Strategy by the sea

The columnists question if this strategy will hold water.


Sometimes you just need a plan. Whether you're a plotter or a plodder, a Machiavellian maniac or just Minnesotan “nice,” having a strategic vision is a key step to success. This is true in medicine, whether you are planning a new service line, plotting market expansion, or devising a new care model.

There are many ways to develop a strategy. One formulation is offered by the book “Blue Ocean Strategy,” by W. Chan Kim and Renée Mauborgne. As they describe it, a blue ocean is an open expanse, without competition. Those entering it sail through uncharted waters. This is opposed to the shark-invested, highly competitive, and sanguineous “red ocean.”

Illustration by David Rosenman
Illustration by David Rosenman

We live in a world of many colors, however, both literally and figuratively. Hospitalists might be able to employ or at least recognize strategic approaches of a number of tints.

Blue ocean

Imagine you are sitting by your hotel in the Caribbean when your boss calls you and tells you to design a new model of care for inpatients. Most hospitalists know the story of Lee Goldman, MD, FACP, asking Bob Wachter, MD, FACP, to design such a program, though I suspect it was more likely to have occurred at Ocean Beach in San Francisco than on St. Maarten. At that time, the concept of hospital medicine was a blue ocean. There was nothing like it in the academic world, though there were nonacademic hospitalists elsewhere. This strategy led to the development of the fastest-growing specialty in the history of American medicine.

Purple ocean

A purple ocean is slowly turning from blue to red. A few drops of blood start to change the color of the water. And it doesn't take much, as anyone with mild hematochezia can attest when they look at the bowl. When doctors like John Nelson, MD, FACP, formed hospitalist groups in the late 1980s and then began to cover multiple hospitals by the mid-1990s, that was pure blue ocean. But within a few years, large, soon-to-be-national groups joined the party. Blue started to shade to purple. The ocean was more Prince than B.B. King.

Red ocean

This water is filled with sharks. Don't confuse the red ocean with the Red Sea, which is much more salty. If you want to enter this marketplace, you will be competing with many other bigger fish. You have to have something that will distinguish you from the others. If you are a hospitalist group that wants to enter a saturated market, you had better be willing to undercut prices or offer unique high-value services and either be a very strong swimmer or have an orca, like a big hospital chain or an insurance company, as a partner.

Green ocean

A green ocean is where you go when your strategy is gently easing your way into a marketplace. The water at the edge of the beach is often tinged slightly green. As described in the January 2017 Newman's Notions, hospital medicine is slowly edging its way into Japan, not with a quantum leap, but with a slow and measured progress into the deep water. If you're not sure of your swimming skills or the dangers of the deep, this is the ideal strategy.

Black ocean

This is a favorite strategic maneuver, best actualized by Korean pop music fans but certainly a viable option for hospitalist groups. In an evolutionary leap from lighters held high at concerts of yore, South Korean fans hold colored glowsticks or use phone apps to light up the stadium in their favorite band's colors. When fans are offended by the actions of a band, they express their displeasure by going dark, creating a black ocean. The next time your division has a meeting and information is given about increasing service caps, you may want to try flipping the lights to give the ultimate cold shoulder, the black ocean.

What color to choose?

It's time to decide on a strategic vision. Are you an explorer of the briny deep? A barracuda ready to take on the sharks? A timid swimmer or a teenage music fan? Or perhaps it's best to kick off your shoes, grab a frosty, umbrella-laden, fruity drink, and collapse into your hammock as the radio plays that number-one hit from 1984, “Caribbean Queen.” Yes, that's right, it's the Billy Ocean strategy.