HCM 415 Module 2 Mission and Environment Short Paper Example

Does Our Mission Still Point Anywhere? A Mission Test and Environmental Scan for Ashford Valley VNA

[Student Name]

Southern New Hampshire University

HCM 415: Healthcare Strategic Management and Policy

Module Two Short Paper

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Does Our Mission Still Point Anywhere? A Mission Test and Environmental Scan for Ashford Valley VNA

Ashford Valley Visiting Nurse Association adopted its current mission in 1996, when most of its patients were in traditional Medicare, its nurses carried paper charts and no competitor within fifty miles offered home health. The agency's world has changed completely since then, and its leaders are beginning a strategic planning cycle. This paper does two things that planning texts place first. It asks whether the mission still tells staff and the board what to pursue, and it scans the general environment for the trends most likely to affect the agency over the next three to five years.

The Current Mission

The 1996 statement reads: "Ashford Valley Visiting Nurse Association provides quality home health services to the residents of our community in a caring and professional manner, consistent with our heritage of service and our commitment to excellence." Staff can recite parts of it, and the board reads it aloud at the start of each annual meeting. Yet when I asked six managers how the mission had shaped a decision in the past year, none could name one. That is the first sign that a statement has become ceremony rather than direction.

What Research Says About Mission Content

Bart and Hupfer (2004) surveyed Canadian hospital executives about 23 possible mission statement items and grouped them into seven factors. Four factors were positively related to behavioral, financial and mission achievement measures: grand inspiration, meaning an ambitious purpose that motivates people; benefactors, meaning the groups the organization exists to serve; competitive orientation, meaning what sets the organization apart; and business definition, meaning what the organization actually does. Their conclusion that not all components are equally useful matters for a small agency. A mission does not need to mention everything, but it should do those four things well.

Testing the Statement

Measured against those four factors, the 1996 wording is weak on three. It names no inspiring purpose beyond "quality" and "excellence," words any agency could use. "Residents of our community" is a broad benefactor group but does not say whether the agency serves people regardless of ability to pay, which it has always done. It says nothing about what makes the agency different, even though it is the only nonprofit home health and hospice provider in four counties. Only the business definition, home health services, is clear, and it now omits hospice, palliative care and the remote monitoring program begun in 2022.

Table 1. The 1996 Mission Against Bart and Hupfer's Four Performance-Related Factors

Note. Assessment by the author using the factor definitions in Bart and Hupfer (2004).

A Proposed Revision

A revision for the board to consider: "Ashford Valley VNA helps people of every age and income live safely and die peacefully at home. As the four-county region's nonprofit home health and hospice provider, we bring skilled nursing, therapy and hospice teams to patients and families wherever they live." The first sentence supplies the inspiration and the benefactors. The second supplies a competitive orientation and a business definition. At 43 words it is barely longer than the original, but a manager deciding whether to accept a rural referral with a poor payer now has a sentence that answers the question.

Vision and Values

The agency has no written vision. A vision describes the organization's desired future, while the mission describes its present purpose. A draft vision for discussion: "By 2030, every hospital and physician practice in our region will see Ashford Valley as the first call for care at home." The existing values, compassion, integrity and excellence, are sound but unexplained. Each should be paired with one behavior staff can observe, such as returning a family's call the same day, so the values can be taught and noticed.

The Environmental Scan Framework

Ginter et al. (2018) divide the external environment into the general environment, which affects every organization, and the health care environment, which includes the service area and its competitors. The general environment has several sectors, which planners usually sort into political and regulatory forces, the economy, population and social change, technology and competition. This paper covers the first four plus the workforce, which behaves like a separate sector for a labor-intensive agency. The service area and specific competitors will be analyzed in the Module Four project. Each trend below is described, sourced and rated.

Legislative and Regulatory Sector

Two federal programs dominate. The Patient-Driven Groupings Model, in effect since January 2020, pays for 30-day periods based on clinical grouping, admission source and functional level instead of the number of therapy visits, which rewarded agencies that previously relied on therapy volume. Second, the Home Health Value-Based Purchasing Model went nationwide in 2023 after a nine-state test. Pozniak et al. (2022) found that in the original test states it was associated with fewer unplanned hospitalizations and skilled nursing stays and greater functional improvement, with lower Medicare payments. For Ashford Valley, up to 5% of Medicare payment now rises or falls with measured quality.

Economic Sector

Medicare Advantage now accounts for 38% of the agency's admissions, up from 22% five years ago. Plans negotiate per-visit or per-episode rates, usually below traditional Medicare, and require prior authorization, which adds intake staff time. Meanwhile, nurse wages in the region have risen about 6% a year for three years, while Medicare base payment updates have been smaller. Commercial insurance is a small share of the agency's revenue. The economic pressure is therefore squeezing from both directions: lower average payment per patient and higher cost per visit.

Social and Demographic Sector

The four counties' share of residents past their 65th birthday should climb from about 19% today to about 24% by 2035, based on the state demographer's projections. Most older adults say they want to remain in their homes as they age, and families increasingly expect care that fits around work schedules. At the same time, more older residents live alone, which makes discharge home riskier and raises demand for visits, remote check-ins and caregiver teaching. Demand is not the agency's problem; the ability to meet it is.

Technological Sector

Levine et al. (2020) randomized acutely ill adults to hospital-level care at home or usual hospital care and found lower cost, fewer laboratory orders and imaging studies and fewer readmissions in the home group. The regional health system that sends the agency 41% of its referrals has announced its own hospital at home program, which could either depend on Ashford Valley's nurses or bypass them. Remote patient monitoring and better data exchange with hospital records are also maturing, and the agency's own monitoring program covers 90 patients with heart failure.

Workforce Sector

The agency's registered nurse vacancy rate is 17%, and it declined about 1,100 referrals last year because no nurse was available. Home care work carries particular strain. McCaughey et al. (2012) analyzed national survey data on home health aides and found that workers who had been injured on the job were more likely to report intent to leave. Travel time, working alone in unfamiliar homes and documentation after hours all push nurses toward hospitals that now pay similar wages for shift-based work.

Rating the Trends

Table 2 rates each trend on its likely impact on the agency and the likelihood it continues over five years. The highest-priority items combine high impact with high likelihood: the Medicare Advantage shift, the nurse shortage and value-based purchasing. Hospital at home is less certain, since the health system's plans could change, but its impact would be large either way.

Table 2. Priority Trends for Ashford Valley VNA

Note. Ratings reflect the author's judgment from the sources and internal data cited.

What the Scan Means for the Mission

The scan confirms why the revised mission matters. Every major trend forces a choice between volume and focus, between independence and partnership and between accepting every payer and protecting the margin. A mission that commits to serving "every age and income" and names the agency's nonprofit, regional role gives leaders a basis for those choices. It also exposes tension: serving everyone with 17% of nursing positions empty is impossible, so the plan must fix the workforce before it can fully honor the mission.

Conclusion

Ashford Valley's 1996 mission is sincere but no longer steers anything. Revising it around inspiration, benefactors, competitive position and a complete business definition would give leaders a test for decisions. The environmental scan shows the decisions will be hard: payer shifts, a thin workforce, quality-based payment and new models of acute care at home. The next step is to look closely at the service area and competitors, and then at the agency's own strengths and weaknesses.

References

Bart, C. K., & Hupfer, M. (2004). Mission statements in Canadian hospitals. Journal of Health Organization and Management, 18(2), 92-110. https://doi.org/10.1108/14777260410538889

Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2018). The strategic management of health care organizations (8th ed.). Wiley.

Levine, D. M., Ouchi, K., Blanchfield, B., Saenz, A., Burke, K., Paz, M., Diamond, K., Pu, C. T., & Schnipper, J. L. (2020). Hospital-level care at home for acutely ill adults: A randomized controlled trial. Annals of Internal Medicine, 172(2), 77-85. https://doi.org/10.7326/M19-0600

McCaughey, D., McGhan, G., Kim, J., Brannon, D., Leroy, H., & Jablonski, R. (2012). Workforce implications of injury among home health workers: Evidence from the National Home Health Aide Survey. The Gerontologist, 52(4), 493-505. https://doi.org/10.1093/geront/gnr133

Pozniak, A., Lammers, E., Mukhopadhyay, P., Cogan, C., Ding, Z., Goyat, R., Hanslits, K., Ji, N., Jin, Y., Repeck, K., Schrager, J., Young, E., & Turenne, M. (2022). Association of the Home Health Value-Based Purchasing Model with quality, utilization, and Medicare payments after the first 5 years. JAMA Health Forum, 3(9), Article e222723. https://doi.org/10.1001/jamahealthforum.2022.2723