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Literature on strategic management in public sector organisations often borrows from theory developed in business-oriented contexts. The recent influence of new public management is evident, and rhetoric about the usefulness and goodness of strategic planning tools developed for the
private sector is at its peak. The work of public managers, however, is not adequately reflected in the proposed frameworks of this body of literature research. There is a need for a conceptual framework that better captures the essence of strategic public management and provides a better
foundation for research. The aim of this paper is to contribute to the building of this framework. Given this research goal, we performed a study based on semi-structured individual interviews with CEOs and medical directors of public health organisations (PHOs). Findings were analysed, and
a theoretical framework emerged. A preliminary version of the contents and the structure of the framework was discussed on several occasions with CEOs and MDs of PHOs participating in leadership programs at Bocconi School of Management (SDA). After revision, the framework was consolidated
around the following five dimensions: playmaking, enabling (and engaging), aligning, compromising and equivocality. Each dimension is defined and discussed. The conclusion offers managerial implications and further research aims.