AbstractAn internal analysis of an organization looks at the financial information, human resources, information technology, strengths, and weaknesses and uses that information to determine the competitive advantages that the organization has to offer (Duncan, Ginter & Swayne, 1998). The evolution in healthcare has become more patient-centered and government reimbursement has become more reliant on patient satisfaction. The competitive analysis report focused on the external environment and what the organization had to compete with in terms of adaptation to the market needs. The purpose of this paper is to do an internal analysis of patient demographics, Nebraska Medicine’s resources and their competition strategy to meet patient needs.IntroductionAn internal analysis of an organization looks at the financial information, human resources, information technology, strengths, and weaknesses and uses that information to determine the competitive advantages that the organization has to offer (Duncan, Ginter & Swayne, 1998). The fact that the ability to maintain a competitive advantage is becoming increasingly more difficult as competitors can easily replicate products and services (Duncan et al., 1998). As a result, organizations must get into the minds of their customers to provide what they want and need which requires an examination of the internal environment (Duncan et al., 1998). In order to gain a competitive advantage, organizations must provide value to their customers by keeping costs down, offering quality products and services, and by offering a service line that is important to the community it serves (Duncan et al., 1998). Harris (2018) says that some larger organizations might have to evaluate their internal environment and service lines separate from their smaller organizations, while the smaller organizations consider their own. In the case of Nebraska Medicine, it appears that they do both because the organization share resources to meet the needs of the community. The purpose of this paper is to do an internal analysis of Nebraska Medicine and their competition strategy.Nebraska’s Population DemographicsAccording to the Census Bureau, Nebraska’s population was over 1.8 million in 2014, which was a three percent increase from four years prior and a ten percent increase for fourteen years prior (DHHS, 2016). Of this population growth, the growth appears to be more evident with older adults, racial minorities and the larger cities in the state (DHHS, 2016). The average life expectancy in Nebraska is approximately 80 years which is not much higher than the national average (DHHS, 2016). Cancer was found to be the leading cause of death for Nebraskans and has been a greater cause than heart disease for six straight years, but this is largely related to a decreased number of heart disease related deaths rather than an increase in cancer deaths (DHHS, 2016). Heart disease comes in second for leading cause of death, chronic lung disease is third, stroke is number four and finally, deaths by unintentional injuries (motor vehicle accidents, falls, etc) is at number five (DHHS, 2016). In 2014, approximately fifteen percent of Nebraskans reported not having any insurance, private or public, for those aged 18-64 and this has declined steadily over the years (DHHS, 2016). One of the most common barriers that Nebraskans report is not having a primary care provider and for those that do have one, they reported that cost was a major barrier to seeing him/her (DHHS, 2016). Another barrier is the varied access to healthcare across the state (DHHS, 2016). The majority of the state has been identified as having a shortage of specialists, dentists, and mental health providers (DHHS, 2016). Internal AnalysisInternal analysis allows an organization to look at the competencies and capabilities, financial position and viability against its competition (Williams, 2018). Furthermore, Williams (2018) notes that strong organizations have updated technologies for staff to carry out their duties. Moreover, organizations with strong competency reputations also have a strong brand identity that is connected with expertise in the field, capabilities and resources (Williams, 2018). In contrast, weaker organizations have outdated technologies, lack a solid reputation of expertise and do not have adequate financial assets (Williams, 2018). A successful analysis will help administration identify any apparent weaknesses that need addressed and any goals that aren’t being realized (Williams, 2018). The strategic plan can then be addressed to allow opportunity to re-address objectives that weren’t realized and either work on or eliminate weaknesses (Williams, 2018). Finally, the internal analysis will show the status of human capital and their contributions from their expertise and innovative abilities through patient satisfaction, increasing revenue and efficient supply chains (Williams, 2018).Nebraska Medicine Bellevue is a community hospital that operates in conjunction with Nebraska Medicine- Nebraska Medical Center (the largest metro hospital in the state). Originally opened as Bellevue Medical center in 2010 close to Offutt Air Force Base, it was developed by private physicians in conjunction with The Nebraska Medical Center to serve the military population but also key demographics in the area that were being largely unaddressed. The hospital accepts military insurance as well as HMO’s, PPO’s Medicare and Medicaid. Moreover, it has made significant growth in a short period of time as its emergency room has quickly become one of the top three busiest in the region. It’s big brother, Nebraska Medical Center (also known as main campus by those employed within Nebraska Medicine), has been nationally ranked in one specialty, identified as a high performer in eight adult specialties, and five procedures (US News, nd). It is one of the oldest hospitals in the region and is a teaching hospital and offers a plethora of specialty services offered shared with Bellevue including world renowned cancer treatment, gastroenterology, geriatrics, nephrology, neurology, pulmonology, orthopedics, urology, endocrine and many more (US News, nd). Common procedures and conditions treated at the Bellevue location include COPD, heart failure, pneumonia, stroke, infectious diseases, orthopedic surgery, alcohol withdrawal, palliative care, cardiac rehab and births. The main campus treats those conditions in addition to aneurysm repairs, coronary artery bypass grafting (CABG), chronic obstructive pulmonary disease, hip and knee replacements and lung cancer surgery (US News, nd). It has been ranked by US News as the number one hospital in the state (US News, nd). For over fifty years, changes in patient expectations such as a desire for transparency in hospital costs, more immediate access to providers and increase pharmaceutical use has driven the healthcare sector to change the direction in which they strategize their competition (Torres, 2017). This has been further cemented with the passing of the Affordable Care Act (ACA) in 2010 which implemented the value-based purchasing system that remits reimbursement payments to hospitals partly based on patient satisfaction scores (Torres, 2017). Patient satisfaction scores are measured in a variety of methods, but the most influential method is via Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores (Torres, 2017). Even with such an impressive resume, Nebraska Medicine in its entirety appears to suffer in patient satisfaction in comparison to its closest competitors. While generally rated four or five out of five in many categories of patient satisfaction, the following areas have been rated just three out of five and include: satisfaction with doctor’s communications, pain relief, efforts to prevent medication harm, staff responsiveness, room cleanliness, and noise volume (US News, nd).Nebraska Medicine Bellevue’s location is so new and the equipment is quite modern in comparison to much of what is offered at the main campus (see Appendix A for details) as well as other facilities in the region. Moreover, patients who had to use Bellevue’s services in lieu of Catholic Health Initiatives (CHI) during the Blue Cross Blue Shield negotiations said based on the service and appearance of the location they would be coming for services more often. The core resources available at this location are similar in comparison to those of similar size in the region. However, according to Andersen (2018), the closest hospital CHI Midlands is no longer a full service hospital as of January 2018 as their organization decided to focus the efforts there on ambulatory services and emergency room. Healthcare organizations have implemented the strategy of growing service lines into their strategic plan such as cardiology, orthopedics, and neurosciences to exhibit them as some specialty service offered (Becker’s Hospital Review, 2012). Designed to increase revenue, census, market share and attract new talent, these services help to increase or at least sustain financial viability to make up for the care or inefficiencies that aren’t being reimbursed or paid for (Becker’s Hospital Review, 2012). The fact that it has the capability to couple with Nebraska Medicine- Nebraska Medical Center allows it to double its capabilities, service lines and core resources with its consumers. The smaller community hospital size and limitations that coincide with that such as needing to transfer more critically ill patients to main campus for more in-depth assessment and care can potentially increase patient costs and decrease satisfaction scores. Moreover, the size and limitations of services require that the medical staff work more collaboratively in teams to get things done, which also means they develop closer relationships than what reportedly occurs at the main campus. Moreover, the smaller organization has better observation of its core staff to ensure compliance with policies and procedures, and therefore, in general quality rates have been better with central line infection and urinary tract infection rates than main campus. However, the patient satisfaction scores are lumped together with Nebraska Medicine as a whole, so the scores aren’t fairly represented.The ACA has increased the number of individuals that have access to healthcare and organizations nationwide have had to quickly accommodate them (Torres, 2017). Nebraska Medicine Bellevue has accommodated this change by increasing the size of the emergency room, number of licensed beds on the medical/surgical floor, hiring more medical staff and other essential positions, bringing in more providers and specialties as well as more service lines over the course of time. For example, the immediate care clinic was implemented on the opposite side of the building from the emergency room to help alleviate the wait times and improve patient satisfaction. However, due to federal law that prevents emergency room personnel from making any suggestion of its use, word was a little slow to spread and advertising was limited. Nebraska Medicine Bellevue is able to save money as an organization by coupling its financial resources, human resources, quality team, and more to keep costs under control and maintain satisfaction of patients and employees alike. Translators are shared and utilized via computer and phone between the two campuses. However, the limitations with the Bellevue location and probably the organization as a whole are staff and management turnover. In the last few years, Bellevue’s staffing was at critical lows during very high census times due to staff discontent with management. Key upper management positions have had turnover at least three times in the organization’s short life which tends to decrease staff satisfaction and adds to lack of certainty in their own role. The costs associated with orienting new hires only to lose them within a year and continued poor staff satisfaction scores on surveys required the organization to take action and correct it. During the times of staff shortages, the Bellevue location was able to utilize the float pool from main campus to a certain extent, but had to also reach into its fiscal pockets to pay for travel nurses. When nurses cannot spend as much time with patients communicating and educating and providers are burning out with the increased patient loads as well poor attitudes from the healthcare team can negatively impact the patient’s perception of care and service (Torres, 2017). In order to prevent this, employee satisfaction must be addressed as well (Torres, 2017). Change in management was most recently seen in the last year, which just happened to come right as MAGNET surveyors came and the NDNQI survey was reported out with negative scores. This resulted in improved employee attitudes because their prior complaints about management that weren’t addressed for over three years, which led to many leaving in droves, were finally being addressed. Human resources has also increased efforts to share the growth rewards with staff by giving compression wage adjustments and raises consistent with market analysis. For the last year, staffing is beginning to stabilize again and employee engagement is improving. This should hopefully positively affect patient satisfaction scores. The organization has also implemented EPIC as its electronic health record which has increased the ability to share patient information with other organizations and reduce redundant labs and diagnostic tests which in turn reduces costs for the patient. Computers on wheels are used for accurate and timely charting by staff. Providers have the ability to log in remotely from home to enter orders, see test results, and manage patient care after hours or when they are seeing other patients at other locations. Wi-Fi Internet is available for patient and guest use at no extra cost. The organization utilizes professional resources to gather data on evidence based practice and works in conjunction with the University of Nebraska Medical Center for research projects that improve processes and practices, which saves money for the organization. All of these resources make medical practice in these turbulent conditions more tolerable enjoyable to contend with. The internal analysis report used to evaluate the environment at Nebraska Medicine Bellevue is located in Appendix A. Impact on Healthcare AdministratorsOnce the environmental assessment is completed, the planning team needs to fully discuss their competitive strategy to identify how they will remedy the organization’s weaknesses and build on the strengths. They must be able to predict future trends and pay attention to legislative changes, major stakeholders, themes and developing research to stay on top of patient needs and demands that may impact future satisfaction scores. Nebraska Medicine Bellevue and the main campus both have considerable strength in their collaborative service lines, financial viability and resources together. However, what they share is the fact that some of their patient satisfaction scores are marginal and could be improved to further improve their revenue. Conclusion Internal analyses can offer administration an opportunity to assess the competitive advantage in the market. Nebraska Medicine is a very reputable organization with a plethora of service lines, advanced diagnostic tools and technological resource to offer the greater community and medical personnel. However, these things can easily be replicated by their competition. It is the job of the healthcare administrator to set the organization apart from the competition to remain financially viable and in the current healthcare model, patient satisfaction is where the focus should be to improve financial viability and stay ahead of the competition.ReferencesAnderson, J. 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