Capstone Chapter 4

CapstoneChapter 4

BostonChildren’s Hospital: SWOT Analysis

BostonChildren’s Hospital: SWOT Analysis

Bothlarge and small organizations have some weaknesses and face somethreats as they try to maximize their internal strengths and exploitopportunities that are within their environment. However, thecapacity of the organization to enhance its competitive advantagedepends on the balance between weakness and strengths. This chapterentails the SWOT analysis of Boston Children’s Hospital (BCH),which is the largest pediatric care facility in the U.S. (BostonChildren’s Hospital, 2015). BCH can overcome its major challenges(including the shortage of registered pediatricians and researchfunds) by developing plans for sourcing resources, such as humancapital and funds.

Internalweaknesses and strengths


Theranking of the Boston Children’s Hospital (BCH) as among the bestchildren`s health care facilities in the U.S. can be attributed toits growth master plan. The long-term master plan has allowed thehospital to expand its facilities in a manner that is consistent withthe increase in the number of clients. This has been achieved throughthe construction of new facilities, expansion of existing facilities,acquisition, and the redesigning of different campuses to accommodatemore clients (Bilfinch, 2015). Moreover, the adoption of efficienttechnology as it emerges is among the key plans that have beenhelping BCH to remain competitive in the health care sector.


AlthoughBCH has a viable plan for future growth, the hospital’s master planis inadequate because it focuses on material items, such as expansionof campuses and adoption of technology. The plan fails to considerthe fact that the possibility of delivering quality care at all timesis based on the hospital’s capacity to invest in research, not justtechnological devices and buildings. The lack of adequate researchfunds from the government and other financiers in pediatric healthcare facilities is not a new phenomenon, which means that themanagement of BCH already knows that relying dominations may notsatisfy the hospital’s demand for research and innovation. However,BCH has failed to develop a plan for generating research funds fromreliable sources, but instead it has continued to depend on wellwishers (such as the National Institute of Health and Harvard MedicalSchool) for research funds (Denhoff, Milliren, Ferranti, Steltz &ampOsganian, 2015).

Inaddition, the shortage of health care professionals has been a keychallenge in the pediatric sector for a while, but in spite of thisknowledge, BCH has failed to develop a plan for maintaining anadequate ratio of physicians to clients (Schell, Lavieri, Toriello,Martyn &amp Freed, 2014). Being a medical teaching center, BCH oughtto have developed a plan that could help it retain the best of itstrainees and address the issue of physicians as well as pediatricianshortage that it is currently facing. It is ironical and clearindication of a failure to plan for a medical teaching center tocomplain of inadequate staff. This is because BCH supplies itsgraduates to other health care facilities, but lacks a proper plan toretain some within its campuses.


BostonChildren’s Hospital has an established chain of command, which isconfirmed by the existence of a hierarchical management structure.Orders flow from the president or the CEO of the hospital to the vicepresidents in charge of different units, and percolate down to thejunior members of staff (BCH, 2015). A proper organization hascontributed to hospital’s efficiency in delivering care to itsclients. In addition, the separation of different campuses as centersof excellence for different types of medical conditions is anindication of proper organization.


Apoor organization of members of staff, especially in terms of shiftsand rotation has denied them the opportunity to diversify theirskills. Many health care providers at BCH have been complaining thatthey are placed in one section for a long time, which makes workmonotonous while limiting their room to advance (Indeed, 2015). Thischallenge can be attributed to poor organization of employees, whichleads to the delegation of the same duties to the same employees fora long time.


Thesuccess and continued growth of BCH can be attributed to a strongleadership team that drives the vision of the hospital. BCH pridesitself in a team of experienced executive officers, who have servedin other national as well as multinational organizations. Forexample, Sandra Fenwick, the current president of BCH is a holder ofa master’s degree in Health Service Administration and have servedin numerous top leadership positions (such as the vice president incharge of ambulatory care at BCH and the chief operating officer)since 1999 (BCH, 2015). A team of highly trained and experiencedexecutives has shaped BCH’s vision and directed it towardslong-term growth. After taking the officer as the president of theorganization, Fenwick, together with a board of experienced directorsdeveloped a master plan that is currently guiding BCH towards itslong-term growth.


AlthoughBCH has one of the most experienced leadership team, its hierarchicalleadership structure inhibits the delivery of services. This isbecause a hierarchical structure is known to be quite rigid andfocuses on the centralization of power at the top leadership, whichlimits the growth of leadership skills at lower levels. This gives anexplanation for the failure by nurse leaders and pediatricians todevelop and adopt newer methods of handling clients. For example,nurse leaders cannot authorize the use of the latest methods ofmanaging children since they have to wait for such initiatives tocome from the top executives (Grant, 2014).


Controlis among the key management functions that help organizations inweighing outcome against goals in order to determine if theirstrategic plans are being implemented as expected. In the case ofBCH`s strong quality control and assurance program has been given theresponsibility of reviewing the key therapeutic procedures anddetermine the level of their effectiveness (BCH, 2015). Theestablishment of a strong quality control unit has helped BCH tomeasure the level of treatment quality and patient safety andcompares them with the organization’s missions, which holds thatthe hospital intends to offer quality care to its clients.


AlthoughBCH has managed to establish a system for controlling the quality ofcare, its electronic systems are still vulnerable to unauthorizedaccess. The 2014 case of the data breach that affected about 2,000patients is a clear indication that BCH does not have adequatecontrol measures to safeguard the electronic records, which hasincreased the chances for infringement of clients’ rights toprivacy (BCH, 2015) cases of medical kidnapping indicate the lack ofadequate control that will ensure that prescription that agreeable toparents and health care providers. According to Shilhavy (2015) BCHhas recorded the highest number of medical kidnappings, whichindicates that the management has failed to control the activities ofhealth care providers, who retain children within the hospitalagainst the will of their parents. This could also be perceived to bea case of Medicaid fraud, where the hospital retains clients longerthan necessary in order to make higher medical claims.

Externalopportunities and threats

Porter’sfive forces


Competitionamong children`s hospital in Boston is very low, given that pediatrichealth care facilities are quite few. This is confirmed by the factthat the existing children’s hospitals (including BCH) are tryingto expand their facilities in order to accommodate the large numberof clients (Bilfinch, 2015).

Threatof new entrants

Thethreat of entrants in the children’s health care sector is very lowgiven the existence of numerous barriers to entry. Some of the keyfactors that prevent the entry of new children’s hospitals includethe strict regulations by the government agencies, the high cost ofhiring pediatricians, scarcity of specialists in child care, and thehigh cost of machines that are required in pediatric care centers(Kolcy &amp Ennes, 2014).

Suppliers’bargaining power

Themain suppliers of children`s health care facilities includepharmaceutical companies and technology firms that produce healthcare machines. Their bargaining power is very low given thatpediatric care centers can order drugs and equipments from differentmanufacturers or even order them outside the country (Ali, 2015).This means that many suppliers deliver their products to a marketcomprising of a few children’s hospitals.

Threatof substitute

Thethreat of substitute to pediatric care offered by modern hospitals isquite minimal. This is because the chances of getting services thatwill enhance the wellbeing or the health of children outside theformal health care system are minimal. Traditional medicine (such asacupuncture and the Chinese medicine) is not common in Boston, whichmeans that BCH’s services are rarely substituted (Ali, 2015). Mostimportantly, even communities that have a tendency to try traditionalmedicine rarely do it with children given that they have a delicateimmune system and subjecting them to trial and error medication couldeasily lead to their death.

Customer’sbargaining power

Thereexists a few children’s hospital in Boston, which implies thatparents do not have many alternatives to select from. In addition,BCH has an established brand that makes one of the most popularpediatric care facilities in Boston and in the U.S. Additionally,buyer’s volume can be considered to be relatively low since eachfamily is likely to at most one child in the hospital at a time (Ali,2015). A combination of these factors leads to a low customer’sbargaining power.



Globalforces will impact pediatric care facilities and BCH in positive aswell as in negative ways. For example, the increase in demand forevidence-based practice is a global phenomenon that will continuepushing health care facilities to increase their investment inresearch (Lee, 2014). However, some hospitals (such as BCH) that useunreliable sources of research funds are likely find it difficult tocompete at the global level. In addition, the adoption of technologyin the health care sector is currently a global issue where thestakeholders are convinced that technology is the most significantsolution to issues of medical error and inefficiency in the deliveryof care. However, excessive use of technology in pediatric carefacilities is likely to inflate the cost of operating these carecenters.


Demographicforces affect pediatric care facilities in a direct way because theyaddress health care issues that are linked to demographiccharacteristics of their clients. The increase in the birth rate indifferent countries implies that the children’s hospitals will havemore clients. For example, it has been reported that the U.S.birthrate has risen for the first time in a period of seven years,which means that the demand for serviced rendered by BCH and otherchildren’s hospitals will increase (Calfas, 2015). In addition, therate of obesity is relatively higher among children, especially thosein the adolescent stage. This implies that the demand for medicalconditions that are associated with overweight as well as obesitywill increase with time.

Politicaland legal forces

Legaland political forces affect nearly all organizations operating in agiven jurisdiction. In the case of the health care organizationsoperating in the U.S. (including BCH), the enactment of Obama Care orwhat is commonly referred to as the Affordable Care Act will changesome of the ways in which they operate. According to Garfield &ampRudowitz (2015) hospitals will continue to experience an increase indemand for care, a decline in the amount of uncompensated health carecost, and an increase in client revenues. Others laws and politicalinterventions that are likely to affect BCH include those that focuson the protection of client rights to privacy and quality standards.


Currently,technology is perceived as among the leading determinants ofhospitals’ competitive advantage and their ability to deliverquality care (Denhoff etal.,2015). This has contributed towards the tendency of hospitals topurchase or lease modern equipments with the objective of deliveringservices that address the medical needs of their clients. However,the high rate of obsolescence of technology coupled with the highcost of equipment is the major limiting factor towards theapplication of technology in Children’s hospitals.


Thechances for taking care of a diverse clientele in a children’shospital are increasing as people continue to migrate and establishmulticultural communities. This means that health care providers whoare used to serving patients from their race should be prepared tocare for people from different race, religion, or other social group(U.S. Census Bureau, 2015). This calls for further training of thehealth care providers on cultural sensitivity programs.


Inadequateplanning on the part of BCH’s management has resulted in theshortage of pediatricians and the lack of a diverse source ofresearch funds. However, BCH is still strong enough to address a fewweaknesses that have resulted from the lack of a comprehensive planthat seeks to help the hospitals boost its research fund and retainthe most experiences pediatricians. Given its strong brand in theU.S. and at the global levels, BCH can still attract experiencedhealth care providers from any part of the world and raise researchfunds from different sources, even without changing its internalstructures. For example, liaising with other organization to raiseresearch funds, developing a plan for expansion of the scope ofprimary care providers, and retaining pediatric graduates can beachieved without altering the current leadership as well as theorganizational structure. This confirms that the strengths of BCHoutweigh its weaknesses. Consequently, BCH will continue to growamidst a myriad of challenges that are associated with internalweaknesses and threats that the hospital has been facing from theexternal environment.


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