Türk sağlık sektöründe miles ve snow’un stratejik tipolojisi: hastaneler üzerine bir araştırma

Miles ve Snow tarafından geliştirilen ve sağlık sektöründe sıklıkla kullanılan stratejik tipoloji temelde dört tip örgütten oluşmaktadır. Bunlardan ilk üçü istikrarlı strateji tipleridir. Bulundukları sektörde uzun dönemli istikrar sağlayabilir ve benzer şekilde performans gösterebilirler. Dördüncü strateji tipi ise tepkici strateji tipidir. İstikrarlı bir yapısı yoktur ve diğer üç strateji tipinden daha düşük performans sağlar. Bu çalışmanın amacı Türkiye'de faaliyet gösteren hastanelerin hangi strateji tiplerini geliştirdiklerini ve geliştirdikleri strateji tipine göre aralarında performans farkı olup olmadığını bulmaktır. Araştırmada kullanılan veriler ilgili literatürden yararlanılarak oluşturulan bir anket ve Yataklı Tedavi Kurumları 2007 İstatistik Yıllığından elde edilmiştir. Çalışmadan elde edilen bulgulara göre hastaneler daha çok savunmacı ve analizci (%31,21) yapıdadır. Bunları atılgan tipteki hastaneler (%24,20) ve tepkici hastaneler (%13,38) izlemektedir. Ancak özel hastanelerde analizci (%39,53) ve atılgan (%25,59) hastane tipi belirgin şekilde farklılaşmaktadır. Tepkici hastanelerin performansları diğer tipteki hastanelerden daha düşüktür. Ancak istikrarlı olarak bildirilen hastaneler arasında da performans farklılıkları vardır. Hastane yataklarının kullanımı bakımından atılgan hastaneler daha iyi performans gösterirken, hekim ve diğer sağlık personelinin kullanımında analizci hastaneler belirgin şekilde avantajlı görülmektedir.

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The first and probably the best-known structure has been used by health providers is strategic typology was developed by Miles and Snow. This structure was not designed specifically for organizations that provide health services. However, typology has been widely accepted due to quotes that are used in the field of health care studies. Strategic typology basically consists of four types (defenders, prospectors, analyzers, reactors) of organizations, and they have been often used in the health sector. Defenders seek to maintain stability and control in the defense of current market niches. Prospectors seek to be flexible and assertive in the pursuit of new product and market opportunities; stresses innovativeness. Analyzers seek to combine control and flexibility, there by pursuing new opportunities after thorough analysis. The first three types of strategies are stable. They can provide long-term stability in their sector, and can perform similarly. The fourth of them is reactor. Reactors have not consistent pattern or strategy and therefore adjust to environmental change in an inconsistent and unstable manner. Reactor is not a stable structure, and its performance is lower than the other organizations. The purpose of this study is to find, which strategic types can be developed by hospitals in Turkey, and whether the differences in the performances of hospitals according to the type of strategies. The data that used in the study was obtained from a questionnaire that was created by utilizing related literature and 2007 Inpatient Facilities Statistical Almanacs of Ministry of Health. First, the reliability and validity of the survey were analyzed. After that, analyses of data was used descriptive statistical methods, Independent Samples T Test, One way ANOVA, Mann Whitney U test, Kruskal-Wallis test and Chi-Square Test. In addition, differences of hospitals' performances were compared on the basis of strategic types of hospitals. The public hospitals (72.7%) and private hospitals (27.3%) are participated. to study. According to the findings of study, structures of hospitals are mostly defenders and analyzers (31.21%). They are followed by Prospectors (24.20%) and reactors (13.38%). However, analyzers (39.53%) and prospectors (25.59%) differ in private hospitals significantly. The performance of reactor hospitals is lower than other hospitals. However, there are differences of performance between hospitals that were reported stable. Prospector hospitals have better performance to use of hospitals beds than other hospitals; while analyzer hospitals have significantly advantageous to use of physicians and other health personnel. In addition, Inpatient rates of defenders hospitals are higher than other hospitals. The whole of performances values of reactor hospitals are lower than other hospitals. In terms of organizational size, analyzers can be larger organizations than other hospitals. Because, they has been investing in promising areas, and preserving the existing production areas. In contrast, reactor can be smaller firms. The defenders and prospectors are located between these two types' organizations. According to the results of the study, 40.91% of hospitals are analyzers, 31.82% of hospitals are defenders, 18.18% of hospitals are prospectors, and 9.09% hospitals are reactors in hospitals that have ≥400 beds. While analyzer hospitals are more in hospitals that have ≥400 beds; reactor hospitals are more in hospitals that have ≤99 beds. Hospitals that were founded in 1991 and subsequent years are more successful than other hospitals in developing stable types of strategies. Hospitals with ≤99 beds are more successful than the other hospitals in developing prospector strategies. Effect of the number of private hospitals between hospitals with ≤99 beds is striking in this result. While, Defensive and prospector type's hospitals have aimed to reach the middle and upper income groups' patients, reactor types of hospitals have aimed to reach the lower income group patient. In contrast to analyzer hospitals have aimed to reach every portfolio servicing patients. Performances of hospitals are affected by their characteristics. Therefore, hospitals have to develop strategic types to take into consideration environmental factors and their characteristics, and have to improve a flexible structure that can be orientated to them changing in sector.

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