Abstract
BackgroundThe 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?MethodsAn 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.ResultsThe 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.ConclusionsThe 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.
Highlights
The culture of New Public Management has promoted the diffusion of strategic management tools throughout Public Healthcare Organisations (PHOs)
The aim of the study was to investigate whether PHOs use strategic documents to support their actual strategy and decision-making processes, or whether these documents serve some of the purposes highlighted by other authors, namely building consensus, advertising, testing internal management competence, and responding isomorphically to institutional requests
We investigated the following research questions: 1. Has the New Public Management (NPM) approach changed the organisational culture of PHOs in terms of how they adopt, diffuse, and use strategic planning documents?
Summary
The culture of New Public Management has promoted the diffusion of strategic management tools throughout Public Healthcare Organisations (PHOs). There is some consensus in the literature that - especially in turbulent and complex contexts - strategic tools are required to achieve higher levels of performance [1,2]. This view has been strongly influenced and supported by the New Public Management (NPM) scholars. They stress that public sector organisations must adopt strategic planning practices if they are to improve their management in the long-term, to guide public institutions, and to improve their performance in an increasingly turbulent context [3]. The reality of effective management of PHOs lies somewhere between the two viewpoints
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