Implementing strategies in complex systems: Lessons from Brazilian hospitals

Abstract

Hospitals, as social organizations, are seen as complex, surprising, ambiguous and paradoxical. The theoretical foundation finds its roots in organizational complexity, strategic management characterized by strategy implementation, and sensemaking especially in the context of complex adaptive systems. Managers frequently neglect elements of complexity when they develop models and implement management practices. The purpose of this study is to analyze the implementation of strategies in complex organizations. The focus of the study is two Brazilian nonprofit hospitals. This is a comparative, qualitative case study. Data were gathered from three main sources: interviews, non-participant observation, and documents. Two important aspects of the strategic approach are discussed: first, the implementation of strategies, and second, the influence of ambiguity, unpredictability and uncertainty in the way strategies are implemented. The analysis indicated that the implementation of strategies in the hospitals has to do with the practices and processes that are adopted (how) and the practitioners (strategists) involved (who). The findings reinforce the importance played by the strategizing process in the implementation of strategies. The findings also highlight that strategic practices are adopted in parallel with the formal planning and are characterized by informality.