Health Policy 81 (2007) 29–41 How CEOs use management information systems for strategy implementation in hospitals David Naranjo-Gil a,∗ , Frank Hartmann b a Pablo de Olavide University at Seville, Spain b RSM Erasmus University, The Netherlands Abstract Institutional and market changes seem to force hospitals across the Western world to revitalize their corporate strategies towards more cost efficiency on the one hand, and more flexibility towards customer demands on the other hand. Hospitals, however, apparently differ in the extent to which they are able to implement such strategies effectively. This paper explores whether these different levels of effectiveness depend on how hospitals’ top managers’ use of the available management information systems (MIS). Based on data obtained from the 218 CEOs of public hospitals in Spain, we analyze how CEOs’ professional and educational backgrounds affect their use of MIS, and how the use of the MIS subsequently supports or inhibits the implementation of these strategic goals. The results indicate that CEOs with a predominant clinical background focus more on non-financial information for decision-making and prefer an interactive style of using MIS, which together support flexibility strategies. CEOs with a predominant administrative background seem more effective in establishing cost-reduction strategies, through their larger inclination to emphasize financial information in combination with a diagnostic use of the MIS. Implications for the strategic management of hospitals are outlined. © 2006 Elsevier Ireland Ltd. All rights reserved. Keywords: Management information systems; Upper echelon perspective; Strategy implementation; Hospital management 1. Introduction The medical industry across the Western world is currently involved in processes of serious strategic and managerial reorientation [1,2]. These processes orig- inate in a number of different structural and demo- graphic developments, such as the progressive age- ing of the Western population, the impact of new pathologies and technologies, autonomous increases ∗ Corresponding author. E-mail address: dnargil@upo.es (D. Naranjo-Gil). in health care demands by citizens, and the need to repair supposed inefficiencies in the design and run- ning of national health care systems [3–6]. In several countries, such as Spain, formal legislation requires regional health care authorities to encourage hospi- tals to become flexible organizations that are more receptive to the demands from the public, and to offer these higher quality services at lower cost [7,8,9]. Although these strategic goals and policies are not mutually exclusive by definition, the strategic man- agement literature suggests that the organizational requirements for the effective implementation of qual- 0168-8510/$ – see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2006.05.009