Implementing Strategies in Complex Systems: Lessons from Brazilian Hospitals

Abstract

Hospitals, as social organizations, are seen as complex, surprising, ambiguous and paradoxical. The theoreticalfoundation finds its roots in organizational complexity, strategic management characterized by strategyimplementation, and sensemaking especially in the context of complex adaptive systems. Managers frequentlyneglect elements of complexity when they develop models and implement management practices. The purposeof this study is to analyze the implementation of strategies in complex organizations. The focus of the study istwo Brazilian nonprofit hospitals. This is a comparative, qualitative case study. Data were gathered from threemain sources: interviews, non-participant observation, and documents. Two important aspects of the strategicapproach 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 theimplementation 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 thestrategizing process in the implementation of strategies. The findings also highlight that strategic practices areadopted in parallel with the formal planning and are characterized by informality.

Keywords

• implementation of strategies
• complex systems
• strategic practices.