Portugal has a vast and intricate public health system that is being impacted by rising costs. The concepts of New Public Management, together with foreign experience, drove the creation of public-private partnership (PPP) models around the turn of the century to enhance the focus on performance and cost-effectiveness in healthcare. The first wave of PPPs, which began in 2001, featured an innovative and integrated concept that linked hospital infrastructure building and administration with clinical service delivery. The growth of PPP projects to avoid financial limitations reveals a lack of strategic thinking and the government’s short-term perspective on contracts lasting up to 30 years. Various procedural delays, miscalculated costs, and external advice on contract monitoring have exposed the public sector’s incapacity to handle complex projects and contracts properly. Following a widely criticized first wave that resulted in some clinical service delivery going back to the public sector, Portugal is now seeking to establish a second wave of hospital PPPs that do not include this problematic component. In response, this work suggests Portugal’s first strategic management method for managing healthcare PPPs. This paper initially examines the Portuguese legal framework before doing an organic SWOT analysis that combines the expertise of national PPP specialists. Filling existing knowledge gaps in public institutions, increasing tight collaboration and accountability with the private sector, and examining methods to contract management, renegotiation, and value-for-money evaluations are all recommended in the strategic formulation.