醫管策略管理Strategic Management of

Health Care Organization

Week 3~5(Oct 5~19, 2006)

Strategic ReviewDevelop a Stakeholder Map for your health care organization or a program in your organization

發展 “利害關係人 / 切身相關人士”地圖

Outline the framework of Porter’s “Industry Structural Analysis” provide 3-5 specific examples of each of the five forces in your health care environment that are relative to your health services organization

列舉 “波特五力分析”之競爭策略架構 , 並各舉出3~5項相關例證

Session 2Understanding the External Environment

Service Area Competitor Analysis

External Environmental Analysis

Process of understanding the issues in the external environment, including the general environment, the health care industry, and specific competitor strategies to determine their implications for the organization

Baker suggested that “in times of turbulence the ability to anticipate dramatically enhances your chances of success. Good anticipation is the result of good strategic exploration.”

Importance of Environmental Influences~p.52

在美國 50 年前 , 存在於醫療設施﹑醫師及病人之間的關係是非常簡單的關係。之後 , 眾多私人企業、利益團體、政府等多方介入。

Baker suggested that “in times of turbulence the ability to anticipate dramatically enhances your chances of success. Good anticipation is the result of good strategic exploration.”

Efficiency VS. Effectiveness~p.53

醫療組織成功與失敗的重要關鍵在於 “ do the right thing” (effectiveness), 而非 “ do things right” (efficiency).

Organizational effectiveness has an external orientation and suggests that the organization is well positioned to accomplish its mission.

Efficiency, on the other hand, has an internal orientation and suggests that economics will be realized in the use of capital, personnel, or physical plant.

Need for Environment Analysis(1)

Minimize surprisesPosition organization within its environmentIdentify current strategic issuesDetect emerging trends (weak signals)

Need for Environment Analysis(2)

利用問題來決定組織是否需要 “環境分析”– Does the external environment influence the capital

allocation and decision-making processes?– Have previous strategic plans been scrapped because of

unexpected changes in the environment? – Has competition growing in the industry? – Is competition growing in the industry? – Is the organization or industry becoming more marketing

oriented?– Do more and different kinds of external forces seem to

be influencing decisions?– Is management unhappy with past forecasting and

planning efforts?

Goals

Classify informationIdentify and analyze current issuesDetect emerging issuesSpeculate on what is likelyProvide organized informationFoster strategic thinking

Limitations

We aren’t fortune tellers- we cannot see everything

We cannot always obtain pertinent and timely information

We cannot eliminate the gap between events occurring– and the interpretation of those events

We cannot always act quicklyWe have preconceived notions

Components of Health Care Environment

organizations that plan and regular primary and secondary providers

政府衛生單位內不同層級之財管及人管部門、公共衛生相關部門、管理醫療院所評鑑單位…

organizations that provide health services (primary providers)

醫院、衛生服務場所、醫療保險兼醫療提供之服務單位… organizations that provide resources for the health care system

(secondary providers

醫療教育機構、醫療保險服務單位、藥局、檢驗所… organizations that represent the primary and secondary providers

醫學會、醫院協會、護理學會、檢驗學會… individuals involved in health care and patients (consumers of health care

services)

醫師、護士、病人…

Scanning— 環境分析之步驟

View external environmental informationOrganize information into desired categoriesIdentify issues within each category

Monitoring — 環境分析之步驟

Specify the sources of data (organizations, individuals, or publications)

Add to the environmental databaseConfirm or disprove issues (trends,

developments, dilemmas, and possibility of events)

Determine the rate of change within issues

Forecasting — 環境分析之步驟

Extend the trends, developments, dilemmas, or occurrence of an event

Identify the interrelationships between issues and between environmental categories

Develop alternative projections

Assessing — 環境分析之步驟

Evaluate the significance of the forecasted issues to the organization

Identify the forces that must be considered in the formulation of the vision, mission, internal analysis, and strategic plan

Environmental Analysis Tools (Ⅰ)

Simple trend identification and extrapolation

--identify opportunities/threats and potential

impact

--plot probability Solicitation of expert opinion

--Delphi Technique

--Nominal Group Technique( 名目團體技術 ), Brainstorming

NGT( 名目團體技術 )

NGT是一種群組溝通的方法，主要包括一連串的活動：(1)沈默寫下構想。(2)隱蔽簽名順序將構想列舉在圖表上。(3)一連串的構想討論。(4)沈默的列表和優先順序的排列。(5)優先順序的討論。(6)沈默的重新排列和安排優先順序的等級。

Brainstorming

BS方法是指針對某特定問題，藉由大家的互相腦力激盪，以接龍方式集思廣益來激發大量的構想。是最早提出的一種激發創意的方法，因此有「創意激發之母」之名，根據調查顯示是使用頻率最高的。

BS法運用群體創造力，來引發個人創造力的極至，是一個群體創造的策略，且是思考訓練與尋求創意構想的一種不錯的方法。最大功用是產生解決問題的方案

使用 BS法理論上是以 5 至 7 位最適合，不過依有經驗的人指出以 8 至 12人為最佳，資淺與資深人員各半。

BS法的使用有四個基本的原則：嚴禁批判、自由奔放、先廣後深與綜合改良。

Environmental Analysis Tools (Ⅱ)

Dialectic inquiry (thesis/antithesis)Stakeholder analysisScenario writing and future studies

Issues in the Health Care Environment

TechnologySocial Political/RegulatoryEconomicGeneral CompetitivePrimary/ Secondary ProviderPlanning/Regulatory OrganizationsProvider RepresentativesPatients/Individual Person

Competitor Analysis

“The process by which an organization attempts to further define and understand its service area through identifying its competitors, determining the strengths and weakness of these rivals, and anticipating their strategic moves.” 藉由確定競爭者身分 , 判定競爭者之優勢及劣勢以了解服務區域範圍。

Competitor analysis yields: identification of new business opportunities, clarification of ideas, anticipate surprises, development of market penetration and market share growth strategies

Importance of Competitor Information (Ⅰ)

General Competitor Information 之目的 : --Avoid marketplace surprises, 避免震驚的市場消息 --Forum to evaluate competitive assumption, 提供行政管理

者討論及評估有關組織能力 , 市場地位及競爭力的假設 --Identify competitors requiring response, 使所有人都能明

瞭組織必須面對一些影響力高且敬畏的對手 --Learn from rivals through benchmarking, 協助組織自競

爭對手中學習一些具有指標性的行為 --Building consensus on goals and capabilities, 針對組織的

目標及能力建構行政管理者間的一致看法 , 以增加其在決策選定前的任務參與程度

--Fostering strategic thinking through the organization,培養整個組織進行策略性思考

Importance of Competitor Information (Ⅱ)

Offensive Information( 主動性 )

--Identifying market niches and discontinuities

--Selecting a viable strategy

--contributing to implementation of strategyDefensive Information( 被動性 )

--Anticipating competitor’s

--Shortening time required to respond to

competitors moves

“Blind Spots”

Misjudging industry and service area boundaries

Poor identification of competitionOveremphasis on competitor’s visible

competenceFaulty assumptions about competitionAnalysis paralysis

Service Area Competitor Analysis

Define service categories, Ex: 兒童照護 : well-baby care, infectious diseases, developmental pediatrics, pediatric hematology-oncology, etc.

Define service area and create service area profile, 針對圍繞著服務提供者之地理區域 , 界定區域間的社經、人口、生活型態及疾病型態等特徵 , 可蒐集 3 方面的資料 : 便於了解服務區域的各種量化及質化的資料 , 以母全體為基礎的健康狀態資料 , 健康服務之利用情形。

Conduct service area structure analysis (Threat of Entrants , Intensity of Rivalry Among Existing Organizations, Threat of Substitute Products and Services, Bargaining Power of Customers, Bargaining Power of Suppliers)

Conduct competitor analysis and map strategic groups Synthesize analyses

Industry Structural Analysis (Ⅰ)

Level of competitive intensity is key factor in organization’s environment

Understanding underlying cost structure is critical

Forces outside industry are significant in a relative sense: key is differing abilities of organizations to deal with them

Industry Structural Analysis (Ⅱ)

Threat of New EntrantsThreat of Substitute Products and ServicesBargaining Power of BuyersBargaining Power of SuppliersRivalry Among Existing Organizations

Service Area Structure Analysis

Threat of New Entrants

新進業者對現存業者是具威脅的 , 他們通常企圖很快地攻佔市場。下列情形可阻礙新進業者的市場進入及減低新進業者的威脅性 :

現存業者的規模經濟 (economies of scale) 現存產品或服務的差異 (differentiation) 可匹敵的資本需求

Threat of New Entrants

新進業者對現存業者是具威脅的 , 他們通常企圖很快地攻佔市場。下列情形可阻礙新進業者的市場進入及減低新進業者的威脅性 :

Existing organization’s economies of scale, 現存業者的規模經濟

Existing product or service differentiation, 現存產品或服務的差異

Capital requirements needed to compete, 可匹敵的資本需求 Switching costs – the one-time costs for buyers to switch

from one provider to another, 轉換成本 , 即當顧客轉換其他服務提供者所需之費用

Threat of Substitute Products or Services

替代品具有與現存產品相同功效的特性 , 例如傳統醫療的需求。

Substitute products limit returns to an industry because at some price point consumers will switch to alternative products and services

The more diverse the industry, the more likely there will be substitute products and services

A major substitution taking place in health care has been from inpatient care to ?

PolyServe – NYMU (case study)

To integrate the sequencing and microarray data that these activities generate, NYMU has established the Bioinformatics Research Center.

The Challenge:– Share data across a 30 node bioinformatics compute farm– Solve the performance bottleneck of a single NSF serve– Reduce costs– Deliver cost-effective file serving performance– Allow for non-disruptive expansion

Using Intel serves and Linux allowed NYMU to realize higher file serving performance at an attractive price point.

Power of Buyers

A buyer group is powerful if it: 消費者再對高品質的醫療有所需求的同時亦會嘗試爭取最低的價格。如果消費者擁有強大的力量 ( 如下所述 ) 則競爭轉趨激烈。 – Purchase large volumes– Concentrates purchases in an industry– Purchases products that are standard or

undifferentiated– Has low switching costs– Earns low profits– Has low quality requirements– Has enough information to gain bargaining advantage

Power of Suppliers

Suppliers tend to be powerful if ( 醫療供給者可藉助對價格及品質的控制影響其競爭者。下列情況使得醫療供給者佔有優勢 ):

– There are few suppliers– There are few substitutes– The suppliers’ products are differentiated– The product or service supplied is important to the buyer’s

business– The buyers’ industry is not considered an important

customer– The suppliers pose a threat of forward integration

(entering the industry)

Rivalry Among Existing Firms

Intense rivalry is the result of ( 同業間的組織是會彼此影響的 , 當以下情況發生時 , 競爭轉趨激烈 ): – Numerous or equally balanced competitors, 較多的競爭者 – Slow industry growth, 整體產業成長緩慢– High fixed or storage costs, 高固定成本 – A lack of differentiation or switch costs

– Capacity augmented in large increments , 眾多組織擴大其服務容量

– Diverse competitors, 產品缺乏差異性 – High strategic stakes

How does use of Porter’s analysis help identify the major competitive forces in the service area?

Why is an identification and evaluation of competitor strengths and weakness and the determination of strategy essential in competitor analysis?-- <例 > 專門提供食品、飲料、環境或醫療等領域調查資料的 Market Strategy Group, Inc.對於糖尿病的監測機器與影響市場的要因，依主要的範疇類別做詳細的調查之後，發行了包含整理至 2008年未來預測的報告書 "The U.S. Diabetes Glucose Monitoring Market-Forecast and Competitor Analysis "。

Critical Success Factor Analysis

Identification and analysis of a limited number of areas in an industry in which an organization must achieve if it is to be successful ( 掌握兵家必爭之地 )

Evaluation of competitors relative to critical success factors

Strategic Dimensions/Options

SpecializationReputationService/product qualityTechnological leadership Vertical integrationCost positionServicePricingRelationship with parent company

Strategic Group Analysis

Strategic Group: a number of organizations within the same industry making similar decisions key in area

Characteristics of the strategies if organizations competing within a service area

( 作法是將據有相同策略性質的組織劃歸同一組，藉以與同產業採取其他不同策略的組織族群相互比對，以作為組織策略修訂及績效改進之參考。 )

編者按 : 由於策略聯盟的興起 , 使得產業策略群 (Strategic groups)的競爭本質發生變化 , 策略群已不足以解釋產業的動態競爭 , 許多 IC廠商紛紛打破策略群所形成的移動障礙(Mobility barriers),和別的策略群廠商合作形成各種聯盟型式 , 其目的或在於彰顯特有的策略能力 (Strategic capability),或是強化自己所缺乏的策略能力。

Implications of Strategic Group Concept

Organizations pursue different strategies within service categories and service areas

organizations within a strategic group are each other’s primary or direct competitors

Strategic group analysis can indicate other formulas for success for a service category

Strategic group analysis can identify unoccupied market niches

What are the benefits of strategic group analysis and strategic mapping?

Prediction

Strategy planning requires predicting competitors next moves

Past behaviors give a good indicationStrategic time line—”stream of decisions”

Key Term (Ⅰ)

Industry: a group of firms producing products that are close substitutes for each other

Service Area: the geographic areas surrounding the health care provider, limited by defined geographic boundaries

Cost-Shifting: process of shifting the costs of care for the under or uninsured patients to insured patients

Key Term (Ⅱ)

Distinctive Competence: those services or characteristics that distinguish you from your competitors, area/s of excellence

Strategic Decision Time Line: summary of key decisions made over time which will reveal their strategic intent, “the stream of decisions”

Strategic Group: a number of organizations within the same industry making similar decisions in key areas

Service Area Competitor Analysis Review

Define service categoriesDefine service area and create service are

profileConduct service are structure analysisConduct competitor analysis and map strategic

groupsSynthesize analysis