How do medical managers strategize? A strategy-as-practice perspective

Strategic planning (SP) is a widely-used practice within public sector organizations. However, SP does not only take place in strategy workshops and senior management levels. This paper explores how medical managers of English hospitals ‘do’ SP in their clinical directorates. The authors investigate the practices, the usage of strategy tools and the implications of medical managers’ strategizing. The paper argues that what makes financial sense to medical managers strategizing in the local circumstances of their directorates does not always equate to value for patients, the hospital or for the public sector as a whole.Strategic planning is not only performed by senior managers and trained strategists. Middle managers also engage in strategic planning in their day-to-day activities, and their emergent strategies may align with, or cut across, formal organizational strategic objectives. This paper provides practical insight into how medical managers of English hospitals strategize within their clinical directorates. It shows that their strategizing and use of strategic tools are fine-tuned to improve the profitability of their service lines and deliver on cost improvement targets. The authors suggest that strategizing at the directorate level creates risks since patient care, cost control, the financial viability of the hospital as a whole and its public value may become subordinated to the narrow pursuit of service line profitability. Hence, it is important for senior managers and policy-makers to improve clinicians’ knowledge, training and overall engagement with the strategic management of clinical directorates, hospitals and the broader health economy.