STRATEGIC PERFORMANCE MANAGEMENT OF HEALTHCARE INSTITUTIONS IN UKRAINE UNDER CONDITIONS OF BIFURCATION CHANGES

Abstract

The article examines the specific features of strategic management of healthcare institutions in Ukraine under conditions of healthcare system transformation, increased managerial responsibility, and growing external environmental instability. It substantiates that, unlike business organizations, healthcare institutions operate within a framework that combines a strong social mission, rigid regulatory constraints, limited competition, and a high dependence on public funding, which significantly reduces the effectiveness of traditional market-based management instruments. It is demonstrated that the reforms initiated after 2017, particularly the autonomization of healthcare institutions, the introduction of contracting with the National Health Service of Ukraine, and the development of the eHealth electronic system - have substantially altered the institutional environment of healthcare delivery, while failing to ensure an adequate level of strategic management capacity. The study reveals that a predominant focus on formal compliance and quantitative performance indicators has led to the dominance of short-term managerial decisions, thereby limiting attention to strategic objectives related to quality, patient safety, and long-term healthcare outcomes. The research further explores the challenges arising from the full-scale invasion by the aggressor state, which has intensified pressure on the healthcare system and heightened the need to ensure the operational resilience of healthcare institutions under crisis conditions. Based on an analysis of global management trends, the article identifies promising directions for the development of strategic management in Ukrainian healthcare institutions, including the implementation of multidimensional performance evaluation systems, data-driven management approaches, and the strengthening of managerial leadership. It is argued that the integration of national healthcare reforms with global best practices, while accounting for bifurcation processes as critical points of systemic development, contributes to enhanced adaptability, performance, and long-term resilience of healthcare institutions.