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Customer Focused Strategy

Yoshihito NAKAYAMA
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1. Introduction: profile of company

In 1975, our company - the Medical Corporation Jin-i Association - was established in Japan.
We have provided medical services specifying in eye diseases (an ophthalmological clinic)
covering general eye diseases (e.g. trichiasis, epidemic ophthalmia, glaucoma, 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.

2. Identification of entire customer problems

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.

3. 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.
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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

4. Constructing Customer Activity Cycle

i. Existing market

Existing market: Eye Disease Management

Pre  Consult with family, friends etc. about eye problems
 Gather information about eye clinics
During  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
Post • 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

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
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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.

ii. Emerging market

Emerging market: Eye Care Management

Pre  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
During  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
Post • 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.
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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

iii. Imagined market

Imagined market: Wellbeing Promotion

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.
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5. Possible gaps, alliance and operation

Action List 1. Building:

 screening 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,

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 syste-m.

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.