FAQ: An Organizational Vision. Question 1: Why is it important for a mission statement to be so succinct? Answer 1:

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1 FAQ: An Organizational Vision Question 1: Why is it important for a mission statement to be so succinct? Answer 1: The simpler the mission statement, the clearer the message. Think, for example, of a mission statement for Electra Motors (a fictitious company): To build the best cars possible for the greatest possible profit. This simple sentence conveys purpose, business, and values. Having a clear mission statement helps to reduce confusion about what is truly the underlying purpose for existing. Once everyone understands this mission, they will have an easier time understanding why certain decisions are made. Of course, employee concerns such as staff satisfaction, job security, and employee benefits are all important. However, not one should forget that Electra Motors is in the business of making money its decisions will reflect that. Thus, to the extent that staff satisfaction, job security, and employer commitment all help Electra Motors make better cars for a greater profit, management at Electra Motors is likely to create policies and procedures to address these concerns. Of course, the issues are somewhat different with a health care organization. Like other businesses, it must make money; although, depending on the financial structure of the health care organization (public, for-profit, or private non-profit), how much money it makes may be of lesser or greater importance. Nevertheless, all health care organizations must be costeffective and supportable given their resources (both internal and external). Moreover, quality care and cost-effectiveness can be at odds with each other and, indeed, though both are important, HCO s often feel pressured to compromise one to achieve the other. This, of course, creates a critical dilemma when striving to fulfill both aspects of any HCO s mission: health care and finances. Because health care organizations generally exist to serve community health needs, mission statements for these organizations typically focus primarily on health care goals, ignoring the financial component altogether. Indeed, it is likely that any mention of finances in the mission statement might be interpreted as insensitive or gauche. Regardless, even if unstated, the implicit mission is to achieve whatever is stated explicitly in a cost-effective manner. Question 2: Identify at least two program goals and two objectives for a clinic that services primarily adolescents at high risk of pregnancy. Answer 2: Program goals may vary, but here are two possibilities: to increase knowledge about contraceptives among high-risk adolescents or to modify attitudes toward use of condoms among high-risk adolescents. Examples of objectives for each are as follows: Program Goal: To increase knowledge of contraceptive choices among high-risk adolescents.

2 Objective #1: To increase awareness of contraceptive options among high risk adolescents by 25% within 30 days of the onset of the health education program. Objective #2: To increase knowledge about the respective failure rates of condoms, IUD s, diaphragms, and rhythm method by 25% within 30 days of the onset of the health education program. Program Goal: To modify attitudes toward use of condoms among high-risk adolescents. Objective #1: To increase favorable attitude toward using condoms among high- risk adolescents by 25% within 30 days of the onset of the health education program. Objective #2: To improve perception of condoms as convenient, inexpensive, fun, and sexy by 25% within 30 days of the onset of the health education program. Question 3: Why is it important for objectives to be so specific? Answer 3: Objectives need to be specific so everyone will know whether or not they have been met. In many ways, objectives define the outcome measures of a program and, thus, like any variables measured in a study, they must be clearly defined in operational terms so those involved in the assessment and those reviewing the results will understand exactly what has been evaluated. Unless all aspects of the objectives are clearly defined at the outset, no one will really know whether or not the program objectives have been achieved. Question 4: What are the key components of an objective, and what are the important considerations for writing a good objective? Answer 4: The key components of an objective are who does what by what amount by when? The who, of course, refers to the participants, otherwise known as the target population of interest in this case high risk adolescents (e.g., low-income, children of single-parent families, academically unsuccessful). This is usually defined elsewhere, but it can also be identified in the objective if it can be stated fairly succinctly. The what reflects what is known in research as the dependent variable, or the outcome measure. In this case, it is increase favorable attitude toward using condoms and improve perception of condoms as convenient, inexpensive, fun, and sexy. Typically, these types of variables are measured via a survey, which allows respondents to select among a variety of choices (typically 4-7) that reflect their attitudes toward a particular statement. An example of this might be the following item, which is from a 5-point Likert scale:

3 The by how much is how the dependent variable is quantified. This is often expressed as a change in value, such as a percentage increase or decrease. Of course, if the value is an increase or decrease, this implies that the variable was measured before the program began and measured again afterward. This is called a pre-post-design and is a much more rigorous method than just measuring dependent variables after an educational program (called postonly design), which does not permit any comparison with a baseline before the program. Because such a design would make it difficult to know how the participants would have scored on this variable without the program, one could not conclude with any confidence that the attitudes were, indeed, due to the program or whether they might have existed before the program even began. An alternative, of course, is to include a control group which receives the identical surveys as the experimental group but does not receive the educational program; in this instance, the control group would represent the baseline. However, a more cost-effective approach is probably to simply use a pre-post design where the identical measures are given at the beginning and the end of the health program. Finally, by when identifies the time-frame for achieving the objective. Often, this is during, just after, or even a while after the completion of a health education program. Each time period is important and has its value. For example, measurement during the program can assess how effective the program is and can be used to make modifications and adjustments to the program as needed. Measurement right after the program will be the best indication of the short-term impact of the program. Measurement much later will reflect long-term change and is typically considered to be the gold standard of behavioral and attitudinal change. Indeed, many programs include booster sessions many months after the initial program to reinforce and maintain any changes that occurred previously. Question 5: What are the three common types of dependent variables that are measured in most health education programs? Answer 5: Generally, health education programs measure three types of psychological variables: knowledge, attitude, and behavior. Knowledge reflects awareness and understanding of new information and is one of the easiest areas to assess. Typically, new information is presented to participants as subject matter. Comprehension, retention, and application can be easily assessed via closed-ended (e.g., multiple-choice) or open-ended (e.g., short answer) questions. Attitudes are typically assessed using the Likert scale (1-5 or 1-7) or a bipolar adjectival Likert scale, in which antonyms are placed at polar extremes and participants are asked to rate their feelings on a topic according to the scale. Here is an example of this:

4 Question 6: To what extent can changes in beliefs or attitudes actually lead to changes in health behavior? Answer 6: In many ways, this is the million-dollar question with regard to changing health behaviors. Many behavioral scientists have made careers out of trying to predict how to create predictable, lasting behavioral change. One model that has been especially useful in trying to predict health behavior is the Health Belief Model (Hochbaum, 1958; Rosenstock, 1966), which focuses primarily on beliefs. Specifically, this model proposes that two factors predict any health behavior: 1) perception of health threat and 2) perceived threat reduction. Within the first factor, perception of health threat, are three components: a) general health values, b) specific beliefs about vulnerability, and c) beliefs about the severity of the disorder. Thus, these authors argue that the importance of health in general, the recognition that a negative health behavior could lead to severe consequences (e.g., cancer), and the understanding that this consequence would be deleterious (e.g., could lead to death) all play a role in whether or not a person adopts a new, healthy behavior. The second factor, perceived threat reduction, contains two components: a) belief that a particular measure can eliminate a particular threat and b) belief that the advantages of the health behavior outweigh its disadvantages. In other words, for someone to follow through in incorporating positive health behaviors, s/he must have confidence that the new behavior will eliminate the risks associated with the unhealthy behavior and that any benefits are worth the cost. Notably, many costs of a new health behavior are unstated, yet powerful. For example, a major cost of using a condom for an adolescent girl may be the risk of losing her boyfriend, who refuses to wear a condom. One must define costs broadly to include financial, emotional, social, political, and other possible ramifications, keeping in mind the unique norms, attitudes, behaviors, and values of the target population. Question 7: How does the visioning culture influence a health care organization?

5 Answer 7: As mentioned previously, the visioning culture reflects a combination of values, attitudes, beliefs, norms, and dreams with respect to key aspects of the organization (e.g., mission, program goals). All of these, independently and in combination, can profoundly influence every aspect of a health care organization. For example, if a shared belief within a substance abuse treatment program is that abstinence is the only way to achieve long-term sobriety, all of the programs will probably require abstinence as a condition of participation. Thus, this one belief will dictate the eligibility requirements for participation in its program. Likewise, if a shared value within an HCO is that wasting patients time is not important, it is likely that efforts will not be taken to monitor or reduce patient waiting time, which is a major cause of patient dissatisfaction. On the other hand, if staff members have contradictory dreams that they have not shared with one another, this could lead to confusion, resentment, splintering, and other negative emotional outcomes. Question 8: Who is typically on a strategic planning committee, and how does it operate? Answer 8: Usually, a strategic planning committee is composed of key leaders or stakeholders within an organization and within a community. For example, in-house members of a strategic planning committee for a public hospital might include the medical director; the hospital administrator; staff physicians; RN s; and representatives from housekeeping, patient billing, patient records, etc. Community members for this organization might include directors of a women s shelter, a rehab program, a soup kitchen, etc. Individuals may lobby to be included on the committee, but more often, membership is by invitation only. Efforts are usually made to ensure that the committee represents a diverse set of interests; though, because the members are usually known beforehand, initial efforts are often made to select members who have common values, beliefs, or goals. Once the strategic planning process is underway, however, subtle and not-so-subtle differences typically emerge among participants, which is the essence of a promising strategic planning committee. Strategic planning committees typically follow a specific format under the direction of the strategic planning leader, who is often the administrator or an outside consultant. Often, subcommittees are formed within the strategic planning committee to hammer out specific language or proposals with regard to mission, goals, benchmarks, etc. Once consensus is achieved, the subcommittee typically presents their ideas to the larger group, which either accepts, rejects, or modifies the subcommittee s recommendations. Through negotiation and compromise, the strategic planning committee eventually crafts a comprehensive plan that is put into writing and distributed to the staff.

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