Ascension Leading Change in Healthcare

1. Executive Summary Ascension was found in 2012 with the mission “to serve all persons especially those living in property and who are struggling the most, and to deliver compassionate, personalized care and lead healthcare transformation in the United States” (Ascension, 2021). Ascension is one of the largest and leading non-profit and Catholic health systems in the U.S., operating in more than twenty states and the District of Columbia. At the heart of Ascension is its mission, vision, and values. It is the driving force that guides their strategy, molds their culture, and empowers their people. Since 2012, it has acquired and merged with several health networks around the U.S., expanding their reach to communities in Illinois, Oklahoma, Kansas, Michigan, and Wisconsin. The Ascension network provides $2.3 billion in care of persons living in poverty and other community projects. They have 2,600 sites of care in more than 20 states, 146 hospitals, and more than 40 senior care facilities, making it one of the largest nonprofit senior living providers in the U.S. Vision: To be the leading Catholic health ministry in the United States, transforming healthcare to support all communities, especially the less fortunate and impoverished. Mission: Provide holistic care which improves and sustains the health and well-being of individuals and communities. Strengthen our communities, especially the vulnerable and poor communities, through the loving ministry of Jesus as a healer. Value Statement:  Integrity: Delivering on the promise and doing the right thing.  Service of the Poor: Provide mercy to those who are ill, impoverished, and vulnerable and provide guidance to strengthen their current situation in their health and life. Diversity: Respect all walks of life and show compassion for the diversity of life.     Dedication: Commitment to the mission and providing quality care through your calling to the ministry. Wisdom: Using knowledge and experience to provide a deeper understanding of people and their situations. Quality: Never compromise patient or family care. Strive for excellence in stewardship and compassion. Execution Strategy The execution of the strategy will outline a plan to enhance patient care and patient engagement through telehealth options, such as, virtual visits as well as creating community clinics for inner-city and rural areas who may not have access to a primary care doctor and/or clinic in their area. International ventures are also discussed in this report, as Ascension has had an international facility at one point before selling the venture. The strategy includes several factors when considering how to offer and expand facilities and services. The strategy also discusses the pros and cons of the expansion of services and how it benefits the patients and the community as a whole. All areas of the organization will be utilized in the preparation and execution of the strategy. Financial Evaluation of Strategy To measure the efÏciency and effectiveness of the strategy, the organization will need to use return on investment (ROI), return on assets (ROA), and return on equity (ROE), as ROI will not provide an outlook overtime. A cost-benefit analysis will analysis the benefits of the expansions, both with intangible and tangible assets. The goal will be to recoup its investment funds within 5 years. Ascension will create other metrics for measuring patient satisfaction, patient engagement, cost analysis of care, and budgetary costs to measure the success of the strategy and its profitability during its change. Metrics are not only measuring financial benefits for the organization but the added value from patients, providers, and the community. Conclusion Ascension is one of the largest and leading non-profit and Catholic health systems in the U.S., operating in more than twenty states and the District of Columbia. Ascension focuses on “serving all persons especially those living in property and who are struggling the most, and to deliver compassionate, personalized care and lead healthcare transformation in the United States” (Ascension, 2021). Ascension has an opportunity to continue to grow and further its mission of serving the poor and the vulnerable and being a strong competitor in the healthcare industry. Due to its strong market position and stable financial portfolio, Ascension can continue to invest in the communities they serve. They have the opportunity to transform healthcare and reduce the climbing costs of healthcare by enhancing patient care through new workflow models, such as, telehealth visits and community clinics in rural and inner-city, underserved communities. A2. Vision, Mission, and Value Statements At the heart of every strategy is the vision, mission, and value statements. The vision, mission, and values guide everything the company does, including providing guidance for company decisions, creating code of conduct, establishing the culture, and developing the vision for the future of the company. This is what frames the overall strategy of the company. The vision, mission, and values are crucial to the success of the company. These three statements are like lighthouses; they are the signals that give us direction, meaning, and purpose. They are the anchors that hold up the foundation of the company. Ascension’s vision to be the leading Catholic health ministry in the United States, transforming healthcare to support all communities, especially the less fortunate and impoverished. Ascension’s strategy to become the leading Catholic health ministry relies heavily on integrity, service, and quality. With many competitors, patients have several options for healthcare. However, quality, service, integrity, compassion, and stewardship of our leadership and staff can provide patients with the confidence to use our services and facilities to seek care. Without the trust of our patients and staff, Ascension will not achieve its goal of being a leading Catholic health ministry and a transformative force in the healthcare arena. The mission statement focuses on the organization’s current operations, practices, and purpose. Ascension’s mission is to provide holistic care which improves and sustains the health and well-being of individuals and communities. Strengthen our communities, especially the vulnerable and poor communities, through the loving ministry of Jesus. At the heart of Ascension is its desire to serve and care for the sick and dying and improve the health and well-being of the communities it serves. By creating a clear, detailed mission statement, it sets the company apart from the rest by distinguishing its business makeup and purpose (Thompson et. al, pg. 28). When associates, patients, or families want to know what Ascension’s mission is, it is clear, specific, and direct, which is important to guide the current operations and culture of the organization. The Value Statements are:  Integrity: Delivering on the promise and doing the right thing.  Service of the Poor: Provide mercy to those who are ill, impoverished, and vulnerable and provide guidance to strengthen their current situation in their health and life.  Diversity: Respect all walks of life and show compassion for the diversity of life.  Dedication: Commitment to the mission and providing quality care through your calling to the ministry.  Wisdom: Using knowledge and experience to provide a deeper understanding of people and their situations.  Quality: Never compromise patient or family care. Strive for excellence in stewardship and compassion. According to Thompson et. al (2020), “values (or core values, as they are often called) we mean certain designated beliefs, traits, and behavioral norms that management has determined should guide the pursuit of its vision and mission” (Thompson et. al, 2020). Values guide Ascension in everything they do. They are the foundation of their work, and they help prioritize the goals of the organization. It is important that the values align with the vision and mission of the organization. Values help guide leadership and management in ethical decision-making and how to conduct themselves as a business. In conclusion, the vision, mission, and values serve as the anchors of the company’s strategy. From there, a company’s culture is developed from these pillars of the strategy. Culture is the company’s DNA; it is a product of the core values and beliefs created by the leaders of the company. To the same degree that vision, mission, and values are interconnected, strategy, people, and culture also should be in-sync. Thompson et. al (2021) suggests “when a company’s present culture promotes atÝtudes, behaviors, and ways of doing things that are in sync with chosen strategy and conducive to first rate strategy execution, the culture functions as a valuable ally in the strategy execution process” (Thompson et. al, pg. 360). A3. Use of Analytical Tools A SWOT analysis is a tool that is commonly used to gain insight into the company’s strengths, weaknesses, opportunities, and threats. As the company grows and becomes more profitable, it will need more resources and human capital to continue to have its competitive edge. Financial gains, profitability, and improvement in market standing and competitive advantage are the best indicators of how effective the strategy is. However, there are many other indicators of how well the strategy is working. This could include trends in company earnings, stock price, financial strength, new customers acquisition, and improvement of internal processes (Thompson et. al, pg. 93). Competition is a very crucial part of the strategic advantage. Gaining a competitive advantage helps the company differ from its competitors and improves its market standing and financial gains. In order to be competitive, it is vital to test the strategy’s effectiveness. It is important to review both external and internal factors that can hinder or enhance the strategy. To ensure that a strategy is a wiling strategy, it has to be able to pass three tests: the fit test, the competitive edge test, and the performance test. For the fit test, Ascension’s strategy must be able to stand against competitive forces; the company must be flexible to exhibit both internal and external fit and execute the strategy competently. Although, a well-conceived, wellexecuted strategy can be credited for a company’s strong overall performance in the market, even a wellcrafted strategy still evolves over time. The next test is the competitive advantage test. This test investigates if the company is able to sustain the competitive advantage over its competitors. If it is not sustainable, the company will fail to produce a solid performance financially. The last test is the performance test. This focuses on two performance indicators: competitive strength and market standing and profitability and financial strength. Ascension has the ability to be a major competitor in the healthcare arena. It invests in technology, its people, and its community. The company has the ability to keep their competitive edge by diversifying their assets, revising parts of the strategy that does not work, and elevating the strategy that will help Ascension in the long-run for profitability and sustainability. A4. SWOT Analysis of Ascension Ascension is one of the largest and leading non-profit and Catholic health systems in the U.S., operating in more than twenty states and the District of Columbia. The parent company, Ascension Health, was formed in 1999 and Ascension was created in 2012. Ascension Health formed Ascension to help with restructuring and “to further its Mission of serving all persons especially those living in property and who are struggling the most, and to deliver compassionate, personalized care and lead healthcare transformation in the United States” (Ascension, 2021). Strengths  It is the leading non-profit and Catholic health systems in the U.S. The Ascension network provides $2.3 billion in care. Operational in 22 states and British Columbia. They have 2,600 sites of care, 146 hospitals, and 40 senior care facilities. Strong financial and market position     Recapture some of their market share Enter new markets Create comprehensive care clinics $87.7 million from the sale of four ventures     Weaknesses     Opportunities Relying heavily on elective surgery as income Pandemic stopped all elective surgeries Relied on government aid and sale of investment equity to fund operations and keep positive balance sheets Loss of market share Threats     Increased government legislation Competition from rivals Changing technology and medical advancements StafÏng shortages In this SWOT analysis, Ascension’s strengths, weaknesses, opportunities, and threats are reviewed. First, Ascension has many strengths. It is the leading non-profit and Catholic health system in the U.S. It provides services in more than twenty states. Since 2012, it has acquired and merged with several health networks around the U.S., expanding their reach to communities in Illinois, Oklahoma, Kansas, Michigan, and Wisconsin. The Ascension network provides $2.3 billion in care of persons living in poverty and other community projects. They have 2,600 sites of care in more than 20 states, 146 hospitals, and more than 40 senior care facilities, making it one of the largest nonprofit senior living providers in the U.S. The pandemic brought many challenges to health networks across the world. Operations and volumes had experienced significant volatility because of the pandemic. Restrictions were put in place to stop the spread of novel coronavirus throughout 2020 and early 2021. These restrictions affected elective procedures, which is a large piece of the revenue for Ascension. Although Ascension and healthcare facilities around the world faced unprecedented financial and operational challenges, Ascension was able to maintain a strong financial position. However, this was not without sacrifice and restructuring. The pandemic uncovered several weaknesses. To maintain a positive financial position, many changes occurred. Ascension relies on elective procedures as a large part of its income. The pandemic also created consumer hesitation, creating adverse impacts on the network’s overall volumes. During the height of the pandemic, the organization relied on government funding and favorable investment performance to contribute to the network’s ability to maintain its operations. To generate a positive financial balance sheet and maintain a strong financial position, Ascension had to make many strategic changes to their investments and equity. Ascension and the University of Alabama at Birmingham Health Systems formed an alliance, to increase access to new networks in Alabama. Ascension divested all the assets of St. Clare’s Hospital, severed ties with St. Mary’s Healthcare in Amsterdam, New York, and Northern and Central Wisconsin markets transitioned to Aspirus (Ascension, 2021). While Ascension kept their financial position strong, they lost several assets, investments, alliances, and some market share. This could be looked at as a strength and a weakness. Ascension gained $87.7 million from the sale of four ventures, which assisted in creating more revenue to cushion the blow from the increasing expenditures caused by the pandemic. But this is a loss of assets and investment funds that could have been used later. Ascension has an opportunity to recapture some of their market share, after the transition of Wisconsin markets to Aspirus and transition of St. Mary’s Healthcare in New York. Although it has not been finalized, Ascension and their Illinois alliance with AMITA will also be disbanding soon. With loss in several major markets, they are needing to recapture some of these markets. The pandemic changed the way healthcare is delivered. In 2020, Ascension created three comprehensive care clinics and a virtual provider in Michigan to add more to their innovative care delivery portfolio. During the height of the pandemic, inperson care had declined, and telehealth became critical for non-emergency care. Ascension worked to create a better telehealth system. As the pandemic continues to evolve, Ascension will need to evolve with it. This can involve redesigning care delivery, everything from workflows to treatment. The last part of the SWOT analysis is threat. Ascension is facing numerous threats, both internally and externally. With the pandemic came federal regulation with the vaccine mandate. The government mandated that people had to be vaccinated, in order to continue their employment. This mandate led to hundreds of employees being suspended, fired, or forced to retire. This federal mandate and Ascension’s decision to follow it has exacerbated the stafÏng shortage that Ascension was already experiencing. Unfortunately, since Ascension relies on funds from programs, such as, Medicaid and Medicare and other governmental funding, not following the mandate could have led to loss of these revenue channels. A5. Competitive Advantage Ascension could benefit from a best-cost provider strategy. Ascension could face are increased intensity of competition, slowdowns in market growth, entry of potent new competitors, changes in technology, adverse economic conditions, and regulatory restrictions. As healthcare evolves, more competitors will enter the market for providing care efÏciently and cheaply. With Ascension exiting some markets, they have potential to enter others but with the loss of markets, creates more competition. Ascension will need to stay ahead of its competition by continuing to examine the market, invest in the right markets at the right time and create alliances with the right partners. These partnerships will help expand into new markets. Ascension is invested in equity, investment capital, and technology. It is imperative that Ascension remains observant about changes in technology and medical advances and provide care more efÏciently and economically. These changes can help set them apart from their competition. They must compete, differently. When reviewing the competitive conditions in a company’s industry, the most valuable tool is the Five Forces Framework tool. This tool states that competitive pressures within an industry come from five sources: “competition from rival sellers, competition from potential new entrants, competition from producers of substitute products, supplier bargaining power, and customer bargaining power (Thompson et. al, pg. 57). This can be a complex tool due to the amount of data that is analyzed. It analyzes a variety of pressures in the industry. The Five Forces Framework tool assists leadership in "assessing how to insulate the company from the strongest forces, identify attractive arenas for expansion, or alter the competitive conditions so that they offer more favorable prospects for profitability” (Thompson, et. al, pg. 86). While resource analysis, value chain analysis, and benchmarking are all great tools, but a more comprehensive assessment of competitive strength should be performed. The second tool that a company can use in SWOT analysis is the VRIN test. These tests focus on internal factors. These tests analyze the company’s resources and capabilities. First, the company should identify its most important resources and capabilities because these elements are what set them apart from their competition. The tool conducts tests on the resources and capabilities to see if they are valuable, rare, inimitable, and non-substitutable. If a company’s resources and capabilities have these four qualities, they will have the competitive advantage over their rivals in their markets and the company can sustain that advantage, even when their rivals try to seize the market from them. The competitive offense for keep the competitive edge is making partnerships and alliances with competitors. Although, this helps limits and protects the competitive arena, mergers and acquisitions can cause catastrophic results, rather than competitive ones. A6. International Markets Ascension operates prominently in the United States. At one time, they had a division in Canada but that has been disbanded. Competing in international markets can have its benefits as well as liabilities. When companies enter international markets, they have access to new markets and new customers. By accessing new markets, companies have the potential to increase profits and revenue and improve long-term growth. Companies have the opportunity to further exploit its core business model, gain access to resources and capabilities located in foreign markets, and achieve lower costs through increased purchasing power and experience. Unfortunately, Ascension is in an industry that is very different in every country, and it is constantly changing due to governmental regulation, demand and supply, and new developments in technology and medical advancements. The healthcare industry is a very diverse industry, especially in Western countries. Many countries rely on a universal healthcare system whereas the United States’ citizens rely on private insurance and public health coverage, such as, Medicaid and Medicare systems. The difference between healthcare systems, payment for fees, and government regulations creates financial and governance hurdles for companies to overcome. In the United States, Ascension also has a non-profit status but in Canada, they may not have the same status. They may be subject to higher taxes or fees to achieve compliance with a country’s regulations. It is important to understand a country’s laws and regulations before considering entering the healthcare system in a country that has different pay systems and care systems. It may be too expensive and too complex to enter a market that differs from your own. A7. Diversification Strategy Diversification is incredibly important to the long-term success of a company and profitability for shareholders. Diversification provides business strategies for multiple individualized companies under one umbrella. Diversification is more than just spreading business risks across various industries. According to Thompson et. al (2020), “diversification cannot be considered wise or justifiable unless it results in added long-term economic value for shareholders” (Thompson et. al, 2020). Ascension has a diversified business strategy. They have several subsidiaries, including Ascension Care Management, Ascension Global Mission, Ascension Investment Management, Ascension Living, Ascension Medical Group, Ascension Technologies, Ascension Ventures, and The Resource Group. They invest in intangible and tangible capital, which includes property, equipment, leases, software, and so on. Ascension has acquired many organizations throughout its history. Ascension operates several subsidiaries, as listed above. These subsidiaries were obtained through acquisitions. When the acquisitions fail, divestitures may be sold or transferred to another company as it did not provide the profit as previously expected. For example, Ascension completed the transition of Ministry Health Care, Inc. to Aspirus, Inc in August 2021. Ascension St. Clare’s Hospital, Inc. completed the sale of certain assets and liabilities in August 2020. Ascension can use a joint ventures to achieve diversification in overseas operations. While they can provide an easier way to manage the “intricate web of financial, technical, political, and regulatory factors”, joint ventures can have significant drawbacks due to conflicting views, disagreements on operations, and usually only last until the partners disband their venture. Another potential diversification strategy to extend its reach in the United States is implementing telemedicine services in underserved communities, especially inner city, and rural areas and providing community clinics for these areas. Creating smaller community hospitals and clinics provides opportunities to serve smaller communities, helping create a healthier community. Telemedicine has provided opportunity for patients who cannot drive, who are home-bound, or have to drive too far for doctor’s appointments the ability to take part in improving their health by speaking with a medical professional. This means earlier decisions in disease processes as well as earlier means of preventive care. Ascension has provided 935,000 virtual visits in 2020. A8. Ethical Considerations The first potential ethical issue Ascension could face involves international regulation. If Ascension wants to function in an international company role, they have to agree to that nation’s regulatory and governmental rules. These rulings may include cross-country ethical differences. The United States relies on a pay system that is paid by mostly private insurance, creating astronomical costs for the insured. Other countries may deem this irresponsible and maybe even unethical. As suggested by Thompson et. al (2020), host-country cultures have the opportunity to exert some influence over the moral and ethical standards of business units operating in that country (Thompson et. al, 2020). Another potential ethical issue Ascension could face is involving telemedicine. Telemedicine is a great resource for patients and doctors. It allows patients more freedom and allows patients to attend their doctor’s appointments. It reduces unnecessary non-urgent ER visits and eliminates transportation expenses for regular checkups. It has increased patient engagement and reduced the amount of patient no-shows. It has led to fewer hospital admissions. It has a lot of advantages. However, there is an ethical issue when there is a possibility for patient mismanagement and mismanagement of insurance. Some patients are using telehealth services that connects them to a doctor they have no connection to and may never have a connection with again. This can cause care continuity to suffer, in turn, causing the patient to have decreased quality of care. Telemedicine should provide access to quality care; the same way in-person care is supposed to. It is important to ensure that patients are provided with consistent, quality care, to lead to healthier lives. This can be done by making sure accurate records are created for the patient and continuous care is prompted and provided through telehealth options, with the occasional in-person consultation. These records should be forwarded to the patient’s primary care doctor and if they do not have one, help the patient establish an on-going relationship with a primary care doctor. A9. Planned Execution of Strategy To become an international entity, Ascension will need to have a team capability of working with other groups to establish and maintain a relationship and partnership when creating a healthcare enterprise across the border. It is important to have individuals who can execute the strategy well, develop the resources, create a supportive structure and fostering a culture that promotes good strategy execution. Strategies fail due to poor execution. It is critical that the company is ready to execute strategy and sustain the strategy for the short-and-long term. According to Thompson et. al (2020), “how well managers perform these 10 tasks has a decisive impact on whether the outcome of the strategy execution effort is a spectacular success, a colossal failure, or something in between” (Thompson et. al, 2020). With Ascension’s second strategy opportunity to further its patient engagement, provide virtual visits, and community clinics in underserved communities, following the action agenda for executing their strategy will assist in successful implementation. Successful strategy planning and execution is ensured by people (and resources) doing the right thing, at the right time, in the right place, the right way. The first three tasks involve human capital. Having the right people with the right capabilities at the beginning assures a smoother progression through the execution process. These includes the doctors, administrative staff, IT staff, community leaders, and the community as a whole. It is important to understand the needs and hardships of the community in order to create measurable outcomes and results for the strategy. For example, if the community experiences a higher rate of lung cancer, it is important for the medical staff to review the community as a whole. It would be important to find out what is contributing to the disease process of lung cancer. The next five tasks focus on establishing policies and procedures, allocating resources, employing business process management tools installing operating and information systems and rewarding the achievement of goods results. The last two tasks involve company culture and leadership. The right leadership should be appointed at the beginning and remain prominent throughout the entire strategy process. Leadership buy-in is crucial to good strategy execution and promoting a company culture that embraces change. Leadership can help inspire and engage employees in the mission, vision, and strategy. It is critical that culture support the execution strategy. Involving everyone in the process will lessen the resistance against change and strategic objectives. A10. ROI & Cost Benefit Analysis Return on investment (ROI) is an important metric for determining profitability and efÏciency. It is a ratio that is commonly used to determine how much your investment has profited or loss. According to Forbes, an annual ROI of approximately 7% or greater is considered a good ROI for an investment in stocks (Birken & Curry, 2021). ROI can be a difÏcult metric to use as it does not take time into account. It may be important to use Return on Assets and Return on Equity alongside Return on Investment(s) to see how the company is doing financially over a period of time. If Ascension reallocates operating funds to invest 25% of its funds into beginning a new venture, it would be vital to set a 10%-15% return on the funds invested in the first year, 20%-25% in the 2nd year, and 50% by the 5th year. To extend their reach beyond our borders, this will be a massive undertaking. Unless Ascension plans to acquire a business or merge with a current international hospital network, it will be costly to plan, build, and manage an international hospital network. A cost-benefit analysis may reveal that creating an international component to the business is too costly and keeping business operations with the United States is best for their company. For the strategy initiatives Ascension is trying to achieve within their communities, they will also need to include other metrics to determine its effectiveness and efÏciency. For the neighborhood clinics and virtual visits, patient engagement and patient follow-through are two important metrics to follow. Patients attending their appointment, whether virtually or physically or both, can show that patients are benefiting from clinic’s outreach. A decrease in complications and comorbidities of the disease process, decrease in ER and urgent care visits, decrease in preventable hospital admissions and reduction of certain integrated scorecard goals, such as, asthma, COPD, and diabetes also can show that patients engaging in their health and attending their preventive care appointments is occurring due to the clinic availability and various approaches to patient appointments allow patients to attend their appointments. Ascension is working to reduce the cost of healthcare through creating new models. Using virtual visits reduces costs for patients, reduces the use of unnecessary resources, enhance patient care by offering care to patients who normally have difÏculty attending appointments or home bound. Ascension is driving down costs by improving care coordination. They are working to optimize fee-for-service model, focusing on enhancing care and patient satisfaction while reducing the fees associated with care. The cost-benefit analysis will show that an upfront cost of building neighborhood clinics will be the majority of the costs, along with hiring new talent to fill positions within these clinics. However, virtual visits will not require such upfront costs. Most major hospital networks now have their own application to run virtual visits since the pandemic caused closures and mandatory quarantines at the heigh of the pandemic. Patients only need their laptop or cell phone to run a video call with their doctor. Restructuring of the population health team has allowed resources and talent to be allocated in a more efÏcient way. The population health team can provide healthcare outreach to the underserved, impoverished populations, especially in rural and inner-city populations. Outreach to underserved populations also creates new expenditures, as these communities may need more financial assistance, educational resources regarding their health, opportunities to improve their health, such as, healthier eating options and exercise programs. IU Hospital in downtown Indianapolis provides a farmer’s market to hospital associates and the community to build fresh vegetables, fruits, and baked goods. In inner cities, the loss of grocery stores within causes underserved, impoverished people to rely on gas stations and fast food to provide food to their households. By working with the community, the hospital and local growers can provide better food to those in their community, in turn, providing healthier options for healthier lives. A11. Conclusion Ascension is one of the largest and leading non-profit and Catholic health systems in the U.S., operating in more than twenty states and the District of Columbia. Ascension focuses on “serving all persons especially those living in property and who are struggling the most, and to deliver compassionate, personalized care and lead healthcare transformation in the United States” (Ascension, 2021). Ascension has an opportunity to continue to grow and further its mission of serving the poor and the vulnerable and being a strong competitor in the healthcare industry. Due to its strong market position and stable financial portfolio, Ascension can continue to invest in the communities they serve. They have the opportunity to transform healthcare and reduce the climbing costs of healthcare by enhancing patient care through new workflow models, such as, telehealth visits and community clinics in rural and inner-city, underserved communities.