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Purpose

In this research, hospitals with varying type, size and operational characteristics are grouped into distinct strategic groups. The competitive methods emphasised by these groups are studied. Also, the extent of effective implementation of quality improvement tools is examined. The purpose of this paper is to discuss these issues.

Design/methodology/approach

Utilizing a sample of 109 hospitals, cluster analysis is used to accomplish the objective of this study.

Findings

Four strategic groups of hospitals were identified. These groups tended to emphasize different competitive methods and quality improvement efforts implementation profiles.

Research limitations/implications

The findings of this study have important implications for the relationship between operational performance and strategic effectiveness in a hospital operational environment.

Practical implications

The findings of this research tend to emphasize the importance of patient's service and satisfaction to strategic effectiveness. Also, the findings stress the importance of clinical effectiveness at the operational level.

Originality/value

This study empirically examines operational and strategic performance‐related issues in a hospital operational environment.

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