Discussion

In recent times, the expenditure of national healthcare has risen to 5.3% in the year 2014 and 5.5% by the year 2016 (Cms.gov 2018). In addition to that, the hospital ownership hiked to 86% from 2012 to 2015 (Cms.gov 2018). According to the statistics, 140,000 nation’s physicians are hospital providers (Cms.gov 2018). However, there are many family owned medical service providers in the United States and on such family run hospital service is taken into consideration that is- Royal Health Service. The service is owned by a family man named Nologist and his wife. Currently, they have only two employees, who are not enough educated in medical field and thus the organization is currently facing many issues.

This business report will highlight all such issues through different models. All the advantages and the drawbacks will be identified through those models. Mc Kinsey 7S Model will be used to identify alignment of the department with the goals that the company has developed, to enhance the style of the organization and to determine how the goals will be achieved. The Balanced Scorecard Model will be discussed to set up a vision, mission and objectives along with the stakeholder analysis that will improve the current business condition. In addition to that, for analyzing the internal and external environmental factors of Royal Health Service, the model SWOT and PESTLE will be used. Some leadership, managerial, ethical theories will also be illustrated so that the current leadership and managerial quality of the concerned person can be evaluated. Recommendations based on the implemented changes and organizational charts will also be provided for the betterment of the organization.

Singh (2013) stated that the model of Mc Kinsey 7S is used to improve the performance of an organization, aligning all the operational functionalities of each department with the formulated objectives of the organization, identifying the future strategies to enhance the productivity and profitability of the company and lastly to find out ways to implement the identified strategies in a best possible way (Nour and Mouakket 2013). There are seven aspect of this model that are grouped in two categories- “Hard S” and “Soft S”. Rao and Mandal (2013) stated that “Hard” elements are easy to define and manage as it a formal way to represent the organization’s functionalities. On the other hand, Nour and Mouakket (2013) argued that “Soft” elements are equally implementing as it represent the effectiveness of the organizational culture.

The core value of Royal Health Services is to provide a quality treatment to all kind of patient at an affordable cost. The Royal Health Services also have shared value of providing a great work environment for the staffs and they also intend to incorporate a diverse working environment. Royal Health Services also formulated the value of professional integrity, training for skill advancement, following ethics and honesty, delivering treatment value for money, data management for patient’s details and partnering with other healthcare for mutual benefits and future success.

Alshaher (2013) depicted that setting corporate goals and formulate procedure to implement the goals defines the strategy. All the administrative people along with the head of the organization set some required objectives, which is fulfilled through effective communication. The strategy also comprised of the situation analysis of the company which allow Royal Health Services to take effective organizational decisions.

McKinsey 7S Model

Jurevicius (2013) depict that structure of the organization defines the different position or department and the work roles among those positions. The CEO or the head of the organization is Nologist followed by the planning and commissioning committee and Administration. The administration boards is planned to comprise with all the heads of the available department of Royal Health Services.

The required system used in Royal Health Services are- computer systems, operational systems, administrative systems, human resources system and budget system. The computer system is required to store all the data of the patient’s and organization. Marion and Gonzales (2013) stated that operational system is required to process the day-to-day transactions and preserving its integrity. Royal Health Services should utilize administrative systems for tracking fiscal management, procurement activities and human resource. Moreover, through human resources system, Royal Health Services can manage payrolls, planning the retirement process of their staffs, storage of employee data and tracking attendance record of the employee. Lastly, the organization should also implement budget system for effective coordination and allocation of resources and tracking how much money is spending to accomplish a particular objective.

The new members of Royal Health Services will be selected based on their experience and educational; qualifications. These candidates are selected from reputed medical colleges and universities. Medical training will be providing to all the members of the Royal Health Services so that they can enhance their knowledge base and aware of using the new technology and machines. These staffs will also be provided with job security and proper reward based on their tenure-period and performance respectively. Candidates will also be selected from different cultural background in order to formulate a diverse work environment.

Style

Rao and Mandal (2013) highlighted that ‘style’ refers to employee’s shared way of thinking and behaving with each other and the norm of thought that promotes their organizational behavior. In case of Royal Health Services, foundation of honesty, capability, professional integrity and quality are considered. Royal Health Services also welcomes the personal growth and innovative ideas that stakeholders are suggested so that they can gain the support from them also. Royal Health Services also desire to manage and warehouse the data by using information technology.  

The area of treatment that Royal Health Services are- Primary treatment, Accident and emergency (A&E), Ear nose and throat (ENT), Diagnostic imaging, Optical solutions, Anaesthetics, Sleep Studies , Elderly services department and Maternity care. Thus, the staffs hired for each of the department should have educational knowledge as well as professional experience in their destined department. Moreover, for handling the IT department, staffs with database knowledge should be taken into consideration.

Shared Values

Tjader et al. (2014) stated that marketers considers balance scorecard as a performance measurement model and the main aim to use this tool is to convert organization’s estimated goals into action. There are certain factors of this model- financial perspective, customer perspective, internal business processes and learning and growth.

Date:   ..  /  ..   /  ….	Objectives	Measures	Targets	Initiatives
Financial	To grow the market share by maximum of 7% in US market through high profitability	· The profitability will be measured quarterly which should be 4% at the end of every 3rd month.	· Target of obtaining 3% profitability growth rate at the end of every month	· Regular tracking the organizations performance · Calculating market share regularly
Customer	· To provide quality treatment at affordable cost · Suggest affordable medicine after dismissal of patients from health care · Take regular news of critical patients after their dismissal	· Calculating number of patient returned back to Royal health Services · Number of positive feedback	· Suggest effective medical treatment and prescription according to their  budget to minimum 10 patients a day	· Communicate with the patients well so that their actual problem can be identified.   · Considering the patient’s as well as their family member’s feedback to incorporate suggested changes
Internal Business Processes	· To hire effective doctors with years of experience in their field. · Training from re-known medical experts to the staffs · To incorporate new departments that is till now absent in Royal Health Services · To buy new medical equipment for accurate treatment	· To allocate budget for adding new departments and buying new medical equipment · To generate a hiring process for experienced doctors · Formulating of training plan for the staffs	· To sanction $50,000 per month for purchasing new machinery and building extensions ·  To conduct two training  classes from experienced doctors	· Collaboration with government so that they can help Royal Health to enhance their presence · Meeting with committee members and governing  bodies to pass the budget bills
Learning and growth	· Enhanced knowledge of the staffs · Competitive price of the treatment · Targeting low and high income people · Providing family care	· Number of retained employees · Number of increase in patients per month · The amount of profitability increase	· To reward efficient employee at the end of every month · 3% profitability growth per month	· Developing friendly environment · Providing challenging job roles to the responsible staffs

Table 1: Balance Scorecard Model for Royal Health Services

(Source: Created by Author)

Vision statement

In future, Royal Health Services intends to develop all existing departments and incorporate new medical departments so that all kinds of patient’s can be targeted. The vision is also to educate the staffs from reliable sources so that they can serve extra-ordinary to humankind.

Mission statement

The mission statement of Royal Health Services is “Serving humankind with most effective medical care with homely experience and educating staffs with effective training from medical experts”.    

Stakeholder Analysis

Mendes et al., (2012) stated that there are two types of stakeholders- internal and external stakeholders. The internal stakeholders are the staffs of every department; whereas the external staffs are the one, who are outsiders of the organization but related with the company through some means (Grigoroudis et al. 2012). The staffs, medicine suppliers, distributor logistics, protective associations and societies, government, medical professionals, medical schools and patients are the stakeholder for Royal Health Services.

Stakeholders	Internal/External	Knowledge (Low-1, Medium-2, High-3)	Supports (S), Opposes (O), Neutral (N)	Interest (Advantage-A / Disadvantage D)	Power (Low-1, Medium-2, High-3)
Staffs	Internal	1	S	A	1
Medicine suppliers	External	2	S	A	2
Distributor logistics	External	2	N	A	2
Protective associations and societies	External	3	S	A	3
Government	External	2	S	A	3
Medical professionals	Internal	3	S	A	3
Medical schools	External	3	S	A	2
Patients	External	1	N	A	1

Table 2: Stakeholder Analysis for Royal Health Services

(Source: Created by Author)

Greater retention rate- The number of staffs currently present compared to the past is a measure that shows that the concerned organization is growing. The effective training sessions and the effective environment of the healthcare motivate the staffs to retain longer in the organization. This approach shows the high level of employee satisfaction and good performance of the company.

More patient allocation- The friendly atmosphere and the quality treatment at affordable rates attract many patients to get a treatment in Royal Health Services. The rate of cured patients should also be calculated as it will allow company to measure the effectiveness of the treatment.

Greater profitability- The Company however intends to obtain 3% profitability rate at the end of each months and estimated a minimum profitability enhancement of 7% in the US market share. However, the number of patients arrives and the total sale of medicine from the healthcare helps the organization to evaluate their profit.

Higher demand of placements- Another mission of Royal Health Services is to increase their knowledgeable staffs. After incorporating different departments in the organization and handling more staffs than before, eligible staffs intends to enroll their employment in Royal Health Services.  This can be measured from the high number of application forms for recruitment.

Strategy

More business networks- Not all departments are present in Royal Health Services and thus effective partnership with other medical institute will help them to enhance their brand presence.

The Doctor, Nologist, is extremely meticulous and has expertise in providing the medical treatment to the patients. The Royal Health Service welcomes multi cultural community so that diversification can be incorporate in the working environment. Moreover, the working culture is relaxed and the staffs do not have to follow any strict rules resulting in high satisfaction rate among the working personnel (Bohari et al. 2017). Thus, the effective medical service is provided with a family environment.

Since, there are no strict rules; staffs are unable to complete their work within time. Sometimes staffs become careless. The lack of knowledge also results in unclear goals and no real commitments. The knowledge level of the staffs is low and they only follow the instructions given to them. There is not management of record keeping and thus it is difficult to identify the accomplished target and the goals that need to be fulfilled. There are several departments not present in the current organizational structure like department for sleep studies and measuring EEG. There are no counseling specialists in order to overcome the adversity of patient non-compliance.

Royal Heath Services can provide training to their existing staffs. They can also conduct a hiring process, where only candidates from medial college or experienced people in medical field will be taken.  Royal Heath Services can also change their organizational structure and formulate organizational policies that e staffs have to follow to obtain the desired goals of the organization. They can also extend their healthcare services by adding some more healthcare departments.

There are several established medical hospitals and clinics are present in United States that has high customer base and reputed brand recognition. Moreover, huge financial resources are required to implement hiring process, training process and establishing change in current business structure.  Additionally, political or monetary changes can impacts on the price of the treatment and medicines and this may results in unsatisfied customers.

Political

US has effective rule of law and strong democratic setup. In recent times, the law imposed by Donald Trump, they cannot target foreign patients, who eventual looks for low budget treatment and healthcare. However, the political condition is good and Royal Heath Service can prosper in US economy.

There are many established healthcare sector but fewer homely owned healthcare services are present. Moreover, the GDP of US was 18.62 trillion US in the year 2016 (Tradingeconomics.com 2018). Thus the economy of the nation can support this growing healthcare organization.

Social

Structure

The social impact may be more towards the negative result as people do not want to trust on an organization that is not established as they do not want to take risk with the health.  Thus, this will leads to lower profitability of the organization due to which the concerned organization have to develop their own production line for medicines.

In order to incorporate departments for ‘sleep studies’, Royal Health Service should incorporate Electrocardiogram (ECG) machines, Electro-occulogram (EOG) machine for measuring the eye movements and Electroencephalogram (EEG) machines for measuring brain cells by using machines like Mitsar-EEG 202 system- 24 EEG channel system or Mitsar-EEG 202 with 31 EEG channels (Mitsar-medical.com 2018).  Moreover, Electrosurgical Units and Surgical Light Sources will be used for treating Ear nose and throat (ENT). In addition to that, for maintaining the patient’s record, database management system (DBMS) should be used.

Royal Health Services should develop legislations in terms of medical schemes and health insurance. The concerned organization should follow The Health Information Technology for Economic and Clinical Health (HITECH) Act for creating The Health Information Technology for Economic and Clinical Health (HITECH) Act (Healthit.gov, 2018). They should also follow Patient Protection and Affordable Care Act of 2010 fkr providing reliable treatment (Loc.gov 2018).

Considering the demographic environment, Royal Health Services intends to target all age group people and all income range communal. At the end of 2017, population of US was 326.5 million (Census.gov 2018). This indicates that people need maternity services and old age services and these services are available in Royal Health Services. In terms of international environment, the company may face challenge as they do not have any international participation.

There are many established health care in US and compared to that Royal Health Services is a family owned business and thus, the competitive rivalry is very high. The development of additional medical departments and technological equipments along with hiring professionals need much cost that is difficult for Royal Health Services to obtain in the initial few years.

 Supplier Power

The supplier power is medium to low as there are many service provider available in the market intends to enhance their network for better recognition. The medium rank is given as the suppliers have the power to leave Royal Health Services if they cannot agree on their minimum budget and this can be a challenging aspect.

 Buyer Power

The Buyers power is medium to high. Royal Health Services targets mainly those, who want quality treatment at affordable cost but some patients ready to give more money if they get extra facility from established healthcare. Moreover, people with high income can have the power to switch from their products and services.

Systems

 Threat of Substitution

The threat of substitution is medium to high for the reason that people want a quality treatment and if there is any delay in treatment or invariability of medicines, people can substitute their services and opt for another healthcare. However, this adversity can be resolve if Royal Health Services can develop partnership with other medical institute and can refer to their patients there and obtain commission.

 Threat of New Entry

The threat of new entry is low s starting a medical healthcare in a nation like US need much effort and abiding legislations. Moreover, knowledge about the re required departments and then managing of the records also need much research. Moreover, attracting customers towards the organization with attractive facility is another big challenge.

The person considered is Nologist, who is a hard working man but lacks managerial skills. However, he guides his subordinates so that they can improve their experience and confidence. Thus, the best leadership theory that can be considered is transformational leadership theory. Northouse (2015) stated that the qualities of a transformational leader is that they should have clear vision, set a standard, courage to progress, self-motivated and being the inspiration for others.  Avolio and Yammarino (2013) furthermore supported the arguments by stating that there are four elements of transformational leadership- inspirational motivation, idealized influence, individualized consideration and intellectual stimulation. Nologist should inspire the subordinate to work hard and gather all the knowledge that is required for handling more patients. Antonakis and House (2013) depicted that influencing others displays a charismatic personality that motivate other to being the leaders of their department by their effective work and willingness to take risks. Moreover, leader with transformational leadership also value every members of the organization and resolve their queries so that they can outperform and retain in the organization. Thus, Nologist sometimes have to conduct one-on-one coaching and mentoring so that the staffs, which need extra support from their leaders can be addressed. Lastly, in intellectual stimulation, a transformational leader values the creativity and autonomy of the followers. Thus, Nologist should have to assess their staff’s performance and give constructive feedback so that the nurses and other staffs can develop. Nologist should also celebrate the

The best suited managerial theory that can be incorporated in Royal Health Services is Marris’s theory. Pierce and Aguinis (2013) stated that according to the Marris’s theory of the managerial enterprise, a modern business firm should follow a separate division for management and ownership. Drury (2013) furthermore depicted that stakeholders are equally considered as owners and they collaboratively work together to obtain the organizational objectives. Nologist should also consider utility functions that compromise of evaluation of profits, public images and market share. Nologist can also develop analysis of customer satisfaction, practicing shared goals and values and maintaining available resources. Bonnafous-Boucher and Rendtorff (2016) stated that the analysis of the customer satisfaction can be measured from survey, interviews and feedback after their experience with the organization. Nologist can formulate a feedback form for the patients and family members of the patient so that they can know the effectiveness of their services in the healthcare and what are the suggested criteria that can motivate to take their services again in case of requirement. Moreover, the shared goals and values can be practices through effective communication through which every member of an organization can share their concern. This can also be attained through the effective training session and meetings, where leaders can make the subordinate realize the importance of the organizational objectives and the process to obtain those aims. Lastly, the available resources in Royal Health Services are staffs, facilities, communications, funding and equipment. Staffs can be managed through human resource departments, which are liable for analyzing the staff’s demands, training requirement for development and giving them positive feedback to overcome their adversity. The facilities are related to the healthcare devices that is used for treating sleep disorders, emergency accidents and diagnostic imaging (like- CT, Ultrasound, Magnetic Resonance Imaging). The facility of elderly services and maternity services should also be considered.  

Staffs

There are four ethical theories- utilitarian, deontology and virtue ethical. However, in this case, the utilitarian theory is most applicable as the final result is more matter in order to obtain effective brand recognition in the market. Nologist should also apply deontology theory for treating the patients in en ethical way that do not make any harmful impact. Moreover, Monteverde (2014) stated that an ethical practice is a systematic approach for effective decision- making. Thus, Royal Health Services should follow the aim of curing all the patients and should also follow ethical treatment procedure.

Royal Health Services should conduct group assessment that can evaluate practices of the employees and prepare a detailed report for the progress of the organization, completion of tasks, shared goals and method of conduct to obtain those goals.

The organization should implement CCTV camera to assess the working condition of all the employees and note arising conflicts among the employee so that it can be solved in the initial stages.

The organization should also conduct several staffs communication session through meetings, formal and informal gathering, where staffs can share their experience and good achievements and failed experiences and the process through which they have overcome those adversities. This sharing of concerns and ideas will help all the employees to get the best possible solution based on a situation.

Prior implementing a decision, a detailed plan should be formulated so that the future scenario can be estimated. This will allow an organization to overcome the problem of plan failures and frequent budget allocations.   

The existing organizational structure only have Nologist as a unit head of the Royal Health Services, his wife as an administrator and two staffs. There are not financial management team, human resource management team and training team. However, in recent time, they intends to extent their services not only by implementing some additional departments in their healthcare but also to hire people from medical colleges and provide them training so that they can accomplish the organizational goals and objectives of Royal Health Services. Thus, the new organizational chart shows the additional department that needs to be incorporated in the concerned organization. The additional departments are primary treatment, Accident and emergency (A&E), Ear nose and throat (ENT), Diagnostic imaging, Optical solutions, Anaesthetics, Sleep Studies, Elderly services department and Maternity care. Moreover, additional department for accountant and human resources should also be incorporated.

Conclusion

Thus, it can be concluded that the Royal Health Services intends to serve good health to their patients. Mc Kinsey 7S Model is used to evaluate the shared values that are to provide a quality treatment to all kind of patient at an affordable cost. The strategy of the Royal Health Services is to formulate procedure to implement the goals, conduct situation analysis of the company and taking effective organizational decisions. The structure of the organization represents the CEO, Planning and commissioning committee and administrator. This structure also defines the different departments that Royal Health Services intends to formulate. The systems comprised of computer systems, operational systems, administrative systems, human resources system and budget system. It is also found that the staffs comprised of the new members selected based on their experience and educational qualifications. There style refers to the foundation of honesty, capability; professional integrity and quality are considered. The report also shows that the skills should illustrated based on professional experience and database knowledge for IT department. The Balanced Scorecard Model also highlighted the financial perspective, customer perspective, internal business processes and learning and growth that show that the organization is to target to obtain 3% profitability growth rate at the end of every month. It is also found that the stakeholder of Royal Health Services are staffs, medicine suppliers, distributor logistics, protective associations and societies, government, medical professionals, medical schools, patients. The Key performance indicators (KPI) to measure the effectiveness of the concerned organization are greater retention rate, more patient allocation, greater profitability, higher demand of placements and more business networks.

Style

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