Examining the Intersection of Strategic Thinking and Continuous Process Improvement in Medical Education Strategic Planning: A Content Analysis Case Study of the United States Air Force School of Aerospace Medicine
Background: In 2017, the Department of the Air Force Surgeon General and Secretary of the Air Force identified a need for a drastic change in the quality of education conducted at their premier medical institution of higher learning, the United States Air Force School of Aerospace Medicine (USAFSAM). Although it had adopted continuous process improvement (CPI) using Lean Six Sigma to address challenges, the school still struggled with decreased student throughput, low graduate effectiveness, and risk of accreditation loss for their aerospace medicine residency. This deterioration compromised the Air Force’s ability to successfully educate 6,000 students annually in unique medical readiness skills. Purpose: The purpose of this study was to record the detailed strategic planning efforts of USAFSAM’s first civilian dean. Using documentation produced from those efforts, this study aimed to create a novel strategic planning model that combined best practices from military CPI and academic strategic thinking. Methods: This case study focused on one location, USAFSAM at Wright-Patterson Air Force Base in Dayton, Ohio. After relevance sampling of 2,628 pages from the dean’s strategic planning process, a total of 150 pages were coded using ATLAS.ti 22 to conduct relational content analysis. Results: A hybrid approach to coding uncovered 44 deductive codes and 5 inductive codes from 10 strategic tools. Concept occurrence identified the number of times a theme was present in the text, and proximity analysis was calculated using the c-coefficient to determine the strength of the co-occurrence between each concept. This methodology yielded strong results indicating a converging relationship between all strategic processes tested – strategic planning, strategic thinking, and continuous process improvement (CPI) – and their associated tools. Strategic tool origin, whether civilian or military, was not a clear indicator of outcomes. The SWOT (strengths, weaknesses, opportunities, threats) analysis produced the greatest number of connections between all tools with six of the 44 deductive codes having co-occurrence “closely related to” (c ≥ 0.90) relationships and four codes having “perfectly dependent” (c = 1) relationships. The Hot Spots scale, a theme-categorizing strategic thinking tool used to understand the “voice of the customer,” produced the most novel information with the fewest connections and only one of the 44 deductive codes having co-occurrence “closely related to” another deductive code (c = 0.95). Conclusion: A novel five-step model called the ‘Triple O’ Pentagonal OODA loop framework was created, combining best practice tools from strategic planning (SWOT analysis and purpose trident), strategic thinking (Hot Spots scale and GOST [goals, objectives, strategies, tactics] framework) and CPI (Phases 6-8). Member checking, peer debriefing, a third-party data collector, and a nonhuman subjects-based methodological approach was used to increase reliability and trustworthiness and decrease bias. Further data analysis with additional coders to strengthen this study’s findings is recommended. Future research should focus on testing of the new framework for effectiveness in military medical educational institutions and beyond.
Health Sciences, Education, Business Administration, Management, Education, Higher
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