What is strategic management?
MELANIE JASPER PhD, MSc, BNurs, BA, RGN, RM, RHV, PGCEA 1 and FRANK CROSSAN PhD, MN, DipN, RN 2
Professor of Nursing, Head of College of Human and Health Sciences, Swansea University, Swansea, UK and 2
Professor, Director of the WHO Collaborating Centre for Nursing Midwifery, Education, Research and Practice,
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
College of Human and Health
Swansea SA4 3FX
E-mail: [email protected]
JASPER M. & CROSSAN F. (2012) Journal of Nursing Management 20, 838â€“846
What is strategic management?
Aim To discuss the theoretical concept of strategic management and explore its
relevance for healthcare organisations and nursing management.
Background Despite being a relatively new approach, the growth of strategic
management within organisations has been consistently and increasingly
promoted. However, comprehensive definitions are scarce and commonalities of
interpretation are limited.
Method This paper presents an exploratory discussion of the construct of
strategic management, drawing on the literature and questioning its relevance
within health-care organisations.
Evaluation Literature relating to strategic management across a number of fields
was accessed, drawing primarily on meta-studies within management literature,
to identify key concepts and attempt to present a consistent definition. The
concept within health care is explored in relation to nursing management.
Conclusions Inconsistency in definitions and utilisation of key concepts within
this management approach results in the term being loosely applied in health-care
organisations without recourse to foundational principles and a deep
understanding of the approach as a theory as opposed to an applied term.
Implications for Nursing Management Nurse managers are increasingly asked to
adopt the â€˜next-best-thingâ€™ in managerial theories, yet caution needs to be taken
in nurses agreeing to use systems that lack an evidence base in terms of both
efficacy and relevance of context.
Keywords: nursing management, strategic management
Accepted for publication: 27 July 2012
Ginter et al. (2002) suggest that strategic management
is â€˜the essential process for coping with external
changeâ€™, is the major philosophy guiding the management of all types of contemporary organisations and is
â€˜an externally-oriented philosophy of managing an
organisation that links strategic thinking and analysis to organisational actionâ€™. However, strategic
management is a relatively new concept within the
management literature, having developed from the
1960s out of studies from economic organisation,
bureaucracy, the science of work and the roles of
managers, to name but a few (Nag et al. 2007, Furrer
et al. 2008, Ketchen et al. 2008, Nurer et al. 2008). It
has become a common term in both the academic and
professional literature, but is not often defined;
indeed, as an emerging school of thought it has yet to
establish itself convincingly as a separate social
movement (Hambrick & Chen 2008). However, as
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Journal of Nursing Management, 2012, 20, 838â€“846
organisations providing health care strive for models
of management practice commensurate with their
mission, and nurses and other health-care practitioners
are increasingly required to engage in managerial
roles, an understanding of the underpinning components, beliefs and values contributing to the notion of
strategic management needs to be explored.
Arising from the rapid growth of interest in the
topic from different academic disciplines, various definitions and paradigms have emerged, which makes an
unambiguous definition for use in any particular field
challenging (Stacey 2000, Elfring & Volberda 2001,
Furrer et al. 2008, Johnson et al. 2008). Multiple theories result in confused terminological use with different authors and managers using the same terms to
mean different things or using different terms and definitions to mean the same thing. This is further compounded by the tension between theoretical definitions
and â€˜common senseâ€™ ones, as business and organisational parlance become the norm in large organisations, and particularly those in health-care settings.
The aim of this paper is, therefore, to discuss the
concept of strategic management, identifying its key
features and explore them in relation to healthcare
organisations and nursing.
A historical overview of development
With its precursors in the earlier part of the 20th century, strategic management as a stream of management
research started coherently in the 1960s, which saw
business development as a â€˜more contingent perspective
where organisations need to adapt to their external
environmentâ€™ (Furrer et al. 2008). The 1970s witnessed
the beginnings of the move to a research-based
approach, characterised by the development of two
strands based on different ontological and epistemological perspectives identified by Furrer et al. (2008) as â€˜a
process approachâ€™ and â€˜research seeking to understand
the relationship between strategy and performanceâ€™
with the emphasis moving to the environment and its
relationship with organisations. The 1980s brought
acknowledgement of the significance of an organisationâ€™s internal resources, capabilities and structures,
resulting in two major streams of research activity:
transaction costs economics, and agency theory (Furrer
et al. 2008). The Strategic Management Journal, dedicated to the topic, was launched in 1980. Key scholars,
such as Porter (1980), and Schendel and Hofer (1979)
led the development of the field from â€˜the reliance on
toolkits developed by consultancy firms to a systematic,
theoretical analysis of firm-level strategyâ€™ (Nurer et al.
2008), with an avenue for publication through the
journal. Since the 1990s there has been movement from
environmental and strategy-based research into a focus
on financial and resource-based research and a swing
back to an inside perspective (Furrer et al. 2008).
The study and exploration of strategic management is
important in order to understand policy and strategic
development within organisations. The need to explore
the relationship between the stated intentions of strategic management and the reality of operational activity is
particularly valuable if those who seek to influence
change and organisational development are to do so in
an â€˜evidence-basedâ€™ way that is grounded within reality
(Johnson et al. 2008). Mintzberg and Walker (1989)
suggest that strategic management should be viewed as
a pattern of deliberate and emergent actions that results
in the reality of strategy implementation and realisation.
Fragmentation of ideas within the body of knowledge is evident when one examines the plethora of
strategic management literature related to the concept.
Throughout its history, various schools of thought
have developed, leading more recently to attempts to
identify key concepts, classify and define the field
(Ramos-Rodriguez & Ruis-Navarro 2004, Nag et al.
2007, Furrer et al. 2008, Nurer et al. 2008).
Mintzberg (1990), for example, describes 10 schools
of thought: design, planning, positioning, entrepreneurial, cognitive, learning, political, cultural, environmental and configurational. These schools are based on an
extensive body of empirical work by Mintzberg since
the early 1970s, with the later work attempting to put
the others into context. Elfring and Volberda (2001)
brought the first nine of these schools together as three
emerging strategy schools: the Boundary School, the
Dynamic Capability School and the Configurational
School. The main difference between this synthesis and
past attempts at theory integration is that first, they are
based on theories from various base disciplines (e.g.
sociology, economics, psychology) which are explicit,
second, they are related to a cluster of problem areas in
strategic management, and third, they provide the basis
for development of clear problem-solving tools.
Nurer et al. (2008) bibliographic study identifying
significant influences on the fieldâ€™s development, using
co-citation analysis, suggests latterly that four schools
of thought are evident, arising from the key works of
financial and institutional economics (Williamson),
industrial organisation economics (Porter), process
school (Mintzberg) and the powerâ€“resource dependence school (Pfeffer).
The development of these schools of thought illustrates the complexity and multiple faces of strategic
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Journal of Nursing Management, 2012, 20, 838â€“846 839
What is strategic management?
management. Mahoney (1993) suggests that this intricacy should be seen in a positive light and should be
viewed as an indication of the richness of the theory
development and therefore should act as a basis of
broadening oneâ€™s understanding of the field as opposed
to narrowing it by only considering one or two possible conceptions of strategic management; this view is
shared by others (Mintzberg 1999, Stacey 2000, Nag
et al. 2007). However, Moore (1995) is less positive
about the fragmentation and suggests that clarification
and the solutions suggested by one concept of strategic
management may be the problems and complexities
of another. This further supports the criticism that
strategic management research is focused on onedimensional problems rather than considering the multidimensional world in which strategic management
activities take place. Later authors suggest that it is
important not only to gain common understandings,
but also to value the diversity within the field and, as
Nurer et al. (2008) suggest â€˜a map based on co-citation
data (thus) sheds light on the social construction of the
field by its membersâ€™. If health care is to embrace strategic management as an operational framework it will
be necessary both for its key concepts to be more fully
understood and for its field-related factors to be identified and framed within the contemporary context.
Strategic management as a multifaceted
This section explores the conceptual inclusivity/exclusivity presented for the term within the literature, with
seminal papers from the past decade used to identify
what the key concepts within strategic management
may be in relation to its scope and process.
Scope of strategic management
Using expert panellists to identify 447 articles published over 20 years in four leading management journals focusing on strategic management, Nag et al.
(2007) used content analysis of abstracts to identify
the distinctive lexicon of the field â€“ a definitive list of
54 words that appeared more than 10 times across the
total of papers. These were classified under six elements: (1) the major intended and emergent initiatives;
(2) taken by managers on behalf of owners; (3) involving the utilization of resources; (4) to enhance the
performance; (5) of firms; (6) in their external environments (Nag et al. 2007).
Following this study, Nag et al. (2007) compared definitions across four disciplines (economics,
sociology, marketing and mainstream management),
analysing the work of 57 main authors in major
journals in 2001â€“05 and comparing these with their
own findings of conceptual prevalence. They then
added a seventh dimension to the original six, that of
internal organisation. Comparison across the four fields
identified strong similarities between concepts and
definitions, with variations related to the focus of the
field; for example, economics-oriented strategic
management scholars focused more on the â€˜structureâ€“
conductâ€“performanceâ€™ paradigm but made little mention of managers and owners, strategic initiatives or
resources. In relation to health care this work provides
a basis against which notions of strategic management
can be tested, with the proviso that individual disciplines will need additional or reduced conceptual scope
dependent on field. It is also important in acknowledging that while business sectors are often for profit,
many health-care organisations operate within the nonprofit or voluntary sectors, and, as such, need different
definitional configurations while ascribing to the same
wider concept (Kong 2008, Clarke & Fuller 2010).
Ramos-Rodriguez and Ruis-Navarro (2004) and
Nurer et al. (2008) published complementary studies
exploring the intellectual structure of strategic management using co-citation analysis. The former, using
quantitative bibliographic methods, concluded that
earlier history of strategic management demonstrated
a greater influence of books as opposed to journals in
terms of conceptual definition, suggesting the lack of a
definitional evidence base, the pre-eminence of Porterâ€™s
work and the ascendency of the resource-based view
in the late 1990s. Nurer et al. (2008) built on RamosRodriguez and Ruis-Navarro (2004) work using factor
analysis and multidimensional scaling to identify key
influences in the field by delineating disciplinary subfields and determining the relationship between them.
They identified authors that spanned two intellectual
domains and presented a â€˜mapâ€™ of authorsâ€™ influence
and change of that influence over time. Eight factors
in this influence are identified, modifying over time,
but leading to the following conclusions:
â€˜the semi-permeability of the strategy and organisation theory areas, the growing influence of the
economic perspectives, and the increasing gravitational pull of theories of the firm along with a
move away from practitioner orientationâ€™.
(Nurer et al. 2008)
Furrer et al. (2008) content-analysed 2125 articles
published in four leading management journals
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840 Journal of Nursing Management, 2012, 20, 838â€“846
M. Jasper and F. Crossan
(unsurprisingly, the Strategic Management Journal
accounted for approximately 65% of the papers sampled) over 26 years, identifying relationships between
the subfields of strategic management, providing a
map of key words and authors, and a framework for
tracking the literature. Papers were rated against one
or more 26 major themes or keywords (reduced from
1000 identified as a preliminary stage to the analysis).
The top eight keywords used were performance,
environment, capabilities, organisation, methodologies, international, alliances and corporate, and these
accounted for 49.6% of the occurrences, with the
first three accounting for 24.2%. As the authors
point out, occurrences 2â€“4 represent the three major
paradigms of strategic management research: the
resource-based theory, environmental modelling, and
strategy and structure. They concluded that â€˜there
was an increase over time in the number of articles
concerning capabilities and alliances, and a decrease
in those concerning environment and fitâ€™. They further suggested that the research agenda polarizes
between financial models of the resource-based view
of the firm and less through the strategy process and
Process in strategic management
Johnson et al. (2008) describe strategic management
activity as having three distinct elements: strategic
analysis, which is concerned with understanding the
strategic position of the organisation; strategic choice,
which is the understanding of the bases and underpinnings that guide strategic decisions; and strategy
implementation concerned with translating strategy
into action. They suggest that strategic management is
achieved through a logical and linear process. However, Stoney (2001) argues it is more complex than
these three stages suggest and that when considering
strategic management from a sociological standpoint
it can be seen that it influences beyond strategic
planning and implementation.
In contrast, Swayne et al. (2008) identify that three
operational criteria of strategic thinking, strategic
planning and managing strategic momentum must
occur together in strategically managed health-care
organisations. A key idea within strategic management, they say, is that it:
â€˜requires everyone in the organisation to cease
thinking solely in terms of internal operations
and their own operational responsibilities. It
insists that everyone adopts what may be a
fundamentally new attitude â€“ an external orientation and a concern for the big pictureâ€™.
(Swayne et al. 2008)
These criteria, derived not from a disciplinary
underpinning but from an operational one, draw
attention to the need for human engagement in the
processes of strategic management, and are particularly pertinent in the health-care industry.
The link between strategic management and organisational development is considered by Heracleous and
DeVoge (1998) to be the means by which effective strategic planning and implementation is achieved. They
suggest the integration of organisational development
concepts and strategic management concepts as a means
of achieving effective strategic management by ensuring
engagement with stakeholders at all organisational
levels. They also suggest that integration of strategic
management activities and organisational development
is the key to reducing the gap between intended
(planned) and emergent (actual) strategy realisation.
The importance of bringing together the â€˜hardâ€™
elements (organisational configuration, environment,
business context) of strategic management and the
â€˜softâ€™ elements of organisational development (staff,
expertise, culture and interpersonal relationships), is
relevant to nurses today. It is particularly important
as nursing attempts to grapple with the need for commitment to professional hands-on caring expected by
the public and the pressure to be more politically
aware and increasingly involved in management at
both strategic and operational level (Oâ€™Neill 2000).
These elements are brought together by ensuring a
holistic approach to management, which places people
at the centre of all its activities.
From a sociological standpoint, strategic management
may be seen as having a major impact on all aspects
of organisational function, including structure and
empowerment within organisations.
From the literature a summary of the features of
strategic management can be formed:
â— the process of organisational leadership, recognising
and involving the whole workforce;
â— facilitating the â€˜fitâ€™ between the organisation and its
â— envisioning and responding to the future through
fostering anticipation, innovation and excellence;
â— providing processes for coping with change and
organisational development, with a focus on
performance and achieving organisational strategic
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Journal of Nursing Management, 2012, 20, 838â€“846 841
What is strategic management?
â— facilitating and communicating consistent decisionmaking.
Having identified the current structure and concepts
embedded in strategic management in terms of both
scope and process, it should now be possible to identify definitions that encompass these.
Brackerâ€™s (1980) early definition suggests that strategic management entails the analysis of internal and
external environments of a firm to maximise the utilization of resources in relation to objectives. While this
acknowledges the internal/external interrelationship it
is limited by the notion of analysis as process as
opposed to the more dynamic explanations provided
in the previous section. It may well have been sufficient at the time it was written and, indeed, it is one
of the few examples of a definition found, yet clearly
does not represent the concept today.
Kong (2008) provides a definition that includes the
notions of advantage and better performance in relation to competitors:
â€˜Strategic management can be interpreted as a
set of managerial decisions and actions of an
organisation that can be used to facilitate competitive advantage and long-run superior performance over other organisationsâ€™.
Kong thus aligns more closely with Furrer et al.â€™s
(2008) most commonly identified features. However,
perhaps the most comprehensive definition encountered during this brief analysis of the literature, and the
most robust in relation to its origins and methodology,
is the one provided by Nag et al. (2007) on joining
their six elements together into one sentence as a generic definition spanning multiple disciplinary fields:
â€˜The field of strategic management deals with the
major intended and emergent initiatives taken by
general managers on behalf of owners, involving
utilization of resources, to enhance the performance of firms in their external environmentsâ€™.
Nag et al. (2007)
Having identified a workable definition of strategic
management, the remainder of this paper will consider
its applicability to healthcare systems and the role of
the nurse in strategic management.
Strategic management in a professional
(nursing and health care) context
With the strong proviso that any exploration of a theoretical concept in relation to health-care systems per se
can only be superficial in a paper of this sort, and an
acknowledgement of the diversity of the nature of
health-care systems internationally, this section considers whether strategic management is a realistic option
for driving healthcare organisations now and in the
future. As already established, effective strategic management is a means by which organisations achieve
their desired levels of performance and appears to be
the preferred strategy within health care, despite lack
of published definitional consensus and the fact that
strategic management research appears to be moving
more towards resource management and away from
strategy and environmental foci (Furrer et al. 2008).
Those levels of performance are heavily influenced by
the context in which the strategic activity is taking
place. In other words, the organisationâ€™s configuration
and the way in which it brings together various elements is key to strategic success (Swayne et al. 2008,
Lawler 2009), i.e. closing the gap between their
planned strategy and the actual strategy (Ren & Guo
2011, Zhang et al. 2011). Mintzbergâ€™s (1999) professional bureaucracy model proposes that health-care
organisations are characterised by the following:
â— Standardisation of skills is the primary control/coordinating mechanism and not top-down management
â— Professional staff have a major influence over strategic decisions.
â— The major operating units act autonomously within
a flat or horizontal organisational structure.
â— Employee skills are the major resource.
â— Communication is vertical and a two-way process.
â— Management controls such as direct supervision
and financial control do not predominate.
Mintzberg (1999) suggests that it is the context in
which these elements are combined that has an overarching affect on whether strategy will be realised.
Context also envelops the culture/s prevailing within
the organisation. The impact of organisational culture
on management activity is well documented (Anderson-Wallace & Blantern 2005, Carney 2006, 2010,
Johnson et al. 2008, Mensah & Qi 2012). In relation
to health-care organisations it is particularly so, as
established practices and embedded cultures can effectively prevent development, movement and change
within an organisation (Swayne et al. 2008). Bodley
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M. Jasper and F. Crossan
(1994) states that culture has three distinct components â€“ what people think, what they do and the
material products they produce â€“ emphasising that
mental processes, beliefs and values are parts of culture. However, Seel (2000) suggests organisational
culture is viewed as the emergent result of the continuing negotiations about values, meanings and proprieties between the members of that organisation and
with its environment.
This definition suggests that organisational culture is
derived from the organisationâ€™s staff in their everyday
activities and conversations. This affects strategic
management in two ways. First, if strategic decisions
and thinking by executive managers are based solely
on elements of organisational life, such as structure
and processes, and do not consider the culture arising
from the people in the organisation, then it could be
argued that a mismatch between strategy and reality is
inevitable (Mintzberg 1999, Konteh et al. 2011, Clark
2012). Second, if we accept that part of the organisationâ€™s culture is a sense of agreement among staff as
to what constitutes the best way forward in any given
situation then acknowledgement of those values and
beliefs when formulating strategy will be key to successful implementation.
This disparity is illustrated by the differences found
in culturally-derived perceived beliefs and values
between managerial and professional staff groups.
Carney (2004), working in the Republic of Ireland,
noted that middle managers with a non-clinical background reported higher levels of involvement in strategic management than their clinical colleagues who
held similar middle management positions. This was
partly because senior managers with a non-clinical
background undervalued and misunderstood the contribution that expert clinical advice could make to the
development of effective strategic management. This
conclusion is supported by findings from a Scottish
survey of over 400 senior nurses which indicated that
the majority felt excluded from the development of
strategic plans and policy by senior managers who
lacked a clinical background (Crossan 2008).
However, there is evidence that nurses and managers do share core values within the health-care sector.
A qualitative study by Merali (2003) involving 27
middle managers drawn from two UK acute National
Health Service (NHS) Trusts, found that managers
with a non-clinical background held the same core
altruistic beliefs and drivers as their clinical colleagues.
A larger study by Carney (2006), using a mixed
methods approach across 60 acute health-care organisations and 856 managers with both clinical and
non-clinical backgrounds in Ireland, found that both
groups held similar ethical values and beliefs about
health-care delivery but, interestingly, that clinicians
did not believe that non-clinical managers held the
same set, and vice-versa. This apparent lack of trust
between the two groups of managers has the potential
to have a negative impact on patient care and could
be an inhibiting factor in strategic management.
There is limited literature evaluating strategic management in the health-care sector focusing on the
effects and influence of the introduction of managerialism and new public sector management. Engagement in
strategic management in the UK NHS, with its objectives and outcomes-focused management approach, is a
recent introduction arising from the need for competitiveness and value-for-money, within an internal/external context of provision politically led by the founding
principles of socialism. While successive British governments overtly subscribe to the notion of â€˜care for all,
free at the point of deliveryâ€™ the hard economics of
funding a universal health-care system from general
taxation has led to erosion of socialist principles in
favour of market principles, managerialism and cost
economies, resulting in restrictions to strategic options
and limitations imposed on services offered (Johnson
et al. 2008, Zhang et al. 2011). This confusion of driving principles is further compounded by the increasing
diversity of NHS provision within each of the four constituent countries of the UK. Scotland, Wales and
Northern Ireland have developed different models for
the NHS yet attempted to resist market-driven principles subsuming more humanistic drivers; England
stands alone in pursuing healthcare-as-a-business, with
wider measures proposed in the current Health Bill
progressing through Parliament.
The role of the nurse in strategic
Over time, several persistent themes emerge from the
literature on nurses as managers, with papers that
detail the main role components (Oroviogoicoechea
1996, Willmot 1998, Hutchinson & Purcell 2010,
McSherry et al. 2012), those that evaluate the nature
of the role (Crossan & Robb 1997, Oâ€™Neill 2000,
Reedy & Learmouth 2000, Bolton 2003, Crossan
2003, Suhonen & Paasivaara 2011, Udod & Care
2012) and those that identify the developmental needs
of nurse managers â€“ an area of research that seems to
have been given consistent attention over the last
10 years (Loo & Thorpe 2003, McMurray & Williams
2004, Currie & Procter 2005, Purcell & Milner 2005,
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Journal of Nursing Management, 2012, 20, 838â€“846 843
What is strategic management?
Sellgren et al. 2008, Drennan 2012, Martin et al.
2012). There is support for a hybrid clinical-management role as the key to bridging the gap between cliniciansâ€™ and general management views of quality of
care and other clinical issues (Savage & Scott 2004,
Meyer et al. 2011, McSherry et al. 2012). These
include a strong indication that the role is a complex
one with multiple components: the tension and potential conflict caused by the juxtaposition of two sets of
values in the role of nurse manager (i.e. those values
traditionally associated with nursing and those values
traditionally linked with management) (Hewison &
Stanton 2002, Crossan 2008); the need to meet the
developmental needs of nurse managers in support of
their middle management role (Hewison & Griffiths
2004, Clarke et al. 2012); and the need to empower
nurse managers and other middle managers to fulfil
the role effectively. Carney (2009) indicates that there
is a lack of awareness among nurse managers in relation to the strategic management of their organisations
and suggests that nurse managers need to further
develop their understanding and knowledge of the strategic management process and identify ways to influence their organisational strategy. However, this can
only happen if nurse managers are given more support
from the executive level of the organisation and recognition that the provision of enhanced education in strategic management is necessary if nurse managers are to
play a meaningful role in the strategic development of
Strategic management is a variously defined and fragmented concept, and one that authors have often
failed to define because of its perceived â€˜taken-forgrantedâ€™ nature. The literature has also indicated that
a narrow or traditional concept of strategic management is likely to have an impact on attitudes and
levels of understanding and involvement. However,
maturity over the past 50 years has resulted in several
studies that, in combination, identify key concepts of
strategic management and commonalities across the
many disciplines using the concept (Ramos-Rodriguez
& Ruis-Navarro 2004, Nag et al. 2007, Furrer et al.
2008, Nurer et al. 2008). Nag et al. (2007) empirically derived definition, comprising six key features
provides a sound conceptual basis for exploration of
the utility of strategic management approaches in
health-care organisations. The features of health-care
systems â€“ professional context, culture and boundaries, issues of power, ethics, values and beliefs, the
hierarchical nature of healthcare systems and the
foundations of systems rooted within different economic frameworks â€“ are considered as complicating
factors to the implementation of strategic management
as defined by Nag et al. (2007). It is clear that nurses
and other health-care professionals are expected to
perform beyond their professional boundaries and
embrace the mission functions of their organisations
within a business culture. Although not necessarily
for-profit, health-care organisations globally function
within the prevailing economic climate where value
for money and delivering optimal services for the most
effective cost is now a primary consideration. The
tenets of strategic management, in a generic sense, are
sufficiently broad to be able to encompass the challenges of professional power and external influences.
Strategic management in a professional context is conceptualised as a phenomenon that requires input from
expert specialists within that organisation. This is necessary at all levels of strategy development and implementation if success is to be achieved. Finally, theory
related to organisational culture indicates that the cultural beliefs and values of staff have an impact on the
development and implementation and therefore the
success of strategy. While strategic management has
developed across disciplinary boundaries, little has yet
been reported of its specific nature in health-care management theoretical perspectives. As a broad and
enveloping concept aimed at maximising the performance of organisations within their external environment, strategic management may be a solution to the
increasing diversity of health-care providers within a
growing specialist market sector.
Implications for nursing management
Nurse managers tend to have little control over the
strategic philosophies that drive operational management in the organisations they work in, yet, as the
largest group of managers within health-care organisations, it is arguable that success or failure of managerial approaches within those organisations is largely
dependent on them. Nurse managers are therefore in a
powerful position to ensure that the underpinning values, beliefs and philosophies of managerial strategy
are coherent with both the context and culture of
nursing, and expected quality of care and patient outcomes. While many managerial approaches imported
from different industries arise from profit-making
approaches, many health-care systems world-wide are
not in a competitive market, or have, as their primary
aim, profit for shareholders. Therefore, it is incumbent
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M. Jasper and F. Crossan
on nurse managers to ensure that any form of strategic management they are required to implement is
translated into the needs and language, and outcomefocused approach that will deliver high-quality health
care for patients. Without this patient-focused
approach, which is driven by the profession that has
most to do with patients, any theoretical approach is
doomed to failure.
Sources of funding
No funding was received for this paper.
No ethical approval was required.
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