‘Strategy-as-Practice’ by Personnel in Hospitals: A Scoping Review

Abstract

BACKGROUND Globally, hospitals face growing demands with increasing patient acuity compounded by workforce challenges, balancing finite resources, and responding to strategic developments. Strategizing in organizations is an active process of sensing, planning, implementing, and evaluating strategy. It is recognized that there is a disconnection between strategic planning and implementation; however, little is known about how organizational context influences the strategic process or how hospital personnel engage in strategic activities.

STUDY AIMS This review aimed to map the extent and breadth of strategy-as-practice peer-reviewed literature relating to hospital personnel and establish how strategizing or ‘strategy-as-practice’ is described in hospital settings, how it is used, and what gaps exist.

METHODS Four databases (Business Source Complete, CINAHL, PsycINFO through EBSCOhost, PubMed) were searched from January 1st, 2018, to June 27th, 2023. All study designs were included, and language was restricted to publications in English. Records were independently screened for eligibility, followed by full-text review. Reporting follows PRISMA-ScR guidelines.

RESULTS 4,719 unique records were identified, and 45 full-text papers were included. Preliminary evidence from 17 countries is reported: 27.8% of studies (12/45) report evidence from the USA. All study designs are reported. Few studies (n=4) provided a specific definition of strategizing. 53.3% (24/45 studies) report multidisciplinary team perspectives, with only three studies including patients' perspectives. Flexible approaches are critical to adopting.

IMPLICATIONS Current evidence shows that when hospital personnel strategize in practice, they use a combination of planning processes, varying quality improvement tools, and methodological approaches.

CONCLUSION Understanding and operationalizing strategy in a hospital setting is critical to maintaining organizational adaptability and improving performance and quality of care. Future research should focus on robust studies with longitudinal follow-up to understand the sustainability of strategizing in hospital settings and how it continues to meet the growing demands for services and activities.