The relationship between organizations and their environments has been object of study by scholars of the theory of organizations and in discussions concerning organizational strategy. When these perspectives come together, two sets of different but overlapping forces in the strategy formation process are highlighted. The purpose of this study is to analyze how strategic management contributed to reducing tensions derived from managerial and institutional logics in philanthropic hospitals. It is a comparative case study, with a multi-method approach. The data were examined using narrative and document analysis techniques. The analysis indicated that integrating organizational-managerialist and institutional perspectives raises continuous tensions within organizations with a direct impact on managerial decisions, strategic actions and performance. The strategic management approach should be sensitive enough to recognize and reduce these tensions and find ways to integrate them more effectively. This effort requires a combination of strong leadership skills and appropriate managerial tools. Flexibility, adaptability, creativity and informal interactions should be the basis of any strategic initiatives. Daring and innovation of the hospitals - more than acquiescence - are essential to their social and financial sustainability.
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