As in other industries, the mission of a hospital is its reason for being; it defines its role and associated responsibilities in the community, namely, the service it should provide to society.1

On the other hand, when seen alongside companies of the same size in other industries, the complexity and scope of the mission of hospitals are comparatively greater. The purpose of a hospital comprises and underscores variables such as clinical care, community service, health promotion, training and research (for and by doctors, nurses, pharmacists and other participants in the sector), financial results and, in some cases, religious factors, etc.2

Taking into account the scope and importance of the studies on mission in leadership and the management of organizations in general, it is clear that the hospital industry lags far behind other sectors with respect to the design, development and use of the mission statement,3 and there is a surprisingly meager amount of research that has applied it to the healthcare sector as a whole and to the mission statement in hospitals in particular.

Crafting a mission statement with the proper direction is one of the most critical strategic tools for a healthcare organization to succeed,4 as it is an important management tool in healthcare sector organizations5 and guarantees the foundations for the future success of a hospital. On one hand because it sets out organizational guidelines6 and on the other, because it can be one of the most powerful methods for assessing the success of the hospital.7

In addition, it is crucial for both executives and employees in the healthcare sector that there should be a robust mission statement that they can turn to in times of uncertainty, and this because the healthcare sector is the target of a rapidly changing situation (financing, legislation, technology, etc.) which may lead the members of healthcare organizations to lose sight of the institution's reason for being. Besides, given the scope and complexity of the interprofessional relations established among doctors, nurses, managers and other healthcare professionals, employees need to have the support of the organization as a whole, to know they are supported and included in the joint efforts involved in fulfilling the mission.8

This is also upheld by Bart,9 who sustains that given the progressive complexity and dynamics of change in the healthcare sector, the mission statement has gained increasing importance in modern healthcare organizations because

• (a)

  it helps identify and focus on its critical core capabilities in order to better cope in times of change;

• (b)

  it addresses the allocation of scarce resources, simultaneously promoting operational effectiveness and efficiency, especially important during periods of budget constraints;

• (c)

  it helps react when faced with new strategies, turning the organization's focus back to its intended purpose;

• (d)

  it can compensate the breakdown in employee morale, creating an inspiring, motivating movement around the high aspirations of the organization.4

In another study made of the healthcare sector10 the reasons put forward to justify the mission statement were summarized as follows: focus resource allocation; motivate and inspire employees to reach a common purpose or aim; balance competing interests among the different stakeholders; ensure the alignment of the organization during a crisis; create standards of behavior; provide direction and common goals; define the challenge for the company's activities; maintain control over the organization; develop a common culture and values.

A well-known phenomenon that is widely recognized in the literature is that professionals in the healthcare sector – doctors, nurses, managers and others, form different groups with specific activities, organizational arrangements and ways of relating with each other.11

The healthcare sector is therefore multidisciplinary, insofar as it contains several professional groups. The dynamics of interprofessional interaction by far exceeds this complexity: the organizational subcultures that coexist in the healthcare sector – doctors, nurses, managers and others, are heterogeneous, have multiple levels of identity and arrange themselves in various professional communities.12 The way these professionals experience the sector and their responsibilities often leads them to confinement in self-contained professional silos,13,14 which reveals certain growing complications.

In an organization as complex as a hospital, a collaborative stance with views to fulfilling the mission may help overcome organizational obstacles. In a hospital setting, collaboration presupposes a shared mission.15 Having a common culture is beneficial to professionals in that it leads them to identify with the institution and its operating model, share with others and remain motivated with altruistic aspects that benefit patients.16

So, the success factors for this collaboration may include clearly defining the mission, having a robust implementation strategy17 and striving for consistency between what is expressed in the mission and the day-to-day reality of the institution18 what it's called “managing by missions”.

If we could speak of an “implicit” connection between the corporate mission and the personal mission, many would argue that the healthcare institutions have been managing by missions for a long time. And they would have a point. Chances are, as a philosophy of action, management by missions has been in the mindset of directors and collaborators in many healthcare organizations. But speaking of “implicit” management by missions can lead to confusion rather than understanding of what we are discussing here, since we are talking about something more than a philosophy of action of “some managers” or a cultural phenomenon (in which missions are transmitted tacitly through socialization processes).

Management by missions is a systemic transformation of management, where missions are defined and, more importantly, explicitly evaluated by all members of an organization. Although management by missions starts when a company, a team or an individual defines a mission, it is not executed until the company, team or individual conducts continuous and periodic monitoring of the degree of fulfillment of these missions.19–21

As management by missions becomes standard practice in business organizations, several forms of developing the connection between the institutional mission and the role mission of their members have emerged in the literature. Some of these are, for example, the “nested missions”,22 “shared missions”,20 the “matrix of interdependencies”,18 the “leadership philosophy”,19 the “letter of understanding”,23 or the “mission impact plan”.24 These solutions seek vertical coordination of the missions (by deploying the corporate mission in cascade throughout the divisions, departments and people) and horizontal coordination (by establishing negotiation and support processes among people who have interconnected missions). In turn, they propose the integration of missions in management systems (objectives, processes, competencies, compensation, etc.).

Applying these ideas in the healthcare sector involves tackling a fundamental issue which is not always well resolved, namely, clarifying the shared mission of the 3 main groups in the healthcare sector: doctors, nurses and managers/administrators.11 This should result in a vertical as well as horizontal coordination of the missions. The aim of vertical coordination is that everyone knows how they contribute to the organization's mission from their own job. As suggested by some authors,18,21 this would be achieved through a knock-on effect of the institution's mission, beginning with each of the 3 groups, continuing down to the level of each collaborator.

In turn, horizontal coordination of the missions should seek to clarify the relations of mutual interdependence that exist among the 3 groups since, while it is important that each group understands its role mission, it is also fundamental that each group understands the mission of the other roles. In this way, doctors should fully understand the role of nurses as well as of managers (Fig. 1). And the same can be said about nurses and managers; ensuring that each collaborator understands the mission of the institution, their own, and that of the other groups with which they interact.

Figure 1.

Shared missions: deployment of the corporate mission.

(0.04MB).

According to Cardona and Rey,18 mission integration should follow 3 fundamental criteria:

Through management by missions, healthcare organizations have the opportunity to attain a greater level of identification among their members and better coordination of groups. This new form of management will offer healthcare institutions a huge potential for motivation and performance, we think of equal magnitude as the transformation that meant moving from management by tasks to management by objectives. This becomes especially evident in the matter of coordination, where the missions and other elements of an organization (structures, processes and systems) form a whole that cannot be coordinated properly if it is not considered as such.18,29,30 Thus, further research on organizational theory based on missions is required; one that contemplates individuals from a transcendent perspective, capable of acting for reasons other than the mere satisfaction of their own needs, and considers something that is especially relevant in the healthcare sector: above all other things, the first motivation of human beings is to find a mission in their daily activities.31

The authors declare that there is no conflict of interest.