Background <p>Hospitals are subject to a&#xa0;large number of regulations, the origin of which are of a&#xa0;legal nature; however, little is known about the strategic management of the medical service in Austria’s largest hospitals.</p> Objective <p>The aim of this study was to investigate the general views and approaches of the strategic management of the medical service on the part of the medical and economic management in Austria’s largest hospitals.</p> Method <p>To answer the research question, seven guided interviews with experts were conducted. The qualitative content analysis according to Mayring and the analytical content quality criteria according to Krippendorff were applied.</p> Results <p>Hospitals need a&#xa0;corporate strategy. Strategic priorities can be set based on knowledge of strengths and weaknesses as well as opportunities and risks. Key issues include finding and retaining qualified medical staff; actively shaping patient care and recognizing the patient needs of the future; an innovation strategy that is economical, sustainable and adapted to future changes in the hospital landscape; a&#xa0;digitalization strategy for medical processes taking the potential of artificial intelligence into account; promoting training and further education as well as scientifically based working methods; striving for an agile decision-making culture; and using the positive aspects of lobbying to the hospital’s advantage.</p> Conclusion <p>Austria’s hospitals are undergoing change and are competing with each other in a&#xa0;diversified supply environment. The key success factor is an agile and future-orientated management.</p>