The governing board of a healthcare organization is comprised of the board of directors, where it offers an oversight role of ensuring that duties and functions are not only efficient but in the interest of all stakeholders. The board must carry out the duty of tactical planning, overseeing the organizational operations, manage the human and financial resources and meet the interests of shareholders like the consumers, the donor's other affiliated groups ( Austin, & Pinkleton, 2015) . They should also be accountable for the establishment of human resources as well as coordination of all HR practices like staffing, rewarding and training of all employees as a way of ensuring that the employees work towards a common purpose. The board should also handle duties like the creation of a hierarchical system of governance, while each team member within the stipulated platform must know the duties and functions ( Poe & White, 2010) . After the establishment of duties within each departmental level, the board should ensure that the members have the ability and avenues of reaching out to the expectations and core values. For instance, the board should design a corporate culture and ensure that each member of the healthcare organization works towards meeting the objectives set.
The governing body should also be proactive in identifying and giving solutions to the accountability of management of medical entities ( Bodenheimer, 2008) . At the Middleville healthcare facility, entities tend to operate on the border of the public sector as well as the business sector, while they ought to fulfill the mission of assisting all beneficiaries to be economically efficient. The purpose of the board of directors is to manage the existing resources in an efficient way through building business models and implementing them through strategic initiatives. To implement the strategies, the board should ensure that a program is put in place to define and implement the set objectives and the mission. The program should contain the time of reaction to the specified entity to its surroundings ( Poe & White, 2010) . The management should, therefore, make an analysis of the current position within the organization and correlate the performance therein with the set mission, objectives, strategies, and then analyze the environment. Conducting an organizational audit may also help the management teams in the determination of the best long-term plans that can help reach out to better patient and organizational outcomes.
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Performances that Middleville can use to measure its success in the provision of healthcare.
It is imperative to note that evidence-based management implies that the operational and strategic decisions are set based on the end result of achievement of the set goals and objectives. In this regard, the management can easily identify and measure the quantitative measurements like financial performance and other related fields of operation. The suppliers and stakeholders within the healthcare system share a common purpose of offering a high-quality care to the patients and realizing the best patient outcomes ( Austin, & Pinkleton, 2015) . Delivery of high-quality care can be determined by the rate of readmissions, the rate of patient satisfaction, the utilization of financial and non-financial resources and the correlation between performance and the set goals.
Measurement of performance helps stakeholders to understand how well the organization is reaching out to its objective. Analysis of performance also helps the organization to comprehend the areas that may need modifications, where the operational teams may make necessary adjustments to evade possible risks like a financial loss (Grunig, 2013) . At the Middleville healthcare organization, there are different quantitative measures that can be used to determine its performance in relation to its competitors. Analyzing the healthcare facility in terms of these quantifiable measures can help in comparing the performance of these healthcare facilities, where the management can use the comparisons to resolve on areas of poor performance.
The first quantifiable measure is the number of beds, where the Middleville healthcare facility has 575 beds, while its competitors comprising of the Brierfield and the Greystone have 380 and 350 beds respectively ( Poe & White, 2010) . The Middleville hospital has more beds as compared to the other competitors, although this measure alone cannot give a conclusion that the facility is better as compared to the latter. The next quantifiable measure is the total number of admissions. The Middleville has a total number of admissions of 13000 patients, while the Brierfield has a total of 17,000, while the Greystone has a total of 10,000. From the number of admissions, Middleville has a lower admission rate as compared to the Brierfield, which shows that more patients prefer the latter, despite the fact that Middleville has more beds.
The other measure of performance given is the op visits, where that for Middleville stands at 221,000, against 17,000 and 40,000 for Brierfield and Greystone respectively. It is evident that the Middleville hospital has a higher figure of the OP patient turnovers, where the facility has a higher bed capacity as compared to its immediate competitors. On the other hand, Brierfield has the highest rate of expenditure, where the facility incurred a total of $130000, while Middleville and Greystone had a total of $125000 and $80000 respectively in terms of the total expenses incurred. Categorically, Middleville has a higher patient base, which totals to $350000 and greater personnel to service, where it is expected that the facility would have a higher rate of expenditure ( Austin, & Pinkleton, 2015) . On the contrary, it had a lower rate, which is attributed to cost effectiveness on the part of financial management, which is a positive outcome in terms of utilization of financial resources. Consequently, the facility has a higher number of birth rates , which can be attributed to better healthcare outcomes in terms of caring for expectant mothers and their newborns.
Areas of Improvement and focus to maintain a competitive market share
The first area of improvement is to improve the quality of service delivery. Here, the healthcare organization should ensure that patient safety is given a priority ( Poe & White, 2010) . Quality improvement is one of the major objectives of healthcare management. Improvement of quality of care is the only way that the organization will use to ensure that it has an increase in the admission rate compared to its competitors.
The healthcare facility should also ensure that there is a well-organized system of internal information. For example, the company should restructure its information technology to foster towards effective communications among teams ( Austin, & Pinkleton, 2015) . There should also be a system of determination of the future position in a precise manner that can aid in influencing the environment. For instance, the company should use its current position to determine the determinants of performance like the OP visits, the expenses and the structure of its corporate strategy to predict the future performance levels through influencing the environment. The healthcare facility can also determine the internal environmental conditions and how it is implementing the current strategies using the available resources.
The healthcare organization must also choose from possible outlined variants of strategies that are under development to make a selection of the key determinants that significantly affect the future of the hospital ( Poe & White, 2010) . There should also be a strategic plan for reaching out to the proposed solutions. Some of the solutions that may be viable may include the development of training programs for employees to increase their levels of proficiency in decision making. The other proposal is to reward the highest performing healthcare practitioners to increase their levels of motivation and instill the spirit of competition among project teams. The healthcare facility may also carry out research on individual patients on their levels of confidence with the proposed outcomes, while the findings may be used to identify specific areas of development for better outcomes.
To increase the number of admissions, the healthcare organization should foster a culture that is supportive of the safety and diversity of the patient populations. The culture within the organization should also be one that is adaptive to the current medical systems and one that identifies medical errors. Patient confidentiality is also a key element that improves the levels of trust between patients and healthcare providers ( Austin, & Pinkleton, 2015) . The healthcare organization must, therefore, ensure the safety of patient information for both the manual and electronic records. Overly, the management should address the root causes of the prevention of medical errors among the patient population.
Implementing EMR and associated health data system
The electronic medical record forms the foundation of an adaptive and effective system of care, where they are projected to have an undesirable impact on the overall spending within the healthcare facility. The execution and exploitation of an electronic medical record system, therefore, conveys constraints in terms of the costs and trials that must be put into consideration prior to implementation ( Poe & White, 2010) . The noteworthy costs may include the equipment, the professionals, and training of employees. On the other hand, implementation of the EMR system has benefits that outweigh the costs incurred. For instance, the system will reduce the errors that come about as a result of the use of manual records. The system will also have long-term benefits like the substantial decline in the organizational health outflows, while the organization will have more efficient alternatives for lowering the costs incurred as systems are automated. The time for retrieval of the medical records will also be reduced, which will, in turn, reduce the cycle of treatment of the patient.
Employee Satisfaction and Retention
Employee satisfaction and retention are determined by the levels of motivation, the safety of the working environment and the levels of professionalism ( Poe & White, 2010) .The first method which the healthcare organization can use in employee retention and increase the levels of satisfaction is to provide training programs. Training programs for employees increase their levels of professionalism and awareness on the field of expertise. It also increases the levels of performance among employees, where they are motivated to work for longer periods (Smith, 2013) . On the other hand, there should be a system of the motivation of employees through incentives, rewards, and promotions.
In this regard, promotions are the greatest sources of recognition and motivation on the part of employees, while it also fosters a competitive attitude, which leads to higher performance. Consequently, their working environment should be safe for all employees ( Austin, & Pinkleton, 2015) . The healthcare organization must ensure that all employees are insured against any possible sources of harm, while the environment should be free from contaminants. The healthcare facility should be designed in a way that there is less hospital acquired infections, where all employees should be provided with protective gear. Any form of injury or infection resulting from the environmental conditions at the workplace should be compensated for as this will enable the practitioners to work without the fear of loss of life or harm resulting from contact with patients.
References
Austin, E. W., & Pinkleton, B. E. (2015). Strategic public relations management: Planning and managing effective communication campaigns (Vol. 10). Abingdon: Routledge.
Bodenheimer, T. (2008). Coordinating care--a perilous journey through the health care system. The New England journal of medicine , 358 (10), 1064.
Grunig, J. E. (Ed.). (2013). Excellence in public relations and communication management . Abingdon: Routledge.
Poe, S., & White, K. M. (Eds.). (2010). Johns Hopkins nursing evidence-based practice: Implementation and translation . Indianapolis, Indiana: Sigma Theta Tau.
Smith, R. D. (2013). Strategic planning for public relations . Abingdon: Routledge.
