In this chapter, the research worker will discourse the findings presented in the last chapter and the concluding decision of the research. In add-on, recommendations, added value to the literature and future suggestions are presented.

In this subdivision, the research worker will discourse the findings from the information analysis mentioned in chapter four and attempts to correlate these findings with the literatures review discuses in chapter two. The research worker will discourse each variable represented in the research theoretical account regardless of the linkage between the variable and the phase it affect.

Consequence of dynamism: the informations analysis from the interview suggested that there is lack in the analysis of the external environmental factors particularly the political and societal factors. This deficiency in the analysis of the external analysis by the infirmary direction leads to the trouble of monitoring or even mensurating the consequence of environmental instability on the strategic direction procedure. Besides, this leads to the inability of the organisation to accurately foretell the hereafter ( Reeves et al. , 2003 ) and placing the organisation external chances and menaces ( Hunger and Wheelen, 1996 ) . Thus the organisation will non be able to be in harmoniousness with the environment that it is in, and will non be able to analyse and/or learn from the external environment ( Dess and Lumpkin, 2003 ) .

Some grounds that can be mentioned for this deficiency of involvement in the external environmental analysis by the infirmaries directions are: foremost, the high stableness of the political factor in Kuwait which makes the hospital directions ignore or have incorrect perceptual experience that this factor will non hold impact on their strategic direction. The 2nd ground may be because the private health care sector in Kuwait is still in the “ babyhood phase ” as from the twelvemonth 1985 till the twelvemonth 2001 there were merely four private infirmaries without emerging of any new private infirmary, meanwhile in the two old ages at that place were three new infirmaries opened.

External Hostility: as mentioned in subdivision ( 4.2.2 ) , there were two different sentiments refering the degree of competition. One sentiment saw that the competition is high ; the other sentiment was in the opposite way where this sentiment stated that there is still room for more competition. The research worker notices that those who believe that the competition is high stand foring the freshly opened infirmaries while those who believe the opposite represent the old established infirmaries.

Despite this difference in sentiments about the grade of competition, all the respondents agreed on the importance of monitoring and analysing the competition particularly the rivals ‘ activities which will be taken into consideration when explicating the strategic program. This seems to be in conformity with what Miller and Friesen ( 1984 ) stated that there is an impact of competition on the strategic program.

The limitations the regulative authorization, ministry of wellness ( MOH ) in this instance, put are perceived to impede the development and growing of the infirmaries. Some of these obstructions are due to the bureaucratic nature of the authorities. The complicated processs of blessing from the MOH which takes long clip affects the rate of growing of the infirmaries, for illustration as it was mentioned before, some sections in the infirmary where left under employed waiting for the MOH to give licences to the new doctors. These limitations, as mentioned by Miller and Friesen ( 1984 ) , have negative consequence on the strategic direction procedure where the execution of the strategic program will be delayed. As an illustration, in one infirmary, there was a strategic determination to open a new section for the kidney dialysis which was delayed for months due to the MOH limitations.

However, bulk of hospital take his variable into consideration when explicating their strategic program and program harmonizing to these limitations. One infirmary idea of opening a new section for invasive cardiac processs, but this was put on clasp as the MOH limitations forbid this sort of processs to be conducted in the private sectors.

It is clear that this variable attracts a batch of attending by the infirmary direction when planning for the hereafter.

Internal civilization: the internal civilization is the designation of the organisation internal strengths and failing. Swayne, Duncan and Ginter ( 2006 ) have argued that by implementing the internal strengths and rectifying the internal failing, the organisation can develop competitory advantage which will take to the high quality of the organisation over the rivals. This is more or less absent in the private infirmaries in Kuwait. There are no solid differences between the private infirmaries.

Ironically, one infirmary after happening competitory advantage for itself by advancing their specialisation in supplying epicurean services in the field of OBs and gynaecology, it expanded its services to include other unrelated fortes after merely one twelvemonth without any enlargement in its bed capacities. This leads to the internal competition between sections on the beds available. Despite the fact that the infirmary net income addition for the short term, but on the long term the infirmary will lose some of its clients due to the addition in the waiting clip for having the services. This strategic determination may non be taken if the infirmary performs the internal analysis which will ensue in apprehension of the drawbacks that will go on in the long term.

Being of strategic program: Harris and Ogbonna ( 2006 ) argued that the presence of strategic program in add-on to procedure to accomplish this program would profit the organisation ( Harris and Ogbonna, 2006 ) . Five out of the six infirmaries have written strategic program, the being of the strategic program was seen to be of great importance to the direction of the private infirmaries.

However, the demand for holding the strategic program written is different from what Kaissi et Al. ( 2008 ) has mentioned. The respondents have explained that the strategic program work as mention for them for the aims and ends need to be achieved while Kaissi et Al. ( 2008 ) have argued that the presence of written strategic program genuine the organisation in forepart of its stakeholders which is non the instance in this research.

This leads to the point that was notices by the research worker which is the ill-defined distinction between strategic program and other programs, for illustration the operation program and aims execution program. This is in conformity with what Begun and Kaissi ( 2005 ) found in their research.

Time skyline and reappraisal frequence of the strategic program: the clip frame for the strategic program is either one twelvemonth as short term or three old ages as long term planning. The infirmaries holding long term program besides have short term program. This clip frame is considered by most research workers, e.g. Begun and Kaissi ( 2005 ) and Kaissi et Al. ( 2008 ) , as equal clip frame for the strategic program.

As for the reappraisal frequence, Delgado et Al. ( 2009 ) concluded that the higher the reappraisal frequence, the higher the fiscal public presentation. The reappraisal frequence of the strategic program in the Kuwaiti infirmaries is high. Some infirmaries review the short term program quarterly, others review it monthly.

Physician engagement in strategic planning: Parayitam, Phelps, and Olson ( 2007 ) argued that physician engagement in strategic planning procedure additions committedness and heighten the quality of determination. All the infirmaries that have strategic program involve doctor, chiefly medical managers and caput of units, in the strategic planning phase as they can give instant position for the trifle of the strategic program.

Centralization of strategic decision-making: the centralisation of the strategic decision- devising in the top direction and the decentalisation of the decision-making described by Reeves et Al. ( 2003 ) and Andresen ( 2004 ) are available in the Kuwaiti private infirmary. The research worker noticed that the top- underside procedure of strategic preparation is represented in the well established infirmaries while the bottom-up procedure is represented in the freshly opened infirmaries. This determination may be due to the fact that the good established infirmaries have higher disposal in control for long clip and that these disposals do non desire to alter the manner things are done while in the freshly opened infirmaries, the direction staff is more flexible and opened to the recent, up to day of the month, direction schemes.

Resources handiness for execution:

The resources, as defined by Reeves et Al. ( 2003 ) , handiness or reallocation is taking a great attending by the infirmaries directions. These resources harmonizing to Reeves et Al. ( 2003 ) are of two sorts ; the human resources and the fiscal resources. The human resources in Kuwait are rare nevertheless the option of exporting these resources from all over the universe decrease the consequence of this scarce in strategic direction procedure.

On the other manus, the fiscal resources are available to a great extent as the Kuwaiti population is considered rich and they are entrepreneurs by nature.

Internal communicating:

The communicating system inside the infirmaries is good developed. The infirmaries directions use different schemes to heighten the internal communicating, for illustration, unfastened door policy, batch of meetings with the staff and within the sections and electronic communicating. The hospital direction know that the internal communicating aid in circulating the information to the whole organisation and ease the execution of the strategic program in add-on to increase the ends committedness by the staff throughout the organisation which is in conformity to what Tourish ( 1997 ) concluded.

Therefore the internal communicating affects many phases of the strategic direction. It affects the preparation of strategic program, its execution and the rating and control of the strategic program, in add-on to this it enhance the internal civilization.

Use of rating & A ; public presentation indexs:

All the infirmaries use fiscal public presentation indexs, bulk established their ain KPI ( Key Performance indexs ) including fiscal, result and proficient indexs. This is more or less the same consequences Delgado et Al. ( 2009 ) found which indicates that bulk of infirmaries they examined uses the fiscal indexs, operational and clinical indexs.

Meanwhile, there was no indicant that any hospital utilizations balanced scorecard technique, Kaplan and Norton ( 1996 ) , to measure or command the execution of the strategic program despite the presence of many researches and article showing the utility and supplying general theoretical accounts of the balanced scorecard addressed to the health care sector particularly infirmaries ( Kershaw, R.,2001 ) .

Use of Information System:

The information system in the infirmary is good advanced and there is a tendency by the infirmary direction to promote the use of the information system all over the infirmary. ( Lee et al. ( 2002 ) argued that the usage of sophisticated information system will significantly heighten the quality betterment and accordingly will develop the effectivity of the strategic direction procedure. All the respondents stated the importance of the information system that affect all the procedure in the infirmary and increase the efficiency of strategic direction.

However there are some hinders that limits the gaining of the to the full benefits from the information system. The major obstruction is the reluctance of the staff to to the full incorporate the information system tools in their work. This obstruction may be due to the ignorance of the staff in utilizing the engineering and their fright about their self-importance in forepart of other staff when cognizing that they do non cognize how to utilize the engineering. The staff is concealing behind the alibi of that utilizing engineering requires more clip that they do non hold and it is doubling of work.

Hospital Accreditation:

This variable was non examined before in literatures refering its consequence on the strategic direction procedure. However, many articles demonstrated the positive consequence of the accreditation on the quality of service provided by the infirmaries ( Ratcliffe, R. , 2009 ) .

It was obvious from the interviews conducted that the procedure of acquiring accreditation helped the infirmaries in bettering the whole procedure of strategic direction. The accreditation gives the infirmaries systems that they have to follow in order to acquire the accreditation. These systems can be considered as base for emerging more sophisticated and efficient systems tailored to each infirmary harmonizing to its fortunes.

5.3 Decision

The chief purpose of this research is to place the features of the strategic direction procedure in the Kuwaiti private infirmaries. The aims of the research are identify the pattern of the strategic direction in private infirmaries in Kuwait, Assess the variables that influence the strategic direction procedure in the Kuwaiti private infirmaries and eventually Research the differences in strategic direction procedure between the freshly opened and the old established Kuwaiti private infirmaries.

The first research inquiry: What is the strategic direction procedure in Kuwaiti private infirmaries?

From all what have been mentioned before, it can be concluded that the strategic direction procedure in the Kuwaiti private infirmaries is someway similar to that was mentioned by the literatures with some major differences.

The strategic direction in Kuwait private sector begins chiefly with analysing the competition which takes a great trade of attending on the disbursal of other external environmental factors as the political and economic factors. The internal environmental analysis is non good developed, non performed on regular bases and sometimes ignored at all. Most of the infirmaries hired external consultancy agent to set for them the vision and mission of the infirmary.

The environmental analysis, except for the completion and the rivals ‘ activities and services, is non equal plenty to understand the state of affairs and expect the alterations that may come in the hereafter. This may be bulk of the direction staff thinks that the environment they work in is stable and do non hold major fluctuation.

The planning preparation stage is carried out with the engagement of the doctors inside the infirmary. The bulk of infirmaries have written strategic program with clip frame of either one or three old ages that are reviewed quarterly or yearly severally. The preparation procedure in the well established infirmaries is top-bottom where the higher direction put the strategic pan and discusses it with the lower direction. While in the freshly opened infirmaries, the strategic program preparation is from bottom-up where each section is requested to fix its strategic program and so the programs from all sections are gathered, merged, prioritized and discussed by the higher direction to come up with one strategic program for the whole infirmary.

The execution of the strategic program in the Kuwaiti private infirmaries is performed in an effectual manner where the internal communicating is, to a great extent, active which helps in the airing of the stairss needed to implement the program to the staff in an efficient manner.

The resources, either the homo or the fiscal, that needed for the execution are available or reallocated harmonizing to the budget. The chief obstruction that may confront the handiness of resources is clip needed to do these resorts available and in bulk of instances this is due to external factors like long clip for acquiring the licence from MOH.

The control and rating phase can be considered the most developed phase in the strategic direction procedure in the Kuwaiti private sectors. The infirmary performs control and rating through many ways. Each infirmary has KPI ( Key public presentation Indexs ) for each section which is measured sporadically ; besides there are extra indexs beside the KPI that contain fiscal, operational and proficient indexs. The infirmaries besides conduct periodical meetings for discoursing the stairss taken and what will be done following in add-on to measuring the indexs and cognizing why these indexs did non run into with the criterions set.

The information systems in the infirmaries are sophisticated and integrated to about all the activities in the infirmary. However there are some hinders arise against the full integrating of information system. The chief hinder is coming from the staff as they missing the basic cognition and accomplishments to utilize the engineering in add-on to this, the staff does non to the full cognizant of the importance and benefits the information system provide to the organisation. The staff is believing that the information system is waste of both clip and money. Despite this obstruction is good known to the infirmaries directions, they did non offer solutions to get the better of it. The infirmaries directions are coercing the staff to utilize the information system without work outing the existent ground for non to the full usage of the information system.

The 2nd research inquiry: What are the variables act uponing the strategic direction procedure in Kuwaiti private infirmaries?

From the analysis of the interviews conducted and analysis of the informations emerged from these interviews, the research worker found that of the 13 variables examined, two variables did non act upon the strategic direction procedure in Kuwaiti private infirmaries. These two variables are the consequence of dynamism and the internal civilization ; both are supposed to impact the environmental analysis phase.

The research worker besides found that there are some variables have a medium grade in act uponing the strategic direction procedure. These variables are the internal communicating and usage of the information system.

The variables that have the highest influence on the strategic direction procedure, harmonizing to what the research worker found, are the external ill will, usage of rating and public presentation indexs and the infirmary accreditation.

The research worker found that the staying variables lay between those holding average grade of act uponing the strategic direction procedure and those extremely influence the strategic direction procedure.

The 3rd research inquiry: What are the differences in strategic direction procedure between the freshly opened and the good established Kuwaiti private infirmaries?

The research worker found two major differences between the freshly opened and the good established Kuwaiti private infirmaries. The first difference found is in the environmental analysis where the freshly opened infirmaries direction agreed that the competition is tough and high while the good established infirmaries directions see that the competition is normal and non aggressive. This difference may be because the good established infirmaries have big base of clients that exceed their capacity as said by one respondent “ demand exceeds supply ” while the freshly opened infirmaries don non hold this base so these infirmaries suffer and have difficult clip to pull and construct their ain client trueness base particularly, as it was mentioned earlier, there are no being of competitory advantages for the freshly opened infirmaries over the good established infirmaries.

The 2nd difference was found by the research worker is in the strategic planning preparation phase where the good established infirmaries follow the centralisation theoretical account in preparation of the strategic program as the it begins with the higher direction put the strategic program and so discoursing this program with the in-between direction and after agreed on it, the program is disseminated to the whole organisation. On the other manus, the freshly opened infirmaries follow the decentalisation theoretical account in explicating the strategic program where each section is requested to set its ain strategic program, so these programs are collected and discussed with the higher direction and circulate if approved.

The other phases of the strategic direction procedure were found to be similar between the freshly opened infirmaries and the good established infirmaries.


This research can be considered as the first research examines the strategic direction procedure in the Kuwaiti private infirmaries. The research worker did non happen any articles or research published refering the strategic direction procedure in any Kuwait private sector. Thus this research add value to the existent literatures through casting some visible radiations on the how the private infirmaries in Kuwait execute the procedure of strategic direction.

Besides, the research was the first to include the hospital accreditation as a variable in the strategic direction procedure as this variable was used in old literatures as variable impacting the quality betterment and there was no individual articles could be found that relates the consequence of the infirmary accreditation on the strategic direction procedure. This research concluded that the accreditation of the infirmaries may hold an impact on the strategic direction procedure which may take to utilize the infirmary accreditation as an of import variable by the hereafter research that will analyze the strategic direction procedure in the health care sector.

5.5 Recommendation

The undermentioned recommendations are suggested harmonizing to the analysis of informations obtained from the interviews conducted:

The private infirmaries directions have to execute external environment analysis in more efficient manner epically those concerned with the political and societal factors in order to be able to break expect any future alteration that may happen in the environment and program consequently.

The private infirmary directions must give more attending to the internal civilization inside their infirmaries as this may take to developing a competitory advantage that is alone to the infirmary and can non be imitated by other infirmaries.

The private infirmary directions should happen solutions to the existent grounds for the job of non to the full utilizing the engineering by the staff in the administrative work. This could be done by educating the staff how to utilize the engineering available harmonizing to the staff degree of engineering instruction and the importance and benefits this engineering will supply to the staff and organisation.


This research has many restrictions ; one of these restrictions is that as the research examines merely the consequence of each of the variable on the strategic direction procedure, the research did non look into the relationship that may be between the variables and each other and the consequence of these relationships on the strategic direction procedure.

The research used the qualitative method as a research method which although it was considered the most suited for this research as it is the first research turn toing the strategic direction procedure in the Kuwaiti private sector, some restrictions should be mentioned. The findings that were obtained from the analysis depend on the informations gathered from the respondents whom the research worker proposed that they will give honest and indifferent information which could compromise the informations obtained if this proposition was non true. However, the research worker overcomes this by comparing the informations gathered from the respondents in the same infirmaries and the gestural responses of the respondents.

Another restriction is that the research did non include any staff member from the infirmaries which could hold given another point of position from the staff perceptual experience refering the strategic direction procedure in the private infirmaries.


As this research is considered a innovator research in the field of strategic direction in healthcare private sector in Kuwait, it is of import to reiterate it including more respondents particularly the staff members to acquire broader image of this subject. The inclusion of larger population sample will besides ease the scrutiny of the relationships between the variables in the strategic direction procedure.

In add-on it will be of a great value to reiterate this research utilizing quantitative method alternatively of the quantitative method to guarantee the cogency of the findings.

This research can besides be a base of big figure of researches that examine the subject of strategic direction in other private sectors in Kuwait to hold more apprehension of the strategic direction procedure in Kuwait.

Finally, some respondents have commented that the civilization of Kuwait is different. Therefore, the conductivity of research turn toing the civilization consequence on the strategic direction procedure will be good part to the literature.

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