Formal strategy in public hospitals

Professionalizing Change

Lessons from successful change in professional firms can be usefully applied in manufacturing and engineering businesses.

Decoupling the use and meaning of strategic plans in public healthcare

Background

The culture of New Public Management has promoted the diffusion of strategic management tools throughout Public Healthcare Organisations (PHOs). There is consensus that better strategic planning tools are required to achieve higher levels of organisational performance. This paper provides evidence and understanding of the emergent uses and scope of strategic planning in PHOs, in order to answer three research questions: (i) has the New Public Management approach changed the organisational culture of PHOs in terms of how they adopt, diffuse, and use strategic planning documents? (ii) how coherent are strategic planning documents in PHOs? and (iii) what are the main purposes of strategic documents in PHOs?

Methods

An analysis was carried out in three Italian Local Health Authorities. We analysed the number and types of formal strategic documents adopted between 2004 and 2012, evaluating their degree of coherence and coordination, their hierarchy, their degree of disclosure, and the consistency of their strategic goals. A content analysis was performed to investigate overlap in terms of content and focus, and a qualitative analysis was carried out to study and represent the relationships between documents.

Results

The analysis showed that a rich set of strategic documents were adopted by each PHO. However, these are often uncoordinated and overlap in terms of content. They adopt different language and formats for various stakeholders. The presence of diverse external drivers may explain the divergent focus, priorities and inconsistent goals in the strategic documents. This planning complexity makes it difficult to determine how the overall goals and mission of an organisation are defined and made visible.

Conclusions

The evidence suggests that PHOs use a considerable number of strategic documents. However, they employ no clear or explicit overarching strategy currently, and strategic planning appears to be externally oriented. All the documents communicate similar topics to different stakeholders, although they use different language to answer to the different expectations of each stakeholder. Therefore, strategic planning and plans seem to be driven by neo-institutional approaches, as they are means to build consensus and negotiate ground for strategic actions, rather than means to identify strategic choices and priorities.

Resource constraints and strategic change in a public hospital system

It has been suggested that strategic management in public services tends to be oriented towards preserving and perpetuating current patterns of service provision, rather than changing priorities. However, faced with severe resource constraints combined with growing demand and rapidly developing technology, public hospitals in Canada have come under increasing pressure. Based on an empirical study of strategic management and change in 32 Montreal hospitals, this paper examines the relationship between financial adversity and the extent and nature of strategic change in these organizations. Strategic change indicators considered in the study include overall product mix, product diversity, product complexity, market demographics, efficiency, and revenue diversification. Results suggest that resource constraints have indeed stimulated changes within these organizations. In particular, hospitals suffering more severe financial difficulties have reduced their size and focused on a narrower range of services. Moreover, there is evidence that greater complementarity has been achieved among the entire sample of hospitals.

A stakeholder's communication approach for balancing hospital information systems investment priorities

The Stakeholders Communication Approach is aimed at supporting the decision process in the choice of information systems (IS) applications at the start of a hospital IS planning cycle. It promotes discussion among senior management, key stakeholders, IS Department management, end users and the Accounting Department using specific tools and a negotiation process. The IS applications portfolio profile allows visualizing the hospital's strategic position and directions for development of IS. End users' responses to a questionnaire give a measure of "user functional value added" (UFVA) to inform management about the effectiveness and usefulness of the systems implemented. Stakeholders' evaluation of recently completed IS applications uses UFVA and cost, both separately and combined, along with assessment of strategic changes, to edify the priority-balancing process for deciding on investments in further IS applications.

The role and impact of formal strategic planning in public hospitals

In recent years, formal strategic planning methods originally developed for private business have been increasingly adopted by health care institutions, including publicly funded hospitals. Yet, as a technocratic management process, formal planning may seem at first sight to run counter to the natural mode of strategy formation in these organizations where negotiation and mutual adjustment between powerful groups of professionals, managers and government agencies traditionally control decision-making. This article describes an exploratory study aimed at understanding how formal strategic planning has become integrated and adapted into the management practices of a group of 23 Canadian hospitals. The context, processes and impact of planning are first examined over the entire sample of hospitals (descriptive analysis), and an attempt is then made to explain different planning outcomes in terms of a variety of contextual and process design characteristics (comparative analysis). The descriptive analysis shows that in practice formal strategic planning is easily absorbed into the political process: political and symbolic motives often drive the initiation of planning, the processes themselves are highly participative and the resulting plans often reflect the difficulties of obtaining consensus on goals in these complex organizations. The comparative analysis suggests that in general, contextual factors (eg, stimuli behind planning) appear to be more significant than process design factors (eg, extent of participation) in determining outcomes. In conclusion, it is noted that the confrontation between technocratic rationality and professional bureaucracy gives rise to a number of paradoxes that make both the use and the subsequent evaluation of formal strategic planning a difficult task in these organizations.

Through a dark glass more clearly? Health information managers and strategic planning in the 1990s

This article considers the application of a formal strategic planning approach to the health information management profession. After a brief discussion of the two main strategic planning models, the process adopted by the Health Information Management Association of Australia at its recent strategic planning workshop is described and the planning outcomes are outlined. The merits of explicitly expressing strategic intent through the creation of a vision of the future and the establishment of strategies and an action plan to realise the vision are discussed.

Environmental scanning for Social Services

This article describes the development of a process of systematic regional environmental scanning as part of strategic planning in the Ministry of Social Services (MSS) in British Columbia, over the 1987-1990 period. Social Services, a large regionalized social service organization, adopted a formal strategic planning process in early 1988. Ministry services are delivered in ten regions with widely varying characteristics. To ensure that this diversity is reflected in the planning process, it is essential that regional environmental information receive consideration. A simple format was developed and regional directors asked to consult with their staff and to scan their regions for issues that may impact the ministry over the medium term. The information obtained was presented by regional directors at a Senior Management Committee meeting and included in the ministry's annual Business Plan, a document which informs staff, contractors, stakeholders, and the community at large of the ministry's values, objectives, and operational goals. The inclusion of regional analyses adds useful information to the Plan. A second output of the planning process is the ministry budget. The systematic regional scans were found to be extremely useful to regional staff, other directors, and to the ministry executives while setting priorities.