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8/13/2019 Book Chap 3-5 IIHMR Delhi
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CHAPTER IV
INTERNAL ENVIRONEMNTALANALYSIS ANd COMPETITIVE
ADVANTAGE
Minakshi Gautam
Assistant Professor
IIHMR, Delhi
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• Initiatives by the institute for Healthcare Improvement’s Idealized
Design of clinical office practice and Dartmouth-Hitchcock Medical
Centre’s efforts to understand clinical ‘microsystems’ have
encouraged physicians around US to redesign their practices and
come closer to the ideal.
• Methods adopted from automobile industry – Lean Design and Lean
thinking
• It involves seeing organization as a value chain – each activity/
process should add value for patients
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• Methods adopted from automobile industry – Lean Design and Lean
thinking
• It involves seeing organization as a value chain – each activity/ process should add value for patients
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MUDA – 7 wastes
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8th Waste:
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Learning Objectives
• Understand the role of internal environmental analysis in identifying
the basis for sustained competitive advantage.
• Describe the organizational value chain, including the components of
the service delivery and support activities.
• Understand the ways in which value can be created at various places
in the organization with the aid of the value chain.
• Use the value chain to identify organizational strengths and
weaknesses
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Learning Objectives
• Determine the competitive relevance of each strength and weakness
with the aid of a series of carefully formulated questions.
• Describe how competitively relevant strength and weaknesses can be
used to suggest appropriate strategic actions.
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Identifying Competitive Advantage
• So far, focus of situational analysis – external environment
• Attempted to answer the first of three strategic questions
concerning situational analysis – “What should the
organization do?”
• Next step –Situational analysis emphasis shifts to
ORGANIZATION and establishing COMPETITIVE
ADVANTAGE.
• .
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Identifying Competitive Advantage
• Experts writing on Competitive Advantage have concluded
that successful organizations “focus relentlessly on competitive
advantage ……. (they) strive to widen the performance gap
between themselves and competitors. They are not satisfied
with today’s competitive advantage – they want tomorrow’s.”
• Health care strategists often must think about business as well
as medical issues in pursuing competitive advantage.
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Identifying Competitive Advantage
• Developing a better product, charging a lower price, or
delivering better service does not guarantee success.
• Competitive advantage requires an organization to develop a
distinctiveness that competitors do not have and cannot easilyimitate.
• Therefore, an answer to second strategically relevant question
of situational analysis – “What can the organization do?”
•
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INTERNAL ENVIRONMENTAL
ASSESSMENT: AN INTEGRATED
APPROACH
• Understanding competitive advantage is an ongoing
challenge for strategic decision makers especially in
dynamic industries.
• Historically, competitive advantage was primarily amatter of “position”.
• It had a great deal to do with where the hospital, physician
practice was located .
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• A stable environment allowed static strategies to be
successful.
• In today’s environment, the ability to develop a
sustained competitive advantage is increasingly rare.
• Sustained competitive advantage is the direct result of
an enduring value.
• This reality makes internal environmental factors
important.
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• They must anticipate what the rapidly changing
environment will be like.
• Traditionally, the focus has been on organizational
strengths and weakness.
• Internal environmental analysis is much like external
environmental analysis except the focus in on the
organization rather than environmental forces.
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Analyzing the Internal Environment
• Create value for present and prospective customers and
other stakeholders.
• The organizational value chain is a useful tool for
creating value
• By evaluating functional areas such as
– Clinical Operations
– Information Systems
– Marketing
– Clinical Support
– Human resources
– Financial administration and so on
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Value Creation in Healthcare Organizations
• Value is defined as the amount of satisfaction received
relative to the price paid for a health care service.
• For e.g. patient going to cosmetic surgeon and paying
high price vs. patient going to a free family practice
clinic.
• Therefore, value is the perceived relationship between
satisfaction and price, it is not based solely on price.
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The Value Chain
PRE – SERVICE
Market/Marketing
Research
Target Market
Services offered/
Branding
Pricing
POINT- OF –
SERVICE
Clinical Operations
•Quality
•Process Innovation
Marketing
•Patient Satisfaction
AFTER –SERVICE
Follow-up
•Clinical
•Marketing
Billing
Follow-on
•Clinical•Marketing
A
D
D
V
A
L
U
E
A
D
D
V
A
L
U
E
ORGANIZATIONAL CULTURE
Shared Assumptions, Shared Values, Behavioral Norms
ORGANIZATIONAL STRUCTURE
Function, Division, Matrix
STRATEGIC RESOURCES
Financial, Human, Information, Technology
SE
R
V
I
C
E
D
E
L
I
V
ER
Y
S
U
P
P
O
R
T
AC
T
I
V
I
T
IY
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Organizational Value Chain
• The organizational value chain is an effective means of
illustrating how and where value may be created .
• Value may be created in the service delivery sub system
and by effective use of support subsystem.
• Service delivery activities – fundamental value creation
activities
• They are supported by activities that facilitate and
improve service delivery
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Organizational Value Chain
• Service delivery has three elements – pre service, point of
service and after service.
• It includes primarily operational processes and marketing
activities.
• Organizational culture, organizational structure and strategic
resources are the subsystems that support service delivery.
• It happens by ensuring an inviting and supporting atmosphere,an effective organization, and sufficient resources such as
finances, highly qualified staff, information systems and
appropriate facilities and equipment.
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Organizational Value Chain
• Service Delivery Activities:
– Can create value and significant advantages over competitors.
• Support Activities
– If the organizational culture is service oriented patients can feel it when they walk
in the door.
– The organizational structure can increase the patient satisfaction by effectively
and efficiently facilitating the service delivery.
– Structure should have enough standardization and enough flexibility.
– Strategic resources are important to overall perception of value- employees with proper skills, up to date information system, accessible parking lot etc has
positive impact on patient satisfaction.
– Goals, values and behaviors of all employees must be integrated towards the
common objective of patient satisfaction
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Description of Value Chain Components
Value Chain
Component
Description
Service Delivery The activities in the value chain that are
directly involved in ensuring access to,
provision of, follow up for health
services.
Pre Service
•Market/Marketing
research
Determine the services that create value
prior to the actual delivery of health
services, determine appropriate target
market.
•Target Market The process of identifying recognizable
groups (segments) that make up the
market and selecting appropriate groups
upon which to focus.
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Description of Value Chain Components
Value Chain
Component
Description
•Services offered/
Branding
Information dissemination to present to
prospective patients and other
stakeholders regarding the range of
available services.
•Pricing Charge schedule for available services
•Distribution/ Logistics Activities and systems that facilitate
patient entry into the service delivery
system including appointments and
registrations
•Promotion Activities that ensure all the elements
needed to deliver health services are
available at the appropriate place at
a ro riate time
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Description of Value Chain Components
Value Chain Component Description
Point-of-Service
•Clinical operations
Quality
Process Innovation
Those service delivery activities that
create value at the point where services
are actually delivered.
The activities that convert the human
and non human resources into health
services
Actual provision of health services to
the individual patient
Activities and groups of activities that
are designed specifically to improve the
quality and quantity of health services.
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Description of Value Chain ComponentsValue Chain
Component
Description
•Marketing
Patient
Satisfaction
Activities to offer new products, seek new
customers, provide better services delivery
and cause services to be perceived as higher
value.
After-Service
•Follow – up
Clinical
Marketing
Activities that create value after the patient
has received the health services.
Activities designed to determine the
effectiveness of or the patient satisfaction with
health services received.
Activities that assist in determining what other
service need to be delivered.
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Description of Value Chain Components
Value Chain
Component
Description
•Billing Value creating activities that ensure more
understandable and efficient billing
procedures
•Follow-on
Clinical
Marketing
Activities that facilitate entry into another
value chain (from hospital to home care, etc.)
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Description of Value Chain Components
Value Chain
Component
Description
Support Services The activities in the value chain that are
designed to aid in the efficient and
effective delivery of health services.
Organizational Culture The overarching environment withinwhich the health services organization
operates.
•Shared Assumptions The assumptions employees and others
share in the organization regarding all
aspects of service delivery. (e.g. needs of patients, goals of organization)
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Value Chain
Component
Description
•Shared values The guiding principles of the
organization and its employees.The understanding people in the
organization have regarding excellence,
risk taking, etc.
•Behavioral norms Understandings about behavior in the
organization that can create value for patients.
Organizational
Structure
Those aspects of organization structure
that are capable of creating value for
customers/ patients
•Function Structure based on process or activitiesused by employees (e.g. surgery, finance,
human resource)
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Value Chain
Component
Description
•Division Major units operate relatively
autonomously (e.g. hospital division,outpatient division, northwest division)
•Matrix Two dimensional structure where more
than the single authority structure
operates simultaneously. (e.g.
interdisciplinary team withrepresentatives from medicine, nursing,
administration)
Strategic Resources Value creating financial, human,
information resources and technology
necessary for the delivery of healthservices.
•Financial Financial resources required to provide
the facilities, equipment, specialized
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Value Chain
Component
Description
•Human Individuals with the specialized skills
and commitment to deliver healthservices.
•Information Hardware, software and information
processing system needed to support the
delivery of health services.
•Technology The facilities and equipment required to provide health services
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Identifying current and potential competitive
advantage
• Assessing current and potential competitively relevant strengths and
weaknesses is the goal of internal environmental analysis.
• Competitively relevant strengths are the pathways to sustained competitive
advantage
• Strengths and weakness may be objective or subjective as well as absolute or relative.
• Some strengths possessed by a health care organization are clear by objectivestandards. These are clear and easily recognizable. E.g. a particular location.
• Some weaknesses can also be easily recognizable and clear e.g. excessivefinancial debt.
• At times, a strength or weakness may be subjective.
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Identifying current and potential competitive
advantage
• At times, a strength or weakness may be subjective. E.g. opinion of the people.
• The management team may think that the “philosophy” of the board of directors is more conservative than that of other organizationseven though there are no concrete data to support the assertion.
• Sometimes organizational strengths and weakness are absolute or relative.
• These are not so obvious and can only be determined in relationshipto strengths and weaknesses of primary competitors.
• E.g. renowned health centre loses famous surgeon to a local hospital(relative weakness)
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Identifying current and potential competitive
advantage
• Sometimes organizational strengths and weakness are absolute.
• The Johns Hopkins University School of Medicine is recognized
worldwide as a leader in medical education.
• Strengths and weaknesses are easier to identify if one thinks in terms
of organizational resources, competencies and capabilities.
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A. RESOURCES• The resource based view of strategy argues that valuable,
expensive or difficult to copy resources provide a key tosustainable competitive advantage.
• Resources are the stocks of human and nonhuman factors that areavailable for use in producing goods and services.
• Resources may be tangible, as in case of land etc. and may beintangible e.g. intellectual property, reputation, and goodwill.
• Robert Kaplan and David Norton point out that unlike financial and physical resources intangible resources are hard for
competitors to imitate. Thus making them powerful source of sustainable competitive advantage.
Strengths and weaknesses are easier to identify if one thinks in terms of
organizational resources, competencies and capabilities.
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A. RESOURCES
• Furthermore, according to a Harris Interactive Health Care Poll, agood reputation and trusted physician’s recommendation are twoof most important indicators of quality of medical care.
• These factors ranked above more tangible indicators of resources,
including location, appearances, etc,
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B. COMPETENCIES
• Competency is defined as knowledge and skills that may be a
powerful source of sustained competitive advantage.
• It is about ideas and intellectual know-how.
• The organization must possess threshold competencies- the
minimally required knowledge and skills necessary to compete in
a particular area.
• E.g. all organizations offering cardiac services may possess
threshold competencies, but only one or two will develop the
knowledge and skills to the point that it becomes distinctive
competency.
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C. CAPABILITIES
• Capabilities are a health organization’s ability to deploy resources and
competencies, usually in combination.
• Coordination of resources and competencies is another potential
source of sustained competitive advantage.
• Some assets never create value by themselves, they need to be
combined with other assets.
• E.g. investment in IT (a resource) have little value unless
complemented with effective HR training (competencies)
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C. CAPABILITIES
• It is likely that two or more organizations competing in the same
health care market could have same resources and competencies.
• In such case, competitive advantage is likely to be the result of
different capabilities – a unique culture, strategic leadership, set of
processes.
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Strategic Thinking Map for Discovering Competitive Advantages and
Disadvantages
PRE –
SERVICE
POINT- OF –
SERVICE
AFTER –
SERVICE
ORGANIZATIONAL CULTURE
ORGANIZATIONAL STRUCTURE
STRATEGIC RESOURCES
Step 1
Identify Strengths and Weaknesses
Service Delivery
Strength and
Weaknesses
Support Activities
Strength and
Weaknesses
Value
Rare
Imitable
Sustainable
Competitively
relevant
strengths
Competitively
relevant
Weaknesses
Step 2
Evaluate competitive relevance of
strengths and weaknesses
Competi
tive
advantage and
Competi
tive
Disadva
ntages
Step 3
Focus on
Competitive
Strengths and
CompetitiveWeaknesses
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• Strengths must have value, be rare, be difficult to imitate and be
sustainable in order to create competitive advantage.
• Competitive relevance is determined by critically considering four
important questions;
– Question of Value: Is the resource, competency, or capability of value to
customers?
– Question of Rareness: Is this organization the only one that possess the resource,
competency and capabilities or do many or all of its competitors possess it?
– Question of Imitability: Is it easy or difficult to duplicate the resource,
competency or capability?
– Question of Sustainability: Can the resource, competency or capability be
maintained over time?
Organizational Strengths
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Strategic Thinking Map for the possible combinations of 4
questions regarding strengths and implications
Is theValue of
Strength
High or
Low
(H/L)
Is thestrength
rare (Y/N)
Is thestrength
easy or
difficult to
imitate (E/D)
Can thestrengt
h be
sustaine
d (Y/N)
Implications
H N E Y No competitive advantages.Most competitors have the
strength and those that do
not can develop it easily and
sustain it. Because the
strength is widely possessed
and can be sustained it islikely that it already has
become a minimum
condition for long term
success.
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Strategic Thinking Map for the possible combinations of 4
questions regarding strengths and implications
Is theValue of
Strength
High or
Low
(H/L)
Is thestrength
rare (Y/N)
Is thestrength
easy or
difficult to
imitate (E/D)
Can thestrengt
h be
sustaine
d (Y/N)
Implications
H N E N No competitive advantages.Most competitors have the
strength and it is easy to
develop. However, the
strength generally is not
sustainable. If the
organization is the onlyorganization in the service
area that cannot sustain the
strength, it will become a
short term competitive
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Strategic Thinking Map for the possible combinations of 4
questions regarding strengths and implications
Is theValue of
Strength
High or
Low
(H/L)
Is thestrength
rare (Y/N)
Is thestrength
easy or
difficult to
imitate (E/D)
Can thestrengt
h be
sustaine
d (Y/N)
Implications
H N D Y No competitive advantages.Many competitors possess
the strength but it is difficult
to develop, so care should
be taken to maintain this
strength. Because the
strength is widely possessed and can be sustained, it is
likely that it already has
become the minimum
condition for long term
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Strategic Thinking Map for the possible combinations of 4
questions regarding strengths and implications
Is theValue of
Strength
High or
Low
(H/L)
Is thestrength
rare (Y/N)
Is thestrength
easy or
difficult to
imitate (E/D)
Can thestrengt
h be
sustaine
d (Y/N)
Implications
H N D N No competitive advantage.Many competitors possess
the strength but it is difficult
to develop and those who do
possess it will not be able to
sustain the strength. If the
organization is the onlyorganization that cannot
sustain the strength it will
become the long term
competitive disadvantage.
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Strategic Thinking Map for the possible combinations of 4
questions regarding strengths and implicationsIs the
Value of
StrengthHigh or
Low
(H/L)
Is the
strength
rare(Y/N)
Is the
strength
easy ordifficult to
imitate
(E/D)
Can the
strength
besustaine
d (Y/N)
Implications
H Y E Y Short term competitive
advantage. Because the
strength is valuable and rare,competitors will do what is
necessary to develop this easy
– to – imitate strength. The
organization should exploit
this short term advantage but
should not base the long termstrategies on this type of
strength. Overtime, this
strength may become a
minimum condition for long
term success.
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Strategic Thinking Map for the possible combinations of 4
questions regarding strengths and implicationsIs the
Value of
StrengthHigh or
Low
(H/L)
Is the
strength
rare(Y/N)
Is the
strength
easy ordifficult to
imitate
(E/D)
Can the
strength
besustaine
d (Y/N)
Implications
H Y E N Short term competitive
advantage but not a source of
long term competitiveadvantage. The strength is
easy to imitate but cannot be
sustained. The organization
should not base long term
strategies on this type of
strength but may obtain benefits of short term
advantage.
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Strategic Thinking Map for the possible combinations of 4
questions regarding strengths and implicationsIs the
Value of
StrengthHigh or
Low
(H/L)
Is the
strength
rare(Y/N)
Is the
strength
easy ordifficult to
imitate
(E/D)
Can the
strength
besustaine
d (Y/N)
Implications
H Y D Y Long term competitive
advantage. This strength is
rare in the service area,difficult to imitate by
competitors, and can be
sustained by the organization.
If the value is vary high, it
may be worth ‘betting the
organization’ on this strength.H Y D N Short term competitive
advantage but not a strength
that can be sustained over the
long run.
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Strategic Thinking Map for the possible combinations of 4
questions regarding strengths and implications
Is theValue of
Strength
High or
Low
(H/L)
Is thestrength
rare
(Y/N)
Is thestrength
easy or
difficult to
imitate
(E/D)
Can thestrength
be
sustaine
d (Y/N)
Implications
Although rare and difficult toimitate, the strength cannot be
sustained. This strength
should be exploited for as
long as possible.
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How to chart value creating strengths and value
reducing weaknesses (e.g. of one component from
Medtronics)
Value Chain Component Value creating Strength Value Reducing Weakness
Service Delivery
•Pre-service •Reputation as leading biomedical
engineering company
•Established presence in the market
•Founded in 1949
•Market leader in selected segments
(e.g. implantable cardiac rhythm
devices)
•Operations in more than 120
countries world wide
•Vulnerability to diverse
cultural mores and regulatory
constraints.
•Subject to high risk of
litigation over patents,
trademarks and product
liability claims.
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Strategic Thinking Map for the possible combinations of 4
questions regarding weaknesses and implications
Is the
Weakness of High
or Low
(H/L)
Is the
weaknessCommon
(Not Rare)
among
competitor
s (Y/N)
Is the
weaknessEasy or
Difficult
to
correct?
(E/D)
Can
competitors sustain
their
advantage
?
(Y/N)
Implications
H Y E Y No competitive disadvantage.Although a weakness of the
organization, most other
competitors are also weak in this
area. However the weakness is easy
to correct and competitors will
likely work to correct the weakness.
If organization fails to correctweakness, competitors could
achieve a short term competitive
advantage. Can become minimum
condition for long term success
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Is the
Weaknes
s of High
or Low
(H/L)
Is the
weakness
Common
(Not Rare)
among
competitors (Y/N)
Is the
weakness
Easy or
Difficult
to
correct?(E/D)
Can
competito
rs sustain
their
advantage
?(Y/N)
Implications
H Y E N No competitive disadvantage .
Other competitors are also weak.
Easy to correct. Most competitors
are likely to work to correct the
weakness. Therefore no
organization can sustain their
advantage.
H Y D Y No competitive disadvantage. Most
other competitors are also weak.
Difficult to correct. However,
situation is dangerous. Important to
ensure that competitors don’tovercome this first. If competitors
correct the weakness and continue
to sustain their advantage the
weakness could become long term
com etitive disadvanta e.
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Is the
Weaknes
s of High
or Low
(H/L)
Is the
weakness
Common
(Not Rare)
among
competitors (Y/N)
Is the
weakness
Easy or
Difficult
to
correct?(E/D)
Can
competito
rs sustain
their
advantage
?(Y/N)
Implications
H Y D N No competitive disadvantage . Most
other competitors are also weak in
this area. Difficult to correct.
Chronic, almost all competitors
have it. Corrections in the weakness
tend to erode over time.
H N E Y Short-term competitive
disadvantage. Most competitors not
weak in this area. Easy to correct.
Organization should correct it
quickly. Correcting is likely to
become a minimum condition for long term success.
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Is the
Weaknes
s of High
or Low
(H/L)
Is the
weakness
Common
(Not Rare)
among
competitors (Y/N)
Is the
weakness
Easy or
Difficult
to
correct?(E/D)
Can
competito
rs sustain
their
advantage
?(Y/N)
Implications
H N E N Short term competitive
disadvantage. Competitors not
weak in this area. Weakness easy to
correct. Organization should move
quickly to correct it. Likely that all
competitors correct it and therefore
cannot sustain any advantage.
H N D Y Serious competitive disadvantage.
Weakness is valuable, most
competitors do not have it. Difficult
for organization to correct it.
Competitors can sustain their advantage. May threaten the
survival of the organization.
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Is the
Weaknes
s of High
or Low(H/L)
Is the
weakness
Common
(Not Rare)among
competitor
s (Y/N)
Is the
weakness
Easy or
Difficultto
correct?
(E/D)
Can
competito
rs sustain
theiradvantage
?
(Y/N)
Implications
H N D N Short term competitive
disadvantage. Weakness is valuable,
most competitors do not have it.Difficult for organization to correct
it. However, competitors cannot
sustain the advantage. Until it
becomes the weakness for most
competitors in service area or
weakness corrected by the
organization., it will continue to bea Serious disadvantage.
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Strategic Implications of Competitively Strengths and
Weaknesses (Medtronic’s)
Competitively Relevant Strength or
Weakness
Strategic Implications
Strengths
Market leader in selected business
segments
Economies of scale could be leveraged over competitors
with smaller market shares.
Integrated product line focused on
manufacture and sales of device based
medical therapies
Although competitors are strong and have comprehensive
product lines, Medtronic appears more focused on
manufacture and sale of integrated line of device based
medical strategies
Entrepreneurial culture History and performance has established firm reputation
for innovation
Numerous patents, trademarks, and trade
names
Legal protection of products and product names can
constitute important aspect of differentiation
Strong intellectual capital underlying key
products
Same as for patents and trademarks
Weaknesses
Ongoing legal claims that could prove a
threat to financial viability
Settlements agains the company could result in serious
financial consequences
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• Careful analysis of the internal environment provides a
better understanding of where strategic leaders should
focus their efforts.
• Where they should be careful to avoid vulnerabilityrelative to competitors
• It is not possible to be everything to everyone.