Introduction. 2
Strategic Plan3
Program Description.5
Leadership Challenges..6
Ethical Implications..7
Engaging communities and building constituencies.7
Budgeting, financing, and human resources.8
Performance management & Health Informatics..9
Appendix 1 SWOT Analysis10
Appendix 2 SMART Objectives..11
Appendix 3 Budget..13
References15
Introduction
In the past decade, chronic lifestyle diseases such as type 2 diabetes, heart/cardiovascular disease and stroke have increased exponentially in the state of Minnesota. Sedentary lifestyle and poor diet has led to an increase in obesity which in turn has led to an increase in heart disease and stroke. Most adults in Minnesota have poor lifestyle which has increased their risk to heart disease and stroke. As per the Minnesota department of health, heart disease is the 2nd leading cause of death while stroke is the 5th leading cause of death among adults. However, racial disparities with respect to heart disease is reported in Minnesota, wherein American Indians have a 43% higher risk of developing heart disease. Some of the common lifestyle and modifiable risk factors include: High blood pressure, high cholesterol levels, diabetes, overweight/obesity, cigarette smoking, and physical inactivity. However, some common predisposing factors such as age, gender, family history, race/ethnicity cannot be modified and contribute to the burden of heart disease in Minnesota (MDH 2014).
The Minnesota department of health has collaborated with many healthcare organizations and societies to promote better health/well-being with a focus to reduce the burned of heart disease and stroke in Minnesota. Some of the common and successful programs implemented till date include MDH Heart Disease and Stroke Prevention Unit which developed the Minnesota Heart Disease and Stroke Prevention Plan 2011-2020. Minnesota Pollution Control Agency (MPCA) Air Quality Monitoring Program helps in reducing the air pollution and improving the quality of air by reducing particulate matter. MDH Health Economics Program (HEP) is aimed to assess the epidemiology of heart disease and stroke in Minnesota with key components such as illness burden, quality of healthcare, heart disease/stroke related healthcare costs, and burden on specific racial/ethnic communities. MDH Tobacco Prevention and Control Office aims to reduce tobacco use which in turn is aimed to reduce heart disease.
Background
An estimated 3.8% of adults in Minnesota have been reported to have suffered from heart attack in 2014 in a lifetime for every 150,000 people. Heart disease accounts for over 18% of deaths in Minnesota, wherein 7,571 deaths were reported in 2014. Heart disease is the 2nd leading cause of death followed by cancer (MDH 2014). An estimated 2.2% of adults in Minnesota have been reported to have suffered from stroke in 2014 in a lifetime for every 90,000 people. Stroke accounts for over 5% of deaths in Minnesota, wherein 2,172 deaths were reported in 2014.Stroke is the 5th leading cause of death in Minnesota. A total of 45,000 hospitalizations were reported due acute heart disease while 12,000 hospitalizations were reported due to acute stroke events in 2013 and 2014 respectively (MDH. 2015).
Rationale
As of 2010-2014, the stroke death rate was higher among African Americans (25%) while in Asians (30%) higher than Whites in Minnesota. Hispanic men and women have the lowest rates of stroke-related deaths. American Indians had a 28% higher death rate compared to whites with respect to heart disease in Minnesota. Although there is key difference between heart death rates for African Americans and Whites, the diagnostic rates are similar for both groups. The incidence and prevalence of heart disease is the same for American Africans and Whites in Minnesota as well as the US average. An estimated $418 million was spent on stroke in-patient hospitalizations while $2 billion was spent on heart disease related in-patient hospitalizations (MDH 2015). The total heart disease related medical cost in the US for medications, procedures, lost productivity, and rehabilitation amounted to $215.6 billion while the total stroke-related medical cost in the US amounted to $33 billion (MDH. 2015). Thus, it is of prime importance to develop a heart disease and stroke prevention plan.
Strategic Plan
The leadership and strategy plan is aimed to reduce the burden of heart disease and stroke in Shallow Lakes, Minnesota. The Lake Troubled Shallows Health Department would be involved in the planning, development, and implementation of a comprehensive, robust, and effective community control and prevention plan for heart disease and stroke prevent. SWOT analysis is widely used and accepted strategy to assess and develop business models and plans. It helps leaders assess the various strengths and weaknesses of a plan, intervention or strategy. SWOT analysis stands for strengths, weaknesses, opportunities, and trends. Based on these 4 components, it would help leaders to assess and develop a robust plan (Terzic-Supic, et al. 2012). In this case, a comprehensive and robust plan for heart disease and stroke prevention would be developed based on SWOT analysis (Appendix 1).
Identify any connections between listed items in the quadrants (i.e., is there an opportunity that can be taken advantage of to address a particular threat or weakness?).
The Minnesota department of health has developed many health-based programs and policies to facilitate healthy living among adults at risk of heart disease/stroke. These programs are well-recognized and accepted by the community members. The Minnesota Heart Disease and Stroke Prevention Plan 2011-2020 aims to educate, motivate, and encourage people to lead a healthy life (Shanedling, Mehelich, & Peacock. 2012). Since most the programs are well-recognized and perceived by the community, the inclusion of an educational intervention would help addressing the weakness. Based on the SWOT analysis, a well-developed program was considered as the key strength while lack of education and awareness was a perceived weakness. Thus, inter-relating the two would help in addressing preventable measures to heart disease and stroke. The Lake Troubled Shallows Health Department would utilize some its funds to implement educational and awareness programs to facilitate community encouragement and participation in heart disease and stroke prevention plans. Similarly, the scientific committee can assess or take advantage of the cultural diverse community ad provide cultural and linguistic support to facilitate participation of ethnic/minority groups in the heart disease and stroke prevention plan.
Propose strategies to maintain, enhance or leverage potential strengths (e.g., make appropriate assumptions about internal strengths of the Health Department)
The identified strengths include the presence of an interdisciplinary scientific team and experts from the stroke and heart disease fraternity. The scientific committee can collaborate with different organizations, NGOs, societies, and ethnic/racial minority groups to explore the various opportunities to target minority and high risk groups. The collaborative approach can also help developing plans for the community with respect to wide-spread awareness, communication, and education. The existing programs should include robust plans and adopt new policies to facilitate patient education, early diagnosis, and prevention of heart disease and stroke in the community. Since the African Indians and minority group are observed to be affected with heart disease, the existing programs should include ethnic/racial based scientific research and development (Shanedling & Schardin. 2013).
Based on the SWOT analysis, the state of Minnesota along with the Lake Troubled Shallows Health Department would assess the key strengths, based on their internal strengths and policies including a robust community assessment. Key barriers perceived by community members, the risk factors, and current policies/regulations would also be assessed to increase the strength of the strategic plan with respect to heart disease/stroke prevention and management (Benjamin 2012).
Strategies to minimize weaknesses
The Heart disease and stroke prevention plan has perceived short and long-term findings. However, there is limited scope to intervene the short-term findings. There is a lack of educational programs for the community and limited training for healthcare providers to assess the diverse group of patients. The cultural and linguistic barriers is a key weakness observed within the community and a potent threat to the strategic plan. It is important for the Lake Troubled Shallows Health Department to either collaborate with educational institutes or develop educational events and programs for the members of the community. The educational programs should not be limited to adults affected with heart disease or stroke but spread across schools, colleges, and high risk ethnic/racial groups. The objective of the educational programs is to implement preventive treatment and early detection of heart disease or stroke. Since the state comprises of culturally and linguistically diverse groups, it is important to include interpreters in the healthcare system to enhance communication between service provider and receiver (Green & Johnson 2015). The short-term findings can be intervened with the help of local experts and the scientific committee in Lake Troubled Shallows Health Department.
Propose options for leveraging or taking advantage of opportunities
In the recent healthcare reform and anticipated change in healthcare policy due to President Trump, a new leader in the community health department can be seen an opportunity for collaborative research and development. New leaders are perceived to be easy to work and collaborate with due to their positive attitude to help the community and lack of political influence from third parties or vendors. Thus, a key opportunity would be to interact and collaborate with the new leader for a robust and effective heart disease and stroke prevention plan. The success of the strategic plan is primarily based on leveraging the opportunities found during the SWOT analysis. The strengths and opportunities can be equally assessed and used as a leveraging tool to implement successful plants. In this case, the anticipated new state law and the FDA approval for a new antihypertensive and cholesterol are key opportunities to reduce the risk of heart disease and stroke in the community (Sadeghifar, et al. 2015).
Potential impact of threat/challenges and proposed resolutions
Identification and addressing potential threats would help achieve goals easily. In this case, the closure of an acute care hospital and the rise in use of junk food by food stamp users are potential threats to the intervention or plan to prevent heart disease. For example, the closure of the hospital (A key partner) for the plan limits the option for access to healthcare services. It prevents the community from accessing diagnostic procedures or adhering to treatment plans. It has a negative impact on the community since it would increase the burden on remaining acute care hospitals and centres. Junk or unhealthy food is a potent risk factor to obesity, diabetes, and heart disease. Promoting or including such food items against food stamps would only encourage people to live an unhealthy life. Lastly, there are limited regulations and policies on the food that is served in school canteens. Cheap and unhealthy food were observed as a greater threat to the community. Childhood obesity and unhealthy lifestyle promotes lifestyle disease such as heart disease and stroke (Kumar & Preetha 2012).
Potential strategic issues that the health department may need to address
Collaboration with educational institutes, healthcare organizations, NGOs, political parties, societies and associations that promote welfare for heart disease and stroke such as the American Heart Association of Minnesota would help bridging the gap between education, training, and awareness in the community. It will also facilitate an interdisciplinary approach to tackle heart disease and stroke and require limited funding (McManus 2013).
Program Description
Review the evidence for a program intervention
The proposed program to prevent, control, and manage heart disease in the community would be in-line with the objectives of Healthy People 2020. It is important to develop and implement an intervention/program based on a National agenda to reduce and control lifestyle diseases such as heart disease and stroke. It is important to assess the Heathy People 2020 objectives on heart disease and stroke along with a few programs and interventions that were aimed to reduce the burden of stroke and heart disease in the community, state, or country. Till date, there ae many health promotion and prevention programs, but a few were known to be highly effective in terms of patient awareness, community welfare, and reduction in morbidity of heart disease and stroke. Turn the Beat Around, The Million Hearts Initiative, Paul Coverdell National Acute Stroke Program, The Heart Truth: A Campaign for Women About Heart Disease, and the NINDS Know Stroke Campaign are aimed to prevent and control heart disease and stroke in US. These programs/campaigns or interventions were funded and supported by many state, local and community agencies. However, most of these campaigns had a far outreach and impact on the health and mindset of people.
The Department of Health and Human Services collaborated with many agencies to implement the Million Hearts Initiative. The program perceived and focused on two key objectives (a) Reduce the need for blood pressure and cholesterol treatment by adopting healthy choices and (b) Improve the care of people to prevent heart failure or stroke. The program was developed with the help and collaborative approach by over 8 main organizations and societies such as the Association of State and Territorial Health Officials, The Virginia Pharmacists Association, and The WomenHeart organization. The program was a success and involved more than 5 million Americans (Benjamin 2012). The Turn the Beat Around was aimed to reduce the risk of heart disease and stroke in the African American community. It was a church-based stroke prevention pilot program developed and implemented to assess its effectiveness on the target community. The program comprised of a 6-session group-based health education program. The local trained community health workers were deployed to present, assist, and help the participants. It is a promising strategy to prevent heart disease and stroke among ethnic/racial minority communities (Williams, Franklin B, Evans, Jackson, Hill, & Minor 2016). The CDC funded Paul Coverdell National Acute Stroke Program was successful since it helped in benefits over 620,000 Americans in a span of 10 years. The program aims to promote preventative care, educate patients on early signs of stroke, and facilitate healthcare programs for minority communities (CDC 2016). The National Institute of Neurological Disorders and Stroke funded the Know Stroke program which was based on education of patients and awareness of stroke (NINDS. 2016). The Heart Truth was a campaign for women on heart disease funded by the NIH aimed to reduce the burned of heart disease by educational reform and preventative care in women (NIH 2016 and Ehrenthal, et al. 2013).
Measurable objectives based on SWOT analysis (SMART Objectives)
Leadership Challenges
Leaders in the healthcare industry are considered individuals with high acumen, calibre, determination, and vision to grow individually and perceive to abide by the organization’s values, vision, and mission. The leadership style and skill determines the ability and agility of a true leader to endure and endeavour in a complex and challenging system. The American Society of Association Executives have identified 8 key leadership styles based on the skills and perseverance. Not all leadership styles are followed by the same individual but it is observed that true leaders are known to have more one leadership style. To execute the strategic plan for the prevention and control of heart disease and stroke in Minnesota, the following leadership styles and skills would be employed:
Charismatic
The word charismatic is more than enough to define a leader. Being charismatic is known to be associated with the power to influence and attract people in the community and healthcare system (Tsai. 2011). It is important to behave and respect professionals and community members involved in the development and implementation of the strategic plan. Some of the perceived behaviours that would help making a leader charismatic include influencing the crowd through the power of personality, inspiring passion to all co-workers and staff, motivating community members and key stakeholders to look forward, acting energetically and efficiently, and self-reliance and self-belief/confidence over the team (Al-Sawai, 2013). As a leader, it is critical to inculcate these behavioural patterns and styles not only to demand but work compassionately with team members. It is important to spur actions to other that would help expand the organization’s presence and position in the market place. The strategic plan would have a wider audience and higher rate of acceptance when a charismatic leader is involved (Al-Sawai, 2013).
Innovative
Innovation and creativity are the key success factors of leaders. Strategic planning involves the creation of unique, innovative, and creative plans that not only target and benefit the community but also aim in gaining presence of the organization to a large audience. It is important for a leader to be innovative in various work processes (Al-Sawai, 2013). Some of the behavioural traits required to be an innovative leader include the willingness and ability to go beyond the usual course of action, being involved in the situation with a resolution at sight, assess negative or barriers to the course of action, perceives innovation, encourages team members to bring out innovation, and implement actions in the shortest time. Innovative leadership styles are mainly used in situations with an intractable issue or inculcate a workplace environment that focuses on innovation, problem solving, and development of new strategies/interventions (Tsai. 2011)
Emotional intelligence and cultural competence
It is important to be culturally and linguistically competent to be successful leader, specifically for a strategic plan aimed to target ethnic/racial minority communities. Key skills that would increase cultural competence and emotional intelligence of a leader include effective communication, delegation, motivation, positivity, trustworthiness, creativity, commitment, responsibility, feedback, and flexibility. It is important to delegate and provide feedback to team member which would boost self-morale and confidence to handle teams without micro-managing. It is critical to be committed and responsible for assigned tasks and be flexible and trustworthy with team members. All these factors not only create a positivity at the workplace but brings about creativity and job satisfaction (Curtis & O'Connell. 2011).
Ethical Implications
Leadership in the healthcare sector is often associated with complex challenges and ethical dilemmas. Clinical-decision making or robustness in developing and implementing strategic plans for the welfare of the community, all come with ethical implications that a leader should face and resolve. Some of the anticipated ethical implications associated with development and implementation of the strategic plan include:
Honesty and complete disclosure
Team members involved in the implementation of the project may not be honest with their work or agenda. As a leader, false prepositions from external sources or team-based conflicts are common but preventable ethical issues. It may not be possible to disclose all financial and confidential information to team members about the organization, its internal policies, or scope of amendment during the implementation. Most team members are expected to question the complete disclosure of the strategic plan, but the ethical dilemma of honesty plays a key role in such cases (Flite & Harman 2013).
Indirect compensation
Leaders are often compensated for their work through internal and external stakeholders. Internal policies and regulations do not permit a leader to accept benefits or indirect compensation from external sources. For example, Organization ABC would like to offer an indirect compensation of $2500 to the leader for successful collaboration. However, internal policies consider such compensations as unethical. A common, personal, and unavoidable ethical dilemma for most healthcare leaders (Donnellan 2013).
Tainted money
The ethical dilemma of acquiring funds from organizations or communities that have led to an increase in the risk of heart disease and stroke. For example, the ethical dilemma of acquiring funds from a school canteen that serves junk or unhealthy foods to school children. The funds raised from the canteen are to compensate for the negative environment created for school children with respect to unhealthy, sugary, and oily food (Flite & Harman 2013).
Conflict of interest
The director of the Lake Troubled Shallows Health Department including the management team may acquire or raise funds for profits and personal gains against the non-profit elements of the organization. The ethical dilemma in this case is to support the management team for the profits gained or raise ethical issues on them without facing the wrath of being discriminated or even terminated (Donnellan 2013).
Engaging communities and building constituencies
As a leader of the strategic plan, it is important to identify, review, assess, address, and manage key stakeholders for its successful implementation. Each partner or stakeholder identified would have key obligations, responsibilities, privileges, and tasks. Some of the key stakeholders/partner would include:
American Heart Association
The principal supporter for the plan who would be directly involved in educational, organizational, and administrative requirements. The AHA is a renowned and global image to heart disease education, management, and welfare. As a principal partner, it would help in wide-spread participation.
Minnesota Stroke Association
As a secondary collaborative partner, the MSA would help in patient engagement, education, and support with respect to stroke care. It would be involved in building a database of adults affected with stroke and assess the overall success of the plan based on the SMART objectives (Appendix 2). It would be responsible for research and development of stroke-related drugs, interventions, and hospitals/centres.
Minneapolis Heart Institute - Abbott Northwestern Hospital
A secondary support for education of patients, training of healthcare staff, primary source for identifying physicians/clinicians to assist in the SMART objectives (Appendix 2), and responsible for quality care and services for heart disease patients. It would also act as an alternate fund raiser and educational grant partner for heart disease-related services.
Epidemiological studies, findings, and interventions would be the sole responsibility of the University of Minnesota. An executive team from the university would collaborate with the AHA and MSA to identify, review, assess, analyse, and publish epidemiological data. The executive team would coordinate with the Minneapolis Heart Institute - Abbott Northwestern Hospital to support the SMART objectives through advanced research.
Anticipated conflict resolution and negotiation skills
As a leader, conflict of interest is anticipated during the process of implementation. Since there are many stakeholders and partners involved in the plan, the risk for conflict of interest increases. The management of Lake Troubled Shallows Health Department are bound to receive grants, funding, and compensation from many partners, NGOs, government agencies, and local organization. However, the management may aim to direct certain funds to generate revenue or adjust it to the profits of the organization. As a leader who is bound to be honest and committed to the SMART objectives based on a comprehensive review of SMART analysis, a clear of conflict of interest is perceived. In this case, it is empirical to negotiate with the management to direct the funds for its said objective. However, profits for the organization can be generated from revenue-based systems such as events and fund-raising program.
Budgeting, financing, and human resources
The budget and human resource management is basic on basic calculations with a budget of $250,000 as start-up funding. The estimated revenue and expenses for the strategic plan can be found in appendix 3. An estimated 35% of funds would be directed and reserved towards salaries and contract labour. No more than $10000 would be spent toward rental expenses and no more than $1750 can be spent for the development and maintenance of the website. An estimated $10,500 is assigned for travelling/meetings and professional fees while a maximum cap of $1750 for marketing/advertising and $3250 for insurance has been assigned. The American Heart Association and Minnesota Stroke Association are expected to generate revenue for the strategic plan and the Lake Troubled Shallows Health Department. The total revenue and expenses for financial year 2017 has been explained in detail (Appendix 3). The two stakeholders, AHA and MSA are expected to generate over $100,000 through grants and funds for the strategic plan and the organization itself. Thus, it is important to partner with these two societies to generate revenue and prevent losses. A variance of 5% from the total estimated budget provided as start-up funding is expected. A variance in total revenue generated is expected to be between 10% to 55%, citing an unexpected grant or funding from non-profit organizations, government agencies, and community-level grants.
Performance management and health informatics
As a strategic leader, it is important to address and review the various outcomes of the proposed plan with the help of the SMART objectives (Appendix 2) and detailed SWOT analysis (Appendix 1). Based on a review of current evidence, information obtained from individuals living in Lake Troubled Shallows, 4 SMART objectives were proposed for the plan to prevent and control heart disease/stroke. The following outcomes and their respective outcomes measures/parameters have been discussed below:
SMART OBJECTIVE 1: To reduce the health disparity for heart disease among ethnic/racial minority communities in the community, Minnesota
Outcome measure/parameter: Rate of heart disease by ethnicity would be obtained from the AHA/MSA and the University of Minnesota - School of Public Health. The epidemiological data and results for ethnic/racial based information can be obtained in collaboration with the University and the AHA/MSA
SMART OBJECTIVE 2: To reduce the proportion of adults with hypertension in the community, Minnesota
Outcome measure/parameter: Data from the AHA would be used to assess and review the rate of adults with hypertension. The University of Minnesota - School of Public Health would help in reviewing and conducting statistical analysis from epidemiological data. A team of experts from the AHA would review the same.
SMART OBJECTIVE 3: To increase awareness among adults above 20 years of age on the early signs and symptoms of stroke
Outcome measure/parameter: Surveillance or questionnaire to assess the overall impact of education and training of adults. The University of Minnesota - School of Public Health would be responsible for the surveillance while the AHA/MSA would co-ordinate to develop the questionnaire. In all cases, the Minneapolis Heart Institute - Abbott Northwestern Hospital would acting as the educational resource in terms of providing a hall and other educational resources for programs and events.
SMART OBJECTIVE 4: To reduce the rate of hospitalizations of elderly patients (65 to 74 years) with heart attack or stroke
Outcome measure/parameter: Incidence and prevalence of preventable hospitalizations among elderly patients in the community. The Minneapolis Heart Institute - Abbott Northwestern Hospital would be primarily responsible to assess and review the impact of education on the community. Assessment of primary health care centres, acute care hospitals, and funding from sponsors would be done by the internal staff of the Lake Troubled Shallows Health Department.
The success of the SMART objectives are entirely based on the co-operation and support from all key stakeholders, availability of resources such as community hall, primary healthcare centres, acute care hospitals, and competent healthcare providers.
Appendix 1
SWOT Matrix Analysis
Action plan
Appendix 2
SMART OBJECTIVE
Appendix 3
BUDGET
Revenue FY 2017
Expenses FY 2017
Expenses
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