x TABLE OF CONTENTS ABSTRACT i ABSTRAK iii THE GUIDANCE FOR USING THE DISSERTATION vi STATEMENT OF AUTHORSHIP viii ACKNOWLEDGEMENTS ix TABLE OF CONTENTS x LIST OF APPENDICES xiv LIST OF FIGURES xv LIST OF TABLES xvi LIST OF ABBREVIATION AND SYMBOLS xvii Chapter I 1 Chapter I Introduction 1 I.1 Background 3 I.2 Research Objectives 4 I.3 Research Questions 5 I.4 Research approach and methods 5 I.5 Key Assumption and Research Limitations 6 I.6 Novelty and originality. 6 I.7 Writing Structure 7 Chapter II Literature Review 9 II.1 Introduction 9 II.2 Underlying Theories 11 II.3 Institutional Context 12 II.4 Research State of the Art 13 II.4.1 Past Studies on Strategy Execution and its Complexity 17 II.4.1.1 Strategy Execution Complexity Factors 19 II.4.2 Past Studies on Overcoming Strategy Execution Complexity Factors through Operational Effectiveness 29 II.4.2.1 Translate the Strategy into Action Program in the Business Process 32 II.4.2.2 Appointing a Person in Charge of Operational Management 35 II.4.2.3 Authority of the Person in Charge 38 II.4.2.4 Hospital Operation performance and profitability, the authority and Transparency 39 II.4.3. Past Study on Operational Profitability and Management Control. 40 II.4 3. 1 EBITDA, the proper Hospital Operational Profitability 41 xi II.4. 4 Past Study on Hospital Operation Management: The challenges of Hospital Management in meeting operational performance and Profitability. 49 II.4.4.1 The complex nature of Business Process Management (BPM) in the context of hospital operations. 51 II.4.4.2 Exploring the Intersection of Clinical Ethics and Hospital Profitability in the Hospital Business Process 56 II. 4. 5 Past Study on Activity-Based Costing, Business Process, and Operation Management. 63 II.4.5.1 Potential benefits of establishing an ABC and TD - ABC for transparency and profitability in hospital operations 64 II.4.5.2 . Integrating BPM with TD - ABC and EBITDA to create Hospital Operation Management tools 68 II. 4. 6. The Operation System Tools: EBITDA Matrix, Capacity Matrix, and EBITDA Tree 70 II.4.6 1. EBITDA matrix 71 II.4.6.2. Capacity Matrix 76 II.4.6.3 EBITDA Tree Dashboard 79 II.4.7 Proposed Research Developing Hospital Strategy execution by maximizing daily EBITDA to deliver better operations performance and profitability. 82 II.4.7.1 Hospital Operations Framework to Maximize Daily EBTIDA For Strategy Execution 82 II. 4. 7.2 EBITDAMAX Management Systems 90 II.