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8https://doi.org/10.32921/2225-9929-2021-1-41-39-47 UDC 614; 614.2; 614:33 IRSTI: 76.75.75
Review article
The Essence of Strategy formation as an Element of Strategic Management in Health care
Azamat Umertayev
Director of the Department of Medical Care Planning, Non-Profit Joint Stock Company "Social Health Insurance Fund",
Nur-Sultan, Kazakhstan. E-mail: a.umertayev@fms.kz
Abstract
The article discusses the types of strategic management, scientific approaches to the application in practice of each of the 10 schools of strategic management and their distinctive features.
The use of the tools considered in the article schools of strategic management in a complex helps to manage risks, achieve efficiency, provides an opportunity to avoid common mistakes, increases the competitiveness of medical organizations, and most importantly provides executives and middle managers with the methodology of strategic management.
Key words: strategic management, schools of strategic management, management of organizations, healthcare.
Corresponding author: Azamat Umertayev, Director of the Department of Medical Care Planning NJSC "SHIF", Nur-Sultan, Kazakhstan. Postal code: Z05T3E9
Address: Kazakhstan, Nur-Sultan city, Dostyk street 13/3 Phone: +7 (777) 770 33 44 E-mail: a.umertayev@fms.kz
J Health Dev 2021; 1 (41): 39-47 Recieved: 02-01-2021 Accepted: 28-02-2021
This work is licensed under a Creative Commons Attribution 4.0 International License
Introduction
It is known that the development of an effective strategy for any medical organization begins with the formation of a certain vision and the choice of direction in development, where the vision of the company can be presented as a certain set of tools, methods, principles of technology that apply this medical organization to achieve certain results (goals) in a certain time interval, taking into account the available resources and changing conditions [1-3].
The study of various sources on the emergence of strategy, the use of techniques of the strategic approach to management of organizations, gives reason to believe that the use of tools of strategy is carried out since time immemorial.
Meanwhile, according to the explanatory dictionary of S.I. Ozhegov, the word strategy has several meanings.
The science of warfare, the art of warfare.The
general plan for waging war, combat operations. The art of leading a public, political struggle, as well as in general
Types and Scope of Strategy
Based on the level of economic potential, the stage of an organization's life cycle and industry, and its
the art of planning leadership based on correct and far-reaching predictions [4].
The basic approaches to understanding of strategy, it is necessary to note, that modern conditions of the changing world dictate new conditions, thus development of strategy is directed on adaptation of the organization to long-term viability in changing conditions. Here it would be desirable to note, such fact, that, carrying out this or that change in the activity the medical organization develops, gets additional functions or on the contrary excludes unnecessary, and as a whole aspires to become competitive.
A separate process should also be noted the interaction of elements of strategic management, the synthesis of which grows into a strategy.
A modern tool for managing the development of an organization under conditions of changes in the external environment and the associated uncertainty is the methodology of strategic management [5].
position in the market, we have identified two types of basic strategy (Figure 1).
Basic strategy
f
Long-term
The implementation of this strategy is associated with the takeo\fer of competing organizations, with the expansion into new industries and new markets, attracting new customers and the development of new products.
V__
f-\
Survival
Applied incaseswhere the performance of the company tends to deteriorate and no measures do not change this trend.
V_J
Figure 1 - Types of basic strategy
Having considered these types of basic strategy, it should be noted that, in general, no medical organization can guarantee successful development in the absence of a clearly developed strategy. Thus, if the strategy takes into account possible risks, threats, possibilities and obstacles which a concrete organization can face in the future, the higher its probability to be more stable, more competitive than other enterprises in the sphere of its activity.
According to A. Petrov et al, the main task of a strategy consists in "moving an organization from its current state to its desired future state" [6].
Having studied the main approaches to the necessity of developing a strategy, it should be noted that the main prerequisite for strategy development is the current economic situation of the state.
Thus, O. Mashevskaya notes that the development of a clearly formulated strategy and the definition of development goals is a consequence of the external conditions affecting the enterprise, for example, the conditions of macroeconomic instability, the complexity of the relationship between the economic and political environment, etc. [7].
We should agree with the author, because
the causal relationship, which is manifested as a consequence of all economic phenomena stimulates the application of new methods, approaches, in management, aimed at achieving objectives, coordination of certain actions, that is, processes that are transformed into a strategy.
In this context, it should be noted that the strategy is developed depending on the scale of activity, since it is the scale of activity of an individual enterprise; the state determines the scope/scope of goals, objectives provided for the successful implementation of the strategy.
If we talk about the scope of the state, the process of transition from the old political and economic system, in which Kazakhstan has been in the last decades, allowed to develop long-term priorities, the implementation of which is provided by the Strategy "Kazakhstan 2030" (Figure 2) [8].
Figure 2 - Main long-term priorities of the Strategy "Kazakhstan 2030" Strategy
To date, each of these priorities has been put into practice by a specific strategy, and the topic of our manuscript comes from priority number 4.
It is important to note such a fact as the state's effort to improve and maintain the health of its citizens throughout their lives. In turn, citizens should be aware and bear joint responsibility for the maintenance of their health, as well as participate in the system of Mandatory Social Health Insurance of the Republic of Kazakhstan (MSHI) by making regular contributions to the Non-profit joint-stock company "Social Health Insurance Fund" (SHIF) [9].
The introduction and development of the MSHI system is aimed at improving the quality and accessibility of medical services, increasing the efficiency of management and financing of the health care system,
as well as the rational use of available resources, the financial stability of the health care system, and in general to ensure the socio-demographic development of the country [10-12].
By creating the SHIF, the state pursues the goal of ensuring that citizens receive quality and affordable medical care. This goal of the SHIF, together with the joint responsibility for health on the part of the patient, the state and business, is outlined in more detail in the second and third chapters of this work.
It should be noted that a well-developed strategy allows you to achieve efficiency, certain results, as well as manage risks in a changing environment of both political and economic and social nature.
Elements and models of strategic management
Having studied the definition of strategy, as well as its main directions, there is an understanding that the interaction of the subject with the object creates a certain process, transforming into strategic management, and speaking of management, it is important to understand what goals are set for a particular company.
One of the main tools of strategic management, which forms the information base for defining and correcting strategic choice, is strategic analysis [5].
It is a strategic analysis aimed at the development
of an enterprise that makes it possible to ensure the scientific and economic validity of strategic decisions regarding the development of the enterprise as a whole and its individual elements, to determine the effectiveness of the use of labor, production (technical, technological, material) and financial resources, as well as to check the optimality of managerial decisions.
Meanwhile, M. Chernyshev distinguishes three stages of the strategic management process (Figure 3) [13].
Figure 3 - Stages of strategic management
It is necessary to agree with the approaches of the authors, as the analysis is the initial process, also the analysis creates the basis for further determination of the purpose and objectives and in the context of the individual enterprise. The analysis, as well as synthesis allows to improve the use of tools and methods of analytical nature, which allows to manage risks.
The study of the elements of strategic management is of particular interest to researchers, scientists.
Taking into account the harsh conditions of
competition, which are the causal effect of the rapidly changing spheres of life activity, the study of this issue is also devoted to such an area of strategic activity as "strategic management" [14-17].
Strategic management as the highest field of managerial activity, originates from the study of trends in the development of national economy with the high growth of commodity markets.
Over time, as crisis phenomena intensified and international competition intensified, strategic control, which was applied in the conditions of the national
economy, was transformed into strategic management. between ten main schools of strategic management, Today, strategic management distinguishes which are illustrated in Figure 4 (a-b) [18,19].
a)
b)
Figure 4 - Schools of strategic management
Next, let us consider the scientific approaches to the practical application of each of the schools separately.
Representatives of the Design/Design/ Construction Schools invented the widely known acronym SWOT (Strengths, Weaknesses, Opportunities, Threats) [20,21]. Based on the name, this school offers a model of strategy building as an attempt to achieve a coincidence or matching of internal and external capabilities [20-22]. According to the approaches of this school, strategy development begins with the results of the study of strengths, weaknesses, opportunities, threats or assessment of the company's activities and environmental conditions by conducting a SWOT analysis [23]. The distinctive features of this methodology are pragmatism, clarity and simplicity, as well as the emphasis on the formation of development strategy [24-26].
The school of strategic planning in many respects overlaps with the school of design, based on the analysis of the internal and external capabilities of the organization - its strengths and weaknesses, as well as external opportunities and threats [27].
The main difference between the planning school
and the design school is that the design school model is transformed within the planning school into a strictly defined sequence of actions to be taken, where strategy is the result of a controlled, conscious process of formal planning, schematically illustrated in the form of control tables and supported by appropriate models [28].
The school of positioning, represented by M. Porter's school of positioning looks like three interrelated concepts - competitive analysis, the competitive advantage of the company and the construction of a competitive strategy based on it, and the value chain [29].
In contrast to the schools of design and planning, the school of positioning proposes to limit for each organization operating in a particular industry the number of standard strategies that can produce the desired results that allow the company to ensure a competitive position in the industry, that is, the specific advantages that the firm receives in the market [30].
The School of Entrepreneurship of which Schumpeter is the founder is the following five typical changes that could subsequently lead an enterprise to a successful operation (Figure 5) [31].
organization of production andmethods of its logistical support
v._J
Figure 5 - School of Entrepreneurship
using new raw material
The next school is Simon's cognitive school, thinking, mental, mental, intellectual [32]. which is formed on the basis of the mental process -
The cognitive school is based on the process of individual or collective cognition, leading to the formation of strategy [33].
The school of learning, represented by Gilbert J. et al. is based on an evolving process - constant strategic learning and updating the knowledge needed in developing strategies [34].
The School of Power, founded by R.M. Cyert and J.G. March, "Strategy is seen as politics, and strategy-building as a political process" [35].
The Schools of Power are based on the following four basic tenets:
- "strategy formation is determined by power and political forces," regardless of the origin of the processes, within the organization or in the external environment;
- "strategies tend to be spontaneous and take the form of a position or gimmick rather than a further perspective";
- "micro-power sees strategy creation within the enterprise as an interaction based on methods of persuasion, negotiation, and sometimes direct confrontation, in the form of political games around overlapping interests and coalitions formed;
- "macro-power sees the enterprise as seeking its well-being by controlling the actions of other market agents or by cooperating with them" [36].
The school of External Environment, of which M. Mescon is a representative, differs in that it "makes both management and the organization itself dependent on a set of forces of a general nature, on the external environment, which determines the strategy, is the main element in its creation" [37].
As a whole, school of external environment is focused, that "is outside of the organization, as external environment and builds strategy as process of reaction to changes of external environment and search of new possibilities. Thus, as the basic components of the external environment act as economy as a whole, and the opportunities arising in branches in which the given enterprise is focused" [38].
School of Configuration, the founder of which Miller considers "strategic management as the activity of moving an organization from one stable state to another in accordance with changes in business conditions" [39].
The school of strategic management configuration "is based on two most important positions - configuration and transformation, where configuration means stable structures and external environment, and transformation means the process of strategy development of the firm. The process of strategy development has as its main goal to change the orientation of the organization; the resulting strategies are designed to stabilize its movement in the chosen direction" [40].
Johnson's School of Culture, as the main provisions, distinguishes the following directions:
- "the process of strategy formation is seen as a process of social interaction based on the beliefs and attitudes common to the enterprise;
- each individual's beliefs are the result of processes of acculturation or socialization;
- the enterprise team is only partly able to characterize the beliefs on which their culture is based;
- culture, including ideology, contributes not to strategic change, but to the preservation of the current
strategy" [41].
In turn, strategic management through the prism of the methodological approach gives a certain classification of the above schools.
According to this classification, a number of schools have proven themselves at the proper level and continue to hold a reliable position necessary to analyze the activities of the enterprise.
The next number of schools in practice show the effectiveness of the applied methodology in newly developing business sectors (for example, the school of entrepreneurship), while others are more suitable for designing strategic changes in non-profit organizations or municipal management organizations [42].
According to Y. Lapygin, in modern conditions it is difficult to talk about the success of an enterprise within the framework of only one school [43].
In addition, the author supports the position that "to some extent the absence of strategy can also be considered as a kind of good" for the following reasons:
- "increased strategic flexibility of the enterprise is promoted (and without the development of a strategy) thoughtful actions of the manager;
- rigid adherence to a strategic course leads to a loss of the ability to innovate (a strategy "as a dogma" kills the ability to learn and adapt);
- the absence of formal elements of a strategy provides freedom from bureaucracy" [43,44].
On the whole, the author has a rational approach, since the real-time process of ranking schools according to their effectiveness is unlikely to be productive for the enterprise. Here, rather, an enterprise needs to learn how to apply the necessary and effective methods from the whole selection of methods offered by the schools of strategic management, to solve the set goals arising for the enterprise in a particular period of time [44].
In the practice of strategic management, a certain system of methods and tools of strategic management has been formed, which allow you to plan the strategy of the organization. All these techniques and tools are aimed at planning the future strategic position of organizations in order to achieve the effectiveness of activities.
The existing set of strategic methods allows to use them in various situations. Many methods are universal and can be used in various enterprises regardless of the specifics of activity, some, on the contrary, are used in specific organizations.
Studying the works of famous researchers in the field of strategic management, I would like to note the following main stages of formation of the strategy of SHIF interrelated with each other and logically following from each other [45]:
- mission of the organization;
- organization's goals;
- analysis of the external and internal environment;
- definition of strategic alternatives;
- development of strategy;
- implementation of the strategy;
- evaluation and control of the strategy.
Analyzing the stages of development and
implementation of the strategy of the organization, it should be noted that strategy development includes goal-setting, analysis of factors affecting the functioning
of the organization, the study of strategy alternatives, the definition of mechanisms for implementation and evaluation of the strategy.
Determination of the mission pursues the purpose of a clear understanding of the purpose of the organization. Goals and objectives are derived from the understanding of the mission and form the mission tree, including both operational activities (objectives) and project goals. Objectives should be clearly classified and structured, while meeting the requirements of SMART (specific, measurable, achievable, realistic and time-based) [46].
At the stage of analysis, a thorough study of the external environment affecting not only the organization, but also the industry as a whole, threats and opportunities is carried out. Analysis of the internal environment in conjunction with the analysis of the external environment allows to form an idea of the current position of the organization, as well as to determine the benchmark and conduct a trajectory, following which the organization can make the most effective use of its advantages and level out the weaknesses [47].
Subsequently, at the stage of developing strategic alternatives for the organization's development, a thorough analysis is performed, and various options for further development of the organization are evaluated based on the ways, ways, time to achieve the goals, the
use of resources, etc. [48].
As a result of considering different alternatives, a strategy of the organization is formed. At the same time during the implementation of the strategy takes into account the impact of the internal and external environment the strategy can change. This requires managers to be able to initiate the necessary changes, motivate employees, continuously improve business processes, etc.
During the evaluation and control phase, the following actions must be implemented:
1) adopt control evaluation standards, including a measurement system that will show the extent to which goals are being achieved;
2) establish a relationship between the process of achieving the goals and the goals themselves, the strategy adopted;
3) to evaluate the results of the comparison and to develop, if necessary, corrective actions, which may relate to both the strategy and goals and objectives of the organization.
In general, evaluation and monitoring are cyclical processes that should find out if the implementation of the strategy will lead to the achievement of the organization's goals.
Conclusions
Summarizing this topic, it should be noted that the application of the tools of all the above schools in the complex, helps to manage risks, achieve efficiency, provides an opportunity to avoid typical errors, increases
the competitiveness of medical organizations, and most importantly provides managers and middle managers with the methodology of strategic management.
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Денсаулык сактау саласындагы стратегиялык баскарудыщ элемент ретшде стратегияны
калыптастырудыщ мэш
©ммртаев А.К
«Элеуметтiк медициналыц сацтандыру цоры» коммерциялыц емес акционерлк цогамыныц Медициналыц квмек квлемн жоспарлау департаментiнih| директоры, Нур-Султан, Н,азакртан. E- mail: a.umertayev@fms.kz
Туйшдеме
Мацалада стратегиялык, басцару тYрлерi, стратегиялык, басцарудыц 10 мектебтц тэж^рибеде к,олданудагы гылыми квзцарастары жэне олардыц айрыцша ерекшелiктерi царастырылган.
Мацалада талцыланган стратегиялык, басцару мектептерiнih| цуралдарын кешендi пайдалану тэуекелдердi басцаруга, тшмдлкке крл жетюзуге квмектеседi, кец таралган %ателiктердi болдырмауга MYмкiндiк бередi, медициналык, уйымдардыц бэсекеге ^аблеттмян жогарылатады жэне, ец бастысы, басцарушылар мен орта буындардагы менеджерлердi стратегиялык, басцару эдiстемесiмен цамтамасыз етедi.
Туши свздер: стратегиялык, менеджмент, стратегиялык, басцару мектептер/, уйымдарды басцару, денсаулык,
сацтау.
Сущность формирования стратегии как элемента стратегического управления в здравоохранении
Умертаев А.К.
Директор департамента планирования объемов медицинской помощи, Некоммерческое акционерное общество «Фонд социального медицинского страхования», Нур-Султан, Казахстан. E- mail: a.umertayev@fms.kz.
Резюме
В статье обсуждены виды стратегического управления, научные подходы по применению на практике каждой из 10-ти школ стратегического управления и их отличительными особенности.
Применение инструментариев школ стратегического управления в комплексе помогает управлять рисками, достигать эффективности, предоставляет возможность избежать типичных ошибок, повышает конкурентоспособность медицинских организаций и обеспечивает руководителей и менеджеров среднего звена методологией стратегического управления.
Ключевые слова: стратегический менеджмент, школы стратегического управления, управление организациями, здравоохранение.
