A faculty created strategic plan for excellence in nursing education.

doi 10.1515/ijnes-2013-0066

International Journal of Nursing Education Scholarship 2014; 11(1): 19–29

Research Article Connie Joan Evans*, Eileen Francis Shackell, Selma Jean Kerr-Wilson, Glynda Joan Doyle, Jodie Anita McCutcheon and Bernice Budz

A Faculty Created Strategic Plan for Excellence in Nursing Education Abstract: Strategic planning for nursing education, when seen through a faculty lens creates a deeper, more meaningful critical analysis of effective program development. New strategies are required for academic institutions to transform their curricula to meet the needs of a dynamic healthcare and changing global environment to provide quality education for students. In this article, an evidenceinformed process is presented that was progressively co-created by the faculty and facilitators. Seminal business frameworks, leadership development philosophies, and innovative interventions enabled faculty to become engaged and developed as they created a strategic plan for a future-driven nursing program. Phase One presents the process of developing a strategic plan for excellence in nursing education by leveraging faculty potential and preparing for an upcoming accreditation. In Phase Two, four team members from Phase One continue as part of Phase Two team serving as the collective memory for this initial work. This method of strategic planning encouraged faculty engagement and leadership and laid the groundwork for a positive culture change among nursing faculty. Keywords: innovative strategic planning, organizational change, nursing education, faculty development

*Corresponding author: Connie Joan Evans, Department of Nursing, Bachelor of Science in Nursing Program, British Columbia Institute of Technology, 3700 Willingdon Avenue, Burnaby, BC V5G-3H2, Canada, E-mail: [email protected] Eileen Francis Shackell: E-mail: [email protected], Selma Jean Kerr-Wilson: E-mail: [email protected], Glynda Joan Doyle: E-mail: [email protected], Jodie Anita McCutcheon: E-mail: [email protected], Bernice Budz: E-mail: [email protected], Department of Nursing, Bachelor of Science in Nursing Program, British Columbia Institute of Technology, 3700 Willingdon Avenue, Burnaby, BC V5G-3H2, Canada

The current healthcare environment in Canada and the United States is challenging nursing academia to educate nurses who provide quality patient care within a system undergoing continuous transformation (Benner, Sutphen,

Leonard, & Day, 2010; Institute of Medicine [IOM], 2010; Villeneuve & MacDonald, 2006). Nursing students face technological advances, higher patient acuity and complexity, and an expanding scope of practice (Benner et al., 2010; IOM, 2010). Recent research describes a widening theory – practice gap, new teaching and learning paradigms, financial pressures, lack of clinical opportunities, and faculty shortages (Benner et al., 2010; Canadian Nurses Association [CNA] & Canadian Association Schools of Nursing [CASN], 2012; IOM, 2010; Villeneuve & MacDonald, 2006). Developing a strategic plan to transform nursing education within this climate is a daunting task. “A strategic plan based on vision, mission, values and goals, guides program delivery and scholarship and reflects societal and cultural trends” (Canadian Association Schools of Nursing [CASN], 2012, p. 14). The creation of a futurefocused strategic plan that is accountable to students, nursing educators, patients/families, communities, and other stakeholders requires knowledge of a multitude of factors including the advancement of evidence-informed education (Emerson & Records, 2008; Kop & Hill, 2008), keeping pace with evolving healthcare trends, and the changing scope of practice for nurses (MacMillan, 2013; Villeneuve & MacDonald, 2006). The authors hypothesized that an innovative pluralistic approach to a critical contextual analysis of their nursing education program, developed through a grassroots faculty-led process, was essential to create a more meaningful strategic plan. The purpose of this article is to describe a creative, multi-layered, iterative process that leverages faculty engagement to develop a future-focused strategic plan for the British Columbia Institute of Technology (BCIT) Bachelor of Science in Nursing (BSN) program.

Method In order to increase the group’s capacity to understand the strategic planning process and ensure it was evidence-informed, members read numerous articles and

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C. J. Evans et al.: Strategic Planning for Nursing Education

books suggested by the strategic planning consultants. As well, the group performed a broad literature search related to strategic planning and organizational change. A literature search in GOOGLE Scholar, Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE via EBSCO, Business Source Complete and Academic Search Complete databases between 1990 and the present was conducted. Various combinations of the key words “strategic planning”, “nursing education”, and “organizational change” were searched. This search resulted in a number of articles, books, websites, and peer-reviewed journals. The following inclusion criteria were applied: seminal works on strategic frameworks, strategic theoretical frameworks applied to nursing education, business models, innovative models, and written in English. Exclusion criteria included literature outside of undergraduate nursing programs and business literature outside of seminal frameworks. The articles were initially selected for inclusion by review of the title. Then the authors independently reviewed the abstracts for relevance. Full text copies of the articles and books deemed congruent with the inclusion criteria were read by all the authors. Of these, a number of articles and books were excluded because they did not introduce a new framework or were not relevant to nursing education. The goal to utilize innovative contemporary strategic planning strategies focused the group to restrict the primary literature review to nursing and business literature from 2000 to 2013 as primary sources. As a result, the authors used 20 books and articles for the literature review.

Literature review A strategic plan is intended to align an organization’s vision and mission with its objectives and initiatives, provide direction for insightful, goal-directed allocation of resources, and assist an organization to remain dynamic and competitive into the future (Andrews, 1990). The process of strategic planning has been common practice in business environments for decades, but is a more recent activity in academic institutions (ReganKubinski, 2005). The CASN requires accredited schools of nursing in Canada to develop and implement a strategic plan (CASN, 2012). Preparation of future healthcare professionals requires that educational program’s strategic objectives align with anticipated future trends in healthcare (Higginbotham & Church, 2012). Traditionally, the process of strategic planning has been conducted by high-level managerial personnel

within organizations (Higginbotham & Church, 2012; Knox, Sigsby, & Irving, 1997). However, some authors claim conventional administrative top-down approaches are outdated and not dynamic or sustainable (MiloneNuzzo & Lancaster, 2004; O’Neil & Krauel, 2004). Collins (2006) established a Good to Great Framework that focuses first on getting the right people involved and then focusing on the tasks. Innovative approaches to strategic planning began to appear in the business literature in the 1990s. Kaplan and Norton (1996) introduced the concept of the Balanced Scorecard to strategic planning. This holistic method takes into account factors critical to business success beyond financial drivers by adding strategic objectives and measures that direct the organization to invest in: (1) financial sustainability, (2) customer perspectives, (3) internal processes/organizational capacity, and (4) learning and growth (Higginbotham & Church, 2012; Kaplan & Norton, 1996). Eppler and Platts (2009) discuss the use of graphics as a visualization tool to improve the quality of strategic planning by addressing cognitive, social, and emotional challenges. More recently, non-traditional approaches to strategic planning based on change theory and appreciative inquiry that engage stakeholders in plan development have surfaced in the nursing literature. This methodology is purported to result in buy-in to the strategic plan and result in a cultural transformation within the organization in less time (Flanagan, Smith, Farren, Reis, & Wright, 2010; Gantt, 2010; Harmon, Fontaine, Plews-Ogan, & Williams, 2012; Higgenbotham & Church, 2012; MiloneNuzzo & Lancaster, 2004). Aligning the faculty toward a mutual goal encourages collaboration and yields more results with limited resources (Lange, Ingersoll, & Novotny, 2008). These collaborative approaches focus on partnerships that create unique strategic initiatives that can keep pace with the future (Milone-Nuzzo & Lancaster, 2004; O’Neil & Krauel, 2004). To ensure success in the process developing faculty as effective participants and leaders in strategic planning is essential (Lange et al., 2008; Milone-Nuzzo & Lancaster, 2004). Pink’s (2009) motivation theory supports appreciative inquiry and posits that true motivation is intrinsic and comes down to three elements: autonomy, mastery, and purpose. Autonomy is giving individuals the freedom to determine what tasks to be involved in and when, how, and with whom work is accomplished. Mastery is the desire for continual improvement at something that matters by fostering an environment of learning and development. When individuals understand how they contribute to the purpose and vision of an organization,



their natural desire to contribute to a greater purpose than themselves is fulfilled. When all three elements are in place an organization achieves stronger results and greater employee engagement (Pink, 2009). In the last decade, a review of the nursing literature suggests strategic planning and organizational change in the current healthcare context requires a transformed nursing education model (Halstead, 2013) and innovative planning (Lange et al., 2008; Milone-Nuzzo & Lancaster, 2004). Many authors claim the key to strategic planning and organizational change is to use a collaborative approach that involves multiple stakeholders (Billings, Allen, Armstrong, & Green, 2012; Halstead, 2012; Lange et al., 2008; Mundt, Clark, & Klemczak, 2013; O’Neil & Krauel, 2004). Recent strategic plans focus on core program competencies for creating specific objectives such as culture and diversity (de Leon Siantz, 2008), sustainability and safety (Mundt et al., 2013), and leadership (Halstead, 2013). Some propose that a managed organizational change through visionary leadership, intentionally aligned structures, stakeholder participation, communication, feedback, and evaluation can directly link to accomplishing outcomes and strategic direction (Lange et al., 2008). This literature indicates the success of the strategic planning process is dependent on leveraging faculty expertise and values with a predetermined methodology or framework that is directed by either consultants or administrators. Currently, the literature does not describe a consultant and faculty collaborative process where faculty members select and implement various strategies to create their own unique strategic planning process.

Strategic planning process Led by two strategic consultants, the BSN strategic planning process began with a group of eight faculty members and their Associate Dean. This team represented Phase One of the strategic planning process which is the focus of this article. Phase Two will be started with a combination of new faculty and four original members who will move forward with developing an implementation plan. The consultant Tekara group named themselves after the Tekara Mountain, situated in the Canadian Rocky Mountains. Cree guides once walked with and supported travelers in these mountain ranges and the Tekara style is based on supporting people and their belief in the power of human potential (Tekara, 2013).

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Organizational size up Strategic alignment The School of Health Sciences (SOHS) strategic plan directs the nursing program to prepare students to think and be responsive to evolving practice environments now and in the future. The institute’s philosophy has a strong focus on community engagement. The community includes healthcare partners, faculty, staff, and students. The institute’s engagement philosophy (BCIT, 2009; SOHS, 2010) flows into the BSN program as part of the strategic plan development work. The consultants and faculty planning team were mindful of the need to respect and engage faculty in the process to create and ultimately implement their own strategic plan.

Strengths, weaknesses, opportunities and threats (SWOT) analysis Initially, the team members spent some time identifying and sharing their individual leadership qualities to enable effective group process, then the overall strategic planning process was introduced. Two groups were established to examine internal and external factors influencing the nursing program. Each group brainstormed data sources and stakeholders that were critical to the achievement of sustainability and excellence in the program. The external group reviewed seminal reports from both local and national levels and evidenceinformed literature on the state of healthcare and education. The internal group interviewed staff within the institution, reviewed multiple surveys, including student exit, student course evaluations, curriculum documents, institutional documents, and employee satisfaction surveys. A SWOT analysis was utilized in the process of strategic planning (Abdolvand & Asadollahi, 2012). The purpose of a SWOT analysis is to evaluate and synthesize internal and external factors that influence the program. The SWOT analysis assists with exploring new possibilities and uses a collaborative approach that empowers participants to capitalize on future opportunities (Camden, Swine, Tetreault, & Bergeron, 2009). The intent was for faculty members to have a clear understanding of their vision for education-based literature and their values in order to create strategic objectives before collaborating/engaging with others. In follow-up to the SWOT analysis, the group brainstormed and acknowledged their collective assumptions related to the current state of the nursing program, changes in


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Financial Budget, allocation, value, secure, sustainability

Sustainability through creative responsible fiscal management

Creative funding/ partnerships

Connectivism to engage students,

Curriculum must meet current and future health trends

Accountable to students and society

accountability

Collaborative, evidence-informed accountability

Diversity, embracing change, culture of excellence

Environment is supportive and responsive

Learning and development (People)

Faculty recruitment, development and support

Innovative, dynamic curriculum

Inspire passion, excellence and scholarly practice.

Customers Students, health authority, society, support

Internal processes

Acknowledge and support evolving student demographics and learning styles

Leverage partnerships

Faculty/staff, work– life balance, mastery, autonomy, purpose, program and school partners Figure 1 Strategy map – critical success factors

healthcare delivery, technology, faculty’s willingness to engage in transformation, and characteristics of nursing students of the future. This process helped to raise awareness that although assumptions were necessary to plan for the future, they require continual revisiting for validation. Analysis of all of the data collected for the internal and external review, including the brainstormed assumptions resulted in themes from which seven critical implications emerged. The seven critical implications became the critical success factors the team considered essential for achieving program success and excellence. The critical success factors fit into the four categories (see Figure 1) of a balanced scorecard resulting in the initial draft of the strategy map (Kaplan & Norton, 1996). The critical success factors would later provide the foundation for creating strategic objectives.

Strategy platform To begin the process guided by CASN (2012), the team created a roadmap to operationalize the planning process beginning with formulating a vision, values, and strategic objectives. Visioning Team members started a 1-day visioning session by creating individual drawings representing each person’s unique aspirations and visions for the program. A graphic facilitator then synthesized the group’s drawings, and ideas into a collection of images and graphics, and created an image to represent the group’s collective vision on paper as a dynamic and connected roadmap to success (Figure 2).



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Figure 2 Vision

Values Values are formidable influencers on how individual faculty move toward disruptive change. Iwasiw, Goldenberg, and Andrusyszyn (2009) indicate that agreed-upon values are vital for moving forward to create faculty cohesion. Ownership and professional accountability for the plans, goals, and objectives are enhanced when faculty participate in creating the strategic plan (CASN, 2012). Collective values were co-created when team members chose photos from a myriad of images that identified values seen by the group as critical to the success of the program. In order to ensure alignment with the institute-wide and SOHS strategic plans, the Dean of the SOHS was invited to participate. This experience was extremely energizing for the team and brought a new sense of optimism to the group who initially felt overwhelmed at the thought of transforming the program (Figure 3).

Figure 3 Values

SOHS strategic plan, the team’s vision, values, and strategy map. The three strategic goals are as follows: 1.

Strategic objectives 2. The critical success factors were further distilled and key strategic objectives formulated in alignment with the

3.

Develop a responsive and supportive environment that motivates faculty to achieve excellence in nursing, Create and maintain an innovative and dynamic curriculum, and Embed sustainability in order to be globally relevant.


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Figure 4 Strategy map and cultural climate

As an example, one critical success factor, inspire passion, and excellence and scholarly practice (see Figure 1) distills into the No. 1 objective, developing a responsive and supportive environment that motivates faculty to achieve excellence in nursing. The work done to this point was shared with the Specialty Nursing program, a key partner involved in the preceptorship component of the undergraduate program. Common themes, values, and directions were identified between the two group’s teams. The balanced scorecard provided the direction for strategic objectives, measures, targets, and initiatives with timelines of 1–3 years and 3–5 years. Measures and targets were prioritized and plans of the initiatives were also detailed as achievable targets.

Strategy execution The strategic team led efforts to clarify and build consensus and understanding around the strategic plan by sharing their aspirations and visions in a faculty meeting. Faculty worked in groups to explore their visions and shared ideas by drawing images. The common themes of the faculty were mostly in alignment with the strategic planning group’s identified mission and vision, and some additional ideas were integrated into the graphic of the strategy vision and mission map (Figure 2). Other

communication strategies included circulating an email summary of the group’s work, displaying the graphic images created by faculty and the creation of a Word cloud (www.wordle.net) to visually represent the collective values shared by all faculty. Finally, the team identified the cultural shift and vital attributes required to support the implementation of the strategic plan. The graphic facilitator captured the positive cultural climate on the strategic plan graphic as a pathway to move the strategic plan toward an achievable vision and mission for the program. Some of these attributes include transparency, autonomy, accountability, engagement, caring, and excellence (see Figure 4). The finalized graphic representation of the strategy plan was presented at a faculty meeting to enhance understanding of the process, and as a starting point to inspire faculty to apply for an opportunity to participate in the Phase Two implementation team (Figure 5). Invitations and criteria for the implementation team were presented to faculty by the Associate Dean.

Evaluation of strategic planning process The discussed strategic planning process above represents the first phase of a larger process. Upon completion



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Figure 5 Strategic plan – global leadership in nursing excellence

of the identification of strategic objectives, measures, and initiatives, the initial strategic planning team disbanded. The second faculty team, whose purpose will be to identify priorities and implement initiatives critical to the success of the plan, will be formed to continue the strategic planning process. The intent of inviting new team members to Phase Two creates opportunity to leverage diverse skill sets and to create broader engagement and motivation within the faculty. The synthesis of the various approaches to strategic planning engaged the initial team in a dynamic, creative process. Co-creating the progressive plan utilized the diversity of each of the individual team member’s strengths and was an essential component in the process. This provided the group with hope for change amidst current educational and organizational challenges. A faculty-led internal process allowed the instructors to shape the vision, mission, and strategic objectives from an evidence-based academic and future healthcare perspective to build a strong and coherent strategy (Halstead, 2012; O’Neil & Krauel, 2004). These strategic objectives will guide the Phase Two team to partner with relevant stakeholders at the appropriate time. Each group will then collaboratively craft an implementation plan that leverages their valuable perspectives. The external consultants layered evidence-informed frameworks with compelling questions that helped the group members focus energy on their strengths and

build leadership capacity within the group. The team constantly challenged the process inviting the consultants as well as themselves to explore new concepts, theories, and frameworks that would inform the strategic planning process. The use of the balanced scorecard as a traditional basis for strategic planning ensured a broad holistic approach that identified critical success factors that include the creation of a supportive culture, an innovative and dynamic curriculum and embedded sustainability. The graphic facilitator assisted the team members to expand their thinking and creatively represent the aspirations that the faculty held for the program. The inclusion of front-line faculty on the team created a meaning-driven critical analysis that informed the creation of a dynamic and relevant strategic plan. Table 1 describes the integration of theory and process co-created by the consultants and the strategic planning team. The outcomes of Phase One of the strategic planning process include: – – –

Establishing a 3-year strategic plan with strategic objectives, outcomes, and measurable initiatives; Engaging faculty from diverse parts of the program in the planning process; Creating a common vision and shared understanding of the strategic plan that made the requirement for change clear and tangible for the strategic planning team;


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–

–

–


Developing ambassadors and leaders in the original team to carry forward the collective memory of the strategic plan development; Generating motivation and trust amongst faculty, to engage others in the process and break down “silos” within the entire program; Creating an awareness among faculty on the team and within the broader faculty group of the breadth

–

and depth of scholarship required for excellence in nursing education; Expanding individual ownership and collective accountability within the strategic planning team to the future of nursing education.

The Phase Two team is in the process of the implementation and thus the outcomes of the plan itself will be

Table 1 Strategic planning process Session number

Activities

1. Tekara1 Motivational theory2

– – – –

2. SWOT analysis3 Appreciative inquiry: discovery phase4

– Literature review to determine current strengths and weaknesses pertaining to the BSN program – Two groups: external and internal factors

3. SWOT analysis3

– Share strengths and weaknesses – Determine opportunities and threats (SWOT) – SWOT analysis to determine critical implications to planning process

4. Tekara1 Motivational theory2

– Identified strategic goals to support the vision and targets for each goal – Identified assumptions – Identified implications

5. Appreciative inquiry: design phase4

Introductions and welcome SP process overview Personal style activity Expectations

– First draft of strategy map

6. Appreciative inquiry: dream phase Graphic facilitator5

– – – – –


– Strategy map – three-dimensional draft circle

4

Drew personal aspirations on flipchart Determined concepts vital to success of BSN program Graphic illustration of vision by graphic facilitator Determined six core values Started developing mission statement

8. Tekara

– Values discussed further – Strategic objectives

9. Appreciative Inquiry

– Meeting with specialty nursing group

1

10. Appreciative inquiry: destiny phase4 Balanced score card6

– – – – – – –

11. Appreciative inquiry: dream phase4 Motivational theory2

– Provided feedback to the greater faculty and received input to identify their aspirations and vision for BSN program strategy

12. Appreciative inquiry: design phase4 Motivational theory2

– Determined themes from faculty maps to create word cloud (www.wordle.net) – Discussed methods for providing feedback to faculty


– Finalized strategic plan and established evaluation systems

Finalized strategy map Determined measures and identified targets for strategic objectives Defined core values Reviewed current BSN initiatives and alignment with strategic objectives Identified new/shifted/changed BSN initiatives to support strategic objectives Determined priority initiatives Planned faculty “pitch”

14. Appreciative inquiry: design phase

– Determined implementation strategy

15. Appreciative inquiry4

– Planned handover from strategic planning group to implementation group – Documented plan: vision, mission, and strategic plan into templates – Learning circle: evaluation of strategic planning process

4

Notes: 1Tekara (2013); 2Pink (2009); 3Gantt (2010); 4Cooperrider and Whitney (2005); 5Eppler and Platts (2009); 6Kaplan and Norton (1996).



identified at the end of the first year and each subsequent year of the plan.

Challenges and limitations Every process comes with its challenges. Although multiple appreciative approaches such as inspirational video clips, graphic inspirational exercises, and themed interactive activities were implemented to engage the larger faculty group, meeting attendance was initially limited due to teaching schedules. Therefore, input into the process was not as robust. In hindsight, a communication strategy to encourage large group participation might have promoted increased sharing and engagement for the greater faculty group. A contributing factor for lack of overall participation in the early stages of the process was an expressed confidence in the representative diversity and competence of the strategic planning team. Within the strategic planning team, individual team members required more time to trust the co-creative process. An identified gap in the described process in relation to the literature is a lack of external stakeholder engagement. Effective partnerships require intentional planning and result in more potential for success if clear processes and goals are determined (O’Neil & Krauel, 2004). Direct student and external stakeholder perspectives would have informed the first phase; however, “different partners bring different values” (O’Neil & Krauel, 2004), and the strategic planning team wanted to have a clear vision and objectives before engaging the correct partners at the right times later in the process. Lastly, the team felt closure for the initial phase would have been enhanced if the plan had been publicly documented. The plan was subsequently formally documented into the CASN accreditation template; however, the implementation team will create the public document as part of implementation phase.

Recommendations The authors recommend that strategic planning for undergraduate nursing education needs to be an evolving iterative dialogue that includes faculty teams to ensure a quality outcome. Although a linear strategic architecture was introduced, the diversity, backgrounds, and commitment of the Phase One team led to a constantly evolving, time-consuming process that encouraged “strategic risk taking” (Halstead, 2013, p. 4). Conversations over time were required to explore the culture of healthcare and nursing to create language that resonated with the

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faculty. Time for reflecting and revising was integral to the process and enhanced the quality of the plan. Leveraging Phase One faculty expertise and tackling salient priorities created a relevant yet flexible plan that the Phase One team could confidently pass on to the implementation team. Further, the creation of the plan empowered the strategic planning team to think of themselves as leaders in nursing education who have the power to directly influence nursing curriculum and practice. A recent Canadian nursing education Think Tank provides further guidance to this recommendation and suggests that strategic partnerships between nursing practice, education, and significant stakeholders are necessary to create, support, and future-proof of a lifelong career in Nursing (MacMillan, 2013, p. 11). In addition, the authors consider sponsorship and involvement by administration as integral to the plan’s development. Facilitators from outside the program brought knowledge perspectives from varied disciplines outside the realm of nursing education. The meetings over time required commitment by all the participants and administration to secure meeting space, time away from campus, and teaching. The original Phase One planning team served as ambassadors for the strategic plan and supported the broader faculty to understand the importance and relevance of having a strategic plan. Finally, the authors would like to share that strategic planning can be an enthusiastic energizing process exercise that does not need to be prescribed or linear.

Conclusion Discussed in this article is a strategic planning process that utilized a pluralistic method of inquiry to engage faculty in the creation of a future-focused plan for a nursing education program. Seminal business frameworks, leadership development philosophies, and innovative strategies engaged the strategic planning team as they created a dynamic and transformative strategic plan. This unique and collaborative method of strategic planning lays the groundwork to promote positive culture change critical to the success of an undergraduate nursing program. Faculty engagement in the process provided the platform for a clear vision and sustainable plan for the future of the nursing program. The team embraced the notion of excellence in nursing education and the pivotal role nurse educators play in leading positive change in healthcare.


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Acknowledgments: The authors would like to thank the following individuals of the BScN Strategic Planning Committee: Isabelle Clements and Russell Hunter from Tekara for facilitating the strategic process; Avril Orloff for the graphic facilitation (http://avrilorloff.com);

Theresa Shaughnessy for her work on the committee and being involved in editing this article; and committee members Joan Walker and Devon Benoit for their support throughout the strategic planning process.

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