Analysis of Healthcare and Quality Improvement

This assignment involves a comprehensive analysis of healthcare-related topics, including A&E waiting times, quality improvement initiatives, and patient outcomes. The analysis is supported by various sources, including news articles, academic papers, and government reports. The assignment requires the student to critically evaluate these sources and provide insights into the effectiveness of different approaches to improving healthcare quality.

Running head: BUSINESS STRATEGY (MANAGEMENT)
An exploration and critical analysis of East and North Herts NHS Trust
Name of the Student
Name of the University
Author Note

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Executive Summary
Situational analysis of an organization allows their management to identify the present strength
and weakness and observe threats in order to get knowledge about the opportunity to porper in
the future. In this business report, the two situational analysis tool that is 5C analysis and SWOT
analysis is taken into consideration. Through this snalysi it has been found that the organization
East and North Herts NHS Trust serves the people of UK with quality medical care facility.
Though there are many threats like poor treatment quality for the accident and emergency
patients especially during the festival season. There were lack of bed resources for the critical
patients and several operations also got postponed due to the same factor. It has been also found
that through the organization have good financial reputation, they were failed to meet their target
to attend emergency patients. They also face loss once due to cyber attack and this represents the
poor maintenance of the data managed within the organization. This report highlights the
qualitative and quantitative data for some of the strategic issues and desired recommendations is
also made so that the performance of the organization can be improved.

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Table of Contents
1.0 Introduction................................................................................................................................3
2.0 Discussion..................................................................................................................................4
2.1 Theories related to Strategic Situational Analysis.................................................................4
2.1.1 5C analysis......................................................................................................................4
2.1.2 SWOT Analysis..............................................................................................................6
2.1.3 PESTLE analysis-...........................................................................................................7
2.1.4 VRIO-.............................................................................................................................8
2.2 Identified strategic issues facing the business:......................................................................9
2.2.1 Issues in broad environment...........................................................................................9
2.2.2 Issues in industry environment.....................................................................................10
2.2.3 Issues in resources and capabilities..............................................................................13
3.0 Strategic options or recommendations.....................................................................................15
3.1 Developing transparent policies..........................................................................................15
3.2 Effective collaboration with local heath care services........................................................15
3.3 Recruitment of knowledgeable staffs..................................................................................16
3.4 Attainable changes in policies.............................................................................................16
3.5 Development of IT department and modern IT technology................................................16
4.0 Conclusion...............................................................................................................................17
5.0 Reference List and Bibliography.............................................................................................18

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1.0 Introduction
The situation analysis plays an important role in analyzing the strengths and weakness of
an organization along with its threats and opportunity to prosper in future. Ginter et al. (2018)
stated that this assessment also allows the company to focus on important details like actual size
of the audience and noticing the positive traits in them through which the business can be
improved. This assessment is also important for analyzing the business environment and the
ability of the contenders. (Kotler 2015) highlighted that many business people consider
assessments for product’s situation, situation of the competitions, distribution situations,
opportunity and issue analysis and evaluation of environmental factors. The organization taken
into consideration for this business report is East and North Herts NHS Trust. East and North
Herts NHS Trust were established in the year 2000 and serves medical treatment and care
services to the communal. This human care organization is best known for their every kind of
simple and chronicle diseases, blood test equipments, maternity, radiology services and
outpatient appointment services (Enherts-tr.nhs.uk 2018). Their strategy is based on their people,
patients and their experience. They have 75.2% of the staff survey engagement score and have
bullying and harassment score of 27% (Enherts-tr.nhs.uk 2018). Though they have 7.91%
vacancy rate and a turnover rate of 26.35% within first twelve months of service but they have
target set for each of these milestones in order to assess their organization’s performance and rate
their efficiency (Enherts-tr.nhs.uk 2018).
The two of the most important theories for strategic situation analysis in this report will
be the 5C analysis and SWOT analysis. Thus report also highlights the main strategic issue of the
considered organization in terms of issues in broad environment, industry environment and
resources and capabilities. A plan will be presented so as to overcome the existing issues and a

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recommendation section will highlight some of the strategies through which the suggested plan
can be improved for future benefits.
2.0 Discussion
2.1 Theories related to Strategic Situational Analysis
2.1.1 5C analysis
The major components of the 5C analysis are company, customers, competitors,
collaborators and climate.
2.1.1.1 Company
Sauria et al. (2015) stated that the main purpose for the analysis of company’s situation is
to emphasize on its vision, strategies, capabilities, culture, technology used and objectives.
Miyanji et al. (2018) furthermore depicted that if these aspects are carefully measured, then it
helps in understanding the current issues present in the organization and its future impacts if not
addressed. East and North Herts NHS Trust values their patient’s first and thrives for continuous
improvements that prove their excellence, they are also open and honest to everyone and prefer
to work collaboratively as a team.
2.1.1.2 Customers
In order to know about the target audience, market size, market growth, customer’s
behavior, buying patterns, average purchase size and preferred retail channels, understanding the
customer’s perspective is important (Skoog et al. 2017). The patients throughout the United
Kingdom are their customers. Moreover, due to their system for 4 hour treatment for the
emergency patients, people who are severely injured are their prime customers.

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2.1.1.3 Competitors
Montgomery (2017) depicted that though analysis of internal environment is important as
it provide knowledge of their capability to overcome any problem. However, external
environmental analysis is also important s it provides the ability of the competitors working with
the same business objectives. Kelley et al. (2015) furthermore stated that competitors analysis
involves competitors’ strengths, weaknesses, upcoming initiatives, market shares and
positioning. East and North Herts NHS Trust have several competitors- Barnet General Hospital,
Chase Farm Hospital, Great Ormond Street Hospital, North Middlesex Hospital, Royal Free
Hospital, University College Hospital, Whittington Hospital and others (Enherts-tr.nhs.uk 2018).
These hospitals are great in terms of customer service and post treatment check-ups. They also
have sufficient accommodation management for their patients.
2.1.1.4 Collaborators
Effective mutual partnership also plays an important role in attaining business
profitability and success. Ravaioli et al. (2014) stated that relationships with suppliers,
distributors, collaborators and business partners should also be assessed in order to find the
business problem easily. The East and North Herts NHS Trust have collaborated with many of
the local and established health care organizations of NGOs that are serving for humankind.
Some of their partners are- Age UK, Headway Hertfordshire, Macmillan Cancer Support,
Hertfordshire Society for the Blind, Breathe Easy – North Herts, Royal Voluntary Services
(RVS) and others (Enherts-tr.nhs.uk 2018).
2.1.1.5 Climate
Many businesspeople evaluates the macro-environmental factors to assess the “political”,
“economic”, “socio-cultural”, “technological”, “environmental”, and “legal scenarios” of the

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business (Kotler 2015). The concerned trust follows many legislation, and also policies of staffs.
The technological management and resource system of the concerned organization need to be
improved.
2.1.2 SWOT Analysis
2.1.2.1 Strengths
East and North Herts NHS Trust have the strength of stable management team, who are
liable for handling all the track records and also manages the potentially contentious change.
They also provide range of specialist service like ENT, renal and urological cancer, Vernon
Cancer Centre and plastics (Enherts-tr.nhs.uk 2018). They also have modern environments
system like post-spring 2015 QEII and recognized as clinically and financially sustainable
organization.
2.1.2.2 Weakness
There is a limitation of the business intelligence system resulting which the trust have
faced cyber attack from WannaCry attackers. Moreover, the trusts have lack of capacity that does
not allow them to overcome through any change efficiently. In addition to that, they also has lack
of strategic direction, infrastructure, capacity and investment through which facility like decision
support tools, patients records and Wi-Fi cannot be implemented (Enherts-tr.nhs.uk 2018). They
also lack strong clinical leadership due to which the organization often lacks strategic vision.
2.1.2.3 Opportunities
The trust is facing problem of lack of bed resources and thus, incorporating many of beds
for treatment of the critical patients can be an opportunity for the company. The trust also has the
involvement of political parties and thus initiating “Better Care Fund” through Commissioners’
integration strategy is also an effective opportunity (Enherts-tr.nhs.uk 2018). Growth from

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research activities through CRN and EAHSN and development of extra specialist service that
includes treatment for hyper-acute stroke, robotic surgery and PPCI should also be involved in
the existing business functions (Niederwieser et al. 2016).
2.1.2.4 Threats
The change in the financial climate can be one of the greatest threats that his trust is
currently facing. Series of bad news like forcing patients to lie on the floor, delayed A&E
treatments, harassment of the staffs and poor IT management have impacted their reputation
adversely (Enherts-tr.nhs.uk 2018). The trust takes more time to react on unmanaged and
unanticipated change that leads to the lack of proper growth in the market. Moreover, due to the
innovative change in medical science and cost reduction of the treatment cost in other hospitals,
there can be rise in the customer’s expectation (Enherts-tr.nhs.uk 2018).
2.1.3 PESTLE analysis-
Political
 UK has constitutional monarchy
therefore stable political situation.
 Prerogative government
 Brexit problem
 High corruption
Economic
Positive
 Second highest GDP in Europe
 Diversified economy
 flourishment in both public as well
as private sectors
 Growing FDI
 Slow recovery from economic
recession
 Increasing unemployment
Social Technological

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 Dense population that encourages
market investment
 High level income
 Skilled but cheap workforce.
 Increasing cost for both education
and training.
 High innovative skills
 High expertise in information
technology
 Internet availability at cheap price
 Strong telecommunication
infrastructure
 Slow advancement in compared to
the United States.
Legislative
 Strong legislative provisions for the
workplace discrimination
 Stable wage system
Environmental
 Strong environment policy
 excellent regulation in the
environmental issues
 promotion of sustainable
development
2.1.4 VRIO-
Value- value increases based on the quality of service or product. Here The East and North
Hertfordshire Trust needs to be innovative and more attentive to their services which will
definitely enhance their values to their customers.
Rarity- the industry infrastructure has high quality technological appliances for providing best
care for the patients. It cannot be availed by the clients in other local organizations.

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Imitability- the care and treatment which this institution provides, cannot be imitated. The
innovation and operation of the institution have provided it competitive advantage.
Organization- this institution is organized, prepared, and capable to exploit all the resources
available.
2.2 Identified strategic issues facing the business:
2.2.1 Issues in broad environment
Kabisch et al. (2015) stated that in an organization’s broad environment there are total of
six environment that consists- demographic, economic, natural, technological, political and
social-cultural environment.
The East and North Hertfordshire Trust suffered from staff harassment from their
management and colleagues. 52% of the total Trust’s staff opted for whistle-blowing concerns
and 85 of the Trust’s respondents says that they are conformable from the services that is
provided in their workplace. Apart from the harassment of the staffs, the patients were also ill
treated and forced to lie on the floor. There were lack of proper resource that is for the bed but in
order to treat all the patient, the officials of the organization have to force some of the patient’s
to lie on the floor. In such cases, there were people roaming in the hospitals stepped over these
patients (Mail Online 2018). Moreover, the staffs of the NHS hospital have also asked those
patients not to disclose their name of asked by someone.
It is found that for the year 2017, the East and North Hertfordshire Trust, did not meet
their financial year target and also faced the steep deterioration with a £28m deficit (Dunhill
2018). Apart from this economic loss of the trust, there is another bigger technology loophole
that was utilized by the cyber intruders. On May, 2017, “WannaCry” was the largest internet or
cyber crime occurred. This group of cyber intruder attacks established and wealthy forms and

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demand ransom for the crucial information that is present in the organization’s database. East
and North Herts NHS Trust are one of the organizations infected by WannaCry (Welwyn
Hatfield Times 2018). The cyber criminals selected this trust as it runs more than 80 NHS Trusts
and have much crucial information that should be kept confidential. The hackers infected the
system in such a way that Lister’s A&E emergency departments get diverted to other hospitals
and could not treat the emergency patients (Welwyn Hatfield Times 2018). The total financial
loss due to this cyber attack was £700,000among which total of £400,000 has not received by the
trust as the patients during this period were treated in other NHS hospitals and the remaining loss
of £300,000 is due to the fact that the organization did not attend any outpatient appointments
(Welwyn Hatfield Times 2018). It is also found that Forty of the 47 NHS organizations were
attacked by WannaCry Cyber Attack and they have also created interruption in the program that
many of the crucial operation gets cancelled. The action that was taken by the NHS trusts are that
the officials have invested £50 million in NHS cyber security centre so that they can find the
intruders (Campbell and Siddique 2018).
Another problem that was faced by the East and North Herts NHS trusts is that many
workers were listed to get the refund but have not received. The trusts have initiated “Widening
Access Training (WAT) scheme” in which the employees of the East and North Herts NHS
trusts have to give money from their main wage. However, after a certain time, it was revealed
that trusts have paused claims and also refuse them to get the refund. In the year 2016, 10,000s
of NHS workers were refused for the refund.
2.2.2 Issues in industry environment
It is found that the patients of the hospitals run by East and North Herts NHS Trust have
to wait longer than any other health care organization. It is also published in the new article that

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East and North Herts NHS Trust have the worst A&E waiting times (Minassian 2018).
According to the organization’s objectives, the officials should attend 95% of the patients
admitted for accidents and emergency purpose. However, in reality, the concerned organization
is only able to serve for 77.2% of the total patients that makes the not fulfilling almost 20% of
their target mission (Minassian 2018). It is also seen that in December, 2017, East and North
Herts NHS Trust’s hospitals have 13,073 patients attended A&E among which 2,975 had to wait
more than four hours (Minassian 2018). According to the recommendation of the Care Quality
Commission in the year 2016, the concerned trust have to improve their service as it has not
obtained the 95% of the target since 2015 (Minassian 2018).
In addition to that, the NHS trust also has A&E standard that is violated since 2004 that is
all the A&E patients will be treated within four hours. Moreover, when their officials were
questioned, they have said that they divide the patients based on their injury. They have also
highlighted that the types 2 and 3 A&Es are those, who have minor injuries and will positively
be treated within four hours; however, the type 1 A&E patients with major injuries it will be
harder to achieve the four-hour target (Qualitywatch.org.uk 2018).

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Image 1: Number of people spending more than 4 hours at East and North Herts NHS
(Source: NHS England, A&E Attendances and Emergency Admissions)
Earlier the concerned NHS has the target to attend 95% of the A&E patients, which was
reduced to 95% and this the new target of the organization. However, patients have to wait
longer since the four hour strategy was implemented. Ladenheim, et al. (2016) argued that there
are some patients, who have waited less than an hour; while, some waited to almost 4 hours.

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Image 2: Median and 95 percentile of the time waited by patients for treatment to begin
(Source: NHS England, A&E Attendances and Emergency Admissions)
Thus, it can be seen that when median is considered then it is found that after suffering
from many allegation of late treatment for A&E patients, their attention have raised and the
organization provide treatment ranges from a low of 46 minutes to a high of 69 minutes in
January 2015 and in March 2016 respectively (Qualitywatch.org.uk 2018). However when 95
percentile is considered, the performance is found to be much worse and the time value
fluctuated between 185 minutes to 223 minutes until August 2015 and in March 2016
respectively (Qualitywatch.org.uk 2018).
2.2.3 Issues in resources and capabilities
In December 2018, the Stevenage’s Lister Hospital runs by East and North Herts NHS
Trust put the safety of patients at risk. This issue is shortage of critical beds that was reached to
10% occupancy rate for seriously ill patients (Hertfordshiremercury.co.uk 2018). The published

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news highlighted that he hospital considered 85% of the occupancy rate of the critical bed to be
safest limit line so that further surge in demand for the same can be handles in emergency
situations. This leads to the capacity issue in the organization. Moreover, in 3rd January, 2018,
total of 585 beds that comprised of General and Acute (G&A) beds were fully occupied but the
occupancy rate for the hospital on 7th January showed 99.3% (Flanagan 2018). It is said that
during the festive reason, the occupancy rate of the hospital is more and reached up to 90% to
99% (Flanagan 2018). Aditionally, between Christmas Day and New Year's Eve, more than 30
hospitals stated that they have no free beds left in their hospitals. The safe level of occupancy of
bed at the hospital is 85% and it is recommended not to exceed this limit as patients are more
likely to die from infection. As a result, the doctors of that organization have taken the decision
to postpone 55,000 operations in order to overcome the adversity (Mail Online 2018).
Image 3: NHS trust’s hospitals where there were no bed for December 2017 and January
2018

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(Source: Mail Online 2018)
However, in many other NHS hospitals it has been noticed that even though the
operations were cancelled, still they have to struggle for beds for emergency patients. This
indicates that they do not have enough bed for the serious patients and have resource crisis. The
reason for no free beds are found to be some serious patients, who need time to recover and some
elderly patients, who lacks social care in their home.
The solution that was taken to overcome this occupancy issue is that they have suggested
patients not to consider themselves under A&E unless it is a life or limb-threatening emergency.
They have also said that people, who need emergency clinical service, can also speak to a local
pharmacist, consult the online NHS services or dial NHS 111 for free 24/7 service
(Hertfordshiremercury.co.uk 2018).
3.0 Strategic options or recommendations
3.1 Developing transparent policies
It is found from the report that the organization did not informed with all the details
regarding the Widening Access Training (WAT) scheme to their employees. As a result,
confusion and dissatisfaction arises. Some employees get the refund but some of them were
refuse to receive the refund. Thus, the organization needs to make their policies transparent so
that the employees can plan their employment efficiently.
3.2 Effective collaboration with local heath care services
East and North Herts NHS Trust is an establish heath care organization; however, they
have suffered from low bed service for their critical patients during the festive seasons. The
scenario also represented that all other NHS hospitals also run out of bed. In this case, if the

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organization will develop partnership with local care centers; they can provide sufficient beds to
their critical patients for the treatment.
3.3 Recruitment of knowledgeable staffs
The human resource management is also liable for recruiting efficient candidates for
providing the health care service to the patients. As the report also highlighted that there is
almost 30% of the employee turnover rate at East and North Herts NHS Trust. Thus, in order to
fulfill the vacancies; the organization needs to recruit knowledgeable candidates, who have
experience in serving public. Knowledgeable candidates are less likely to leave their job and in
this approach the employee turnover rates can also be diminished.
3.4 Attainable changes in policies
The policy of providing treatment to emergency patients within 4 hours is unattainable
during the festival months. In such cases, if this policy is not attainable for the organization, it is
better to change the policies or recruiting many staffs for offering treatment to the patients. In
this way, all the critical pat4eimts can get treatment. Otherwise, the timing mentioned in the
policy should have to be changed.
3.5 Development of IT department and modern IT technology
In order to overcome the problem of cyber attack, the concerned organization is
recommended to utilize the modern technology if IT like cloud technology and concept of big
data. They should always make a copy of all the partnership details and the patient’s record in
the cloud. So, that even if the attacker grabs all the details, they cannot demand for ransom or
hampering the actual data as one copy of the data will always be present. Moreover, the data
sheet should have to be shared with all partners; so that they can also implement their IT security
measure to secure the data.

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4.0 Conclusion
Thus, it can be concluded that East and North Herts NHS Trust is one of the established
heath care service provider in the United Kingdome. They have served their srevyce to the
community people since 2000. In spite of their years of experience to the public; they have faced
many problems. Though the situational analysis it has been found that they have the UK people
as their main customer, they are unable to provide them quality treatment or quick treatment
service in case of emergency during the festival season. All of their trust’s hospital runs out of
beds. Moreover, the IT technology of the organization is not all secured as a result they have
attacked by WannaCry cyber attackers. Thus, it is recommended in the report to develop an IT
department under the trust so that all the data can be ma obtained by management people.
Moreover, the problem of staff bullying and misbehaving with patients is also observed. This can
be overcome through development of strict policies within the workforce.

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5.0 Reference List and Bibliography
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Flanagan, C., 2018. Stevenage’s Lister Hospital ran out of beds last week, latest figures show.
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Mail Online., 2018. Patients forced to sleep on floors at a West Yorkshire hospital. [online]
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