A multi-dimensional SWOT-based strategic planning framework for tertiary public hospitals during the 15th Five-Year Plan period

This study aims to develop and empirically test a multi-dimensional SWOT-based strategic planning framework for tertiary public hospitals during the 15th Five-Year Plan period, using a large tertiary hospital in Shenzhen as a case study to demonstrate its application and provide decision-making support for high-quality public hospital development. Taking a tertiary public hospital in Shenzhen as the research subject, a self-designed semi-structured questionnaire was used to survey 531 hospital staff and external stakeholders. The questionnaire covered the selection assessment of internal strengths/weaknesses and external opportunities/threats, employed a Likert 5-point scale to evaluate the hospital’s overall performance across 14 dimensions, and collected open-ended planning suggestions. Frequency statistics and cross-analysis were used for SWOT analysis, based on which the strategic plan was constructed. Internal staff ( n = 478, 90.02%) constituted the primary cohort, with external stakeholders ( n = 53, 9.98%) providing complementary validation perspectives a limitation we acknowledge in the discussion. The core internal strengths were service attitude and humanistic care, geographical location, and community health center construction; the main weaknesses were insufficient disciplinary competitiveness, lack of high-level talents, and insufficient competitiveness of employee compensation. The primary external opportunities were national/local policy support and regional economic development, while the foremost threats were competition from surrounding hospitals and cost-control pressure from medical insurance payment reforms. Three-dimensional cross-validation showed that service advantages were consistent with the highest-scoring scale item (service attitude) and high-frequency open-ended suggestions (improving service levels); disciplinary and talent weaknesses were corroborated by the low-scoring scale items (research capability, talent cultivation). Based on this, a strategic planning matrix consisting of four types of strategies (SO, ST, WO, and WT) was formed. By integrating empirical data from multiple stakeholder perspectives, this study expands SWOT analysis from an environmental assessment tool into a prescriptive strategic planning framework. The proposed strategic system can provide scientific and operable pathway references for tertiary public hospitals in formulating their 15th Five-Year Plans. Beyond the Chinese context, the methodological framework and generic strategic archetypes (SO, ST, WO, WT) are adaptable to hospitals in other healthcare systems, provided that local contextual factors are incorporated.