Performance Assessment Report

PerformanceAssessment Report

OlufunmikeGeorge

UMUC

August02, 2014

ORGANIZATIONALSTRUCTURE

TEXASDEPARTMENT OF STATE HEALTH SERVICES

P.1Organizational Description:

TexasDepartment of State Health Services mainly focuses on prevention ofdisease. This department incorporates a public health network such aslocal and state offices. The environmental and consumer safetyadvocates for their safety and compliance using activities such asinspections, samplings and risk assessments (Martin et al., 2009).The main goal of Texas disease prevention department is to coordinatethe efforts between stakeholders, communities and coalitions in orderto sustain an enabling environment for a healthy Texan.

a.Organizational Environment

  • Product Offerings

Productoffering refers to goods and services offered. These products andservices include disinfectants like “Pro-Tech” that eliminatesbacteria, viruses and microorganisms that could result to diseases.These products and services are accessed by customers in the healthdepartment centers (Martin et al., 2009). The organization acquiresinformation of the products required through surveys and deliversthese products through its regional offices, health centers andpartners.

  • Vision and Mission

Themain vision of Texas disease prevention department is to ensure thateveryone lives, learn, play and learn in a society that supportshealth a healthy lifestyle. This department`s mission is to serve allTexans by supporting policies, systems and environments that promotea healthy life (Hall, 2010). The mission acts as a guide of how theorganization conducts its activities. Therefore, under the guidanceof the mission, the organization achieves core competencies forsustainability and competitive performance through workforceanalysis, forecasting future needs, analyzing gaps, developingstrategies, implementing strategies, monitoring and evaluatingability of workers in implementing them (Balcazar, 2013).

  • Workforce Profile

Thesize of the workforce in health care services varies with the type ofpopulation served. The public health experts have demonstrated theneed for better public heath workforce with diverse and bettertrained staff members (Martin et al., 2009). The provision of healthservices requires one to possess particular qualification. Notably,the organization prides itself of one of the most competent,well-trained and capable workforce. The organization ensures it hasan exemplary workforce through several ways: planning forimprovement, making workers accountable for their performance,setting clearly articulated goals, clarifying the organization’sexpectations of the workers and enhancing communication between theworkers and the management. Such factors, together with rewardingoutstanding performance by employees, heve been a great motivatingfactor for its workforce.

  • Assets

Capitalassets and equipment are significant investments in all health careservices. These assets have a value in the market. They assist inproviding excellent care to the patient. Technology at thishealthcare organization is important in almost every department, andthis has played a significant part in reducing costs. The use of thedevice such as a mobile biomedical requires technology (Hall,2010).

  • Regulatory Requirements

Thestate government is responsible for licensing and inspecting healthcare facilities. An agency inspects the activities of TexasDepartment of health services within the state government. Agenciesalso provide other services to health departments such as technicalassistance(Martin et al., 2009).

b.Organizational Relationships

  • Organizational Structure

Theorganizational structure of Texas Department of State health servicesshows that half has the state has independent state health agencieswhile the other half has councils of health. It also consists oforganizational charts that illustrate the structures of differentunits within this department(Martin et al., 2009).The number of health departments has increased due to demand ofhealth responsibilities. The department has been able to put upfunctional governance system to oversee its activities. Toachieve this, the organization has a result-based accountabilitysystem. The organizational has done this quite well through activelistening, providing context and relevance of communication, showingthey care about workers and by building trust and credibility whichmakes them visible and approachable. By doing this, the departmenthas been able to measure its organization performance and thusimproved responsibility.

  • Customers and Stakeholders

Thehealth service sector`s stakeholders include healthcare systems suchas care providers, hospitals, drug manufacturers, governmententities, consumers among others. Each of these stakeholdersfunctions independently and represents an individual segment in themarket. To determine customer requirements and expectations, theorganization in frequently involved in listening,engaging, monitoring and responding to customers through surveys,online platforms, offline and through customer contact and follow upapproaches.

  • Suppliers and Partners

Thishealth care depends on a group of purchasing organization as itsprincipal supplier of health care facilities. They purchase in volumeand negotiate their discounts with manufacturers(Martin et al., 2009).These groups help reduce medical errors by standardizing the productsused at hospitals. The organization is involved in critical andin-depth analysis of potential suppliers and partners. Through itsprocurement section, the organization is able to maintain value inits supply chain and ensure strong and collaborative relationshipsare maintained with customers.

P.2Organizational Situation

a.Competitive Environment

  • Competitive Position

Competitionis the driving force of any organization. Competition in healthorganizations can be either between hospitals, drug companies,hospitals and physician groups among others. Competition leads tolower cost of providing the services (Hall,2010). The organization’s main competition comes from independentstate health agencies. After analyzing the operating environment, theorganization identifies strategic options and selects the bestoptions and health services on offer. Ability to understand itsrespective audiences gives the organization a competitive edge overits competitors.

  • Competitiveness Changes

Competitivenesschanges the quality of services offered to customers. Competitionamong healthcare organizations assumes that this service is for sale.Different organizations offer different policies which lead todifferent in quality of services (Hall, 2010). It is also common tofind monopolistic markets in health sectors. Recently, there has beencharacterized by rapid changes in customer needs and requirements.This has necessitated the organization to act fast to fend off itseagle-eyed competitors. The organization has accepted and recognizedinevitability of change. Its management plans, organizes, controlsand coordinates innovation processes to keep up with competitivechanges. To get the required data to engineer these changes, theorganization builds strong relationships with customers throughengaging, monitoring and following them up.

b.Strategic Context

Oneof the challenges affecting Texas health department is financialdifficulties and hospital productivity. The rising energy costs arepressuring this healthcare organization to provide more and efficientservices to customers without compromising their health (Scales etal., 2014). On the other hand, improving the community health andproviding an enabling environment for workers is a powerfulmotivator. By collecting data through surveys and customer contact,the organization is able to carry out strategic planning throughdeveloping and deployment of action plans. However, it faceschallenges in garnering enough resources and support to steerimplementation of such action plans.

c.PerformanceImprovement System

TexasDepartment of State health services uses a formal process to evaluateits performance to identify the development needs. These processesare directed towards particular programs. Some of the structuredassessment techniques include performance standards, health plandevelopment and the quality improvement assessments that enable it toimprove the public health services. Further, this department adopts aperformance evaluation effort that helps to survey customersatisfaction (Hall,2010).Theorganization measures performance quite well by doing so through arelevant, meaningful and timely process, using balanced data andaligning the system with the organization’s mission. Findings fromthese measurements help project future performances which helpformulate plans to make future performances even better. Such plansinvolve measures such as replicating what is done in high performingareas.

DETAILEDAPPROACH TO CONDUCT THE ASSESSMENT

Toeffectively assess the performance of the Texas Department of StateHealth Services, several steps were taken:

  1. Development of an evaluation form

Astandard evaluation form for each evaluation category was developed.Most of the information in these forms was derived from PDF downloadsof questionnaires from the NationalInstitute of Standards and Technology website.These forms focused on the major questions in categories 1 to 6 ofthe Baldrige criteria. Limiting the questions covered in the formsmade the assessment more meaningful and relevant ensuring that issuesthat mattered most were well represented.

  1. Identifying of performance measures

Ensuringthat the Baldrige criteria enmeshed standard performance measures wasalso an important part of the assessment. It helped in actionplanning of what was to be considered when assessing performance.This made sure that all vital categories were assessed objectively.This step also ensures that questions involved in the assessmentobjectively measured even the more subjective areas such as workhabits (Lettieri et al, 2004).

  1. Setting guidelines for feedback

Notably,feedback is what the assessment was all about. Therefore, allrespondents of our assessments were informed on what feedback theywere expected to give and how they were expected to give it. Most offeedback was acquired through interviews and filling of evaluationforms by respondents from the Texas Department of State HealthServices.

  1. Creation of evaluation procedures and schedule

Procedureswere laid out on how to obtain information regarding qualityimprovement efforts in the organization. This was followed by sitevisit which included visiting the organization’s premises forseveral days. This period involved checking documents and conductinginterviews to fill the evaluation forms. Responses from theleadership and workforce members were obtained differently to be usedcomparatively.

  1. Analyzing responses

Thisstep involved conducting assessment on the organization based onresponses obtained on the criteria questions and developing apercentage score of each category based of the criteria’s scoringguidelines. Comments and candid observations from respondents helpeddevelop accurate and sophisticated understanding of “How” and“How well” the organization is attempting to meet therequirements of the criteria questions.

SELF-ASSESSMENTUSING BALDRIGE CRITERIA QUESTIONS

CATEGORY1: LEADERSHIP

    1. Vision, Values and Mission

Thisitem looks at how senior leaders set vision and values of theorganization and how they have deployed them throughout theorganization. Notably, as outlined in the organizational structure,the TexasDepartment of State Health Services (DSHS) has set a comprehensivemission and vision. The mission and vision have been deployed quitewell throughout the organization where leaders have directed alltheir efforts in ensuring everyone in Texas lives a healthy life.They have also achieved this trough an array of public healthservices across the state through 8 regional offices. Outstandingly,its vision and mission are well tied with and interconnected with theservices and products offered.

    1. Communication and Organizational Performance

Involveslooking at how senior leaders communicate with and engage theorganization’s workforce and customers. Texas Department of StateHealth Services has achieved this through setting procedures forcommunication and feedback. The organizational has done this quitewell through active listening, providing context and relevance ofcommunication, showing they care about workers and by building trustand credibility which makes them visible and approachable. However,the organization can improve this by adapting to respectiveaudiences.

    1. Organization Governance

Thisitem looks at how the leaders evaluate and achieve effectivegovernance over the organization.

    1. Legal and ethical behavior

Looksat how the organization promotes and ensures ethical behaviorthroughout all interactions. The organization has a code of conducton human and labor rights to follow among other guidelines. TexasDepartment of State Health Services has incredibly promoted ethicalbehavior through empowerment of employees. An opportunity to improvethis is by having an ethics policy and facilitating feedback withinthe organization and interaction to ensure effective implementation.

    1. Societal Responsibilities and Support of Key Communities

Howthe organization considers societal well-being in its strategies anddaily operations and how it actively supports and strengthens thecommunities in Texas.

CATEGORY2: STRATEGIC PLANNING

2.1Strategy Development Process

Howthe Texas Department of State Health Services collects and analyzesrelevant data, how the organization identifies strategic planning andhow it conducts strategy planning. To achieve this, the organizationhas a result-based accountability system. Noticeably, theorganization intuitively achieves this through surveys, for instancethe Mental Health and Substance Abuse Division conducts surveys inschools. After analyzing the operating environment, the organizationidentifies strategic options and selects the best options and healthservices on offer. The organization can improve this by examininginternal and external factors that affect the organization so as toidentify its clear advantages.

2.2Strategic Objectives

Thisitem looks at what are the key strategic objectives of theorganization and how they are to be achieved, together with what arethe challenges, advantages and opportunities.

2.3Action Plan Development and Deployment

HowTexas Department of State Health Services develops and deploys itsaction plans, how the organization ensures it is equipped withadequate resources to support the action plans and how it is able totrack the performance and adjust these plans when necessary.

2.4Performance projections

Howthe organization’s performance projections for its short-term andlong-term planning horizons benchmark and match up to those ofcomparative organizations and competitors.

CATEGORY3: CUSTOMER FOCUS

3.1Customer Listening

Howthe organization listens to customers, monitors existing customersand other potential customers and how it obtains responsibleinformation and feedback. Texas Department of State Health Servicesconducts customer satisfaction surveys in areas where it provides itsservices and frequently studies customer needs. Arguably, theorganization hasn’t done pretty well in the part. The departmentlacks a customer relationship management system to hold valuableinformation regarding residents of Texas. Notably, the organizationhas an opportunity for improvement where it can formulate aneffective customer contact strategy to allow more listening to peopleof Texas and tell them more about what it offers.

3.2Determination of customer satisfaction and engagement

HowTexas Department of State Health Services determines whethercustomers are satisfied, dissatisfied and engaged across itsdifferent regional offices in the state, how it compares with otherorganizations and how to get such information to avail customerengagement and satisfaction. The organization does this shrewdly bysticking to the set goals wherever it has a presence such aslistening, engaging, monitoring and responding to customers online.Offline it does this through surveys such as the Texas Survey ofSubstance Use which was administered to approximately 100,000 publicschool students statewide. Texas DSHS has strength of having beingcloser to the target population i.e. it is positioned at the centralcampus at 1100 West 49thstreet in Austin which is easily accessible.

3.3Product Offering and Customer Support

Howthe organization determines requirements by customers and theproducts offered, how it helps customers get information regardingitself and how these activities vary throughout its market segments.

3.4Building Customer Relationships

Howthe Texas DSHS builds and maintains relationships with customers toacquire them, retain them and engage with them, along with how itmanages customer complaints. The organization does this byestablishing communication with customer to keep to date with theirneeds and preferences. Markedly, the Texas DSHS has attempted toremain outstanding in having strong customer relationships throughprovision of customer support, adapting its action plan and askingfor customers opinions but has not done so well. The organization hasan opportunity for improvement in which it can build networks withpartners, association members, the community and acquaintances suchas Texas A &amp M University. Markedly, networking is a long terminvestment (Cooks, 2010).

CATEGORY4: MEASUREMENT ANALYSIS AND KNOWLEDGE MANAGEMENT

4.1Performance measurement

Thisitem looks at how the organization collects, chooses, integrates andaligns comparative and customer data to track daily operations andoverall organizational performance, and how responsive itsperformance measurement system is to respond to rapid changes. TexasDepartment of State Health Services collects and aligns data througha performance measurement system. The organization measuresperformance quite well by doing so through a relevant, meaningful andtimely process, using balanced data and aligning the system with theorganizations visions. In effecting this, the department has a strongpoint of a supportive climate such as an evaluative organizationalculture and easier stakeholder involvement.

4.2Performance Analysis and Review

Howthe organization conducts analysis and reviews its performance andcapabilities. Providentially, the organization has bodies andcommissions that oversee and review the performance of theorganization such as the Texas Sunset Advisory Commission. Inaddition, the department conducts frequent performance measurementand assessment through itself through such measures as surveys andanalyzing performance contracts of employees.

4.3Performance improvement

Howthe organization improves underperforming areas by replicating whatis being done in high performing areas, how it uses performancefindings to project future performance for continuous improvement.

4.4Organizational Knowledge

Thisitem looks at how Texas Department of State Health Services collectsand transfers workforce knowledge and how it uses this knowledge forembedded learning throughout the organization.

4.5Data and Information Technology

HowTexas DSHS manages organizational data and information, how it usesuser-friendly hardware and software systems to ensure effective,secure and reliable data management.

CATEGORY5: WORKFORCE FOCUS

5.1Workforce capability and capacity

Howthe organization conducts assessment on the workforce capability andcompetence needs, how it organizes, manages and prepares theworkforce for changing capability and capacity needs. TexasDepartment of State Health Services achieves this by effectivepreparation of the workforce which includes: workforceanalysis, forecasting future needs, analyzing gaps, developingstrategies, implementing strategies, monitoring and evaluatingability of workers in implementing them (Balcazar, 2013).Nonetheless, the organization could improve this by adopting aunified Human Capital Management (HCM) application that helps accountfor all the operational aspects of its workforce.

5.2Workforce Climate

Howthe Texas Department of State Health Services addresses workplaceenvironmental factors to make certain and improve workforce health,safety and accessibility

5.3Workforce Performance

Thisitem focuses on how the organization determines the key elements thataffect workforce engagement to promote an open, engaged and highperforming workforce. The organization ensures it has an exemplaryworkforce through several ways: planning for improvement, makingworkers accountable for their performance, setting clearlyarticulated goals, clarifying the organization’s expectations ofthe workers and enhancing communication between the workers and themanagement.

&nbsp5.4Assessment of Workforce Engagement

Howthe Texas Department of State Health Services determines and assessesworkforce engagement and what are the indicators the organizationuses.

5.5Workforce and Leader Development

Howeffective is the learning and development system and how the systemensures it manages effective career development for all workforcemembers. The organization assesses employee knowledge and skill levelto establish their promptness and readiness for change. Then theorganization gives appropriate training to them to get them betterequipped into adopting new challenges and roles. This could beutterly improved by adopting a workforce plan to help in recruitmentand selection, education and training, development and retention.

CATEGORY6: OPERATIONAL FOCUS

6.1Product and Process Design

Thisitem looks at how Texas Department of State Health Servicesdetermines key products and requirements and how these products andwork processes meet all key requirements. Foster et al (2007) notesthat, as in the Texas Department of State Health Services, eachhealth care organization should shrewdly accomplished this byincorporating new technology, organizational and customer knowledgein product design and aiming at product excellence. Remarkably, thedepartment has a clear product vision due to proper understanding ofthe state people which has helped develop an actionable strategy.

&nbsp6.2Process Management

Howthe department determines key work processes and make certain thatthey meet important process requirements

6.3Cost Control

Looksat how the Texas Department of State Health Services controls thegeneral costs of operations i.e. how it prevents and manages defects,productivity and performance issues and services errors.

&nbsp6.4Supply-Chain Management

Focuseson how the organization selects measures and evaluates current andpotential suppliers, and how it manages its supply chain.

6.5Safety and Emergency Preparedness

Howthe Texas DSHS provides a safe operating environment for itsworkforce.

6.6Innovation Management

Thisitem looks at how the department manages innovation, prioritizes,pursues and finances strategic and premeditated opportunities. Theorganization has accepted and recognized inevitability of change. Itsmanagement plans, organizes, controls and coordinates innovationprocesses in the company.

STRENGTHSAND OPPORTUNITIES FOR IMPROVEMENT

Category1: Organizational Leadership

Strengths

  • The vision and mission are well tied with and interconnected with the services and products offered. This strength has a medium level of importance.

Opportunitiesfor Improvement

  • By adapting to respective audiences, the organization can improve communication and organizational performance. This OFI has a high level of importance.

  • The department can develop an ethics policy and facilitate feedback within the organization through interaction to ensure effective implementation. This OFI has a high level of importance.

Category2: Strategic Planning

Opportunityfor improvement

  • The organization can by examining internal and external factors that affect the organization so as to identify its clear advantages. This OFI has a medium level of importance.

Category3: Customer Focus

Strengths

  • The organization can formulate an effective customer contact strategy to allow more listening to people of Texas and tell them more about what it offers. This strength has a high level of importance.

  • It can build networks with partners, association members, the community and acquaintances such as Texas A &amp M University. Markedly, networking is a long term investment. This strength has a medium level of importance.

Opportunitiesfor Improvement

  • Texas Department of State Health Services has its headquarters closer to the target population i.e. it is positioned at the central campus at 1100 West 49th street in Austin which is easily accessible. This OFI has a medium level of importance.

Category4: Measurement Analysis and Knowledge Management

Strengths

  • The department has a supportive climate such as an evaluative organizational culture and easier stakeholder involvement. This strength has a medium level of importance.

Opportunitiesfor Improvement

  • Formulation of an effective customer contact strategy to allow more listening to people of Texas and tell them more about what the organization offers. This OFI has a high level of importance.

Category5: Workforce Focus

Opportunitiesfor Improvement

  • Adopting a unified Human Capital Management (HCM) application that helps account for all the operational aspects of its workforce. This OFI has a high level of importance.

  • Texas Department of State Health Services could adopt a workforce plan to help in recruitment and selection, education and training, development and retention (Redman, 2006). This OFI has a high level of importance.

Category6: Operational Focus

Strengths

  • The department has a clear product vision due to proper understanding of the state people which has helped develop an actionable strategy. This strength has a medium level of importance.

PERCENTSCORES

Category1: Leadership

70%.Outstandingly, the leadership of the Texas Department of State HealthServices has been very effective in spearheading the operations ofthe organization. They have put up well-set vision and mission,maintained ethical behavior and have been very active is supportingthe Texas community.

Category2: Strategic Planning

40%.Notably, the organization has not been equally as effective instrategically positioning itself. Being a state agency, theorganization has mainly relied on set state projects and occurrencesthat happen in Texas to plan action.

Category3: Customer Focus

60%.The organization has not failed in its core mandate of providinghealth-related services in the state. It is a leading organization incustomer listening, ensuring customer satisfaction, building andmaintaining customer relationship. For instance, it conducts annualand biennial surveys which have helped achieve two-way feedback withcustomers.

Category4: Measurement Analysis

50%.Texas Department of State Health Services has attempted tocollect and analyze performance but with not much success.Dysfunctionality in the process of collecting, managing andtransferring organizational data has affected the effectiveness ifthe organization’s measurement analysis.

Category5: Workforce Focus

60%.The organization has been effective in analyzing the capability oftheir workforce and recruitment systems. Consequently, this hashelped achieve a high performing workforce and effective workforcedevelopment.

Category6: Operational Focus

50%.The Texas DSHS has considerably been able to measure and maintain henecessary product and work process requirements such as safeoperating environment and changing through innovation.

Theaverage percentage score is 55%.

MOSTVITAL OPPORTUNITIES FOR IMPROVEMENT

  1. By adapting to respective audiences, the organization can improve communication and organizational performance. The organization serves many dissimilar customers from different regions, adapting to these audiences is vital for efficient service provision.

  2. Adopting a unified Human Capital Management (HCM) application that helps account for all the operational aspects of its workforce. Such a system is fundamental of an organization intends to keep up to date with the workforce.

  3. The department can develop an ethics policy and facilitate feedback within the organization through interaction to ensure effective implementation. Such a policy acts as a guideline to legal and ethical behavior of all workers, managers and stakeholders of an organization.

  4. Formulation of an effective customer contact strategy to allow more listening to people of Texas and tell them more about what the organization offers. To effectively provide health-care services such as dealing with drug and alcohol abuse, the organization has to keep frequent contact with respective customers for successful diagnosis.

  5. Texas Department of State Health Services could adopt a workforce plan to help in recruitment and selection, education and training, development and retention. According to Draganidis &amp Mentzas (2006). The plan acts as a guide in measuring the aptitude of employees, helping the organization identify who to employ, retain, dismiss and promote.

ACTIONPLANS FOR THE MOST CRITICAL OF THE OPPORTUNITIES FOR IMPROVEMENT

Adoptinga strategic and functional workforce plan is one of the most vitalopportunities for improvement of the Texas Department of State HealthServices. An action plan for this would involve several activities.It should all start with environmental scanning to identify internaland external talents. To effectively assess this talents, there hasto be an alignment between the HR and the organizational goals. Thiswill result to development of a current workforce profile of theworkforce in the headquarters and regional offices. Then theorganization will develop a future workforce review by consideringemerging trends. Then this will be followed by analyzing the future,identifying talent gaps and coming up with strategies to close them.Finally, the organization will close these gaps by implementing thestrategies.

Notably,having an effective customer contact strategy is a fundamental OFIfor the organization. This starts by the organization identifying itscompetitive landscape, its customers (Texas Community) and itscapability. This will help the organization know its audience andthus develop compatible goals. Then the organization will adopt an“outside-in” approach where it will draw technology, markettrends and the needs of customers to its operational activities.Finally, the action plan will involve seeking customer-centeredexperiences through referrals, engaging customers and prospects andsetting its customer engagement.

EXPECTEDRECEPTION FROM MANAGEMENT

Thoughchange is inevitable, most organizations tend to be resistant tofrequent change or fail to effectively manage change. However, thiswould not be the case at the department since the organization has acommitted leadership which is receptive to change. At first blush,the upper-level management would feel pressured and feel unable todeal with the huge underlying demand due to the “general adaptationsyndrome”. Nevertheless, under Dr. David Lakey, Commissioner of theTexas Department of State Health Services, the organization wouldsupport to act upon the findings and recommendations of thisperformance assessment report. The customer/ resident of Texas Stateis King for this organization and therefore any proposal which willbetter the health lifestyle and customer experience would be dulyaccepted by the organization.

Theorganization will therefore probably act immediately to neutralizethe situations that seem dangerous for the organization. Then theorganization will evaluate the report to determine its legitimacy andapplicability such as acting on facts. The management will thendevelop a plan to confront the problems.

Reference

Balcazar,H. (2013, November). Study of the community health worker workforce:A report to the Texas legislature. In 141stAPHA Annual Meeting and Exposition (November 2-November 6, 2013).APHA.

Cook,S. (2010). Customercare excellence: How to create an effective customer focus.Kogan Page Publishers.

Draganidis,F., &amp Mentzas, G. (2006). Competency based management: a reviewof systems and approaches. InformationManagement &amp Computer Security,14(1),51-64.

Foster,T. C., Johnson, J. K., Nelson, E. C., &amp Batalden, P. B. (2007).Using a Malcolm Baldrige framework to understand high-performingclinical microsystems. Qualityand Safety in Health Care,16(5),334-341.

Hall,R. T. (2010). Anintroduction to healthcare organizational ethics.Oxford: Oxford University Press.

Lettieri,E., Borga, F., Masella, C., &amp Savoldelli, A. (2004). Perfomancemeasurement in nonprofit organizations: how to link theory andreality. PerfomanceMeasurement and Management Control: Superior OrganizationalPerfomance,355-374.

Martin,M. K., McFall, S. L., Smith, D. W., &amp University of Texas HealthScience Center at Houston. (2009). Hospitaland environmental variation in Texas nonprofit hospitalorganizational policies regarding charity care.(Masters Abstracts International, 46-5.)

Redman,R. W. (2006). Leadership succession planning: an evidence-basedapproach for managing the future. Journalof Nursing Administration,36(6),292-297.

Scales,T. L., Streeter, C. L., &amp Cooper, H. S. (2014). Ruralsocial work: Building and sustaining community capacity.

TexasDepartment of State Health Services. (n.d.). Regions. Retrieved Fromhttp://www.dshs.state.tx.us/regions/default.shtm

TexasDepartment of State Health Services.&quotVisitor Information.&quot Retrieved from

http://www.dshs.tx.us/visitor/default.shtm

TheMalcolm Baldrige National Quality Improvement Act of 1987 in H.R. 8121987