‘Mission-driven’ priorities vs. ‘goal-driven’ objectives: New study looks at the tradeoffs hospital CEOs often have to make

To adapt a well-worn idiom, senior hospital leadership often risk missing a low-level storm stressing the whole forest for the sake of a few high-maintenance trees up front. 

Which is to say that American hospitals operate under persistent pressures to pursue multiple—and often competing—missions and goals.

Researchers define the challenge while suggesting evidence-based ways to meet it in a paper published in Academy of Management Proceedings.

“Mission–goal tensions are a defining and enduring feature of the U.S. hospital sector,” report Hüseyin Tanriverdi and colleagues at the University of Texas at Austin. 

These pain points are apparent across ownership and governance models, the researchers add, and are “shaped” by financial constraints, regulatory environments, market dynamics and institutional mandates.

Mission–goal tensions: ‘structural rather than episodic’ 

For the study, Tanriverdi and team conducted a scoping review of the relevant peer-reviewed literature. A total of 66 studies met their research criteria.

Their key findings by hospital subsector include: 

• Nonprofit hospitals must balance community-benefit obligations against financial sustainability. 
   
• For-profit hospitals face tensions between profit maximization imperatives and expectations to provide accessible, high quality, community-oriented care. 
   
• Religious hospitals navigate conflicts between doctrinal commitments and service scope. 
   
• Academic medical centers manage tensions between education and research missions and clinical productivity. 
   
• Government hospitals, particularly within the Veterans Health Administration, address competing mandates related to access and efficiency. 

Across all these types, mission–goal tensions are structural rather than episodic, Tanriverdi and co-authors report, adding that the observed friction points “reflect tradeoffs between mission-driven objectives and financial performance, efficiency or productivity pressures.”  

4 points of light  

In their discussion, Tanriverdi et al. offer four conclusions, as follows. 

1. Mission–goal tensions are not aberrations within U.S. hospitals but enduring features of organizational life shaped by competing institutional logics. 

‘Across hospital types, tensions between mission-oriented objectives and financial, operational or performance-driven goals persist despite—and sometimes because of—efforts to manage them through governance, leadership and technology.’

2. Hospitals do not resolve mission–goal tensions but continuously negotiate them through organizational processes. 

‘Leadership practices, particularly those involving hybrid professional–managerial roles, emerge as central mechanisms for mediating conflicts between competing objectives. However, prior research suggests that reliance on such roles may render tension management fragile, as it depends heavily on individual discretion, professional norms and contextual judgment.’  

3. Governance structures and technological systems designed to align organizational goals often redistribute rather than eliminate tensions. 

‘Performance metrics, accountability frameworks and digital tools can make tradeoffs more visible and manageable, yet they may also intensify pressures by embedding economic rationalities into clinical and mission-driven domains. This dynamic helps explain why mission–goal tensions remain persistent even in highly structured organizational environments.’

4. Mission–goal tensions should be understood not as problems to be solved but as conditions to be governed. 

‘Recognizing the persistence and fragility of tension-management strategies has important implications for policy, leadership development and organizational design. Rather than seeking definitive solutions, stakeholders may need to focus on building adaptive capacity and institutional arrangements that support ongoing negotiation among competing objectives.’

The study is posted here (behind paywall).