Degree Name

EdD (Doctor of Education)


Educational Leadership

Date of Award


Committee Chair or Co-Chairs

W. Hal Knight

Committee Members

Jean Garner Stead, Russell F. West, Terrence A. Tollefson


The purpose of this study was to determine hospital executive management’s perceptions of how turbulence in the politico-legal sector of the macroenvironment impacted the strategic management systems of Tennessee hospitals. In particular, how did Federal and State funding restrictions (Medicare and TennCare) impact the strategic planning and implementation process of their hospitals? The study was also designed to gain insight regarding specific changes to strategic management systems that may have resulted from these funding restrictions.

The research was conducted during April and May of 2003. Data were gathered by surveying the Chief Executive Officers (CEOs) of acute care hospitals in Tennessee using a survey instrument covering the areas of strategy formulation, implementation and evaluation.

Fifty five percent of CEOs of Tennessee’s acute care hospitals responded to the study Using the number of hospital beds as an indicator of hospital size, the results of a Chi Square test demonstrated that the sample of CEOs responding approximated the population (Chi Square=.986, df=6, p=.986). Proportions of CEOs representing for-profit hospitals and rural hospitals also approximated population proportions.

The results of the data analysis gave insight into how reductions in TennCare and Medicare funding levels impacted the strategies employed by Tennessee hospitals, and potential impact on patient care. For example, by a two to one margin, CEOs indicated their hospitals had elected not to offer new services and a majority indicated their hospitals had eliminated services as a result of changes in TennCare/Medicare funding levels. Seventy nine percent of the CEOs responded that their hospitals had delayed the replacement of capital equipment as a result of changes in the funding levels under study. Sixty percent attributed workforce reductions at their facilities to changes in TennCare/Medicare funding levels. Using subscales, differences were found between the responses of CEOs of for-profit and not-for-profit hospitals with regards to selected goals and with regards to strategy evaluation. In both instances, the mean scores of the subscales for CEOs of not-for-profit hospitals were higher.

Document Type

Dissertation - unrestricted


Copyright by the authors.