Strategy management

Strategy management

Strategy (or Plans of action) is all about goals and procedures; that is, about how we plan to do what needs to be done and setting up the things to achieve those goals successfully. Strategy is managed, mainly, by setting goals, as these goals tend to inform us what we need to have in order to achieve those. When talking about strategy we are talking not just about the goals but the things necessary to achieve those, as well.

For example, a heart operation needs not just the "goal" of doing a heart operation, but also the appropriate scheduling of the patient, the operating theater, equipment, operating team, etc, including, if necessary, any revision of knowledge, medical literature, simulation training, etc.

Standard operating procedures are tools that fall within the strategy element of managing safety. Standard operating procedures are quite conspicuous in, for example, aviation, and are highly dependent on in emergencies. They work both as tools that provide for a step-by-step strategy management of emergencies, and as mnemonic tools that alleviate having to memorize multiple procedures that are seldom used. In healthcare, WHO's (2008) surgical safety checklist is an attempt to bring the dependability of aviation standard operating procedures into the operating theater, for a better management of patient safety

Surgical safety checklist (WHO, 2008)

One interesting thing about WHO's surgical safety checklist is that it covers much more than what a typical operating procedure does. This also means that the checklist itself is not a proper operating procedure (or it is a rather "messy" one) and its effectiveness in reducing safety is due to it addressing other "weaknesses" in the healthcare system that fall beyond strategy management per se (eg, by providing for continuity in patient identification and care, and by encouraging team cohesiveness).

The elements marked as green on the image below are the elements in the checklist that fall 'squarely' within strategy management. The darker green elements can be considered as part of a typical standard operating procedure: anaesthesia safety check completed, pulse oximeter on patient and functioning, antibiotics given within the last 60 minutes; instrument, sponge and needle count, and review of key concerns for recovery and patient management. These are the 'here and now' steps needed for an operation to go ahead safely (notice that even if antibiotics have not been given, they can still be given right then).

The lighter green elements, on the other hand, are part of the strategy elements but need to be taken far ahead of the operation. They could be considered as part of a different standard operation procedure (a pre-op sop, for example). As included in WHO's surgical safety checklist, they act as elements for aborting the operation altogether. For example, if the team does not know of any allergies (and the patient is unconscious, for example), they should either postpone or abort the operation until gaining such knowledge or be prepared for the possibility of an anaphylactic shock (and have the appropriate standard operating procedure handy). If the surgeon anticipates blood loss and no blood is ready, it also calls for aborting the operation, as well.


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Functional management system


Jose D PEREZGONZALEZ (2011). Massey University, New Zealand (JDPerezgonzalezJDPerezgonzalez).

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