Faith Community Hospital: Case Analysis and Recommendations Modern day organizations, including community or not-for-profit ones, have to integrate political, legal, societal, cultural and economic concerns of the environment with corporate goals and interests. While many such environmental issues are relatively minor in the context of organizational legitimacy and survival, there are times when the issues go to core business practices or products. At such times, an organization must take immediate and effective corrective measures or be willing to be forced out of existence by various concerned publics and stakeholder groups (Metzler, 2001). A review of Faith Community Hospital's current situation indicates that its problems may be severe enough to challenge its very legitimacy and existence. Indeed, this is evident in the list of critical issues facing the management.

Situational Analysis: A close examination of the list of issues facing the management of Faith Community Hospital reveals the following environmental concerns:

1. Political and Legal: Public health and safety is a primary concern of government, which is why the health care industry is subject to regulatory frameworks that monitor adherence to established standards of medical practice. It is likely that Faith Community Hospital is inviting close scrutiny in this area given that the organization's spiritual approach is clearly in conflict with and violation of the ethics of the medical profession, and several federal and legal regulations. Indeed, this inference is evident in the example of the Child Protective Services taking custody of a baby and threatening to file charges against the hospital for failure to provide the appropriate health care measures.

2. Societal: Like the government, society and local communities are concerned with the creation and maintenance of healthy citizenry and public safety. In addition, societal concerns in the health care area also include access to affordable but high quality health care services. On this front, while Faith Community Hospital may be satisfying the community's need for affordable and even "free of cost" medical care, it can be concluded that the organization is equally inviting the wrath of the public by allowing practices that could be construed as medical errors or negligence. This conclusion can be drawn on the basis of the CEO's anecdotal evidence of staff initiating or ignoring "Do Not Resuscitate" directives in spite of instructions to the contrary. For, these are operational issues of grave societal concern since such procedural violations directly affect patient safety and health outcomes.

3. Cultural: This is one area where Faith Community Hospital is likely to achieve a high approval rating, stemming from its religious heritage and belief in respecting the religious beliefs of its patients and staff. However, as observed earlier, this strength of the organization is also its biggest "achilles" heel as it conflicts with the health care objectives of both the organization and society. In fact, it can be concluded here that the spiritual heritage and values of Faith Community Hospital cannot feasibly serve as the foundation for the organization's stated mission to "promote the health and well-being of the people in the communities we serve."

4. Economic: From an economic perspective, the chief concern of all stakeholder constituencies in the environment would be to see financially healthy health care organizations. This concern arises primarily from empirical evidence that financial robustness leads to high quality care and further investment in upgrading and expanding the range of health care services. Leading from this, it is evident that Faith Community Hospital has a looming problem in this area considering that its rising premium and patient costs per day are threatening its financial health.

Problem Definition: The preceding situational analysis clearly reveals that Faith Community Hospital has been unable to integrate environmental concerns into its corporate goals and interests and, therefore, runs the risk of its organizational legitimacy being questioned or being forced out of existence. Such a situation can be termed as a crisis management situation that calls for a major revamp of the organization's corporate and business goals and strategy. In effect, this implies that Faith Community Hospital's corporate philosophy and strategy is insular and out of sync with the environment. The second and equally important problem that Faith Community Hospital clearly has is the lack of fiscal discipline and financial controls.

Key Issues: Although Faith Community Hospital clearly needs to review its corporate and business strategy, it would be prudent to simultaneously address the diverse range of issues outlined by the CEO before attempting to develop any strategic recommendations. Such an exercise is important in order to...

To do so, a fishbone diagram was developed (refer Appendix 1). The fishbone problem solving technique was chosen precisely because it was best suited to trace all the root and real causes that result in a single effect. In addition, it was felt that the fishbone technique would also help determine the relationship between various issues and thus help establish the relative importance of each (SkyMark, 2005).
As is evident in the fishbone diagram, the root cause of all Faith Community Hospital's problems can be traced back to its corporate philosophy or rather, over emphasis on a spiritual approach to health care services. This philosophy, in fact, acts as the cause for most of the defined management issues such as the threat to the organization's legitimacy and reputation; the threat of federal action for medical negligence and violation of medical and societal norms; the risk of non-reimbursement of patient costs from insurance and managed care providers due to non-adherence of established policies and procedures; and spiraling costs per patient per day necessitating the likelihood of cost reduction exercises and a possible impact on quality of services provided.

Alternative Strategies: Working on the basis that faith Community Hospital needs to revamp its very corporate philosophy, two essential steps are indicated. The first is to review the mission statement itself and the second is to consider how any change in philosophy will enable management to integrate environmental concerns with its corporate goals and interests. The obvious solution, of course, lies in Faith Community Hospital adopting a purely business like approach to health care, which means a complete change in its philosophy. In other words, a total and absolute de-emphasis of its spiritual heritage and approach to health care. A possible alternative to such a massive organizational re-engineering exercise is a modification of the organization's current philosophy. While there can be little doubt that the first will be more conducive to integrating environmental and organizational business concerns, it remains to be seen if the second route can successfully be developed to do the same.

Alternative 1: This alternative, as observed earlier, is best suited to meeting all the environmental concerns that were discussed in the situational analysis. This is because this approach will allow for a single minded focus on promoting the health, safety, and well-being of Faith's patients. In addition, such an approach will also eliminate all possible conflict between religious beliefs and health interventions, besides removing any ambiguity whatsoever from standard operating procedures. Such a business like approach will further have the added advantage of allowing management to exercise stringent control on financial decisions. This approach, however, does have two major weaknesses. The first is that the organization is likely to face stiff opposition to its giving up its spiritual approach to health care. Indeed, this opposition is likely to be felt from virtually all the hospital's stakeholder groups beginning with the Board of Directors of the Faith Foundation who are clearly committed to the traditional spiritual values of the hospital. Such opposition may even result in a withdrawal of financial funding and support. In addition, if the hospital were to move away from its spiritual approach to health care, it needs to be prepared to manage both patient and staff resistance to such cultural change. And finally, such a plan will also entail careful management of any controversy stirred up by the media or community.

Alternative 2: Working on the assumption that the spiritual approach of Faith Community Hospital is a strength that must be retained in the interests of patients' psychological well-being, this alternative proposes a modification to the hospital's current philosophy in terms of a change in emphasis. To illustrate, such a change in emphasis can be seen in, for example, a modified mission statement that could read: "Faith Community Hospital's purpose is to promote the health and well-being of the people in the communities it serves through a comprehensive continuum of services provided in collaboration with our partners. Faith Community Hospital believes that the delivery of safe and expert health care interventions is key to achieving this purpose. However, the staff of Faith Community Hospital respect the role that spirituality plays in promoting a patient's well-being and will, therefore, strive, at all times, to respect a patient's religious wishes."

The modified mission statement suggested above demonstrates how Faith Community Hospital can bring about a change in emphasis to health outcomes without necessarily giving up its spiritual heritage and touch. Such a change, if managed well, will also lend itself to management successfully instituting…