Facing Challenges: Sustaining Operations of Modern-Day Orgs.

Section 1. Introduction1.1 Background of the StudyOne of the main problems facing many modern-day organizations is lack of vision and inability to sustain their operations. Most organizations focus more on profitability than sustainability which enables them to achieve economic goals fast. However, statistics show that about 45% of companies in the United States file for bankruptcy as soon as the profitability starts to decline (Seifert, 2018). With the privatization of many public hospitals, sustainability plans are pushed down the priority list as managers focus on driving revenue and growth. However, the managers do this oblivious of the fact that ignoring sustainability goals hurt the organizations in the long run (Amore, Bennedsen, Larsen & Rosenbaum, 2019; Stevanovic, Allacker & Vermeulen, 2017). To achieve sustainable development, companies must define and redefine their strategy and implement the pragmatic approach. That is a difficult fete to achieve especially for private organizations managing public hospitals which are constantly faced with a new paradigm of balancing the social welfare and the stakeholders' wealth objectives (Bergmann, 2016). Resolving the conflict between offering services at a sustainable fee and the goals of maximizing stakeholder wealth requires the management to compromise on one goal, and this is where sustainability objectives come in (McDonald, 2016; Tcihospital.tc, 2019).

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According to Nascimento, Araujo, and Alves (2017), lack of sustainability plans and failure to integrate sustainability plans with the overall strategy of the company are among the main reasons for inadequate focus on sustainability. On the other hand, Spangenberg (2016) explains that corporate sustainability is an approach of creating long term value for the stakeholders by implementing a business strategy focuses on ethical, social, environmental, cultural as well as economic aspects of the hospital. The motivation and rationale behind integrating sustainability plans and strategy serve as a prelude to the examination of challenges and course of action in a hospital's strategy for development and integration (Bocken, Short, Rana & Evans, 2014). While most organizations have successfully implemented the sustainability plans, the inclusion of sustainability plans is not complete because they perceive sustainability as a separate project and not part of the company's core goal (Bocken et al., 2014, Liang, Ng, Lam, Castner, Leach, Gu, Healey, Galloway & Chen, 2018). On the other hand, Seifert (2018) stated that the additional legislative considerations and stakeholder requirements made in most cases introduce complexities in managing the sustainability plans (Nicolaescu, Alpopi and Zaharia, 2015).

Landrum and Ohsowski (2017) explored the issue of sustainability and noted that the strategic objectives of a company are multi-dimensional and must be broken down into individual departments. These departments are then tasked with planning, measuring, and communicating the defined value creations holistically. Additionally, Pacheco, Alves, Kruger, Lourencao, and Caldana (2018) argue that a solution for the corporate sustainability management and its evaluation are particularly necessary for balancing the economic, ecological, as well as social performance factors (Erdil, Aktas & Arani, 2018). This is the only ways that sustainability decision can be made and optimized. The national hospitals must balance between social performance and economic factors and focus on how the hospital can remain operational against the backdrop of demand for financial returns.

1.2 Problem StatementThe proposed handover of the management of TCIH hospital from InterHealth Canada to the government of Turks and Caicos islands is highly likely to affect the sustainability of the hospital negatively. TCIH was commissioned officially in 2010 as one of the country's acute secondary health care facility. The hospital has two state-of-the-art medical centers, one at Cockburn Town medical center in Grand Turk and the other one at Cheshire Hall medical center in Providenciales. Both sites serve the patients from the local communities and tourists visiting across the archipelago (Tcihospital.tc, 2019). Initially, the hospital was commissioned as a public hospital but currently is being managed by a private company known as InterHealth Canada after the Turks and Caicos Islands' government signed an agreement with the company through a public-private partnership agreement (Kim & Kim, 2018). InterHealth Canada is one of the leading pioneers in the public and private health care partnership as well as a world leader in healthcare operations, planning, consulting, and management (Tcihospital.tc, 2019). In addition, the company has exported Canadian intellectual expertise in the healthcare sector by offering on-site services as well as ambulatory services. With the hospital under the management of InterHealth Canada, sustainability has been a major concern for the Turks and Caicos government (Hussain, Ajmal, Gunasekaran & Khan, 2018). Some of the key areas under consideration in terms of sustainability include utility and consumption, waste, sourcing, environmental pollution, financial planning, execution as well as reporting and transparency in the political environment (John, Qadeer, Shahzadi & Jia, 2019).

If InterHealth Canada was to hand over the management of the hospital to the Turks and Caicos administration, there is high likelihood that the sustainability of the institution would be at risk given that the sustainability plans are not integrated into the management framework of the hospital (Kim & Kim, 2018). If the hospital's current sustainability plans comprehensive enough to meet sustainability goals. If so, are the sustaining plans integrated into the hospital overall goals?

1.3 Research AimsThe aims of the study will be to investigate the best practices for successful implementation of sustainability plans in Turks and Caicos national hospital management framework and the impacts of implementing such plans.

Research Objectives The objectives of the study include:

To determine the impact of implementing a sustainability plan on TCI hospital's goals and objectives

To determine how best the InterHealth Canada can manage sustainability in the company

To determine how the hospital is balancing or trading off sustainability and profitability objectives

1.5 Research questionsWhat are the actions or strategies that the company can pursue to ensure that the sustainability plans are properly integrated into the company's management framework and aligned with the vision and mission?

What are the benefits of integrating a sustainability plan into the hospital's management framework?

1.6 The Significance of the Study.While there are several studies that have been conducted on the integration of sustainability plans in hospitals, no study, until now, has ever been conducted to specifically focus on the integration of sustainability plans in the Turks and Caicos Islands. Therefore, this study will fill this literature gap by studying the problem in the archipelago area to produce a solution that is relevant to all the hospitals in the archipelagos. Secondly, this study will provide a practical and actionable solution to the sustainability problem faced by hospitals in the area, which means that it will have management implication. Also, the study will provide a good background for future researches in the same topics and context. Therefore, the research will prove significant to researchers, hospital management, the government, the communities, and the agencies in the locality.

Section 2: Literature Review.Sustainability plans refer to the strategies developed by an organization or a government to help the achievement of goals that relate to community, environmental, and financial sustainability. Braithwaite, Testa, Lamprell, Herkes, Ludlow, McPherson, Campbell, and Holt (2017) underscored that sustainability plans are critical for the development of goals which are core to the organization. Maitland, Malcolm, and Handfield (2015) observed that organizations which have sound sustainability plans do not depend on the government for help in management of their core activities. The hospitals in the Turks and Caicos are some of the organizations which have been able to create and implement their private plans with little help that is only delivered through close partnerships with the government.

Some of these hospitals focus on achieving the sustainability plan implementation and incorporation by issuing contracts to other private organizations. Braithwaite et al. (2017) pointed out that even though the hospitals in the Turks and Caicos Islands Hospitals are owned by the government, the organizational operations are managed by private contracting companies. This implies that these hospitals strive to have authority over their Contingency Plans. A study by Braithwaite et al. (2017) shows that the Accident and Emergency Centers of the hospitals have been tested and approved to become part of the exercises of the national, and agency-led simulation.

Integrated Healthcare Services Delivery

The hospitals have developed a healthcare system, which separates the funding from the provision of services. The system explicitly defines the role of the government to be a regulatory body of the whole health sector in the region. International Monetary Fund (2015) noted that the responsibility of managing the contingency plans is delegated to the hospitals. They, therefore, provide that the role that the government plays is not just to oversee the publicly provided services. It is important to note that healthcare and other specialized services are currently provided using two different healthcare complexes at Grand Turk and Provo. Also, Interhealth Canada Limited is tasked with operating and building hospitals that provide healthcare services.

In addition, the responsibilities of private contracting companies expand to encompass the provision of a full range of vital clinical services (Hani and Awad, 2017). This implies that, as much as the government owns the healthcare institution, the hospitals have created plans whose implementation has been outsourced to other organizations. The healthcare services have been set to be provided under the ICL for 25 years, during which the contract will still be active.

Plans beyond the Contract

The contracted services on the operations of the healthcare institutions will proceed since sustainability plans on the same has already been established. The end of this period will mark the point in which the infrastruc...