AQIP Category Eight



8C1 Institutional Vision

The University of Saint Mary (USM) will realize its mission by developing a regionally recognized nursing program, building on its liberal arts foundation, with the introduction of program and strategic partnerships in allied health, and foster financial stewardship to further promote and enhance its reputation of academic excellence

8C2 Strategic Initiatives aligned with mission and vision

The current strategic initiatives are:

•  USM will develop allied health, starting with nursing, as a niche for which the university will be recognized
•  USM will improve its financial stability through revenue enhancement, fund development and cost containment.

The following criteria informed the selection of initiatives to ensure alignment with USM goals, values, and priorities:

•  Fit with Mission
•  Fit with Mandates for Services
•  Fit with USM strengths and opportunities
•  Required resources available
•  Financial stability improved


8P1 Strategic and systematic planning process

A central feature of USM's strategic and systematic planning process is the OnGoing Improvement (OGI) concept, graphic, and template used by all university departments, linking strategic initiatives and annual goals to mission, research, collaborations, actions, evaluation, and improvement. This was designed and implemented as a necessary university-wide component for the 2001 Comprehensive Curricular Initiative (see 1P1).

Figure 8-1 graphically depicts the centrality of mission and student learning in the OGI process which utilizes a data-based, collaborative decision making approach.

Figure 8-1: In pursuit of Excellence….Circle of On-Going Improvement

The reliance on the OGI model in priority setting and decision making is evident in USM's strategic planning process, initiated in the fall of 2005 by the Administrative Council (AC) as an AQIP Action Project. The comprehensive Strategic Plan (SP) linked the mission with new strategies and action plans resulting in a clearly defined and innovative institutional vision for the next five years. The timing of this strategic plan was significant in pursuing growth opportunities as USM faced fiscal stability challenges.

The strategic planning process resulted in a blueprint to successfully bring stability to the University over the next five years. Specifically, this plan provided for the collection of data and trends in several key areas. Analysis of information informed the decision process which then led the University to pursue its vision. The Strategic Planning Committee (SPC) used this data-based process to monitor, track and evaluate the steps completed during implementation.

The SPC was formed with representative members, selected by the President from the Board of Trustees (BOT), AC, faculty, staff, and the Extended Sites (ES). The SPC met on a regular basis and engaged in every aspect of the Strategic Plan development. Members also completed individual research and provided data to the SPC throughout the process. The SPC sought input from the BOT and the entire USM community at key points in the planning process. The SPC provided regular progress reports to the BOT and community throughout the plan development.

The SPC agreed to use a fairly standard approach to strategic planning with one exception. Generally once a Mission statement is established, the next step in the process is to develop a Vision statement. Both of these steps are usually completed early in the planning process before data are gathered and analyzed to determine strategic issues. However, the Committee felt the development of a Vision statement without considering background data and information on strategic issues would lead to a predetermined outcome that would not fully address the challenges facing USM. Therefore, the development of a Vision statement was purposefully delayed until after the identification of strategic issues.

The planning process used by SPC is shown in Figure 8-2 below.

Figure 8-2: Strategic Planning Process

8P2 Selecting short- and long-term strategies

To select strategies using the OGI model, SPC did the Information Gathering (IG) step through an environmental scan and SWOT analysis. They used internal and external factors of the scan in determining the mandates for USM's services. They reviewed demographic indicators for both traditional and nontraditional students, identifying probable majors and degrees earned both nationwide and at USM. SPC studied factors impacting the changing work place, including occupations with the largest anticipated job growth over the next several years. Allied health, information technology, education, and business topped the list and USM had these programs. Internally, several student surveys found why freshmen attend college, the importance of attaining learning outcomes, and what attracted students to USM. The SWOT analysis identified the strengths (S) and weaknesses (W), and examined the opportunities (O) and threats (T) facing the University. By looking at the University and its competitors, USM crafted a strategy to help compete successfully in the regional market.

The Committee spent a great deal of time and effort on Internal Collaborative Processes (ICP) , the next step in USM's OGI process. The SCP sought to have an informed, data based process. Given current challenges for higher education, it was incumbent upon USM to engage the University community in defining initiatives that reflect the changing needs of constituencies, while maintaining fidelity to the mission and values in providing a quality education. For a full day during the January 2006 Spring Institute, faculty and staff were engaged in conducting a SWOT analysis, reviewing external trends, and doing affinity mapping to define initiatives. A recurring theme was that USM had a lack of focus for distinctive priorities. The SPC decided to narrow the strategic issues down to two or three key issues. The SPC felt this would result in a manageable plan.

Moving into the Action & Implementation ( AI step of OGI), the SPC focused on two critical points. First, USM lacked focus . The Committee decided USM should define a niche. The second critical strategic issue was USM is challenged by limited resources. The Committee decided USM must increase financial stability. Consequently, the strategic initiatives and the Vision for the next 5 years were identified (8C1-2).

8P3 Developing action plans to support institutional strategies

Developing, implementing, tracking, and evaluating action plans occur during two steps in the OGI process, AI and On-Going Evaluation ( OGE ). The strategic plan and USM's action projects follow this model with these steps:

•  Objectives target a desired initiative
•  Metrics are identified to determine succes
•  Activities, responsibilities and timelines are established
•  Progress is discussed at University Assemblies
•  Results are analyzed
•  Findings are examined with internal and external stakeholders
•  Conclusions lead to revised or new OGI Goals

Subcommittees, with oversight by the administrative council, are tasked with following through on these steps.

Exemplifying these steps, the SPC formed two subcommittees to formulate action steps necessary to implement the strategic initiatives. The allied health subcommittee developed criteria for potential programs. Those criteria included: Market & Competition, Clinical Space, Partners, Startup Costs, Return on Investment (ROI), Accreditation, Equipment/Lab and Faculty Availability. The fiscal stability subcommittee constructed an action plan to improve financial stability by addressing finances, academic programs, student life, admissions/marketing and administrative services. Successful implementation of the action plan steps lead to accomplishing the vision and ensuring financial viability for the future.

Within the context of both external and internal realities, the action steps include program and operations analyses which drive data based decision making. This comprehensive approach balances an awareness of resources and trends with curricular, cultural, and mission related considerations.

8P4 Aligning planning processes, overall institutional strategies, and action plans

To align processes, strategies, and action plans, USM recognized that a systems approach was essential for collecting, sharing, and using information to drive effective decision making. Beginning in January 2006, USM undertook a two-part AQIP Action Project to develop a comprehensive management information system for institutional decision making that would be accessible, reliable, and systemic. The vision is represented below in Figure 8-3 and depicts the closed loop OGI model highlighting input by internal and external stakeholders, a focus on programs and initiatives, a systematic process for assessing progress, and analysis of data to make informed decisions which are reviewed by stakeholders leading to renewed objectives. With oversight by AC, the transparency of this process makes information accessible and aligns efforts across the university.

Figure 8-3: Informed Decision Making Model

The first phase of the Data Based Decision Making Action Project, led by the Assessment Committee, identified information currently collected and evaluated usefulness of reports. Through interviews, the committee learned that much data were collected, some reports were generated for use by single offices or departments, and a process did not exist for systematic sharing of information. Concurrently, USM converted to a Jenzabar EX system which provided the technology to systematize data reporting. As a result, the committee streamlined and prioritized existing report tools based on effective measurement of AQIP criteria.

The second phase of the project focused on establishing indicators for institutional effectiveness, revising report tools, and establishing procedures for decision making. This has occurred in three primary areas: learning outcomes assessment; fiscal stability, and distance learning. Each of these areas crosses departments, programs, offices, and campuses. As a result, procedures are in place for these initiatives that break down silos, open communication about data based information, and define a process for decision making. These procedures are transferable to other initiatives which can influence institutional operations. Work continues to fully realize the comprehensive goal of this project.

8P5 Selecting and Setting Performance Measures for initiatives and action plans

USM uses the OGI model to select and set performance measures for strategic initiatives and action plans. At various points throughout the process—IG, ICP, and OGE—faculty, staff, and committees:

•  Analyze information, data-based results, and trends which lead to new objectives for action plans
•  Define benchmarks for effective achievement of objectives based upon this systematic review of results and opportunities
•  Select metrics and define targets for performance measures
•  Finalize action steps and implementation procedures, aligning activities with anticipated goals and outcomes

The action plans proceed through the governance structure for review and approval by AC, and when appropriate, to the BOT. Since the OGI model is cyclical, the analysis of results leads to new goals and objectives, that when studied (IG) and discussed (ICP), yield new performance measures and benchmarks for the next improvement cycle.

8P6 Accounting for resource needs

USM identifies resource needs for program improvements and action plans during the AI step of OGI. Committees conduct a thorough review of human and financial resources needed for each action step determining what is essential for effective implementation. If the action plan can be supported within existing budgets, the department chair and/or appropriate vice president allocate the resources. If the plan becomes a strategic initiative, AC either approves resources or modifies the scope or timeline of the action plan based on budget realities. AC uses a ROI approach to determine priorities and allocations. During the OGE step, ROI is a factor in judging effectiveness and ongoing support.

8P7 Developing faculty, staff, and administrator capabilities

USM provides opportunities to build the capabilities of faculty, staff, and administrators to meet strategic goals. Supervisors determine needs through professional development reports, stakeholder and employee surveys, and training consultants. Based on the review of this information, strategic initiatives, and action plans, AC sets priorities for capacity building. For example, two Action Projects (Strategic Plan & Client Service) built capacity for increasing admission results and client satisfaction. Through Noel Levitz consultant training for admissions and extended sites staff, target action plan objectives were met. As a result of survey findings from prospective students and their parents, USM is providing training to the first-contact staff to increase responsiveness to client needs.

Also, an individual faculty, staff member, or department can initiate professional development activities to build capabilities. AC designates annual budget allocations for professional development and training and these funds are requested through the appropriate vice president. In the request, the individual or department identifies how participation in the proposed activity will advance their professional skills and USM priorities.

8P8 Continuous improvement effectiveness measures

Effectiveness measures for ongoing, continuous improvement are collaboratively determined as a part of the OGI process. Individuals, departments, and committees work together to define measures and assess progress based on USM goals and priorities. Administrative heads determine progress toward objectives and mission-related goals by analyzing the Annual OGI Reports that faculty and staff submit describing their individual growth and their program's improvement. Administrative vice presidents submit a report to the President summarizing accomplishments and improvement needs. The President submits a compiled annual report to the BOT. The criteria for judging effectiveness focuses on the steps of the OGI template as well as on the measurable results of the targeted action plan.


8R1 Results for accomplishing institutional strategies and action plans

Current status on achieving the action plan results for the 2006-11 Strategic Plan is summarized in the following Table 8-1.

Table 8-1: Strategic Plan Progress Results

Fiscal Stability: Improve financial stability through revenue enhancement, fund development, and cost containment

Action Plans

2008 Progress Results

Fiscal Planning & Policies

Established monitoring process using benchmarks

Approved and activated Activity Based Costing (ABC)


Built expenditure control incentives

Supplemental Budget process approved


Activated plan to increase annual revenues and endowed funds

Activated system to control discounting, increase bill collection, & track overtime comparisons

Enrollment & Marketing

Increased enrollment

Improved data tracking of recruitment & admissions effectiveness

Improved customer satisfaction

Student Life

Established standards for career development activities

Academic Programs

Established ABC

Based on ABC results, 3 targeted programs are implementing growth plans

OPC Objectives

Revised structural relationships

Increased student satisfaction with course management system

Monitoring improved procedures for admission & registration

Administrative Services & Governance

Simplified administrative procedures for revenue recording, payroll & benefits, and accounts payable


Allied Health: USM will develop allied health, starting with nursing, as a niche for which the university will be recognized

Action Plans

Progress Results

Program Feasibility & Development

Nursing Program full capacity enrollment

Healthcare Informatics program approved and implemented

Completed AQIP Action Project for DPT

Plan for specialty certifications within existing science programs

Online Offerings

Activated On-line RN-BSN program—76 enrolled 2008

Professional Development Services

Canceled feasibility study due to change in personnel

Partnership Development

Changed online partner and enrollment increased by 34%

Hospital full scholarships for nursing students

Preliminary agreements with KC Univ of Medicine & Biosciences.

8R2 Performance Projections for 2011

In Table 8-2 Administrative Council projects performance goals for 2011 which are aligned with USM's strategic initiatives.

Table 8-2: Performance Projections



Performance Projections

Focus on sustainability


$650,000 annual fund (2009)

$6.7 mil SMART initiative (2010)

Increase Retention

50% graduation rate of FFF by 2011

Raise quality of student life

New dorm opens 2009

Refurbished facilities by 2011

Raise efficiencies through improved processes

Improve registration processes

Activate admissions to registration software by 09

Automated scheduling module in use by Fall 09

70% of students register online by Fall 09

Improve advising processes to increase retention

Activate advising module by Fa 09

New Advising-Student Success Plan activated Fa 10

Build brand

Health care education

Implement marketing plan for Health Care brand by 2011

Activate additional allied health major by 2010

8R3 Comparing projections with others

Comparing performance projections for action plans and strategies with others occurs in two ways. First, the environmental scan that is regularly updated at USM provides a comparative picture of strategic priorities in relation to changing needs and market demands. Increasing retention, shifting demands for student life quality, and allied health professions are top priorities in the trends literature based on demographic shifts, educational trends, and workforce realities now and in the future.

Second, translating these trends into performance projections, USM uses its peer institutions for comparisons through Council of Independent Colleges (CIC) Key Indicators Tool reports. Indicators that are tracked are listed in Table 8-3. From these patterns, the target projections for USM are realistic and in accordance with peers.

Table 8-3: Performance Projection Comparisons




USM 2006

USM 2007

USM 2011 Target

Admission Yield Rate (Admission-Enrollment)





Retention Rate 1 st to 2 nd yr*





Grad Rate-6yr*





*Based on cohort group

8R4 Evidence of system effectiveness for planning continuous improvement

The evidence that USM's OGI process is effective can be found in how changes are made and how they align with intended goals. The Comprehensive Curricular Initiative (CCI) depicts the effectiveness of curriculum restructuring and assessment efforts (see 1P1 and 1R3). Also, Category 3 provides evidence that systematic information is gathered, analyzed, and used to revise practices that yield greater student and stakeholder satisfaction (see 3R1-2), such as new student orientation and technology enhancements at the Extended Sites.

Two items on the 2006 Culture Survey identified faculty and staff satisfaction with ongoing improvement process as shown in Figure 8-4.


8I1 Improving processes and systems for continuous improvement

In the schemas depicting ongoing improvement (8P1) and alignment of institutional structures (8P4), steps are clearly delineated for ongoing evaluation and informed decision making, respectively. During these steps two levels of examination simultaneously occur:

  1. assessing and revising targeted objectives
  2. reflecting critically on the improvement process itself

Consequently, at the level of an individual, a program staff, a committee, or AC, deliberations take place regarding the effectiveness of the system. In this way, those closest to relevant decisions have input not only on desired results but on the means for continuous improvement. Recommendations are acted upon through USM's governance structure.

8I2 Setting targets and communicating results

The committees that have primary responsibility for the current initiatives analyze the results on stated objectives according to the action plan timeline. Based on the results, committees draw conclusions and make recommendations for improvement, leading to the articulation of new goals and objectives. This information is submitted for feedback and approval to USM's AQIP committee and/or AC.

The current improvement priorities grew out of this analysis process and are listed in 8R2. Communicating the results and the subsequent improvement targets occurs through the University Assembly which meets each month and is chaired by USM's President.