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[Type text] Market Growth Strategies in XYZ Healthcare, Malaysia Alisa Ibrahim, Mohd.

Zailani Othman, Noor Azam Abd Aziz (PhD), Suhailah Kassim, Faculty of Business Management MARA University of Technology, Malacca Abstract Malaysia is one of the developing countries in the world that is on the verge to become de-veloped (Internationella Programkontoret, 2003). In 2010, Malaysia had a growth rate around 7.2% and it is implied that the Malaysian market is continuously growing. Healthcare expenditure has contributed 5% of the gross domestic product (GDP) growth in the same year. The healthcare industry has become a powerful engine of economic growth, due to demographics shifts such as extended longevity and a rise in lifestyle diseases such as hypertension and cardiovascular ailments and diabetes. People pay their attention on their health protection and treatment, but simultaneously, they need to bear the high expenditure for their healthcare processing. Through a few significant players in the industry, the report examines the competencies that XYZ Healthcare has developed in this sector. It explores how these healthcare providers are endeavouring to provide services to Malaysia vast and widely spread population, through innovative methods. How these strategies implemented affects market share is also an elaborate part of this study. In this light, the study sets to identify the market growth strategies implemented by this company, its strategy development process and how the strategies have affected its market share. As basis for an empirical research process, a theoretical framework was compiled from existing literatures on market growth strategies and strategy development process, where the strategies were considered both at the business level and corporate level. The analysis of the empirical findings showed that this company implements acquisition, partnership/networks and diversification at the corporate level, differentiation at the business level as its market growth strategies. This company develops these strategies through a planned process, meaning that strategies are intended and these strategies have a positive impact on the company as its overall market situation has increased. This study offer some contributions for this company on how some strategic adjustments can be made in order to improve the current market situation and some recommendations for its management in better decision making. Keywords : Healthcare, Growth Strategies, Competencies


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[Type text] The Malaysia Healthcare Industry has enjoyed the rapid growth in the last decade. It is important for an industry player to increase their market share in order to take leverage in the economy of scale to increase productivity and profitability. However, increasing marketing activities, prudent financial management and quality improvement are imperative due to intense competition. The private healthcare sector in Malaysia has experienced continuous growth since the beginning of the 90s. Approximately 5% of the GDP are dedicated towards the health care sector. During 9 th Malaysian Plan (9MP) period, the government has allocated about RM10.28 billion for health, a 7.55% increase from the previous 8th Malaysia Plan. Due to quality of services at reasonable cost, Malaysia is experiencing a constant increase in health tourism. Patients from neighbouring countries with less developed medical infrastructure (Indonesia, Indo China, etc) as well as patients from highly developed countries that only provide health care at a high cost, choose to seek treatment in Malaysia. The government is making efforts to expand the health tourism industry in a big way and has identified as one of the potential growth areas in the countrys tourism industry. The Ministry of Health (MOH) has set up a health tourism department to work together with Tourism Malaysia to actively promote the health tourism. The local health providers have the potential of raking in at least RM2.2 billion earnings a year in health tourism packages by 2010. The private healthcare industry in Malaysia is set to record steady growth. The overall expenditure on healthcare is expected to rise, driven by an expanding economy and growing awareness on the importance of healthcare and prevention of diseases. Nevertheless, Malaysias 5% expenditure on healthcare as a percentage of GDP and on a per capita basis still trails that of the Organization for Economic Co-operation and Development (OECD) countries average of 8.6%, indicating more upside. The number of private healthcare provider has increased and mostly controlled by the major player. The competition among them had resulted in the tremendous improvement of the service level. Service level in public provider is still behind those in private sector. The increasing level of education and standard of living among Malaysian has resulted in customer being more demanding and meticulous about health issues. But, look at the different angle; it has given more avenues to the private healthcare in Malaysia to continue their growth and fulfilling the needs of their customers. Thus, given the abundance of opportunities available in Malaysia, how would a major operator position itself for intensive, extensive and diversified growth? Healthcare Industry in Malaysia Malaysia is as part of ASEAN, a gateway to the rest of Asia, which has the fastest growing economies and where 75% of the worlds population resides. To this, Asias health care market constitutes approximately 45% of the global health care market and this share is expected to increase to around 55% by the end of 2009. Accordingly, a diverse range of medical equipment has to be imported to meet the growing needs. The health care sector in Malaysia has received increasing focus throughout the last couple of years and was rated as number one on the American Embassy New economy sector as the sector in Malaysia with the best business opportunities in 2007. [Type text]

[Type text] There are two types of medical services in Malaysia, namely, the public medical sector and the private medical sector. The public sector is the main provider accounting for approximately 57% of the total health care expenditures. During the last two decades the private sector has developed significantly. The government wants gradually to shift from its role as being a provider to that of a regulator, who sets norms and standards for both the public and private healthcare. Similar to the other industry in Malaysia, healthcare industry has been through the privatization phases. Some of the steps in the privatization process are listed below: a) Rapid growth in the number of private hospitals. In 1980 there were only 50 private hospitals with less than 2,000 beds, and currently there are 224 private hospitals with almost 9,000 beds. b) Privatization of non-clinical services, such as cleaning, laundry, facility maintenance, and waste management. c) Privatization of pharmaceutical distribution. The previously public Pharmaniaga, which distributes about 75% of all drugs in the public sector, was privatized in 1994. d) The Malaysian government finances the public health care sector, whereas the private sector is either financed by charity organizations, run on a non-profit basis or as profit-oriented companies. Although the government does not finance the private sector it is still very supportive, as the private sector supplements the public sector in meeting the demand for health services. Market Growth Strategic Types Multinational companies are recognized to play a great role in globalization but the fact that they display a wide range of market expansion or growth strategies is of little note. In strategic management, there are three main strategies that can be adopted by any organization in a growth process and these strategies include internal development, strategic alliance, mergers and acquisition. These strategic types can be divided in two levels:a) Business (internal development) b) Corporate level (strategic alliances, mergers and acquisitions) strategies. These two levels of strategy are the same levels in which strategies in a companies being identified: Business Level Strategies Business level strategies are strategies a company uses to compete successfully in a particular market. This means that business level strategies are concerned with which products or services to be produced, in which markets to sell these products/services so as to have advantage over competitors in order to achieve the companies objectives which could be long term profitability or growth of market share. This level of strategy is often called competitive strategies as they are used to achieve competitive position in a particular market. Porter was the first to propose the three elements that of business level strategy are compose. These Porters three generics of strategy include overall cost leadership, differentiation and focus but it was very difficult to differentiate these elements, so a [Type text] a.

[Type text] strategy clock that is composed of these three generics was used to better explain what business strategies are. The strategy clock considers price in addition to Porters three factors and how these factors serve as competitive strategies at the business level are explained below. Competitive advantage can only be achieved if a company provides its customers what they actually want or need and at a price better than its competitors. The strategy takes this into consideration as it represents the different positions in the market where customers have different requirements and the strategies that can be used at each position to achieve this competitive advantage. The various strategic options on the strategy clock are shown below.

Figure 1 : Competitive Strategy Options From the table above, there are eight different strategic options from the strategy clock and these options form an important concept that helps managers to better understand the changing requirements of markets and the choices they have when it comes to market positioning and/ or achieving competitive advantage. b. Corporate Level Strategies Corporate level strategies refer to the levels of an organization management above that of the business units that has no directs interaction with buyers and competitors. This means that they are concerned with the overall purpose and scope of a company. It also involves how value is added to the different parts of the organization (SBU). Corporate strategy consists of deciding the scope and purpose of the business and resources by top management to achieve the objectives set for the business and how a corporate parent creates or adds value to SBUs. In every organization it is looked as management strategy above the business strategy and comprises of decisions about the scope of the organization [Type text]

[Type text] and the diversity of the organization product/service as well as the geographical diversity of the business unit in a corporate portfolio. To do this it ensures proper management of the organization scope and diversity to corporate level in order to gain market growth. Methodology This applied research analyzed document obtained from the XYZ Healthcare in order to enable researchers to conduct the analyses. Researchers used the Ansoff Model, PESTEL Analysis of the Macro-environment, Porters 5 Forces, Critical Success Factors and Drivers of Change, Competitive Analysis, Value Chain Analysis, and SWOT. Findings and Analysis The standout feature of this paper is a presentation of Michael E. Porters five forces model of competition and Ansoff Model of Growth. The analysis of the financial performance review the financial position of the company and its contribution to the shareholders. Porters 5 Forces Based on the model, the following analyses were obtained. a) Competitors The major competitors is ABC, that captured 14% of the total healthcare market share. Its followed by few others private healthcare company in Malaysia. Due to government control, the competition in this industry is said to be fair. Government had imposed zoning requirement to ensure that no hospital is built within the vicinity of the other hospital. b) Bargaining power of the suppliers In terms of manpower supply, XYZ gets its supply from many institutions in Malaysia that provide skilled workers such as Putri Nursing College and Masterskills Malaysia. In terms of raw medical supply, XYZ obtained its pharmaceutical supply from its very own pharmacy chains called XYZ Care. By controlling the whole supply chain, XYZ can gain the competitive advantage and become stronger and more established compared to its competitors. c) Barriers to entry / Potential entrants A barrier to entry to this industry is relatively high due to the control from government. Government had enforced a regulation called zoning requirement to control an entry into the market. d) Bargaining power of the buyers In this industry, there are few dominant seller and plenty of buyers. Since government control in the industry is very high, none of the industry player can control the price.

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[Type text] e) Threats of substitutes Substitutes may be from government hospital, other private hospital and general practitioners clinic (GPs). The emergence of new private hospitals and upgrading of government hospital has become threats to XYZ and in the same time become substitutes to customers. PESTEL Analyses Healthcare in the future will be shaped by a complex set of converging forces that are anticipated to cause monumental shifts in how healthcare is provided and delivered. The uncertainties and expectation from the PESTEL analysis pointed up major drivers that will shape the future directions of XYZ namely Economic Growth, Government Initiatives, Increase in Household Consumption Expenditure, Increase level of patients awareness, Increase level of life expectancy, and Changes in lifestyle. Change become the organizations attempt to respond and adapt to new operating requirements generated by demands from the environment. Value Chain Analysis Infrastructur e Management emphasis on quality of services to meet the customer expectation. It can be done through Clinical/Corporate governance, Accreditation & General Audit HR Recruitment Training & Multi skills, Training & Dev Cust. Relations Management & Selection, Dev Measure competent & Performance training Transfer Performance responsible Measurement feedback staff Technology ITS MIS MIS Internet/Intranet Internet/Intranet Development Clinical Audit BSC Cust Database Cust Database BSC BSC BSC Procurement Supplies, Transport, IT Services Drugs, Clinical Billing & Equipment Medical Services Accouns Devices, IT Pdt Quality Certs - Design, Hospital - Hospitals - Customers - Custs survey built hosp Operational outpatient profiling feedback building Systems & inpatient database - Health (Policy & Svcs - Advance - CRM promotion & Procedure) med. - Advance - XYZ Hosp. Edu. Facilities Clinical healthcare brand name - Clinical - Qualified Process & Facilities correspond - Centralized healthcare Procedures & - Multiple ence marketing Treatment pros clinical activities - Home visits disciplines - Shared [Type text] MARGIN

[Type text] support services - Materials supplies INBOUND LOGISTIC S Figure 7 : Value Chain The Value Chain Analysis above indicates that human resource is the core competence and the key to XYZs competitive advantage. In recognizing this, XYZ has been moving towards HR driven. HR has been acknowledged as the driving force in achieving the overall strategy. Human resource is important in the primary and secondary activities of XYZ. Most of XYZ staff is well trained. There are various human resource development programmes and training conducted continuously to cater the need of various levels of management and staff. Most of the management and staff are multi-skill and involved in various quality improvement activities. Teamwork among the doctors, nurses and staff, enhance the quality of service delivery. XYZ hospitals through their Credential Committees ensure that only doctors of high credential and reputation are accepted in XYZ hospitals. XYZ is the only private organization that established its own Good Medical Practice Guidelines to maintain a good standard of professional practice, prevent and manage poor practice i.e. misconduct, poor performance or practice by the doctors. Continuous training programmes (academic and practical) are being held for managers, executives and paramedics. They will be exposed to the practices of the hospitals and universities overseas. XYZ is also sending its staff for various training programmes organized in and outside the country. Collaboration with international varsities proves that the management has a strong commitment in staff training and development. XYZ also has valuable experience in project management, hospital and equipment maintenance and project commissioning. However, the company is experiencing shortages of experienced nurses and allied health personnel. These are due to global shortage of nurses that results higher demand for Malaysian nurses and highly attractive offers overseas. Moreover, the compulsory service requirement by the government will also be detrimental to the private sector. The shortage of paramedic staff in the country affects service delivery to a certain extent. These shortages will require higher investment in training. XYZ hospitals are also facing the problem of conflict and relationship between the management and some doctors. Although most of the consultants in the hospitals are resident consultants, they are not employees of the hospitals. Hence their behaviours are difficult to manage towards achieving corporate objectives such as in the areas of management, fees, charges, QIA etc. Skills There are few industries that employ personnel with such a wide range of expertise as healthcare. Physicians, nurses, technicians, and semi-skilled employees work [Type text]



[Type text] interdependently to care for patient. Healthcare organization like XYZ cannot function properly if it fails to attract them to fulfil its manpower requirements. This is particularly important since hospitals are labour intensive, hence vulnerable to shortages. The increase in types of services coupled with technological changes demand for different types of personnel. Selection strategies, training programs, compensation systems and career development programs need to be dealt properly to attract and retain the workforce. Staff development program through job enrichment or multi skills is another way to have effective workforce. Leadership Styles Characteristics of XYZ leadership conform to visionary characters. Visionary leadership is essential, particularly in developing and inspiring teams. Mentoring program is also helpful in assisting the succession plan of XYZ. Shaped Values The essential and enduring tenet of the company is its core values - the very small set of guiding principles that have a profound impact on how everyone in the organization thinks and acts. XYZs Corporate Core Values are Safety, Courtesy, Integrity, Professionalism and Continuous Improvement. These values are powerful guiding principles; the soul of the organization - the values that guide all actions. These essential core values also define, inform, and guide professional practices of XYZ staff. System XYZ is directed and controlled by its system of corporate governance. The appointed directors, in conjunction with the executive management team, determine policy and strategy to continuously develop the business, control risks and enhance performance of the company. XYZs corporate governance systems provide the framework for directors and company management to achieve these outcomes within an accountable environment. XYZs corporate governance system includes Risk Management and Clinical Governance. Policies and procedures are continuously improved and streamlined based on best practices throughout the Group. XYZ has developed internally Hospital Information Technology System (HITS). The team is also implementing K-CIS, an integrated Information System that enhances efficiency and effectiveness in service delivery and decision making process. SWOT Analysis The IFE and EFE SWOT Matrix is tabulated which reflects the strategy used by XYZ to tackle the SWOT issues. Figure 4.3 explains the matrix in details.


Oppurtunities O [Type text]

Strength S Human Resource Operational Support Technology and R&D Financial Aspect Marketing SO Strategies

Weaknessess W Competencies Gap High Operation Support Rapid Change of Technology Slow Economic Growth Emerging Competitor WO Strategies

[Type text] Acquisition Govt Policies towards healthcare Brand Reputation Growing demand Threats T High Initial Set-up Cost Shortage of competent & skill staff Change in customer preference (DD & SS) Political Change Figure 7 : SWOT Matrix In the case of XYZ, the main factor that contributed to its success is the competent human capital. Together with another strengths, XYZ can balanced its weaknesses and maintain its position as the market leader in healthcare industry. Growth Strategies in XYZ Growth Strategies in XYZ can be divided into three main streams which are: (1) Concentrated Growth Strategies, (2) Business Strategies, and (3) Functional Strategies. Concentrated Growth Strategies the application of Ansoff Model Joint ventures partner of choices for non success hospital. Proven financial back-up 9Al-Agar Reit / XYZ) ST Strategies Establishment of PNC Acquire hospital to avoid high set-up cost Capture customers info system and study nthe need to meet the changes in demand Re-align business operation to suit the new environment. High operation cost and high risk (unstable economic growth) WT Strategies Focus on Customer Centricity Distinguish the company form its competitors by providing excellent customer service and state of the art medical facilities

Figure 9 : Ansoff Model a) Market Penetration

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[Type text] XYZ Group continues to strengthen its position as the number one private healthcare provider in the country. The existing market remains the most important focus for the Group. Aggressive marketing strategies are called to ensure the Group current market share does not erode. Existing and new customers are offered value added service such as health promotion campaign at clients premises, local and overseas exhibition, generous discount in return for volume business, and loyalty rewards. b) Market Development The company embarks on new market expansion via the following various efforts such as; i. Forming strategic alliances with potential partners in various industries. ii. Considering strategic acquisition or management for speedier growth in new areas. iii. Expanding and improving facilities of existing hospitals to stay ahead of the competitors. iv. Identifying and seizing future business opportunities such as health and medical tourism to generate wider base revenue generator. v. Focusing on other target markets such as students in tertiary institutions, people with long term and chronic diseases, the elderly and preventive program like Wellness Screening c) i. Product Development Introduction of the new facilities and create Centre of Excellence to existing hospitals to develop new products and services such as supercon MRI, fertility centre, catheterization laboratories, cardiac centre, orthopaedic, birthing centre, obesity centre, rehab centre, etc. Bring in experienced consultants of various disciplines to complement existing medical workforce and also JV with sub speciality consultants to enhance the services and introduce new product to customers. Upgrade outdated equipment and facilities with state-of-the-art equipment as to keep ahead of the competition and to recruit staff with various talents and skills to complement a range of services offered by the hospitals. Develop and provide new services such as retail pharmacy within the hospital, home nursing, disease counselling and support group, day care centre, commercial street in the hospital and also managing of GP clinics to act as the gatekeeper for XYZ Group of Hospitals.

ii. iii. iv.

Business Strategies The generic strategies of XYZ for 2007 2011 are to grow with focus in core activities which is hospital management while continuing to differentiate the company and services from the competitors. Depending on the hospitals, the alternative directions will still be following the ansoff models as follows: Market Development: a) Increasing market share by managing or acquiring more hospitals locally and overseas. b) Business Excellent Project (BEP) [Type text]

[Type text] c) d) Bid for Government contracts like foreign workers screening services, ambulance and laboratory Managing retirement home

Service Development: a) Develop & innovate new services to existing customer e.g Cardiac, Oncology, Obesity, Daycare, Home Nursing, International Centre. These strategies will be implemented for Johor Specialist Hospital, Ampang Puteri Specialist Hospital, Damansara Specialist Hospital, Ipoh Specialist Hospital. Market Penetration a) Increasing marketing activities by improving customer retention through Customer Relationship Management and increasing capacity at all existing hospitals. Related Diversification a) The company has been diversifying and growing healthcare related business such as laboratories, nursing education, hospital management, commissioning and consultancy services. b) Manufacturing of health and health related products. The strategies can be applied and summarized in as per Ansoff Model as the figure 10 below.

Figure 10 : Ansoff Model for Business Strategies Functional Strategies XYZ adopted five Ps strategies as the marketing mix promotion tools to strengthen its market position. i. Pricing The XYZ Group pricing policy covers both consultant charges as well as hospital charges. For the consultant charges, the company adopts the current Malaysian Medical Association (MMA) Fee Schedule which is accepted in the industry. For hospital charges, [Type text]

[Type text] the Group practices a competitive pricing policy to ensure patients enjoy value-added service especially with regards to the pharmacy charges and other support services such as laboratory, radiology, rehabilitation and physiotherapy services. The Group also introduces various packages to cater for the demand requiring fixed pricing. Discounted pricing pressures from institutional clients such as corporate, MCOs and insurance companies require the Group to adopt an aggressive pricing model for them. ii. Product The XYZ Group provides the full spectrum of comprehensive curative, therapeutic, preventive and specialized care in its hospitals. XYZ Group also continues to offer different niche specialties in different hospitals within the region to promote group synergy as well as to achieve cost efficiency. The key services provided by the XYZ Group are as follows; a) Specialist outpatient services b) Specialist inpatient services c) Day care services d) 24-hour accident and emergency services e) Medical checkup and health screening services f) Professional support services in the areas of physiotherapy and rehabilitation care, nutrition and diet counseling, home nursing care, and pharmacy counseling. g) Niche specialty services such as cancer care, cardiac care, renal care, neonatal care, ICU/CCU care, and diabetic care. In addition, XYZ Group will explore the possibility of providing ambulatory care to its patients in order to cut down on days stayed in the hospital, at the same time increase the number of episodes of the patients. iii. Place All XYZ Group of hospitals are strategically located in major towns in Malaysia. The hospitals are situated along main roads and near housing areas, thus make them easily accessible by the surrounding community. This strategy will remain to be a major consideration for development of future hospitals. iv. People XYZ Group always encourages its staff to acquire knowledge on a regularly basis for them to be an effective workforce. The company adopts a strategy to develop and maintain an efficient and experienced nursing team throughout the hospitals through continuous education, overseas placement program, besides getting experienced nurses from different countries. v. Promotion XYZ Group recognizes the importance of effective promotional campaigns in order to become a hospital of choice for the public. Therefore, promotion of XYZ Brand throughout its hospitals is essential so that the patients will associate the brand with quality and professional service, known domestically as well as internationally. Apart from promoting curative and therapeutic services of the hospitals, the Group also actively [Type text]

[Type text] promotes preventive healthcare campaigns, such as public talks on dietary and rehab, medical forum, regular blood and blood pressure checking, and health campaigns. In line with this, XYZ Group offers competitive medical screening packages to encourage the public to go for routine checkups to maintain their health as well as to prevent development of new diseases, and for early detection of diseases. Recommendations Additional research should be undertaken to gain a continuous view of growth strategies used by the company. Growth strategies even after some fifty years of continuous research will still be one of the problems and challenged facing companies today. Furthermore, factors like technological advances, globalization, changes in customers perception and expectations leave companies with an uncertain growth future as most organizations today do not guarantee which strategy is best for growth. Therefore, we proclaim the need for researchers to continue carrying out studies on growth strategies used by XYZ or any other companies. The outcomes of such studies will enable a company to be at par with changes in both its external and internal environment. The result of the study have shown that XYZ had utilized the concept of Ansoff Model in order to come out with the three main strategy focus which are the Concentrated Growth Strategies, Business Strategies as well as Functional Strategies. Therefore, it could be interesting if further research could be undertaken to confirm either fully or partially the findings of the study.

Product-market strategy, as a competitive level strategy, concerns how the firm can best compete in its chosen markets to achieve organizational goals (Hughes & Morgan, 2007); ultimately, with the primary objective of achieving superior performance relative to rivals. Strategic managers must understand their market environment, customer needs, value drivers, and competitors behavior and from this, formulate and implement the correct product-market strategy (Varadarajan & Jayachandran, 1999), that is, to realize the strategy (Chowdhury & Lang, 1996).

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Consequently, strategic managers invest much time and effort in this strategy-making process to bring the product-market strategy to fruition (Menon, Bharadwaj, Adidam, & Edison, 1999). A key decision facing strategic managers is whether to persist or adhere with the current product-market strategy or change the direction of the organization and follow a new strategy (Lant, Milliken, & Batra, 1992).

Chowdhury, S.D., & Lang, J.R. (1996). Turnaround in small firms: An assessment of efficiency startegies. Journal of Business Research, 36, 169-178. Hughes, P., & Morgan,R.E. (2007). A resources-advantage perspective of product-market strategy performance & strategic capital in high technology firms. Industrial Marketing Management. 36. 503-517. Lant, T.K., Milliken, F.J., & Batra, B. (1992). The role of managerial learning and interpretation in strategic persistence and reorientation: An empirical exploration. Strategic Management Journal, 13, 585-608. Menon, A., Bharadwaj, S.G., Adidam, P.T., & Edison, S.W. (1999). Antecedents and consequences of marketing strategy making: A model and a test. Journal of Marketing, 63, 18-40. Menon, A., & Vandarajan, P.R. (1992). A model of making knowledge use within firms. Journal of Marketing, 56, 53-71. Vadarajan, P.R., & Jayachandran, S. (1999). Marketing strategy: An assessment of the state of the field and outlook. Journal of the Academy of Marketing Science, 27, 120-143. Sheppard, J.P., & Chowdhury, S.D. (2005). Riding the wrong wave: Organizational failure as a failed turnaround. Long Range Planning, 239-260.

Menon et al. (1999) identified from interviews with managers that staying the course (p. 21) is an important aspect of successful strategy making. This decision would appear, on the face of it, to be a relatively simple one to address: if the environment changes substantively enough then surely a new product-market strategy is best? After all, the organization will not be in fit with its market environment and so requires a new strategy (Sheppard & Chowdhury, 2005) as advocated in strategic fit theory.

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