Applied Sciences

Mission: A Statement of Distinctiveness  In the hierarchy of goals (end results and organizational plans to accomplish them), the mission captures the organization’s distinctive character. Although a well-conceived mission is general, it is more concrete than vision. An organizational mission is an attempt to capture the essence of the organizational purpose and commit it to writing. Stryker Corporation, an international leader in the development of medical technologies, has a mission statement that is simple and to the point – “Together with our customers, we are driven to make healthcare better.”4 Emphasis is placed on the interactions with customers, physicians, researchers, and so on, in the development of innovative products and services. This simple statement is used to coordinate the actions of thousands of employees in more than 100 countries. An organizational mission is a broadly defined and enduring statement of purpose that distinguishes a health care organization from other organizations of its type and identifies the scope of its operations in product, service, and market (competitive) terms.5 The mission statement of the University of Texas MD Anderson Cancer Center in Exhibit 5-2, for example, distinguishes the center from other health care organizations in the service area by its relationship with the University of Texas; its emphasis on a specific disease (cancer); its commitment to the integration of patient care, research, education, and prevention; and its intention to accomplish these through education at the undergraduate as well as graduate levels.

• The mission of the University of Texas MD Anderson Cancer Center is to eliminate cancer in Texas, the nation and the world through outstanding integrated programs in patient care, research, education and prevention, and through education for undergraduate and graduate students, trainees, professionals, employees, and the public. Source: University of Texas MD Anderson Cancer Center.

Exhibit 5.2 Mission Statement of the University of Texas MD Anderson Cancer Center MD Anderson developed an effective logo that states that MD Anderson Cancer Center is dedicated to “Making Cancer History” with a bold red line through the word “cancer”. With cancer “wiped” out, MD Anderson is definitely making history. Since 1990 when U.S. News & World Report began a ranking of hospitals, MD Anderson has been ranked first or second, and has received the top ranking nine times in the past ten years. Although mission statements are relatively enduring, they must be flexible in light of changing conditions. The changes facing academic medicine will continue to impose pressures on specialized centers of excellence such as MD Anderson because of the substantial costs involved in integrating patient care with the teaching and research mission and the increasing reluctance of payers to reimburse for educational costs. Essentials for a Strategic Thinker 5–2, “What Are Academic Medical Centers?” highlights the nature and some challenges facing academic medical centers. Despite the challenges, MD Anderson has retained its mission statement for a number of years and has remained focused on its distinctiveness in a rapidly changing environment.

Mission statements are sometimes not the true “living documents” that are capable of encouraging high performance. Studies of mission statements confirm that the full potential of this directional strategy is rarely achieved.6 Often mission statement creators seem to feel obligated to make reference to specific stakeholder groups such as patients or communities because of institutional pressures and refer to pressing social issues because of policy decisions within the organization.7 To be effective, mission statements must be carefully crafted to the organization’s unique purpose.8

One study of hospital mission statements found that almost 85 percent of the respondents had mission statements; however, some of the executives who completed the survey did not perceive a high level of commitment to the statement by employees or that specific actions were influenced very much by the mission.9 Another study of state-level departments of public health indicated that more than 90 percent had formal, written mission statements. Despite the frequency with which formal mission statements are encountered, a great deal of confusion exists regarding their value and the influence that these statements actually have on behavior within organizations.10 This confusion is unfortunate because the mission statement is a crucially important part of strategic goal setting. It is the superordinate goal that stands the test of time and assists top management in navigating through periods of turbulence and change. It is, in other words, the stake in the ground that provides the anchor for strategic planning. It must be emphasized, however, that mission statements, even at their best, can never be substitutes for well-conceived and carefully formulated strategies.11 A sense of mission is not a guarantee of success. A positive relationship between mission statements and performance assumes a commitment to the organizational purpose. This is especially true of health care organizations.12 The organization has to adhere to the mission and regularly review it to be sure that it remains relevant. When the mission is carefully crafted, mission fulfillment influences a variety of key psychological states related to employee motivation (e.g. employee engagement, organizational identification, and so on).13 It has been suggested that “mythopoetic leaders,” who use the mission of the organization to anchor behaviors, can be instrumental in building robust cultures that can lead to a competitive advantage.14 Mission statements remind managers in health care organizations to ask questions of themselves and their colleagues. It is

important to ask individuals throughout the organization the following questions as the answers radically affect how the organization performs. These questions include:

• Are we not doing some things now that we should be doing? A rehabilitative medicine center, after analyzing the environment and studying its own referral patterns, might determine that it should enter a joint venture with a group of surgeons to provide outpatient surgery services. The rehabilitative medicine center, located in a professional building adjacent to an acute care hospital, had simply been referring patients requiring surgery to the hospital. However, insurance company policies and patient preferences suggested that the majority of surgeries could be performed on an outpatient basis.

• Are we doing some things now that we should not be doing? The rehabilitative medicine center, after extensive analysis, concluded that it should divest its rehabilitative equipment business and contract with medical and sports equipment suppliers for needed services.

• Are we doing some things now that we should be doing, but in a different way? Throughout its history the rehabilitative medicine center required patients to come to the facility for services. For many patients, particularly those with serious injuries, travel to the facility was difficult and often impossible. As a strategic response, the center purchased a mobile trailer with a fully equipped diagnostic and treatment facility that can transport services to local high schools and industrial locations.15

An organization should carefully evaluate strategic decisions using its mission statement when new opportunities are presented. The above three questions may be used to determine whether or not the new opportunity is consistent with its essential distinctiveness. Moreover, these questions are important guards against mission drift, which is the tendency to move into

businesses and programs not in line with the stated mission.16 As an example, Cancer Treatment Centers of America’s (CTCA) mission statement (see Exhibit 5-3) provides guidance for its leaders and employees in its network of hospitals across the country in determining whether or not new opportunities should be pursued. CTCA has established a reputation for “treating the whole person.” In pursuit of this central goal, the use of state-of- the-art technologies is prioritized and treatment teams include medical oncologists, spiritual support personnel, rehabilitation therapists, dietitians, radiation oncologists, naturopathic clinicians, and more. Adherence to the mission enables CTCA to evaluate any and all innovative and even sometimes less conventional cancer care.

• Cancer Treatment Centers of America (CTCA) is the home of integrative and compassionate cancer care. We never stop searching for and providing powerful and innovative therapies to heal the whole person, improve quality of life, and restore hope. Source: Cancer Treatment Centers of America.

Exhibit 5.3 Mission Statement of Cancer Treatment Centers of America Another important function of mission statements is to assist the strategic leader in asking “what should we not be doing?” If leaders do not ask this question each time they face a new opportunity they open themselves to two dysfunctional possibilities. The first is mission drift and the second is mission creep. Mission drift occurs when the mission is altered, often unintentionally, and the organization fades into areas it should not pursue. Indeed, mission statements do eliminate certain areas of operation (for example, a well formulated mission statement would discourage a health care organization from entering the construction industry). When organizations devoted primarily to health care delivery engage in businesses where they have little or no experience the results are unsuccessful more often than not.

Another temptation for organizations is mission creep. In this case the health care organization does not drift into an unfamiliar activity, it simply allows itself to add on more and more related activities to the point where the diversity of operations becomes unmanageable. Consider a local public health department founded by a local government to ensure the health of the public. Initially, this was interpreted as providing disease control services, vital records, and health policy advocacy. Then the absence of primary care resources for the local medically indigent population required the health department to open primary care clinics; because many in the local population did not have the transportation required to receive the services of the primary care clinics, health officers decided to devote some minimal resources to home health activities. Over time the demand for home health grew and consumed more and more limited resources. Eventually, the local health department with essentially the same budget it had when it was founded, was providing a portfolio of services that included disease control, primary care, and home health and was considering additional services in the area of environmental health. This example demonstrates how organizations can overwhelm their resources by allowing too many activities and services to creep into their organizational missions, even while proceeding with the best of intentions. Characteristics of Mission Statements  The mission statement of Shriners Hospitals for Children (Exhibit 5-4) illustrates some of the important characteristics of an effective mission statement. The product portfolio (specializing in services to children with neuromusculoskeletal conditions, burn injuries, and other special health care needs) is articulated in the mission statement so that interested parties can immediately understand the uniqueness of Shriners Hospital for Children. Clearly, this is not the typical children’s hospital. Moreover, insights are given into the Shriners Hospital for Children’s concern for family, diversity, and so on. Using the Shriners

mission statement, four important characteristics of effective mission statements can be illustrated:

1. Missions are broadly defined statements of purpose. Well- formulated mission statements are written and communicated to those involved in doing the work of the organization. They are broad but also, in a sense, specific. The Shriners Hospital for Children’s mission statement specifies the specific type of work it does. That is, mission statements should be general enough to allow for innovation and expansion into new activities when advisable (Shriners covers this with the phrase “other special healthcare needs”) yet narrow enough to provide direction.17

2. Mission statements are enduring. The purpose, and consequently the mission, of an organization should not change often and should be enduring. People are committed to ideas and causes that remain relatively stable over time. Shriners Hospital for Children has evolved from specializing in pediatric orthopedic care in the 1920s, to burn units, to its present portfolio. The consistent underlying theme has been its focus on children and their families.

3. Mission statements should underscore the uniqueness of the organization. Shriners Hospital has a number of unique qualities including its focus on children, its emphases on education and research, and its non-discriminatory philosophy of providing care without regard to the patient’s ability to pay.

4. Mission statements should identify the scope of operations in terms of service and market. However, it is important for the mission statement to specify what business the organization is in (health care) and who it believes are the primary stakeholders.18 Note that Shriners Hospital for Children clearly identifies the type of conditions it is committed to treating.

Shriners Hospitals for Children has a mission to: • Provide the highest quality care for children with

neuromusculoskeletal conditions, burn injuries and other special healthcare needs within a compassionate, family- centered and collaborative care environment.

• Provide for the education of physicians and other healthcare professionals.

• Conduct research to discover new knowledge that improves the quality of care and quality of life of children and families.

This mission is carried out without regard to race, color, creed, sex or sect, disability, national origin or ability of a patient or family to pay. Source: Shriners Hospitals for Children. Exhibit 5.4 Mission Statement of Shriners Hospital for Children These characteristics illustrate the essential properties of well- conceived and communicated mission statements and outline worthy ideals that are always in the process of being achieved by strategic leaders in health care institutions.19 The mission provides direction. Mission statements are not easy to write, but fortunately there is general agreement on what they should include.

Components of Mission Statements  There is no one best way to develop and write mission statements. Research has shown, however, that in non-profit organizations the content of mission statements is influenced by interorganizational peers or other non-profits in their own networks.20 Studies of Canadian not-for-profit hospitals indicate that they emphasize a variety of factors in their mission statements.21 To define the distinctiveness of an organization, mission statements must highlight uniqueness. Some of the more important components of a mission are discussed and illustrated with the use of mission statements from a variety of health care institutions.

• Mission statements target customers and markets. Frequently the mission statement provides evidence of the kind of customers or patients the organization seeks to serve and the markets where it intends to compete. Exhibit 5-5 provides the mission statement of the Cleveland Clinic. This mission statement clearly states who are considered the customers or stakeholders of the Clinic – the patients, researchers, and all employees. Ultimately, the mission is to provide better care for the sick by investigating the reasons for their illness, providing education to those who serve the patients, and engaging in research.

• The mission of The Cleveland Clinic is to provide better care of the sick, investigation into their problems, and further education of those who serve. Source: Cleveland Clinic.

• Exhibit 5.5 Mission Statement of The Cleveland Clinic

• Mission statements indicate the principal services delivered or products provided by the organization. A specialized health care organization might highlight the special services it provides in its mission statement. Amedisys is a home health and hospice care company dedicated to providing a continuum of care in the home setting. Its mission statement reflects its goal to deliver complete home health and hospice services to patients in their homes (see Exhibit 5-6).

• To provide patient-centered care every day and be the leading healthcare at home team in the communities we serve. Source: Amedisys, Inc.

• Exhibit 5.6 Mission Statement of Amedisys, Inc.

• Mission statements specify the geographical area within which the organization intends to concentrate. This element is most frequently included when there is a local, state, or regional aspect to the organization’s service delivery. The California Department of Public Health’s mission statement provides an example of this component of mission statements (see Exhibit 5-7).

• The California Department of Public Health is dedicated to optimizing the health and well-being of the people in California. Source: California Department of Public Health.

• Exhibit 5.7 Mission Statement of California Department of Public Health

• Mission statements identify the organization’s philosophy. Frequently the mission of an organization will include statements about specific and distinguishing beliefs, values, aspirations, and priorities. Although not specifically part of the mission statement, it is useful to see the statement of philosophy that Amedisys provides in addition to its mission statement (see Exhibit 5-8).

• Taking care of your loved ones as we would our own – that is the philosophy Amedisys was built on. This simple concept, coupled with our core beliefs, has guided Amedisys growth in becoming one of the nation’s leading health care companies focused on bringing home the continuum of care. Source: Amedisys, Inc.

• Exhibit 5.8 Philosophy Statement of Amedisys, Inc. • Mission statements confirm an organization’s preferred

self-image. How a health care organization views itself may constitute a singularity that should be included in the mission. The mission statement of Fresenius Medical Care

makes it clear that it views itself as the standard setter when it comes to health care (see Exhibit 5-9).

• To deliver superior care that improves the quality of life of every patient, every day, setting the standard by which others in the health care system are judged. Source: Fresenius Medical Care.

• Exhibit 5.9 Mission Statement of Fresenius Medical Care

• Mission statements specify the organization’s desired public image. This image customarily manifests itself in statements such as the organization’s desire to be a “good citizen” or a leader in the communities where its operations are located or a similar concern. However, organizations may have a particular approach or focus that they want to communicate to the public. The mission statement of Promise Healthcare, a long-term acute care hospital (LTACH) (see Exhibit 5-10), expresses its intent to be known as a high-quality, professional, and compassionate organization.22

• Promise Healthcare’s mission is to deliver the highest quality of professional and compassionate care to our patients and their loved ones. Source: Promise Healthcare

Exhibit 5.10 Mission Statement of Promise Healthcare Not every one of the characteristics should necessarily be included in the mission statement.22 Any particular statement will likely include one or several of these components but seldom will include all. The organization must decide which of these, or some other characteristics, really account for its distinctiveness and emphasize them in the mission statement. Interestingly, studies have found that higher-performing organizations generally have more comprehensive mission statements. Elements such as

organizational philosophy, self-concept, and desired public image were particularly associated with higher-performing organizations in the sample studied.23 Building a Mission Statement  For a mission statement to be useful a leader must begin the discussion concerning the need to examine or re-examine the organization’s mission to clearly state its purpose. This statement helps all employees focus their efforts on the most important priorities. One process that can be conducive to building mission statements is to convene a group of interested employees (administrative and non-administrative) who understand the issues facing the health care system as well as the strengths and weaknesses of the organization. Each member of the group should understand the “big picture” and be able to look at things from the perspective of the CEO, not just from his or her personal viewpoint. Prior to actually writing the mission statement, everyone should understand why a mission statement is being written or rewritten and the desire for a well-understood and widely communicated statement of organizational distinctiveness. Without a common ambition shared among organizational members, the usefulness of the mission statement and its ultimate purpose will not be realized. Once commitment has been established, assessments should be made of what makes the organization successful from the perspectives of employees and other key stakeholders. Further, consideration should be given to what perceptions of success will be in the future.

After the group has been given time to think about the organization, its distinctiveness in its environment, as well as the likely future it will face, the group should meet in a planning retreat. Often it is useful to remove the participants from the office, and encourage unplugging from social media to have the opportunity to truly focus on the organization’s mission. To

stimulate strategic thinking, each person should be asked to reflect on the mission statement components listed in Exhibit 5-11. Recognizing that some members may not have been previously involved in writing a mission statement, this exhibit was developed to encourage initial thought without introducing too much structure into the process. Group members should be asked to present key words relative to each of the components. The key words should be recorded and eventually used as the raw material for the mission statement. Participants can be encouraged to generate the key words through a series of fill-in- the-blank statements listed under each mission statement component.

Component Key Words Reflecting

Component 1. Target customers and clients:

“The individuals and groups we attempt to serve are …” Do not be limited to only the

obvious. 2. Principal services delivered:

“The specific services or range of services we will provide to our customers are …”

3. Geographical domain of the services delivered:

“The geographical boundaries within which we will deliver services to our customers are …”

4. Specific values: “Specific values that constitute our distinctiveness in the delivery of our services to customers are …”

Exhibit 5.11 Strategic Thinking Map for Writing a Mission Statement After discussion and fine-tuning of the language, a draft of the mission statement can be developed. The draft should be refined by the group until there is consensus on the wording and meaning of the mission statement. Once the group is satisfied with the statement, it should be circulated among key individuals to gain their input and support.

Top-Level Leadership: A Must for Mission Development  For a mission statement to be a living document, employees must develop a sense of ownership and commitment to the mission of the organization. Involving employees is therefore essential in the development and communication of the mission. However, top- level leadership must be committed. Management must stay engaged in the mission development process but not dominate it. Board rooms and executive suites can produce great ideas for mission development but everyone must commit to the mission for it to be achieved.24 Developing a mission statement is a challenging task. Frequently, attempts are made to formulate “blue sky” statements of environmental and competitive constraints and little more. For example, it is of little real value to state that a health care organization is devoted to being a good citizen in the community and to paying wages and benefits comparable to those of other organizations in the area. Realistically, the organization must be a

5. Explicit philosophy: “The explicit philosophy that makes us distinctive in our service area is …” 6. Other important aspects of distinctiveness:

“Other factors that make us unique among competitors are …”

good citizen and, if it wants employees, its wages and benefits must be competitive. The role of the chief executive officer in formulating the mission should not be underestimated. Mission statement development is not a task that should be delegated to a planning staff. The CEO, the leadership team, and other key individuals who will be instrumental in accomplishing the mission should provide input. Although the process appears to be simple, the actual work of writing a mission statement is time consuming and complex, with many “drafts” before the final document is produced. The strategic thinking map (Exhibit 5-11) is useful for identifying clients, services, and domain; however, the development and communication of a well-conceived mission statement requires use of the compass (leadership) as well. Step 3: Develop a Statement of Vision The mission is developed considering the needs of stakeholders – groups who have a vested interest in the success and survival of the organization. Vision, on the other hand, is an expression of hope. It is a description of the organization when it is fulfilling its purpose.25 Vision involves creating compelling images of the future and produces a picture of what could be and, more importantly, what a leader wants the future to be.26 Effective visions possess four important attributes: idealism, uniqueness, future orientation, and imagery.27 Visions are about ideals, standards, and desired future states. The focus on ideals encourages everyone in the organization to think about possibilities. It is dynamic and collaborative, a process of articulating what the members of an organization want to create. Vision communicates what the organization could be if everyone worked diligently to realize the potential. Health care organizations need leaders who are forward looking. Effective visions are statements of destination that provide direction to where the organization’s leadership collectively wants to go. Finally, visions are built on images of the future. When people are

asked to describe a desirable place or thing, they almost always do so in terms of images. Images motivate people to pursue the seemingly impossible. One study of archival information in 151 hospitals and experiments with 62 groups of full-time employees found that leaders who used specific combinations of large amounts of vision imagery and smaller amounts of values improved organizational performance by triggering a shared sense of organizational goals thereby improving coordination.28 Origins of Vision  Health care leaders develop vision from an appreciation of the history of the organization, a perception of the opportunities present in the environment, and an understanding of the strategic capacity of the organization to take advantage of these opportunities. All these factors work together to form an organization’s hope for the future. History and Vision  An organization’s history is comprised of a variety of events and activities including the founder’s philosophy. The story of St. Jude Children’s Research Hospital began with Danny Thomas, a struggling entertainer, who prayed to St. Jude Thaddeus, the patron saint of hopeless causes and said, “Show me my way in life and I will build you a shrine.” Thomas’ fortunes changed and he became one of the best known stars in the entertainment industry. In the 1950s, Thomas enlisted members of the business community in Memphis to build a hospital for children. Supporters became convinced that rather than a general hospital for children, a research hospital devoted to childhood cancers would be a better option. Thomas and his wife devoted their time to funding the hospital and eventually enlisted fellow Americans of Arabic-speaking descent to assist. The American Lebanese Syrian Associated Charities (ALSAC) now raises hundreds of millions of dollars annually to support St. Jude. Over 9 million donors and more than one million volunteers contribute to make St. Jude’s the nation’s largest health care charity.

Think of the inspirational impact of the relationship between the history and vison of St. Jude to employees, donors, and all other stakeholders. Danny Thomas’ dream was that “no child should die in the dawn of life.” In 1962 the survival rate for childhood cancer, for example, was 20 percent. As of 2017, it is over 80 percent. And, no child is turned away for an inability to pay.29 Vision and the Environment  The vision must be relevant to the larger system and be sensitive to the changes taking place in the general and health care environments. For example, Essentials for a Strategic Thinker 5– 3, “What Are Health Care Sharing Ministries?” demonstrates how some religious organizations reacted to the passage of the Affordable Care Act in 2010 that offered an exception to the individual insurance coverage mandate allowing individuals with similar ethical or religious beliefs to form organizations to share medical bills. This resulted in the emergence of health care sharing ministries.

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