Date of Award

3-26-2026

Embargo Period

4-2-2026

Document Type

Dissertation

Degree Name

Doctor of Health Administration

Department

Health Administration

College

College of Health Professions

First Advisor

Jillian Harvey

Second Advisor

Jami Jones

Third Advisor

Delaney Serfling

Abstract

Background: Despite widespread adoption of strategic planning in healthcare, empirical evidence linking strategic planning time horizons to hospital financial and quality performance outcomes remains limited. Healthcare executives invest substantial resources in strategic planning processes, yet lack evidence-based guidance on whether longer or shorter planning horizons yield enhanced financial and quality-related results.

 

Methods: This study employed an exploratory sequential mixed-methods design combining executive survey data with archival performance data. A REDCap survey was administered to 22 hospital CEOs, CFOs, and other C-suite executives between January and February 2026. Survey responses were matched to publicly available financial and quality performance data from CMS Cost Reports and Hospital Compare databases, encompassing 173 hospitals across 22 organizations. Multiple regression analyses examined five dependent variables: operating margin, total margin, CMS overall star rating, likelihood-to-recommend rating, and hospital excess readmission ratio.

 

Results: Strategic planning time horizon and update frequency did not significantly predict financial or quality performance. Financial performance models were non-significant across all planning variables. However, quality outcome models were statistically significant. Comprehensive KPI integration was positively associated with higher CMS overall star ratings (β = 0.444, p = 0.039), while CEO-led planning responsibility and greater hours invested in planning were negatively associated with both CMS star ratings and likelihood-to-recommend scores.

 

Conclusion: Planning horizon length is not, by itself, a meaningful predictor of hospital performance. What matters more is how the strategic plan is structured, governed, and executed. Healthcare executives should prioritize rigorous KPI frameworks and distributed planning governance over simply extending or shortening their planning horizon.

Rights

Copyright is held by the author. All rights reserved.

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