Flevy Management Insights Case Study
Operational Efficiency Strategy for Nursing Facilities in the Healthcare Sector


Fortune 500 companies typically bring on global consulting firms, like McKinsey, BCG, Bain, Deloitte, and Accenture, or boutique consulting firms specializing in Cost Reduction Assessment to thoroughly analyze their unique business challenges and competitive situations. These firms provide strategic recommendations based on consulting frameworks, subject matter expertise, benchmark data, KPIs, best practices, and other tools developed from past client work. We followed this management consulting approach for this case study.

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Consider this scenario: A mid-sized nursing and residential care facility is facing a strategic challenge with a Cost Reduction Assessment.

The facility is experiencing a 20% increase in operational costs while its occupancy rates have declined by 15% over the past two years due to rising competition and changing patient preferences. Additionally, the facility is grappling with a 10% increase in employee turnover, impacting patient care and operational efficiency. The primary strategic objective of the organization is to enhance operational efficiency and reduce costs to improve profitability and patient care quality.



The organization under review is a recognized player in the nursing and residential care sector, yet it is currently at a crossroads due to escalating operational costs and diminishing patient occupancy rates. Initial analysis suggests that the root cause of these challenges may be multifaceted, involving both inefficient operational processes and a failure to adapt to the evolving healthcare landscape which emphasizes personalized and high-quality patient care.

Market Analysis

The nursing and residential care sector is experiencing a transformative shift, driven by an aging population and evolving patient demands for more personalized and high-quality care services. These dynamics are reshaping the competitive landscape, making it imperative for facilities to adapt swiftly to remain relevant.

To understand the competitive forces at play, we consider the primary dynamics influencing the sector:

  • Internal Rivalry: High, as facilities vie for a limited patient base with similar service offerings.
  • Supplier Power: Moderate, given the number of suppliers providing medical supplies and equipment, but rising due to increasing specialization in medical technologies.
  • Buyer Power: Increasing, as patients and families have more options and access to information about care facilities.
  • Threat of New Entrants: Moderate, with regulatory hurdles acting as a barrier, but offset by growing market opportunities due to demographic trends.
  • Threat of Substitutes: Low to moderate, given the specialized nature of care, though home care services are emerging as a viable alternative.

Emerging trends, such as the integration of technology in patient care (telehealth, electronic health records) and a shift towards personalized care plans, are reshaping the industry. These trends present both opportunities and risks:

  • Adoption of Telehealth Services: Offers the opportunity to expand services and improve patient care, with the risk of requiring significant investment in technology and training.
  • Increasing Demand for Personalized Care: This creates the opportunity to differentiate service offerings but requires enhancements in staff training and operational flexibility.
  • Regulatory Changes: Ongoing healthcare reforms present both opportunities for funding and risks associated with compliance costs.

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Internal Assessment

The facility boasts a committed staff and a reputation for quality care but is hampered by operational inefficiencies and outdated technology.

SWOT Analysis

Strengths include a dedicated team and a strong community reputation. Opportunities lie in leveraging technology to improve care and operational efficiency. Weaknesses are seen in high operational costs and staff turnover. Threats include increasing competition and regulatory changes impacting operational costs.

Core Competencies Analysis

The facility's core competencies lie in its patient-centric approach and experienced care team. However, to maintain its competitive edge, it must enhance its operational efficiency and adopt technological innovations. Strengthening these areas will enable the facility to deliver higher quality care more efficiently, positioning it for success in a rapidly evolving healthcare environment.

Value Chain Analysis

An examination of the facility's value chain identifies inefficiencies in patient intake processes and resource allocation. Streamlining these processes through digital solutions can significantly reduce costs and improve patient experiences. Strengths in patient care and community engagement are critical assets to be leveraged.

Strategic Initiatives

Based on the insights from the market analysis and internal assessment, the management team has identified the following strategic initiatives to be pursued over the next 18 months :

  • Implement a Digital Transformation Initiative: This initiative aims to integrate digital health technologies into patient care and operational processes to improve efficiency and patient outcomes. The expected value includes cost savings from operational efficiencies and enhanced patient satisfaction. This will require investments in technology infrastructure and staff training.
  • Develop a Staff Retention and Training Program: Focused on reducing turnover and enhancing staff skills, particularly in personalized patient care and technology use. The initiative intends to improve employee satisfaction and patient care quality. Resources needed include funding for training programs and incentives for staff retention.
  • Expand Personalized Patient Care Services: By focusing on tailored care plans and integrating patient feedback into care processes, this initiative aims to differentiate the facility in a competitive market. Value creation comes from increased patient satisfaction and occupancy rates. This requires investments in staff training and patient engagement technologies.

Cost Reduction Assessment Implementation KPIs

KPIS are crucial throughout the implementation process. They provide quantifiable checkpoints to validate the alignment of operational activities with our strategic goals, ensuring that execution is not just activity-driven, but results-oriented. Further, these KPIs act as early indicators of progress or deviation, enabling agile decision-making and course correction if needed.


A stand can be made against invasion by an army. No stand can be made against invasion by an idea.
     – Victor Hugo

  • Operational Cost Reduction: To measure the effectiveness of digital transformation in streamlining operations.
  • Employee Turnover Rate: To gauge the impact of the staff retention program.
  • Patient Satisfaction Scores: To assess improvements in patient care quality and personalization.

These KPIs will provide insights into the strategic initiatives' effectiveness, highlighting areas of success and opportunities for further improvement. Monitoring these metrics closely will enable the facility to adjust its strategies as needed to achieve its objectives.

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Cost Reduction Assessment Deliverables

These are a selection of deliverables across all the strategic initiatives.

  • Digital Transformation Roadmap (PPT)
  • Staff Retention and Training Plan (PPT)
  • Personalized Patient Care Framework (PPT)
  • Operational Efficiency Financial Model (Excel)

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Digital Transformation Initiative

The team employed the Balanced Scorecard framework to guide the Digital Transformation Initiative. The Balanced Scorecard, developed by Robert S. Kaplan and David P. Norton, is a strategic planning and management system used to align business activities to the vision and strategy of the organization, improve internal and external communications, and monitor organizational performance against strategic goals. It was particularly useful for this initiative as it allowed the organization to view its digital transformation efforts from multiple perspectives including financial performance, customer knowledge, internal process efficiency, and learning and growth.

Following the deployment of the Balanced Scorecard, the organization:

  • Developed specific objectives and measures for each of the four perspectives (financial, customer, internal business processes, and learning and growth) that digital transformation would impact.
  • Conducted workshops with department heads to align digital transformation goals with strategic objectives and identify key performance indicators (KPIs) for each perspective.
  • Implemented a dashboard to regularly monitor progress against these KPIs and adjust strategies as necessary.

As a result of implementing the Balanced Scorecard, the organization successfully aligned its digital transformation efforts with its strategic objectives, ensuring a holistic approach to change. This alignment helped in achieving a smoother transition to digital processes, with improved oversight of progress and outcomes across all dimensions of the initiative.

Staff Retention and Training Program

For the Staff Retention and Training Program, the organization utilized the McKinsey 7-S Framework. This framework, developed by Tom Peters and Robert Waterman during their tenure at McKinsey & Company, focuses on seven internal elements of an organization that need to align for it to be successful: strategy, structure, systems, shared values, skills, style, and staff. It was instrumental in this initiative because it emphasized the importance of aligning the organization's capabilities and values with its strategic goal of reducing staff turnover and enhancing training.

In applying the McKinsey 7-S Framework, the organization:

  • Assessed the current alignment of the seven elements with the strategic objectives of the staff retention and training program.
  • Identified gaps in skills and staff alignment that contributed to high turnover rates and developed targeted training programs to address these gaps.
  • Revised recruitment and onboarding processes to better communicate shared values and integrate new staff into the organizational culture.

The implementation of the McKinsey 7-S Framework led to a more cohesive approach to staff retention and training. By ensuring that all elements of the organization were aligned with the strategic objectives of the initiative, the facility saw a significant reduction in turnover rates and an improvement in staff satisfaction and competencies.

Expansion of Personalized Patient Care Services

The organization adopted the Blue Ocean Strategy for the Expansion of Personalized Patient Care Services initiative. The Blue Ocean Strategy, formulated by W. Chan Kim and Renée Mauborgne, encourages organizations to create new demand in an uncontested market space or "Blue Ocean," rather than competing head-to-head with other providers in an existing industry or "Red Ocean." This framework was particularly relevant for this initiative as it guided the organization in identifying and executing on untapped opportunities in personalized patient care.

In implementing the Blue Ocean Strategy, the organization:

  • Conducted a comprehensive analysis to identify the current state of patient care services and uncover areas where patient needs were not being fully met.
  • Developed innovative care models that emphasized personalization and patient involvement in care planning, distinguishing the organization from competitors.
  • Launched pilot programs to test these new care models in select departments, gathering patient and staff feedback for continuous improvement.

The application of the Blue Ocean Strategy enabled the organization to successfully differentiate its patient care services, creating a unique value proposition that attracted more patients and improved patient satisfaction scores. This strategic approach not only positioned the organization favorably in a competitive market but also established a new standard for personalized care in the sector.

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Key Findings and Results

Here is a summary of the key results of this case study:

  • Operational costs reduced by 12% following the Digital Transformation Initiative, exceeding the initial target.
  • Employee turnover rate decreased by 8%, indicating positive impacts from the Staff Retention and Training Program.
  • Patient satisfaction scores improved by 15%, reflecting enhanced care quality and personalization.
  • Occupancy rates increased by 10%, reversing the previous declining trend.

The strategic initiatives undertaken by the organization have yielded significant positive outcomes, notably in operational cost reduction, employee retention, patient satisfaction, and occupancy rates. The successful implementation of digital transformation has not only streamlined operations but also contributed to cost savings, demonstrating the effectiveness of aligning digital efforts with strategic objectives through the Balanced Scorecard framework. The Staff Retention and Training Program, guided by the McKinsey 7-S Framework, has effectively reduced turnover rates, indicating a more satisfied and aligned workforce. Furthermore, the expansion of personalized patient care services, inspired by the Blue Ocean Strategy, has differentiated the facility in a competitive market, as evidenced by improved patient satisfaction and increased occupancy rates. However, while these results are commendable, there were areas where outcomes did not fully meet expectations. The anticipated cost savings from digital transformation were slightly offset by the initial investment costs and ongoing training requirements. Additionally, the increase in occupancy rates, while positive, still falls short of offsetting the previous decline entirely. These challenges suggest that further optimization of digital investments and a continued focus on market differentiation strategies could enhance future outcomes.

Given the current results and insights gained, the recommended next steps include: 1) Conducting a detailed cost-benefit analysis of all digital investments to identify areas for further optimization, ensuring that future technology expenditures contribute to sustained operational efficiency. 2) Expanding the personalized patient care services initiative to more departments, leveraging the positive patient feedback and satisfaction scores to further increase occupancy rates. 3) Continuing to monitor and adjust the staff retention program, focusing on areas where turnover rates can be further reduced, and employee satisfaction can be increased. These actions are expected to build on the current successes and address areas needing improvement, positioning the organization for continued growth and competitiveness in the evolving healthcare landscape.

Source: Operational Efficiency Strategy for Nursing Facilities in the Healthcare Sector, Flevy Management Insights, 2024

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