One Year Into the Affiliation: A Strategic Momentum Review of What to Keep, Change and Stop
Student Name
Master of Science in Nursing Program, Aspen University
N547: Health Care Strategic Management and Planning
Instructor Name
Month Day, Year
One Year Into the Affiliation: A Strategic Momentum Review of What to Keep, Change and Stop
A year ago, the composite independent hospital signed its agreement with the university teaching hospital and adopted an action plan with five objectives and a twelve-measure balanced scorecard. Strategy does not end when the plan is approved. Ginter et al. (2018) describe managing the strategic momentum as the work of carrying out the strategy, measuring results and deciding whether to maintain the current strategies, adjust them or change direction. This paper reviews the affiliation's first year: what was delivered, what the measures show, why some results fell short and what the hospital should keep, change or stop.
Why Reviews Matter
Strategy implementation is widely said to fail most of the time, with figures of 50% to 90% often quoted. A review of the literature behind those figures found that most estimates rest on evidence that is outdated, fragmentary or absent, and that the true rate of implementation failure remains unknown (Cândido & Santos, 2015). A balanced scorecard is designed to support exactly this kind of checking, because its leading measures show whether a strategy is on course before the financial results arrive (Kaplan & Norton, 1992). The practical lesson for a hospital is not a statistic but a habit: because nobody can predict how often strategies fail, each strategy has to be checked against its own evidence, early and honestly, so that problems are found while they can still be fixed.
What Was Delivered
Four of the five objectives were completed on time. The affiliation agreement was signed in month four, and the joint capital planning process and review triggers were agreed in month six. Telemedicine coverage in neurology began in month eight and in endocrinology in month nine. The joint nurse residency enrolled its first cohort of 24 new graduates in month ten. The diabetes and heart failure program, the most complex objective, opened in month thirteen, a month late, because hiring the second nurse care manager took longer than planned.
What the Measures Show
The table compares the year-one results for the measures with the most change against their baselines and year-two targets.
| Measure | Baseline | Year 1 | Year-2 target | Status |
|---|---|---|---|---|
| Registered nurse first-year turnover | 24% | 16% | 12% | On track |
| Contract nurse spending, percent of all nursing labor | 7% | 5% | 3% | On track |
| Transfers for neurology or endocrinology conditions | 310 | 236 | 200 | On track |
| Telemedicine consults completed within 60 minutes | Not measured | 88% | 90% | On track |
| Heart failure patients contacted within 72 hours | 40% | 82% | 85% | On track |
| Heart failure 30-day readmission rate | 21% | 21% | 17% | Behind |
| Program patients with A1c above 9% | 28% | 26% | 20% | Behind |
| Commercial outpatient visits, change from prior year | -4% | -1% | +2% | Behind but improving |
| Operating margin | 1.0% | 1.4% | 2.5% | Behind but improving |
Interpreting the Results
The workforce part of the strategy is working. First-year turnover among new nurses fell by a third, and spending on contract labor fell with it. Nurses in exit interviews from the previous year had most often cited feeling unsupported in their first months; the residency, with protected preceptor time and monthly cohort sessions at the academic center, addressed that directly. Neurology telemedicine also succeeded, accounting for most of the reduction in transfers, because the emergency department now receives a stroke specialist's assessment within minutes.
Two results fell short, and the reasons differ. Endocrinology video visits were rarely used: primary care physicians did not want a scheduled video appointment for questions they could answer with advice. That is a design problem, not a failure of the affiliation. The heart failure results are more puzzling. Follow-up calls reached their target, yet readmissions did not move. A review of 40 readmissions found that most patients had been reached by phone but that about half could not get a clinic appointment within seven days of discharge. The process measure was met while the process that mattered, timely visits, was not, which shows that a scorecard is only as good as the link between its measures.
Keep, Change and Stop
Keep: the nurse residency and neurology telemedicine should continue unchanged, and the residency should expand to a second cohort each year, since it is the strategy's clearest success and supports the hospital's main advantage, its nursing culture. Change: endocrinology telemedicine should be converted from scheduled video visits to electronic consultations, in which primary care clinicians send a question and receive written advice within two business days, a format that matches how the physicians actually want to use specialists. The heart failure program should add a measure and a fix for its real bottleneck, guaranteeing a clinic or nurse practitioner visit within seven days of discharge, with two protected slots a day in the cardiology clinic.
Stop: the plan's marketing campaign for outpatient services, which cost $85,000 and produced no measurable change in commercial visits, should end. The small improvement in outpatient volume appears to come from better specialist access through the primary care network, which is where further effort belongs. Finally, the review triggers set when the affiliation was chosen have not been reached: the operating margin is positive and days cash on hand remain above 60, so there is no case for reopening the merger question this year.
Bringing Learning Into the Next Plan
The review also yields lessons for future planning. Measures should be chosen for the outcome they are meant to drive, and each process measure should be tested against that outcome during the year rather than at the end. The people who use a service, in this case primary care physicians, should help design it before it launches. And nurse leaders should keep presenting workforce results as strategic results, since the residency's success is now the strongest evidence that the affiliation was the right choice.
Conclusion
One year into the affiliation, the strategy is working where it builds on the hospital's nursing strengths and falling short where services were designed around assumptions rather than users. Managing the strategic momentum means acting on that difference: keeping what works, redesigning what does not and ending what has no effect, while checking whether the conditions that justified the strategy still hold. The hospital's direction remains sound; the review has made its execution better.
References
Cândido, C. J. F., & Santos, S. P. (2015). Strategy implementation: What is the failure rate? Journal of Management & Organization, 21(2), 237-262. https://doi.org/10.1017/jmo.2014.77
Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2018). The strategic management of health care organizations (8th ed.). Wiley.
Kaplan, R. S., & Norton, D. P. (1992). The balanced scorecard: Measures that drive performance. Harvard Business Review, 70(1), 71-79.
How this N 547 Module 7 example is structured
Aspen does not publish N547 module prompts, so check your classroom for the exact instructions. This example defines managing momentum, uses a critical review of implementation failure rates to justify disciplined review, reports what was delivered, compares scorecard results with baselines and targets, explains successes and shortfalls with evidence, and makes keep, change and stop decisions with lessons for the next plan.
N547 Module 7 questions, answered
What does N547 Module 7 usually ask for?
Managing the strategic momentum is the third part of strategy in Aspen's N547 description, so a late-course assignment evaluating how a strategy is performing and what to adjust is typical. Check your classroom for the organization and data to use.
What is the difference between a status report and a momentum review?
A status report says what happened. A momentum review explains why, tests whether the measures still reflect the strategy's logic, and ends with decisions to keep, change or stop specific parts of the plan.
Is it true that most strategies fail?
The commonly quoted figures of 50% to 90% are poorly supported; a review of the literature found the true failure rate unknown. The safer conclusion is that every strategy should be reviewed against its own evidence.
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