Internal Environment

mutual accomodation

- people voluntarily helping one another in ways that facilitate the work being done - aide can't fulfill PTAs role, but PTA can clean a whirlpool

desired management knowledge talent

1. Finance - cost control, reimbursement essentials, coding 2. Information - sources, use of management data, record keeping 3. Networking - professional development, consultation, negotiation 4. human resources - self-management, direct personnel, lead 5. Operations - compliance, resource allocation, meeting management 6. planning and forecasting - sector analysis, competitor analysis, strategy analysis

work standardization

skills, processes, or outputs through policies, procedures, protocols, pathways, and treatment plans

vision

• A clear vision for the future serves to focus and align the efforts of the business toward a common goal. • BOD/upper management form the vision • The vision - Concisely identifies what the business can be like - Provides guidance when choosing between options - Evolves as the business grows and changes

mission

• A good mission statement concisely identifies: - Who we are - Who our customers are - What sets us apart from our competitors

support for internal environmental analysis

• A large organization may have several organizational structures with authority over the strategic planning process, including the internal environmental assessment. • Senior leadership typically manages and facilitates the strategic planning process. • A large organization may have a senior leadership level position responsible for this function (Vice President of Planning). • Operational managers (Director, Physical Therapy) and support managers (Director, Human Resources) and staff-level employees may have more or less of a role as determined by the planning model employed. • An inclusive model is more likely to have greater employee buy in to changes.

uniqueness

• A primary purpose of examining the internal environment is to identify what differentiates the organization from those offering similar services. • This or these differentiators is/are commonly called the organization's competitive advantage(s).

internal analysis

• An internal environment scan and analysis focuses on the organization itself to: - Understand its resources and capabilities - Identify its core competencies, which can become competitive advantages • Internal Analysis Is Part of the Strategic Planning Process • Internal sources reviewed include: - Mission, vision, and values statements - Assessment of strengths and weaknesses - Performance outcomes measures - Input from across the organization

culture or character

• An organization's culture: - Reflects what is expected and valued throughout the organization - Is management's means of transmitting expectations, shaping attitudes, shaping behaviors, and motivating employees • Internal network for transmitting and reinforcing desired behaviors • Events to reinforce what the culture is/means • Organization members understand importance of fitting in

strengths and weaknesses

• Analysis of S and W assists strategy development by raising key questions including: - How can our strengths be leveraged to achieve our goals? - What is the competitive advantage (distinctiveness) we have or can have? - How can our weaknesses be eliminated or, better yet, turned into future strengths? • how can you make others in the community aware of your strengths?

resources

• Anything an organization has (as a strength) could be a resource, such as: - Sound financial position - Real estate (buildings, land, fixtures, functionality) - Goodwill • Assessment of the financial status of a PT organization includes: - Accounts receivable (money due the organization) - Cash flow (funds available to pay current bills) - Expenses - Gains - Losses - Efficient systems to account for the above

authority

• Authority = formal power • An internal assessment of power considers the internal mechanisms used to pass power down through the levels of management. • Mechanisms include - Organizational chart - Organization and department policies - Job descriptions

importance of compliance

• Businesses develop corporate compliance programs to mitigate against noncompliant acts. - manager can't tolerate non-complicance • For any business, noncompliance can result in criminal or civil monetary penalties. • For government-sponsored programs, almost any level of noncompliance with coverage and reimbursement guidelines represents substantial risk to the health care provider.

internal environmental analysis for small businesses

• Businesses lacking internal resources to scan the environment may obtain support through: - Paid and no-cost external consultants - Academic-based programs - Government-sponsored business services

areas examined in workforce assessment

• Career development and promotion • Compensation and benefits • Discipline and grievance procedures • Diversity management • Performance assessment and feedback • Recruitment (availability) and retention

corporate compliance program to minimize risk

• Code of conduct • Compliance infrastructure (compliance officer) • Policies (what) and procedures (how) • Prevention measures (training) • Violation responses (contacts) • form follows structure - if you want people to perform a certain way you need policies and infrastructure that supports it

financial audit

• Commonly, a financial audit (examination) of a business' financial statements and records is conducted by an independent third party. • The third party renders its opinion on whether or not those financial statements are relevant, accurate, complete, and fairly presented. • Once authenticated, the business' financial statements are published. • Judgments are made about financial performance.

variables influencing care satisfaction

• Communication • Convenience • Cost/value • Interpersonal relationships • Responsiveness of personnel • Satisfaction with direct-care personnel • Satisfaction with the overall PT experience

sources of internal information

• Consultant reports • Customer feedback • Financial annual reports • Financial consultants/brokers • Government agency reports and publicly shared databases • Human resources reports • Information technology reports • Publicly reported clinical outcome reports • Trade association reports • Treatment outcomes reports • Vendors

governance

• Corporations are governed by a BOD. - ultimately responsible due to Banes-Oxley • A corporate BOD has legal obligations to the: - Corporation, stockholders, and its members (referred to as fiduciary duties) - Government - People or organizations with whom the corporation interacts

authority in PT management

• Decision-making scope and supervisory responsibilities in job description • Control over communications • Scheduling and attending meetings • Documenting meeting proceedings • Dealing with reports • Access to information • Job descriptions that include decision-making scope and supervisory responsibilities • Control over communications • Scheduling and attending meetings • Documenting meeting proceedings • Dealing with reports

questions to guide HR's workforce assesment

• Do we have the right employees? • Do we have the right number of employees? • Do they have the right skills? • Are they available at the right times? • Are they doing what they are supposed to do? • Are they doing only what they are supposed to do?

organizational structure

• Effective businesses organize their employees (managers and staff) into a cohesive structure. • defining the role of each employee in relation to every other employee. • A map of supervisory and reporting relationships is called an organizational chart. • Common ways management uses to coordinate work between individuals are: - Work standardization - Mutual accommodation - Supervision

areas where regulations affect health services businesses

• Employment • Environmental impact • Financial management and taxation • Health services coverage and reimbursement • Occupational health and safety • Securities and exchange • Service delivery (licensure, registration, etc.)

categories of key processes

• Error reduction - through pathways and procedures • Efficient inventory control - can buy in bulk • Reduce quality variation - can implement benchmarks • Service improvement • Time management • Work environment

internal uses of strategic planning

• Examine strategic position - Identify strengths & weaknesses • Identify organizational problems - Implications - Solutions • Define performance expectations - Set productivity standards • Objective basis for appraisal & reward • Coordination of activities organization-wide • Encourage strategic thinking

excellence

• Excellence requires a standard for comparison. • External recognition is a key marker of internal excellence. - Accreditations (Commission on Accreditation of Rehabilitation Facilities [CARF]) - Adherence to professional standards (APTA standards) - Awards (APTA state chapter award) - Compliant (involved in few legal actions) - Licenses and certifications (Medicare provider) - Relative position compared to industry benchmarks (Focus on Therapeutic Outcomes [FOTO])

financial management

• Financial management = management of all aspects of financial resources • Accounting and financial reporting • Budgeting • Collecting accounts receivable • Risk management • Insurance

what are internal factors?

• Internal factors are those under the control of the business. • Internal factors are often referred to in terms of strengths and weaknesses. • Internal strengths and weaknesses are the S and W of a SWOT analysis (the O and T comes from the external environmental analysis).

cyclical internal assessment

• Internal variables can change rapidly. • This is a key reason for adopting a cyclical strategic planning process. • Annual internal assessment is a good practice. • Some internal changes may have to be addressed outside of your normal cycles

elements of an internal organizational assessment

• Mission, vision, and values • Regulatory compliance • Governance and management model • Organizational structure • Operational processes • Human resources • Customer satisfaction • Financial operations and resource availability

customer satisfaction

• No customers = no income = business fails • Some of the questions to be answered about customer satisfaction include - Who are our customers? (mission) - What services or products do they purchase? - How do our customers rate our services and products compared to our competitors? - Do they say they would return? - Do they say they would recommend us to someone else? - Do our customers have needs that we are not meeting?

objectives

• Objectives = are action statements that, when enacted, will help move an organization toward achievement of its strategic goals • An organization's mission statement sets parameters for objectives and goals. • An organization's vision statement is the ultimate goal.

operational processes

• Operations = usual activities that keep the business going • Key operational processes - Provide for the direct delivery of health services - Support the delivery of health services - Help the business achieve success

regulatory compliance

• Regulatory = control by law, regulations, rules - Health services businesses are highly regulated. • Compliance = practices that are in accord with relevant laws, regulations, and rules - BOD and upper management are responsible. - Internal assessment includes examination to assure that applicable regulatory requirements are followed.

scope of an internal environmental analysis

• Scope = breadth, reach, range of interest(s) • The scope of the internal analysis matches the scope of the strategic plan. • Scope can cover an entire organization or just a segment of the business. - size of business affects how much analysis you can do • internal environmental assessment may be segmented by both customer characteristics and services offered.

Governance responsibilities include:

• Setting the vision • Monitoring upper management's performance, quality services or products, financial performance, and self-assessment • Accountable to stockholders (for-profit BOD) • Accountable to stakeholders (not-for-profit BOD) • A corporate BOD chooses how it implements its roles such as: - Which decisions it will make versus the decisions it will delegate - How much it will be involved in daily operations - How it will interact with management and staff

talent

• Talent = possession of competencies that enable excelling at chosen tasks - certifications, experience, con. ed., skills • An internal environment analysis considers if there is enough talent in the right places to fulfill the organization's mission. • Talent analysis is organization wide (from BOD downward). • Performance criteria are listed in job descriptions. • Department managers and human resource staff collaborate on how and what to assess at the department level. • Consultants may assess leadership performance.

technology

• Technology = anything that helps expand human capabilities - Knowledge - Skills - Efficiency • Technology is constantly changing. • Technology is unevenly used. • Technology: - Changes what is known - Changes how things are done - Changes what can be learned - Influences outcomes

satisfaction

• The customer's view of what is valuable about a physical therapy service encounter is what counts when assessing competitive advantages. • Customer satisfaction combines emotional and cognitive evaluations of what are considered salient aspects of their treatment encounter(s). • There are multiple internal influences on a customer's satisfaction level besides quality • Other internal health service organization activities influencing customer satisfaction include: - Accreditation - Employee retention and satisfaction - Marketing strategy - Incidence of suits - Profitability

time frame of an internal environmental analysis

• The internal environmental assessment represents the characteristics of the business at a specific point or period in time. • Internal changes may be rapid, temporary, or permanent.

human resources (HR)

• The most important resource that any business has is its people. • Management's responsibility includes recruitment and retention of capable employees. • A workforce assessment is a critical component of an internal environmental assessment.

mission, vision, and values statements

• Together, these statements provide guidance when choosing between business and behavioral options. • Yearly reviews needed to: - Assure current reality is reflected - Refresh employees' understanding - Assure statements represent consumers' needs

structure

• Two components of organizational structure: - How employees relate to one another (supervisory and reporting relationships indicated by solid lines) - The legal designation chosen to meet the mission (for-profit, not-for-profit, incorporated)

values statement

• Value statements describe the forces that motivate a business and the behaviors it promotes in its employees. - Identify what is important in interactions - May be updated periodically to keep it in sync with leadership priorities and business changes

questions to assist in identifying competitive advantages

• What do we believe are our strengths? • Do our customers value this? • Is this strength unique to us? • Can others copy this uniqueness? • Can we hold/improve our strength? • Which strength can we develop into an advantage?

examples of internal changes

• business performance - impacts resource availability, employee recruitment and retention • business structure - single to multisite, etc • labor availability - employee illness, economic changes • leadership - changes in senior leadership • market position - rapid expansions or retractions in workforce or locations • ownership - affects mission, vision, and goals; cultural clash in mergers • regulatory requirements - change in business processes and performance

structure: mulutilocation practice

• chief executive, managers, clinical staff • dotted lines indicate a person would occasionally report to a certain manager, like if floating to a different site • "Yes" answers = the structure is adequate - Are there indications of management-employee strife? - Is there cohesion between managers' directives? - Are there sufficient or too many managers to smoothly and efficiently get work done?

CORE STATUS

• elements of an organization's framework and operations, as part of an internal environmental assessment • The CORE letters represent: - Culture or character - Objectives - Resources - Excellence • The STATUS letters represent: - Structure - Technology - Authority - Talent - Uniqueness - Satisfaction

structure: working PT manager/owner

• employees report to working owner • "Yes" answers = the structure is adequate - Can the owner-manager keep up his or her clinical and business knowledge and skills? - Is there quality control supervision and follow up? - Are employees being mentored? - Are bills being sent and payment received in a reasonable amount of time?

revenue terms

• gross revenue - what was billed • net revenue - gross revenue minus expenses, accounts payable, bad debt, and contractual allowance • contractual allowance is the amount the payer will give you less than what you billed them for

goodwill

• in intangible that can be a competitive advantage • moneys paid for branding, name and reputation out in the community - this is subjective, so this is where the disagreement comes in when buying a practice

supervision

• oversight of employees to assure work standardization occurs • The larger the organization, the more important supervision becomes. • The work and decisions of supervisors is supported by: - A formal organizational structure and policies and procedures - Communication tools - Job competency requirements - Outcome measures - Written job descriptions

competitive advantage

• something Customers recognize as unique to an organization and value • something the organization continuously improves to maintain customers' perception of value • something competitors lack, find difficult to duplicate, or are unable to develop one or more substitutes for

structure: larger practice with managers

• the further the owner is from the business, the more disconnect can occur • "Yes" answers = the structure is adequate - Are there regularly observable organization-wide instances that the culture is as it should be? - Is the owner adequately informed about the operations? - How is the organization doing financially? - Are all positions filled? - Are staff retention levels as expected? - How do our customers feel about the organization?