title: Strategic planning processes and financial performance among hospitals in Lebanon.
abstract: BACKGROUND
  Strategic planning has been presented as a valuable management tool. However, evidence of its deployment in healthcare and its effect on organizational performance is limited in low-income and middle-income countries (LMICs). The study aimed to explore the use of strategic planning processes in Lebanese hospitals and to investigate its association with financial performance.
  
  
  METHODS
  The study comprised 79 hospitals and assessed occupancy rate (OR) and revenue-per-bed (RPB) as performance measures. The strategic planning process included six domains: having a plan, plan development, plan implementation, responsibility of planning activities, governing board involvement, and physicians' involvement.
  
  
  RESULTS
  Approximately 90% of hospitals have strategic plans that are moderately developed (mean score of 4.9 on a 1-7 scale) and implemented (score of 4.8). In 46% of the hospitals, the CEO has the responsibility for the plan. The level of governing board involvement in the process is moderate to high (score of 5.1), whereas physician involvement is lower (score of 4.1). The OR and RPB amounted to respectively 70% and 59 304 among hospitals with a strategic plan as compared with 62% and 33 564 for those lacking such a plan. No statistical association between having a strategic plan and either of the two measures was detected. However, the findings revealed that among hospitals that had a strategic plan, higher implementation levels were associated with lower OR (p < 0.05).
  
  
  CONCLUSIONS
  In an LMIC healthcare environment characterized by resource limitation, complexity, and political and economic volatility, flexibility rather than rigid plans allow organizations to better cope with environmental turbulence.
authors.affiliation: American University of Beirut, Department of Health Management & Policy, Beirut, Lebanon. ss117@aub.edu.lb
authors.forename: Shadi
authors.initials: S
authors.lastname: Saleh
authors.forename: Amer
authors.initials: A
authors.lastname: Kaissi
authors.forename: Adele
authors.initials: A
authors.lastname: Semaan
authors.forename: Nabil Maher
authors.initials: NM
authors.lastname: Natafgi
mesh_terms: D001509:Bed Occupancy / Q000191:economics; D003625:Data Collection; D003906:Developing Countries; D004469:Economics, Hospital / Q000458:organization & administration*; D006285:Health Planning / Q000191:economics / Q000379:methods*; D006739:Hospital Administration / Q000379:methods; D016304:Hospitals, Private / Q000191:economics / Q000458:organization & administration; D006779:Hospitals, Public / Q000191:economics / Q000458:organization & administration; D006784:Hospitals, Teaching / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007861:Lebanon; D009937:Organizational Objectives / Q000191:economics