Factors Affecting Strategic Planning in the Saudi Healthcare System

Abstract

Background.<br/> Strategic planning has evolved as an essential component in the planning process for sustainability, continuity and improvement of healthcare organisations. It assumes that planning promotes services that are high in quality at a low cost and is described as an intellectual journey that aims to envision the future and acts accordingly, to ensure that services are more receptive to community needs and requirements.<br/> Aims.<br/> This study explores factors perceived by employees to affect the effective implementation of strategic plans, identified the types of strategic planning processes adopted by healthcare organisations in Saudi Arabia and how these processes assisted in achieving the strategic plans, and examined the challenges in developing and implementing strategic plans within healthcare organisations in Saudi Arabia. Methods.<br/> Design: This study adopts a sequential quantitative–qualitative mixed methods design, in that quantitative data informed the structuring of the interview questions used to collect the qualitative data.<br/> Sample and settings: 508 employees participated in this study, representing four main healthcare organisations representing three major cities in Saudi Arabia: King Fahad Medical City (Riyadh), King Saud Medical City (Riyadh), King Abdullah Medical City (Mekkah) and Ar'ar Central Hospital (Ar'ar). Employees and managers from various levels of management and specialisations participated in this study.<br/> Instrument: A new instrument was developed for the purpose of this study, as follows: a comprehensive search was conducted in a range of databases on related literature. Thematic analysis of the retrieved documents was performed to investigate what constituted strategic planning as a concept. Themes were then transformed into statements that describe the concept, to form the first draft of the study questionnaire, which was sent to experts in the field to obtain face validity. This step resulted in a refined version of the questionnaire. The questionnaire draft, which comprised 64 statements, was then pilot tested on 60 participants from different specialisations (α=.912). As the questionnaire was found to be reliable and had a high internal consistency, no changes were made, and the questionnaire was ready for data collection.<br/> Findings from the quantitative part provided information that guided the interview questions necessary to address what was missing from the data. Therefore, questions were structured based on the quantitative findings. The questions asked:<br/> • What constitutes the process of strategic planning (SP) that leads to choosing, adopting and implementing a plan in healthcare organisations in Saudi Arabia, including the processes and the means to achieving the strategic planning objectives?<br/> • What are the benefits, challenges and barriers to implementing strategic plans effectively?<br/> • How do managers affect the process of achieving strategic plan goals?<br/> The quantitative data were collected using the survey questionnaire and were analysed using quantitative measures as appropriate by testing for normality and descriptive statistics to describe participants' characteristics. Then, factor analysis was conducted to ensure the validity and reliability of the research instrument. Next, analysis of variance was used to examine the effect of different sample characteristics on the mean scores of the factors. Second, the qualitative data were analysed using content analysis, which resulted in emerging evidence on several factors. The participants reported the effects of the process of planning, implementing and evaluating strategic plans in their organisations.<br/> Results.<br/> There were 54 valid statements of the questionnaire, distributed over five factors that were believed to affect SP in Saudi healthcare organisations. These factors are: organisational characteristics, explained by 19 statements on the questionnaire; leader characteristics, explained by 20 statements; mission and vision of the organisation, explained by seven statements; goals and objectives of the organisation, explained by six statements; and management involvement in SP, explained by two statements.<br/> Normality tests and reliability measures were tested to prepare data for factor analysis. As the number of items was high (i.e., statements), principal component analysis was adopted.<br/> Participants had positive views about SP and the required resources to achieve the strategic goals in Saudi healthcare organisations. Participants perceived that the mission and vision, the administration of their organisations, their leaders and the provided resources were all supportive and facilitated carrying out the tasks to achieve the strategic goals, including the presence of consultants and qualified personnel, who were available to provide assistance whenever needed.<br/> There were 17 respondents interviewed from three major healthcare centres. Four main themes have emerged from thematic analysis of these interviews: 1) describing SP; 2) SP is an internal responsibility with external guidance; 3) the success of the strategic plan: everybody is responsible; and 4) SP requires more challenges and barriers.<br/> Discussion and Conclusions.<br/> According to the findings of this study, there are elements that determine the successful implementation of any strategic plan in healthcare organisations, including the presence of a well-written and clearly understood mission and vision, open communication about the details of the strategic plan, and the involvement of all employees in the hierarchy in the process of planning and implementation of the strategic plans. Additionally, leaders from various levels within the organisation are key components of the SP. It is also imperative to adopt tools and employ specialised personnel to evaluate the progress of the SP, and ensure all plans are prompted and under continuous evaluation. In case of failure, rescue plans should always be available. This requires organisational culture to become more responsive, more intuitive and open to creativity to these factors, so that SPs can be successfully achieved. Finally, SP is a very meticulous and exhaustive process, where resources are utilised wisely and effectively. Sustainability is a major challenge to any healthcare organisation. Strategic plans can improve the outcome of the organisation, therefore enhancing sustainability and improving future services.