Management of a Care Facility


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Managers are tasked to create their organisation’s vision in such a way that it will aide in assuring future stability. This academic paper will discuss how an organisation’s vision is created, communicated and implemented and how this vision will pave the way for conceptualizing its strategic direction in a chosen residential home.

The residential home care that was discussed in this paper is a home care that provides older adult services to about 60-70 residents with various geriatric needs. The residential home care is divided into units depending on the needs assessments made on each resident during their admission. There are about four nearby residential home cares providing the same services. The home care is the newest of the four and is gradually gaining recognition within the serviceable area. In its everyday operations, bulk of the employees consists of nurses and health care aides. Major problems faced by the organisation are the shortage of nursing staff along with the need to expand the business due to increase influx of clients being admitted.

The vision and its stakeholders

An organisational vision is a statement of what the organisation wants to do and hopes to become in the future (Nagelkerk, 2005). In creating a vision, it must first be congruent with mission and philosophy of the organisation and anchored on shared values and beliefs (Polifko-Harris, 2005). At the same time, the vision must be dynamic and motivational to its stakeholders because the vision is said to be meaningful only to those who are involved in its creation (Roussel, 2011; Thamm, 2011; Allen, 2007)

A stakeholder is a person or a group that takes strong interest on organisation (Kelly and Tazbir, 2013). In health care industries such as the residential home care, the stakeholders include the patients or clients, nurses, medical practitioners, insurers, administrators, and accrediting bodies (Kelly and Tazbir, 2013). In vision planning, consideration of the stakeholders and fostering a good relationship with them are very crucial as their involvement and engagement in the organisation can bring the vision into reality (Kelly and Tazbir, 2013; Malloch and Porter-O’Grady, 2010). They must be adequately represented as they are expected to support management initiatives and perform certain roles for fulfilling organisational success (Gantz, 2010; Harris et al, 2010). As Sare and Ogilvie (2010) say, nursing is a people-centered profession and thrives in involvement. The more we get to involve people to share in the organisational vision, there is higher likelihood that the vision will be put to reality.

Oftentimes, it is heard that only those in the middle and upper management make decisions and policies for the organisation. However, it is not only them who must be involved in creating the vision. In the chosen health care setting, the stakeholders include the elderly residents and their families, the nursing personnel and other employees, unit managers and supervisors and the board of directors. Feedbacks and perceptions of service users are crucial in service improvements. Thus, satisfaction of the elderly residents and their families must be solicited from them. Moreover, the people working for the company especially the nursing staff who provide direct nursing care must be considered. Nurse leaders need to make the employees committed to the organisation and gain ownership of its goals and objectives so that the vision can be brought to reality (McIntyre and McDonald, 2013). Nurses who are motivated and satisfied in their work are more likely to perform better that contribute to better patient outcomes (Potter et al, 2014). As mentioned, the home care is now facing a shortage of nursing staff which can affect their level of dedication and work quality (McGilton et al, 2013; Peng et al, 2013). This should be one of the things that must be considered if the management would want to make the nursing staff form a sense of ownership of the vision.

Factors that may impact the organisational vision

Aside from the stakeholders, there are influential factors that must be paid attention to if the organisation is to create a feasible vision. Intrinsic and extrinsic factors can be assessed using SWOT analysis (Kelly and Tazbir, 2013). These factors that need consideration include the areas of operation, finances, competition, changing needs of clients, technological advances, changing political climate, market conditions, economy, competition, current trends and issues in healthcare (Nagelkerk, 2005).

Organisational vision and strategic decision

In consideration of the characteristics of the residential home care, its stakeholders and other environmental factors, the created vision is written below:

“Our vision is to be the foremost residential home care for older adults in the community that promotes independence and higher quality of life through excellent and safe nursing care.

The next step would be to create the strategic direction for the organisation. In the strategic management process, the strategic direction is the long term goals and objectives of the organisation that outlines the purposes of the organisation and its operational scope (Enz, 2009). It must be anchored on the organisation’s mission and vision statements (Enz, 2009). In consideration of the strategic direction, the organisational competencies will be assessed together with surrounding environmental factors (Wilson, 2005). In developing the strategic direction, answers to the following questions will be sought with the help of the management and key stakeholders: 1) What are the expertise of the home care?; 2) What kind of home care will it be in three or five years?; 3) What type of population will we be serving?; 4) What additional functions or services are we going to provide given the evolving market?; 5) What are the technology requirements given the evolving market?; and 6) What changes are taking place in the internal and external market that will affect the home care? (Paley, 1999).

Communicating the vision

One of the qualities of a highly effective leader is the ability to make the people involved in the organisation understand and remain committed to the vision (Gill, 2011). Continuous and sustainable communication of the vision enables members to be clearly informed of the current status of the organisation and its future directions (Gill, 2011). When properly communicated, shared vision prospers and stakeholders will most likely understand their roles and responsibilities in realising the vision inspite of uncertainties and problems along the way (Papp, 2001). The created vision will be communicated by: 1) finding key persons who will motivate others to listen and be engaged in the vision; 2) setting-up a formal communication team who will disseminate the new vision through advertisements and staff education; 3) including the vision in marketing ads of the home care; 4) place posters containing the vision in strategic locations within the organisation; 5) spark conversations among people around about the new vision; 6) create activities such as contests that are themed based on the vision; 7) get other’s feedback and perception of the new vision through personal interviews and group discussions; and 8) use social media and other information-dissemination technology that will keep others informed and reminded of the vision (Center for Creative Leadership, Cartwright and Baldwin, 2011).

Right leadership for vision sharing

For the organisation to see the fulfillment of its vision, everyone with vested interest in it must work collectively through appropriate leadership and management behaviours. Making everybody feel that they own and share a common vision is a major focus of transformational leadership. According to Bass and Riggio (2006), leaders must appeal to the followers’ sense of self-worth to ensure their commitment and involvement in the entire efforts and activities of the organisation. Transformational leaders motivate their followers to always put their best in what they do, empower them by making them involved in crucial organisational activities, and allow them to expand their potentials and abilities (Bass and Riggio, 2006). Followers are able also to develop a strong sense of identification with the organisation that moves them to working and thinking not just to suffice their self-interests (Hutchinson and Jackson, 2012).In nursing, transformational leadership has been seen as a model of leadership that is enabling, empowering and suitable for nurses to remain committed to excellent and safe care practises (Lievens and Vlerick, 2014; Ross et al, 2014; Schwartz et al, 2011).

To embed the vision to the followers, the leaders must employ the four components of transformational leadership. These are idealised influence, inspirational motivation, intellectual stimulation and individual consideration (Doody and Doody, 2012; Schwartz et al, 2011). In idealised influence, the leader must be seen by the followers as a role model (Doody and Doody, 2012). The manager of the home care must set an example by ensuring that all personal actions are in accordance with the vision. They must be the frontline communicator of the vision to the staff and be the first person to act when everyone is having difficulty fulfilling the vision (Doody and Doody, 2012). Inspirational motivation must also be applied by encouraging followers to always work to achieve organisational goals and objectives while at the same time achieving their own goals (Bally, 2007). Allowing members to participate in decision and policy-making exemplifies intellectual stimulation (Schwartz et al, 2011). For example, the nursing staff can be involved in projects and programmes that will be launched to achieve the vision and strategic direction of the home care. Lastly, leaders in the home care must be open to the individual needs of the followers by supporting them in their actions, giving them recognition for their efforts and allowing them to achieve professional growth (Schwartz et al, 2011). Rewards and incentives can be given to those staff who exceptionally performed to achieve the goals set by the home care. They may also be given opportunities for further trainings and in-service education to make them more competent. In turn, these activities can bring about better services and improved patient outcomes.

Organisational objectives

Organisational objectives are the prescribed actions that will be used to achieve and evaluate organisational goals (Kelly, 2011). Based on the vision, the following are the organisational objectives:

Our residential home care aims to:

Deliver client-centered and holistic care to our residents
Create a therapeutic environment for our clients
Provide compassionate, ethical, safe, caring and dependable nursing services
Commit ourselves to quality improvement and safety standards
Increase the services we provide based on our clients’ changing needs
Put the organisation and clients’ needs first before our own interests
Respect, value and empower people within the organisation
Support individual growth and opportunities
Increase stakeholders’ satisfaction
Move for organisational stability and viability

Strategic planning process

Strategic planning is the process of setting the future direction of the organisation through alignment of its mission and vision with its actions to achieve the desired outcomes (Feldman and Alexander, 2012). The strategic planning process that will be done follows Odiorne’s recommendations (as cited in Swansburg, 1996):

Gap analysis. This involves identification of the problems of the organisation in order to determine what the organisation wants to do about it in the future.
Examining extrinsic factors. Assess outside influences that contribute to the problems identified.
Enumerate the critical issues. From a pool of problems identified, select the most pressing issues and those which more likely create a high-impact on the organisation.
Ranking the important. Plan according to the most important issues for the organisation.
Decide. Decide on the issues by involving all key stakeholders.
Time and resource planning. Construct a time frame as to when the objectives should be met. This will also include identifying who will be responsible and the resources that will be needed.

Summary and Conclusion

Managing an organisation is never an easy task. It gets more difficult as the organisation becomes more complex and the needs of stakeholders continue to rise. Nurse managers and leaders must be able to consider all factors inside and outside of the organisation and every individual who has an interest to it. Leaders and managers must craft a well-defined and shared vision to make everyone involved in the organisation to remain committed and motivated towards fulfilling it. Such work will entail the need to adopt transformational leadership through idealised influence, inspirational motivation, intellectual stimulation and individual consideration.

With the new vision, it is likewise necessary to craft the strategic direction and objectives of the organisation. In doing so, leader-managers must be able to align these to the vision, mission, philosophy, and values of the organisation. When all of these are in place, the organisation can now move to making a strategic plan for the entire organisation.