostering a Fair and Just Culture
Nurse leaders are responsible for creating a fair and just culture to minimize blame and punishment and encourage individuals to report errors so that the system problems can be corrected. In the past, health care took a punitive approach toward errors, viewing those who made errors as “bad apples” (Institute of Medicine, 1999). This approach served as a disincentive to reporting errors and mistakes and resulted in missed opportunities to uncover and correct problems that impacted safety. The approach also over‐simplified safety by overlooking the impact of the system on safety care. More recently, the concept of a just culture has been embraced within health care.
A just culture creates an atmosphere of trust, encouraging and rewarding people for providing essential safety‐related information (Reason, 1997). It views errors as opportunities to improve the understanding of both health care system risk and individual behavioral risk. It changes staff expectations and behaviors so that everyone looks for risks in the environment, reports errors, helps to design safe health care systems, and makes safe choices. A just culture also identifies what constitutes acceptable and unacceptable behavior. The American Nurses Association (2010) has endorsed the just culture model.
Learning Organization
Ultimately, the just culture model creates a learning culture that is open and fair; manages behavioral choices; and designs safe health care systems. An HRO cannot exist in the absence of learning. The learning organization is an organization where people continuously learn and enhance their capabilities to create (Senge, 1990). Nurse leaders in HROs view each failure as an opportunity to learn from mistakes. They readily admit weaknesses and commit to learning from its mistakes. They take a systems approach to safety and improving the culture of safety. Nurse leaders in these organizations create a supportive learning environment by putting processes in place to facilitate learning and encourage creativity among employees. Such a learning environment requires transparency related to safety, so that everyone is aware of opportunities for improvement.
Reporting errors and near miss safety events can assist in understanding a problem rather than hiding that a problem exists. As a result, nurse leaders must put tactics in place to increase error reporting. Speaking up for safety may appear to be easy. Health care providers come into health care to do the right thing, help patients, and cause no harm. However, errors happen. In an HRO, all health care providers are responsible for reporting safety events, including near misses, adverse events, and sentinel events.
