MMHA 6999 Week 4 Strategic Options Analysis Example

Criteria First, Options at Their Best, No Recommendation Yet: Four Futures for Obstetric Care at Alder Creek

Student Name

Walden University

MMHA 6999: Strategic Leadership Management

Instructor Name

Month Day, Year

Criteria First, Options at Their Best, No Recommendation Yet: Four Futures for Obstetric Care at Alder Creek

Purpose and Discipline

Juniper Valley Health, the composite rural system in this capstone, must decide the future of obstetric services at Alder Creek, its critical access hospital, within eighteen months, when two of three delivering physicians retire. This analysis compares four options. It follows three disciplines. Criteria and weights are set before the options are scored, so they cannot be tuned to favor a preferred choice. Each option is written in its strongest form, as its best advocate would present it. And the analysis stops short of recommending, leaving the decision to the Week 5 memo. Multi-criteria decision analysis supports this kind of transparent priority setting in health care, because it makes trade-offs explicit and lets others see how a conclusion was reached (Baltussen & Niessen, 2006).

Criteria and Weights

The criteria and weights were agreed with the system's executive team and two board members before any option was described.

Table 1

Criteria and Weights

Safety carries the most weight; finance carries less than safety, access or staffing. The weights reflect the board's statement that finances constrain the choice but do not decide it.

The Four Options, Each at Its Best

Option A: Keep full obstetric services at Alder Creek. At its best, this option recruits two family physicians with obstetric training through a loan repayment package, contracts with the regional hospital's anesthesia group for rotating coverage and keeps about 140 births a year close to home. Advocates cite evidence that closing rural birth units pushes some deliveries into emergency rooms and cars and is linked to more preterm births (Kozhimannil et al., 2018), risks a local unit avoids.

Option B: Consolidate births at Juniper Valley Regional, keep prenatal and postpartum care at Alder Creek. At its best, this option moves deliveries to the regional hospital, 48 miles away, where volume supports 24-hour obstetric and anesthesia coverage, while Alder Creek keeps prenatal and postpartum visits, telehealth with the regional maternal-fetal medicine service, emergency obstetric training and equipment in its emergency department, and a transport and lodging program for families near term.

Option C: Operate a low-risk birth center at Alder Creek staffed by certified nurse-midwives. At its best, this option keeps low-risk vaginal births local under midwives, with clear transfer criteria and an ambulance on standby, while higher-risk patients deliver at the regional hospital.

Option D: Partner with the larger system eighty miles away for obstetric services. At its best, this option shares the cost of physician and anesthesia coverage at Alder Creek with a partner whose own rural clinics would refer births there.

Scoring

The scores depend on judgments the board should examine. Option A's safety score assumes recruitment is uncertain; if two physicians were already signed, it would rise. Option C's safety score reflects the absence of cesarean capability on site, which makes rapid transfer essential.

Table 2

Options Scored 1 to 5 on Each Criterion (Illustrative)

Option B scores highest, mainly on safety and staffing sustainability. Option C is second. The analysis does not recommend; the totals inform the decision memo.

Sensitivity

If safety and access are weighted equally at 25 each, Option B's lead narrows but remains. If finance is removed entirely, Option B still leads because of staffing. Only if access is weighted above safety does Option A move close to Option B. These checks show that the result is driven by safety and staffing rather than by money. That matters for how the decision will be explained to the community: leaders will be able to say truthfully that finances did not decide the outcome.

Options Considered and Set Aside

Two further options were raised and set aside before scoring because they failed a basic test. Closing Alder Creek's obstetric unit without any replacement services was excluded because it would leave prenatal care and emergency readiness unplanned, which the board ruled unacceptable. Moving births to Stone Fork, the other critical access hospital, was excluded because Stone Fork has fewer births, no surgical capacity and the same staffing problems. Listing excluded options shows the board that the four scored options were chosen deliberately rather than by habit.

What the Analysis Leaves for the Decision

The analysis leaves three questions for the decision memo: how much risk from rapid labor and travel the board will accept, how to protect community trust during a change and what the system will fund to make any choice work for families. National evidence that rural obstetric closures continue (Hung et al., 2017) means the decision is not unusual, but its consequences must be planned.

Conclusion

Four options were scored against criteria set in advance. Consolidating births at the regional hospital while keeping prenatal care at Alder Creek scored highest, followed by a midwife-led birth center. The analysis stops there. The decision memo must now commit, and say what the rejected options would have delivered.

References

Baltussen, R., & Niessen, L. (2006). Priority setting of health interventions: The need for multi-criteria decision analysis. Cost Effectiveness and Resource Allocation, 4, 14. https://doi.org/10.1186/1478-7547-4-14

Hung, P., Henning-Smith, C. E., Casey, M. M., & Kozhimannil, K. B. (2017). Access to obstetric services in rural counties still declining, with 9 percent losing services, 2004-14. Health Affairs, 36(9), 1663-1671. https://doi.org/10.1377/hlthaff.2017.0338

Kozhimannil, K. B., Hung, P., Henning-Smith, C., Casey, M. M., & Prasad, S. (2018). Association between loss of hospital-based obstetric services and birth outcomes in rural counties in the United States. JAMA, 319(12), 1239-1247. https://doi.org/10.1001/jama.2018.1830