create a question for : The Health Care Manager Volume 24, Number 3, pp. 200-208 2005, Uppincott Williams & Wilkins, Ine. Environmental Scanning and the Health Care Manager Elizabeth J. Layman, PhD, RHJA, CCS, FAHIMA; Richard Bamberg, PhD, MT(ASCP)SH, CLD, CHES Health care managers and supervisors work in an environment of major changes and ongoing turbulence, Basic terms and strategic approaches are described to enable managers and su- pervisors to better understand the process of environmental scanning in the turbulent health care environment. Drawing from multiple disciplines, the information allows health care managers and supervisors to improve their skills as environmental scanners as they develop and implement strategic plans in this environment. Key words: environmental scanning, leadership, organiza- tion and administration, planning techniques, strategic planning STRATEGIC PLANNING IS critical to the survival of health care organizations in today's turbulent environment,' Knowledge of strategic planning is important for all lev- els of management, including midlevel man- agers,^ Midlevel managers are responsible not only for developing plans in concert with the plans of upper administration, but also for executing these plans,^'' Skills in strategic planning become more important as busi- ness and corporate models are increasingly adopted and used in health care. An important component of strategic plan- ning is environmental scanning,' In environ- mental scanning, leaders assess threats and opportunities in the external environment. This information becomes the basis of future initiatives. Understanding the environment, however, is not a simple task. The literature spans several disciplines and presents nu- merous conceptual and operational defini- From the Department of Health Services and Information Management (Dr Layman) and Department of Clinical Laboratory Science, School of Allied Health Sciences, East Carolina University, Greenville, NC (Dr Bamberg). Corresponding author: Elizabeth J. Layman, PhD, RHLA, CCS, EAHLMA, Department of Health Services and Information Management, School ofAllied Health Sciences, East Carolina University, Greenville, NC 27858-4353 (e-mail: l..e@mail.ecu.edu). 200 tions of the environment and its elements. Moreover, in health care, multiple and varied terms have been used to describe the envi- ronment including uncertain, turbulent, hy- perturbulent, and unstable,^"^ Previous articles have described the pro- cess of strategic planning and strategic change.''^'" This article defines key terms and summarizes the major theories about envi- ronments and strategic initiatives. Particular attention is paid to the turbulent environ- ment of today and the past 2 decades. Health care managers and supervisors can use this knowledge as they participate in strategic planning and forecasting, develop plans for their departments, and implement strategic initiatives. As a briefing on the health care environment, this article also offers assis- tance in individual leadership development. Therefore, this article serves as a primer for new health care supervisors and managers and as a review for seasoned practitioners, HEALTH CARE ENVIRONMENT "Turbulence exists when changes faced by an organization are nontrivial, rapid, and discontinuous "'i(p225)Divingturbulenceare short cycles of technological innovation and obsolescence and the explosion of knowl- edge.'^ For health care, researchers and the- orists agree that turbulence began in the 1980s with the implementation of Medicare's inpatient prospective payment system.^'"'' In fact, the health care environment has been described as unremittingly turbulent.'^ It has even been described as hyperturbulent.^ Four macrodynamic trends in health care are the basis for this turbulence; 1. Socioculturalwellness, self-care, and consumerism; 2. Technologicalshorter life cycles, higher costs, and rapid obsolescence; 3. Economicthe inpatient prospective