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DDBA 8560 - Seminar in Healthcare Managerial Decision Making
Walden University
Background of the Study
Strategy can be defined as the balance of actions and choices between internal
capabilities and external environment of an organization. Accordingly, strategy can be
seen as a plan, ploy, pattern, position and perspective. According to Bateman and
Zeithman (2003), a strategy is a pattern of actions and resource allocations designed to
achieve the goals of the organization. A strategy involves an evaluation of the likely
impacts of both the external and internal organizational environment, the long-term goals
of the organization. From the perspective of classical strategic management theory,
strategy is considered a deliberate planning process, initiated by top management, based
on an elaborate industry analysis and aimed at designing a cohesive grand strategy for the
corporation (Mintzberg & Lampel, 2009).
The study was anchored on four theories; the resource-based theory, stakeholder theory,
systems theory and institutional theory. The resource based theory looks at the internal
strengths and weakness in organizational resources showing how the resources are
allocated and deployed in order to assist in the implementation of the strategies. On the
other hand, the stakeholder theory informs the study by urging managers to be clear about
how they want to do business, specifically what kinds of relationships they want and need
to create with stakeholders to deliver on their purpose. The systems theory however
views an organization as a real system that is open to and interacts with the environment
and can acquire qualitatively new properties through emergence, resulting in continual
evolution. The institutional theory assumes that organisations are deeply embedded in the
wider institutional context. Thus, organisational practices are either a direct reflection of,
or response to, rules and structures built into their larger environment (Montgomery,
2004; Freeman, 1994 & Kaplan, 2009).
The demands for increased performance and accountability in health care arise from
increasing expectations for improved service and higher standards of care by patients, the
public, government and policy makers. Health care workers must do more than practice
medicine and play increasingly more demanding roles of leading and building teams
effectively allocating resources and ultimately addressing the needs of the people they
serve. The management of hospitals in Kenya, Mombasa included remained in the hands
of medical doctors, who, despite having a lot of technical and professional expertise,
lacked adequate strategic management skills to access and make proper use of the
resources and mitigate against the new devolution challenges. The procurement of goods
and services at county level has been centralized at County headquarters and that has led
to Confusion and procurement challenges which might affect quality of procured
products and service delivery.
Strategy Implementation
According to Bhasin (2009) implementation is the process through which a chosen
strategy is put into action. It involves the design and management of systems to achieve
the best integration of people, structure, processes and resources in achieving
organizational objectives. A strategic plan provides a business with the roadmap it needs
to pursue a specific strategic direction and set of performance goals, deliver customer
value, and be successful. However, this is just a plan, it does not guarantee that the
desired performance is reached any more than having a roadmap guarantees the traveler
arrives at the desired destination.
Although formulating a consistent strategy is a difficult task for any management team,
making that strategy work, that is, implementing it throughout the organization is even
more difficult. A myriad of factors can potentially affect the process by which strategic
plans are turned into organizational action. Unlike strategy formulation, strategy
implementation is often seen as something of a craft, rather than a science, and its
research history has previously been described as fragmented and eclectic. It is thus not
surprising that, after a comprehensive strategy or single strategic decision has been
formulated, significant difficulties usually are during the subsequent implementation
process (Starkey, 2004).
The challenges of strategy implementation are illustrated by the unsatisfying low success
rate (only 10 to 30 percent) of intended strategies. The primary objectives are somehow
dissipated as the strategy moves into implementation and the initial momentum is lost
before the expected benefits are realized. Successful implementation is a challenge that
demands patience, stamina and energy from the involved managers. Henry (2004)
identified four challenges affecting successful strategy implementation. He cited lack of
fit between strategy and structure; inadequate information and communication systems;
and failure to impart new skills. He identified most challenges as concerning connecting
strategy formulation to implementation; resource allocation; match between structure
with strategy; linking performance and pay to strategies; and creating a strategy
supportive culture.
The most important thing when implementing a strategy is the top management’s
commitment to the strategic direction itself (Rapa & Kauffman, 2005). The top managers
must demonstrate their willingness to give energy and loyalty to the implementation
process. To successfully improve the overall probability that the strategy is implemented
as intended, senior executives must abandon the notion that lower-level managers have
the same perceptions of the strategy and its implementation, of its underlying rationale,
and its urgency. They must not spare any effort to persuade the employees of their ideas
(Rapa & Kauffman, 2005).
Communication process plays a major role in the strategy implementation process. The
way in which a strategy is presented to employees is of great influence to their
acceptance of it (Rapa & Kauffman, 2005). It is essential both during and after an
organizational change to communicate information about organizational developments to
all levels in a timely fashion (Miniace & Falter, 2006). Aaltonen and Ikåvalko (2002)
stated that organizational culture also influences strategy implementation. Marginson
(2002) contend that strategy implementation evolves either from a process of winning
group commitment through a coalitional form of decision-making, or as a result of
complete coalitional involvement of implementation staff through a strong corporate
Al Ghamdi (1998) argues that for most of the firms, strategy implementation takes more
time than originally expected due to lack of coordination. Similarly Rapa and Kauffman
(2005) argue that strategy implementation processes frequently result in difficulties and
complex problems due to vagueness of the assignment of responsibilities and diffusion of
responsibilities through numerous organizational units. To avoid power struggles
between departments and within hierarchies, organizations should create a plan with clear
assignments of responsibilities regarding detailed implementation activities (Rapa &
Kauffman, 2005).
Chakravarthy, B.S., & White, R.E. (2001). Strategy process: forming, implementing and
changing strategies, in Pettigrew, A., Thomas, H., Whittington, R. (Eds),
Handbook of Strategy and Management, Sage Publications, London,
Corboy, M. & O'Corrbui, D. (1999). The seven deadly sins of strategy. Management
Accounting Journal, 29-30.
David, F.R. (2002). Strategic management concepts and cases (8th ed.). Prentice Hall:
New Jersey.
Devanna, M.A., Fombrun, C., & Tichy, N. (1981). Human resource management: A
strategic perspective. Organizational Dynamics, 9(3):51-68.
Drazin,R. & Howard, P. (1984). Strategy Implementation: A Technique for
Organizational Design, Columbia Journal of World Business, 19, 40-46.
Eisenstat, R. (2003). Implementing strategy: developing a partnership for change,
Planning Review Journal, 21 (5), 33-6.
Freeman, E. R. (1999). Strategic Management: A Stakeholder Approach. Marshfield,
Massachussets: Pitman Publishing Inc.
Greenwood, R., Oliver, C., Sahlin, K. & Suddaby, R. (2008). Introduction: in R
Greenwood, C Oliver, K Sahlin & R Suddaby (eds.). The Sage Handbook of
Organizational Institutionalism, SAGE Publications, London.
Hann, W. & Powers, T. (1999). The impact of planning sophistication and
implementation on firm performance. The Journal of business and economic
studies, 5:19-35.
Henry, A. (2004). Understanding Strategic Management. New York. Oxford.
Igecha, E.N. (2014) Determinants of implementation of strategies at the Institute of
Quantity Surveyors of Kenya. Unpublished MBA project, University of Nairobi.
Jauch, L. & Glueck.W. (1984). Business Policy and Strategic Management, (4th ed.)
New York McGraw-Hill, Inc.
Johnson, G, & Scholes, K. (2008). Exploring Corporate Strategy. (8th ed.). London:
Prentice Hall.
Kalali, N.S., (2011). Why does strategic plans implementation fail? A study in the health
service sector of Iran. African Journal of Business Management, 9831-9837.
Kamanda, C. (2006). Factors Influencing the Regional Growth Strategy at KCB,
Unpublished MBA Project, School of Business, University of Nairobi.
Kaplan, R.S. (2009). How the balanced scorecard complements the McKinsey 7-S model,
Strategy and Leadership, 33(3), 41-46.
Kaufman, B.E. (2011). Comparative Employment Relations: Institutional and Neo-
institutional Theories in M Barry & A Wilkinson (eds.). Research Handbook of
Comparative Employment Relations. Edward Elgar Publishing.
Kiptugen, E. J. (2003). Strategic Responses to a Changing Competitive Environment, the
Case Study of KCB, Unpublished MBA Project, School of Business, University of
Korten, D.C. (1990). Third generation NGO strategies: a key to people-centred
development. World Development 15 (supplement): 145–59.
Langfield, S. K. (1997). Management control systems and strategy: a critical review,
Accounting Organisations and Society, 22 (2) 207-32.
Mankins, L. & Steele, V. (2005). Obstacles to Strategy Implementation in a Nationalized
Industry. Journal of Management Studies, 22, 632-648.
Marginson, D. E. W. (2002). Management control systems and their effects on strategy
formation at middle management levels: evidence from a UK organization,
Strategic Management Journal, 23, 1019-31.
Mbaka, R. M. & Mugambi, F. (2014). Factors affecting successful strategy
implementation in the Water Sector in Kenya. Journal of Business and
Management, 16 (7), 61-68.
Miller, D. (2002). Successful change leaders: what makes them? What do they do that is
different? Journal of Change Management, 2 (4), 359-68.
Miniace, J.N. & Falter, E. (2006). Communication: a key factor in strategy
implementation. Planning Review, 24, 26-30.
Mintzberg, H., Quinn, J.B. & Ghoshal, S. (1998). The Strategy Process: Prentice-Hall.
Mintzberg, J. & Lampel, K. (2009). Patterns in Strategy formation. Management Science,
24(9), 934-948.
Montgomery, C. (2004). Corporate diversification, Journal of Economic Perspectives, 8,
Muturi J.G. (2005). Strategic Responses by Christian Churches in Kenya to Changes in
the External Environment, A Case of Evangelical Churches in Nairobi,
Unpublished MBA Project, School of Business, University of Nairobi.
Mwamuye, M. K. & Nyamu, H.M. (2014). Devolution of Health Care system in Kenya,
A strategic approach and its implementation in Mombasa County, Kenya.
International journal, 2, 263 – 268.
Nachmias, V. F. & Nachmias, D. (1996). Research Methods in the Social Sciences.
Pitman publishing, Nairobi.
Orodho, J. A. (2004). Techniques of Writing Research Proposal and Reporting in
Education. Nairobi: Masda publishers.
Paauwe, J. & Boselie, P. (2003). Challenging strategic HRM and the relevance of the
institutional setting. Human Resource Management Journal, vol. 13, no. 3, pp.
Porter, M. (1997). Competitive Strategy: Techniques for analyzing industries and
competitors. New York: Free Press.
Rapa, A. & Kauffman, D. (2005). Strategy Implementation - an Insurmountable
Obstacle? Handbook of Business Strategy, 6 (1), 141-146.
Sekeran, U. (2006). Research Methods for Business. A skill building approach. Wiley,
India New Delhi.
Singer, S. & Shortell, S. M. (2011). Implementing accountable care organizations: Ten
potential mistakes and how to learn from them. Journal of the American Medical
Association, 306(7), 758–759.
Viseras, E.M., Baines, T., & Sweeney, M. (2005). Key success factors when
implementing strategic manufacturing initiatives. International Journal of
Operations & Production Management, 25, 151-179.
Wernerfelt, B. (2004). A Resource Based View of the Firm, Journal of Economics &
Management Strategy, 13, 171-180.
Young, R. D. (2001). Perspectives on budgeting: Budgets, reforms, performance-based
systems, politics and selected state experiences. Columbia, SC, University of
South Carolina, Institute for Public Service and Policy Research.
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