Processing of intended and unintended strategic issues and integration into the strategic agenda.

Background: Strategic change is needed in hospitals due to external and internal pressures. However, research on strategic change, as a combination of management and medical expertise in hospitals, remains scarce.

Purpose: We analyze how intended strategic issues are processed into deliberate strategies and how unintended strategic issues are processed into emergent strategies in the management of strategy formation in hospitals.

Differences in the implementation of diagnosis-related groups across clinical departments: a German hospital case study.

Objective: This article aims to examine the implementation process of diagnosis-related groups (DRGs) in the clinical departments of a German hospital group and to explain why some gain competitive advantage while others do not.

Study Setting: To investigate this research question, we conducted a qualitative study based on primary data obtained in six clinical departments in a German hospital group between 2003 and 2005.

Study Design: We chose the case study method in order to gain deep insights into the process dynamics of the implementation of DRGs in the six clinical departments.