MANAJEMEN STRATEGIS

author : Inggriane  P. Dewi

DEFINISI

Manajemen strategis dapat didefinisikan sebagai seni dan pengetahuan dalam merumuskan, mengimplementasikan serta mengevaluasi keputusan-keputusan lintas-fungsional yang memampukan sebuah organisasi mencapai tujuannya. Manajemen strategis adalah proses penetapan tujuan organisasi, pengembangan kebijakan dan perencanaan untuk mencapai sasaran tersebut, serta mengalokasikan sumber daya untuk menerapkan kebijakan dan merencanakan pencapaian tujuan organisasi. Manajemen strategis mengkombinasikan aktivitas-aktivitas dari berbagai bagian fungsional suatu bisnis untuk mencapai tujuan organisasi.

TAHAP-TAHAP MANAJEMEN STRATEGIS
 Proses manajeen strategi terdiri atas tiga tahap :
a.      Perumusan Strategi
Mencakup penentuan bisnis apa yang akan dimasuki, bisnis apa yang tidak akan dijalankan, bagaimana mengalokasikan sumber daya, perlukan ekspansi atau diversifikasi operasi dilakukan, perlukan perusahaan terjun ke pasar internasional, perlukan merger atau penggabungan usaha dibuat dan bagaimana menghindari pengambilalihan yang merugikan.
Perumusan strategi terdiri dari beberapa tahap yaitu :
1)     Pengembangan Visi Misi
Pernyataan visi
Visi adalah cara pandang jauh ke depan kemana organisasi harus dibawa agar dapat eksis, antisipatif dan inovatif. Visi adalah suatu gambaran yang menantang tentang keadaan masa depan yang diinginkan oleh organisasi.
Pernyataan misi
Misi merupakan pernyataan yang menetapkan tujuan organisasi dan sasaran yang ingin dicapai. Pernyataan misi membawa organisasi kepada suatu fokus. Misi menjelaskan mengapa organisasi itu ada, apa yang dilakukannya, dan bagaimana melakukannya.
Misi adalah sesuatu yang harus dilaksanakan oleh organisasi agar tujuan organisasi dapat terlaksana dan berhasil dengan baik. Dengan pernyataan misi tersebut, diharapkan seluruh pegawai dan pihak yang berkepentingan dapat mengenal organisasi dan mengetahui peran dan program-programnya serta hasil yang akan diperoleh dimasa mendatang.
2)     Identifikasi peluang dan ancaman eksternal
Peluang dan ancaman eksternal menunjuk pada berbagai tren dan kejadian ekonomi, social, budaya demografis, lingkungan hidup, politik, hokum, pemerintahan, teknologi dan kompetitif yang dapat secara signifikan menguntungkan atau merugikan suatu organisasi di masa yang akan datang. Sebagian besar peluang dan ancaman berada di luar kendali suatu organisasi.
Salah satu aspek utama dari manajeman strategis adalah bahwa perusahaan perlu merumuskan berbagai strategi untuk mengambil keuntungan dari peluang eksternal dan menghindari atau meminimalkan dampak ancaman eksternal. Karena alasan ini, identifikasi, pengawasan dan evaluasi peluang dan ancaman eksternal sangat penting bagi keberhasilan. Proses riset dan pengumpulan serta asimilasi informasi eksternal ini kadang diistilahkan sebagai pemindaian lingkungan. Melobi adalah sebuah aktivitas yang dipakai untuk memengaruhi peluang dan ancaman eksternal tersebut.
3)     Kesadaran akan kekuatan dan kelemahan internal
Kekuatan dan kelemahan internal merupakan aktivitas terkontrol suatu organisasi yang mampu dijalankan dengan sangat baik atau buruk. Mereka muncul dalam manajemen, pemasaran, keuangan/akuntansi, produksi/operasi, penelitian dan pengembangan dan aktivitas system informasi manajemen suatu bisnis. Mengidentifikasi serta mengevaluasi kekuatan dan kelemahan organisasi dalam wilayah fungsional merupakan sebuah aktivitas manajemen strategi yang esensial. Organisasi berjuang untuk menjalankan strategi yang mampu menggandakan kekeuatan internal sekaligus meniadakan kelemahan internal.
4)     Penetapan tujuan jangka panjang dan tujuan tahunan
Tujuan jangka panjang adalah hasil-hasil spesifik yang ingin diraih oleh suatu organisasi terkait dengan misi dasarnya dalam waktu lebih dari satu tahun. Tujuan sangat penting bagi keberhasilan organisasi sebab ia menyatakan arah, membantu dalam evaluasi, menciptakan sinergi, menjelaskan prioritas, memfokuskan koordinasi dan menyediakan landasan bagi aktivitas perencanaan, pengorganisasian, pemotivasian serta pengontrolan. Tujuan sebaiknya menantang, terukur, konsisten, masuk akal serta jelas. Tujuan harus ditetapkan untuk keseluruhan perusahaan dan tiap-tiap divisi.
Tujuan tahunan adalah tonggak jangka pendek yang mesti dicapai organisasi untuk meraih tujuan jangka panjangnya. Seperti tujuan jangka panjang, tujuan tahunan mesti terukur, kuantitatif, menantang, realistis, konsisten dan terproiritas.
5)     Pencarian strategi-strategi alternative dan Pemilihan strategi tertentu untuk mencapai tujuan
Strategi adalah sarana bersama dengan tujuan jangka panjangyang hendak dicapai. Strategi adalah aksi potensial yang membutuhkan keputusan manajemen puncak dan sumber daya perusahaan dalam jumlah besar. Selain itu strategi memengaruhi perkembangan jangka panjang untuk lima tahun ke depan dan karenanya berorientasi ke masa yang akan datang. Strategi mempunyai konsekuensi multifungsional atau multidivisional serta perlu mempertimbangakan, baik factor eksternal maupun internal.
6)     Kebijakan
Adalah sarana yang dengannya tujuan tahunan akan dicapai. Kebijakan meliputi pedoman, aturan dan prosedur yang ditetapkan untuk mendukung upaya pencapaian tujuan tersurat. Kebijakan adalah panduan untuk mengambil keputusan dan menangani situasi-situasi yang repetitive atau berulang-ulang. Kebijakan dapat ditetapkan di tingkat  korporat dan berlaku untuk keseluruhan organisasi, ditingkat divisional dan berlaku untuk satu divisi tersebut, atau di tingkat fungsional dan berlaku untuk aktivitas atau departemen operasional tertentu. Seperti halnya tujuan tahunan, kebijakan sangat penting bagi penerapan atau implementasi strategi sebab mereka menjabarkan pengharapan organisasi pada karyawan dan manajernya. Kebijakan memungkinkan konsistensi dan koordinasi di dalam dan antar departemen organisasional.
b.      Penerapan Strategi
Mengharuskan perusahaan untuk menetapkan tujuan tahunan, membuat kebijakan, memotivasi karyawan dan mengalokasikan sumber daya, sehingga strategi-strategi yang telah dirumuskan dapat dijalankan. Penerapan strategi mencakup pengembangan budaya yang suportif pada strategi, penciptaan struktur organisasional yang efektif, pengerahan ulang upaya-upaya pemasaran, penyiapan anggaran, pengembangan serta pemanfaatan system informasi dan pengintaian kompensasi karyawan dengan kinerja organisasi.
Penerapan strategi sering kali disebut “tahap aksi” dari manajemen strategis. Menerapkan strategi berarti memobilisasi karyawan dan manajer untuk melaksanakan strategi yang telah dirumuskan. Sering kali dianggap tahap yang paling sulit dalam manajemen strategi, penerapan strategi karena membutuhkan disiplin, komitmen dan pengorbanan personal. Penerapan strategi yang berhasil bergantung pada kemampuan manajer untuk memotivasi karyawan yang lebih merupakan seni daripada pengetahuan. Sehingga keterampilan interpersonal sangat penting bagi penerapan strategi yang berhasil.
c.       Penilaian Strategi
Adalah tahap akhir dari manajeman strategi. Manajer mesti tahu kapan ketika strategi tertentu tidak berjalan dengan baik. Penilaian atau evaluasi strategi merupakan cara utama untuk memperoleh informasi semacam ini. Semua strategi terbuka untuk dimodifikasi di masa yang akan datang karena berbagai factor eksternal dan internal terus menerus berubah. Tiga aktifitas penilaian strategi yang mendasar adalah :
1)     Peninjauan ulang factor-faktor eksternal dan internal yang menjadi landasan pada strategi saat ini
2)     Pengukuran kinerja
3)     Pengambilan langkah korektif
Penilaian strategi diperlukan karena apa yang berhasil saat ini tidak selalu berhasil nanti. Keberhasilan senantiasa menciptakan persoalan baru dan berbeda, organisasi yang mudah berpuas diri akan mengalami kegagalan.

BUDGETING
Manajemen Keuangan adalah suatu kegiatan perencanaan, penganggaran, pemeriksaan, pengelolaan, pengendalian, pencarian dan penyimpanan dana yang dimiliki oleh organisasi atau perusahaan. Manajemen keuangan berhubungan dengan 3 aktivitas, yaitu :
1. Aktivitas penggunaan dana yaitu aktivitas untuk menginvestasikan dana pada berbagai aktiva
2. Aktivitas perolehan dana yaitu aktivitas untuk mendapatkan sumber dana, baik dari sumber dana internal maupun sumber dana eksternal perusahaan
3. Aktivitas pengelolaan aktiva yaitu setelah dana diperoleh dan dialokasikan dalam bentuk aktiva harus dikelola seefisien.

sumber :
Marquis, B. L., & Huston, C. J. (2003). Kepemimpinan dan manajemen keperawatan :Teori dan aplikasi (Widyawati, Trans. 4 th ed.). Jakarta: EGC.
Resnick, B., & Mitty, E. (2009). Assisted living nursing: A manual for management and practice. New York: Springer Publishing Company.
Swansburg, & Swansburg. (1999). Indroductory management and leadership for nurses (2nd ed.). Toronto: Jones and Bartlet.

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Staffing in Nursing Servce

Introduction:

In an organization always there are too many things to think about, too many factors to consider, too diversified knowledge required for solution for the unaided capacity one leader to encompass. So, the chief and other executives at head of major organization need help and the individual officer and units that render this help are known as staff officers of the units. Staffs is an expans

ion of the personality of the executive which means more eyes, more ears, and more hands to help the executive in forming and carrying out his plans.

Meaning of staffing:
Staffing is a selection, training, motivating and retaining of a personnel in the organization. Before the selection of the employees, we have to make analysis of the particular job, which is required in the organization, then comes the selection of personnel.

Actions involved in staffing:

1. Identifying the type and amount of service needed by agency client.
2. Determining the personnel categories that have the knowledge and skill to perform needed service measures.
3. Predicting the number of personnel in each job category that will be needed to meet anticipated service demands.
4. Obtaining, budgeted positions for the number in each job category needed to service for the expected types and number of clients.
5. Recruiting personnel to fill available positions.
6. Selecting and appointing personnel from suitable applicants.
7. Combining personnel into desired configurations by unit and shift.
8. Orienting personnel to fulfil assigned responsibilities.
9. Assigning responsibilities for client services to available personnel.

Staffing involves man power planning:
Man power planning may be defined as a strategy for the acquisition, utilization, improvement and preservation of the human resources of an organization. This involves ensuring that organization has enough of the right kind of people at the right time and also adjusting the requirements to the available supply.

The main objectives of man power planning include:

1. Ensuring maximum utilization of the personnel
2. Assessing future requirements of the organization
3. Determining the recruitment sources.
4. Anticipating from past records, i.e. resignations, simple discharge, dismissal and retirements.
5. Determining training requirements for management's development and organizational development.

Major activities of manpower planning:

* Forecasting future manpower requirements
* Inventorying, present manpower resources and analysing the degree to which these resources are employed optimally.
* Anticipating manpower problem by projecting present resources into the future and comparing them with forecast of requirement of requirement to determine their adequacy, both quantitatively, and qualitatively
* Planning the necessary program, recruitment, selection, training, development, motivation and compensation, so that future manpower requirements will be met.

Steps of manpower planning:

1. Scrutiny of present personnel strength.
2. Anticipation of man power needs.
3. Investigation of turnover of personnel
4. Planning job requirements and job descriptions

Steps of staffing:

1. Determine the number and types of personnel needed to fulfil the philosophy, meet fiscal planning responsibilities, and carryout the chosen patient care management organization
2. Recruit, interview, select, and assign personnel based on established job description performance standards.
3. Use organizational resources for induction and orientation
4. Ascertain that each employee is adequately socialized to organizational values and unit norms.
5. Use creative and flexible scheduling based on patient care needs to increase productivity and retention
6. Develop a program of staff education that will assist employees meeting the goals of the organization.

Philosophy of staffing:
Philosophy: a statement encompassing ontologic claims about the phenomena of central interest to a discipline, epistemic claims about how the phenomena came to be known, and what members of the discipline value.
There are three general philosophies of personnel management. The first is based on organizational theory, the second on industrial engineering, and the third on behavioural science.
The organizational theorist believes that

* Human needs are either so irrational or so varied and adjustable to specific situations that the major function of personnel management is to be pragmatic as the occasion demands.
* ? If the jobs are organized in a proper manner, he reasons, the result will be most efficient job structure, and the most favourable job attitudes will follow as a matter of course.

The industrial engineer believes that

* The man is mechanistically oriented and economically motivated and his needs are best met by attuning the individual to the most efficient work process.
* The goal of personnel management therefore should be to concoct the most appropriate incentive system and to design the specific working conditions in a way that facilitates the most efficient use of the human machine.
* By structuring jobs in a manner that leads to the most efficient operation, the engineer believes that he can obtain the optimal organization of work and the proper work attitudes.

The behavioural scientist believes that

* The behavioural scientist focuses on group sentiments, attitudes of individual employees, and the organizations' social and psychological climate.
* Personnel management generally emphasizes some form of human relations education, in the hope of instilling healthy employee attitudes and an organizational attitudes and an organizational climate which he considers to be felicitous to human values. He believes that proper attitudes will lead to efficient job and organizational structure.

Philosophy of staffing in nursing:

* Nurse administrators of a hospital nursing department should adopt the following staffing philosophy.
* Nursev administrators believe that it is possible to match employees' knowledge and skills to patient care needs in a manner that optimises job satisfaction and care quality.
* Nurse administrators believe that the technical andv humanistic care needs of critically ill patients are so complex that all aspects of that care should be provided by professional nurses.
* Nursev administrators believe that the health teaching and rehabilitation needs of chronically ill patients are so complex that direct care for chronically ill patients should be provided by professional and technical nurse.
* Nursev administrators believe that patient assessment, work quantification and job analysis should be used to determine the number of personnel in each category to be assigned to care for patients of each type( such as coronary care, renal failure, chronic arthritis, paraplegia, cancer etc)
* Nurse administratorsv believe that a master staffing plan and policies to implement the plan in all units should be developed centrally by the nursing heads and staff of the hospital.
* Nurse administrators believe the staffing plan details such asv shift- start time, number of staffs assigned on holidays, and number of employees assigned to each shift can be modified to accommodate the units' workload and workflow.

Objectives of staffing in nursing:

* Provide an all professional nursev staff in critical care units, operating rooms, labour and emergency room
* Provide sufficient staff to permit a 1:1 nurse- patient ratio for each shift in every critical care unit
* Staff the general medical, surgical, obstetricsv and gynaecology, paediatric and psychiatric units to achieve a 2:1 professional- practical nurse ratio.
* Provide sufficient nursing staff in general,v medical, surgical, obstetrics and gynaecology, paediatric and psychiatric units to permit a 1:5 nurse patient ratio on a day and afternoon shifts and 1:10 nurse- patient ratio on night shift.
* Involve the heads of the nursingv staffs and all nursing personnel in designing the department's overall staffing program.
* Design a staffing plan that specifies how many nursing personnelv in each classification will be assigned to each nursing unit for each shift and how vacation and holiday time will be requested and scheduled.
* Hold eachv head nurse responsible for translating the department's master staffing plan to sequential eight weeks time schedules for personnel assigned to her/ his unit.
* Post time schedules for all personnel at least eight weeks inv advance.
* Empower the head nurse to adjust work schedules for unit nursing personnelv to remedy any staff excess or deficiency caused by census fluctuation or employee absence.
* Inform each nursing employee that requests for specificv vacation or holiday time will be honoured within the limits imposed by patient care and labour contract requirements.
* Reward employees for long termv service by granting individuals special time requests on the basis of seniority.

NORMS OF STAFFING( S I U- staff inspection unit)

* Norms: norms are standards that guide, control, and regulate individuals and communities. For planning nursing manpower we have to follow some norms. The nursing norms are recommended by various committees, such as; the Nursing Man Power Committee, the High-power Committee, Dr. Bajaj Committee, and the staff inspection committee, TNAI and INC. The norms has been recommended taking into account the workload projected in the wards and the other areas of the hospital.
* All the above committees and the staff inspection unit recommended the norms for optimum nurse-patient ratio. Such as 1:3 for Non Teaching Hospital and 1:5 for the Teaching Hospital. The Staff Inspection Unit (S.I.U.) is the unit which has recommended the nursing norms in the year 1991-92. As per this S.I.U. norm the present nurse-patient ratio is based and practiced in all central government hospitals.

Recommendations of S.I.U:

1. The norms for providing staff nurses and nursing sisters in Government hospital is given in annexure to this report. The norm has been recommended taking into account the workload projected in the wards and the other areas of the hospital.
2. The posts of nursing sisters and staff nurses have been clubbed together for calculating the staff entitlement for performing nursing care work which the staff nurse will continue to perform even after she is promoted to the existing scale of nursing sister.
3. Out of the entitlement worked out on the basis of the norms, 30%posts may be sanctioned as nursing sister. This would further improve the existing ratio of 1 nursing sister to 3.6. staff nurses fixed by the government in settlement with the Delhi nurse union in may 1990.
4. The assistant nursing superintendent are recommended in the ratio of 1 ANS to every 4.5 nursing sisters. The ANS will perform the duty presently performed by nursing sisters and perform duty in shift also.
5. The posts of Deputy Nursing Superintendent may continue at the level of 1 DNS per every 7.5 ANS
6. There will be a post of Nursing Superintendent for every hospital having 250 or beds.
7. There will be a post of 1 Chief Nursing Officer for every hospital having 500 or more beds.
8. It is recommended that 45% posts added for the area of 365 days working including 10% leave reserve (maternity leave, earned leave, and days off as nurses are entitled for 8 days off per month and 3 National Holidays per year when doing 3 shift duties).

Most of the hospital today is following the S.I.U.norms. In this the post of the Nursing Sisters and the Staff Nurses has been clubbed together and the work of the ward sister is remained same as staff nurse even after promotion. The Assistant Nursing Superintendent and the Deputy Nursing Superintendent have to do the duty of one category below of their rank.

Conclusion
The key to success of any hospital primarily depends upon its human resource than any other single factor.The core determinants of staffing in the hospital organization are quality, quantity and utilization of its personnel keeping in view the structure and process. The staffing norms should aim at matching the individual aspiration to the aims and objectives of the organization.

References:

1. Basavanthappa B T. Nursing administration. (Ist edn). Newdelhi: Jaypee brothers medical publishers (p) ltd; 2000.
2. Berkow S, Jaggi J& Fogelson R. Fourteen unit attributes to guide staffing. JONA.vol 37, no.3 mar 2007.

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