Journal of Health Care and Research
ISSN: 2582-8967
Article Type: Review Article
DOI: 10.36502/2024/hcr.6231
J Health Care and Research. 2024 Apr 29;5(1):18-21
The Case to Discard Hospital Mission Statements and Replace It with A Statement of Goals
Simon W. Rabkin1iD*
1Professor of Medicine, University of British Columbia, Division of Cardiology, Vancouver, B.C., Canada
Corresponding Author: Simon W. Rabkin ORCID iD
Address: University of British Columbia, 9th Floor 2775 Laurel St., Vancouver, B.C., Canada V5Z 1M9.
Received date: 09 April 2024; Accepted date: 22 April 2024; Published date: 29 April 2024
Citation: Rabkin SW. The Case to Discard Hospital Mission Statements and Replace It with A Statement of Goals. J Health Care and Research. 2024 Apr 29;5(1):18-21.
Copyright © 2024 Rabkin SW. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.
Keywords: Mission Statements, Healthcare Organizations, Patient Care, Staff Engagement, Burnout
Abstract
Background: Hospitals and healthcare institutions spend a considerable amount of time and capital on constructing an appropriate mission statement for themselves.
Methods: A review of the purpose of mission statements and the statements made by different healthcare organizations was undertaken. For institutions in the USA, their mission statements were examined in the context of their national ratings.
Results: The mission statements of healthcare organizations are often too abstract, using similar phraseology about caring for patients. Concern for the community that the hospital serves is stated by both a hospital listed as one of the best US hospitals and an institution that was considered to be in the lowest tier in the same country. Similarly, the recognition of ‘research’ or ‘innovation and discovery’ was stated by respectively both a top institution in the USA and one in the bottom tier.
Conclusions: Healthcare institutions should replace their mission statements with clear and attainable statements of concrete goals, and indicate how successful the institution is at attaining those goals and improving the experience of its patients and staff.
Background and Introduction
Mission or vision statements, in many industries, are key to crystallizing the purpose of the organization and inspiring the people who work within it to unite for a common purpose. In the healthcare field, there is evidence that the mission statements, in their current form, have become irrelevant. Several explanations support this contention. The mission statements of healthcare organizations are often too abstract, using similar phraseology about caring for patients [1]. No hospital would state that they do not provide good healthcare to their community of patients because the provision of good healthcare is the existential nature of hospitals. Thus, if the rationale for creating a mission statement is ‘the development of a clear definition of the organizational purpose and aspirations’ [2], the core aspect of a hospital’s mission and its very existence is self-evident, and any statement of its mission becomes unnecessary. Second, perhaps an extension of the first point, is that mission statements are often very similar for most healthcare organizations and do not sufficiently distinguish one from another. Indeed, a standard formula is readily available for guidance in their development [3]. The similarity eliminates the purpose of having the hospital’s workforce identify with their specific hospital. It is noteworthy that mission statements have been dismissed as “an expensive expression of politically correct platitudes which leads to cynical alienation of stakeholders” [4].
Relationship of Mission Statements to Hospital Rankings
Let us compare the mission statements of several hospitals in one country (USA) that were ranked either in the top [5] or in the bottom [6] of US institutions (Fig-1). The precise ranking methodology is not critical because the hospitals are at the extremes of opinion.
Fig-1
All institutions have as their mission ‘high-quality’, ‘excellent’, ‘best’, or ‘exceptional’ care. Indeed, looking at those words alone, it would not be possible to discern which institution belongs to a top-rated hospital or one that is not. Concern for the community that the hospital serves as stated by both a hospital listed as the fourth best US hospital (‘people who live and work in Brooklyn and its surrounding areas’) as well as an institution that was considered to be in the lowest tier in the same country (‘meets the needs of the community we serve’). Similarly, the recognition of ‘research’ or ‘innovation and discovery’ was stated by respectively both the top institution in the USA as well as one in the bottom tier. If one cannot differentiate institutions at the extremes of rating performances, what is the value of a mission statement?
One hospital with undoubtedly a lofty mission for patient care was found to be ‘rife with bullying, coercion, harassment, intimidation, lack of trust, nepotism, and favoritism’, according to a damning survey of its staff and executives [7].
Mission Statement versus Unstated Goals
A hospital’s or institution’s implicit goals may be motivated by cost containment, delivering more care with fewer resources, efficiency, profit generation, or even preservation of administrative structure. The implicit goals, reflected in the behavior or actions of the entire staff, not the lofty vision statement, dictate how that organization functions. If the healthcare staff are overworked, overstressed, or ‘burning out’, then their attitude towards patients and colleagues will not reflect the ‘sunny’ words of the hospital’s mission/vision statement. Additionally, physician burnout can be a significant monetary cost to a hospital’s operating budget [8]. Contrasting an excessively stressed healthcare staff or one operating under different implicit hospital goals with a hospital’s (lofty) mission statement will rapidly ensure that the mission statement becomes irrelevant, ridiculed, or worse, a disengaging force for good healthcare.
Bart and Tabone conducted an exploratory analysis to relate Canadian hospital mission statements with hospital performance. Hospital mission statements were rated as to whether they included statements of values or beliefs, specific behavior standards, desired public image, concern for employees, and concern for shareholders [9]. Mission performance was assessed by hospital administrators according to seven outcomes: (i) satisfaction with the current mission statement (ii) degree to which the mission was a source of energy (iii) degree the mission statement was used as a guide for decision making (iv) extent to which the mission influenced respondents’ behavior (v) extent to which it influences members of the organization (vi) extent to which the members throughout the organization are committed to the mission (vii) qualitative perceptual measure of the organization’s financial performance success. The correlation coefficients were low, although sometimes significant. Unfortunately, no stakeholders other than administrators assessed performance, and ‘performance did not include the crucial metric whether or not the hospitals met ‘specific financial objectives’ or a desired competitive position [9].
Reorientation to Goals
Instead of a mission statement, a healthcare organization may be better served by a statement of goals that are regularly updated. Statements of goals can be diverse and may differ to be consistent with their functional objectives [10]. Setting specific goals not only can improve clinical performance [11] but also organizational performance (Soberman & Ginsburg, 2001). Specific and challenging goals lead to higher performance than generalized goals [12], so a specific set of organizational goals should lead to improved organization performance over (mission) statements that have nonspecific statements with the objective to provide high quality or excellent care.
“Goals affect performance by directing attention, mobilizing effort, increasing persistence, and motivating strategy development” [12]. The establishment of a goal statement can be helpful for organizational change as well as being a motivator for improvement [10]. One must be mindful that “failure to have a clear statement of goals, that are refreshed when needed, will lead to stagnation and will impact the development of high-performance teams” [1].
In the clinical setting, a randomized controlled trial demonstrated that attaining appropriate goals strengthens a physician/surgeon’s confidence [11]. Clearly defined goals that are accomplishable improve individual satisfaction in their organization [14]. From a physician’s perspective, increased physician satisfaction leads to increased physician engagement with their organization [15] and ultimately improves healthcare delivery [16–18].
The challenge in setting organizational goals is the potentially large number that may be necessary for a large healthcare organization. The proposed solution is for senior leadership to stretch their goal list while prioritizing these goals to ensure goal attainment and ensuing satisfaction [19].
Conclusion
A healthcare institution should replace the mission statement with a clear and attainable statement of concrete goals and demonstrate how successful the institution is at attaining those goals and improving the experience of its patients and its staff.
References
[1] Rabkin SW, Frein M. Overcoming Obstacles to Develop High-Performance Teams Involving Physician in Health Care Organizations. Healthcare (Basel). 2021 Aug 31;9(9):1136. [PMID: 34574910]
[2] Desmidt S, Prinzie AA. The organization’s mission statement: give up hope or resuscitate? A search for evidence-based recommendations. Adv Health Care Manag. 2011;10:25-41. [PMID: 21887936]
[3] Bean-Mellinge B. Examples of Vision Statements in the Health Care Industry. Chron [Internet]. 2019 Feb 4; Business & Workplace Regulations – Health. Available from: https://smallbusiness.chron.com/would-vision-statement-bowling-alley-37630.html
[4] McDonald A, Sarfraz A. Failing hospitals: mission statements to drive service improvement? Leadersh Health Serv (Bradf Engl). 2015;28(2):77-82. [PMID: 25921314]
[5] Harder B. 2020-21 Best hospitals honor roll and medical specialties rankings. US News & World Report. Accessed Dec 14, 2020. Available from: https://health.usnews.com/health-care/best-hospitals/articles/best-hospitals-honor-roll-and-overview
[6] McIntyre D. These Are the Worst Hospitals in America 2020.
[7] Carelton J., Craig G. Initial Briefing on the Results of the NRGH Cultural Assessment. Accessed on Jan 28 2020. Available from: Shawglobalnews.files.wordpress.com
[8] Han S, Shanafelt TD, Sinsky CA, Awad KM, Dyrbye LN, Fiscus LC, Trockel M, Goh J. Estimating the Attributable Cost of Physician Burnout in the United States. Ann Intern Med. 2019 Jun 4;170(11):784-90. [PMID: 31132791]
[9] Bart CK, Tabone JC. Mission statement content and hospital performance in the Canadian not-for-profit health care sector. Health Care Manage Rev. 1999 Summer;24(3):18-29. [PMID: 10463104]
[10] Ogbeiiwi O. General concepts of goals and goal-setting in healthcare: A narrative review. J Manag Organ. 2018:1–8.
[11] Kishiki T, Lapin B, Tanaka R, Francis T, Hughes K, Carbray J, Ujiki MB. Goal setting results in improvement in surgical skills: A randomized controlled trial. Surgery. 2016 Oct;160(4):1028-37. [PMID: 27531316]
[12] Locke EA, Shaw KN, Saari LM, Latham G. Goal setting and task performance: 1969–1980. Psychol Bull. 1981;90:125–52.
[13] Soberman Ginsburg L. Total quality management in health care: A goal setting approach. Adv. Health Care Manag., vol. 2, Emerald Group Publishing Limited; 2001, p. 265–90.
[14] Arvey RD, Dewhirst HD, Boling JC. Relationships between goal clarity, participation in goal setting, and personality characteristics on job satisfaction in a scientific organization. J Appl Psychol. 1976 Feb;61(7):103-105. [PMID: 1249010]
[15] Owens K, Eggers J, Keller S, McDonald A. The imperative of culture: a quantitative analysis of the impact of culture on workforce engagement, patient experience, physician engagement, value-based purchasing, and turnover. J Healthc Leadersh. 2017 Apr 6;9:25-31. [PMID: 29355220]
[17] Caverzagie KJ, Bernabeo EC, Reddy SG, Holmboe ES. The role of physician engagement on the impact of the hospital-based practice improvement module (PIM). J Hosp Med. 2009 Oct;4(8):466-70. [PMID: 19824089]
[18] Perreira T, Perrier L, Prokopy M, Jonker A. Physician engagement in hospitals: a scoping review protocol. BMJ Open. 2018 Jan 5;8(1):e018837. [PMID: 29306889]
[19] Tang Z, Powell B, Marino L, Tang J, Dickson P. The impact of organizational goal setting on the industrial munificencegoal attainment relationship. Int J Bus Manag 2008;3:107–24.