One in full before the start of the

One
of the most critical and important roles of the managers in any type of
organizations is the decision-making. The process of strategic decision
consider a difficult and complex process between the numerous decisions of
actors and, therefore, must be try to understood in full before the start of
the exercise effectively. The strategic decision of officials is a complex and
ambiguity process. Therefore, many studies have been carried out aimed at
building models that help the officials and executives to take the best
decisions. We do not know just a very few about the strategic decision and
factors affecting in it, in the last century since 1990s,  the scientists started in conducting studies
on strategic decision. Based on this study to the previous theoretical and
empirical studies, the results showed that research in the study of
demographic, and organizational factors, and its impact on strategic decision
either limited  results, particularly variables
(gender, education, the size of the organization and others). Therefore the
researcher turn to conduct the study on the field of the specialized public
hospitals with the addition of some demographic and organizational variables
did not discuss before, the  managers’
learning place, the managers’ growth place, if the managers worked in private
sector, then the number of clients seeking to get service from the hospital,
that a desire to reach results which enhance the form of the relationship
between the variables of the study,  the
study of strategic decision-making also, the factors that affect it is still on
the degree of significance and in an urgent need to conduct pilot studies and
research before reaching any final conclusion can be reached.

Introduction

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The
decision-making process considerable an one of the most complex mechanisms of
human thinking, that because intervene of it with various factors and courses
of action, with various results. (Narayan & Corcoran?Perry, 1997)
argued decision making as the intervene among  an issues that requires to be fixed and an
individual who desired to solve it within a particular environment.

(Halpern,
1997) said to arrive at a decision, there are several steps that must be
followed in order: determine the goals to be achieved, create alternatives that
lead to accomplishing the proposed objectives, assess alternatives and, lastly,
chose the best alternative,
the one that involves an efficient result.(Maria, Maria, & Maria, 2007)

According
to (Nooraie, 2012) (Pearce II & Robinson, 1989) argued, a complex and rapidly changing business
environment, and the shortage in scarce resources, fast changes in information
technology, the new world economic system, and many others. These changes have
progressed on the one hand a very dynamic world of increased population,
inflation, social consumption. Managers are made a many of daily decisions, and
they have to make decisions under all conditions. That no decision is a
decision in itself. That unusual problem in any management,  consequent on their very fast decisions,
forcing the executives who are suffering from the tension of their presence in
the unexpected environment of making many decisions rapid rates (Toffler & Alvin, 1981).

This
study explores demographic and organizational factors affect strategic
decision-making. The select to concentrate on strategic decisions is due to its
nature and importance. The nature of strategic decisions are long-term,
complex, highly unstructured, and integrally risky and have great influence on
the hospital future.

A
many of organizational resources, and hospital’s environment consideration that
typically requires to strategic decisions making. At (1978)Hofer & Schendel
said, the senior management of organization usually plays a central role, in  strategic decision making. At
(1982)Christensen et al argued, the administration, organizational direction,
and structure are influenced by strategic decisions. (Colignon & Cray,
1980) said, strategic decision influences the organization also in society,
(Amason, 1996) mentioned, made question, why the strategic decision takes all
this interest. At (1992)Eisenhardt & Zbarack
mature paradigms and incomplete assumptions. (Nooraie, 2012)

 (Papadakis, Lioukas, &
Chambers, 1998)
said, the research of strategy process has not departed significantly from a
point of being based on.

Literature Review
(Strategic Decision-making)

(Ansoff,
1984) mentioned, in the late 1950’s The first step in the assessment of
strategic management was taken, when organization enhanced a systematic
approach to deciding where and how the organization will do its future work.
(Digman, 1986) said a strategy is a style in the organization’s significant
decisions and actions and involves a few main areas or things by which the
organization is distinguished from others. Mintzberg summarized the strategy in
( five Ps) it is a plan, a ploy, a pattern, a position,
and a perspective,  while to
Drucker, said the defined  strategy is a
purposeful action. Pearce II & Robinson (1985) defined strategic management
as the set of decisions and actions resulting in the articulation and
implementation of strategies intended to attain the objectives of an
organization. (Nooraie, 2012)

As
per to (Child, 1972)
Strategic decisions consider the essential variable into strategic management.

There
are some managers’ personal characteristics especially in the privet sector
have influence the strategic decision making, such as psychological factors,
education, organizational characteristics, and ownership type. (Mintzberg, 1994)
argue, some strategies put organizations at the facade, while others put them
at the last. (Siggelkow & Rivkin, 2005) said administrators are confronted with
many diverse interior and exterior variables, that are and at the same time, each
of one enters the formulation of decision-making. According to (Ismail, 2016),
Ashill and Jobber (2013) discovered that personality and experience variables
(locus of control and tolerance for ambiguity) had an important role in the
kind of perceived environment nonconference experienced by decision makers.

            Hofer & Schendel mentioned at(1978),
strategic decisions in which top managers usually has a fundamental role, are
ill-structured, non – timetable, and important to the organizations. (Quinn,
1980; March, 1981; Das, 1986; Neustadt & May, 1986) defined the strategic
decision-making as gradual and related, shaped by a set of contextual impacts creating
from past occasions, present circumstances, and perceptions of the future.
(Mintzberg et al., 1976) argued, one of the central characteristic of strategic
decisions is lack of structure. (Mason & Mitroff, 1981)this is because of
the complexity of the strategic issues. (Gamble and Thompson, 2009) mentioned
the organization’s strategy composed of competitive changes also develop
management’  approaches that attract and satisfy
customers, grow the business, conduct operations, and attain performance
objectives. (Nooraie, 2012)

Rodriguez
& Hickson in the study at (1995) said the profit organizations have
smoothness methods of decision-making. The experiences of nonprofit
organizations are more turbulence, interruptions, recycles, and conflict (e.g., Perry & Rainey 1988). Some researchers said
these differences related to the roles that private and public organizations
play in our social environment. In profit organizations, the shareholders pay
services or products through markets to build wealth. While, some researchers
like Baldwin (1987) summarized no significant variances between private and
public sector organizations (Samantaray, 2015).

Strategic Decision Making in Public Hospitals

Glassman,
Zell, & Duron concluded at (2005) that circumstances in external
environments are effective in  all nonprofit
government’ hospitals, and successful strategic decision making needs that
these circumstances be suitably considered

The nonprofit government’
hospital’s strategy is more relevant with external environment circumstances, which they are considered extremely complicated
places, its physical limits that can affect its performance. To understand the public
hospitals’ external environment, the senior managers should subdivide the
environment into components. As much as any industrial organizations, public
hospitals, maybe are directly and powerfully influenced by their exterior
environments, and particularly so by the public policy aspects of these
environments. The importance of public policies to hospitals, connected with
the turbulent and frequently unexpected framework in which public policies are
based makes significant challenges in public hospitals especially in strategic
decision making  (Longest, 2010).

The hospitals
have three decisions making levels  (strategic level, administrative level, and
operational level), also there are three organizational planning levels
(strategic, long-term, and operational planning) are connected with each other
closely. Moreover, two main types of decisions exist; programmable
decisions, which includes routine managerial issues and could easily, and
represented standard operating procedures. Another type is nonprogrammable
decisions, that includes conditions happened rarely in the politics of
organization and procedures. To ensure success this decision type requires a
great deal of the decision maker’s care and often involves an official, and multi-leveled decision-making methodology. Toygar
and Akbulut  examined their study on nonprofit
government hospitals’ senior managers in Ankara and achieved  these results;  there is 
a positive effect of administrative experience on the skills of decision-making
and problem-solving; male hospital senior managers have the best
decision-making skills and ability of problem-solving than female senior managers;
administrators with a higher education were better at decision making  and problem-solving than those with a low
education (Toygar & Akbulut, 2013).

         The
incorporating of hospitals’ public policy environments into the process of
strategic decision making, that considered a success for managers of a public
hospital, senior managers must know all information on what these environments
contain. This can help them in systematically imagining and evaluating the
public policy-driven opportunities and fears confronting their organizations. On
the other hand, utilize this information could develop strategic performance,
that because, better public policy-pertinent information facilitates more appropriate
strategic responses.

These four steps
are used directly in analyzing a public hospital’s public policy environment,
are:

1.      Scanning
the public hospital’s public policy environment to know or determine
strategically significant information.

2.      Monitoring
the strategically pertinent public policy information that which have been
determined.

3.      Assessing
the possible implications of the information that which have been monitored for
the hospital.

4.     
 Diffusing gained consequences of the
environmental analysis between strategists in the hospital management who share
liability for formulating, implementing and controlling stages of its strategy (Longest Jr, 2012).

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