Managerialism in Complex Systems: Experiences of Strategic Planning in Non-Profit Hospitals

Abstract

Abstract The aim of this study was to analyse strategic planning practices in complex systems by investigating the experiences of Brazilian non-profit hospitals. Growing pressures have been imposed upon hospitals to improve the quality of their services, to increase access to them by reducing costs and to improve their reliability. In order to respond to these demands, managerial approaches such as strategic planning based on business-sector practices have been adopted by non-profit hospitals. The purpose of this study was to identify the most significant results of the experience with strategic planning in two non-profit hospitals. The study is a qualitative one, and the research was based on the concepts of organizational complexity, strategic planning and managerialism in non-profit hospitals. Data were collected by non-participant observation, from documents and in interviews and were analysed using narrative analysis and document-analysis techniques. Three main factors related to strategic planning in non-profit hospitals were identified: firstly, the unsuitability of strategic planning for hospitals given that they are complex, professional organizations, something that was disregarded by managers; secondly, the significant role played by core operating professionals in strategy making; and thirdly, the representation of strategic planning as fancy management in the eyes of internal and external stakeholders, conferring legitimacy on and generating trust in the hospital. The findings indicate that strategic planning as a traditional managerialist approach applied in a hospital context was dysfunctional and failed to produce a significant contribution to organizational performance.