How CEOs use management information systems for
strategy implementation in hospitals
David Naranjo-Gil a,∗, Frank Hartmann b
a Pablo de Olavide University at Seville, Spain
b RSM Erasmus University, The Netherlands
Abstract
Institutional and market changes seem to force hospitals across theWesternworld to revitalize their corporate strategies towards
more cost efficiency on the one hand, and more flexibility towards customer demands on the other hand. Hospitals, however,
apparently differ in the extent to which they are able to implement such strategies effectively. This paper explores whether
these different levels of effectiveness depend on how hospitals’ top managers’ use of the available management information
systems (MIS). Based on data obtained from the 218 CEOs of public hospitals in Spain, we analyze how CEOs’ professional and
educational backgrounds affect their use of MIS, and howthe use of the MIS subsequently supports or inhibits the implementation
of these strategic goals. The results indicate that CEOs with a predominant clinical background focus more on non-financial
information for decision-making and prefer an interactive style of using MIS, which together support flexibility strategies. CEOs
with a predominant administrative background seem more effective in establishing cost-reduction strategies, through their larger
inclination to emphasize financial information in combination with a diagnostic use of the MIS. Implications for the strategic
management of hospitals are outlined.
© 2006 Elsevier Ireland Ltd. All rights reserved.
Keywords: Management information systems; Upper echelon perspective; Strategy implementation; Hospital management
1. Introduction
The medical industry across the Western world is
currently involved in processes of serious strategic and
managerial reorientation [1,2]. These processes originate
in a number of different structural and demographic
developments, such as the progressive ageing
of the Western population, the impact of new
pathologies and technologies, autonomous increases
∗ Corresponding author.
E-mail address: dnargil@upo.es (D. Naranjo-Gil).
in health care demands by citizens, and the need to
repair supposed inefficiencies in the design and running
of national health care systems [3–6]. In several
countries, such as Spain, formal legislation requires
regional health care authorities to encourage hospitals
to become flexible organizations that are more
receptive to the demands from the public, and to offer
these higher quality services at lower cost [7,8,9].
Although these strategic goals and policies are not
mutually exclusive by definition, the strategic management
literature suggests that the organizational
requirements for the effective implementation of qual-
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