MMHA 6000 Week 7 Mission Alignment Review Example

Margin for Mission or Mission Drift? Testing a Private-Pay Companion Care Line Against the Mission of Calder Ridge Home Care, With Scorecard Measures Set to Catch Drift Early

Student Name

Walden University

MMHA 6000: Foundations of Healthcare Administration

Instructor Name

Month Day, Year

Margin for Mission or Mission Drift? Testing a Private-Pay Companion Care Line Against the Mission of Calder Ridge Home Care, With Scorecard Measures Set to Catch Drift Early

The Mission, Vision and Values

Calder Ridge Home Care is the composite nonprofit home health agency of Calder Ridge Community Hospital, invented for this review. Its statements, adopted by the hospital board, read in full:

Mission: "Calder Ridge Home Care brings skilled nursing and therapy to homebound residents of Calder, Pruitt and Lowe counties, in their own homes, whatever their means to pay."

Vision: "Every resident of our counties who can safely recover or live at home does so."

Values: "Dignity in every visit. Clinical excellence. Stewardship of what the community entrusts to us."

The mission breaks into four operational commitments. Whom it serves: homebound residents of three counties, regardless of ability to pay. What it provides: skilled nursing and therapy. Where: in patients' homes. How: with dignity, clinical excellence and stewardship. A proposal can be tested against each.

The Proposal

Management proposes a private-pay companion and personal care line. Trained aides would provide nonmedical help, such as companionship, meal preparation, bathing assistance and errands, at $34 an hour to clients who pay out of pocket or through long-term care insurance. The line would not bill Medicare or Medicaid. Its purpose is margin: projections show a surplus of about $180,000 a year by the third year, which management would use to fund skilled visits for uninsured and underinsured patients, currently about 900 visits a year subsidized from hospital reserves.

Alignment

Table 1

The Proposal Tested Against Each Mission Commitment

Ratings are the reviewer's judgment, with the reason stated so each can be challenged.

The tension in the first row is the central issue. On its own, a service for people who can pay sits awkwardly with a mission defined by service regardless of payment. The proposal resolves the tension only through its use of the margin. If the surplus funds skilled visits for patients who cannot pay, the companion line serves the mission indirectly. If it is absorbed into general operations, the agency has added a line of business that the mission does not mention. Research on nonprofit hospitals found that mission statements influence behavior when they are tied to the organization's systems and decisions, not when they stand alone (Bart & Tabone, 1998). The proposal's alignment depends on that tie.

The second row deserves a note. Companion care is not in the mission, but the vision, that people who can safely live at home do, gives it a reasonable claim. An older adult recovering from surgery may be safe at home with skilled visits twice a week and a companion for meals and bathing, and unsafe without the companion.

One value, clinical excellence, raises a separate concern. Companion aides work without the clinical supervision that skilled aides receive. A client receiving both services might reasonably assume that the companion is part of her care team and report a symptom to her rather than to the nurse. The agency would need a clear rule that companions pass health concerns to the clinical staff the same day, and clients would need to be told in writing which services are clinical and which are not.

Strategic Context

A brief internal and external scan places the proposal in context. Internally, the agency has strengths: a trusted name, steady referrals from the hospital and experienced aides. It also has a weakness that matters greatly: it already struggles to fill aide shifts for skilled patients, and in the last quarter 6 percent of scheduled skilled aide visits went unstaffed. Externally, the three counties have a growing population over 75, and two franchise companion agencies already operate in the area, charging similar rates. A new line would compete with them for clients and, more importantly, for aides. In the composite figures used here, the agency pays aides $17.50 an hour, while the franchise agencies advertise $18 to $19. Launching a companion line at a competitive wage would either raise pay for the agency's skilled-care aides, adding cost, or create two pay rates for similar work in one agency, a likely source of resentment and movement between the two pools.

Balanced Scorecard Measures

Kaplan and Norton (1992) proposed the balanced scorecard so that managers would track measures beyond finance, across four perspectives, and see trade-offs before they appeared in financial results. Here the measures are chosen so that drift away from the mission shows up early.

Table 2

Scorecard Measures Chosen to Detect Mission Drift

Each measure is set against the mission commitment it protects, not against the companion line's own goals.

Kaplan and Norton (1996) later described the scorecard as a way to translate strategy into action, linking measures to cause and effect. The links here are explicit. If aides move from skilled patients to companion clients, staffed skilled visits fall, waits for low-income patients lengthen, and the companion line's financial success becomes the agency's mission failure. The internal process and learning measures will show that movement months before it shows up in the financial perspective.

Conclusion

Alignment holds under three conditions. First, the board should set aside the companion line's surplus for charity skilled visits by resolution and report it annually. Second, companion care should be staffed by a separate aide pool, hired for that line, so it does not draw from skilled care. Third, the agency should pause the companion line's growth if staffed skilled aide visits fall below 95 percent. Without these conditions, the proposal is a reasonable business decision that the mission does not support.

References

Bart, C. K., & Tabone, J. C. (1998). Mission statement rationales and organizational alignment in the not-for-profit health care sector. Health Care Management Review, 23(4), 54-69. https://doi.org/10.1097/00004010-199810000-00005

Kaplan, R. S., & Norton, D. P. (1992). The balanced scorecard: Measures that drive performance. Harvard Business Review, 70(1), 71-79.

Kaplan, R. S., & Norton, D. P. (1996). The balanced scorecard: Translating strategy into action. Harvard Business School Press.