Strategy development is often seen as top-down, rational, and formal. There are problems in defining and responding to strategy. Hunter(5) defines it as being contingent on both the nature of the organization (size, value system, degree of specialization) and its external environment (stable/unstable). Thus strategy is a continuum ranging from deliberate planned strategy at one extreme to emergent strategy at the other.
Strategy operates on three levels: corporate, business, and operational. Whereas corporate levels of strategy are global, operational levels have to be local. Often the strategy can be planned at the global level but with a clear indication given of how it should be implemented at the local level. A good and manageable step forward is the use of strategic management, which is a unifying concept seeking to bring together planning and management. This approach also seeks to combine the discipline of the planning and management functions with the flexibility necessary for the development and implementation of policies.
Mintzberg(6) contrasts emergent strategy with deliberate strategy, where the latter is a series of actions forming a pattern or series of patterns. Other forms of strategy combine deliberation and control with flexibility and organizational training. According to Johnson, (7) there are three views of strategy:
1. a rational view in which strategy is seen as the outcome of a sequential planned search for optimal solutions to defined problems;
2. an adaptive or incremental view in which strategy evolves in an additive pattern;
3. an interpretative view in which strategy is seen as the product of individual or clinical service provision.
Policy comprises of content whereas strategy consists of content and process. Strategic management does not attempt to provide a prescription for problems but seeks to combine the deliberate and emergent approaches to strategic development and is often seen as both a process and an outcome (5). In addition to developing strategy the clinician may be expected to have personal skills like financial, conflict, time, and stress management.
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