The public healthcare sphere is one of the most important branches of human activity, within which measures are taken to maintain and improve the quality of life of the population. The primary task of the system is to preserve the health status of individuals, which in the long run, will be transformed into the general welfare of the nation. It is essential to recognize that human health is not only the absence of physical or mental diseases but also the achievement and maintaining of a level of full physical, mental, and social well-being. In this regard, the health system offers a number of prophylactic measures aimed at preventing the development of complications during pregnancy.
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It is known that pregnancy is a somewhat fragile state of a woman’s body, in which she may experience psychological stress and public pressure, as well as physiological problems related to the functional course of pregnancy. This situation necessitates the development of healthcare programs that could provide medical support to women during and after pregnancy. It is worth saying that the U.S. federal system of healthcare for the needy, called Medicaid, has a referral for free healthcare services for women during pregnancy. The Medicaid program provides patients with great opportunities to take care of their health and receive high-quality care. According to a policy description given by Gifford et al. (2017), prenatal care for mothers is provided by all states without exception in almost equal amounts. Patients can usually rely on counseling, assessing their child’s development through modern diagnostic procedures, including genetic screening, pregnancy management, and prescription of medication if required. As can be seen, such a rather comprehensive and multifactor approach becomes a significant advantage for the population, along with covering the cost of medical services.
Based on the above, the rejection of Medicaid services by most patients raises questions. Based on the training materials, it can be concluded that only forty percent of women who have access to healthcare actually use it. In other words, it means that the overwhelming majority of patients ignore medical care for unknown reasons. Moreover, the material shows that even if a woman decides to seek help from clinical organizations, she does not perform more than two procedures. This situation is unacceptable, as medical observation should be systematic and periodic. Otherwise, refusal of care can lead to life-threatening complications due to the wrong course of pregnancy. This condition can result in the loss of the baby and the death of the mother. The paradoxical situation leads to the conclusion that there is an urgent need to review and modify the health care program so that more patients will seek health professionals’ assistance.
Questions for SWOT
To introduce qualitative changes in the structure of the program, which have the potential to increase the number of appeals among patients significantly and, consequently, create a more favorable health atmosphere in the territory of the settlement, a preliminary analysis of current conditions is needed. Traditionally, marketers use SWOT diagnostic strategies to manage changes. If one turns to terminology, the SWOT analysis is understood as a complex of marketing and other studies of strengths and weaknesses of the enterprise or a particular object for the development of strategic planning models (Grant & Scott, 2020). SWOT project diagnostics assumes that for successful development of the program, it is necessary to take into account the following characteristics: strengths (S), weaknesses (W), opportunities (O) and threats (T). The advantages of this method are that it allows covering potential effects as a result of both internal and corporate factors, as well as external factors.
In this study, it is necessary to develop four questions to compile a SWOT model on the organizational task of a county healthcare department. As already mentioned, the department is experiencing serious difficulties due to the low number of patient referrals to medical organizations under the Medicaid plan, and consequently, the measurements should be focused on the current crisis. Table 1 presents the formulated questions, which make it possible to create strategic planning for the health system.
Table 1. Questions for SWOT analysis for strategic planning of changes in the healthcare department:
|SWOT Factor||Formulated Question|
|S — strengths||What are the characteristics that have the potential to interest patients in accessing health services?|
|W — weaknesses||What are the current factors in the system that prevent patients from accessing more treatments?|
|O — opportunities||What should be the innovative changes in the system to interest customers? In other words, what opportunities should the company work on to make its services necessary for patients?|
|T — threats||What political reforms, environmental crises, and competitive economic forces could hinder the achievement of the objective?|
Regardless of the level of authority, the main focus of all healthcare centers should be on supporting public health, which ultimately leads to a shared culture of health security and well-being. Even before a woman decides to give birth, during the planning stages with her partner or when choosing an in vitro fertilization procedure, she should understand that she will be provided with professional clinical care and support not only in case of unforeseen circumstances but also in case of healthy embryo development. Definitely, this knowledge helps a woman to be calmer and more relaxed about her pregnancy since she knows that she will be provided with medical care. However, it should be further recognized that the mission of the antenatal department of clinical organizations is not only to provide physical health services, such as biochemical blood and urine tests, ultrasound, or fetal palpation (So et al., 2017; Devi & Khandelwal, 2016). Conversely, a significant role in the prenatal care of the patient is to teach the pregnant woman the fundamental principles of safe activity to preserve her life and that of the fetus. During the preparatory education, psychological and pedagogical training is provided on the mother’s and father’s skills. It is not uncommon for staff to draw the patients’ attention to the fact that even though the labor and delivery process is complicated, it ends, but a small child who will study the world remains under the control of their parents. Therefore, particular emphasis is placed on the patient’s specialized preparation for future motherhood. Professional, quality training helps the woman to prepare properly for childbirth and strengthens her confidence in the doctor. On the other hand, the task of antenatal care centers is also to dispel myths that remain relevant to modern society.
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An interesting task of antenatal care, which should be mentioned separately, is to analyze the mother’s socio-economic situation. In most countries, there are usually no restrictions for healthy patients to have children; accordingly, the category of pregnant women can be represented by quite diverse and different cohorts of the population. Traditionally, the consultant physician is obliged to ask the patient about the presence of harmful habits such as smoking, alcohol, and drugs, as these factors have a direct negative impact on the development of the embryo. It is known that the irresponsible use of alcohol by a woman during pregnancy is associated with severe consequences, as shown by Mårdby et al. (2017). On the other hand, the socio-economic status of the woman in labor also influences the outcome of childbirth: Kim et al. (2018) show that the low economic level of the patient reveals a high correlation with high abortion rates and caesarian sections. The above leads to the conclusion that it is appropriate to investigate the status and lifestyle of the patient in order to improve consultation and use a broader clinical picture.
The mission of the local health department should be to provide high quality medical antenatal services to patients, with the aim of acting for the benefit of clients, the community and the nation as a whole, through continuous improvement of technologies, techniques, and practices. To sum up, the mission of antenatal care is multifactorial: it includes physical examination, psychological and pedagogical support, as well as analysis of the socio-economic status of the pregnant woman. It must be systematic, comprehensive, and professional.
It is worth noting that a marketing vision should define a strategic planning route map since a project that has no vision has no actual purpose. The vision brings clarity to the organization’s goals and direction, creates perspective, and gives meaning and importance to everyday clinical practice. A well-defined vision for the local health office will provide a framework for project implementation and encourage staff to follow corporate values.
The Health Department’s articulated vision is to achieve broad service coverage so that the average number of patient referrals to clinical organizations through the Medicaid program increases. Following this vision ensures that all corporate and marketing efforts are focused on encouraging people to use antenatal care, which ultimately leads to a healthy and prosperous nation. As it can be seen, this statement is quite multifaceted, and a number of critical tasks, such as creating advertising campaigns, improving the corporate policy of communication with clients, demonstrating the benefits of using the insurance program, and organizing a system of consistent management of the patient at all stages of pregnancy up to delivery, must be addressed in order to implement it.
The Four Goals of the Department of Health
The importance of setting the right goals
At first glance, it may seem that setting goals for the health department is not a significant task for the marketing and management office. In fact, there is a transparent link between the current problems, namely the lack of popularity of antenatal medical services under the Medicaid plan among patients, and the actions that need to be implemented to remedy the situation. However, it would be a mistake to think that setting goals is a routine exercise that has no high organizational value. In marketing practice, the goal is defined as a source of inspiration and engagement for the company to achieve the expected results (Rouse, 2018). Thus, through clarity of purpose, employees understand what specific indicators the organization seeks to achieve: the strategic planning of the medical organization must be transparent and clear (Fry & Baum, 2016). In other words, a specific strategic plan can tell employees what actions they should take in their workplace to achieve the overall goal for the benefit of public health.
Model for Adopting Objectives
The best strategy for developing objectives for this situation will be to use the studied organizational practices, the principle of which is based on the fragmentation of the general statement in part to facilitate perception. One of the best models is the SMART method, which regularly demonstrates high performance in everyday household practices and large organizations. According to “SMART goals” (2020), this technology aims to help the user define the final statement by dividing it into components: thus, the term “SMART” is an acronym, parts of which represent individual areas of the final goal. This model assumes that the goal should be specific, measurable, achievable, relevant, and time. In other words, only a goal that fits this description has the potential to become the basis for successful and effective strategic planning.
The most obvious result from the introduction of the new organizational practice should be an increase in the number of visits to the clinic for antenatal care among patients. As discussed above, there is a noticeable trend among patients who do use Medicaid to stop coming to the clinic after one or two examinations. This phenomenon seems to be related to dissatisfaction with service practices and the assistance offered in general. Consequently, one of the priority directions should be to improve the quality of patient care. For this purpose, it is necessary to use the SMART model to concretize the goal of the program.
Table 2. Five statements to establish the first objective:
|SMART Factor||Objective Statement|
|S||Significantly improve the quality of customer service in county healthcare organizations.|
|M||The number of people who discontinue medical examinations after a second time must not exceed 10 percent of the total number of targeted patients.|
|A||Improving the quality of service is achieved through improved communication skills among staff, which is a feasible objective. To implement it, it is necessary to introduce the practice of training employees in corporate ethics.|
|R||The improvement of customer service is associated with the improvement of the medical climate among the population in the country.|
|T||Two months are required for this purpose, including staff training and practice.|
It should not be ruled out that clients do not use Medicaid because they are unaware of these possibilities. Indeed, it is a fairly old program that has existed in healthcare practice for over half a century, but some categories of citizens, such as official immigrants or people who do not speak English, who are covered by the insurance system, may not know about Medicaid. The second goal of the county healthcare department should, therefore, be to create publicity campaigns to inform the public about Medicaid. Table 3 shows the range of statements needed to create the second goal.
Table 3. Five statements to establish the second objective:
|SMART Factor||Objective Statement|
|S||Develop an advertising campaign for citizens, including advertising posters, videos on street banners, and the Internet, as well as calls to action to publicize the use of Medicaid for antenatal medical examinations.|
|M||Intermediate social surveys on awareness should yield at least 50 percent results.|
|A||An organizational task will be prepared for the marketing department to develop and implement advertising materials.|
|R||The advertising campaign will raise awareness among the population, and consequently, more pregnant women are expected to use doctors’ services.|
|T||It will take one month to create an advertising company, and regular social surveys will be conducted within two months as an indicator of efficiency: three months in total.|
The third objective is to improve the system of training courses through which mothers and fathers can learn more about pregnancy and childbirth. It is essential to recognize that while the first two goals were justified by current challenges, the third and fourth goals aim to evolve existing systems to achieve more effective results. Thus, the department’s third goal should be to increase the proportion of patients using psychological and pedagogical medical counseling.
Table 4. Five statements to establish the third objective:
|SMART Factor||Objective Statement|
|S||It is necessary to develop a system of preparatory classes where parents learn more about the stages of pregnancy, possible complications, and emergency response.|
|M||The number of people attending such courses should be at least 25% of the total number of targeted patients.|
|A||To achieve this goal, a curriculum development department should be established, a workspace prepared, and a schedule of classes developed.|
|R||Improving knowledge among the population has a direct impact on the competence of parents, which has the potential to improve the overall level of medical education.|
|T||This goal is technically complicated, so it is necessary to spend six months on all implementation stages.|
Finally, the last objective to achieve the expected results within the country healthcare department is to enhance the status and prestige of local health organizations. It is assumed that clients already know about the benefits of Medicaid and the excellent attitude of staff towards patients, but it is also essential that clinical organizations become a place where an innovative and scientifically based approach is supported.
Table 5. Five statements to establish the fourth objective:
|SMART Factor||Objective Statement|
|S||The task of clinical organizations should be to introduce an innovative and science-based approach to medical services.|
|M||Sociological surveys of client opinions about specialists’ work will be an accessible measure for analyzing the success of the implementation.|
|A||Specific steps include developing new corporate values and periodic employee meetings to discuss and demonstrate the new policy to clients through advertising campaigns.|
|R||The scientific approach will increase interest among the population, as there are demands for proof and exposure to knowledge among modern society.|
|T||It will take one month to realize this goal and train staff in new values.|
Summing up this report, it should be noted that prenatal examination of patients, provision of psychological and medical advice, and training in the most important rules is the essential area of prenatal public healthcare. When a system shows poor results, it needs to be reformed as quickly as possible in order to maintain the nation’s health indicators: the changes begin with an analysis of the current problems, which can be done using the SWOT model. At the same time, strategic planning should be developed that includes clear goals to increase the chances of successful implementation of the changes. In this work, thanks to the SMART methodology, four goals have been identified, which can be implemented in the country healthcare department within the next six months.
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