Strategic decision making process in private healthcare institutions: A study on the cognitive characteristics of managers

The curiosity about the strategy formulation process has been one of the most important issues that have occupied the field of strategic management in recent years. Research on this subject has developed in two different directions. The concept of strategy formulation was first addressed from a planning perspective and it was argued that strategy emerges as a result of a rational planning process. However, with the emergence of criticisms that strategic planning squeezes businesses into narrow molds, a second view of the strategy formulation process has emerged. According to this view, strategy is a phenomenon that emerges in decision processes that evolve over time. In contrast to the planning perspective, this view emphasizes the intuitiveness of decision processes. It is argued that it is not possible to know all alternatives when making a decision, and even if it is known, it is impossible to evaluate all of these alternatives. In line with these views, the aim of this thesis is to explore how strategic decisions are made in private healthcare institutions and how cognitive structures and processes affect this process. A basic qualitative research design was used for the purpose of the study. Data were collected through semi-structured interview technique. Within the scope of the research, face-to-face or online interviews were conducted with 16 people working as senior managers in the private healthcare institutions. Each participant was briefly informed about the purpose and importance of the research before the interview. Before starting the research, the approval of Sakarya University Social and Human Sciences Ethics Committee was obtained. All interviews were recorded and conducted with the knowledge of the participants. The total recording time was 808 minutes. The recordings were transcribed by the researcher and the data set of the research was created. Content analysis technique was used to analyze the data using NVIVO 12 package program. Within the scope of the research, themes were first created based on the literature and the conceptual framework of the research. Based on the literature, 3 themes and 12 categories were created. Then, codes that could go to these themes and categories were searched from the participant views. After the coding process, the data obtained from the research were finally collected under 3 themes and 14 categories. The themes consist of the theme of strategic decision-making models, the theme of cognitive heuristics and the theme of cognitive biases. Under the theme of strategic decision-making models, the participants stated that they mostly made decisions in a way that reflected the characteristics of the logical progression model. The most frequently coded expressions under this category were "step-by-step progress", "joint decision" and "benefit". Under the theme of cognitive heuristics, the participants reported their opinions that they mostly used the shortcut of ready finding. The most frequently coded expressions under this category were "recall" and "similar event". Under the theme of cognitive biases, participants reported their opinions that they mostly fell into the manageability misconception. The most frequently coded expressions under this category were "overconfidence" and "optimism". As a result, even though senior health managers think that they act rationally, they often make decisions that reflect the characteristics of the logical incrementalism model. It is thought that this situation can be explained by two factors: the specific characteristics of the health sector and the country context. However, the study did not find any evidence that the policy model was used in strategic decision-making processes in private healthcare organizations. It is thought that this may be due to the nature of strategic decisions and the organizational characteristics of health institutions. In the study, while the participants stated that cognitive heuristics can only be used in routine decisions, it was found that managers also use these heuristics in strategic decision processes. In order to simplify decision processes, the participants mostly use the availability heuristics. It is thought that this study will make an important contribution to the literature in terms of providing findings from the field about cognitive characteristics that are difficult to test empirically. As a result of the study, policymakers are advised to take steps to eliminate uncertainty in the sector in order to reduce uncertainty, which is one of the most important factors limiting rational behavior.