Invited Commentary
Does Strategic Planning Matter?
William T. Mallon, EdD
Abstract
In this Invited Commentary, the
author examines the history, use, and
effectiveness of strategic planning in
higher education, academic medicine,
and nonprofit settings. Strategic planning
is a process by which an organization
differentiates itself from its direct or
emergent competition to achieve its
mission. This form of planning is distinct
from operational planning, in which
an organization identifies the ways in
which it will continuously improve. Many
organizations employ a combination
of strategic planning and operational
planning but use the former term to
describe their planning process
Editor’s Note: This is an Invited Commentary
on Byrne N, Cole DC, Woods N, et al. Strategic
planning in health professions education:
Scholarship or management? Acad Med.
2019;94:1455–1460.
I’m putting you on the strategic planning
team. It’s like work but without the
satisfaction of accomplishing anything.
—The Boss to Dilbert;
Scott Adams, Dilbert1
W hat is it about strategic planning
that has inspired such cynicism in the
professional literature, the academic
quad, and the funny pages? A debate
persists in the peer-reviewed literature
about whether strategic planning leads
to improved organizational outcomes.
Commentators issue warnings about
“the perils of bad strategy”2; practitioners
ask if “strategic planning [is] relevant
anymore”3; and faculty flat-out assert that
the strategic plan is “neither strategy nor
plan, but a waste of time.”4 The Boss’s
Please see the end of this article for information
about the author.
Correspondence should be addressed to William T.
Mallon, Association of American Medical Colleges,
655 K St., N.W., Suite 100, Washington, DC 20001;
telephone: (202) 828-0424; email: wmallon@aamc.org.
Acad Med. 2019;94:1408–1411.
First published online June 18, 2019
doi: 10.1097/ACM.0000000000002848
Copyright © 2019 by the Association of American
Medical Colleges
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Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
without a clear definition or conceptual
framework.
The empirical literature across disciplines
has not demonstrated that strategic
planning leads to positive organizational
outcomes. Over the modern history of
academic medicine in the United States,
strategic planning may have had limited
impact on organizational outcomes
because of favorable environmental
circumstances that catalyzed growth
and innovation regardless of planning
efforts. In the current environment,
organizational and departmental leaders
need to define trade-offs between the
description of strategic planning from
Dilbert, above, is funny because it may be
closer to the truth than we would like to
admit.
For more than 25 years, I have been
a participant, facilitator, consultant,
scholar, and leader of strategy
development and strategic planning
efforts in higher education, academic
medicine, and nonprofit organizations.
In these roles, I have encountered a fair
amount of cynicism about strategic
planning among faculty, staff, and
other stakeholders, with many people
questioning whether strategic planning
matters. While I do not share that
cynicism, as both a practitioner and
researcher of organizational behavior
and change, I have developed a healthy
skepticism for what strategic planning
achieves and a deep appreciation for
what it means.
In this Invited Commentary, I begin with
a conceptual framework to differentiate
among different types of planning
efforts and then offer 5 observations
about strategic planning in the higher
education, academic medicine, and
nonprofit arenas. These observations
apply to the academic environment in
particular; they may or may not resonate
with the clinical enterprise, which in
many markets has a stronger need for
competitive differentiation.
Academic Medicine, Vol. 94, No. 10 / October 2019
various opportunities that they confront;
allow for both planned and emergent
strategy formulation; avoid platitudes and
fluff; and focus on operational excellence.
Theories from anthropology suggest that
strategic plans may be more important
for what they express than what they
produce. Repetition of the themes and
language of strategy in formal and
informal discourse can have a decisive
effect on the culture of the organization.
Strategic planning, therefore, matters for
its effect on organizational values, rituals,
and ability to move the organization in
new directions.
“Strategic Planning” Versus
“Planning”
Before we can examine whether strategic
planning matters, we need to define the
term. Too often, “strategic planning”
is used as a catchall phrase without
a common definition. When does an
organization’s plan for the future become
a strategic plan?
History shows that strategy, from its
ancient militaristic origins to its 20th-
century business application (from which
higher education’s version of strategic
planning developed), is predicated
on competition. That is, strategy is
focused on gaining advantage over one’s
competitors—even in nonprofit settings,
where direct competition still exists
but may not be as apparent. “Strategic
planning,” therefore, is the process
whereby an organization identifies
how it will differentiate itself from its
competition to achieve its mission—
whether that competition is a nearby
hospital system, a national competitor
for student or faculty talent, or a nascent
competitive threat on the horizon.
Many organizations, however, hold
a less specific, implicit definition of
“strategic planning” that is akin to
“ongoing planning”—a process whereby
an organization establishes short- and
long-term goals for improvement and
measures progress toward achieving

those improvements. While laudable (and
mandatory for medical schools accredited
by the Liaison Committee on Medical
Education [LCME]5), such operational
planning does not necessarily earn the
“strategic” moniker. Organizational
plans may be a combination of strategic
planning (“How will the organization be
different in response to external threats
and compared with our competition?”)
and operational planning (“How will the
organization continuously be better to
improve outcomes?”).
Operational planning is important. But it
is not the same as strategic planning.
Strategic Planning Has Not
Mattered Much
The genesis of strategic planning in
higher education stems from a meeting
of university facility planners held at the
Massachusetts Institute of Technology
in 1959.6 It really took off in the 1980s,
with groundbreaking books about
strategic planning in the public sector
and in higher education.7–9 Since those
early days, universities, medical schools,
and academic health centers have
employed strategic planning techniques
such as environmental scanning, SWOT
(strengths, weaknesses, opportunities,
and threats) analyses, program and
product road maps, scenario planning,
forecasting, and balanced scorecards,
among other research-generated,
consultant-sold, or home-grown tools
and techniques. Most strategic planning
efforts tend to follow a familiar process—
such as the one that Byrne and colleagues
describe in their article in this issue of
Academic Medicine.10
Strategic planning has been studied
extensively by researchers in diverse
disciplines such as anthropology,
public administration, management,
decision sciences, and education,
using quantitative, qualitative, and
mixed methods. Meta-analyses have
found positive relationships between
strategic planning and organizational
performance11–13; however, studies on
strategic planning have been criticized for
conflating correlation with causation.14
That is, strategic planning may not
make a difference to organizational
performance; rather, positive outcomes
may be attributable to other factors, such
as favorable external factors, competent
leaders who know how to effectively
Academic Medicine, Vol. 94, No. 10 / October 2019
Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
manage organizations, and even luck. But
we cannot say that strategic planning in
and of itself causes strong performance.
Ergo, does strategic planning matter—
really?
Beyond the empirical evidence is the
historical context of medical schools and
teaching hospitals in the United States. In
the long view, strategic planning has not
mattered much for academic medicine as
an industry: Since the 1960s, tremendous
growth has created enough slack in the
system that academic health centers have,
in effect, not needed to make choices
or trade-offs regarding one strategy
versus another. They have been able to
balance growth portfolios in all their
mission areas. While there is and has been
variation across the community, with
some medical schools being disciplined
and others facing significant crises that
required dire strategic choices, academic
medicine as an industry has been
enormously successful being many things
to many people.
Suffice it to say that unbridled growth
has, if not disappeared, at least become
more volatile. And the traditional funding
sources for the tripartite missions have
been under duress. Most academic
health centers can no longer ignore the
need for a true strategy—that is, making
choices about what to do and what not
to do to fulfill the institution’s reason
for existence.15 This concept of strategy
emphasizes choosing some things but not
others and, therefore, involves a simple
yet difficult word: “No.”
Strategy Needs Leadership
No-How
Leaders are critical because they are the
ones who can say “no.”
This no-how surely is needed under
difficult financial circumstances, but
not only then. Even if an organization’s
balance sheet is healthy, even when there
are many opportunities for innovation
and investment, no organization can
pursue every opportunity.
Leaders define the trade-offs for the
organization—meaning that “more of
one thing necessitates less of another.”16
This is not to suggest a zero-sum game.
Rather, by choosing to invest in, say, one
area of clinical or research expertise but
not another, leaders make organizational
Invited Commentary
priorities clear. Organizations that try
to be all things to everyone (patients,
students, residents, faculty, staff, the
public) risk diffusion of effort, budgetary
and human resources, and even
messaging. Trade-offs “purposefully limit
what the [organization] offers.”16
That’s easier said than done. The reality
of organizational life works against
making choices about what to do and
not do (i.e., having a strategy). As Porter
states, trade-offs can be frightening.16
Who wants to make the wrong choice?
We do not want to disappoint faculty,
staff, and leaders. We want to minimize
conflict. We want to avoid a dustup with
an influential department or faculty
member that escalates into bad press—or
a pink slip.
In the face of these inclinations,
perhaps the most important word that
organizational and departmental leaders
can assert in the successful development
and implementation of strategy is “no.”
Leaders need to ask themselves whether
the thing that they call the “strategic plan”
for their organization or department is
uniquely focused on trade-offs between
various pathways they could take to
achieve their mission or focused on goals
that are important and laudable for any
high-performing organization. If you
could take a goal and easily drop it into
the strategic plan of an organization
in another industry, you are probably
working on an operational plan, not a
strategic plan.
Planned or Emergent Strategy?
Most approaches to strategy and strategic
planning have an implicit point of view
of organizational rationality—one that
emphasizes hierarchy, rational decision
making, cost–benefit analyses, and
planned interventions. What Mintzberg
pointed out in 1987 is still true today:
“Virtually everything that has been
written about strategy making depicts
it as a deliberate process. First we think,
then we act. We formulate, then we
implement.”17
Mintzberg argued that strategy can form
as well as be formulated. It can and
should emerge in response to evolving
situations. Smart leaders “appreciate that
they cannot always be smart enough to
think through everything in advance.”17
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 Invited Commentary
Should strategy be planned or should it
emerge? I’m a pragmatist, not a purist.
I like a hybrid approach, the type of
strategy development summarized by
Hamel: “Strategy is poised on the border
between perfect order and total chaos,
between absolute efficiency and blind
experimentation, between autocracy
and complete adhocracy.”18 If Hamel’s
description doesn’t sound like an
academic medical center, I don’t know
what does.
Medical schools and teaching hospitals
are particularly well suited to this
hybrid approach, in which strategy
development is neither fully planned nor
fully emergent. Strategic planning is both
top-down and decentralized; rational and
symbolic; and deliberate and emergent.
What About Fluff?
Strategic plans have been criticized for
their “fluff,” or “restatement of the obvious,
combined with a generous sprinkling of
buzzwords that masquerade as expertise.”2
Organizations across industries are prone
to fluff, academe included. One well-
known university stated that its strategic
goals were to “epitomize the scholar–
teacher ideal,” “provide an unsurpassed
education and experience,” “demonstrate
distinction in graduate and professional
studies,” and “engage in the great ideas
and issues of our time.”19 In other words,
this university’s transformational goals
were to be a university. A related criticism
of traditional strategic plans is that their
goals do not facilitate difficult trade-offs
but, rather, constitute “a scrambled mess
of things to accomplish. . . . A long list of
things to do, often mislabeled as strategies
or objectives, is not a strategy. It is just a
list of things to do.”2
Thus, the list of things to do, aka the
strategic plan, has been criticized
for gathering dust on a shelf.20 Even
organizations that employ dynamic,
nimble, and shorter-span planning
approaches sometimes spend too much
time coming up with a strategy and
not enough time implementing one.
Mintzberg proffered:
Most of the time, [leaders] should not
be formulating strategy at all; they
should be getting on with making their
organizations as effective as possible in
pursuing the strategies they already have.
. . . Organizations become distinguished
because they master the details.17
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Copyright © by the Association of American Medical Colleges. Unauthorized reproduction of this article is prohibited.
Mintzberg was not arguing for sticking
with a strategy that is not working.
Rather, an organization should fully
implement the strategy it already has
when the environmental circumstances
indicate it remains valid.
Strategy as Culture
But let us dwell for a moment on those
strategic plans stored on your shelf. Is
strategic planning nothing more than a
ritualized process, “full of storm and fury,
signifying nothing”?21 Just “like work but
without the satisfaction of accomplishing
anything”?1
Before cynicism washes over, it is worth
considering the relationship between
strategy and organizational culture. One
predominant view of this relationship is
adversarial—that “culture eats strategy
for breakfast.” While this viewpoint may
be appealing (perhaps because it absolves
leaders from needing to link strategy
to organizational success), it is not
accurate. Theories from anthropology,
such as cultural theme theory22 and
cultural schema theory,23 suggest that the
recurrent words and phrases and themes
in written documents “stimulate, guide,
and pattern future behaviors.”24
These theories suggest that strategic
planning, and those dusty documents on
your shelf, may be important not for what
they produce but for what they express.25
According to Wiedman and Martinez,
“even though written plans with mission,
goals, and objectives may not be read
until they are updated again, the cultural
themes, orally restated in committee
meetings, informal conversations, job
descriptions, etc., become a dynamic
force of culturally accepted behavior.”24
Repetition of themes in the formal and
informal discourse of an organization can,
over time, change behavior and influence
the culture. Wiedman and Martinez’s study
of strategic planning at a new medical
school found that “strategic planning
can play an important role in directing
organizational culture change.”24(p272) The
language of strategy may have a decisive
effect on culture, as Byrne and colleagues’
case study demonstrates.10 This symbolic,
strategy-as-culture effect can be critical
for leading stakeholders (e.g., governing
boards, faculty, students, state legislatures,
donors), many of whom may not intend to
be led easily.
Academic Medicine, Vol. 94, No. 10 / October 2019
So maybe we have had it all wrong:
Maybe culture is not an oppositional
force that wreaks havoc with attempts
at strategy setting in organizations.
Maybe strategy and culture are different
manifestations of the same force.
Maybe the power of strategic planning
is the way you talk about it to shape
the culture of your institution. Maybe
strategic planning matters for the values
it conveys, the rituals it embodies, and the
way it nudges your organization in new
directions.
New Directions for Research
Curiously, as important as effective
leadership and management practices
are for medical schools, teaching
hospitals, academic health systems, and
the associations that support medical
education, there is little research
on strategic planning and strategy
development and execution within the
academic medicine community. This is
especially surprising for an institutional
exercise that is mandatory for medical
education programs to receive LCME
accreditation. There have been only a
few case studies published in the pages
of this journal.10,26–31 Cross-institutional,
multidisciplinary studies that could
inform practice in meaningful ways are
needed. If strategic planning does in fact
matter, it would behoove institutional
leaders, practitioners, and researchers to
take a multidisciplinary approach to show
us how.
Acknowledgments: The author thanks Anne
Barnes, Peter Buckley, Jennifer Schlener, and
David Skorton for helpful comments on an
earlier version of this article. The author is solely
responsible for its contents.
Funding/Support: None reported.
Other disclosures: None reported.
Ethical approval: Reported as not applicable.
W.T. Mallon is senior director, Strategy and
Innovation Development, Association of American
Medical Colleges, Washington, DC.
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