Journal of Nursing Administration:
Departments: Consider This
An Evidence-Based Business Planning Process
Brandt, Julie A. MSN, RN, NE-BC; Reed Edwards, Donna MA, RN, NEA-BC; Cox Sullivan, Sheila PhD, RN, CNE; Zehler, Jean K. MSE, RN, NE-BC; Grinder, Sandra MSN, RN, CPHQ; Scott, Karen J. MSN, RN; Cook, Judy H. MNSc, RN, APRN-BC; Roper, Debra MSN, RN; Dickey, Aurora MSHA, RN, BC; Maddox, Kathleen L. BSN, RN
Authors' Affiliation: Associate Director, Patient Care Services/Nurse Executive (Ms Brandt); Deputy Nurse Executive (Ms Reed Edwards); Associate Chief, Nurse Research (Dr Cox Sullivan); Magnet Coordinator (Ms Zehler); Associate Chief, Nurse Operations (Ms Grinder); Associate Chief, Nurse Medical Surgical Areas (Ms Scott); Associate Chief, Nurse Community Living Center (Ms Cook); Associate Chief, Nurse Specialty Areas (Ms Roper); Associate Chief, Nurse Ambulatory Care (Ms Dickey); Acting Associate Chief, Nurse Education (Ms Maddox), Central Arkansas Veterans Healthcare System, Little Rock.
Corresponding author: Ms Reed Edwards, Central Arkansas Veterans Healthcare System, 4300 W 7th, Little Rock, AR 72205 (Donna.email@example.com).
Using a systematic, evidence-based approach for developing a business plan allows nurse executives to forecast the needs of the organization, involve nursing staff at all levels, evaluate the direction of the profession, and present a plan with clear, concise goals. The authors describe 4 steps necessary in developing an effective evidence-based business plan.
A fundamental tool for the nurse executive (NE) is the nursing business plan that maps future directions through articulation of goals and strategies.1-3 Given that the business plan must be flexible and evolve as healthcare politics and global economics fluctuate,4 the NE's challenge is to flex with these market forces and develop an evidentiary basis for the business plan. The classic definition of evidence-based practice (EBP) is the conscientious use of current best evidence in making decisions about patient care5 and improving clinical practice.6 In 2001, Titler et al7 expanded the application of EBP principles to operational decision making.
All business plans have common components; however, organizational leaders usually identify a specific format to ensure consistency. These components may include an executive summary, variety of service settings, type of services offered, patient population, market analysis, strategic management, and financial planning. In an evidence-based business planning process, best practices' evidence is identified and data analysis is conducted. This process provides justification for identified needs, including equipment, supplies, space, personnel, and education. When changes to current practices or additional resource needs are identified using the evidence-based approach, recommendations are more readily supported by other key decision makers.
Creating an Evidence-Based Business Plan
Evidence-based business planning is a cyclic process that includes 4 steps with required actions (Table 1).
Step 1: Initial Assessment/SWOT Analysis
The first step is a SWOT (strengths, weaknesses, opportunities, and threats) analysis. The SWOT analysis identifies processes that are or are not working well, opportunities for improvement, and areas with perceived or real threats to the department, profession, or organization.11,12 All entries in the SWOT analysis must be supported by objective data gathered from process improvement reports, nurse-sensitive indicators, patient and staff feedback, and other ongoing sources of evidence. The SWOT analysis should also include an environmental assessment of the clinical care areas. Step 1 assists the NE in setting goals that reinforce and strengthen the facility's mission, vision, and values.
Step 2: Literature Review
The purpose of the literature review is to gather empirical data on which recommendations can be based. Sources of literature should include current journal articles, clinical guidelines, nursing organizations' position papers, criteria from accrediting bodies, and standards of practice. An integrated review of the literature facilitates clarity of findings for all participants.13 Data from literature synthesis are assessed in conjunction with the SWOT analysis information.
Identifying areas of priority through evidence as well as accepted standards of practice provides guidance for organizational planning. If changes in programs, practice, or resources are indicated, the NE can prioritize the recommended changes for inclusion in the business plan. This evidentiary basis for the business plan enhances the likelihood of approval.
Step 3: Strategic Planning
The systematic strategic planning process reinforces 3 key principles: a common mission, vision, and values; mutually agreed-upon goals and outcomes; and commitment to a plan of action.14 The strategic plan should incorporate findings from the SWOT analysis and literature review. A component of the strategic planning process is facilitating discussion among key staff to identify nursing's direction for the future.15 One way to facilitate strategic planning is through a retreat with representatives from all areas of nursing (ie, point of care, midmanagement, and division directors). During this process, past goals and accomplishments are identified and reviewed and successes are celebrated. The facility's mission, vision, and values are reviewed to ensure that nursing's strategic plan is congruent with the philosophy of the organization as defined by the stakeholders (board of directors, community, etc). The final outcome of the retreat is a nursing strategic plan with specific goals and measures for achievement.
Step 4: Implementation and Monitoring
After the strategic planning process, the NE appoints nursing champions to lead initiatives to address each goal. The champions select staff nurses who have a vested interest in goal attainment at the point of care and nursing leaders who can assist in guidance of the project. Each goal attainment team is provided with the evidence identified during the strategic planning process and the identified goal(s) and outcomes they are to address. The goal attainment team is empowered to initiate process improvement strategies that are determined to be cost neutral. Identified improvement strategies that require additional resources (ie, staffing, construction or renovation, equipment, supplies, monitoring tools, etc) are communicated to the NE to be incorporated into the business planning process. The measurement of goal attainment may be facilitated through process improvements or core measures. An example demonstrating the implementation of an evidence-based business plan is described in Table 1.
The management philosophy and practice that occur with the evidence-based business planning process results in the inclusion of point-of-care level staff throughout the process. Staff involvement begins with the SWOT analysis to determine and prioritize goals and continues through the steps of preparation and presentation of the business plan. Staff also participate in implementation of the action plan after approval of the business plan. Evidence-based business planning results in informed decisions based on available evidence and guided by the organizational mission, vision, values, and strategic plan. Nursing can set realistic goals that support the organization while meeting the professional needs of the staff.
Forecasting the specific staffing, resources, and programmatic areas for nursing is unique to every facility. Appropriate monitoring facilitates the change process and allows for analysis of progress toward goal achievement. An evidence-based business plan provides a compelling case for senior executives and explains the rationale for nursing's request. A clearly articulated evidentiary base enhances the NE's ability to convey the importance of the business plan. Using the evidence-based business planning process outlined, the NE can ensure that the needs of the nurses are successfully identified and addressed.
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