Healthcare strategic management and the resource based view

Abstract

Purpose – The purpose of this paper is to examine how two large health systems formulate and implement strategy with a specific focus on differences and similarities in the nature of strategic initiatives across systems. The aim is to gain a better understanding of the role of resource dependency theory (RDT) and resource based view (RBV) in healthcare strategic management. Design/methodology/approach – A comparative case study design is used to describe, categorize and compare strategic change initiatives within a children's health and a multi-hospital system located in two competitive metropolitan markets. A total of 61 in-person semi-structured interviews with healthcare administrators were conducted during 2009. Summary statistics and qualitative content analysis were employed to examine strategic initiatives. Findings – The two health systems have as their top initiatives very similar pursuits, thus indicating that both utilize an externally oriented RDT method of strategy formulation. The relevance of the RBV becomes apparent during resource deployment for strategy implementation. The process of healthcare strategic decision-making incorporates RDT and RBV as separate and compatible activities that are sequential. Research limitations/implications – Results from this comparative case study are based on only two health systems. Further, the RBV perspective only takes managerial resources and time into consideration. Practical implications – Given that external resources are likely to become more constrained, it is important that hospitals leverage relevant internal resources, in the identification of competitive advantages and effective execution of strategic initiatives. Originality/value – The author propose a refined healthcare strategic management framework that takes both RDT and RBV into consideration by systematically linking strategy formulation with deployment of resources.

Implementation of cost accounting as the economic pillar of management accounting systems in public hospitals – the case of Slovenia and Croatia

“…Bearing in mind the scope of preconditions for and requirements of MAS, and particularly the importance of the resources in the healthcare environment, the RBV was considered the most favourable theoretical concept, which we could build our research platform on. The previous studies confirmed that the strategy development is primarily driven by external environmental factors, while on the other side the strategy implementation is influenced by internal resources according to RBV approach (Arbab Kash et al, 2014). Accordingly, our research goals are focused on exploring the factors for successful development and adequate resources for implementation of the effective cost accounting system.…”

“…The RBV's focus is on competitive advantage, based on the internal resources that an organisation develops or hires (Arbab Kash et al, 2014). Joining this growing trend of RBV approach in healthcare organisations, our research has been conceived to include the analysis of two datasets, namely: 1) literature (journal articles, papers, strategy documents, project reports, online resources, etc.…”

“…Deriving from research results, based on our own survey and literature review (Arbab Kash et al, 2014;Burton & Rycroft-Malone, 2014;Rosenberg Hansen & Ferlie, 2016;Haslam & Marriott, 2006;Jacobs et al, 2004;Lutilsky et al, 2012;Malmmose, 2015), we extracted some general conclusions, which are important also from a theoretical contribution perspective. Since public hospitals are floating between economic efficiency and high quality health services, the development of a cost accounting system should be based on analysis of the organisation's heterogeneous resources, focusing mainly on those that create value on one side and efficiency on the other (Rosenberg Hansen & Ferlie, 2016).…”

“…Based on the extensive review of the literature, we can deduce that existing research only partially addresses the technical view of MASs, as illustrated in the Table 1 and the text below. Jacobs et al, 2004 Case study of UK, German and Italian doctors' access to accounting information Ellwood, 1996 Effects of full costing method implementation in UK hospitals Fiondella et al, 2016 The implications of the professionals into the MAS change Malmmose, 2015 The research of the polarised discourses of management accounting and the medical profession in Denmark Lehtonen, 2007 The mechanisms of successful implementation of new accounting and control system Kurunmaki et al, 2003 Consideration of MAS from the clinicians' and accountants' role in the process in UK and Finland Arbab Kash et al, 2014 The analysis of the strategy formulation according to RBV (and RDT) theory to refine healthcare strategic management framework Hassan, 2005 The economic research of the implications of the MAS change in Egyptian hospitals Naranjo-Gil, 2004 The study of the effects of the MAS changes on the performance of public hospitals in Spain Stamatiadis, 2009 The study of the effects of the MAS changes on the performance of public hospitals in Greek Azoulay et al, 2007 The paper reviewed the use of hospital-based cost accounting systems aimed to provide internal reports to administrators for formulating major policies and strategic plans for future activities…”

“…The neglected function of cost accounting within MAS in public sector organisations (Jovanovi c & Dragija, 2018;Lutilsky et al, 2012;Spekle & Verbeeten, 2014) have been perceived as an administrative or even bureaucratic activity. Based on the resource-based view (RBV) in the strategic management theory of public organisations, which observes the interior structure of the organisation, as well as its resources and capabilities (Arbab Kash, Spaulding, Gamm, & Johnson, 2014;Bryson, Ackermann, & Eden, 2007;Rosenberg Hansen & Ferlie, 2016), the paper presents the insight into the development stage of cost accounting systems in Slovenian and Croatian hospitals. The paper is the pioneering attempt to analyse the cost (within management) accounting systems in public hospitals of two post-communist countries (Slovenia and Croatia) from the CEE region, and present new findings in this context.…”