Overview

To make sure that your primary health care center is "on track" in meeting the community's goals and objectives, an annual update of the strategies, accomplishments and issues should be undertaken. This is the time to bring the community back together to review:

• goals and objectives - are they still relevant or do they need to be changed?
• The community's health care needs - has the health status of the community improved? Are there still gaps in services?
• Problems/issues - are there problems/issues confronting the center that act as barriers to reaching the goals and objectives?
• Service delivery - what are we doing right? What areas need improvement?
• Environment - have there been any changes in the environment that will effect the center in the future, e.g., population changes, competition, regulation, funding?
• Future direction - is this the time to consider expanding services or adding a satellite facility?

ANNUAL REVIEW

The first step in the annual review is to initiate a strategic planning process to review the center's current operations in light of the following five key factors:

• its strengths and weaknesses;
• the values espoused for its operations;
• any external events that could impact on the center's operations in the future, e.g., funding, delivery approaches (managed care) or technology advances;
• the community's expectations; and
• goals articulated in the center's own plan.

Documented evidence that health center operations are being evaluated periodically is not optimal for certain categories of centers. For example, you should note that an annual review is a required element for certification as a Rural Health Center. Section 330 grant-supported health centers are also expected to review their progress during the past year and propose (update) both business and health care plans for the next year of operation.

STRATEGIC PLANNING

...connotes thinking about, and anticipating, the future course of events in the environment within which an organization functions, and assuring that the organization is prepared to advance to meet the challenges of the future. (Barnett and Gilbert)

Exhibit 15-1 presents an overview of the strategic planning process. As a rule, the administrator will assume the role of coordinator, initiator, and implementer of the strategic planning process. If your center is a new organization, the question is where to begin. If the center is operational and has already been involved in the planning process, the question is how is it doing and what needs to be changed?

Because strategic planning is an ongoing and evolving process, consideration should be given to keeping a checklist of all external factors involved in decision-making for your center. For example, when considering a new program or service, a review of the checklist may reveal that there are regulatory or funding constraints. Exhibit 15-2 presents examples of factors to consider during your planning process that could affect your center's operations in the future. Exhibit 15-3 presents an example of a strategic plan outline that you may wish to use as a template for structuring a formal strategic plan for your health center.

There are also a number of resources listed at the end of this chapter that provide useful information on strategic planning. We do not recommend any one approach; rather we encourage structuring your planning process to meet your goals and objectives, factoring in your community's unique characteristics and your staff capabilities.

S.W.O.T. ANALYSIS

The next step is to test the appropriateness of your initial strategies and to reassess and evaluate the outcome expectations defined during the initial planning process for the center. Although this planning process seems straight-forward, the center is well advised to spend time analyzing what has been accomplished, and where and how to go from here. The results of this analysis will provide an understanding of the center's strengths, where attention needs to be focused for improvement (weaknesses), opportunities to consider for future expansion, and threats that could impact on the overall goals and objectives. This kind of assessment is often referred to as "S.W.O.T. Analysis" because it focuses on the four key elements of Strengths, Weaknesses, Opportunities, and Threats.

SERVICE GAP ANALYSIS

The next step in the annual review is to determine if there are any gaps in the current services provided and, if there are, to develop strategies for filling these gaps. The Bureau of Primary Health Care (BPHC) has put together a work sheet (Exhibit 15-4) that will help your center determine the stage at which you are currently operating. This process is designed to provide the necessary information to improve services and move to a higher level of primary care delivery. Health Centers receiving grant funding under Section 330(e) of the Public Health Service Act are advised to look for additional operating criteria beyond what is noted in the aforementioned Exhibit. Appropriate operational guidance for grant supported Health Centers are detailed in Policy Information Notice (PIN) 98-23 "Program Expectations for Health Centers" and PIN 2000-06 "Primary Care Effectiveness Review (PCER) of Health Centers." These PINs as well as other current Health Center operational policies set forth by the Bureau of Primary Health Care (BPHC) can be found on the Bureau's website: http://bphc.hrsa.gov.

FUTURE GOALS

A review of your goals will determine how satisfied you are with your current position and to what extent and how soon you should consider a change in strategy. This analysis measures performance against expected outcomes. This is the time to reassess these health care indicators to be sure they still reflect your goals. In addition to measuring priority health care goals, now is also the time to evaluate your overall operations to determine:

• Are your community's values and beliefs regarding the population's health status still valid?
• Is the center's organizational structure flexible enough to allow for coordination between the various providers/ agencies involved in meeting the health care needs of the population?
• What control and incentive systems are in place and are they working? What measures of performance are tracked regularly?
• Are the financial systems appropriate for providing the necessary information for decision-making?
• How effective is the management/clinical team(s)?
• Is the board in agreement with the selected strategic approaches?
• Are there any contractual agreements that are likely to limit future alternatives?
• Are there any regulatory, antitrust or other governmental or social constraints?

NEXT STEPS

The results of the annual planning process will lead to identifying the next steps for the center. Those areas identified as strengths can serve as the baseline for future operational decisions. Areas of weakness can be addressed and, where possible, solutions or alternatives identified. For example, it may not be appropriate for the primary health care center to become directly involved in a housing issue that is resulting in a health problem (e.g., poisoning from lead paint). However, your center may elect to work with the local housing agency to find a solution.

Prepare operating plans that include goals and objectives for the next year. An important part of this plan will be to specify an individual who will be responsible for implementing activities identified under each goal. Develop strategies for implementing these plans. Be sure that these short-term plans are definitive and measurable. Prepare a budget that details the resources required, expected utilization, and revenue and expenses. For example, if transportation has been a barrier to access, a strategy might be to provide bus service for the elderly population in the community on Tuesdays and Thursdays. In this example, you will need at a minimum, a bus, a driver, possibly an assistant to help with the elderly, a schedule and location for pick-up, added clinical and administrative staff to handle the increased utilization, and an area designated for waiting.

The annual implementation plan and budget will be used next year to measure how successful you were in achieving the goals and objectives established during this year's planning process.