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There is nothing simple about the composition of health care organizations.  This complexity comes from, among other things, a concourse of medical professions and other stakeholders (e.g., patients and government) usually with incompatible interests, perspectives and time frames.  Exacerbating the challenges for health care leaders is the well-known need to satisfy the insatiable demand for health care - with limited financial assistance.   Health care executives frequently face additional challenges because: they have disparate stakeholder groups health care organizations have multiple missions (e.g., provide health care to their communities, remain fiscally sound, and be a primary employer in the community) professionals such as physicians and nurses value professional autonomy, and their decisions have a huge influence on health care expenditures, and the information necessary to manage the change process is usually sparse and always insu

Managing On a Strategic Level Health care organizations operate in an environment of rapid change, complex and varying regulations and impending health care reform. Many health care organizations do not employ physicians and face problems getting their input and involvement in strategic planning issues. Quality expectations are continually increasing and data availability is generally limited.  At the end of the day, health care organizations must overcome a number of problems in order to manage on a strategic level. Lack of Physician Involvement Many hospitals do not hire physicians as employees; these health care settings serve as facilities where physicians have privileges to admit and treat their patients.  Under these circumstances, physicians must be treated like customers rather than as employees, with even less available time for non-billable tasks such as administrative meetings and policy decisions.  In either case, physician involvement is a critical component of effective