'Strategizing' by Personnel in Hospitals: A Scoping Review

Abstract

INTRODUCTION: Hospitals are important ecosystems and vital to healthcare delivery. Uncertainty challenges the development of strategic practice capacity and functional flexibility, as well as the ability to keep pace with the evolving definition of services. This scoping review examines evidence on strategizing practices, often termed ‘strategy-as-practice,’ reported by hospital staff in professional and managerial roles, focusing on strategy development, implementation, and evaluation. METHODS: The Population, Concept, Context (PCC) framework guided the scoping review. Four databases (PubMed, CINAHL, PsycINFO, and Business Source Complete) were searched initially in 2023, with an update in 2024. Eligibility criteria included studies focused on adults and hospital settings. Records published in English from 2018 to 2024 were included. We located 6,044 records and uploaded them to Rayyan. Titles and abstracts were independently screened, and 562 full-text papers were assessed for eligibility. An initial analysis using ChatGPT helped identify key themes aligned with the objectives, followed by an independent review by the authors to verify accuracy and ensure reliability and rigor. RESULTS: We included 51 studies and identified seven themes influencing strategizing and planning: 1) Awareness and education, 2) Resource constraints, 3) Organizational culture and leadership, 4) Operational challenges, 5) Interdisciplinary collaboration, 6) External pressure and stakeholder dynamics, and 7) Cultural and structural factors. Facilitators included safe environments and incident reporting systems. The barriers highlighted data silos, increased workloads, and workforce challenges, including time constraints. CONCLUSION: Hospitals need clearly defined strategies, comprehensive quality frameworks, and strong leadership. The evidence underscores the importance of continuous staff development, patient safety systems, and technology integration as critical components for effecting change.