Leadership and up-to-date business principles

Leadership and up-to-date business principles

Running Head: Healthcare 2
1) My company offers project financing solutions to projects that meet its predetermined
investment criteria. Project financing involves appraising project proposals to determine whether
the projects will be viable and sustainable. One of the documents that my company requests
clients to provide for the exercise is a detailed business plan and a feasibility study report. A
business plan and a feasibility study report outlines the market that a project intends to serve.
The documents outline the gap that the project will fill (Orton, Umble, Zelt, Porter & Johnson,
2007). They outline the marketing strategies that the project will implement to fill the gap in the
market. They also outline the organizational plan that the project will use to achieve its strategic
objectives. This involves outlining the organizational structure and profiles of key management
personnel. These documents also look at the technical, environmental, political, socio-cultural
and economic aspects of the project (Orton, Umble, Zelt, Porter & Johnson, 2007).
A business plan is however more detailed than a feasibility study. It identifies the
problem that the project will be formed to solve (Orton, Umble, Zelt, Porter & Johnson, 2007). It
outlines all steps taken to solve the problem and the costs and benefits that will be generated by
the project. The other business practice that is embraced by my company is building working
relationships with professional organizations to benefit from their expertise in different areas
(Kerr, Hendrie, Delia, Gr, & Moorin, Rachael, 2014). The benefit of this practice is that the
organization is able to add value to projects that it handles. Up-to-date business principles are
therefore encouraged in my work place. Applying concepts like return on investment would help
me to implement projects that increase my asset base. The approach will also help me to
maintain investments that add value to my life (Kerr, Hendrie, Delia, Gr, & Moorin, Rachael,

Running Head: Healthcare 3
2) There are several strategies that would help me avoid leadership derailment. One of the
strategies is appraising investments that I make to ensure that I implement only those projects
whose returns on investment are higher than my cost of implementing them. The other strategy
is preparing a business plan that would assist in guiding leadership in all aspects of life (Kerr,
Hendrie, Delia, Gr, & Moorin, Rachael, 2014). A business plan would identify problems that
need to be addressed, identify steps that have to be taken to address these problems and methods
of measuring performance. The other strategy is liaising with the business community to benefit
from advice that can be gained from it and other resources that the business community can offer
(Kerr, Hendrie, Delia, Gr, & Moorin, Rachael, 2014).

Running Head: Healthcare 4


Kerr, R.,B.A.(Econs) G.A.I.C.D., Hendrie, Delia V, BSc, BA, MA,GrDiplApplFin, Gr, &
Moorin, Rachael, PhD,GradDipHlthEcon, M.Sc. (2014). Investing in acute health
services: Is it time to change the paradigm? Australian Health Review, 38(5), 533-40.
Management academy for public
health: Creating entrepreneurial managers. American Journal of Public Health, 97(4),

Business Planning for Public Health From the
North Carolina Institute for Public Health
Stephen Orton and Anne J. Menkens

This special issue is centered on case studies of six pub-
lic health business plans, and the term “public health

business plan” appears throughout the issue. But what
is a public health business plan? And why might you
want one?
First, let us discuss why business planning makes
sense to today’s public health managers. When public
health managers conceive of their work as business
planning, they begin to graft a business-oriented model
of analysis and operation onto the culture of nonprofit
and governmental public health. The goal becomes
customer service,1 and the task becomes creating value.
It means finding new, different sources of support for
programs, diversifying partners, generating revenue,
analyzing efficiency, determining cost per unit of
service, calculating break even points. If public health
were a baseball game, creating a successful business
plan would be like hitting a grand slam to bring home
the resources necessary to improve health in your
The shift toward a more entrepreneurial approach
to planning social interventions comes in the context

of economic uncertainty, rising expectations, and on-
going and emerging health threats. It has roots in the

“reinventing government” movement2 and the concur-
rent movement in the nonprofit sector toward social

entrepreneurialism.3–6 Four needs are driving public

health ventures in this direction: the needs for sustain-
able financing, proven results, improved efficiency, and

effective multisectoral partnerships. Federal and state
resources are becoming scarcer and more restrictive;
public officials increasingly want demonstrable results
for those public funds; grants increasingly require hard
outcomes and sustainability plans; and grant funds
continue to run in unpredictable cycles, though they
are very predictably run out. “Doing more with less”
may seem oxymoronic, but the environment requires it.
J Public Health Management Practice, 2006, 12(5), 489–492
C 2006 Lippincott Williams & Wilkins, Inc.

To sustain public health efforts at the community

level, then, managers have to become expert at blend-
ing and diversifying funding sources and using those

sources as efficiently as possible to achieve outcomes
that are both measurable and sustainable. Business
planning skills help government speak the language of

business—which is increasingly the language of effec-
tive nonprofits as well. Many businesses are looking to

engage in venture philanthropy and achieve a social re-
turn on investment; they are increasingly interested in

public health, starting with public health hazards that
could impact their bottom line. Taken together, these
forces are driving public health managers to analyze
and plan for sustainability the way businesses do.
Envisioning sustainability is a mind-set; business
planning is a means to that end. Public health planning

begins with an idea—a perception of a need in the com-
munity and a data-driven strategy to address it. Busi-
ness planning similarly starts with assessment, always

adding the question, “How can I solve this problem in a
financially sustainable way?” To answer this question,
an entrepreneurial public health manager must first
know—in detail—the feasibility of the proposed plan.

What is the evidence that the plan will work, with lim-
ited risk, in a way that is sustainable after the grant


● The Feasibility Study
Undertaking a feasibility study will help you begin to

think through the practicability of your project. A feasi-
bility study is the first step in business planning, where

Stephen Orton, PhD, Director, Management Academy for Public Health, North
Carolina Institute for Public Health, School of Public Health, University of North
Carolina at Chapel Hill.
Anne J. Menkens, MA, Director, MAPH Special Issue, North Carolina Institute for
Public Health, School of Public Health, University of North Carolina at Chapel Hill.

490 ❘ Journal of Public Health Management and Practice
you look at the data to determine who needs what, you
analyze the environment in which you will act, study

the relevant models, determine exactly how to mea-
sure your success, and insure the sustainability of your

efforts by analyzing the financial picture. A simple fea-
sibility study will help you decide whether to invest

time in a full business plan, and it should serve as a

blueprint for your business plan. The essential distinc-
tion between a feasibility plan and a full business plan

is the level of detail. The following are critical compo-
nents of both.

Narrative description
You should be able to tell your business plan as a story:
this is the problem, and this is the solution. Describe

the plan in two or three short paragraphs, in plain lan-
guage, giving clear answers to key questions about its

practicability: Is the project justified by the available
needs assessment data? Do you have the resources?
Are there models and evidence suggesting plans of this

type are effective? Can outcomes be measured effec-
tively? Will it support itself financially? Is it the same

old thing, or a creative, fresh, tailored solution? Are the
right community partners at the table and committed?
Demonstration of need and target market
Public health managers are experts on the population
health needs of their communities. Use the data to show

how important a problem is, and who is affected. De-
scribe that data, and convince your audience that the

problem is worth solving. Clarify the nature of the gap

your plan is intended to fill. Define your target mar-
ket, and use data to demonstrate need in this particular

market. You may need to demonstrate that members

of the target group have had some input into the as-
sessment and planning process. Show what need is not

being met efficiently, or why clients are not benefiting
from current services. Compare benefits of funding the
project to costs of failing to fund it. Think about tangible
and intangible benefits of implementing your project.

In the Dare County case in this issue,7 some of the bene-
fits of having a cadre of peer health educators have gone

far beyond peer education to affect the health habits of
the larger community. And, the New Hanover County

spay/neuter facility8 has led to higher customer satis-
faction and subsequent higher rates of pet adoption, an

unexpected benefit that is in the long run just as impor-
tant as increasing pet sterilization.

Definition of plan
Describe the idea in detail. Outline the size and scope
of your project, as well as your objectives. What specific

services or products or interventions are you planning?
What is your client/geographic focus? What is your
timeline? What are your plan’s resource requirements?
Are your stated objectives achievable? Carefully work
through the many stakeholders involved individually:
How will each be affected? Are your stated objectives
logical? Are they pointed in the same direction? What
are the critical success factors—the one or two things

that have to happen for the plan to succeed? For in-
stance, many existing programs provide access to den-
tal care for children in rural communities; what factors

do successful plans have in common? Ability to bill
Medicaid? Buy-in from dentists? Availability of dental
Describe the health goals you hope to achieve, and plan
for data collection that will show progress toward those
goals. What improvements in community health status
can be expected as a result of your project? What process
measures will you track? How will they be measured?
How will you know if you have hit a “home run” with
your project? Businesses often have very sophisticated
ways of tracking performance: not just sales but sales to
returning customers, marketing impressions, customer
satisfaction, wait times, and return rates. This section of
the business plan challenges you to understand deeply
the process by which your plan will work to achieve
its objectives, and then figure out how to measure it at
each step. In the Wilkes County access-to-care case in

this issue,9 process measures such as physician satisfac-
tion and outcomes such as number of patients served

are important measures of the program’s value and sus-
tainability. Such measurement will add value to the

program when its administrators need to attract new
partners or sponsors, or affect policy makers, or decide
years down the road whether to continue it.
Industry analysis
We pride ourselves on the extent to which public health
is evidence based, but many businesses are just as
“evidence based” in their planning. Typical business

plans include detailed analyses of things like key suc-
cess factors and life cycle of a particular industry and

market niche. Good public health program plans in-
clude similar analyses of the latest medical science and

the evidence for (and against) specific approaches. De-
scribe the “industry” in which your project fits and

what you know about the structure of the industry. Is

it a health promotion project? A screening project? Per-
haps, as they did in Buncombe County,10 you want to

start a program that provides behavioral healthcare for
the underserved. What are the key success factors in

The Management Moment ❘ 491

the industry? Are there legal, political, regulatory, tech-
nological, or economic obstacles to implementing your

plan? How will you overcome these barriers? Could
partners help?
In the business world, new efforts usually try to escape
competitors, and instead “run to space.” A few decide
to confront competitors head-on. In public health, there
are plenty of health problems to go around: the goal is
generally to describe how your business plan fills a gap
in the public health system. You may have competitors:

for instance, your plan may encroach upon services of-
fered by local hospitals or other healthcare providers,

health clubs, or others. Your plan should describe
how your business plan complements and integrates
with existing efforts in your organization and in the

broader community. Who are the agencies and organi-
zations with interests in this space? Who are the natural

community/state/national partners in this project?
How does this plan fit with their goals and objectives?
Is the local environment receptive to this sort of plan?
What is distinctive about your services relative to those
of competitors in the marketplace?
A detailed listing of key events and specific dates by

which they will happen will help you determine the rea-
sonableness of your idea and your needs for finances,

personnel, and time. This section becomes a critical part
of calculating financial needs in business: you must
have enough cash throughout the process to pay the

bills. In a world where grants or government alloca-
tions often cover start-up costs, initial cash flow is less

a concern, but the timeline is critically important for
clarifying steps and assigning roles for multiagency or
multiorganizational efforts.
Risk and exit plan

Launching a program within the government some-
times requires us to soft-pedal the downside and push

the upside to legislators and constituents, but experi-
enced public health managers understand the risks and

pitfalls of different kinds of interventions. The specific

risks for your topic area and organization or commu-
nity should be listed and analyzed. What are the things

that could go wrong, and what preventive measures
can be taken? How will you know if the program is
not working? How will you shut the program down, if
For public health business plans, exit planning has

an added function: planning the transition of a success-
ful program to another entity. For some public health

programs, success is defined by the ability of the gov-
ernmental agencies to smoothly hand off day-to-day

operations of an ongoing intervention to organizations
in the nonprofit or perhaps even the business sector: to
assure services, in other words. Both possible “exits”
should be prepared for in the business plan.
Financial resources
Writing a business plan means seeing money as part of
the analytical problem, instead of seeing it as part of
the frame. Often in our work, we start with a certain

amount of money as a constant: such-and-such foun-
dation or agency wants proposals for how we would

spend $500,000 over 3 years on diabetes prevention.
Business plan finance is more dynamic. The task is to
balance resources (including cash) and costs, using the

best possible assumptions to get the best possible rec-
ommendation. To return to the dental care example:

How many children can you sign up? How many could
you see, given the staffing and space? What services
will those children need, in what proportions? How

much will it cost to provide fixed items such as person-
nel, equipment, and space? How much will it cost to

provide service to each child? The revenue side of the
equation is similarly complex: Who pays how much
for what, when? How many children must you see to
break even? What is the estimated 5-year budget for
your business plan? What will have to happen to make
the program sustainable financially in the long-term?
The dynamic nature of this analysis requires detailed
financial projections and assumptions. Public health
business plans often use grants to start up an effort, but
the best go beyond grants and general fund monies.
People who read business plans for a living often
start with the finance section. It provides the framework
on which the more narrative parts of the plan hang. And

the level of detail in this section provides an instant re-
ality check on the assumptions made in the plan. Some

signs that your assumptions may be flawed:

• A nurse is funded half-time—to run a screening pro-
gram that will triple in size over 3 years.

• The Public Health Department is providing a big

chunk of the required resources as “in-kind” dona-
tions of staff time—forever, without new hires.

• Monthly expenses are the same every month—for a
program to deliver influenza shots in schools.
Your finance section will give an early indication of
sustainability. Does the program rely on a grant to come

through in the future, or an existing grant to get ex-
tended? Do the revenue projections require unrealisti-
cally large utilization rates or market penetration? Does

the program allocate money for evaluation? Are there

492 ❘ Journal of Public Health Management and Practice
agreements in place with partners who are donating
critical resources such as space and equipment? Have
you accounted for “in-kind” contributions?
● The Business Plan
When you have answered the questions above, you
have essentially begun writing a business plan for a

new initiative that addresses a need in your commu-
nity. You will need a business plan if (1) your sponsors

or political allies (or foes!) want to see one; (2) your

partners want to see one; or (3) you want to gener-
ate revenue. In short, if you want to implement your

initiative and do so in a sustainable way, you need a
business plan. A major difference between feasibility

studies and business plans is that the former asks ques-
tions and the latter makes statements on the basis of

the answers to those questions. A business plan is an
argument that a new venture should be done and can
be done; it sells the idea, and your capacity to execute
it. It also prepares an important road map for action
that is useful to you and your potential partners and
Business plans are not for internal projects, such as

creating a new HR manual, but for external, revenue-
generating projects. Business plans are not for doing

strategic planning but for executing existing strate-
gies: they are concrete implementation plans within the

broader strategic plans of organizations and communi-
ties. And although business plans are designed to sell

ideas, you should not use them to sell yourself on a bad
idea. Business plans are meant to help predict a future
outcome with as much certainty as possible.
Business plans that succeed are often testable (you

could do a pilot version); reversible (can return to sta-
tus quo); divisible (can be implemented in stages); con-
crete(with tangible results);supported (cover sunk costs,

building on existing programs and resources); familiar

(models are available); congruent (match goals, initia-
tives); widely valued (have publicity value that stake-
holders will appreciate); marginal (not risky to the com-
plete enterprise); idiosyncratic (you can start it by your-
self); and timely (reacts to an emerging crisis or uses a

new means of attacking an old problem). Many busi-
ness plans do not succeed. Good business planning can

prevent those failures from being catastrophic.
It takes more than a Management Moment to do all
the work it takes to create a successful business plan.
For more information about getting the skills necessary
to cover all the bases—and hit your own home run—go
to http://www.maph.unc.edu.


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