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What this unit is about

What follows is a caselet based on a TMA submitted by a past student. Whilst the material of such caselets is based on the student submissions, I have taken the liberty of making corrections, additions, fabrications and exaggerations in order to emphasize certain lessons and to make the material instructive to future students. What we have in Units 7- 18 is a wealth of illustrations of how CFS can be applied in very different environments.

I would like to acknowledge with grateful thanks the contribution made by past students for the benefit of future students.

Aims ofthe unit

• to illustrate the applicability of CFS to this environment

What you will learn

• an appreciation of the difficulties involved in moving from theory to practice

• how to approach a seemingly difficult environment

• the practical use of market spaces, the CAC and in particular gaps in the CAC

• how to get lock-on

Distance Learning MBA

2 Customer Focused Strategy


In 1975, our company - the Medical Corporation Jin-i Association - was established in Japan. We have provided medical services specialising in eye diseases (an ophthalmological clinic) covering general eye diseases (e.g. trichiasis, epidemic ophthalmia, glaucoma, and cataract). The strength of our clinic is 'cataract day operation' so that main patients are the aged because the disease is closely related to aging.


In the past forty years,provision of high quality medicine with low costs (universal health-insurance coverage) for patients has been realized and high economic returns for medical institutions has been guaranteed under the sustainable National Health care system.

Hospitals/clinics were confident in their providing medical service and patients believed that it would be the best medicine they could expect at each of the time. Strong trust also was there between patients and medical doctors.

The traditional business model was protected by the national health system so that what clinics should do was to just wait for coming patients, then diagnose and prescribe. There was little necessity to introduce management theory or business mind in the medical industry. In other words, it was reactive business model.

However, the National Health care system has faced the crisis due to huge costs to maintain its system with the rapid demographic change into an aging society since 1980s and highly advanced medical technology. It is required to reform National Health care system, to adjust costs at appropriate level in the total national budget and to sensitize ownership toward own health among people not depending on health care system alone.

Therefore, the new business model is a request of the times. It should be more patient-centred (or customer-focused), needs holistic healthcare approaches (not only eye disease but whole health care). It must be active in communication with patients, medical treatment, health care products and services, consultation and information provision.


Before we reveal what Y oshihito had to say, suggest possible market spaces for this environment.

Imperial College London

© Marcel Cohen

Unit 14



Defining Market Spaces

Market spaces go into one of three categories, progressing from existing to emerging and then to imagined. As the transforming a company extending its market spaces, it opens up more room for customer lock-on and new wealth.

In the case of our medical corporation, the existing market space can be expressed as 'Eye Disease Management' in which diagnosing and prescribing are main services. The main target of customers is the aged. The emerging market is 'Eye Care Management' that is for prediction, reversing and prevent diseases for the potential patients who are the middle aged. And the imagined market is constructed as 'Wellbeing Promotion' where customers are no more patients but ones who show strong enthusiasm to prolong and preserve extended life and wellbeing. It includes the youth, schoolchildren and people who spend healthy life.

Wellbeing Promotion

Main target: the youth, schoolchildren & who may never get eye diseases

Eye Care Management Main target: the middle aged

Eye Disease Management Main target: the aged

? Before we reveal what Yoshihito had to say, consider the elements of a CAC for each of his market spaces.

Distance Learning MBA

4 Customer Focused Strategy


Constructing Customer Activity Cycle

i. Existing market


Undergo treatment Measure results Attend the clinic

Feel difference of eye conditions (before and after)

Feedback/review satisfaction/claim to the clinic, other medical/public organisations, website

Look for second opinions


• Consult with family, friends etc. about eye problems

• Gather information about eye clinics


• Communicate with receptionists

• Fill in disease history interviewed by nurses

• Take ophthalmological examinations

• Communicate with, diagnosed and prescribed by a doctor

• Pay at a reception

In the Existing market, namely 'Eye Disease Management', the assumption is that a patient already has ophthalmological disease and desirable outcome would be to get it diagnosed accurately and quickly. It tries to manage disease with minimum pain and discomfort, maximising and accelerating healing, and trying to hold off or reduce the risk of recurrence. The object is to diagnose and prescribe.

Patients who are suffering from eye diseases go through the three stages in their customer activity cycle: pre the operation when they get the symptoms and decide what to do, during the operation when they experience the various procedures, and post, when they are being monitored and rehabilitated.

When they get the symptoms, they would consult with family, friends about problems and try to gather information or knowledge to know what to do. Then, they decide which an eye clinic they should go. Once they visit there, first of all, they are asked to fill in disease history documents. They communicate and sometimes are being interviewed by nurses.

They also take ophthalmological examinations and see a doctor. A doctor communicates, diagnose prescribe patients. Then, they pay at a reception and make a booking for the next consultation, if necessary.

When patients leave the clinic post operation, a doctor will prescribe what to be done. Patients are going to start treatment and see its effect and result. They may visit a clinic to have further consultation or to monitor progress. The opportunities to give feedback and review satisfaction or sometimes claims from patients are opened at both the reception of a clinic and on the website. They can also access to other medical institutions to have a second opinion.

Imperial College London

© Marcel Cohen

Unit 14


ii. Emerging market


• Realise warning signals in the dairy life or for example, through regular medical


• Look for information (books, internet etc. )about causes

• Consult with family, friends etc.

• Contact to hospitals/clinics


• Visit the clinic or website homepage

• Fill in disease history interviewed by nurses or on the website

• Visit ophthalmological examinations to know more details about the current eye


• Learn preventive care by the clinic visit or website

• Purchase preventive medicine or any other necessary eye care tools

• Pay at a reception or on the website


Undergo preventive care Measure results

• Attend the clinic or visit the website for the feedback/review

• Update knowledge (education & seminar)

In the Emerging market, namely 'Eye Care Management', the assumption is that a patient does not have the disease but that if they are predisposed, they would be told or shown how to detect early warning signals. These would be spotted with advanced technology before the onset of the disease. Individuals would be helped to prevent the disease. The object is to predict, reverse and prevent possible diseases.

In this market space, customers (people who have high risk of disease in the near future) come across an opportunity to realise warning signals in the dairy life or for example, through regular medical check-up initiated by the workplace. Once they know possible risk of disease, it is expected that they start looking for information (books, internet etc.) about causes of disease and consulting with family, friends or directly contacting to hospitals/clinics.

If they find it serious, they will visit the clinic or online medical consultation. They are required to fill in disease history interviewed by nurses or on the website and have more detailed ophthalmological examinations in order to make sure what to do for prevention. They may purchase preventive medicine or any other necessary eye care tools at the clinic reception or on the website.

They continue undergoing preventive care, measuring results, attending the clinic or visit the website regularly for the feedback or review. Moreover, there will be some who are actively updating knowledge through attending open education seminar in medical treatment and prevention.

Distance Learning MBA

6 Customer Focused Strategy

iii. Imagined market

Pre • Realise the current health status (not only eye)
• Discuss with family, friends etc.
During • Self-Learning about common (eye) diseases, especially relating to aging by
• Attend seminars/lectures
• Set own health promotion targets
• Make action plan for health promotion
• Join community network (e.g. sports/healthy food club activities)
• Join virtual health promotion and wellbeing networks (e.g. SNS: Social
Network Service)
• Use health management/promotion game software (e.g. Wii Fit)
Post • Measure results
• Update knowledge In the Imagined market, namely 'Wellbeing promotion', the assumption is that a patient may never get the disease so that the object is to prolong, preserve extended life and wellbeing.

In this market space, both customers and medical institutions, are required to extend our focus from only eye health to whole body and mind, from disease management to health promotion, in other words from cure to care. It is a drastic change of mind-set.

Customers have a great interest of knowing their current health condition, which would not be only eye but about total body. They often discuss about their health with family, friends and try to extend their information network about wellbeing in order to practice any possible actions for health promotion.

First of all, customers try to know more about their body and mind, the way how to spend healthy life and wellbeing so that they may look for self-study materials (books, online learning etc.) about common diseases relating to aging. They will also attend a seminar or lecture, join community network (e.g. sports/healthy food club activities) and join virtual health promotion and wellbeing networks (e.g. SNS: Social Network Service).

Based on knowledge they gained, they will set their own health promotion, make action plan and transform it into action that might include participating any social networks and activities. Enjoying health promotion game (e.g. Wii Fit) with family at home is another possibility. Those activities are monitored, reviewed and updated regularly. The activity cycle will be incorporated into their daily tasks, in other words it becomes a part of life, habit.

The whole point of constructing the CAC's is to establish whether there are any gaps which could lead to competitor entry. Here is what Y oshihito had to say.

Imperial College London

© Marcel Cohen

Unit 14



Action List 1. Building:
• screenmg system of predisposed people;
• Online system for eye care management and self health promotion;
• Preventive activity result measurement tools;
• Knowledge management system (for updating).
2. Setting up, being there and assisting:
• Actual/virtual community for health care and promotion;
• Target setting;
• Assessing results of health care and promotion activities.
Gaps • Insufficient capacity in research, ICT , consulting and promoting
customer service
Alliance · Government (Ministry of Health and Welfare)
• Health care research institutions or other medical organisations in the area
(e.g. General Practice, internal medicine)
· IT system development firm
· Game software firm
Operation • Online doctor (consultation, second opinions)
• Online education and information centre
• Health care/promotion community
· Communication centre for patients and their family (marketing,
satisfaction! claim) It is critical to identify gaps, possible alliance and operation for transforming market spaces from existing to emerging and imagine under the constrained exiting resources and capacity within a company.

It needs building the system of screening predisposed people, online system for eye care management and self health promotion, measurement tools for health-related activities and health knowledge management system.

Setting up both actual and virtual communities for health care and promotion and provide any assistance in setting customers' own health target, monitoring and reviewing their activities.

However, there are some capacity gaps in research, building ICT system management, consulting and promoting customer services to realise these actions.

We need to corporate with the government (e.g. Ministry of Health and Welfare), health care research institutions or other medical organisations in the local area (e.g. General Practice, internal medicine) to provide total health care services. It is also required to enhance communication skills, attitude, and heart of hospitality for achieving professional customer services that influence customer satisfaction. In addition to that, business collaboration with ICT system development and software firms is critical to extend access and improve quality medicine not only for the remote area but for the urban area in the pursuit of harmonisation of health costs and its outcomes.

Distance Learning MBA


Customer Focused Strategy


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Imperial College London

© Marcel Cohen