Health Administration Press Strategic Analysis for Healthcare Chapter 11 Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Financial Statement and Ratio Analysis • The analysis of an organization’s financial ratios combines an internal analysis of the firm’s finances with an external comparison of the same factors. • The financial data you choose to look at depends on the particular organization and the specific industry. • Financial ratios can be grouped into several broad categories— – – – – – – liquidity, leverage, activity, profitability, growth, and valuation. • The analyst should include at least two or three relevant ratios for each. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press LIQUIDITY RATIOS Ratio Current ratio Quick ratio (acid test) CFO ratio Days cash on hand Formula Current assets Current liabilities What it tells you Positive trend Ability to pay short term debts Higher Cash + Marketable Securities + Receivables Current liabilities Financial solvency when inventory is not easily liquidated Higher Cash from operations (aka operating cash flow) Current liabilities Is the firm generating enough cash to cover current operations Higher Cash + Marketable securities+ Long term investments (Operating expense-Depreciation & amortization)/365 Cash available to pay x number of days average cash outflow Higher Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Comparator Peer group Historical average Rule of thumb (>2) Peer group Historical average Rule of thumb (>1) Peer group Historical average Rule of thumb (>40%) Peer group Historical average Health Administration Press LEVERAGE RATIOS Ratio Formula What it tells you Debt-to-totalassets ratio Debt-to-equity ratio Long-term debt-toequity ratio Times interest earned ratio Total liabilities Total assets Total liabilities Total equity (or net assets for non-profits) Long term liabilities Total equity (or net assets for non-profits) Earnings before interest & taxes (aka EBIT) Interest expense The percent of total assets being funded by creditors The percent of total assets being funded by firms owners The amount of long term debt a firm has compared to equity How easily a firm can pay interest due on outstanding debt Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Positive trend Comparator Lower Peer group Historical average Lower Peer group Historical average Lower Peer group Historical average Higher Peer group Historical average Health Administration Press ACTIVITY RATIOS Ratio Formula What it tells you Total asset turnover ratio Fixed asset turnover Inventory turnover Total Revenue (aka sales) Total assets Total Revenue (aka sales) Fixed assets Total Revenue (aka sales) Inventory Receivables Total Revenue (aka sales)/ 365 Accumulated depreciation Depreciation expense The amount of total revenue per dollar of total assets A firms ability to effectively utilize fixed assets How long sales inventory waits to be sold How long it takes to collect monies due How old the plant & equipment is. Newer is better Average collection period Age-of-plant ratio Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Positive trend Comparator Higher Peer group Historical average Higher Peer group Historical average Lower Peer group Historical average Lower Peer group Historical average Lower Peer group Historical average Health Administration Press PROFITABILITY RATIOS Ratio Formula Revenue per adjusted discharge Operating Revenue (Gross patient revenue/ gross inpatient revenue) x total discharges Total operating expense (Gross patient revenue/ gross inpatient revenue) x total discharges Salary and benefit expense Total operating expense Operating revenue generated from patient care services Higher Peer group Historical average Expense associated with patient care services Lower Peer group Historical average Employee expenses as a percent of total expenses Lower Peer group Historical average Net income (profit) Total assets Management’s ability to earn a return on each dollar of assets Higher Excess of revenues over expenses Total assets In Nonprofit organizations; Managements ability to earn a return on each dollar of assets Higher Net income (profit) Shareholders’ equity Rate of return on stockholders’ investment Higher Peer group Historical average Economic comparison (avg weighted cost of capital) Peer group Historical average Economic comparison (avg weighted cost of capital) Peer group Historical average Operating expense per adjusted discharge Salary and benefits as a % of operating expense Return on assets (ROA) Return on total assets Return on equity (ROE) What it tells you Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Positive trend Comparator Health Administration Press PROFITABILITY RATIOS (cont.) Ratio Return on net assets Gross profit margin Formula Excess of revenues over expenses Net assets Net sales- cost of goods sold Net sales Net profit margin Net income (profit) Sales revenue Operating margin Earnings before interest and taxes (ie, from operations) Net sales Cash flow margin Income before depreciation, interest, taxes Return on capital employed Earnings Before Interest and Tax (EBIT) Total assets – current liabilities What it tells you Positive trend Comparator In Nonprofit organizations; rate of return in net assets Higher Peer group Historical average Gross profit margin Higher Peer group Historical average The amount of net profit as a percent of sales Higher Peer group Historical average Operating profit margin Higher Peer group Historical average Income including non-operation sources Higher Peer group Historical average The efficiency with which its capital is employed Higher Peer group Historical average Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press GROWTH RATIOS Ratio Revenue increase Earnings per share (EPS) * Dividends payout ratio * Formula This year’s revenue Last year’s revenue Net income-preferred stock dividends Average outstanding shares Dividends per common share of stock Earnings per share What it tells you Percent increase in revenue year over year The amount of profit per share of stock The portion of a company's profit paid relative to each common share of stock * For public companies Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Positive trend Comparator Higher Peer group Historical average Higher Peer group Historical average Varies Peer group Historical average Health Administration Press VALUATION RATIOS (for publicly traded companies) Ratio P/E Ratio Dividend yield Dividend payout Cash flow per share Price-to-book ratio PEG ratio Return on net worth Formula What it tells you Price per share Earnings per share Dividends per share Price per share Annual dividends per share After tax earnings per share After tax profits + Depreciation Number of common shares outstanding Price per share Total assets-(intangible assets & liabilities) P/E ratio Annual earnings per share growth How much investors are willing to pay per dollar of earnings. Dividend payout as a percent of stock price Dividend payout as a percent of profit Amount of cash per share of stock Higher Peer group Historical average Varies Peer group Historical average Varies Peer group Historical average Higher Peer group Historical average Compares a firm's market value to its book value A stock's value while taking the company's earnings growth into consideration Profit as related to the firm's net worth Higher Peer group Historical average Higher Peer group Historical average Higher Peer group Historical average Net Income Net worth Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Positive trend Comparator Health Administration Press Financial Ratio Analysis • The internal financial ratio analysis is concerned with both the current state of the organization and the trend. • Knowing that the organization is at “point X” is important to the strategist; even more important, however, is observing a trend and predicting where that trend will lead without intervention. • To carry out this kind of observation, the analyst needs to assemble three to five consecutive years of data. • The relevant ratios can be selected from the list in the previous slides or from Exhibit 11.1 in your book. • Once the data has been recorded and reviewed, the analyst should create a list of implications for strategy. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Financial Ratio Analysis • Simply looking at the organization’s financial ratios, however, does not tell an analyst all there is to know. • The data needs to be compared to some reference point. • Though standards exist for every financial ratio, in competitive analysis and strategy development, the relevant comparison is to the firm’s competitors, then to the industry within which the firm competes. • This is because each industry has its own norms. • As an example, it may be self-evident to an analyst that a firm has an extremely high debt-to-equity ratio simply by looking at the numbers. • On the other hand, in addition to knowing that, the strategist would also like to know how highly leveraged the firm’s competitors are and what the norm is for the particular industry. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Financial Ratio Analysis • An even more powerful tool is looking at competitors using five years of financial data. • This allows the analyst to identify trends for the competitors. • The strategist would like to identify deteriorating or improving competitor conditions. • Emerging competitor weaknesses can be exploited, and emerging competitor strengths need to be defended against. • Improving or degrading competitor trends can also be a warning sign for a firm’s own vulnerability. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Exercise • Divide into groups. • Select which ratios are most relevant for the organization you are studying and explain why. • If time permits, research the numbers for your firm and its competitors. • Use the space provided on page 79 of your book. • What implications for strategy emerge? Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Strategic Analysis for Healthcare Chapter 12 Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Boston Consulting Group Matrix • During the 1970s, the Boston Consulting Group (BCG) developed an approach to strategic analysis that compares a firm’s market share to the anticipated growth of its market in the next five years. • The BCG matrix, as the approach became known, usually is used to analyze organizations with multiple divisions or business units. • However, it can also be used to analyze an organization with only one unit, or even to analyze individual product offerings. • Because of its flexibility in this area, the BCG matrix is often called a “portfolio analysis tool.” • By placing market growth rate on the vertical axis and relative market share on the horizontal axis, a four-block matrix can be developed. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press High Low Market Growth Rate Boston Consulting Group Matrix Low High Relative Market Share Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Boston Consulting Group Matrix • Once the firm’s business units are positioned on the BCG matrix, strategies are developed based on the units’ relative positions. • The four quadrants of the matrix, derived by categorizing the two variables into “high” and “low” areas, allow the units to be grouped into four categories: “stars,” “question marks,” “cash cows,” and “dogs.” Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press High Stars Low Market Growth Rate Boston Consulting Group Matrix Question Marks Cash Cows Dogs Low High Relative Market Share Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Boston Consulting Group Matrix • The idea behind the arrangement is that the higher the market growth rate, the more cash is needed from the firm to stay competitive and grow. • At the same time, the higher the firm’s market share, the more cash can be generated. • The cash generated by the high “cash generation” divisions can be used to fund the high “cash consumption” divisions. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Boston Consulting Group Matrix • The ideal path for an organization, division, or product is to move from dog to question mark to star to cash cow. • A dysfunctional movement would go in the reverse direction. • New products often start in the question mark box. • They are introduced into what is anticipated to be a high-growth market but have not generated much cash yet. Time will tell if they move into the star box or the dog box. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press BCG Matrix—Dogs • Dogs are divisions that are not doing well. • They have low market share in markets that have low growth. • Generally, they tend to neither draw much cash from the parent company nor generate much cash—although sometimes they will require an organization’s cash in order to remain in business. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press BCG Matrix—Dogs • At best, dogs are not adding significant value; at worst, they are drawing off cash and management’s time and attention. • Therefore, the typical strategies for dogs seek to turn them around and move them toward the question mark box, to divest them, or to shut them down. • However, a firm may have strategic reasons for keeping a dog. • In the eyewear industry, a niche exists for sports protection; even if positive movement is not seen, the firm may be wise to continue to offer products in, although not focus on, this category. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press BCG Matrix—Question Marks • Question marks are divisions that have low market share in markets that are growing. • Because the market is growing, question marks tend to require cash for continued competition. • Rather than being net cash generators, question marks tend to draw off a corporation’s cash. • In these cases, the strategic approach is not clear—hence the term question mark. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press BCG Matrix—Question Marks • If the strategist sees potential to grow the division’s market share and move the division into the star box, strategies may include product development, market penetration, market development, and other growth strategies. • If the analyst does not see the potential to improve the division, or if the company does not have the cash to invest in the unit, divestiture may be an option. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press BCG Matrix—Stars • Stars are divisions that have high market share in markets that are growing rapidly. • These businesses generate excitement. • They also generate a lot of cash due to their high market share. • At the same time, they require significant cash to fuel their continued growth in the rapidly expanding market and to fend off competitors who wish to take away their market share. • The cash the stars generate usually tends to net out. • In that sense, they are similar to dogs, but they continue to have huge upside. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press BCG Matrix—Stars • Strategic approaches include continuing to fuel the growth and expand market share through market penetration and market development, product development, integration strategies, and even joint ventures. • Defensive moves intended to maintain the large market share are also considered. • If a star maintains its dominant market share as the market life cycle matures, it moves into the cash cow category; at this point, other competitors drop out and the star requires less cash to fuel the strong financial results. • If a star fails to maintain its share, it degrades into a dog. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press BCG Matrix—Cash Cows • Cash cows have a dominant market share in markets that are not growing significantly. • Because market domination tends to correlate with pricing power, they have significant profit margins. • In addition, they require only limited cash investment due to the market’s lower growth, meaning they generate significantly more cash than they consume. • Strategies for cash cows involve continuing to support the division without having to invest significant cash, then using the cash generated to reinvest in turning around dogs or moving question marks into stars. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Boston Consulting Group Matrix • When divisions are placed on the BCG matrix, they are indicated by a circle. • Usually, the size of each circle indicates the relative significance of each business unit to the organization in terms of cash generated. • Alternatively, the circles could be the same size but with pie slices in each. – The pie slice would be shaded to show the relationship between the cash generated by that division (the slice) and the whole. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press High Stars Question Marks Division 2 Division 1 Low Market Growth Rate Boston Consulting Group Matrix Cash Cows Division 3 Dogs Low High Relative Market Share Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Boston Consulting Group Matrix • The BCG matrix allows a quick visualization of a company’s portfolio relative to market share, market growth, size of cash contribution, and relative strength or weakness. • The BCG matrix is the first analysis tool we have seen that begins to suggest strategy in addition to simple analysis. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Exercise • Divide into groups and create a BCG matrix for your project organization using page 91 in the book. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Strategic Analysis for Healthcare Chapter 13 Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press General Electric Matrix • The General Electric (GE) nine-block business screen, commonly called the GE matrix, was developed by the consulting firm McKinsey & Company. • It is similar in many respects to the BCG matrix, but it has surpassed the BCG in popularity. • In the GE matrix, the business’s overall strength is compared to the overall attractiveness of the market within which the business competes. • As in the BCG matrix, multiple divisions can be placed on the GE matrix so that the strategist can quickly take in a great deal of data in a simplified format. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press General Electric Matrix • The popularity of the GE Matrix stems from its flexibility as well as from its ability to include a greater number of variables in the analysis. • Whereas the BCG matrix uses the term market growth for the vertical axis, the GE matrix uses market attractiveness. • And where the BCG uses relative market share for the horizontal axis, the GE matrix uses business strength. • Although the differences may seem subtle, the effect on practical application is significant. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press General Electric Matrix High MARKET ATTRACTIVENESS Low High Low BUSINESS STRENGTH Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Market Attractiveness What makes a market attractive? • There is no clear definition. • Ultimately, market attractiveness is for the strategist to judge, and as a result, successful strategy development hangs in the balance. • One way to define market attractiveness, as with the BCG matrix, is simply to use market growth. • In reality, market attractiveness is much more complex. The recognition of this complexity is where the GE matrix has an inherent advantage over the BCG. • It has the ability to combine an infinite number of variables to arrive at a customized definition of market attractiveness. • At the same time, however, this imprecision could also be a drawback. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Market Attractiveness • When determining market attractiveness, the strategist may consider aspects of other industry analysis models, such as the following: – Porter’s five forces • • • • • Threat of new entrants Rivalry among existing firms Threat of substitutes Bargaining power of buyers Bargaining power of sellers – The opportunities and threats sections of SWOT Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Business Strength • Just as market attractiveness is loosely defined, the same is true for business strength. • When considering the strength of a business, the strategist may think of the strengths and weaknesses sections of SWOT. • These SW issues will likely include things like – – – – – – – market share, strength of the brand, quality, distribution reach, customer loyalty, cost structure, and staff quality. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Constructing the Matrix • The analyst first creates a nine-block chart. • The vertical axis represents market attractiveness, and the three levels of blocks are labeled “Low,” “Medium,” and “High.” • The horizontal axis represents business strength and is divided into the same three levels. • The company’s divisions are placed on the matrix according to their intersection of market attractiveness and business strength. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Constructing the Matrix • When the divisions are placed on the matrix, each is represented by a circle. • The size of the circle represents the size of the market within which that particular division competes. • Within each division’s circle, a pie slice represents that particular division’s share within its market. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press General Electric Matrix High Division 1 MARKET ATTRACTIVENESS Division 2 Low High Low BUSINESS STRENGTH Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press General Electric Matrix • Strategic conclusions can be drawn from each division’s position on the GE matrix. • Strategies associated with the upper-left corner of the matrix can be loosely described as “grow and build” strategies. • Those associated with the lower-right corner can be described as “harvest and divest.” • “Hold and maintain” strategies are associated with the boxes running from the lower-left corner to the upper-right. • More detailed strategic conclusions associated with each of the nine boxes are shown in Exhibit 13.3 in your book. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press General Strategies on Matrix Location • Grow and Build: Integration strategies, intensive strategies • Hold and Maintain: Market penetration, product development, joint venture • Harvest and Divest: Retrenchment, divestiture, liquidation Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Exercise • Form groups. • Develop a GE Matrix for your project company. 1. Identify the divisions. 2. Identify the size of the market the division plays in (size of the circle). 3. Identify the market share the division has (size of pie slice). 4. For classroom purposes, you can approximate these values. For a research paper, they should be research based. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Strategic Analysis for Healthcare Chapter 14 Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press McKinsey 7S Model • The 7S framework changed the way people think about organizational effectiveness. • “A previous focus of managers was on organization as structure—who does what, who reports to whom, and the like. As organizations grew in size and complexity, the more critical question became one of coordination” (McKinsey & Company 2008). Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press McKinsey 7S Model • The 7S model takes its name from seven components: – Strategy – Structure – Systems – Staff – Skills – Style – Shared values (See Exhibit 14.1.) Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press McKinsey 7S Model Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Strategy • When you analyze strategy, ask yourself how well your organization’s current strategy has enabled it to reach its goals. Areas to consider may include the following: – Marketing strategy – Distribution – Product or service development – Business development – Customer service – Understanding of external market factors (Braintree Group 2015) Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Structure • Organizational structure determines how well an organization can respond to new challenges and customer requirements. • Organizations with flat structures tend to allow more autonomy for individual business units and managers, enabling them to respond quickly to changing market conditions. • More traditional, hierarchical organizations tend to be less responsive. – However, they tend to have greater central management control and are better able to leverage the buying and selling power of the whole business (Braintree Group 2015). Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Systems • The third S involves the organization’s managerial processes, systems, and business tools. – Do these elements allow the organization to run efficiently and deliver good customer service, or do they hinder the pursuit of these goals? • Areas to consider include the following: – Customer service, research and development (R&D), sales, and marketing operations – Collection of management information – Financial management – Information technology – Internal communications (Braintree Group 2015) Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Staff • Organizations depend heavily on their staffs. • This point is especially true in healthcare, where poor staff interactions can ruin a customer’s relationship with an organization. • The ability of an organization to recruit, train, and retain a skilled and talented staff is particularly important (Braintree Group 2015). Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Skills • The skills of an organization determine its ability to – – – – provide innovative products and services, differentiate itself from its competitors, charge premium prices, and defend and grow market share. • Highly skilled organizations tend to invest in equipment, R&D, and staff recruitment and development. • They tend to have a strong understanding of their markets, reward success, and maintain a no-blame culture (Braintree Group 2015). Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Style • The style with which managers approach the business tends to be reflected throughout the organization. • Managers who provide a supportive and enabling approach to staff, for instance, will often find that the same positive approach is passed along to customers (Braintree Group 2015). • Style may also be thought of as “culture.” • Healthcare managers work with a diverse a group of employees. All ages, genders, ethnic backgrounds, can be found in healthcare organizations. We must lead effectively with a style that can transcend inherent differences and make the organization function as a cohesive unit. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Shared Values • The final S is shared values. To be truly successful, the entire organization needs to work toward the same goals and values. • Effective internal communications are key to ensuring that staff members are aware of the goals and values and, further, that they understand why those goals and values are so important. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Applying the 7S Model • In keeping with the 7S model’s emphasis on coordination, you should apply the framework with the following key points in mind (JISC InfoNet 2008). • Focus on the links between each of the Ss rather on the Ss themselves. The links are key to identifying the organization’s strengths and weaknesses. No S is a strength or a weakness in its own right; only its degree of support (or lack thereof) for the other Ss is relevant. • The model highlights how a change made in any one S will have an impact on all the others. Thus, for a planned change to be effective, changes in one S should be accompanied by complementary changes in the others. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press McKinsey 7S Model For more information, you can watch a short video from McKinsey & Company on the 7S framework: http://www.mckinsey.com/spContent/Enduring%20IdeasV2/inde x.html#2472097023001?sid={A33BD7BC-F25A-4E9B-A7FA9317110C7B33}&pid={0AFB2116-2539-4238-A6DB1AB7CC7C6E00} Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. Health Administration Press Exercise • Form groups and identify the seven Ss that impact the organization you are studying. • Report out to the class. Copyright © 2016 Foundation of the American College of Healthcare Executives. Not for sale. 
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