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The hospital’s mission, vision, and values are the core of the hospital’s culture and the most profound expression of the hospital’s culture. Although there have been many comparative studies on the mission, vision and values of organizations in the past, there have been few studies on the mission, vision and values of hospitals in the healthcare field. The purpose is to understand how the world’s top hospitals develop the use of mission, vision and values in their “day-to-day management” and this may help other hospitals to develop their mission, vision and value effectively.
This paper collects and discusses the approaches of the world’s top five hospitals in mission, vision and value through a qualitative analysis method. Documents for the study were collected from the publicly available information of the five hospitals, including their websites, annual reports, and relevant academic literature published in English on Google Scholar, PubMed, Medline, and Web of Science.
These five hospitals have similarities and differences in the development of their missions, visions and values, which are worthy of study by other hospitals. The setting of a mission is a useful reflection of the hospital’s focus and direction showing the social responsibility and sustainability of the hospital. The development of a vision has a guiding role in the equity and development of patients and employees and can improve the efficiency and effectiveness of hospital management and ensure the quality of services. The elaboration of values can greatly help hospitals to develop strategic plans and improve daily management.
The top five hospitals in the world have several common valuable cultures in their missions, visions, and values, regardless of the properties of the hospitals or their management models. In addition, each hospital also has some enlightening descriptions that reflect their particularities.
Keywords: Culture, Mission, Vision, Value, Best hospitalsThe hospital’s mission, vision, and values are the core of the hospital’sculture and the most profound expression of the hospital’s culture [1]. While many previous comparative studies have been conducted on organizations’ mission, vision, and values [2, 3]. There are few studies on hospitals’ mission, vision, and value in the healthcare industry. Organizations’ articulation and cultivation of widely shared ownership and commitment to the purpose (i.e., the mission, vision, values, and goals) have long been recognized as critical to effective strategic planning for organizational improvement [4–6]. An organization’s mission is “what can we get for others,“ and the vision is “what can we get for ourselves?“ The values are “How can we achieve these two goals?“ [7]. A clear definition and focus on mission, vision, and values can give hospitals unique development [8]. Almost every healthcare organization in the US has made its cultural aspirations clear through its mission, vision statements, and values [9]. A mission statement is a short statement that describes the purpose and the reason for the hospital’s existence. A vision statement consists of the critical characteristics that leadership wants for the hospital’s future. Moreover, the vision statement is market-based and should reflect the overall direction desired for the hospital. The values statement defines the hospital’s guiding philosophy, ideals, and planning principles [10].
The hospital’s mission, vision, and values can be oriented to the general organization’s stakeholders [11]. For example, improving the quality and operational performance of healthcare services, influencing the willingness of patients to seek care, and helping hospitals communicate to patients whether their care meets the patient’s considerations [12]. It can also help employees recognize and integrate into the hospital’s organizational culture and select the suitable workplace for them [9] such as practicing social responsibility in medical services [13]. In short, when a hospital has the proper mission, vision, and values, it can get the right people in the right place to do the right thing [14].
Currently, few studies are focusing on the content of the hospital’s mission, vision, and values. Only one on the correlation between hospital managers and the mission statements of the hospitals to which they belong. This study showed a difference between the most popular type of mission statement content and managers’ impressions of its role in organizational performance [15]; However, this study did not directly examine the content of the mission statement itself. Some studies have also discussed the hospital’s approach to mission, vision, and values and found that mission and vision shape employee behavior and foster high levels of commitment, which ultimately improves employee performance and contributes to operational success [16]. Some studies of small and medium-sized organizations indicated a correlation between organizational vision and performance [11, 17, 18]. However, it has not been explored to a great extent in the healthcare industry [11]. This study explores the hospital’s commonalities and enlightening characteristics in mission, vision, and values from the top five best hospitals in the world.
Creating an organization’s mission, vision, and values is grounded in the Strategic Adaptation Theory. According to Mick & Wyttenback, this theory proposes that external and internal forces influence the actions taken by the organization to guide their environment and performance. Strategic intent allows an organization to evolve with goals, objectives, and expectations of superior performance [19]. Strategic Adaption theory also addresses categories of relationships important to the organization such as instrumental, institutional, and altruistic. Instrumental involves the exchange of resources between organizations to meet current and future needs. Institutional ties involve consideration of norms and expectations that provide greater legitimacy and credibility to the organization [20]. Finally, altruism addresses those relationships and behaviors that embrace a higher belief or value beyond an economic driver and is adapted because it is the right thing to do [21]. This is particularly important in healthcare because of the not-for-profit mission of many healthcare organizations.
More recently, strategic management theory asserts that organizations change their operations and priorities based on changing market conditions or shifting environmental factors [22]. The theory includes defining strategic management as the process and method for determining the organization’s objectives, polices, services, and priorities and allocating resources (such as people and financial) to implement the strategies and plans. It will often determine how the organization will compete in the market [22].
Content analysis is a form of qualitative analysis used to examine the content of written materials to gain insight into the significance of the social activities described [23, 24]. The analytical process unlocks the knowledge contained in documents to provide insight into social phenomena [25]. The analysis was iterative and repetitive, similar to a dialogue in which we asked questions about the text, discussed new insights, asked further questions, and reiterated them. Discussions, reflections, and questions among the research team ensured consensus [26].
This study was conducted on the top five hospitals in Newsweek magazine’s “Best Hospitals” list for 2021 [27]. The World’s Best Hospitals 2021 ranking lists the best hospitals in 25 countries. These countries include the USA, Germany, Japan, Korea, France, Italy, UK, Spain, Brazil, Canada, India, Australia, Mexico, Netherlands, Poland, Austria, Thailand, Switzerland, Sweden, Belgium, Finland, Norway, Denmark, Israel and Singapore. These countries were selected primarily on the basis of standard of living/life expectancy, population size, number of hospitals and data availability.
In response to the methodology of the ranking, the magazine based its ranking on the following points (1) Recommendations from medical experts (doctors, hospital managers, medical professionals). (2) Results of patient surveys and patient follow-ups (3) Medical KPI indicators/clinical indicators on hospitals. The detailed scoring process is shown in Fig. 1 [28].
Newsweek magazine’s rating criteria for the best hospitals in the world [28]
Each hospital in each country is given a score. Scores are only comparable between hospitals in the same country, as each country looks at different sources of patient experience and healthcare key performance indicators. As these data are not harmonized, it may be inaccurate to compare the performance of hospitals in different countries by using this score (for example, a score of 90 in country A does not necessarily mean that this hospital is better than a hospital with a score of 87 in country B). But the top five hospitals are all from North America, so are relatively less affected by this. However, the overall ranking of the journals is based on international recommendations from peers in different countries and incorporates the scores obtained by the hospitals. Therefore, the top five hospitals in the ranking are comparable [28].
The five hospitals in North America should have enlightening mission, vision, and values (MVV) in order to remain in the top 10 of the world’s best hospitals during the Covid-19 pandemic (2019–2021). Documentation for the study was collected from public information on the MVV of these five hospitals, including their websites, annual reports, and relevant academic literature published in English on Google Scholar, PubMed, Medline, and Web of Science. All documents were queried in 2021–2022, during which the MVV did not change. We conducted a precise inventory of the content of the documents through a document analysis method and extracted the characteristics of the content of the documents, and finally summarized the conclusions. We also invited five experts in the field of hospital management to give their expert opinions. The analysis was iterative, with the researchers asking questions about the content of the documents and having several discussions with the experts to avoid the personal subjective bias of the researchers. Information for this study was obtained from publicly available materials on the website.
The data were imported for data analysis using the qualitative research software Nvivo 12, using the Content [29] analysis method: (1) reading the transcribed text of the interviews carefully and repeatedly until a sense of the whole emerges. (2) breaking down the material and analysing it line by line to identify significant statements and coding them. (3) coding and categorising recurring statements, things and phenomena to produce themes. (4) finding connections between themes to form clusters of themes. (5) repeating this cycle until saturation, i.e. no new themes and sub-themes are presented.
All the data were read carefully, compared and analysed for significant statements, similarities were identified, themes were identified, and the results summarised and compared with the original data to determine the accuracy of the themes. The information is discussed by multiple researchers to refine ideas [29, 30].
Table 1 shows the information we collected on the five hospitals’ characteristics, including Mayo Clinic(MC) [31], Cleveland Clinic(CC) [32], Massachusetts General Hospital(MGH) [33], Toronto General Hospital–University Health Network(UHN)[34], and Johns Hopkins Hospital(JHH)[35]. The five hospitals are all founded more than 100 years ago. MGH and CC were the first and the last to be established, respectively. MC, CC, MGH, and JHH are located in the US and UNH is located in Canada. UHN is a public hospital, and the other four are private hospitals. All five hospitals are registered as nonprofit organizations.
The general information of the world’s top five ranked hospitals
