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Strategic planning

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Integrating strategic planning and performance management in universities: a multiple case-study analysis

  • Open access
  • Published: 13 March 2022
  • Volume 26 , pages 417–448, ( 2022 )

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  • Lucia Biondi   ORCID: orcid.org/0000-0002-3284-5919 1 &
  • Salvatore Russo 2  

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Over time, public universities have been involved in a process of modernisation based on a new concept of governance and managerial methods for increasing efficiency and effectiveness, as well as transparency and accountability. This paper aims to investigate the link between strategic planning systems and performance management systems in Italian universities by answering the following research question: to what extent do strategic planning tools contribute to performance management systems and, vice versa, to what extent can performance management systems help in the reshaping of universities’ strategies? To this end, we adopt a qualitative approach by conducting a multiple case-study analysis in the Italian context. Data are gathered through documentary analysis and interviews as primary research methods. Since scholars have mainly focused their attention on strategic planning or performance management in universities in isolation, the originality of this research lies in the attempt to connect these two important research fields, whose mutual interdependences are still to a certain extent unexplored. The implications of this study concern recommendations and suggestions for universities’ governance bodies to support their decision-making processes in the definition of their long-term objectives and performance management systems.

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1 Introduction

Over the last 20 years, in Italy, as in the rest of Europe, a series of systemic changes has occurred in the university sector. These have strongly promoted the adoption of new governance models and consequent strategic choices. The determinants include: the instances of change triggered by reforms in the governance of the main public sector organisations; and the need to make higher education organisations more effective and efficient. This has required systemic structural interventions both in organisational models and internal decision-making mechanisms.

The wider process of modernisation has been inspired by the reforms following the pervasive wave of New Public Management (NPM) (Hood, 1991 ; Lapsley, 2009 ; Pollitt, 2007 ) and in subsequent movements such as New Public Governance (Osborne, 2006 ). From this perspective, there has been increasing focus on the need to strengthen the governance of public organisations by providing them with strategic tools able to support decision-making processes and, at the same time, the need to appropriately monitor the efficiency and effectiveness of the services offered, ensuring transparency in administrative actions and accountability (Broadbent & Laughlin, 2009 ; Jansen, 2008 ).

The reforms of university governance in Italy culminating in Law 240/2010 (the so-called “Gelmini reform”), which is characterised by a centralised and top-down structure and by considerable uncertainties regarding certain central nodes of the new governance envisaged for universities, are set in this context. In this sense, the analyses carried out attempt to distinguish between the systemic governance orientation, which concerns the contextualisation of universities in their affiliation to the public sector, and specific university governance, which is more focused on examining the tools available for internal decision-making and organisational mechanisms.

The reform of universities has increasingly encouraged the definition, from a multi-year perspective, of development guidelines, pushing for the implementation of a planning process and, at the same time, introducing a performance management cycle, similar to other public administrations. In fact, the regulations for university planning have concerned the adoption of a Three-Year Planning Document (TYPD), which can be revised annually, consistent with the ministerial guidelines that divide the specific objectives to be reached and the possible lines of action, alongside the related operational indicators. As documents with a strong strategic value, they assume therefore a central role in achieving the main objectives related to a university’s mission.

Seizing the opportunity related to regulatory changes, the most proactive universities have attempted to develop a real Strategic University Plan (SUP) with the same time horizon. This choice is part of a managerial dynamism that several universities have chosen to adopt by reconfiguring the tools and boundaries of strategic governance. In this way, they have been able to demonstrate the degree of the spread of “managerialism” within their complex organisational structures, which are required to support innovation but are often subject to constraints and rules that limit their action.

Simultaneously, the performance management cycle is being affected by another important three-year planning document, the Performance Plan (PP), which is a tool that should define the objectives, indicators, and targets of universities’ activities. The PP establishes the main elements for the annual measurement, assessment, and reporting of performance, which, at the end of the year, should be expressed in the Performance Report (PR).

In this context, this paper investigates the link between the two dimensions (strategic planning and performance management) within universities by answering the following research question: to what extent do strategic planning tools contribute to performance management systems and, vice versa, to what extent can performance management systems help in the reshaping of universities’ strategies?

The remainder of this paper is organised as follows. Sections 2 and 3 provide a review of the relevant literature regarding the topics of strategic planning and performance management, respectively, both starting from public sector organisations in general and then focusing on universities in particular. Section 4 details the research methodology adopted. Section 5 presents the results of the analysis conducted for the three case studies. Finally, Section 6 discusses the results and presents the conclusions.

2 Strategic planning in public sector organisations and universities

The use of a strategy in public sector organisations, while the focus of significant debate in the literature, has met with broad consensus regarding its implications for performance. In particular, this has happened at a time when the functioning of public organisations has attracted the attention of results-oriented management. Recent studies in this field confirm that “managerial autonomy” and “result control” have independent and positive effects on an innovation-oriented culture in public sector organisations (Wynen et al., 2014 ).

In order to establish trajectories and make objectives measurable, strategic guidance and co-ordination instruments are needed. According to Boyne and Walker ( 2010 , p. 186), “strategy is believed to set a direction for collective effort, help focus that effort toward desired goals, and promote consistency in managerial actions over time and across parts of the organisation”. Indeed, the focus has been on using strategic planning as a precursor to the implementation of a more pervasive, process-oriented approach, such as strategic management. Although strategic management is often discussed as an extension of strategic planning, and the two terms often are confused and used interchangeably, they are by no means synonymous (Poister & Streib, 1999 ).

Strategic planning has been defined as a disciplined effort to produce fundamental decisions and actions that shape and guide an organisation (Bryson, 1988 ). It blends futuristic thinking, objective analysis, and the subjective evaluation of goals and priorities to chart future courses of action that will ensure the long-run vitality and effectiveness of the organisation. According to Bryson and Edwards ( 2017 , p. 320), “strategic planning consists of a set or family of concepts, procedures, tools, and practices meant to help decision makers and other stakeholders address what is truly important for their organisations and/or places”. The underlying assumption that drives public organisations to use strategic planning is often considered to be that it guarantees a result-oriented approach and better performance.

However, the relationship between strategic planning and strategic management needs to be further investigated and understood. In its broader vision, the system considers strategic planning as the first step in a model oriented towards the measurement and evaluation of results. In particular, in public sector organisations, the use of strategic plans is a way of reducing the political-institutional meaning of choices through strategic guidelines and objectives. In this sense, the strategic plan enables the application of performance management.

Strategic planning is normally considered the main element, but not the essence, of strategic management, which instead uses several phases considered outside of the realm of planning (in the strictest sense of the term) that are related instead to resource management, the implementation of activities and processes, and control and evaluation (Bryson, 2011 ; Poister & Streib, 1999 ). Strategic planning should be understood as a set of concepts, processes, and tools to determine “what an organisation is”, “what an organisation does”, and “why it does it” (Bryson, 2004 ).

From this perspective, strategic planning has been widely used in strategic management applied to the public sector (Barzelay & Jacobsen, 2009 ; Bryson, 2011 ; Poister & Streib, 2005 ). In addition, strategic management tools, such as the balanced scorecard (Kaplan & Norton, 1996 ) and strategic mapping (Kaplan & Norton, 2000 ), have proven to be particularly useful in the public sector because they are able to make the public value more perceptible for the various stakeholders (Talbot, 2011 ).

Since its conceptualisation in the 1960s (Bolland, 2020 ), strategic management has become a diversified field that ranges from the analysis of strategy in businesses to that of strategies in non-profit organisations and the public sector. Its adoption was partly a response to environmental turbulence in the 1970s, which made the traditional planning approach antiquated, and partly a reaction to the non-functioning of some management models, such as the Planning, Programming, and Budgeting System (PPBS), with strong demands in terms of information processing and management capacity (Johnsen, 2015 ). Since the 1980s, therefore, public sector organisations have also begun to make more consistent use of strategic management concepts and techniques and it is now common in the public sector in many countries and at different levels of government (Boyne & Walker, 2004 ; Bryson et al., 2007 ; Poister & Streib, 1999 ).

According to Poister and Streib ( 1999 , p. 308), “effective public administration in the age of results-oriented management requires public agencies to develop a capacity for strategic management, the central management process that integrates all major activities and functions and directs them toward advancing an organisation’s strategic agenda”.

While it is assumed that organisations in general will attract the attention of different stakeholders, it is important to consider how public sector organisations are by their very nature more prone to political processes than other organisations, thus needing to use tools such as stakeholder analysis to analyse actors, interests, and power relations, as well as to find ways other than business to motivate employees (Wright & Pandey, 2011 ) and associates. This is appropriate when the use of documents with a strong strategic purpose becomes part of the set of tools available to public organisations, comprising elements, structures, and methods borrowed from those used in for-profit organisations.

As far as universities are concerned, starting from the 1990s, studies such as that of Conway et al. ( 1994 ) have emphasised the importance of the role of users in defining strategic plans and, in particular, of students in outlining the mission of tertiary education organisations, as well as from a competitive point of view in relation to the surrounding environment; more generally, some contributions have highlighted how to shape a process of mid- to long-term planning in universities (and why this is necessary) (Holdaway & Meekison, 1990 ; Lerner, 1999 ; Rowley, 1997 ). More recently, some studies on the theme have focused on specific territorial contexts, confirming the close link between strategy and the reference environment (Howes, 2018 ; Kenno et al., 2020 ; Luhanga et al., 2018 ; Moreno-Carmona et al., 2020 ; Mueller, 2015 ). With reference to the relationship between the strategic dimension and performance, strategic management is certainly at a higher level and can be interpreted as a performance management process at the strategic level (Poister, 2010 ). The role of strategic management focuses on the actions to be taken to position the organisation so that it can move into the future, while performance management is largely concerned with the management of current programs and current operations. Performance management in public organisations, specifically in universities, will be discussed in the following section.

Traditionally, because of the specific nature of their activities, universities have been considered different institutions from businesses and other public sector organisations. For this reason, studies on universities have, for a long time, not focused on how they operate, how they are managed, or how they conduct their decision-making processes. In these organisations, inputs, outputs, and outcomes are often not clearly established and consequently the measurement system appears severely limited. In the late 1990s, a pioneering study aimed at detecting the presence of strategic planning in European universities found that just over half of the universities surveyed had strategic plans in the form of written documents designed to prioritise objectives; in most cases, however, the strategic plans had an incentivising rather than a prescriptive function (Thys-Clément & Wilkin, 1998 ).

Although the literature on university strategies is not still well developed, some studies have shown that the mere focus on strategic planning in practice may not be particularly relevant. Such practice would be resolved in verifying that the goals achieved fit the objectives. It would, therefore, have a formal or neutral role. Other studies have proposed strategic planning as an indispensable tool for improving performance in these organisations, with particular reference to colleges and universities (Cowburn, 2005 ; Dooris et al., 2004 ; Fathi & Wilson, 2009 ; Ofori & Atiogbe, 2012 ).

In addition, applied proposals to implement performance measurement systems appear to be applicable and capable of measuring the achievement of results in these organisations (Johnes, 1996 ; Johnes & Taylor, 1990 ). The higher education literature identifies several limitations in higher education performance: the lack of data availability; the presence of too many indicators that are not particularly useful in representing performance; and confusion between input, processes, and outcomes (Layzell, 1999 ).

Because of their specific nature, universities would require as a priority “models and systems of strategic awareness, management and progress that recognize the issues, contexts and processes that actually shape their strategic change” (Buckland, 2009 , p. 533).

3 Strategic implications for performance management in public sector organisations and universities

Strategic planning and performance management are closely interconnected. In fact, if on the one hand it is difficult to achieve good results without an adequate strategic planning process, on the other hand it would make no sense to define mid- or long-term objectives, and the corresponding operational actions, without then verifying if, how, and to what extent they have actually been met and what results they have produced (Bryson, 2003 , 2004 ).

Despite this indisputable link, research in public management has mainly focused on performance rather than on strategy (Cepiku, 2018 ). This is probably due in part to the reforms that, over the last 30 years, have introduced this concept (of Anglo-Saxon origin) into the public sector by increasingly formalising its reporting (Bouckaert & Halligan, 2008 ).

Performance measurement (and management) systems are normally aimed at identifying performance targets, enabling the assessment of individuals, and informing managers when to take action to prevent deterioration in performance or when it becomes apparent that targets have not been met (Neely et al., 1994 ). The result is the need for organisations to allow the performance measurement system to support the achievement of objectives and the efficiency and effectiveness of the strategic process.

Several contributions have focused on performance management in the public sector in general (Arnaboldi et al., 2015 ; Broadbent & Laughlin, 2009 ; Cepiku et al., 2017 ; Dal Mas et al., 2019 ; de Bruijn, 2002 ; Jansen, 2008 ; Kearney & Berman, 2018 ; Lee Rhodes et al., 2012 ; Van Dooren et al., 2010 ; Van Dooren & Van de Walle, 2016 ). Others, however, have dealt with the topic of performance in specific public organisations. To name just a few, Smith ( 2005 ) analysed the topic in the healthcare sector, Mussari et al. ( 2005 ) discussed the performance of local public companies, Grossi and Mussari ( 2008 ) attempted to identify the possible different dimensions of local governments’ performance, Cohen et al. ( 2019 ) focused on the relations between local government administrative systems and their accounting and performance management information, highlighting the existence of a mismatch between the two, Bracci et al. ( 2017 ) examined the implementation of a performance measurement system in two public entities, Papi et al. ( 2018 ) elaborated and tested a model for measuring public value in a municipality, and Xavier and Bianchi ( 2020 ) investigated how performance management systems can support governments in crime control.

These studies have sometimes highlighted the important difference between performance measurement and performance management systems (Arnaboldi et al., 2015 ; Broadbent & Laughlin, 2009 ). In fact, the effort to translate results into numbers should not be a mere bureaucratic exercise but should result in the opportunity to use these data to improve the provision of services to the public (Jansen, 2008 ; Van Dooren & Van de Walle, 2016 ).

On this point, Bouckaert and Halligan ( 2006 ) specified that a complete performance management system should follow a logical sequence with three main steps: (i) measuring; (ii) integrating; and (iii) using. Merely measuring, which means collecting and processing performance data into information, is insufficient if such information is not incorporated within a broader system of documents, procedures, and discourses and subsequently used to improve decision-making, strategies, results, and accountability.

Incorporation, which is what this paper investigates, deals with including performance information in the policy, financial, and contract cycles (Van Dooren et al., 2010 ). Specifically, the policy cycle starts from the strategic plan (which defines major objectives and targets for resources, activities, outputs, and outcome), continues with the implementation, then the monitoring, followed by the evaluation (the reports from which incorporate performance information), and this feeds into the next strategic plan. The financial cycle includes budgeting and is ideally embedded in the policy cycle.

Regarding performance in higher education, this theme has attracted the attention of many scholars who have investigated the peculiarities of performance measurement tools in universities (Balabonienė & Veþerskienė, 2014 ) or how they are applied in some territorial contexts. For example, Higgins ( 1989 ) explored the case of British universities, Modell ( 2003 ) dealt with the subject in Swedish tertiary education, Guthrie and Neumann ( 2007 ) outlined the establishment and mechanisms of a performance-driven Australian university system, Ter Bogt and Scapens ( 2012 ) focused on the case of the universities of Groningen in the Netherlands and Manchester in the UK, Kallio et al. ( 2017 ) emphasised the problems of measuring quality aspects in academic work in the Finnish case, and Dobija et al. ( 2019 ) provided experiences from Polish universities. These contributions highlight that different types of performance management are used in universities and that its scope varies among different actors, depending on diverse external and internal factors. Moreover, measuring performance is difficult in knowledge-intensive organisations, where quantitative indicators may fail in catch the complexity of such institutions. Often, performance management is adopted by a university simply to comply with regulations or gain external legitimation, rather than to make a real change in the use of resources to the enhance efficiency and effectiveness of their activities.

Aversano et al. ( 2017 ) examined the evolution of performance management systems in the university context. Their study confirmed that, beyond the desired intentions, the focus is still strongly on the production of the data rather than its use to provide a holistic view of university performance that can guide strategies, programs, and activities.

Moreover, as pointed out by several authors (Bower & Gilbert, 2005 ; de Bruijn, 2002 ; Francesconi & Guarini, 2018 ; Goh et al., 2015 ; Van Thiel & Leeuw, 2002 ), one of the distinctive characteristics of strategic planning and performance management in public organisations, including universities, is connected to the issues encompassing resource allocation and budgeting practices. In fact, assigning adequate resources through the budgeting process is crucial in order to translate strategic objectives into operational objectives. Further, a feedback loop exists as, especially in recent years, the results achieved (as measured via performance management) are increasingly used by the governance body in decision-making related to budgeting.

Recently, Deidda Gagliardo and Paoloni ( 2020 ) took a snapshot of the state of the art of performance management in national universities, highlighting its strengths and weaknesses as well as predicting future challenges.

Examining the Italian context, the Italian experience has been marked by a reform in 2009 (Decree no. 150/2009), which highlighted the inadequacy of existing planning and control systems, as well as the absence or insufficiency of mechanisms for measuring and managing performance in public sector organisations. Nevertheless, to date, there remains no empirical evidence of the concrete usefulness of the tools introduced and their effective capacity to produce improvements in terms of effectiveness and efficiency in public administrations (Arnaboldi et al., 2015 ).

As illustrated, academic literature on the two research topics (strategic planning and performance management in universities) taken in isolation is quite extensive. However, the review of the literature highlights how few contributions directly link the two streams of research, looking for their interconnections (Biondi & Cosenz, 2017 ; Campedelli & Cantele, 2010 ; Cosenz, 2011 ; Francesconi and Guarini, 2018 ). In particular, the study conducted by Bronzetti et al. ( 2011 ), examining the planning methods of Italian public universities and analysing the related strategic plans under the dual dimension of process and content, identified as a future study trajectory the need to investigate the use of this document for decision-making purposes also in relation to the PP. The current paper attempts to join the debate by answering this call.

4 Methodology

In order to address our research question, this paper adopts the case study as a qualitative approach. Case study research is described as a method with which: “[…] the investigator explores a real-life, contemporary bounded system (a case) or multiple bound systems (cases) over time, through detailed, in-depth data collection involving multiple sources of information, and reports a case description and case themes. The unit of analysis in the case study might be multiple cases (a multisite study) or a single case (a within-site case study).” (Creswell, 2013 , p. 97).

Our analysis is carried out through a comparative study of the strategic planning tools and their degree of influence on the performance management systems of three Italian state universities, identified as case studies.

We applied a multiple case studies methodology with an exploratory purpose to understand “how” and “why” certain phenomena occur in a specific economic-social context (Stake, 2005 ; Yin, 2003 ).

Our decision was also motivated by interest in analysing both the single universities in detail and comparatively, in order to investigate similarities, differences, and patterns across the cases (Gustafsson, 2017 ). In this sense, the analysis is also comparative (Yin, 1993 ).

The choice of cases was driven by selecting universities that have been early adopters of these planning tools, thus being pioneers in the Italian context. This made it possible to carry out a longitudinal study for at least two complete planning cycles, highlighting their development characteristics from a temporally consistent perspective (Pauwels & Matthyssens, 2004 ). Although each university examined belongs to a different complexity group according to a recent classification (Rostan, 2015 ), the choice of strategic planning was unrelated to this dimension.

The study was based on the same level of observation, focusing on how the three universities proceeded with the introduction of the strategic planning system over time and which framework they have been using to link it to the performance management system. For all three universities, the analysis took as reference at least two programming cycles, albeit with a different time horizon.

The analysis is supported by the different context and dimensional variables of the three universities (see Table  1 ). These universities are differentiated by year of foundation (one founded in the second half of the nineteenth century, the other two more than a century after), by being located in different geographical areas (North, Central, and South Italy) and therefore having different direct competitors, as well as by size, in terms of student population, departmental articulation, active study courses, tenured teaching staff, and technical-administrative staff.

The research design is structured into different phases. Initially, we created an interpretative framework that could homogeneously highlight the areas under investigation. Hence, the variables that could better highlight the elements characterising the three universities were identified. Subsequently, the three case studies were reconstructed and illustrated. To this end, data were collected through a triangulation of sources. First, we carried out a documentary review of secondary sources, namely institutional documents (Corbetta, 2003 ) pertaining to strategic planning and the performance management cycle of the three universities. Specifically, we reviewed:

three-year planning documents;

strategic plans;

three-year and annual budgets;

reports on periodic monitoring;

performance plan and/or integrated plans;

performance reports;

minutes of the meetings of the academic bodies; and

quality manuals.

These documents are publicly available from the institutional websites of the universities.

Subsequently, evidence was complemented using primary sources, namely semi-structured interviews (Longhurst, 2003 ; Qu & Dumay, 2011 ). The interviews were with academic administrative managers involved in the strategic planning and performance management processes, and who actively participated in the drafting of these documents in each of the universities investigated. The interview protocol was based on open questions agreed by the authors, aimed at investigating “how” and “why” these processes have been developed over time. The answers helped the authors to understand the content of the documents and the dynamics underlying their elaboration.

Evidence gathered from the three case studies is presented according to the following structure, aimed at facilitating the comparison and highlighting the peculiarities among them:

the development of strategic planning process;

articulation and content; and

linking strategic planning with the performance management cycle.

5.1 The development of the strategic planning in the three cases

The three case studies may be considered as early adopters of a structured strategic planning process, in line with the relevant regulation (Law no. 240/2010). However, they have different starting dates. The first SUP of University A was issued in 2012 (although the process began in 2010), while University B’s first SUP was issued in 2013. University C can be considered not just a pioneer but a precursor of what the regulation would require, in that it started the formalisation of its planning process even before the reform came into force, in 2009.

University A’s SUP was entitled “Towards 2018” to symbolise the far-sightedness of a vision aiming for strong innovation. In the preface, according to the Rector’s assertion, the document represents a challenge to enable the university to “ compete and collaborate, with the most prestigious universities to fulfil all three of its institutional missions: research, teaching, and innovation ” (SUP 2012–2014, p. 1).

Since its inception, the SUP has been considered a document to support the Rector in his mandate by involving the top management of the organisational structures considered crucial for the university regarding its preparation (from the central structure to the individual departments, schools, and research centres). A special team was created to work on this, comprising an internal expert in corporate strategy and various collaborators. This team was also supported by the “Planning and Evaluation” Office, an organisational unit of the “Strategic Planning and Programming” area. The SUP of University A is, therefore, the result of meetings, discussions, and comparisons with the main competitors, which creates a shared strategic view of the governance of that university. Creating such “shared strategic ambition” is fundamental to mapping the strategic paths to be adopted and makes it possible to consider the plan as an actual guiding document for the university, shared by all the organisational units.

Hence, the strategic planning process of University A passes through several stages. As mentioned above, the first stage involves mapping the strategic ambition of the main subjects in charge of the university’s governance (phase 1) to verify their degree of alignment (phase 2). These two “interlocutory” phases are followed by an “objective” analysis of the internal and external environment (phase 3) to verify, in the case of conflicting subjective perceptions regarding a topic or objective, which is the correct one, but also in case of agreement, to test the validity of the concordant “subjective” perceptions. In the opinion of those who have experienced it first-hand, this is a critical “dialogical” stage in which different actors participate and discuss to reach a joint agreement. This makes it possible to reach a greater degree of alignment (phase 4) on which University A’s strategic goals should be based, which are then submitted for the attention of stakeholders before creating the final draft of the plan (phase 5). Moreover, University A has also used external consultants for specific aspects of the plan for which there was no in-house expertise.

Regarding University B’s strategic planning process, this happens in a somewhat different way. In fact, the starting point of the process is not the SUP but the TYPD. The TYPD is issued by the Rector considering the programmatic indications coming from the relevant Ministries, the proposals of the Academic Senate (SA), and the indications of the Evaluation Board. The TYPD is part of a multi-year planning process that aims to achieve the university’s effective strategic governance and management. The TYPD is an act of political direction since, drawing inspiration from the university mission, it illustrates the reference values of the government action and, from them, at the strategic level, the general objectives to be pursued regarding the typical institutional functions (research, teaching, third mission), as well as the transversal and support functions (personnel, construction, communication). The planning process then continues with the drafting of a SUP. This document defines in a more concrete and detailed way what is reported in the TYPD. In the preparation of such a document, the Rector is assisted by the Vice-Rectors (covering the areas of: teaching; research; university networks; schools, societies and institutions; relations with the labour market; innovation and technology transfer; infrastructural and workplace safety policies; and relations with university governing bodies and regulatory matters). From the analysis of the last TYPD and SUP, a link emerges between these two strategic planning documents and the document that formalises the performance cycle [called the Integrated Plan (IP), which will be discussed later]. In fact, it has been established that the SUP will undergo a periodic review, and that the TYPD itself may undergo revisions, on an annual basis, concerning the preparation of the IP.

However, the planning process seems less structured and participatory than in University A. As required by the regulations, and as confirmed in the words of one of the managers interviewed: “ The political office is responsible for political guidance, while the administration is responsible for administrative management and assists the political office. On the one hand, the SUP and TYPD are both policy documents and are, therefore, within the sphere of competence of the governing bodies. They are drawn up by the Rector and Vice-Rectors, and then approved by the Board of Directors. On the other hand, the Integrated Plan is an administrative document .”

Nevertheless, it is likely that the Vice-Rectors informally consult the General Director (GD) also regarding the definition of strategic programming documents.

Another difference from University A is that, in University B, the entire process is carried out internally, without involving external consultants. Moreover, we did not find any evidence regarding periodic monitoring of the SUP at University A. In contrast, University B draws up an intermediate monitoring document to check to what extent the objectives have been achieved and, if necessary, to modify decisions and actions. This check takes place one and a half years after the approval of the SUP. A final report is then issued at the end of the three years. While the strategic planning process is top-down (since once the SUP is approved, the departments have to draw up their own strategic plans), drafting the report on the implementation of the SUP is a bottom-up process. Each structure, starting from its strategic plan, verifies in itinere the achievement of the objectives for teaching, research, and the third mission, respectively. These reports are then consolidated and summarised at the central level by the relevant Vice-Rectors.

Moving on to the strategic planning process of University C, as highlighted, this is the university that started the formalisation of its planning process earliest, in 2009. The first SUP had a time horizon of five years and included the triennial strategic guidelines (2010–2012). This is a peculiarity in comparison with the other cases, in that the TYPD is not a separate document but embedded in the strategic plan itself.

As declared in the document, the process to issue the SUP involves much participation and different actors are engaged (like University A). In fact, the aim is to gain consensus among all the university’s stakeholders (students, academics, administrative staff), support the governance, and facilitate decision-making processes and activities, based on participation and shared ideas (SUP 2010–2014, p. 4). This first document was drawn up by a Commission made up of delegates and experts, with an advisory and consultative function of the Rector, with a specific mandate to support the preliminary stage of the university’s strategic planning documents. The document was then presented to the university’s governing bodies, ultimately incorporating the requests that emerged from its public presentations. As stated by an interviewee: “ The whole academic organisation is involved in providing the data; departments have also to adapt their strategic plan to the university’s plan ”.

This path of elaboration, redefinition, and involvement, although taking more time than expected, enhances legitimation, and strengthens consensus regarding its strategic vision by defining quite detailed and shared lines of action. For University C also, the entire process was carried out without involving external consultants.

The drawing up of this document started from the analysis of the university’s current situation, measured through the principal indicators adopted for the assessment of the university system. At the same time, the SUP considered the need for financial sustainability and enhanced efficiency and effectiveness of the university’s activity. Coherently, the delegate of the Rector for strategic planning pointed out that the main objective of University C for the next five years was enhancing the quality of performance by reducing costs and increasing revenues.

In the preface of the document, written by the Rector, we learn that the SUP will also assist in providing the main variables to be used in the next triennial strategic guidelines. In fact, the Ministry assesses and finances higher education entities based on their performance indicators and their improvement according to the objectives. This is an interesting point, which highlights a strong link between the SUP and the triennial strategic guidelines: the strategic plan initially includes the previous triennial strategic guidelines, and at the same time, conversely, is the basis for extracting information to create subsequent guidelines. Moreover, as we will see better later, the SUP also refers to the IP.

Unlike University B, the achievement of objectives is not periodically evaluated, or at least it is not formalised in any way.

5.2 Articulation and content of the documents in the three cases

The three case studies show the SUPs’ different approaches and content. These differences depend on the meaning that each university has given to the SUP, what the motivation is, and what the relationship is with the TYPD. The relationship with the latter is, in fact, a conditioning factor for the entire content of the SUP.

In University A, as already mentioned, the process of formulating the SUP began with several meetings and discussions to map and compare the subjective perceptions of the main subjects in charge of strategic governance (Rector, Vice-Rectors, Faculty Chairs, chairman of the Board of Departmental Directors, GD). To formulate a document involving the strategic nodes of the university’s future, several critical variables were considered regarding the definition of a common strategic ambition: internal structure; external structure and specific context (sector, competitors, potential entrants, complementary companies, customers, suppliers, financing bodies, communities, etc.); mission and vision; internal and external objectives; and strategies and three-year actions. As highlighted in the methodological attachment to the SUP 2012–2014 (p. 3), this document, which precedes all forms of planning and programming for the whole organisation, has been designed in such a way that it can be linked to the strategic guidelines identified, the TYPD, and the PP.

People involved were asked to describe in narrative terms their perception of University A’s strategic ambition, based on which a strategic map was created, leading ultimately to the issuing of the final SUP. The final version was based on the identification of ten objectives to be achieved through specific strategies: strategic reorganisation of research and educational activities; improving University A’s local, national, and international visibility; integration with other close universities and higher education institutions; integration with the territory; improving University A’s student services and attractiveness; enhancing the teaching staff’s potential; enhancing the technical and administrative staff’s potential; reorganising the internal structure; providing new and better spaces; and assuming a transversal sustainability orientation.

As well as focusing on the three macro areas (teaching, research, and third mission), this document also examines each objective in relation to strategies achievable through specific actions (measured via indicators).

The second strategic planning experience was developed under different conditions and initially appeared to have fewer expectations. Moreover, governance conditions had changed [turnover of the Rector and Board of Directors (BoD)] and the change in the SUP’s style appeared to be an element in distancing itself from the previous approach, while maintaining a common basis.

This emerges clearly from examining the document and the responses gathered from those who collaborated in drafting both SUPs.

The second SUP was also developed through a co-owned process that involved the entire academic community and took place in two phases. This is a completely different document, less voluminous in its content and without any methodological details, although the approach has changed.

The first phase was dedicated to identifying the university’s objectives by sharing strategic guidelines and defining the actions to be pursued in 2016–2020. The Vice-Rectors were primarily involved and, in collaboration with the reference structures, helped identify the primary objectives and strategies by dedicating ample space for all the university’s components to collaborate. The second phase was aimed at systematising the collected material, clearly defining the vision, mission, objectives, strategies, actions, and monitoring indicators, and subsequently preparing the final document.

In this sense, the interviews show that the strategic planning in these different periods was emblematically the reflection of the two different styles of governance. In the first SUP, the university wanted to demonstrate strong choices and changes, justified by work carried out with a scientific method but that also ended up creating important breaking points within the organisation. The second SUP focused more on the concept of inclusion, utilised a different leadership approach, focused on objectives other than transversal, and focused on the central administrative apparatus’s functioning. The structure of the document was based on the identification of five macro-objectives: promoting impactful research; creating a transformative study experience; acquiring an international dimension; acting as a catalyst for innovation; and guaranteeing a sustainable academic future. Subsequently, each macro-objective was broken down into objectives for which strategies and actions were identified, confirming the structure followed in the first SUP.

In University B, the SUP is divided into three separate sub-documents in more detail: a Strategic Research Plan (SUP-R); a Strategic Teaching Plan (SUP-D); and a SUP for the Third Mission (SUP-TM). These plans were prepared by the Vice-Rectors; in particular, as far as the third mission is concerned, University B has decided to establish three Vice-Rectorates who together promote and monitor: innovation and technology transfer activities; relations with schools, companies, and institutions (so-called public engagement); and relations with the world of work. As stated by an interviewee: “ The idea behind the choice of the strategic plan, articulated by areas, is to favour comprehensiveness, taking care of each area of detail. The strategic plan must be firmly linked to the lines of academic innovation; it also requires to be based on a broad consensus implemented through an increasingly participatory and inclusive procedure, involving the collegiate governing bodies, departments and schools. ”

Unlike the other two cases, which are more deeply rooted in time, the first SUP relates to the period 2015–2017, while the following SUP refers to the 2018–2020 three-year period. Analysing the two documents from a longitudinal perspective, they are identical regarding the division into the three macro-areas with which the university is concerned (this division was agreed at a central level in adherence with the three institutional activities). However, there are small changes in structure and content, partly due to natural refinements in preparing the document, and partly resulting from a change in governance (Rector and Vice-Rectors). As far as the SUP-R is concerned, its structure mirrors the two programming cycles, defining the general strategic objectives starting from the TYPD, which in turn are then translated into specific strategic objectives for which indicators are identified and actions to support them are suggested. The SUP-D, in its first formulation, after explaining the mission and vision for teaching, indicated objectives, actions, and monitoring/success factors. The second version, however, begins with the formulation of the overall strategy for the university’s didactics, moving to an “as is” analysis based on data derived from the university’s Indicators Sheet (made available by ANVUR, the Italian National Agency for the Evaluation of the University and Research Systems) to identify strengths and weaknesses, subsequently identifying four general “strategic objectives” (called “general lines”), each with (specific) “objectives” and “actions”. The SUP-TM has undergone major changes in the transition from one three-year period to another. In its first formulation, the SUP-TM 2018–2020 was a descriptive report of the initiatives conducted by the university (e.g. activities related to lifelong learning, the Palladium theatre, the Job SOUL platform, summer schools, and social reporting); the SUP-TM 2018–2020 is much more structured, articulating the three established Vice-Rectorates’ third mission areas and indicating for each of them the general strategic objectives (called “lines of intervention”), outlined in actions and a proposal of indicators for evaluating their achievement.

There is no direct evidence of how the Vice-Rectorates proceeded operationally in elaborating the individual plans, although in his policy document the Rector encouraged a “participative” process and, from the minutes of approval of the last SUP by the SA and the BoD, it can be seen that: “ the document is the result of collective work, which has been widely participated and shared ”.

It is only in the SUP-TM 2018–2020 that it is clearly stated that, in order to draw up the document, “ it was considered appropriate to schedule meetings with the individual Departments with the intention of carrying out a complete survey of the experiences and good practices in progress, as well as to submit the main strategic lines represented here, in order to gather possible stimuli and suggestions for improvement from the departmental realities that have so far largely contributed to the development of the Third Mission ” (SUP-TM 2018–2020, p. 40). The data appear to be important as they show how the content of the document is the expression of sharing and participation with the individual departments representing the main driving force of the university, despite their autonomy.

The administrative bodies also participated, as it emerged that the Vice-Rectors, despite having prepared their respective plans without consulting the offices, informally consulted the GD and various structures. This is evident both from the interviews and the minutes mentioned above, where it is stated that the Rector, in addition to thanking the Directors, also thanked the GD as well as the BoD “ for having contributed effectively, each for the aspects within his or her competence, to the drafting of the Plan ”.

In University C, regarding the first document issued in in 2009, by integrating the strategies outlined in the triennial strategic guidelines, the Rector declared: “ The document outlines the roadmap of the university’s actions in the main areas, namely education, student services, research and knowledge transfer, internationalisation, human resources, organisational structure and building plan ”.

The initial aim was to address areas considered of absolute strategic importance, i.e. the three macro-areas (teaching, research, and the third mission), focusing on describing the university, context analysis, and identifying objectives and related targets and indicators. This immediately clarified the meaning to be given to the instrument. Transversal to the whole document, in contrast to the other two cases considered, is the financial dimension and the link between objectives and the forecast of financial flows in and out. As claimed by an interviewee: “ The key point for the university is the improvement of all the university’s performances in relation to parameters of the ordinary financing fund, parameters of the three-year plan, but also to all those parameters that can bring the university back to a better position in national and international rankings ”.

The SUP is articulated in different sections. It begins by describing the university (number of students, professors and lecturers, administrative staff, etc.) and then illustrates its situation “as is” through a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis. The SWOT analysis represents the starting point for the elaboration of the SUP. The SWOT analysis, used as a method to define strategy, focuses primarily on the following points: training, student services, and internationalisation; research and knowledge transfer; and human resources.

Consequently, the document then highlights seven “strategic lines” of interventions: teaching; students services; research and knowledge transfer; internationalisation; human resources; organisational structure; and building plans. For each strategic line, different indicators are derived from the current legislative regulations. Finally, a summary table synthesises objectives, actors, starting year, and human and financial resources allocated for each strategic line.

In the conclusions, the Commission states that the plan is intentionally concise, and it is not further expanded on or detailed in order to allow the governing bodies to define methodologies and responsibilities for implementation. It is also stated that an essential condition for initiating, sustaining, and continuing the process is a control both for the implementation and monitoring of the plan.

The second SUP shortens its time horizon to three years (2014–2016). The document appears less readable, has no summary, is full of tables, and has few descriptions. It includes again a SWOT analysis and subsequently describes the strategic lines, which are almost the same as in the previous SUP. However, unlike the previous SUP, it does not contain a summary table with the objectives, actors, timing, and resources for each strategic line. Moreover, no final considerations or conclusions are displayed; there is only an initial page, written by the delegate for strategic planning, quickly commenting on “how” what they planned in the SUP 2009–2013 had been achieved, and stating that the university had to manage the shortfall, which was worse than expected. Overall, it considers that the general objective of “ enhancing the quality of performance by reducing costs and increasing revenues ” was achieved.

This document appears to be less focused than the first plan and was probably less participatory.

The SUP 2016–2018 starts with the macro-objectives for the following three years: enhancing the quality of teaching, research, and internationalisation; increasing commitment toward the third mission; and pursuing and implementing the university’s quality assurance system. Again, it opens with an analysis of the context, subsequently identifying the strategic lines: didactics; student services; research; internationalisation; third mission; and staff required. For each there are now clearly highlighted objectives, related actions, and coherent indicators. The document also appears to be more understandable thanks to summary tables for each strategic line.

The current SUP (2019–2021) is the shortest in length (35 pages). It appears as an extract from the minutes of the BoD. Both the format and the content are similar to the previous SUP. The only significant difference relates to the strategic lines, with the inclusion in the summary tables of a column highlighting the target.

From the documentary analysis of University C and the interviews, it emerges that there is no real TYPD among the planning documents. The triennial strategic guidelines are somehow included in the SUP. This entails that it is not easy to understand the relation between the two, i.e. whether the strategic planning documents’ strategic objectives are derived from the triennial strategic guidelines or vice-versa.

In all three cases, the SUPs were created in response to the needs arising from governance reforms and different decision-making and management tools at their disposal. In University A, the SUP’s adoption is more than a methodological and recognition exercise, as evidenced by the document that preceded the first concrete plan. The document also makes explicit the decision to promote integration between the TYPD and the PP, as opposed to between the SUP and the PP. This is largely different in Universities B and C, in which this relationship is more linear and the choice of the SUP, in addition to choosing explicit values, objectives, and expected results, becomes a choice of thematic areas on which to work pragmatically.

In University A, as the former Rector states in the prologue to the formulation document, “ the university has gone beyond the regulatory wanted to formulate a Strategic Plan to clearly define the values in which it believes, its mission values in which it believes, the mission it has set itself and, above all, its vision and related objectives, the strategies to achieve them and the necessary actions the necessary actions ”. In University B, although the methodological value of the preamble to the SUP explains the articulation of the components, the document immediately focuses on the three main areas (teaching, research, and third mission). In University C, the drafting methods, while providing an explicit methodological basis, identify various strategic lines, similar to University A.

5.3 Linking strategic planning with performance management in the three cases

From the analysis of the data gathered through the documentary analysis and the interviews, it is possible to attempt to identify a link between strategic planning and performance management systems in the three cases analysed, as well as with the allocation of financial resources.

In University A, as already mentioned, there is a kind of logical inversion between the two strategic planning documents, since the TYPD is a tool for implementing the SUP, through three-year actions. The opposite happens in University B, where the SUP is characterised as a document implementing the three-year strategic guidelines. Something different again happens in University C, where the SUP initially includes the previous triennial strategic guidelines, and at the same time, conversely, is the starting point to for defining subsequent ones.

In University A, the main document of the performance management cycle, the PP, refers to the TYPD. As the methodological document attached to the SUP indicates, “ TYPD and PP can be consolidated into a single document that, while distinguishing the specific areas of intervention, leaves no doubt about their common starting point: the strategic ambition of the University ” (Methodological attachment to the SUP 2012–2014, p. 3). The PP 2014–2016, therefore, explicitly refers to a cascading system between the SUP, the TYPD, and the PP, confirming, on the one hand, the regulatory obligation and, on the other hand, the need to link the planning of activities to the degree of response from the organisation in its various components. The TYPD represents, in terms of continuity and the cascading of objectives, the link between the strategic objectives defined by the SUP and the operational objectives of the individual organisational structures of the university identified by the PP. In other words, the PP is the tool for implementing the TYPD. The PP, structured on an annual horizon (despite having a three-year duration), constitutes the reference for measuring results and assessing organisational and individual performance.

Unlike the strategic planning documents, the PP is prepared by the administrative staff. In University A, the individual organisational structures are required to propose operational objectives indicating: (1) the reference strategy identified within the SUP; (2) the perspective within which the identified operational objective is placed, concerning the eight perspectives identified by the TYPD; (3) the process overseen by the structure to which the objective refers; (4) a brief description of the objective and expected results; (5) the proposed indicator and its valuation with respect to the expected value; and (6) the financial resources allocated to the pursuit of each operational objective. Subsequently, the objectives of the PP are linked to the individual perspectives of the TYPD, such as the internal structure, teaching, integration with the territory, internationalisation, personnel, research, sustainability, and students.

Focusing on the development of the performance management system and the link with the strategic planning system over time, the document’s structure has been kept almost unchanged. However, after 2015, the idea of a document with a solid operational connotation, respecting the three phases of the performance cycle, became more generally accepted. At the same time, an increasing need was perceived to develop, in a systemic way, the planning of administrative activities in terms of performance, transparency, and anti-corruption. In this context, since 2016, the new guidelines have introduced the IP. As declared by an interviewee: “The intention has always been to keep the Strategic Plan separate from the performance management instruments, so that the Integrated Plan would draw on the objectives set by the Strategic Plan, but could also have a life on its own. We are aware that sometimes in other public sector administrations the Strategic Plan coincides with the Integrated Plan.”

The performance objectives identified in the IP, which are operational, are strictly linked to the strategic objectives contained in the SUP. The process for their definition follows two stages. In the first phase, the structures propose transversal objectives, shared by two or more organisational units; in the second phase, the structure objectives are proposed (individual, i.e. associated with a single organisational unit). The performance goals are divided into organisational performance goals and individual performance goals. The process of evaluating organisational performance is hierarchical and starts from the evaluation of the university’s performance based on the evaluation of those indicators related to economic and financial sustainability, scientific productivity, and internationalisation. The organisational performance of the departments, schools, and research centres is measured considering indicators related to research, teaching, internationalisation, and management efficiency. The PR closes the cycle, using the indicators provided by ANVUR.

In University B, the PP, whose first issuing was in 2011, from 2016 also started including information relating to transparency and anti-corruption, becoming an IP. The reason for that can be found in the words of an interviewee: “ The need to move from the PP to the IP derives from the need to avoid writing the same things in different documents or, vice versa, the risk of writing different things in the three documents (actually this has never happened in our university, since the documents were prepared by the same structure). Moreover, it is appropriate to have an IP because, in defining the managers’ objectives, they take into account different aspects (anti-corruption, transparency, efficiency). ”

This document is essentially aimed at the central administration, albeit with references to the university’s entire activity. The IP is drawn up by the office managers and the GD, while the structure that coordinates the entire process is the personnel area management.

As highlighted before, the IP concerns the administrative sphere and is an expression of how the academic organisation pursues its management objectives and implements its functions, in support of the political bodies, in achieving the strategic objectives of teaching, research, and the third mission, as reported in the planning process. The preparation of the IP, therefore, starts from the basic guidelines contained in the TYPD and the SUP and then, through various meetings with managers and top management, they are translated into operational objectives, which are subsequently translated into actions, indicators, and targets based on which performance measurement, evaluation, and reporting is carried out. This is clearly represented in the performance tree, a tool which, in a “cascading” logic, “graphically represents the links between strategic priorities, general strategic guidelines and operational objectives” (IP 2020–2022, p. 15).

While there was no clear link between strategic planning and performance management cycle in the past, University B’s last IP now displays an explicit reference to the SUP. In particular, the GD’s objectives (and related actions) derive directly from the strategic objectives set out in the SUP, while the managers’ objectives derive, in turn, from those of the GD, and therefore only indirectly from the SUP.

Finally, the closing document is the PR. The PR is drawn up by the GD annually, following a specific format. This document makes it possible to highlight the organisational and individual results achieved in relation to the expected targets regarding the individual planned objectives and resources.

The approach described for the IP is also confirmed in this document, i.e. a comparison is made with the strategic planning documents and, in particular, with the monitoring of the SUP, as well as taking into account the report that the GD prepares at the end of each year on management activities.

As declared by the GD during a meeting of the BoD: “ The IP has been really improved compared to the past, both in terms of editorial and content. This is thanks to the fruitful work of the managers involved. The IP demonstrates, in the best possible way, the ability to coherently correlate administrative activities with the planning policy documents adopted by the university […]. This document […] highlights the coherence between the university’s strategic planning system at the political level, the management activities, and the financial planning. ”

In line with the regulations, University C planned also to adopt a system of performance evaluation in 2010 by issuing the first PP for the period 2011–2013. However, on the institutional website of the university, we found an archive where the first PP is the one dated 2013–2015, so we do not have any information about the very first PP, except for the fact it was based on the application of the Common Assessment Framework (CAF) model.

In this document, a performance tree highlights the logical roadmap, which links the institutional mandate, the mission, the strategic areas, the strategic objectives (with their indicators and targets), and the operational plan (which includes operational objectives, actors, and resources). In the first PPs, three different strategic areas were identified: didactics; research; and services (then named the “Executive Plan”). The latter includes the objectives assigned to the GD from which are derived the objectives to be assigned to each manager, in addition to those arising from the strategic planning documents. However, we did not find an explicit link between these objectives and those of the SUP; instead, the document seeks alignment between the performance cycle and the financial reporting planning cycle.

By comparing the different PPs, it emerges that the strategic objectives related to the three strategic areas have changed over time. Moreover, while the strategic areas of didactics and research are under the responsibility of the political bodies, the strategic area of the Executive Plan is under the responsibility of the GD who, also through the other managers, is responsible for the correct management of the organisation, as well as for verifying its effectiveness and efficiency.

Another crucial strategic objective is transparency, which is directly related to the performance of the administrative activity and the best use of public resources; therefore, the objectives of the PP are closely related to the strategic and operational planning of the administration and are considered strategic for the university itself.

In the process of identifying the areas of intervention, different actors have been involved: the political body; the Rector; the delegates of the Rector in the areas of strategic planning, didactics, and research; and the GD, who in turn consults the managers involved. In order to gather and analyse the data, the self-evaluation committee and self-evaluation support group are also involved. The 2013–2015 PP concludes with the desire to improve the process both by anticipating the preparation of the plan together with the budget, and by better involving stakeholders and all delegates and managers and sharing with more actors the actions and strategies to be implemented.

Similar to Universities A and B, in 2016, the PP became an IP. The IP is organised in five sections:

The strategic framework of the university, where the main lines of development of the administrative activity are indicated, according to the strategic planning documents, the financial reporting planning documents, and the actions taken and to be taken.

The organisational performance, which constitutes the central part of the IP, which lists the objectives of the planned actions, the related monitoring and measurement indicators, and all those involved in administrative performance.

Analysis of risk areas, drawn up according to the guidelines provided by the Anti-Corruption Authority (ANAC), whereby the areas at risk of corruption are defined.

Communication and transparency, which specifies the actions that the university intends to promote in order to meet the requirements of transparency and contains the communication plans aimed at informing stakeholders about the results achieved by the university.

Individual performance, the last section of the plan, which describes the criteria that the university intends to adopt for the assignment of individual objectives, as well as for the evaluation and monetary incentives for technical-administrative staff.

In the IP 2016–2018, for the first time, an important attachment was added highlighting the links between the SWOT analysis and the SUP by creating a more direct link between strategic planning and performance management.

This link is strengthened in the IPs 2018–2020 and 2019–2022, where a specific section recalls the macro-objectives of the SUP and connects the strategic guidelines of the IP with them. The document explicitly states that, although the IP strategic guidelines do not precisely coincide in wording and number with those mentioned in the SUP 2016–2018, these strategic objectives derive from that document (IP 2018–2020, p. 12).

Further on in the document, it is reaffirmed that the link between the university’s strategies and the performance cycle is of fundamental importance: the relationship between strategic planning and performance management systems is expressed as a link between the university’s political perspective of development, set out in the SUP, and the management actions to be implemented to achieve the expected results, contained in the IP (IP 2020–2022, p. 17). As learned from an interviewee: “ The university in the last years has introduced a new planning process which aims to maintain coherence between the operational dimension (performance), the dimension linked to access and usability of information (transparency), and the dimension linked to access to information (transparency). Moreover, the more recent IPs aim for greater consistency with the strategic planning system, in that the objectives of the performance planning are in line with, and derive from, the objectives of the strategic planning .”

As literature highlights (Bower & Gilbert, 2005 ; Francesconi & Guarini, 2018 ; Goh et al., 2015 ), evidence confirms that the strategic planning and the performance management dimensions are strongly connected with the resource allocation in all three cases. In University A’s budget, we read that its “ formulation is carried out through a process in which the (strategic and operational) objectives of the University drive the resources allocation aimed at their achievement. It represents the translation of those strategic lines in monetary terms ” (Annual and Three-Year Budget, p. 8). At the same time, in the IP, we found a link between the budget and the performance cycle. In fact, University A is trying to progressively optimise the allocation of its resources, by investing them in long-term projects that can have a positive impact on performance, to draw up a budget that is as consistent as possible with the strategies, following the circularity that characterises the strategic, financial, and operational planning phases.

As far as University B is concerned, on the one hand, the annual budget and the three-year budget (composed of the economic and investment budgets) are the technical and accounting tools through which the university’s strategic goals are set out in the short and medium term following the institutional mission of the university. Another important tool is represented by the activity budget, a document included in the explanatory note to the budget, through which strategic and operational goals are connected to the quantity and the quality of resources allocated to their achievement by highlighting the budget specifically earmarked for the pursuit of strategic actions and objectives. On the other hand, the IP represents the document by means of which performance is linked to the budget cycle. As it is clearly expressed: “ The integration between the budget cycle and the performance cycle makes the Integrated Plan the means through which disclosing both the recommendations included in the strategic planning documents, as well as the initiatives aimed at improving the effectiveness and efficiency of the University’s management processes ” (IP, p. 3). Coherently, the IP depicts the amount of budgetary resources necessary to achieve the operational objectives, as determined in the planning phase.

Turning to University C, both the documentary analysis and the interviews revealed the willingness to make the budget increasingly consistent with the strategic objectives provided by the governance, through a path of integration and circularity between the strategic planning and the budgeting processes aimed at enhancing the quality and efficiency of services, with a view to continuous improvement. This connection was still partial during the years under investigation; however, an interviewee stated that: “ In the next years, we intend to draw up a road map to define the timing of all operational activities, also for a gradual coordination between budget and objectives, towards an alignment of the two planning processes phases ”. Conversely, a similar path has been traced to increasingly link resource allocation to performance. In fact, as scholars have also identified in other cases (Van Dooren et al., 2010 ; Van Thiel & Leeuw, 2002 ), University C has started a performance budgeting system, by identifying specific financial resources for all the GD’s objectives from 2017 onwards. Moreover, the internal distribution of resources to departments is based on the results achieved, with a budget allocation policy based on awards and other selective criteria.

In all three universities, we therefore notice that the integration between strategic planning and performance management systems is an ongoing process that is being improved over time. Evidence demonstrates the willingness of these universities not only to meet regulatory requirements, but also to implement the logic of planning, both at political and administrative levels, to promote the proper functioning of the academic organisation, with a view to improving decision-making processes and accountability towards its stakeholders. However, while strategic planning information is incorporated in the performance management system, the role that performance management systems play in redefining strategies is less evident.

6 Discussion and conclusions

The comparative analysis of the multiple case studies carried out in Section 5, although without making any claims regarding generalisability, provides interesting food for thought on how strategic planning is conceived by universities, how the process to define strategies is developed and connected with the operational documents and budget, and to what extent the strategic planning system can be integrated with the performance management system, overcoming semantic boundaries and capturing the implicit links.

Moreover, the interviews with some of the main actors involved in the two systems help to understand also the reasons underpinning certain political and administrative choices. Table  2 summarises our findings across the three case studies, as detailed in Section 5.

Concerning the strategic planning system, evidence demonstrates that, as Boyne and Walker ( 2010 ) claimed, the definition of the strategies is a process that is more effective the more it results in a shared and collective effort towards a common vision.

This is more likely to happen in those public organisations where the unitary strategy is the synthesis of different strategic visions, linked to heterogeneous contexts and needs. Universities, embracing several areas of teaching, specialisation, and research, fall into this situation. In addition, the decision-making processes at universities are often complicated and extended due to the involvement and different interests of academic structures composed of professors and administrative staff.

Examining the three cases, a core aspect is the degree of participation of different actors involved in the process. While for University B the elaboration of the SUP is mainly delegated to the Vice-Rectors, who probably only informally consult the GD, in University A and University C, it appears to be more participatory and formalised. In fact, in University A, the project team involves different stakeholders in the process (including their competitors) through sharing the strategic ambitions of the governance bodies. This was mainly observed in the first wave of strategic planning. In the second wave, the phenomenon was scaled down, also in terms of participation, to make way for a more apparently centralised vision, but less impactful than the previous one. In University C, different political and administrative actors are involved in defining the areas of strategic intervention: the political body; the Rector; the delegates of the Rector in the areas of strategic planning, didactics, and research; and the GD, who in turn consults the other managers involved. During this time, University C has experienced better involvement from stakeholders and managers, and shared the actions and strategies to be implemented with more actors.

Moreover, University B has apparently not used external consultants, and neither has University C. University A, however, in the drafting of the second SUP, turned to external parties for various specific aspects (definition of strategic positioning and internationalisation strategy).

Therefore, three different patterns emerge, which can be placed along a spectrum ranging from University B, through University C, to University A. For example, University B still wants to maintain a clear distinction between the political and administrative sphere, and the strategic planning process involves only internal actors and only at the political level. University C, still maintaining the process as entirely internal, is instead trying to make a collective effort to bring both the political and administrative spheres of the university together towards common goals. The latter formalises a process in which participation is the widest, even involving external stakeholders.

This is also largely confirmed by when and where the SUP is placed in the strategic planning process and among the planning documents. For example, the placement of the SUP in the three universities is different. In University B, the SUP derives from the TYPD, and both are interpreted as documents of a more political-institutional nature (also due to the methods and actors involved in their elaboration). In University A, the SUP is placed upstream of the TYPD. This position, in addition to projecting a different integration of the concept of strategy that should normally be inferred from political indications/lines, also predisposes it in a different way with respect to the IP. University C displays a peculiarity compared to the other cases, in that the TYPD is not a separate document but embedded in the strategic plan itself. This has been done to highlight and reinforce an even stronger connection between the two planning documents. It should be pointed out that the TYPD takes on a more strictly bureaucratic and ritual programmatic character, while the SUP becomes the instrument to which a more managerial character is assigned, in accordance with a methodology and content more capable of incorporating the involvement of the organisation.

Despite the high political value of strategic planning documents, examining their time horizon reveals that none of the three SUPs has a duration equal to the rectoral mandate. In University B, the duration of the plan is three years, in University A it is four years, and in University C three to four years. Moreover, observing the programming cycles from a longitudinal point of view, it emerges that, for all three universities, although the change in the governance bodies has marked an important transformation, strategies have not been overturned and the SUP has maintained its consistency over time, outlining for all the three universities the importance of guaranteeing continuity and a medium- to long-term vision.

Regarding the performance management system, all three universities comply with the academic regulations, which require issuing a PP (which recently extended its content in terms of transparency and anti-corruption by becoming an IP). At the end of the year, the GD elaborates the PR, highlighting the organisational and individual results achieved with respect to the planned objectives and allocated resources. However, going beyond mere bureaucratic compliance, as the literature affirms (Bouckaert & Halligan, 2006 ; Van Dooren et al., 2010 ), the measuring of performance is only the first step towards a proper performance management process from which implementation should follow. In fact, performance information needs to be incorporated into the management system before it can be used.

The issue of implementation is relevant in answering our research question. As stated, our analysis focuses on the policy cycle, attempting to understand to what extent there is a link between strategic planning and performance management systems, also considering the budgeting process within the financial cycle. As emerges from the documentary analysis and the interviews, all three universities declare a correlation between the two systems and show coherence between the performance objectives and strategic objectives. On the one hand, it is possible to state that performance documents, procedures, and discourse incorporate strategic planning information. Hence, strategic planning tools contribute to performance management systems, since evidence demonstrates that performance objectives included in the IPs are partly derived from the strategic areas of interventions included in the strategic documents. This link is expressed in the connection between each university’s development policy perspectives, outlined in the strategic planning documents, as well as the systems, operations, and logic used by the administration to define its management objectives, monitor its performance, identify corrective actions, and evaluate the results achieved. This seems to happen according to a top-down logic, from the political function (responsible for defining strategic guidelines) to the administrative function (responsible for the most operational activities).

However, on the other hand, performance management systems do not really help to reshape universities’ strategies; barely any performance information is incorporated in the strategic planning process. In fact, the PR evaluates performance information for the purpose of assessing past performance. According to the policy cycle (Van Dooren et al., 2010 , p. 91), these evaluation reports should feed forward into the next strategic plan. However, we do not have evidence about whether, or how, this happens. This is probably because, in many cases, performance barely meets organisational and academic needs. While descending from strategies, the performance system in complex organisations such as universities risks impeding an integrated view of the organisation in its different administrative and academic components.

As far as the financial cycle is concerned, evidence demonstrates that, although internal resources allocation is different among the three cases, this difference reflects their different strategies and priorities. It is, therefore, possible to highlight consistency not only between the strategic planning and performance management systems of these universities, as Francesconi and Guarini ( 2018 ) also demonstrated, but also with their budgeting process. Indeed, in all three cases, willingness is evident to achieve an increasingly meaningful connection between the strategic planning process, the financial planning process, and the more operational dimension of performance. The need to pursue this virtuous path derives from a growing awareness from the academic governance and management of the currently perceived connection and interdependence of these dimensions. The dynamic environment in which universities operate leaves no room for isolated management of these aspects. Therefore, it is necessary to take an overall view to exploit the synergies arising from this link, aiming to improve the efficiency and effectiveness of the services provided.

This study’s main limitation is its focus primarily on the policy cycle, since our analysis has been carried out at the governmental and top management level, without going into detail at the lowest organisational levels, such as departments and other structures. Although conscious of this limitation, we believe this research may have important theoretical and practical implications.

The theoretical implications are twofold. First, evidence leads to considerations regarding the adoption of strategic planning in public organisations with different effects than in other organisations. Although the value of strategic planning is recognised as fundamental for public sector organisations, what emerges for public universities is not immediately generalisable to other public entities because of the specific nature of the higher education sector. Strategic planning shifts from opportunity to necessity for rationalising decisions and vision, redirecting the organisation towards shared values, objectives, and goals, as long as participation in the elaboration of plans is not neglected.

Second, the link between strategic planning and performance management seems to be more evident, even if a university’ performance system undergoes different declinations and it is not always easy to find a cohesive link with strategies. Universities are extremely complex in the articulation of their established aims. What a strategic plan can support in organisational terms may not be of value from an academic point of view in the narrower sense, particularly regarding research, which requires different planning rules from other activities in the organisation. This has consequences on performance, which take on different connotations and nuances. A performance measurement system is undoubtedly linked to the organisation’s ability to define achievable and successful strategies, but the ability to forecast university performance is not always anchored to all the elements that characterise it.

The practical implications of this study include suggestions for universities’ governance bodies related to supporting their decision-making processes in the definition of their long-term objectives and performance management systems. It is also recommended that information arising from the performance management system should also be used to periodically reshape strategies, implementing a virtuous circle between strategic planning and performance management systems.

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Abbreviations

Italian Anti-Corruption Authority

Italian National Agency for the Evaluation of the University and Research Systems

Bachelor’s Degrees

Board of Directors

Common Assessment Framework

General Director

Integrated Plan

Master’s Degrees

New Public Management

Doctoral Degrees

Performance Plan

Planning, Programming, and Budgeting System

Performance Report

Academic Senate

Strategic University Plan

Strategic Teaching Plan

Strategic Research Plan

Strategic Plan for the Third Mission

Strengths, Weaknesses, Opportunities, and Threats

Three-Year Planning Document

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Biondi, L., Russo, S. Integrating strategic planning and performance management in universities: a multiple case-study analysis. J Manag Gov 26 , 417–448 (2022). https://doi.org/10.1007/s10997-022-09628-7

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An analysis of the strategic plan development processes of major public organisations funding health research in nine high-income countries worldwide

  • Cristina Morciano 1 ,
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There have been claims that health research is not satisfactorily addressing healthcare challenges. A specific area of concern is the adequacy of the mechanisms used to plan investments in health research. However, the way organisations within countries devise research agendas has not been systematically reviewed. This study seeks to understand the legal basis, the actors and the processes involved in setting research agendas in major public health research funding organisations.

We reviewed information relating to the formulation of strategic plans by 11 public funders in nine high-income countries worldwide. Information was collected from official websites and strategic plan documents in English, French, Italian and Spanish between January 2019 and December 2019, by means of a conceptual framework and information abstraction form.

We found that the formulation of a strategic plan is a common and well-established practice in shaping research agendas across international settings. Most of the organisations studied are legally required to present a multi-year strategic plan. In some cases, legal provisions may set rules for actors and processes and may establish areas of research and/or types of research to be funded. Commonly, the decision-making process involves both internal and external stakeholders, with the latter being generally government officials and experts, and few examples of the participation of civil society. The process also varies across organisations depending on whether there is a formal requirement to align to strategic priorities developed by an overarching entity at national level. We also found that, while actors and their interactions were traceable, information, sources of information, criteria and the mechanisms/tools used to shape decisions were made less explicit.

Conclusions

A complex picture emerges in which multiple interactive entities appear to shape research plans. Given the complexity of the influences of different parties and factors, the governance of the health research sector would benefit from a traceable and standardised knowledge-based process of health research strategic planning. This would provide an opportunity to demonstrate responsible budget stewardship and, more importantly, to make efforts to remain responsive to healthcare challenges, research gaps and opportunities.

Peer Review reports

Advances in scientific knowledge have contributed greatly to improvements in healthcare, but there have been claims that health research is not adequately addressing healthcare challenges. These concerns are reflected in the increasing debate over the adequacy of the mechanisms used to plan investment in health research and ensure its optimal distribution [ 1 , 2 , 3 , 4 , 5 ].

Over recent decades, methods and tools have been produced in order to guide the process of setting the health research agenda and facilitate more explicit and transparent judgment regarding research priorities. There is no single method that is considered appropriate for all settings and purposes, yet it is recognised that their optimal application requires a knowledge of health needs, research gaps and the perspectives of key stakeholders [ 6 , 7 , 8 , 9 , 10 ].

A number of studies have described initiatives to set health research agendas. Several articles refer to experiences focusing on specific health conditions, for example, those undertaken under the framework of the James Lind Alliance [ 11 ]. There are also reviews of disparate examples of research agenda-setting in low- and middle-income countries [ 12 , 13 ] as well as in high-income countries (HICs) [ 14 ]. These initiatives were highly heterogeneous with regard to their promotor (public organisations, academics, advocacy groups, etc.), the level of the research system (global, regional, national, sub-national, organisational or sub-organisational) and the scope of the prioritisation process (broad themes or specific research questions).

However, there are no studies that have specifically investigated the way large public organisations in HICs devise their research agendas and to what extent this is linked to regulations and organisational setup. In 2016, Moher et al. reported on how research funders had addressed recommendations to increase value and reduce waste in biomedical research [ 15 ]. Within this framework, they provided a general overview of setting the overall agenda in a convenient sample of six public funders of health research. They also affirmed the need for a “ periodic survey of information on research funders’ websites about their principle and methods used to decide what research to support ” [ 15 ]. At the same time, Viergever et al. identified the 10 largest funders of health research in the world and recommended further study of their priority-setting processes [ 16 ].

Given this context, we wished to provide an updated and thorough description of the way public funders of research in HICs devise their research agenda. We therefore analysed the regulatory framework for the actors and processes involved in developing the strategic plan in 11 major English and non-English speaking public research funders across 9 HICs worldwide.

Strategic planning

Our analysis focused on the development of the strategic plan, or strategic planning, at organisational level as a crucial step in the setting of the research agenda by the organisation. By the term ‘setting the research agenda’, we meant the whole-organisation research management planning cycle, which may encompass multiple decision-making level (organisational, sub-organisational, research programme level, etc.) actors and funding flows.

Strategic planning has been defined in social science as a “ deliberative, disciplined effort to produce fundamental decisions and actions that shape and guide what an organization (or other entity) is, what it does, and why ” [ 17 ].

The strategic plan is assumed to be the final outcome of the strategic planning process, in which priority-setting is the key milestone. It is therefore expected that the research priorities of the organisation will be included. Depending on mandate, priorities could be related to research topics (e.g. health conditions or diseases), types of research (e.g. basic or clinical) and/or other planned initiatives (e.g. workforce or research integrity).

The choice to focus on strategic planning was also guided by the fact that it is known from social science that strategic planning is a well-established practice within public organisations worldwide [ 17 , 18 ]. This would enable us to ensure comparability of information on modalities of decision-making in research planning across organisations from different countries.

Selection of public organisations

We created a list of public funders of health research, drawing from a previous study in which the authors identified 55 public and philanthropic organisations and listed them according to their annual expenditure on health research [ 16 ]. In order to strike a balance between learning about the practices of health research funders, and keeping data collection feasible and manageable, we restricted our sample to two organisations per country, with health research budgets of more than 200 million USD annually. In doing so, we identified a manageable subsample of 35 organisations having the greatest potential influence on research agendas, both locally and globally, and representing different health research systems in different countries.

We based our overview on publicly available information and restricted our sample to those organisations with published strategic research plans in English, French, Italian or Spanish (Additional file 1 ).

Information search and abstraction

Since we expected processes to vary across organisations, we did not use guidelines or best practices for strategic planning, which allowed us to document a wide range of experiences. As mentioned earlier, we based this overview on the collection of publicly available information by means of a conceptual framework and an information abstraction form (Box  1 , Additional file 1 ).

We based the conceptual framework on Walt and Gilson’s policy analysis model [ 19 ] and the information that could actually be retrieved after an initial assessment of the available information. The conceptual framework and the data abstraction form were conceived in an effort to (1) standardise the search for and collection of information across organisations, (2) render the collection process more transparent, and (3) make the retrieved information more understandable to readers.

Three authors (CM, CF and MCE) performed the review of information and the compilation of the form independently, with differences of opinion resolved by discussion. Information was collected in duplicate from 1 January 2019 to 31 July 2019. Before submitting the article, we updated the information by accessing and reviewing the official websites of the included organisations until 10 December 2019.

We searched for information that answered our questions by (1) browsing the funding organisations’ official websites and following links providing information about the organisations, e.g. Who we are, About us, Mission, Laws and statutes, Funding opportunities and other similar web pages, and by (2) identifying and reviewing strategic plans. When an organisation was composed of multiple sub-organisations, we limited our analysis to the strategic planning of the overarching organisation.

A second phase of research consisted of producing a profile for each organisation according to the data extraction form (Additional file 1 ). Bearing in mind that the results of this analysis could have been very general, we also used two organisations as case studies to provide more detailed examples of planning and implementing research priorities at the organisational level. We accessed and reviewed the official websites of the case study organisations until 14 April 2020. We did not contact organisations directly to obtain additional information. After collecting and analysing the information, we produced a narrative overview of our findings.

Box 1 Conceptual framework

Organisation profile

 This section describes the funding organisation and its role and relationship with other overarching governmental bodies.

What are the contents of the strategic plan?

 This section examines the publicly available strategic plan of the funding organisation. The strategic plan is assumed to be the final outcome of the strategic planning process and includes the research priorities of the organisation. Depending on the mandate of the organisation, the research priorities are those related to research topics (for example, health conditions/diseases), types of research (for example, basic research, clinical research) and/or other planned initiatives within the mandate of the organisation (e.g. workforce, research integrity).

Regulatory basis

 This part seeks to understand if there is an official basis for strategic planning, for example, a law or a government document that establishes processes and actors for setting priorities.

What are the process and tools of strategic planning?

 This section seeks to describe the processes and tools for identifying the research priorities included in the strategic plan, including whether or not there are explicit mechanisms, criteria, instruments and information to guide and inform the process of strategic planning such as a research landscape analysis or a more structured experience of priority-setting.

Who are the actors involved?

 This section examines who the involved actors are in preparing the strategic plan; for example, who coordinates the process and who is involved in the process (e.g. clinicians, patients, citizens, researchers) and how the organisation relates with other entities in preparing the strategic plan.

Included organisations

We included 11 public organisations with a publicly available strategic plan in English, Spanish, French or Italian (Additional file 1 ). There were two from the United States, two from France, and one each from the United Kingdom, Canada, Australia, Japan, Italy, Spain and Singapore. The mandates of the organisations were diverse – some had the task of funding research and other activities in support of health research, while others were involved in both funding and conducting health research (Table  1 ).

The strategic plan: format and content

The strategic plans varied in format (Additional file 1 ). While some organisations indicated broad lines of research, others structured their strategic plan in a complex hierarchy with high-level priorities connected to goals and sub-goals. In some cases, indicators, or menus of indicators, were added to monitor progress of the planned work and/or assess the impact of the research. In some research plans, the type of research funding (e.g. responsive, commissioned, research training) and budget were explicitly linked to research priorities.

With regard to content, some organisations focused their strategy on supporting the production of new knowledge of specific diseases or conditions. Others prepared a comprehensive strategy to support different functions of the health research system, such as producing knowledge, sustaining the workforce and infrastructure, developing policies for research integrity and conceiving processes for making more informed decisions. Some strategic plans briefly described the research environment at the national, organisational or programme level. One organisation described the process used to develop health research priorities.

Most of the organisations are legally required to present a multi-year strategic plan or at least annual research priorities. In addition, legislation sets rules and procedures by covering subjects such as the actors to be involved, the documents to be consulted and the format of the strategic plan document to be adopted. In some cases, legal provisions indicate areas and/or types of research to be funded (Table  1 ).

Commonly, the main actors are the top-level policy-makers of the organisations. A spectrum of external stakeholders from multiple sectors may be involved and their participation varies across organisations. External stakeholders can be members of academia or government research agencies, or industry professionals and policy-makers. Most frequently, they have a membership role in organisational governing bodies (boards and committees) (Table  1 ).

The government maintains a role in shaping the strategic plan to various extents in different organisations. This may involve producing nationwide strategic plans for research that the organisations have to adopt or align to, directing attention to specific research priorities or types of research, having representatives in the governing bodies of the organisations and retaining the power of final approval of the organisations’ strategic plans (Table  1 ). Other actors involved are overarching government agencies, which play a role in managing or coordinating the research plan at the national level. Examples of this are the Spanish National Research Agency and United Kingdom Research and Innovation (UKRI). When this study was being conducted, the latter had just been established and been given the role of developing a coherent national research strategy.

The participation of civil society in governing bodies, temporary committees or consultation exercises was far less common. There are representatives of the public in the advisory bodies of the National Institutes of Health (NIH; e.g. the Advisory Committee to the Director).

The Chief Executive Officer of the National Health and Medical Research Council (NHMRC), acting under the terms of the NHMRC Act, established the Community and Consumer Advisory Group. This is a working committee whose function is to provide advice on health questions and health and medical research matters, from consumer and community perspectives. Most notably, the United States Department of Defense – Congressionally Directed Medical Research Programs (DoD-CDMRP) involve consumers (patients, their representatives and caregivers) at all levels of the funding process, from strategic planning to the peer-review process of research proposals. Organisations also have external consultation exercises, in which the target audiences and mechanisms implemented vary (Table  1 ).

In order to illustrate the interactions between different actors, we identified two broad categories of organisation. The first comprises those organisations that develop their own plans with a certain degree of independence. Government and legal provisions might provide some direction. In this group are the NIH, the Institut national de la santé et de la recherche médicale (Inserm), the Italian Ministry of Health (MoH), the NHMRC, the Canadian Institutes of Health Research (CIHR), the Medical Research Council (MRC), the DoD-CDMRP, the Centre National de la Recherche Scientifique (CNRS) and the Japan Society for the Promotion of Science (JSPS) (Table  1 ).

The second category is made up of those organisations whose research planning derives from the strategic plan of an overarching entity. In this group are the Instituto de Salud Carlos III (ISCIII), the National Medical Research Council (NMRC) and the MRC. Both categories are represented in the case studies below.

An example of the first category from the United States is the 5-year strategic plan, NIH-Wide Strategic Plan, Fiscal Years 2016–2020: Turning Discovery Into Health, developed by the NIH at the request of Congress. Legislation provides direction on some criteria for setting priorities in the plan, but it is the NIH Director who develops it in consultation with internal (Centres, Institutes and Offices) and external stakeholders (see the NIH case study).

In Australia, the Chief Executive Officer of the NHMRC identifies major national health issues likely to arise during the 4-year period covered by the plan and devises the strategy in consultation with the Minister for Health and the NHMRC governing bodies. The Minister provides guidance on the NHMRC’s strategic priorities and approves or revises the plan. In Canada, the governing bodies of the CIHR are responsible for devising the strategic plan. The Deputy Minister of the Department of Health participates as a non-voting member of one of the governing bodies.

The common characteristic of the second category is that the process of strategic planning derives from one or more overarching entities. This means that the strategic plans of the organisations are informed to various extents by the research programmes of such an entity or entities. In some cases, there is a main institution with research coordination and/or management roles at the national level. For example, in Spain, in order to inform funding grants, the ISCIII adopted the research priorities set out in the Strategic Action for Health included in the State Plan for Science, Innovation and Technology 2017–2020 . This plan, elaborated by the Government Delegated Committee for the Policies for Research, Technology and Innovation ( la Comisión Delegada del Gobierno para Política Scientífica, Tecnológica y de Innovación ), in cooperation with the Ministry of Fianance, is aligned with the four strategic objectives of the Spanish Strategy for Science, Technology and Innovation 2013–2020. The newly established Spanish State Research Agency ( Agencia Estatal de Investigacion ) also participated in the development of the State Plan. However, its role is mainly in monitoring the plan’s funding, including ISCIII funding for the Strategic Action for Health.

UKRI, sponsored by the Department for Business, Energy and Industrial Strategy, is the body responsible for the development of a coherent national research strategy that balances the allocation of funding across different disciplines. In 2018, the MRC became a committee body of UKRI, alongside eight other committees, called ‘Councils’, which represent various research sectors. The MRC is required to develop a strategic plan that is coherent with the strategic objectives set by UKRI. This plan must be approved by the UKRI Board, the governing body responsible for ensuring that Council plans are consistent with the UKRI strategy.

In Singapore, the NMRC refers to the strategic plan developed by the National Research Foundation, a department within the Prime Minister’s Office. The NMRC has a well-described system for incorporating national priorities into the organisation’s research plan (see the NMRC case study).

With regard to the information, sources of information, criteria and mechanisms used to shape decisions, the included organisations were less explicit. Most commonly, organisations introduced health research priorities with an overview of major general advancements in biomedical research or a catalogue of organisational activities and a research portfolio.

A small number of organisations presented a brief situational analysis of the health and health research sectors. In these cases, the scope and nature of the presented information varied from one organisation to another (Additional file 1 ).

For example, the NIH-Wide Strategic Plan contains a brief summary of the state of research at the organisational level. The plans of each DoD-CDMRP health research programme present a summary of both the current health and health research landscapes at the national level.

Other organisations stated that the plan had been supported by information analysis of the research field, but they did not report explicitly on this work.

Case studies

The national institutes of health (nih).

The NIH is an operating division of the United States Department of Health and Human Services whose mission is to improve public health by conducting and funding basic and translational biomedical research. It is made up of 27 theme-based Institutes, Centers and Offices, each of which develops an individual strategic plan [ 20 ].

The first 5-year strategic plan, NIH-Wide Strategic Plan, Fiscal Years 2016–2020: Turning Discovery into Health, was prepared at the request of Congress and published in 2016 [ 21 ]. The legal framework stipulates that the NIH-coordinated strategy will inform the individual strategic plans of the Institutes and Centers. In addition, it provides some direction regarding content and the process to be adopted for generating the overall NIH strategy [ 22 , 23 ]. For example, it sets out specific requirements for the identification of research priorities. These include “ an assessment of the state of biomedical and behavioural research ” and the consideration of “ (i) disease burden in the United States and the potential for return on investment to the United States; (ii) rare diseases and conditions; (iii) biological, social, and other determinants of health that contributes to health disparities; and (iv) other factors the Director of National Institutes of Health determines appropriate ” [ 23 ]. The NIH Director is also required to consult “ with the directors of the national research institutes and national centers, researchers, patient advocacy groups and industry leaders ” [ 23 ]. To fulfil the request of Congress, the NIH Director and the Principal Deputy Director initiated the process by creating a draft ‘framework’ for the strategic plan. This framework was designed with the purposes of identifying major areas of research that cut across NIH priorities and of setting out principles to guide the NIH research effort (‘unifying principles’).

The development of the NIH-Wide Strategic Plan involved extensive internal and external consultations throughout the process. Consultees included the ad hoc NIH-Wide Strategic Plan Working Group, composed of representatives of all 27 Institutes, Centers and Offices, the Advisory Committee to the Director, which is an NIH standing committee of experts in research fields relevant to the NIH mission, and representatives of the research community (from academia and the private sector) and the general public. The framework was also presented at meetings with the National Advisory Councils of the Institutes and Centers.

In addition, the framework was disseminated to external stakeholders for comments and suggestions, which were solicited via a series of public webinars and through the initiative Request for Information: Inviting Comments and Suggestions on a Framework for the NIH-Wide Strategic Plan. In this case, a web-based form collected comments and suggestions on a predefined list of topic areas from a wide array of stakeholders representative of patient advocacy organisations, professional associations, private hospitals and companies, academic institutions, government and private citizens [ 24 , 25 , 26 , 27 ]. A report on the analysis of the public comments is publicly available [ 27 ].

The National Medical Research Council (NMRC)

The NMRC is the organisation that has the role of promoting, coordinating and funding biomedical research in Singapore [ 28 ]. It has developed its own research strategy by adopting the research priorities indicated by the national research strategy in the domain of health and biomedical sciences [ 29 ].

The national research strategy is the responsibility of the National Research Foundation, a department of the Prime Minister’s Office. It defines broad research priorities relating to various areas of research identified as ‘domains’. Within the health and biomedical sciences domain, five areas of research have been proposed with input from the Ministry of Health and the Health and Biomedical Sciences International Advisory Council. These are cancer, cardiovascular diseases, infectious diseases, neurological and sense disorders, diabetes mellitus and other metabolic/endocrine conditions. Criteria for selection of the areas of focus were “ disease impact, scientific excellence in Singapore and national needs ” [ 29 ].

The approach of NMRC to implementing the national research strategy at organisational level involves the establishment of ‘task forces’, i.e. groups of experts, with the role of defining the specific research strategy for each of the five areas of focus. Each task force provides documentation of research recommendations and methods used to prioritise research topics [ 30 ].

For example, the Neurological and Sense Disorders Task Force identified sub-areas of research Footnote 1 after analysing the local burden of neurological and sense disorders as well as considering factors such as local scientific expertise and research talent, ongoing efforts in neurological and sense disorders, industry interest, and opportunities for Singapore. As part of the effort, input was also solicited from the research community and policy-makers. This research prioritisation exercise served for both the NMRC grant scheme and a 10-year research roadmap [ 31 ].

Our study is the first to report on the processes used by a set of large national public funders to develop health research strategic plans. In line with findings from public management literature [ 16 , 17 ], we found that the formulation of a strategic plan is a well-established practice in shaping research agendas across international settings and it is a legal requirement for the majority of the organisations we studied.

We were able to reconstruct the process for developing the strategic plan by identifying the main actors involved and how they are connected. A complex picture emerges, in which multiple interactive entities and forces, often organised in a non-linear dynamic, appear to shape the research plans. In general, an organisation has to take into account legislative provisions, government directives, national overall research plans, national health plans and specific disease area plans. In some cases, it has to consider ‘institutionalised’ allocation of resources across organisations’ sub-entities (institutes, centres and units), which are historically associated with a particular disease or type of research.

On the other hand, we found little documentation of the decision-making mechanisms and information used to inform decision-making. There were, for example, few references to health research needs, research capabilities, the sources of information consulted, and the principles and criteria applied. This despite the increasing attention being paid nationally and internationally to the need for an explicit evidence-based or rational approach to setting health research priorities, particularly in the light of current economic constraints [ 3 , 32 , 33 ]. Given the complexity of the influences of different parties and factors, the governance of the health research sector would benefit from a traceable knowledge-based process of strategic planning, similar to that advocated for the health sector [ 34 ].

We found, however, evidence of an increasing interest in improving ways to establish research priorities at the organisational level. For example, NIH has brought forward the Senate request to develop a coordinated research strategy by including, in the strategic plan, the intention to further improve the processes for setting NIH research priorities and to optimise approaches to making informed funding decisions [ 21 ].

Recently, the DoD-CDMRP, the second largest funder of health research in the United States, reviewed its research management practices upon the recommendations of an ad hoc committee of the National Academies of Sciences, Engineering and Medicine. In the area of strategic planning, the committee recommended an analysis of the funding landscape across different agencies and organisations, the identification of short- and long-term research needs, and harmonisation with the research priorities of other organisations [ 35 ].

In its strategic plan, the JSPS has placed particular emphasis on the development of research-on-research capacity and infrastructures to analyse the research landscape at organisational, national and international levels in order to ensure that funding decisions are evidence based [ 36 ].

The allocation of sufficient resources to develop the infrastructure and technical expertise required for collection, analysis and dissemination of a portfolio of relevant data should be considered a necessary step when a funding organisation or country decides to implement standardised approaches for strategic planning and priority-setting.

Additionally, from the perspective of health research as a system, data collection and analyses should not be limited to ‘what is funded’, but should also include ‘who is funded and where’, and be linked to research policies and their long-term outcomes. The benefit of such an approach is not limited to the prevention of unnecessary duplication of research. Support would also be provided for producing formal mechanisms to coordinate research effort across research entities, within and among countries. Collaborations with other non-profit as well as for-profit organisations would be promoted and the capacity for research would be created and strengthened where necessary.

A number of resources and initiatives in this field already exist at organisational and national level. For example, the NIH has the Research Portfolio Online Reporting Tools, a public repository of data and other tools from NIH research activities [ 37 ]. This repository is linked to Federal RePORTER, an infrastructure that makes data on federal investments in science available. In the United Kingdom, the Health Research Classification System performs regular analysis of the funding landscape of United Kingdom health research to support monitoring, strategy development and coordination [ 38 ].

At the international level, there is ongoing global work to shape evidence-based health research decisions and coordination. In 2013, the WHO Global Observatory on Health R&D was established “ in order to monitor and analyze relevant information on health research and development, […] with a view to contributing to the identification of gaps and opportunities for health research and development and defining priorities […] and to facilitate the development of a global shared research agenda ” [ 33 ]. This effort has been coupled with a global call to action, which asks governments to create or strengthen national health research observatories and contribute to the WHO Observatory. Furthermore, the Clinical Research Initiative for Global Health, a consortium of research organisations across the world, has ongoing projects that will map clinical research networks and funding capacity and conduct clinical research at a global level [ 39 ].

A further key area that deserves comment is the engagement of stakeholders. In general, a spectrum of external stakeholders from multiple sectors is involved and the extent of this involvement varies across organisations. Decision-making processes commonly include people from government bodies, academia, research agencies and industry. However, we found that the participation of civil society, here represented by the intended beneficiaries of research such as health professionals, patients and their carers, remains limited. The fact that decision-making is still the domain of government officials and experts is an unexpected finding. There is a widespread consensus that the participation of a mix of stakeholders can improve the process of strategic planning. The logic behind this is that representatives of those who are affected by decisions can bring new information and perspectives and improve the effectiveness of the process [ 17 , 32 , 40 ]. Broader inclusion is desirable, both for granting legitimacy to strategic planning and for advancing equity in healthcare. Decisions on research priorities shape knowledge and, ultimately, they determine whether patients and their carers will have access to healthcare options that meet their needs [ 41 ].

Additionally, our study shows that the involvement of civil society is not only desirable but is also feasible. Organisations that support the participation of civil society have this practice firmly embedded in their governance, although it may be implemented in different ways.

Strengths and limitations

A particular strength of our study is the innovative way in which we approached the disorienting complexity of whole-organisation planning cycle management. This allowed us to contribute to an understanding of the processes used by large public funders not only in English-speaking countries but also in France, Italy and Spain.

However, one potential limitation concerns the accuracy and completeness of the information. This drawback was imposed by both the unstructured nature of the information and its fragmentation across multiple webpages and legal and/or administrative documents. Nevertheless, we strove to ensure accuracy, consistency and a clear presentation of the relevant information by means of a conceptual framework and a data abstraction form. In addition, to guarantee the reliability of the data, two reviewers abstracted the information independently, before discussing it and reaching a consensus. The use of more accessible information, e.g. through single documents, would therefore be advisable to improve accountability and transparency. This would also be of particular importance for exchanging knowledge and promoting research in the specific field of research governance.

In addition to the limitations imposed by the available data, there is a potential limitation in the methodology of the study. In conducting our research, we decided to rely only on publicly available information and we did not ask organisations for further details. Consequently, we may have missed some actions and drawn an incomplete picture of the organisations presented. Our strategy was based on the assumption that, if a strategic plan existed, both it and a description of its associated decision-making process would be present in the public domain, given that transparency in decision-making is an acknowledged element of good public organisation governance [ 42 ]. We would therefore counter that the process should be more transparent and should address, in particular, the criteria and information used to support decision-making.

In addition, it was not possible to ascertain in detail how processes actually took place. For example, engaging external stakeholders, such as representatives of civil society, is a key feature of the organisations included in the study but we do not know whether this engagement was meaningful or simply granted legitimacy to leadership decisions.

Furthermore, by limiting our inclusion criteria to organisations with strategic plans publicly available in English, French, Spanish and Italian, we excluded two German organisations (the German Research Foundation and the Bundesministerium für Bildung und Forschung – the Federal Ministry of Education and Research) and two Chinese bodies (the National Natural Science Foundation of China and the Ministry of Health). These organisations could have been included on the basis of their health research budgets. While it is unlikely that these bodies from two countries with similar health research systems have practices that would have changed our conclusions, it would nevertheless be useful in the future to acquire information regarding their experiences in this area.

Future research

Having considered the abovementioned limitations, we recommend that qualitative research be conducted to further validate our findings by complementing the information presented here with data gathered from key informants within each organisation. We also suggest that the study be extended to include other organisations and countries. Additional research should also expand on our study by more deeply exploring the perspectives of the members of external stakeholder bodies regarding their involvement in strategic planning within each organisation. Making this information accessible would benefit those funder organisations who wish to both increase public engagement in health research decision-making and make it more meaningful.

It would also be interesting to explore whether and why funder organisations are influenced by the research plans of other organisations (including academic, advocacy and international bodies) within and among countries, and whether they have formal mechanisms in place to coordinate with other such organisations. This information would be of use in guiding research coordination policies, with the aim of avoiding duplication of effort and identifying not only gaps in research but also overlapping interests and opportunities for partnerships.

Our study illustrates the variety of the processes adopted in developing strategic plans for health research in the international setting. A complex picture emerges in which multiple interactive entities appear to shape research plans. Although we found documentation of the actors involved in the processes, much less was available on the mechanisms, information, criteria and tools used to inform decision-making.

Given the complexity of the influences of different parties and factors, both funding organisations and health sector governance would benefit from a traceable knowledge-based process of strategic planning. The benefits of such an approach are not limited to demonstrating responsible budget stewardship as it would also provide opportunities to respond to research gaps and healthcare needs and to move more effectively from basic to translational research.

Availability of data and materials

All data generated or analysed during this study are included in this published article in Additional file 1 .

Neurodegenerative diseases (vascular dementia and Parkinson’s diseases), neurodegenerative eye diseases (age-related macular degeneration and glaucoma), mental health disorders (depression) and neurotechnology.

Abbreviations

High-income countries

United Kingdom Research and Innovation

National Institutes of Health

National Health and Medical Research Council

U.S. Department of Defense - Congressionally Directed Medical Research Programs

Institut national de la santé et de la recherche médicale

The Italian Ministry of Health

Canadian Institutes of Health Research

Medical Research Council

Centre National de la Recherche Scientifique

Japan Society for Promotion of Science

Instituto de Salud Carlos III

Singapore National Medical Research Council

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The authors thank Letizia Sampaolo, Istituto Superiore di Sanità, the information specialist who made an initial search of relevant scientific articles, and Stephen James for English language review of the manuscript.

This research was partly supported by funding for 'Ricerca Corrente' of  the Istituto Superiore di Sanità. 

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Data abstraction form. (a) Table of the included and excluded organisations with reasons; (b) table of the included organisations with budget; (c) the organisations’ profiles according to the fields of the conceptual framework; and (d) full list of the consulted references and web pages for each organisation’s profile.

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Morciano, C., Errico, M.C., Faralli, C. et al. An analysis of the strategic plan development processes of major public organisations funding health research in nine high-income countries worldwide. Health Res Policy Sys 18 , 106 (2020). https://doi.org/10.1186/s12961-020-00620-x

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Strategic Planning, Implementation, and Evaluation Processes in Hospital Systems: A Survey From Iran

Jamil sadeghifar.

1 Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran

Mehdi Jafari

Shahram tofighi.

2 Health Management Research Centre, Baqiyatallah University of Medical Sciences, Tehran, Iran

Hamid Ravaghi

3 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran

Mohammad Reza Maleki

Aim & background:.

Strategic planning has been presented as an important management practice. However, evidence of its deployment in healthcare systems in low-income and middle-income countries (LMICs) is limited. This study investigated the strategic management process in Iranian hospitals.

The present study was accomplished in 24 teaching hospitals in Tehran, Iran from September 2012 to March 2013. The data collection instrument was a questionnaire including 130 items. This questionnaire measured the situation of formulation, implementation, and evaluation of strategic plan as well as the requirements, facilitators, and its benefits in the studied hospitals.

All the investigated hospitals had a strategic plan. The obtained percentages for the items “the rate of the compliance to requirements” and “the quantity of planning facilitators” (68.75%), attention to the stakeholder participation in the planning (55.74%), attention to the planning components (62.22%), the status of evaluating strategic plan (59.94%) and the benefits of strategic planning for hospitals (65.15%) were in the medium limit. However, the status of implementation of the strategic plan (53.71%) was found to be weak. Significant statistical correlations were observed between the incentive for developing strategic plan and status of evaluating phase ( P =0.04), and between status of implementation phase and having a documented strategic plan ( P =0.03).

Conclusion:

According to the results, it seems that absence of appropriate internal incentive for formulating and implementing strategies led more hospitals to start formulation strategic planning in accordance with the legal requirements of Ministry of Health. Consequently, even though all the investigated hospital had the documented strategic plan, the plan has not been implemented efficiently and valid evaluation of results is yet to be achieved.

1. Introduction

In recent years, improving the quality of health services has attracted the attention of many scientific investigations ( Arah et al., 2003 ). The phases that healthcare organizations routinely follow for improvement of services provision quality are setting priorities, establishing sustainable processes and determining an appropriate framework to implement the initiative programs ( Glickman, Baggett, Krubert, Peterson, & Schulman, 2007 ; Rütten, Röger, Abu-Omar, & Frahsa, 2009 ). On the other hand, increasing global competition has led these organizations to re-engineering of business processes as a means to ensure efficiency, effectiveness and ultimately their success ( Jafari, Bastani, Ibrahimipour, & Dehnavieh, 2012 ). One of the most effective strategies for the success of organizations is running the strategic planning. It is one of the most common managerial practices in healthcare provider organizations, largely in the form of research articles that have not been evaluated. Evidence-based management seems inevitable in these organizations to conduct investigations on such common practice ( Kaissi, Begun, & Welson, 2008 ).

Strategic planning is the systematic process whereby an organization creates a document indicating the way it plans to progress from its current situation to the desired future situation ( Perera & Peiró, 2012 ). According to Swayne, Duncan, and Ginter (2006) , strategic planning is a set of processes, which help in identifying the future desired by the organization and to developing guidelines for making the decisions leading to such a future ( Swayne, Duncan, & Ginter, 2006 ). Strategic planning integrates main objectives, policies and associated activities in an individual organization as a whole. A strategy based on the shortcomings and the competence within the enterprise can anticipate changes in the environment, and can be helpful for allocation of enterprise resources in a unique and valuable way ( Mintzberg, Quinn, & Ghoshal, 1998 ).

Successful strategic planning necessitates development of the plan in right manner, as well as appropriate implementation, accurate and on-time evaluation of the results, possibly through the Strategic Control System (SCS). The SCS involves tracking strategies to action, identifying the problems or changes in necessary strategies and reforms. Senior manager must constantly ask himself/herself whether the organization is moving in the right direction or not, and if the assumptions about the intended major trends and changes in the environment are correct. Such questions need to set the strategic controls ( Pearce & Robinson, 2007 ).

Evidence of strategic planning in low-income and middle-income countries (LMICs) is very low ( El-Jardali, Jamal, Abdallah, & Kassak, 2007 ). Compared with high-income countries, healthcare environment in LMIC is more complex, dynamic and challenging ( Mills, Brugha, Hanson, & McPake, 2002 ) where resources are generally more limited. Thus, the need for strategic planning in these countries should be understood to a larger degree. Saleh et al. (2013) in research on strategic planning processes and their relation to the financial performance of hospitals in Lebanon examined six dimensions including having a plan, plan development, plan implementation, responsibility of planning activities, governing board involvement, and physicians’ involvement as components of the strategic planning process ( Saleh, Kaissi, Semaan, & Natafgi, 2013 ). In a research study, among hospitals in Texas, Kaissi et al. (2008) demonstrated that 87% of the hospitals had a strategic plan, and concluded that three dimensions including having a strategic plan, assigning the Chief Executive Officer (CEO) for the plan, and involving the board are positively associated with financial performance ( Kaissi et al., 2008 ).

Iran as a LMIC is an ancient country located in the Middle East, a region between Asia, Europe, and Africa. The Iranian healthcare system is pluralistic and fragmented because of the public-private mixture in financing and provision of health services. At the national level, Ministry of Health is exercising the governance, policy-making, planning, financing and steering the programs. At the provincial level, the Universities of Medical Sciences and Health Services are responsible for provision of health services, including the environmental health ( Mehrdad, 2009 ).

It should be noted that according to the Iranian national accreditation system (effective from 2010); hospitals are required to have a strategic plan that indicates future directions of the hospital (Jafari et al., 2010). Although having a strategic plan is an overarching national health initiative, this study went beyond the requirement of having a strategic plan to assess the actual process and identify the stakeholders involved in the strategic planning within hospitals. The goal of this study was to explore the process of formulation, implementation and evaluation of strategic plans in all the teaching hospitals affiliated of Iran and Tehran Universities of Medical Sciences.

2. Methodology

The research was conducted on the teaching hospitals affiliated with Tehran University of Medical Sciences (TUMS) and Iran University of Medical Sciences (IUMS) in Tehran (N = 26). There are three large medical universities in Tehran that cover medical services through governmental and teaching hospitals. The TUMS and IUMS have 17 and 10 teaching hospitals, respectively. Three hospitals refused to participate in the study; thus, the study was done on 24 hospitals. From the studied hospitals, a total of 8 hospitals were general and 16 hospitals were specialized.

2.2 Data Collection

The data gathering tool was a questionnaire developed by the authors based on the literature review ( Kaissi et al., 2008 ; Poister, & Streib, 2005 ) and expert opinion. The questionnaire consisted of 130 questions and its validity was confirmed by seven experts in the field of strategic planning. The questionnaire included the following sections and questions:

- Demographic variables (9 items) : Specialty of hospital, number of bed, number of employees, hospital age, grade evaluation, field of study and education degree of hospital manager, the number and composition of the strategic planning committee.

- Requirements and Facilitators of Strategic management (7 items) : management systems deployed in hospital, using a consultant in strategic planning, having a strategic planning committee, activation of strategic planning committee, having a documented strategic plan, review of the strategic plan, and incentive for developing strategic plan.

- The strategic planning phase : extent of stakeholders’ contribution (chief of hospital, hospital manager, assistants and matron, clinical departments officials, officials of the supportive sections, staff at operational levels, external stakeholders, representatives of patient/donor, representative of university) in the strategic planning process in 5 dimensions including participation in meetings, provision of the required information, provision of the initial ideas, provision of reformed and completive suggestions for plan development, presentation of gathering and documentation of plan (45 items), and the extent of attention to various components of the strategic planning (15 items).

- The strategic implementation phase : the components of the budget allocation based on strategic priorities (6 items) and taking action based on the strategic plan (7 items).

- The Strategic evaluation phase : status of using indicators for achieving goals (15 items).

- The benefits of the strategic planning (25 items) and a question to determine the level of strategic planning usage in hospitals.

The scale used for the questions relating to the requirements and facilitator of strategic management was “yes/no”, with a range of weak (0-6), to moderate (7-9) and good (12-10). For the remaining questions, the 5-degree scale (5: very good to 1: very low) and triple range from weak (0-2.50), to moderate (2.51-4) and good (4.01-5) were used to analyze and interpret the answers. In order to unifying the scorings, the calculated scores in both the requirements and the strategic management process have been changed based on 100% and classified as following, Low: 0 to ≤ 50- Moderate: greater than 50% to ≤ 80 - Good: greater than 80%.

Data were collected by the researchers at the studied hospitals and the questionnaire was completed by the investigator in the form of interview. In each hospital, the key person/persons with the greatest involvement and awareness of the hospital’s strategic plan were interviewed. Job status of persons that participated in this study in the investigated hospitals included quality improvement officer (13 hospitals), hospital affairs expert (4 hospitals), clinical governance officer (2 hospitals), hospital manager, Research and Development executive (R&D), clinical supervisor, and systems and procedures officer. Objectives of the study were explained to the participants, and to confirm the accuracy of answers, the documents available in the hospitals were also studied if further review required.

2.3 Data Analysis

Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) software, version 18.0. In this study, the strategic management requirements included 10 variables (defined in Table 2 ) as the independent variables, that all of them have a two-way scale. Furthermore, the strategic management process (including planning, implementation and evaluation) has been considered as the dependent variables. Therefore, in order to compare the mean of the differences between the dimensions of strategic management with against the requirements, we used the t-test ( Table 4 ).

Characteristics of hospitals and hospital managers

Situation of strategic management process requirements and facilitators

Situation of strategic planning process, requirements, facilitators and benefits

Relationship between strategic planning (SP) requirements and facilitators with planning, implementation, and evaluation phases

2.4 Ethical Issues

This study was approved by Ethics Committee of Iran University of Medical Sciences Research. The main ethical issue was respondents’ right to self-determination, anonymity and confidentiality. The questionnaires were distributed among participants with a participant information sheet, explaining the nature of study. The consent was taken verbally from the participants. The questionnaire data were kept confidential and the respondents were assured of their right to withdraw at any time. The respondents’ names were not recorded on the questionnaire; thus, the data were rendered anonymously.

All the studied hospitals were medical and teaching as national referral hospitals in Tehran providing medical and educational services. More than two-thirds of the hospitals were specialized and most of them had one evaluation degree. Establishment age of most of the hospitals was more than 30, half of them had more than 200 beds and about one-third had more than 500 employees. Most hospital managers had a Master’s degree in health services management.

From all the surveyed hospitals, about one-third had carried out the quality management system i.e. the International Organization for Standardize (ISO 9000) and European Fundamental for Quality Management (EFQM). All the hospitals are currently implementing national programs of accreditation and clinical governance requirements. The Balanced Scorecard method (BSC) was not considered in 15 hospitals (62.5%), while it is running in 9 hospitals (37.5%). More than half of the hospitals had a consultant for strategic planning. The majority of hospitals had a strategic planning committee; that is more than half of them have an active committee with monthly meeting. In more than half of the hospitals, members of strategic planning committee are between 5 to 9 persons.

All the hospitals have a documented strategic plan and in the majority of them, plan review was carried out. Most hospitals developed the strategic plan as a legal requirement of the Ministry of Health, while a limited number introduced improvement in performance and future prediction as an incentive for developing strategic plan.

In relation to the requirements and facilitators of strategic planning, most hospitals (n=15) have a moderate status. About developing strategic plan, two distinct dimensions were studied. They were stakeholder participation in strategic planning with an average score of 55.7%, and attention to the strategic planning components with an average score of 62.2% (moderate). Implementation of strategic plan consisted of two components. They were budget allocation based on the strategic priorities and action based on the strategic plan. Status of the studied hospitals with an average score of 53.71% was much weaker than other areas and half of the hospitals were weak in this area. Regarding the evaluation of strategic plan, using indicators for objectives achievement was studied and the average score of 59.94% reflected moderate status of the studied hospitals.

The results of the statistical analysis indicate a significant correlation between the incentive for developing of strategic plan and evaluation of strategic plan (P<0.04); that is the hospitals with incentive such as performance improvement attempted to develop a strategic plan and evaluate strategic plan more effectively. Also, a significant correlation was observed between having a documented strategic plan and implementation of plan (P<0.03). Among other requirements and facilitators, the strategic planning process and planning, implementation and evaluation showed no significant statistical correlation.

4. Discussion

In the present study, status of the formulation, implementation and evaluation of strategic plan in all the teaching hospitals affiliated with two major Medical Universities in Iran was investigated. The results showed that all the studied hospitals had strategic plan as a requirement of the national accreditation system; however, the strategic management was not conceptualized in these centers. Consequently, strategy implementation and particular activities related to the strategic control is not seen systematically.

Ideally, the strategic planning process involves all levels of managerial and operational of organization. Undoubtedly, the board of trustees in every organization has the primary responsibility to carry out the strategic planning. Through establishing key policy targets, the board should play a critical role in complex and extensive planning process ( Cleverley & Cameron, 2007 ). In the present study, influential stakeholders, including hospital chief as a representative of physicians’ community, staff of operational levels, external stakeholders, representatives of patient/donor, and the representative of university had very little participation in the formulation of strategic plan. Due to the changing environment of healthcare delivery, physicians not only required to learn strategic planning and be involved in formulating it, but also they should, by engaging actively in the implementation of programs, have an effective role in achieving the organizational objectives ( Schwartz, & Pogge, 2000 ). The study of Khajavi et al. (2009) in Iran showed that physicians’ skills in strategic thinking and planning are in a low level ( Khajavi, Vatankhah, Maleki, Barati, Alami, & Heyrani, 2012 ). Schwartz and Pogge believed that the acquiring such skills requires a systematic and ongoing training ( Schwartz & Cohn, 2002 ).

Executive administrator, assistants, matron, supervisors of clinical and supportive departments had appropriate participation in the formulation of strategic plan. It seems essential that key informants at various levels of within and outside of the organization have effective and adequate participation in formulating a strategic plan. In the study by Saleh et al. (2013) at Lebanon hospitals, the extent of participation of doctors and broad in formulating strategic plan was determined as moderate. Also, in the Amer et al. study at Texas hospitals, the board involvement in formulating strategic plan was reported to be medium ( Kaissi et al., 2008 ).

Based on the findings, attention to various elements of strategic planning was at medium and high levels. Making a vision/study to forecast the future, assess the strength and weakness points and check the threats and opportunities have attracted the highest attention. However, assessing the feasibility of proposed strategies, competitive differentiation, understanding the concerns and needs of stakeholders, clarifying the rules and regulations of organizations and understanding customers’ demands and community needs was considered the least.

The status of strategic plan implementation in the form of budget allocation based on the strategic priorities and doing action according to the strategic plan was poor. Accordingly, in most of the studied hospitals, the university did not review annual budget based on the hospital’s strategic objectives. Moreover, hospital managers and authorities did not request budget based on the strategic plan. There was relatively minor attempt to identify and attract new financial resources to achieve the hospital’s strategic objectives. This is largely associated with the allocation of governmental budgets to hospitals.

Although the administrators and departments authorities in the studied hospitals are responsible for implementation of certain goals associated with the strategic plan, annual evaluation is not practiced based on the achievement of strategic objectives in most of the hospitals, and annual reward in most of the hospitals is not adjusted based on the rate of participation of different wards/individuals in achieving the strategic objectives. In majority of the hospitals, the responsibility for implementing the strategic plan is not assigned to the hospital manager and the annual evaluation is not done based on the achievement of strategic objectives. Unfortunately, hospitals in Iran, only in the formulation of strategic plan efforts to be acted based on existing scientific models and frameworks and in connection with the implementation of the plan are treated merely as traditional. In evaluations of MOH on the hospital’s strategic plan, the implementation of the action plan is not considered significantly.

In most of the studied hospitals, the rates of goals and projects progress derived from the strategic plan are regularly evaluated, and indicators of goal achievement are reviewed at certain time intervals and when necessary. In some hospitals, cause and effect relationship and balance between the indicators are considered. Analysis of measured values obtained from the indicators is done in limited range. The comparison the measured values with previous values, specified standards, and values of similar hospitals rarely done. Reporting the indicator values to the university, the community and stakeholders as well as design and performing appropriate interventions for improvement of performance are limited. Benchmarking of goal achievement indicators to ensure the effectiveness of strategic projects is limited in other hospitals. In the Mihic et al. study (2012) , it is also indicated that healthcare organizations in Serbia attempt to formulate a strategic plan in appropriate manner, however, the monitoring and control of strategies implementation are not based on an scientific method ( Mihic, Obradovic, Todorovic, & Petrovic, 2012 ).

The present results indicate that in cases that hospitals have attempted to establish standards of ISO 9001, status of evaluation strategic plan is more appropriate because of regular and systematic processes and activities as well as observance of documentation principles. According to Rusjan and Alic (2010) , where ever the BSC model has been established as the strategic management tool, employing the quality management system (ISO 9001 QMS), has a positive impact on the strategic objectives of organization in four perspectives including customer satisfaction, financial results, internal processes, and learning and growth, ( Rusjan & Alic, 2010 ). Also, using of BSC model in combination with EFQM, as an organizational excellence model, can lead to improvement in developing and implementing strategies in the healthcare provider organizations ( Groene, Brandt, Schmidt, & Moeller, 2009 ). Both of these models can be considered as quality management tools, in the same way that it proposed for Spanish hospitals as an integrated management approach ( Tejedor, 2009 ). It is essential to these excellence and quality management systems to be integrated within the organization strategic management. This initiative can be an interesting issue for future studies in the field of strategic management in hospital systems.

Finally, most of the studied hospitals something such as focus of hospital instructions on strategic issues, formation of an authentic sense of the hospital missions in community, clear definition of hospital priorities, providing training and development opportunities for all employees and provide high quality services have brought up as most important benefits of strategic management. Stating these benefits is in the condition which the studied hospitals mainly have worked well in the strategic planning, while implementation and evaluation of strategies in these hospitals is seriously impaired.

5. Conclusion

MOH requires Iranian hospitals have documented strategic plan in order to obtain points of accreditation. Hence, a strategic plan leads to performance improvement and increase in quality of care in hospitals. This is supported by our finding that the majority of studied hospitals had documented strategic plan. However, levels of development, implementation and evaluation of plans are moderate. The movement toward excellence, success, and favorable results depends on progress in these fields. The inappropriate status of three dimensions of strategic management in the studied hospitals can be attributed to insufficient knowledge about the terminology and process of strategic management, shortage of time to participate, poor beliefs on strategic management, administrative structure characterized by aversion plan, elitism sub-culture, and serious defect in teamwork, distrust in the external environment, and the centralized structure of MOH in notification of the programs.

It seems for resolving these problems and acquiring the benefits of strategic management in hospital systems in middle income countries, such as Iran, and low income countries, the authorities should attempt in short and long terms levels. A basic action to reduce many of these problems is creating the culture of program-based strategizing the organization, started in the high levels of the Ministry of Health, and then be flooded within the hospital systems. In the short term, the potentials of the Hospitals’ Accreditation National Program can be employed, and provide sufficient and appropriate training on the concept and on the process of strategic management then provide appropriate financial and non-financial incentives, in order to move hospitals towards centralized planning and strategic thinking.

To resolve these problems, the focus of future studies on the identification of infrastructure required for strategizing hospitals and being successful in implementing strategic management system, and on identifying the potential barriers for deployment strategies and evaluating results is recommended.

6. Limitation

This study had some potential limitations that may affect the results. The study was limited to hospitals of two universities in a single city. Therefore, generalizability of the results can be considered as a limitation of the present study. The findings were solely results of a research study and possibly more specialized investigation of these hospitals for strategic planning process will show the most precise results. Another limitation of this study is lack of literature particularly at international level to compare the results. In comparison to other Iranian hospitals, the studied hospitals have a higher proportion of governmental ownership, which limits generalizations of results.

Acknowledgement

This study was part of a PhD thesis supported by Iran University of Medical Sciences (grant No.: IUMS/SHMIS-2012/527). We would like to extend our gratitude to the participants in the teaching hospitals of IUMS and TUMS, and Sayyed Morteza Hosseini Shokouh for his valuable assistance in data analysis.

Conflict of Interest

The authors declare no conflict of interest.

Author’s Contribution

Study concept and design: Sadeghifar, Jafari, Tofighi, Ravaghi, and Maleki. Statistical analysis and interpretation of data: Sadeghifar, Tofighi, and Jafari. Drafting of the manuscript: Sadeghifar and Jafari. Critical revision of the manuscript: Tofighi, Ravaghi and Maleki.

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  1. Does Strategic Planning Improve Organizational Performance? A Meta

    Strategic planning (SP) is one of the more popular management approaches in contemporary organizations, and it is consistently ranked among the five most popular managerial approaches worldwide (Rigby and Bilodeau 2013; Wolf and Floyd 2017 ).

  2. Full article: Getting strategic about strategic planning research

    In this article Full Article Figures & data References Citations Metrics Reprints & Permissions View PDF This introduction to the special issue on strategic planning has four main parts. First comes a discussion of what makes public-sector strategic planning strategic.

  3. Strategic Planning: Why It Makes a Difference, and How to Do It

    This article presents the principles of strategic planning and outlines processes that your practice can adapt for short- or long-term planning. Strategic decision making is needed now more than ever for success in oncology practice. A strategic plan is a tool that moves your practice toward a goal you have set.

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    November 01, 2017 Inside Intel Strategy & Execution Magazine Article Adam Brandenburger Barry J. Nalebuff Although today Intel is a titan, the company's history has been a roller-coaster ride....

  5. Strategic Management in Healthcare: A Call for Long-Term and Systems

    Introduction "Strategy" and "strategic management" have become buzzwords that are frequently used in the practice and theory of healthcare. However, the terms are not as simple as they might seem, and in reality, many managers are still micromanaging without a strategic perspective.

  6. Strategic planning in turbulent times: Still useful?

    Strategic planning differs from other planning in that it addresses the most important issues and aims to ensure that the entity as a whole is adapted to these important issues so that the entity can serve its purposes in the best possible way also in an uncertain future ( Rumelt, 2011 ).

  7. An analysis of the strategic plan development processes of major public

    The first 5-year strategic plan, NIH-Wide Strategic Plan, Fiscal Years 2016-2020: Turning Discovery into Health, was prepared at the request of Congress and published in 2016 . The legal framework stipulates that the NIH-coordinated strategy will inform the individual strategic plans of the Institutes and Centers.

  8. Strategic Planning Research: Toward a Theory-Driven Agenda

    This review incorporates strategic planning research conducted over more than 30 years and ranges from the classical model of strategic planning to recent ... Mangold J., Haran E. G. P. 1976. A comprehensive planning model for long-range academic strategies. Management Science, 22: 727-738. Crossref. ISI. Google Scholar. Weick K. E. 1989 ...

  9. From Strategic Planning to Strategy Impact

    The authors have found many tools and guides to assist health care leaders in creating strategic visions and plans. However, the goals for this article are to: (1) illustrate how the University of Arkansas for Medical Sciences is successfully executing a robust and ambitious strategic plan; (2) outline lessons learned and adaptations made while ...

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    To foster dialogue and mutual learning, the paper uses four key themes familiar to 'Clausewitzian' strategic studies - ends, ways, means, and friction - and introduces key thoughts of contemporary organisational strategy that engage with these themes.

  11. 11. Strategic planning, 2014

    Research article First published online April 30, 2014 11. Strategic planning Volume 42, Issue 14_suppl https://doi.org/10.1177/1403494813515117 PDF / ePub More Abstract There are several types of planning processes and plans, including strategic, operational, tactical, and contingency.

  12. Integrating strategic planning and performance management in ...

    Strategic planning and performance management are closely interconnected. In fact, if on the one hand it is difficult to achieve good results without an adequate strategic planning process, on the other hand it would make no sense to define mid- or long-term objectives, and the corresponding operational actions, without then verifying if, how, and to what extent they have actually been met and ...

  13. Strategic Planning: Why It Makes a Difference, and How to Do It

    A strategic plan is a tool that moves your practice toward a goal you have set. However, the definition of a strategic plan differs among different people, according to management consultant Teri Guidi, MBA.

  14. Full article: Small business strategic management practices and

    2.1. Strategic planning. Since 1990, studies exploring the relationship between strategic planning and performance have produced mixed results (Falshaw, Glaister, & Tatoglu, Citation 2006; Harris, Gibson, & McDowell, Citation 2014; Valčić & Bagarić, Citation 2017).Consequently, researchers have recently focused on what factors may affect the relationship between strategic planning and ...

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    A strategic plan is a roadmap to successfully achieving desired outcomes. Johnson and Scholes define strategy 9 as 'the direction and scope of an organization over the long term which achieves advantage for the organization through its configuration of resources within a challenging environment, to meet the needs of markets and to fulfill ...

  16. (PDF) Strategic Planning and Organization Performance: A ...

    Strategic planning has been an integral part of organizations while its impact on organization performance has been debated for many years. There are mixed (positive and negative) results for...

  17. An analysis of the strategic plan development processes of major public

    Published: 18 September 2020 An analysis of the strategic plan development processes of major public organisations funding health research in nine high-income countries worldwide Cristina Morciano, Maria Cristina Errico, Carla Faralli & Luisa Minghetti Health Research Policy and Systems 18, Article number: 106 ( 2020 ) Cite this article

  18. Resource Allocation and Strategy

    Few strategy scholars would take issue with the claim that resource allocation is fundamental to strategic management. Chandler defined business strategy to include not only the determination of goals and objectives but also the "allocation of resources necessary for carrying out these goals" (1962: 13).Ansoff emphasized resource allocation as an essential element of a strategic plan and ...

  19. Strategic Planning for a Very Different Nursing Workforce

    Strategic planning focusing on the wise use of nursing expertise and creating a positive professional practice environment can support the transition from the current crisis to a more resilient health care system supported by the full utilization of the knowledge and skills of registered nurses. Key Points •

  20. Stakeholder Engagement: Past, Present, and Future

    Long Range Planning 3. Strategic Management Journal* 4. Strategic Organization: 1. Business Strategy and the Environment* 2. Cambridge Journal of Regions, ... relevant contribution to stakeholder engagement research. As a result, our final review sample consists of 90 scholarly articles that provide either an explicit definition of stakeholder ...

  21. Strategic Planning, Implementation, and Evaluation Processes in

    Strategic planning has been presented as an important management practice. However, evidence of its deployment in healthcare systems in low-income and middle-income countries (LMICs) is limited. This study investigated the strategic management process in Iranian hospitals. Methods:

  22. An assessment of implementation and evaluation phases of strategic

    Implementing projects related to the strategic plan by managers and heads of departments: 2: 8.3: 7: 29.2: 15: 62.5: Setting goals based on the strategic plan for heads of departments and other managers: 3: 12.5: 6: 25: 15: 62.5: Annual evaluation of managers and heads of departments according to the level of achievement of the strategic goals ...