NURS 6241 Week 10 Strategic Plan Example

Strategic Plan for a Fort Wayne Regional Health System, Fiscal Years 2027 and 2028

Student Name

College of Nursing, Walden University

NURS 6241: Strategic Planning in Healthcare Organizations

Instructor Name

Month Day, Year

Strategic Plan for a Fort Wayne Regional Health System, Fiscal Years 2027 and 2028

1. Executive Summary

This plan sets the direction of a composite health system, two hospitals serving Fort Wayne and Allen County in northeast Indiana, for fiscal years 2027 and 2028. The system will shift suitable surgical care to its own outpatient setting and protect access to outpatient behavioral health, while holding cost growth to the pace of Medicare prices. It will not add inpatient beds, and it will not leave outpatient behavioral health.

Five objectives carry the direction. By mid-2028, 35% of primary hip and knee replacements, up from 6%, will be done in the outpatient suite. By the end of 2027, a new adult will wait a median of 2 weeks for a behavioral health intake instead of 4. Through 2027, 85% or more of the Medicaid expansion patients on the rolls in January will stay covered. By mid-2028, agency nurses will work 4% of medical-surgical registered nurse hours instead of 9%. And in fiscal year 2027, cost per adjusted discharge will grow no faster than Medicare's 2.3% update, against 4.1% the year before. The first-year request is $1,343,600, rising to $1,649,800 a year at full operation. Four risks are named with signals and owners, and one, a further federal payment cut, is accepted without cover.

2. External Picture

Six pressures shape the plan; the full scan is in Appendix A. Medicare's inpatient update for fiscal year 2027 is 2.3%, a 3.2% market basket less a 0.9 percentage point productivity adjustment (Medicare Program; Hospital Inpatient Prospective Payment Systems, 91 Fed. Reg. 49570, 2026). The 2025 federal budget law limits Medicaid provider taxes and state directed payments and requires community engagement for many expansion adults from early 2027 (Pub. L. No. 119-21, 2025). Medicare is retiring its inpatient-only list in stages through 2028, starting with 285 services, most of them musculoskeletal, in 2026 and expanding the list of procedures payable in surgery centers (Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems, 90 Fed. Reg. 53448, 2025). Nationally, almost 40% of nurses intend to leave the workforce by 2029 (Smiley et al., 2025). In Allen County, 17.4% of adults report frequent mental distress (Centers for Disease Control and Prevention [CDC], 2025), and 44,080 residents, 11.0%, are in the decade before Medicare eligibility (U.S. Census Bureau, 2025). Virtual care models are spreading, but their evidence remains inconsistent.

3. Position Chosen and Alternatives Rejected

The chosen position follows from the first cross pairing in the SWOT analysis (Appendix B): the system's underused outpatient surgery suite, at 58% of staffed hours, meets Medicare's decision to let joint procedures leave the inpatient-only list. Moving suitable cases into the system's own suite keeps them from independent centers and uses capacity already paid for. The second pairing, behavioral health's payer mix against the Medicaid community engagement rule, sets the protective half of the position: access to behavioral health is kept and coverage retention is funded, because the line depends on a patient group about to lose coverage.

Two alternatives were considered and rejected. The first was to grow inpatient volume by adding a 24-bed medical unit. It was rejected because Medicare inpatient prices will rise more slowly than costs and because the system already relies on agency nurses for 9% of medical-surgical hours; new beds would deepen both problems. The second was to exit outpatient behavioral health, whose payer mix produces the system's largest service-line loss. It was rejected because 41% of the line's new patients come from primary care practices whose loyalty the system needs, because every competing provider already has a wait of five weeks or more, and because the county's level of mental distress makes the service a community obligation. Naming both rejections is what makes the position a choice.

4. Objectives

Table 1 lists the five objectives with their owners, dates and the external pressure each answers. Full wording, baselines and the tradeoff each accepts are in Appendix C.

Table 1

Objectives, Owners and the Pressures They Answer

5. Resources

Table 2 repeats the objective numbers and shows the first-year cost beside the cost at full operation, with the largest line in each; staffing, capital and operating detail and the quarterly phasing are in Appendix D.

Table 2

First-Year and Full-Operation Cost by Objective

Nurse staffing costs start from an average local registered nurse salary of $86,030 (U.S. Bureau of Labor Statistics, 2026) plus 30% for benefits. If the request is halved to $671,800, Objectives 3 and 5 continue in full, Objective 1 continues without the navigator, Objective 4 continues with the educator only and a 6% target, and Objective 2 slips a year, for spending of $657,000. The retention incentives in Objective 4 assume that $300,000 prevents at least five departures, since the average cost of replacing a bedside nurse is $60,090 (NSI Nursing Solutions, 2026).

6. Risk Position

Four risks are ranked by how soon they could arrive. First, anesthesia may decline to staff the suite (moderate); the warning is an unsigned coverage agreement on December 15. Second, Medicaid coverage losses may outrun the retention plan (high); the warning is any first-quarter 2027 month ending with over 5% of the cohort uninsured. Third, behavioral health recruiting may lag (moderate); the warning is fewer than two signed offers when the second quarter closes. Fourth, an independent surgery center may open nearby (low to moderate); the warning is a zoning filing or a recruitment letter to local surgeons. Each has a prepared response and an owner in Appendix E. A further federal payment cut beyond current rules is accepted without cover, since nothing the system controls could make up for it.

7. Measurement

Table 3 names the report that settles each objective. One measure needs a report that does not yet exist, and it is flagged.

Table 3

Measures and Their Sources

Progress will be reviewed quarterly by the senior leadership team, with run charts rather than single-month comparisons, so that a real shift can be told from ordinary variation.

Appendices

Appendix A holds the environmental scan with its six sourced pressures and urgency ranking. Appendix B holds the SWOT grid with evidence tags and both cross pairings. Appendix C holds the full objective statements with measures and tradeoffs. Appendix D holds the resource detail and quarterly phasing. Appendix E holds the risk memo. The market analysis of outpatient behavioral health and the stakeholder map for the outpatient surgery move follow as Appendices F and G. Detail was moved to the appendices rather than cut, so every figure in the body can be traced to its working.

References

An Act to Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14, Pub. L. No. 119-21, 139 Stat. 72 (2025).

Centers for Disease Control and Prevention. (2025). PLACES: Local data for better health, county data, 2025 release [Data set]. https://data.cdc.gov/d/swc5-untb

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year (FY) 2027 Rates, 91 Fed. Reg. 49570 (August 4, 2026).

Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems, 90 Fed. Reg. 53448 (November 25, 2025).

NSI Nursing Solutions. (2026). 2026 NSI national health care retention & RN staffing report. https://www.nsinursingsolutions.com/documents/library/nsi_national_health_care_retention_report.pdf

Smiley, R. A., Kaminski-Ozturk, N., Reid, M., Burwell, P., Oliveira, C. M., Shobo, Y., Allgeyer, R. L., Zhong, E., O'Hara, C., Volk, A., & Martin, B. (2025). The 2024 National Nursing Workforce Survey. Journal of Nursing Regulation, 16(1), S1-S88. https://doi.org/10.1016/S2155-8256(25)00047-X

U.S. Bureau of Labor Statistics. (2026). Occupational employment and wage statistics: Registered nurses, Fort Wayne, IN metropolitan statistical area, May 2025 [Data set]. https://www.bls.gov/oes/

U.S. Census Bureau. (2025). Sex by age (Table B01001): Allen County, Indiana [American Community Survey 1-year estimates, 2024]. https://data.census.gov/