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[ANSWERED 2022] Why should program evaluation be used for public health and not-for-profit institutions in the development of adaptive strategies?



  1. Why should program evaluation be used for public health and not-for-profit institutions in the development of adaptive strategies?
  2. Explain the strategic position and action evaluation (SPACE) matrix. How may adaptive strategic alternatives be developed using SPACE?

Professional Development:

Case Study #8: “Dr. Louis Mickael: The Physician as Strategic Manager”

Develop an environmental assessment and an internal capabilities analysis using decision support tools that have been introduced in this module (such as PLC analysis, BCG portfolio analysis, SPACE analysis and so on). Analyze alternative strategies to include pros and cons of each alternative, then conclude with a recommended strategy and brief implementation plan.

Expert Answer and Explanation

Strategic Alternatives


Program Evaluation

According to Ginter et al. (2013), program evaluation is a strategic analysis technique used mainly by public and not-for-profit organizations to assess their programs and develop strategic alternatives in cases where gaining a competitive edge or market share is not relevant. In most cases, the other tools for developing strategic alternatives, such as SWOT analysis, an organization is usually compared with other competing firms or products. However, in program evaluation, the analysis is mainly used for internal and external assessment to evaluate whether the various programs are meeting the mission and vision of the organization (Strang, 2018). Other than that, program evaluation is useful in identifying whether the resources allocated to the various programs are sufficient to fulfill the strategic goals of the organization. In program evaluation, a needs assessment is also conducted to ensure that both public and not-for-profit organizations meet the needs of the communities they are supposed to serve and to identify the best strategic alternatives to fulfill those needs.

SPACE Matrix

A strategic position and action evaluation matrix, also known by the acronym SPACE matrix is a decision support tool that can be used to formulate strategic alternatives (Ginter et al., 2013). The tool expands on the BCG analysis to develop an appropriate strategic profile of the organization. The SPACE matrix uses graphical charts to depict how strategic alternatives can be applied based on various organizational factors (Ginter et al., 2013).

Using the SPACE matrix, adaptive strategic alternatives can be developed by assessing the environmental stability, the competitive position of the organization, the financial and service category strength, after which an examination of the most appropriate adaptive strategic alternative can be done.

Professional Development

            One of the challenging aspects of operating an organization is coming up with effective strategies that can assist the organization to navigate the changing business environment mired with stiff competition  For organizations to remain relevant, they have to assess both their internal and external environment, evaluating their strengths and opportunities for growth, eliminating their threats and working on their weaknesses. This paper will develop an environmental assessment using the case study dubbed: “Dr. Louis Mickael: The Physician as Strategic Manager.” Various decision support tools will be used to assess the strategic positioning of Dr. Louis Mickael amidst the changing business environment.

Environmental Assessment and an Internal Capabilities Analysis of the Business

SWOT Analysis

Using the SWOT analysis tool, there are several internal strengths that were observed in Dr. Lou’s practice. One of the strengths was a good reputation with his clients which enabled the business to have a strong footing within the market space. According to Ginter et al. (2013), a healthy business-client relationship is one of the strengths that can act as a stable foothold in maintaining strategic advantage, and this can be seen by the over 800 patients served by the facility which was fairly higher in comparison to other individual practices. The aspect of a good client relationship can be attributed to the skilled employees Dr. Lou had employed, who had a good rapport with the clients served in the practice. Dr. Lou also invested some finances, though on a need to basis to enhance the skills and competencies of personnel to deliver better services, and also the application of technology that was relevant at the onset of the business, which acted as a strategic tool in gaining a competitive edge (Aithal, 2019). Another strength was the fact that Dr. Lou’s practice was linked with most of the third-party payors, which meant that patients served in the facility had a relatively easy time to process their payments.

Concerning opportunities, the growing market was one of the considerable opportunities that Dr. Louis’s practice could capitalize on. While at the onset of the business, Dr. Lou’s main client base consisted of mainly young clients, but with the rapidly expanding populations with new businesses being developed, means that there are substantially more types of market bases that could be tapped. The development of a university within the business neighborhood also meant that there is an opportunity to capitalize on a joint venture that will provide residence to the young upcoming physicians and office assistants, thus increasing the number of patients tended to, and at the same time, save on some of the work and staff expenses encountered in Dr. Lou’s practice.

Some of the weaknesses that were observed include low financial strength, which is an issue that affected Dr. Lou’s ability to expand and acclimatize to the changing business environment. It can be seen from the financial reports that indicated the firm had yet to have a stable footing in terms of the asset base and the profits generated which could be used to improve the firm’s operations. However, it can be established that the financial strength was steadily improving. This made Dr. Lou have less than enough time to serve his patients. Another weakness was that the technology he was using was outdated as compared to what the competitors were using. Healthcare information technology is a major component that an organization should possess to improve the efficiency of its services, such as processing of client reimbursements (Aithal, 2019). The size of Dr. Lou’s practice was also considered a weakness. This can be seen from when Dr. Lou found it difficult to introduce a new partner to his practice due to worries for accommodation inadequacies.

As for the threats, one of them is that Dr. Lou was doing most of the administrative duties by himself, including billing and following up with the patients’ reimbursements. This is a threat, in that, there is a high likelihood that he will end up losing a chunk of the unattended clients. Another threat was the entrance of two hospitals which substantially increased the amount of competitive pressure faced by Dr. Lou’s practice. The introduction of new competitors is one of the main factors that may pose a threat to an organization’s competitive position and by extension, its existence (Manral & Harrigan, 2018). The introduction of more specialty practice also exposed Dr. Lou’s practice, in that, some of the services that he initially offered were now referred to facilities offering specialized care. Another threat was the changing rules, for example, reimbursement policies which drastically changed the activities and workload required to be done by Dr. Lou, at the expense of dealing with his clients.

External/Internal Strategy Matrix

External Issues
General Environment issues

1. Expanding population (elderly, and white-collar patients)

2. Economic Growth

3. Changing payment regulations

Healthcare system issues

1. Industry growth

2. Declining patient reimbursements

3. Changes in reimbursement policies


Service area and competitive issues

1. Increased number of specialty care practitioners

2. Increasing competition

3. Introduction of new healthcare information systems

4. Introduction of new personnel with new skillsets

Internal Advantages

& Disadvantages

Long-Term Competitive Advantages

1. Brand name



1. Introduction of products targeting the white-collar and elderly population

2. Product enhancement for young clients



1.Training of employees (enhancement strategy)

2.Improvement of efficiency (enhancement strategy)



1. Merger with other specialty practitioners

2. Divestiture

3. Alliance with an existing competitor

4. Acquisition

5. Product enhancement for young clients


Short-Term Competitive Advantages

1. Large consumer base


1.Injection of new capital (market enhancement strategy)

2. Product enhancement (research and development of new products)



1.Training of employees (enhancement strategy)

2. Divestiture


1. Cost leadership strategy

2. Penetration (increased advertising)


Long-Term Competitive Disadvantages

1. Weak asset portfolio (mainly healthcare technology)

2. Inadequate skilled personnel

3. Slow adaptation to changing trends




1. Merger with a competitor with a strong asset portfolio

2. Focus strategy (concentrate on general and family practice, with no specialty services)

3. Employment of new skilled employees (enhancement strategy)


1. Training of employees (enhancement strategy)

2. Cost focus strategy (dealing with mainly blue-collar target market)



1. Cost focus strategy (dealing with mainly blue-collar target market)

2. Divestiture

3. Product focus strategy (concentrate on general and family practice, with no specialty services)

Short-Term Competitive Disadvantages

1. Weak financial strength

2. Limited space for expansion



1. Price reduction (penetration strategy)

2. Product enhancement for young clients

3. Merger with other competing firms



1. Increasing advertisement (Penetration strategy)

2. Adoption of new systems/ healthcare technology (enhancement strategy)


1. Increasing advertisement (Penetration strategy)

2. Alliance with other competing organizations


The external/internal strategy matrix builds upon the SWOT analysis earlier conducted. Based on the analysis there are several strategies that were identified, together with alternatives that will be discussed in detail in the next section.

Analysis of Alternative Strategies

            Based on the analysis of internal strengths and environment assessment of Dr. Lou’s practice, several strategies can be identified. Starting with strategies dealing with general environmental issues, one of the was product enhancement strategy, whereby, the business could opt to improve some of its products such as care services targeting the majority young population and the increasing elderly population. The advantage of this strategy is that it will likely lead to enhanced customer loyalty and possibly an increased consumer base (Mathur & Sutton, 2017). As for its disadvantage, it is a strategy that can be easily be countered by other competing organizations so long as they can match the level of quality in terms of service provision.

Another strategy, which was focused on healthcare system issues, divesture was considered an alternative to enhancement strategy. Divestiture strategy is one of the market exit strategies that entails completely pulling out from a business by selling it off, or terminating its entire operations or that of a specific unit (Ginter et al., 2013). The advantage of this strategy is that it allows resources to be employed in better-performing products. Its disadvantage is that it usually affects an organization’s cost structure (Thywissen et al., 2018).

With regard to competitive issues, cost leadership strategy can be a suitable alternative. Cost leadership involves the competitive position of the organization by providing the lowest possible cost for services/products rendered to consumers. The advantage of this strategy is that it is effective in increasing the market size and within a short period (Bryksina et al., 2018). Its disadvantage is that it may not be sustainable in the long run.


Aithal, P. S. (2019). Information Communication & Computation Technology (ICCT) as a Strategic Tool for Industry Sectors. International Journal of Applied Engineering and Management Letters (IJAEML)3(2), 65-80. Retrieved from:

Bryksina, N., Golovina, A., & Legotin, F. (2018). Implementation of Cost Leadership Strategy by Russian Medical Companies of Laboratory Diagnostics. In Leadership for the Future Sustainable Development of Business and Education (pp. 189-198). Springer, Cham.

Ginter, P. M., Duncan, W. J., & Swayne, L. E. (2013). Strategic Management of Health Care Organizations (7th ed.). San Francisco: Jossey-Bass. (Chapter 4)

Mathur, S., & Sutton, J. (2017). Personalized medicine could transform healthcare. Biomedical Reports7(1), 3-5.

Manral, L., & Harrigan, K. R. (2018). Corporate advantage in Customer-Centric Diversification. Journal of Strategic Marketing26(6), 498-519.

Strang, K. D. (2018). Strategic analysis of CSF’s for not-for-profit organizations. Measuring Business Excellence. Vol. 22 No. 1, pp. 42-63.

Thywissen, C., Pidun, U., & Zu Knyphausen-Aufseß, D. (2018). Process Matters—The relevance of the decision-making process for divestiture outcomes. Long Range Planning51(2), 267-284.

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