1. For health care organizations in the 21st century, the best approach for strategizing is working on internal capabilities and performance rather than expanding market share through acquisition and merger or repositioning products and services. Although all three of these strategies could conceivably be used in conjunction with one another, if only one could be chosen, it would have to be working on internal capabilities and performance. This is because health care organizations today must function effectively in a turbulent, globalized environment where change occurs rapidly and often unexpectedly. The organization's strategy must be future-oriented and able to shift quickly as the environment changes. This means that mergers and acquisitions-which can take months or years to complete-are far too slow a solution, and repositioning products and services is a marketing approach, not a proper response for providing improved health care. Moreover, working on internal capabilities and performance can lend greater value to the other two solutions if or when they are also implemented. It is easier to make a good deal for a merger or acquisition if the health care organization's internal capabilities and performance are at their peak, and it is also easier to reposition products and services when the organization has strong internal capabilities and can weather the reshaping of tasks and job descriptions and the reorganization of its structure.
Bryson and Roering's (11) advice includes identifying the external threats and opportunities that the organization faces and its internal strengths and weaknesses-a SWOT, as it were-noting that externals would include "political, economic, social, and technological forces and trends as well as various stakeholder groups" and the internals would include resources, the organization's current strategy, and its performance. In addition, they recommend "construct[ing] various scenarios...