Evaluating The Impact of Strategic Management and Strategic Thinking On Performance in The Public Health Sector

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Evaluating the Impact of Strategic Management and Strategic

Thinking on Performance in the Public Health Sector
Chapter · January 2020

DOI: 10.4018/978-1-7998-2329-2.ch009
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Istanbul Medipol University
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Chapter 9
Evaluating the Impact of
Strategic Management
and Strategic Thinking
on Performance in the
Public Health Sector
Zafer Adiguzel
https://orcid.org/0000-0001-8743-356X
Medipol Business School, Istanbul Medipol University, Turkey
ABSTRACT
In the 2000s, change in the business world and pioneering strategies that shape
change are becoming the main conditions for superiority in competition. Until
recently the traditional management and organization approaches that are in
place are inadequate to meet the new expectations coming from change. The aim
of this study is to reveal the extent to which the managers of health institutions have
adopted the strategic management approach. In this study, it is explained whether
the managers have knowledge about strategic management tools which are the basis
of strategic management application methods, what strategic management tools they
use, their level of satisfaction with these tools and what tools they intend to use in
the future. In addition, the changes in the health management managers in the field
of strategic management, the priorities in the selection of strategic management
tools, the importance of strategic thinking and the effects of strategic management
understanding on performance are examined.
DOI: 10.4018/978-1-7998-2329-2.ch009
Copyright © 2020, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.
Evaluating the Impact of Strategic Management and Strategic Thinking on Performance
INTRODUCTION
In today’s world, rapid changes in the age of technology and information have made
many of the classical competition assumptions in the business world obsolete. It is
not enough for enterprises to benefit from new technologies in order to increase their
success and competitiveness. At the same time, uniform distribution, competitiveness
and access to consumers should be strengthened in their economies. All the efforts
of the enterprises are aimed at establishing strategies for superiority in competition.
In the 21st century, imagination is becoming the quality most needed by businesses.
Within this framework, the primary purpose of the enterprises is to reach the future
by defining strategies that will make a difference. In order for companies to gain a
structure that is stronger and more competitive in business life and to enable them
to compete, they should be put into practice by making use of different strategic
methods. With this in mind, “Strategic Management Approach” can be considered
as an application that will contribute to strengthening the competitive position of
enterprises in their internal world.
The concept of strategic management has come to the forefront in the management
of business organizations in the 1980s. With the increase in production, developments
in the market began to intensify competition. Increasing pressure from competition
has led businesses to set strategic goals for investment and market. Strategic
management approaches that lead businesses to set goals are the main subject of
the study. Effective management is based on long-term strategic strength as well as
the involvement of the organization in decisions. In this context, the implementation
of strategic decisions is important for organizations as well as for the country. An
excellent structure and criteria of excellence are among the items to be sought in the
future in terms of management. Today, participation principles, strategic management
forms gain importance and weight.
Strategic management is an important concept for health institutions as well as
for other institutions. Health institutions need the concept of strategic management
in order to survive in a competitive environment, to analyze the internal and external
environment of the institution, to identify the strengths and weaknesses of the
institution, and to identify the threat elements of the institution and the aspects that
will provide opportunities for the institution. In the face of globalization and the
concept of competition that comes with this globalization, health institutions are
beginning to give more strategic thinking, strategic decision making and strategic
thinking as much as other institutions.
Although the concept of management is very old, the concept of business
management is a concept that emerged about a century ago and is still being developed.
The reason why the concept of business management is so new is the absence of
large scale production-based enterprises until the industrial revolution that began in
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the 18th century. From this perspective, it is possible to characterize the time before
the industrial revolution as the “pre-period” or “pre-period scientific”. However, it
is possible to say that the management activity existed in ancient times, even in the
early ages, considering that there existed individuals and communities who came
together to manage the same goal in the past.
Strategic Management is a concept obtained by combining the concepts of strategy
and management (Thomas 1984). Therefore, it is necessary to give information about
the concept of strategy. In the literature, it is stated that the strategy is based on two
sources in terms of its origin. One of these; latin concept with stratum meaning
road, line or bed. The second is related to the name of the former Greek General
Strategos. It was used to indicate the art and knowledge of the general (Steiner
1971). The concept of strategic management has entered the business literature
since 1980. Strategic management, planning the research, review, evaluation and
selection efforts necessary for the planning of strategies, taking all kinds of structural
and motivational measures within the organization for the implementation of these
strategies, taking into force and implementing the strategies before and after the
implementation of the top-level staff covering is the sum of the processes that
concern their activities (Eren 2005).
STRATEGY
Strategy literally means “forwarding, directing, sending, taking and moving” The word
is thought to have been used with reference to the knowledge and art of Strategos,
one of the former Greek generals. In some sources, it is stated that the strategy comes
from the Latin “stratum” which means road, line or river bed (Mütercimler 2006).
Although there is controversy about the origin of the word, it can be said that both
definitions have similar meanings in a general approach. This is related to direction
(Dinçer 2007). The concept of strategy has been used as a military concept for
centuries. According to Webster (1990)’s New International Dictionary, the strategy
is the science and art of placing the military power of the parties in accordance with
the conditions in order to reach a result in a war (Üzün 2000).
In general terms, the strategy is defined as the use of all kinds of instruments
and measures in every field taken by an institution (or state) in order to achieve the
objectives chosen in accordance with the politics pursued (Porter 1996). It is readily
understood that the concept of general strategy can no longer remain within the
framework of defense policy and cannot be distinguished from the general policy
of each country (or institution). Since all kinds of political and economic activities
are directed towards the welfare, demand and tendencies of the society, the current
field of the strategy includes psychological, social, economic, ideological, military
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and administrative issues (Güçlü 2003). For the concept of strategy, it is possible to
define definitions from different perspectives with complementary features. These
definitions can be specified as follows (Akgemci 2013):
Strategy as a Plan: Orientation of actions and organizations in line with pre-
defined and announced goals in a conscious and purposeful way.
Strategy as an Emerging Direction: The emergence of the direction of action as
a result of the attitude and participation of the organizations within the sensitivity
of the environment rather than the previously defined and announced target.
Strategy as Location: Explaining the position of organizations within the
organization environment defined by the expectations and functions, and regulating
the relationship between the organization and its environment.
Strategy as a Perspective: The perspective of the organizations meeting in the
joint action, including the norms, values and behavior patterns they share due to
their common missions.
As our world is facing large-scale technological and economic developments in
the 21st century, the scales of all kinds of organizations are growing and turning
to more complex structures and operating systems. Therefore, it is difficult to take
measures to ensure the survival and development of enterprises and management
of enterprises becomes difficult. As a result of these reasons, the ability of the
business executives to anticipate the opportunities and dangers they may encounter
in order to be successful and to have information about them leads to better and more
reliable strategies. Therefore, they need to implement these strategies efficiently. The
Strategy; importance is given to predicting the future direction of external variables
and shaping alternative behaviors (Schelling 1980). The strategist demonstrates the
ability to combine opposing forces in harmony by effectively identifying and testing
strategies (Mintzberg 1987). Evaluating the possibilities of the person, what is being
done, what is wanted to be done, and seeing the strengths and weaknesses of the
enterprise, the values of the enterprise can be seen from a wide angle.
General Characteristics of Strategy
In today’s complex and dynamic business environment, strategy is a tool that

encourages and guides employees to survive and gain competitive advantage in the
market. The characteristics of the strategy which acts as a compass for the activities
of the enterprise, which takes the whole organization in harmony, can be summarized
as follows (Eren 2002):
1. An Art of Analysis: This art is a method of thinking based on inter-factor logic

principles and relationships in an open system, which is about making decisions
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and removing obstacles in decisions and not aiming only one line or only one
solution (Stockport 2010).
2. Is A Factor Of Purpose: The strategy of an enterprise serves the general
objectives of that enterprise and ensures that the forces gather around them.
3. Regulates Interaction Relations with the Business Environment: It provides
the opportunity to comprehend the environmental changes in economic,
technological, political and social terms, to eliminate the negative effects on
the enterprise and to make use of them by realizing the positive effects in a
timely manner.
4. It concerns a distant future system, in contrast to continuously repeated works:
Strategic choices are strictly separated from monotonous decisions and works
since they are related to the policies that the enterprise will follow in a long
time (Miles et al. 1978).
5. Strategy is an Aspect That Manages and Activates All Financial and Human
Resources of the Enterprise in Harmony: The strategy is the guiding or compass
of the events and decisions taken in the daily life of the enterprise. The strategy
sets the rules of the game, reduces uncertainty and clarifies the paths and rules
to be followed (Teece 2010).
6. Strategy is a Tool for Encouraging and Mobilizing the Human Being in a
Complex and Dynamic Organization: Strategy is a motivating factor. People
act more pessimistically in an uncertain environment. However, as they provide
them with information to reduce or reduce uncertainty about the future and
determine the goals to be achieved, their ambitions and courage will increase.
Thus, employees and especially managers will be able to easily draft their
tactical activities and easily determine the suitability of their personal activities
for general purposes.
7. Determines the Business Activity Areas in a Complex and Dynamic Environment:
It includes how to take advantage of the existing resources of the enterprise
and how to distribute it over a long period of time.
Strategic Management Concept
The strategy, which was initially used as a military concept, has become an approach
that businesses should apply in order to adapt to changing conditions and succeed
in a competitive environment (Schendel and Hatten 1972; Bracker 1980). Just as
plans are made after evaluating the status of the unity, the situation of the enemy
and the possibilities at hand in order to achieve victory with the least loss in the
minimum strategy, in challenging competition conditions, transmissions must follow
the changing market conditions well in order to survive and prevent competitors and
know the current characteristics of the competitors well. It should recognize. In the
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globalizing world, people’s consumer awareness as well as their expectations have

increased thanks to dizzying developing and changing transportation, information
and communication technologies. Therefore, in order to adapt to rapid change and
to maintain their existence in the long term, enterprises should adopt a strategic
management style that will enable the direction of the future of transmission rather
than traditional methods.
Strategic management enables the business to adapt to the environment, self-
assessment and predict the future. It establishes a common goal at every level of the
enterprise and ensures coordination and enables the establishment of target unity.
Strategic management should be considered as a process in businesses and should
be implemented (Gluck et al. 1982). The strategic management process should be
considered as all of the information gathering, analysis, selection, decision and
implementation activities aimed at sustaining the long-term life of the enterprise
and providing sustainable competitive advantage (Shrivastava 1994; Ülgen and
Mirze 2004).
Strategic management, planning the research, review, evaluation and selection
efforts necessary for the planning of strategies, taking all kinds of structural and
motivational measures within the organization for the implementation of these
strategies, taking into force and implementing the strategies before and after the
implementation of the top-level staff covering is the sum of the processes that concern
their activities (Strickland and Thompson 1984; Eren 2005). Although there is no
consensus on the definition of the concept of management, “management is to work
through others” is the most accepted opinion (Koçel 2005). Strategic management,
on the other hand, is a management technique that expresses the development of
effective strategies, planning, implementation and control of an organization to
achieve its objectives (Aktan 2008).
That the business world and the upper system it is a part of are constantly changing,
The institutions and competitors in the sector produce and implement various
strategies in accordance with the changing environmental conditions,
To understand the necessity of new strategies that can respond to these strategies
and even to make the company more productive states that they produce ideas and
work on these issues (Ülgen and Mirze 2006).
Although strategic management is not a new concept, today many companies are
unfamiliar with this concept. However, this is a fact that the necessity of enterprises
to anticipate future uncertainties and to plan and manage them accordingly is an
indispensable element. At this point, strategic management provides a competitive
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advantage to enterprises by being a dynamic management style, reacting to changes in

its environment and eliminating uncertainty and shaping the future (Venkatraman and
Camillus 1984). This is an indispensable desire for businesses in tough competitive
conditions. Therefore, businesses should adopt the strategic management approach
in a very good way by following the strategic management process mentioned in this
study carefully and disciplined (Shrivastava 1986). Today, strategic management is
tried to be applied in enterprises. However, it is seen that only the intuitive decisions
based on experience are applied by the top management in the strategic decisions
taken. The word strategy, which entered our literature as a military term in the early
20th century, was used in the sense of making a general plan and activating its own
power when necessary to determine what the enemy could and could not do. For
centuries, the art of war as a military concept and the military strategy to go to the
conclusion of a military operation in the sense of the planning and implementation
of the strategy used in the sense of the first, economists and mathematicians, two
scientists, Neuman and Morgenstern used in the economic sense (Aytepe 2008).
Strategy; is a management tool that aims to keep the changes in progress under
control in order to ensure innovation, progress, communication of the organization
/ institution with the environment and harmony with each other in parallel with
the rapid changes experienced (Hussey 2007). It affects and shapes the decisions
of managers and the behavior of employees. It is more about quality than quantity.
It is not extroverted but extroverted. It is an organization-specific and distinctive
claim (Güner 2005). Strategic management; It can be expressed as a participatory
and flexible management approach that expresses the process of monitoring and
evaluating their performances by establishing measurable criteria, as well as
establishing a vision for the future based on the current situation, mission and basic
principles of organizations, identifying the objectives and strategies that will enable
them to reach these goals (Aytepe 2008). Strategic management not only creates
strategies for the future, but also ensures that these strategies are implemented and
the success of implementation is controlled (Erkan 2008).
Strategic management; research, review, evaluation and selection efforts necessary
for planning strategies; It includes activities related to taking all kinds of measures
within the organization and putting them into force in order to implement the
planned strategies and to control the subsequent studies (Morden 2016). Strategic
management is the process of systematically implementing various research,
examination, evaluation, implementation, coordination and supervision steps for the
most efficient implementation of plans by conducting internal and external analyzes
in order to maintain an organization’s long-term existence and achieve its objectives
(Erdem 2006). Strategic management is a management technique that enables the
determination of future goals and targets in all organizations and the determination
of the procedures to be performed in order to achieve these goals (Atmaca 2007).
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In forming strategies, it is important to have adequate and appropriate answers to

What, Why, How, When, Where and Who questions. The analysis of these questions
forms the basis of strategic management (Aktan 2008).
Strategic management, research, review, evaluation and selection efforts required
for the planning of strategies, implementation of all planned and implemented
structural and motivational measures for the implementation of these planned
strategies, and then the implementation of the strategies once more in terms of
compliance with the objectives of the business is the sum of the processes concerning
the activities of the level staff (Ansoff et al. 2018). In order to achieve long-term
organizational goals, senior managers shape the future of the organization through
strategic management, which is a set of decisions and actions used in formulating and
implementing strategies that will provide a superior harmony with the organization
and its environment (Alpkan 2000).
Development of Strategic Management
In the 1970s, there were many uncontrollable and self-contained problems that would
shake the economic and industrial foundations. Production had fallen, inflation,
trade imbalance and cost competition had emerged. In addition, falling productivity,
increasing regulation, low growth rate, technological obsolescence, rising debts
of the III World, new technologies, fluctuations in money markets, serious global
competition and socio-political problems affected all institutions and organizations
trying to find a strategic direction. All these problems have led to a review of ongoing
implementation and management methods (Gönüllü 2008).
Organizations have had to think more strategically in the face of globalization, rapid
technological change, emerging markets, and the overwhelming competition resulting
from changing customer expectations. Prior to the 1980s, strategic management was
mostly implemented by a limited environment in the private sector, while today
many organizations use strategic management as an important tool (Atmaca 2007).
If we take a short look at the history of management; It is seen that it is aimed to
ensure compliance in every subject from classical management understanding to our
time. The Classical Management Approach, which started in the 1900s, the Behavioral
Approach in the 1930s and the Modern Management Approach that emerged in the
1960s, constitute the basic steps in the history of management. None of them has
completed their mission and has not withdrawn from the application areas and examples
of implementation are seen, if not on their own. Modern management approach
includes system approach, management according to objectives, direction-action
research, contingency approach and strategic management. Strategic management is
a form of management that incorporates, synthesizes and manages these management
processes and was developed to survive against changes (Erdem 2006).
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Once upon a time, the Japanese were leading the whole market. It was a pioneer
because it was able to produce and sell quality products that were intact for the customer.
But every day all competitors have focused on quality service and production. As
a result, there are many competitors in the same sector that do not differ from each
other in terms of quality. As such, the size of the problem changed. Accordingly,
the problem; total quality alone will not be enough, all competitors provide quality
service if the customer is not the opponent, but what superiority of them to come
to you, you must have the difference. The answer to this question can be explained
with the concept of strategic management.
Towards the end of the 20th century, in parallel with globalization, a process of
restructuring was initiated in public administration (Hunger and Wheelen 2003).
In this structuring, the concept of social welfare state, including public ownership
and broad public service, was abandoned. The most obvious aspect of this situation
is the privatization of national industries and the abandonment of public services
suitable for production and delivery by the private sector to market conditions
(Güner 2005). With the change, organizations have had to apply various management
techniques in order to increase their efficiency and effectiveness. In recent years,
the economic, socio-social, health and political changes in the world due to the
changes in the organizations to benefit from the changes, adapt to the differences
in these changes in the environment, to be prepared for unexpected situations and to
be least affected by them depends on the management technique to be implemented
and continuous success.
The main tools used in the strategic management process are situation analysis
(SWOT), portfolio analysis, Q sort analysis, vision-mission statements, scenario
analysis, search conference, brainstorming, delphi technique and nominal group
technique. Among the tools used, SWOT analysis is used to evaluate the internal and
external environment of the organization, and to determine the fields of activity with
the help of portfolio analysis matrices; Q sort analysis is used to identify the most
important and the most important issues that determine the alternatives that can be
used in the selection of the strategy, the mission and vision statements indicating
the reason of existence of the organization, the transformation of the principles
and values into written form; scenario analysis is used in predicting the future and
determining alternative action styles, in-house communication in order to create a
common mind in the organization of the call conference, and delphi technique is
used in obtaining the opinions of experts in order to make predictions for the future,
and the opinions of nominal group technique group members are taken without
discussion. Apart from these techniques, open group discussions, quality circles,
cost-benefit analyzes and risk analyzes are among the other tools that can be used
in the strategic management process (Oyman 2009).
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Characteristics of Strategic Management
Strategic management includes the characteristics of general management (Godet

1987). However, unlike these features, it is possible to mention some of the features of
strategic management. In order to better understand the issue of strategic management,
it is useful to reveal the basic features of strategic management.
Functional management and project or program management, distinguishing them
from strategic management to distinguish these features are as follows (Paul 1982):
1. Strategic management is an issue that concerns mainly senior management.

Strategic management is a function of top managers because it concerns the
future of the enterprise as a whole and tries to determine a direction for it.
2. The future is oriented and related to the long-term goals of the business. Thinks
about what the business will be in the determined time horizon and what needs
to be done to achieve these results.
3. In strategic management, business is seen as a whole composed of interdependent
and interdependent parts. Therefore, strategic management not only deals
with the business as a whole, but also the components that make up it. When
a decision is made for the whole or any of its components, its effects on the
other components are taken into account (Best et al. 2007).
4. Strategic management defines enterprises as open systems. Businesses are
in mutual interaction and dependence with their environment. Any changes
in the environment also affect the business. Therefore, strategic management
closely follows the environment (Wissema et al. 1981).
5. Strategic management considers the objectives of the enterprise and the interests
of the society in integrity. In this respect, strategic management carries social
responsibility towards its external environment.
6. Strategic management guides lower level managers. In other words, the
objectives, decisions and activities determined by the strategic management
constitute the common point of action of everyone up to the lowest units within
the enterprise (Kolb et al. 1986).
7. Strategic management is about the most effective distribution of the company’s
resources. It distributes the necessary resources in accordance with the product
or market compositions in order to realize the main objectives of the enterprise.
8. Strategic management emphasizes the importance of achieving the goals of
the organization based on teamwork. The determination of the strategies is
carried out with wide participation in the senior management and the most
optimal decision-making techniques are selected for the company.
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9. Strategic management helps to identify and solve the most effective problems
in the organization. In this context, total quality methods are widely utilized
(Bracker 1980).
10. Strategic management enables the planning, organization, coordination,
implementation and control of the future activities of the organization.
11. Strategic management utilizes competition and portfolio analysis in the
formation and selection of strategies. Portfolio analyzes are the techniques used
in strategy selection. It is aimed to make a more rational decision on issues
such as staying in the market or withdrawing from the market, merging with
other companies and so on.
12. Strategic management helps to” think strategically”. Within this framework, the
most accurate strategies and tactics are tried to be determined and implemented
(Franke et al. 1990).
13. The sources and data of the information used in decision making are different.
Since strategic management is concerned with the effectiveness and efficiency
of the business as a whole, the information sources and data on the subject
are very diverse. Many businesses require a wealth of information and data
on departments, functions and the environment (Brown 2005).
Strategic Management Process
Strategic management process can be considered as a special decision-making or

problem-solving process (Dinçer and Fidan 1996). In this sense, we can define the
strategic management process as all of the information gathering, analysis, selection,
decision and implementation activities aimed at sustaining the organizations’ long-
term lives and achieving sustainable competitive advantage (Ülgen and Mirze 2010).
The changing environmental conditions and the adaptation of the competitors
have led the organizations to have strategic awareness. For this reason, in order to
implement the process, it is necessary to select and appoint strategists to take part
in the organization. While analyzing both the internal and external environment,
the strategists employed determine the situation, reveal the current situation and
question the future developments. After all these analyzes are made in the strategic
orientation phase, the mission, vision, goals and objectives of the organization are
determined. It is given the answer to how these objectives and targets determined
in the strategy formation phase can be implemented according to which strategies.
The quantitative and qualitative data obtained through the strategies applied after the
studies on the structure of the organization and the decisions taken in the strategic
implementation phase in which the prepared strategic plans will be applied are
evaluated in the strategic control phase. The strategic management process, which
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can be reverted to the previous stages at every stage, is of great importance for the
survival of the organizations.
Importance and Benefits of Strategic Management
Strategy is very important for businesses. Businesses that do not have a strategy
cannot clearly and precisely determine their objectives. In addition, resources can
not be used effectively and efficiently in enterprises without strategy (Eren 2005).
The benefits of strategic management can be summarized as follows (Glueck
and Jauch 1989):
Strategic management allows organizations to anticipate changing situations.

Strategic management provides clear objectives and orientations.
Research in strategic management makes progress so that the process can help
managers.
Things that perform strategic management are more effective.
Strategic management systemises business decisions.
Strategic management helps the communication of the enterprise, the coordination
of individual projects, the allocation of resources and the development of
short-term planning such as budget.
The phases of strategic management can be listed as follows (Ülgen and Mirze
2006): Selection and assignment phase of strategists, Strategic analysis phase:
Determination of environmental opportunities and limitations, analysis of non-
operating environment and analysis of internal environment, preparation of due
diligence matrices,
Strategic steering phase: Determination of mission, vision and objectives,
Strategy formation phase: Determination and selection of basic and sub-strategies,
institutional, sectoral and functional strategies, determination of techniques to be
used in their implementation,
Strategic implementation phase: Studies on organizational structure, information
and decision systems to be used during the implementation of the strategy, appropriate
leadership understanding, corporate culture and management styles,
Strategic control phase: Control of performance obtained through the
implementation of strategies and techniques related to the control process.
In order to survive in the face of changing environmental conditions, today’s
enterprises must constantly change their balance and be prepared for new balance
situations. The rapid and constant change that the world is experiencing affects all
sectors to a great extent, renders existing goals and strategies invalid and inadequate
in a short period of time, creates a ball of new problems and threatens its existence by
242
dragging organizations into an environment of uncertainty. The fact that knowledge

accumulation improves the technology and feeds the production and consumption
of the developing technology increases the speed of change. The ability of the
organization to survive in such an environment; to know the conditions of the
environment in which it is located, to fulfill the necessity, to distinguish themselves
from its competitors, to be more flexible and to adapt to changing conditions by
responding to changes more quickly.
Strategic management is in a sense to manage environmental complexity and
change (Coulter and Coulter 2002). In this sense, strategic management means
meeting the future rather than waiting for the future, giving direction to the future
and managing the future. This requires organizations to be managed in such a way
that they can act as improvisations under very fast changing conditions. In terms
of strategic management, predicting the future, which is a passive function in
managing change as an improvisation (leading or creating change) is not sufficient,
it is important to shape and manage the future, which is an active function, and that
is what is desired. Because in an environment where only reaching the strategic
goals of the future will never be enough; it is possible both to remain in the achieved
goals and to make conscious and systematic leaps to further goals by managing the
future (Karakaya 2004).
From a strategic point of view, enterprises capable of evaluating the environment
and predicting the future provide orientation and consistency as a whole. In this way,
businesses form a framework by referring and planning their activities to specific
departments and evaluate themselves better. This improves the quality of business
decisions and projects. Developing effective strategies for achieving predetermined
or revised objectives, implementation is realized through concepts, methods,
approaches and principles related to strategic management, planning, organizing,
staffing, steering and auditing as a whole of decisions to evaluate and control the
results (Rodoplu 2001).
Having Strategic Consciousness
The Strategic Management process starts with having ‘strategic consciousness’

(Ülgen and Mirze 2010). Consciousness is defined as man’s ability to know himself
and his environment, the process of viewing perceptions and information in the
mind (Wheelen et al. 2010). Based on these definitions, we can say that strategic
thinking is the first step in strategic management process in order to have strategic
awareness. So if we define the definition of strategic thinking; According to Dess
and Miller (1996), strategic thinking is the art of overcoming the opponent and
doing this by keeping in mind that he is trying to apply the same to you. Strategic
243
thinking starts with your basic skills and examines how they are best used. Strategic
thinking sometimes means knowing when to avoid the game.
The main reason for drawing a strategy is to take long-term and rational actions;
all actions carried out by reason are planned actions. Practical strategic thinking is
all about planning future actions (Betz 2010).
Strategic management, which is a function of the top manager, is important for
the organization to carry out its strategic actions with the decisions planned and
made in the future. This is done with the support of senior management.
Therefore, Ülgen and Mirze (2010) emphasize the strategic awareness of managers
in organizations;
• That the upper system in business and as a part of it is in constant change,

• Organizations and competitors in the sector produce and implement various
strategies in line with the changing environmental conditions,
• They express the necessity of new strategies that can respond to these
strategies and even make the organization more productive, understand, think
about these issues, produce ideas and make studies (Ülgen and Mirze 2010).
STRATEGIC MANAGEMENT IN HEALTH INSTITUTIONS
Strategic management in health institutions consists of managerial decisions and

practices for the health institution to continue its activities in harmony with its
environment. In addition, strategic management in health institutions covers all
applications related to the inspection, research, evaluation and elections required
for the planning of strategies, taking all kinds of internal and external measures for
the implementation of the planned strategies and putting them into operation after
they are put into operation. It is also possible to see strategic management as a
management technique in all organizations operating in the health sector and in all
other sectors, which enables the determination of the goals and targets for the future
and the determination of the actions to be taken in order to achieve these targets
(Hitt et al. 2012). Strategic management is an important concept for the health sector
as it is for all organizations. With strategic planning, health institutions can design
futures and draw a direction for the unknown future. With strategic management,
health institutions can determine their goals and objectives for the future. In addition,
strategic management enables health institutions to determine the path to be followed
in order to achieve their goals and objectives.
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Definition of Strategic Management in Health Institutions
Strategic management in health institutions is divided into three main headings.

These three main headings are as follows:
• Series of decisions
• Corporate behavior
• Plan
The concept of strategic management, known as a series of decisions, means a

collection of decisions to determine the position of the health institution within the
environment. Strategic management, which is expressed as corporate behavior, is seen
as activities aimed at reacting and adapting to changes in the external environment.
In addition, strategic management can be seen as a plan. The strategy is related to
the future and expresses the results the organization wants to achieve in the future
(Pearce et al. 2000). These three concepts are known as common features of strategic
management. The series of decisions, corporate behavior and plan are important
concepts for health institutions to be oriented towards the external environment or
to provide competitive advantage. The concept of strategic management is a very
important concept for health institutions in terms of superiority over competitors
and ideas that direct the behaviors of the institution. The concept of strategic
management is defined as a continuous and repetitive process that enables the health
institution to work in harmony with its environment. There are three main concepts
that are important in the strategic management process for health institutions. These
concepts are as follows:
• Environment: Strategic management focuses on the external environment.

Health institutions operate in a variable environment. In this respect,
environmental changes create both opportunities and threats. A health
institution will be able to survive to the extent that it can benefit from
environmental opportunities and be protected from environmental threats.
• Continuity: Strategic management is not a process that starts and ends;
Since the environment in which it is constantly changing, the institution must
always adapt to these changes successfully.
• Duplicate Process: As discussed in the following section, strategic
management is a process involving more than one stage. Strategic
management starts with the analysis of the external environment, but does
not end with the stage of strategic control. The process starts again with the
analysis of the external environment and this cycle is repeated continuously
(Freeman 2010). Strategic management process is an important concept
245
in health institutions. This concept includes environment, continuity and

repetitive process concepts. Health institutions operate in a constantly
changing environment. For health institutions, environmental changes can
pose both threats and opportunities. In this context, health institutions can
continue their lives and provide quality services as long as they can benefit
from environmental opportunities and be protected from environmental
threats. Strategic management is not a concept for health institutions, but a
continuous concept because of the continuous change in its environment. In
addition, strategic management is a continuous process for health institutions.
Strategic management in health institutions starts with external environment
analysis and ends with the audit of strategies. It is possible to say that it is a
recurring process because it is repeated in the same way.
Functions of Strategic Management in Health Institutions
The functions of strategic management in health institutions are defined as

performance-based budget, e-government, accountability, performance management,
governance and total quality management (TQM). For health institutions to become
more effective, managers need to use the concept of strategic management as a
useful tool. Strategic management in health institutions contributes in particular
to the vision, mission, goals and objectives of the institution. In this way, health
institutions can have an idea about predetermining their future and directing their
works in this direction. Public managers view their activities through strategic
management from a long-term perspective. Strategic management contributes
to public organizations, especially in terms of vision, mission and values. Thus,
public institutions have the opportunity to determine their future in advance and to
direct their activities accordingly. Strategic management has many side functions
as well as the main function of securing long-term permanence in the public sector.
These; coordination function, change function, reflection and explanation function,
integration function (Elma 2010). Strategic management in health institutions is
defined as the process of reviewing, researching, selecting and evaluating necessary
for the planning of corporate strategies and taking all internal and external structural
and motivational measures in order to implement the planned strategies. In addition,
strategic management includes the process of examining these strategies applied to
health institutions both before and after implementation and performing supervisory
procedures.
All of the decisions and actions used in determining and implementing the
strategies that can adapt to both the internal and external environment of the health
institution in order to reach the long-term institution goals considered in health
institutions can direct the future of the managers in the health institution through
246
the strategic management. In addition to its relationship with the environment,

strategic management gives a new meaning to the administrative functions in the
long run by taking holistic functions and functions of the institution in order to create
the future of the institution. Strategic management is an important management
technique which aims to define the goals of the health institutions about what they
are doing and where they want to reach as a result and integrates all efforts in this
field, including the creation of strategies, the implementation of the activities and
the control of the activities.
Development of Strategic Management in Health Institutions
Due to the rapidly changing technology, globalization, changing expectations of

service users and the competition resulting from emerging markets, health institutions
need to think more strategically. While strategic management was used in some
areas in the private sector until the 2000s, many organizations today use the concept
of strategic management. Strategic management has been used as an important
tool in health institutions after the 2000s. If we take a short look at the history
of management; It is seen that it is aimed to ensure compliance in every subject
from classical management understanding to our time. The Classical Management
Approach, which started in the 1900s, the Behavioral Approach in the 1930s and
the Modern Management Approach that emerged in the 1960s, constitute the basic
steps in the history of management. None of them has completed their mission and
has not withdrawn from the application areas and examples of implementation are
seen, if not on their own. Modern management approach includes system approach,
management according to objectives, direction-action research, contingency approach
and strategic management. Strategic management is a form of management that
incorporates, synthesizes and manages these management processes and was
developed to survive against changes (Erdem 2006). Due to technological change
and the creation of new markets, health institutions have had to find and apply new
management techniques to keep their effectiveness and efficiency at the highest
levels. As a result of the changes in social, health, economic and political fields in
recent years, health institutions need to apply new management techniques in order
to benefit from these changes and adapt to the differences in the environment as
a result of these changes. The most important of these management techniques is
strategic management.
The Importance of Strategic Management in Health Institutions
Strategic management is very important for health institutions to form the vision
of the organization based on the current situation, mission and basic principles and
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to determine the objectives and appropriate targets and strategies in line with this
vision. In addition, strategic management is defined as a flexible and participatory
management approach that expresses the process of monitoring and evaluating
the performance of the institution by establishing measurable criteria for health
institutions by various methods. Strategic management in health care institutions
is not only a way to determine and formulate future-oriented strategies, but also to
implement these strategies and to check the success at the end of the implementation.
Strategic management; research, review, evaluation and selection efforts necessary
for planning strategies; It includes activities related to taking all kinds of measures
within the organization and putting them into force in order to implement the
planned strategies and to control the subsequent studies (Kavaler and Spiegel 2003).
Strategic management is the process of systematically implementing various research,
examination, evaluation, implementation, coordination and supervision steps for the
most efficient implementation of plans by conducting internal and external analyzes
in order to maintain an organization’s long-term existence and achieve its objectives
(Teece et al. 1997). It is a management that will create a strategic management
mission in health institutions and will enable the determination of the vision, goals
and targets for the future and the actions that can be taken to reach these targets.
Strategic management in health institutions is a management technique that helps
the organization to work more effectively, efficiently and with high performance.
Purpose of Strategic Management in Health Institutions
The purpose of strategic management in health organizations is to determine the

future of the organization and act in line with the objectives of the organization.
Strategic management is an important concept not only for businesses but also
within countries. Political existence is an important fact for countries. Today, being
politically required now requires economic strength, and countries need to act with
project-based plans due to factors such as economic change constantly, countries
looking for new resources, development of space technologies, and information
technology showing itself in every field. The goals of strategic management are as
follows for health institutions:
1. To create a vision to guide the health institution,

2. To set goals based on this vision,
3. Setting a strategy to achieve the objectives,
4. To implement the selected strategy effectively and efficiently,
5. The strategy is to start implementing its objectives and long-term implementation
instructions correctly with the vision, in the light of new opportunities, new
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ideas, changing conditions and experiences, and to evaluate performance

(David and David 2013).
One of the most important objectives of strategic management in health institutions

is to determine the dangers or opportunities that may occur within the organization
and to act accordingly. With the strategic management, health institutions can achieve
the level of patient satisfaction that the quality of service they provide. In health
institutions, a solid framework is established for strategic management, plans and
budgets to be made for the organization, internal communication is strengthened,
the goals and objectives of the organization are put forward in a more realistic
manner and all activities carried out within the institution are carried out at a better
and higher level.
Characteristics of Strategic Management in Health Institutions
Strategic management, which is an important concept for all organizations, has

the same importance among health institutions. It is possible to say that strategic
management is the most effective way for health institutions to follow in the light
of the existing opportunities and conditions in the environment in order to achieve
their future goals and objectives. Therefore, the concept of strategic management
has several features. In this sense, the basic features of the concept of strategic
management applied in health institutions are as follows:
1. Strategic management in health institutions is a method of analysis and thinking.

Therefore, strategic management is related to decision processes based on
inter-factor logic principles and relationships in an open system.
2. Strategic management in health institutions ensures that forces are gathered
around goals.
3. Strategic management in health institutions ensures that environmental changes
are monitored and the organization evaluates external factors effectively.
4. The strategic management process in health institutions is a long-term process.
This character is distinguished from routine decisions and jobs.
5. Strategic management in health institutions is an element that ensures that the
resources of the institution are managed in harmony.
6. Strategic management in health institutions determines the areas in which the
organization can operate with its existing resources and clearly shows how its
resources will be utilized and its long-term distribution.
7. Strategic management in health institutions is defined as a guiding and
motivating factor. Because it is possible to say that the uncertainty about the
future is relieving or reducing (Martin and Singer 2003).
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These characteristics are expressed as the general content of strategic management

in health institutions. It is possible to say that these features are the backbone of
strategic management to be implemented in health institutions. In order to implement
a successful strategy in health institutions, these features should be taken into
consideration and all strategies to be implemented should be built on these features.
Because of the increasing competition and changing technology, it is not important
for health institutions to have a successful strategy, but to have a successful and
optimal strategy and to implement this strategy.
Strategic Thinking
Strategic thinking requires a series of decisions about what actions the company wants
to take to achieve its goals more quickly and more successfully (Schoemaker 1995).
Companies should try to make strategic thinking not during the interim periods,
but throughout the whole process in which they operate. At the heart of strategic
thinking is the ability to identify and exploit opportunities that arise by anticipating
significant gaps in the competitive market. Strategic thinking helps managers make
crucial choice decisions and makes a vision contribution to the organization. In other
words, strategic thinking involves seeing and thinking of the future (Hartmann and
Rosche 2003). Strategic thinking, which is interested in balancing the environment,
opportunities, value and culture, is a continuous method. Strategic thinking is a
fundamental necessity and a useful first move for strategic management that seeks
to achieve its goals (Tampoe and Macmillan 2000). Strategic thinking requires
early action to keep pace with future variability. Strategic thinking is beneficial for
the business as it enables being targeted. Because the employees who focus on the
target offer all their powers cumulatively. Another benefit of strategic thinking is
the ability to think at the right moment (Heinrichs 2001).
Having strategic thinking helps businesses to minimize the risks of choosing
decisions they will regret later (Eren 2002). Organizational activities reduce the
risks and make it easier to solve the problems that arise during these activities
thanks to the plans that enterprises make in order to achieve their goals and targets.
In addition, the higher the level of strategic thinking in enterprises, the higher the
synergy associated with it (Pablo and Javidan 2009). Synergy is a sign that will
determine in which areas the existing tools or elements of the enterprise will be
successful and in which areas they will fail (Timuroğlu 2010). Therefore, synergy
is a key element in the choice of strategic decisions.
According to Heracleous (1998), strategic thinking primarily enables a manager
to determine how to use the limited resources he / she has in the most efficient way
and to advance the company towards its goals. At the same time, the emerging
competitive threats enable the company to be prepared by making various plans for
250
the situations that may arise as a result of changes in the national and local economy.
Companies with strategic thinking skills are strengthening the hand of managers on
the right time and the best tools to attack opponents, as they continually evaluate
the strengths and weaknesses of their businesses and the strengths and weaknesses
of the major competitors. On the other hand, it prefers to survive and grow by
renewing by contributing to the innovation of all aspects of the business. Finally,
it enables managers who make strategic thinking a central element of management
philosophy and become strategic thinkers in time as it enables them to use improved
decision making methods.
According to Liedtka (1998), strategic thinking can be a critical factor in the success
of companies as it helps managers to recognize and take advantage of opportunities by
chance, but also allows them to identify and evaluate lost opportunities. In addition,
since it encourages business managers and employees to think critically about the
rooted causes of the problems, it offers different recommendations for focusing on
problem solving about the company’s business model and operations. In the same
way, it enables the formation of an internal strategic mentality set and makes the
company active in creating a clearer strategy. Finally, it takes the company forward
to be proactive, as it requires working on programs to show early signs of how to
be successful in current business conditions and in more difficult times.
Creative Thinking and Strategic Thinking
Edward Mead Earl defines strategy as “a state or a community of states to take

control of the resources and armed forces to take advantage of them to develop and
secure their vital interests” (Luecke 2010). The strategy is about understanding
what you are doing, looking at long-term looking to determine what you want to
be, and - most importantly - focusing on how you plan to get there (Fogg 2010).
Strategy is an art because it requires creative thinking or thinking, both the ability
to identify alternative positions for the future, to inspire people to implement the
strategy, and strong communication skills to connect them; it is a science because it
requires managers or interested persons to collect and analyze the information they
can then put into action (Fogg 2010). In short, strategy can be expressed as a blend
of art and science. Strategic thinking, in its most basic sense, is about analyzing
opportunities and problems from a broad perspective and understanding the possible
impact your actions may have on others (Collis 2011).
Strategic thinkers envision what might happen and take holistic approaches to
everyday challenges and challenges; and they do this as a process that goes on rather
than a one-off event (Collis 2011). In this process, strategic thinkers have to be clever
in areas where we already feel stupid / ignorant (Gilhooly 1988). Individuals with
strategic thinking or strategic thinkers have a sense of the future, are at risk, perceive
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and identify patterns and tendencies, make concessions, think holistically, see the
“big picture”, activate their intuition, rely on the validity of these intuitions, engage
in complexity, think and visualize with metaphor they derive meaning from smoke
or a handful of air, collect complex and sometimes ambiguous data and interpret
them effectively and accurately, identify strategic goals effectively, are creative and
have creative thinking, analyze information and prioritize demand and competing
priorities (Collis 2011).
One of the specific steps in the process of strategic thinking, or in other words,
an important component of strategic thinking, is expressed as having creative and
creative thinking skills (Collis 2011). It should be remembered immediately that
effective strategic planning requires effective and very strong strategic thinking or
“strategic thinkers”, but the number of experts or strategic thinkers with strategic
thinking skills is very small (Mumford et al. 2012). No doubt, some of the award-
winning work (Bademci 2007) As can be seen, Vahid Bademci, “strategy” and
“strategic thinking” stands out as the most important and valuable names in the
Turkey issues (Korkmaz 2010).
Performance in Strategic Management Process
The concept of performance is related to the execution or realization of a specific

purpose, task or function (Akal 1992). Each economic unit converts the resources
(inputs) it obtains from its external environment into outputs in the form of goods
and services by using a certain production technology in order to realize its aims.
Evaluating the performance of enterprises in a certain period of time is the examination
of how rationally they behave while converting the inputs they use to outputs (Tetik
2003; Yürüşen 2011). The performance of a system is the output or run result at
a given time. This result is the degree to which business objectives or tasks are
fulfilled. In this sense, business performance can be defined as the evaluation of
all efforts made to achieve business objectives (Zerenler 2005). When the concept
of performance is analyzed on an organizational basis, it expresses the ability of
the organization to reach its predetermined goals by using its resources in the most
effective way (Nutt and Backoff 1987). The performance of an enterprise is defined
as the evaluation of the results obtained at the end of a certain period of time and
the efforts made for the realization of the business objectives (Simsek and Nursoy
2002). Corporate performance is the definition of the degree of fulfillment of the
business purpose or task according to the output / result obtained at the end of a
certain period (in a certain period of time) (Öztek 2005; Turunç 2006). Performance
at the enterprise level is the total result obtained by the interaction of all components
of the organization, machines, employees, management and environment (Çakmak
and Ocakli 2006).
252
Performance in terms of health institutions can be defined as the quantitative

or qualitative determination of the results of the activities and the activities of
the personnel and the activities they undertake to realize the strategic objectives
determined by the Ministry of Health, thus determining the overall success of health
institutions (Alptekin 2007). In order to determine the performance, the results of
the activities should be evaluated. The values that emerge after the performance is
measured constitute the performance indicators. Individual business performance is
very important for the organization. The organization is also affected by the strong
or weak performance of individual employees. Since increasing the performance of
the organization is the duty of the manager, it is the responsibility of the manager
to increase the performance of the employees (Wooldridge and Floyd 1990). Every
behavior an employee performs to fulfill his or her task is part of his / her performance.
The scope of performance; to produce a certain number of parts / goods, to solve
a problem, to carry out a project, to do a job, such as doing any job-oriented. It is
a function of performance, motivation and skill from an individual perspective. In
terms of organization, performance can be expressed as the degree of approaching
the expected goals and behaviors in compliance with pre-determined standards as
a requirement of any task (Arslan 2007).
In order for the performance appraisal system to be successful, firstly the task and
job analysis should be done and the work and tasks should be defined. Afterwards, the
process of defining the criteria which are the evaluation dimensions that employees
will be measured can be started. Among the data to be evaluated for the criteria
observed in employee performance; subordinates, peers and customers are also
very important (Paksoy 2006). It provides the information needed in management
processes such as performance measurement, planning, budgeting, performance
management, process improvement and comparison, and plays a critical role in
achieving corporate objectives by showing the priorities of the organization and the
activities that personnel should focus on in order to realize these priorities. Establish a
comprehensive performance measurement process; to define the performance, in other
words, to clarify the objectives of the programs, to establish the relationship between
inputs, processes and results, to clearly determine how to measure performance, to
overcome technical problems related to the performance measurement system, to
provide information on realizations and planned performance in a regular manner,
and performance information should be created in a structure suitable for use in
strategic decisions.
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SOLUTIONS AND RECOMMENDATIONS
Today, the rapid changes experienced in social, economic, political and technological
aspects necessitate renewal and adaptation to these changes. Regardless of the sector,
enterprises also need effective strategic management in order to exist and sustain
these assets despite environmental changes. Strategic management in general can be
expressed as the process of using the production resources effectively and efficiently
in order to realize the objectives of the organization (Ülgen and Mirze 2010). Health
institutions are highly complex, full-time and vitally important healthcare providers,
technology and labor intensive, affected by legal regulations and include many
different occupational groups. Each of these features causes health institutions to
face internal and external changes at any time. Therefore, the fact that the health
sector has an ever changing and developing environment increases the importance
of strategic management in the field of health and it becomes a subject that strategic
management managers should emphasize in both private and public sector (Swayne
et al. 2006). Hospital managers also benefit from strategic management tools as well
as other business executives within the scope of the strategic management approach
required for health institutions to adapt to all the changes and developments that
are experienced today, to anticipate the opportunities and threats that may occur,
to make the necessary organizational changes and to sustain their lives in short.
Given that the health sector is built on human life and health, it is thought to
be more complex and more difficult to manage than other sectors. However, it can
be difficult to implement the strategic management which can bring success in a
systematic way in the health sector where different professional groups, physicians
and managers operate together, whose common aim is to provide health services
and both groups have a say in its management. Therefore, all managers in the health
institution, who are responsible for both administrative and medical services, need
to be knowledgeable and effective in strategic management. Therefore, all managers
in health institutions are expected to be actively using strategic management tools
with the awareness of strategic management practices. Strategic management tools
are all techniques, methods, models, frameworks, approaches and methodologies
that help managers make strategic decisions (Preble 1997). The right strategies can
only be realized with the help of strategic management tools which are of great
importance in order to prevent the gap between theory and practice and to realize
the strategic management effectively (Key and Popkin 1998)
In the international literature, there are studies conducted in various sectors for
the use of strategic management tools. Among these studies, Bain & Company, a
global management consulting firm, has been conducting regular research every
year since 1993. On behalf of Bain & Company, Rigby and Bilodeau update this
study every year and use the 25 management tools they have developed to manage
254
the world’s leading companies and publish their results, revealing the management
trend in the world and annual changes in this trend (Rigby and Bilodeau 2013).
However, such a study investigating the level of knowledge and use of health care
managers about strategic management tools is not found in the literature.
FUTURE RESEARCH DIRECTIONS
Today’s health services are becoming more expensive in parallel with the developments
in rapidly changing technology and service provision, the share of the amount spent
on treatment services in total health expenditures increases and social security
institutions face payment problems. This situation necessitates the reduction of the
cost of the treatment services consuming a significant portion of the resources in
our country and the efficient use of the resources. To this end, efforts are underway
to make public hospitals autonomous, self-sufficient and to provide services in a
competitive environment with private hospitals in accordance with the principle of
efficiency. These studies aim to ensure that public and private hospitals produce
better quality and efficient services together and under competitive conditions in
the sector and this necessitates competition in the health sector.
Where there is scarcity, there is always competition. However, the peculiar
characteristics of health care markets make this competition different from most other
markets (Morrisey 2001). Therefore, health institutions have to take into account the
characteristics of health services in determining their competitive strategies. Because
the basis of determining a competitive strategy is to be successful in a competitive
environment. Determining appropriate competitive strategies for an enterprise
requires, first of all, an examination of the sector in which the entity operates and
its competitive status. To be successful in every sector, different needs must be met.
At the same time, there may be various differences between sectors depending on
factors such as concentration, economies of scale, product differentiation and entry
barriers.
In this case, developing a competitive strategy means developing a general formula
on how a company will compete, what its goals should be and what policies are
needed to achieve these goals (Porter and Locations 2000). Therefore, an enterprise
should examine the market and develop a competitive strategy before developing a
competition strategy. The aim of the competition strategy is to find a place where
the business can best defend itself against the competitive forces in the sector. This
defense can be realized by examining the structure of the market and competitive
forces (Pollard and Hotho 2006). More precisely, the development of a product or
service should be based not only on the capabilities of the organization, but also on
the competitive situation or external risks. Therefore, position strategies should be
255
selected considering internal requirements and external risks (Ginter et al. 2018).
So the essence of strategy formation is to overcome competition. The competition
situation in a sector is based on the five forces. The power of the sum of these forces
determines the ultimate profit potential of the sector (Porter 1998).
CONCLUSION
Today, when the waves created by globalization have changed the perception of
time and space and radically changed society and social structures, restructuring has
become a necessity in public health and management. Turkey, the health sector in
its geography, is destined to become a reference center in the health sector. In line
with this objective, radical changes and developments are experienced in the sector.
On the one hand, the number of private health institutions is increasing rapidly and
therefore competition has intensified, and on the other hand, the regulations have
paved the way for patients to receive health care services from both private hospitals
and public health institutions. Also; Providing service providers in health institutions
affiliated to the Ministry of Health to benefit from the revolving fund revenues of
the institution brought a different dimension to the competition. Service quality
and patient satisfaction have gained importance for healthcare providers in order to
gain and maintain superiority in such an environment. Targeted with the quality of
health services; it is not only a longer life, but an improvement in the quality of life.
It is important to provide equal, continuous and adequate service in the health
sector, to create the necessary infrastructure for these services, to meet the need of
manpower and financial resources, and to use the physical infrastructure and manpower
effectively. Health is one of the most important tools and indicators of development.
Since health care is an abstract product that transfers value to the recipient at the
time of production, it is difficult to define and measure the output. The quality of
health services provided by health institutions requires patient satisfaction. The high
level of patient satisfaction causes the patients to choose the same health institution
or recommend it to others in their subsequent needs and consequently to become a
loyal customer of that health institution.
In the context of globalization and overwhelming competition, organizations
have to renew and change their management structures, systems, processes, human
and information resources. Especially in the health sector, the concept of strategic
management is one of the most important concepts to be considered. Although
strategic management has emerged primarily in the private sector, it has found
application in public institutions as well. It is important to implement strategic
management of public organizations not for profit as private sector organizations,
256
but for the principle of effective service, and for citizen-oriented applications rather
than customer-oriented organizations such as private sector organizations.
Planning of a realistic reform according to the advantages and weaknesses,
opportunities and dangers of the internal and external environment analysis of
public administration, institutionalization and continuity of change can only be
ensured by the understanding of strategic management. Another important concept
for institutions is performance evaluation. In order for organizations to obtain the
expected benefits from performance measurement, the performance measurement
system must be in harmony with the organizational strategy, the information obtained
as a result of performance measurement should be reliable, the selected performance
indicators should have the capacity to reflect all aspects of performance and the
obtained performance information should be used in the decision process. Use
of strategic management and performance measurement in the public sector, It is
important for public institutions to require that they evaluate their internal processes
and external environmental conditions, to determine the objectives and strategies to
achieve these objectives by clarifying them, and to be the basis for the evaluation
of implementation results and accountability.
Modern management approach requires employees to be rewarded according to
their success. The most common of these rewarding methods is the performance-based
remuneration system. In other words, performance-based remuneration systems are
the means used to reward and appreciate employees in proportion to the achievement
of an organization’s goals or individual performance goals. The basic starting point
of these systems is to determine a part of the wages or the additional payment given
with the fixed wage according to the performance of the employee. Wages paid
based on performance are variable and are often a reflection of their performance.
These wages depend on the performance of the employee in the specified period
and vary depending on the performance of the organization, the performance of the
department in which he / she works, the individual’s performance or the combination
of these within the specified unit time period.
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Evaluating the Impact of Strategic Management and Strategic

Chapter · January 2020

Stakeholder Management View project

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General Characteristics of Strategy

In today’s complex and dynamic business environment, strategy is a tool that

1. An Art of Analysis: This art is a method of thinking based on inter-factor logic

Strategic Management Concept

globalizing world, people’s consumer awareness as well as their expectations have

advantage to enterprises by being a dynamic management style, reacting to changes in

In forming strategies, it is important to have adequate and appropriate answers to

Development of Strategic Management

Characteristics of Strategic Management

Strategic management includes the characteristics of general management (Godet

1. Strategic management is an issue that concerns mainly senior management.

Strategic Management Process

Strategic management process can be considered as a special decision-making or

Importance and Benefits of Strategic Management

Strategic management allows organizations to anticipate changing situations.

dragging organizations into an environment of uncertainty. The fact that knowledge

Having Strategic Consciousness

The Strategic Management process starts with having ‘strategic consciousness’

• That the upper system in business and as a part of it is in constant change,

STRATEGIC MANAGEMENT IN HEALTH INSTITUTIONS

Strategic management in health institutions consists of managerial decisions and

Definition of Strategic Management in Health Institutions

Strategic management in health institutions is divided into three main headings.

The concept of strategic management, known as a series of decisions, means a

• Environment: Strategic management focuses on the external environment.

in health institutions. This concept includes environment, continuity and

Functions of Strategic Management in Health Institutions

The functions of strategic management in health institutions are defined as

the strategic management. In addition to its relationship with the environment,

Development of Strategic Management in Health Institutions

Due to the rapidly changing technology, globalization, changing expectations of

The Importance of Strategic Management in Health Institutions

Purpose of Strategic Management in Health Institutions

The purpose of strategic management in health organizations is to determine the

1. To create a vision to guide the health institution,

ideas, changing conditions and experiences, and to evaluate performance

One of the most important objectives of strategic management in health institutions

Characteristics of Strategic Management in Health Institutions

Strategic management, which is an important concept for all organizations, has

1. Strategic management in health institutions is a method of analysis and thinking.

These characteristics are expressed as the general content of strategic management

Creative Thinking and Strategic Thinking

Edward Mead Earl defines strategy as “a state or a community of states to take

Performance in Strategic Management Process

The concept of performance is related to the execution or realization of a specific

Performance in terms of health institutions can be defined as the quantitative

SOLUTIONS AND RECOMMENDATIONS

FUTURE RESEARCH DIRECTIONS

Akal, Z. (1992). İşletmelerde performans ölçüm ve denetimi. Ankara: Milli

Alpkan, L. (2000). Stratejik Yönetimin Kapsamlılığı. Stratejik Tercihler ve Yönetici

Çakmak, N., & Ocakli, E. (2006). Performans değerlendirmesi gerekli midir?

Karakaya A. (2004). Stratejik Yönetim Sisteminin Kriz Yönetimine Katkısı Üzerine

Mumford, M. D., Medeiros, K. E., & Partlow, P. J. (2012). Creative thinking:

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