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Mengapa SpringBoard SpringBoard adalah program instruksional College Boards dalam Seni Bahasa Inggris dan Matematika untuk nilai 612, tersedia dalam format cetak dan digital. Program ini dibangun berdasarkan keyakinan inti ini: Bila guru dipasok dengan bahan, metode, dan dukungan terbaik, kesuksesan siswa berikut. Demonstrasi Sekolah Tur model sekolah SpringBoard untuk melihat dampak program di kelas kehidupan nyata. SpringBoard Digital Jelajahi platform digital pemenang penghargaan kami dan lihat bagaimana alat canggih dan mudah digunakannya akan mengubah pengajaran dan pembelajaran di sekolah atau distrik Anda. Persiapan Mendapatkan sampel dan akses percobaan ke menu SpringBoard Digital.Primary Crowding di Departemen Darurat: Strategi untuk Mengakhirinya Penulis: Abdullah Bakhsh, MBBS (Dokter Residential Geothermal, Emory Emergency Medicine) Editor: Justin Bright, MD (JBright2021) Definisi: The ACEP Crowding Resources Task Force mengadopsi definisi berikut kepadatan ED: Situasi di mana kebutuhan yang teridentifikasi untuk layanan darurat melebihi sumber daya yang ada di ED. Keadaan ini terjadi pada rumah sakit EDs bila ada lebih banyak pasien daripada tempat tidur ED yang berreparasi dan waktu tunggu melebihi jangka waktu yang wajar 80. Kerumitan melibatkan ketidakmampuan untuk pasien triase yang tepat, dengan sejumlah besar pasien terakumulasi di daerah tunggu ED dari kategori penilaian triase. Kepadatan ini menyebabkan pasien dievaluasi dan dipantau dalam waktu kurang dari pengaturan ideal seperti di ruang tunggu atau lorong ED saat mereka menunggu tempat tidur dengan ED. Skenario Klinis: Seorang pria berusia 62 tahun datang ke departemen gawat darurat (ED) dengan nyeri punggung bawah setelah jatuh mekanis saat ia tergelincir di genangan air. Setelah menunggu 14 jam, akhirnya dia dipindahkan ke ruang ujian. Setelah diperiksa, Anda memperhatikan kelembutan tulang belakang lumbal dengan ketidakmampuan melenturkan paha kirinya. CT dari tulang belakangnya yang lumbal menunjukkan fraktur tubuh vertebra L2 dengan retropulsi. Pasien harus dipindahkan ke rumah sakit lain karena tidak tersedianya layanan bedah saraf. Penundaan perawatan sebagian besar disebabkan oleh pasien asrama dan kurangnya staf. Bahaya Keributan ED: Keadaan darurat berhubungan dengan keamanan dan akses terhadap perawatan kesehatan 1. Penundaan terhadap analgesia, terapi antibiotik, trombolisis, atau intervensi koroner perkutan akibat kepadatan ED semuanya dijelaskan dengan baik 2-5. Pasien Intensif (ICU) yang menumpang ED yang mengalami keterlambatan lebih dari 6 jam saat diantar ke ICU telah meningkatkan lama tinggal di rumah sakit (7 lawan 6 hari), dan tingkat kematian yang lebih tinggi (10,7 banding 8,4) 6. Kerumunan Juga merusak martabat, privasi, dan kelengkapan asuhan. Kesalahan meningkat dengan kepadatan ED. Banyak dari ini adalah kesalahan kelalaian daripada kesalahan komisi karena staf darurat harus secara bersamaan merawat pasien rawat inap dan fokus pada keadaan darurat baru yang masuk di pintu 7,8. Apa Penyebab ED Crowding: Jumlah pasien di gawat darurat pada suatu waktu tertentu adalah fungsi dari tiga variabel: input, throughput, dan output. Hal ini dapat dijelaskan oleh model asplins perawatan akut (gambar 1). Sebelum intervensi dilembagakan, sangat penting untuk mengidentifikasi penyebab utama berkerumun di departemen gawat darurat individu. Periset awalnya berfokus pada faktor input seperti penggunaan ED untuk keluhan yang tidak muncul. Data mereka pada akhirnya menunjukkan bahwa alasan mereka untuk melakukannya termasuk akses yang tidak mencukupi atau terlalu dini untuk perawatan primer 23,24. Penelitian yang lebih baru, bagaimanapun, sangat menyarankan bahwa faktor masukan ini bukan akar permasalahan 25,26,27,28. Staf yang tidak memadai adalah faktor throughput yang umum diteliti yang dapat menyebabkan crowding. Tingkat kepegawaian staf yang lebih rendah dan perawat triase cenderung untuk menunggu lebih lama untuk perawatan 34. Penggunaan layanan tambahan. Termasuk pemindaian tomografi (CT) terkomputerisasi dan prosedur lainnya, memperpanjang lama ED tinggal di antara pasien perawatan kritis bedah 36. Penyebab paling umum dari kepadatan ED dianggap sebagai blok akses (output). Pasien yang mengalami blok akses, yang ditentukan oleh waktu naik kapal yang melebihi 8 jam, dikaitkan dengan peningkatan pengalihan, waktu tunggu, dan tingkat hunian di ED 35 Australia. Lama tinggal di satu ED meningkat secara substansial ketika tingkat hunian rumah sakit melebihi 90 37. DEPARTEMEN DARURAT INTERVENSI Sebagai crowding meningkat, masuknya pasien melebihi arus keluar untuk jam diperpanjang setiap hari, sehingga kebutuhan untuk menempatkan pasien di suatu tempat 9. Untuk semakin banyak EDs solusinya adalah untuk memindahkan kedua pasien stabil dan semi stabil dari tempat tidur ED yang bersertifikat ke Lorong ED yang berdekatan, sehingga membebaskan tempat tidur ED resmi untuk pasien lain 10. Jika penyebab utama kepadatan penduduk adalah blok keluar, maka cukup bangun ED yang lebih besar untuk meningkatkan kapasitansi mungkin tidak menyelesaikan masalah 11,12. Dokter rawat inap dan rawat inap di Stony Brook University Hospital di New York berkolaborasi dan mengembangkan sebuah program dimana pasien lorong yang dirawat dipindahkan dari saluran ED ke rawat inap 13. Pasien mendapat lebih banyak perhatian di lingkungan yang lebih tenang dan lebih pribadi. Pengalihan perawatan pasien ini terbukti aman, dan pasien lebih suka naik di lorong rawat inap 14-16. Di beberapa pusat akademik pintu ke lantai melebihi 21 jam untuk 90 pasien yang dirawat. Akan masuk akal kemudian untuk memindahkan pasien yang dirawat dari lorong ED sampai ke lorong-lorong di daerah rawat inap saat rumah sakit penuh. Proposal semacam itu tidak baru dan, sebenarnya, digunakan secara luas di Pantai Timur 17. MENINGKATKAN PERSYARATAN DEPARTEMEN DARURAT Satu studi menyimpulkan bahwa penambahan dokter selama shift sibuk mengurangi lama tinggal dari 176 menit sampai 141 menit untuk pasien. Dipulangkan setelah evaluasi di bagian gawat darurat 18. Satu personil cadangan teraktifasi di rumah sakit sesuai kebutuhan selama musim epidemi virus, mengurangi waktu tunggu hingga 15 menit dan tingkat pasien yang meninggalkan tempat tanpa terlihat oleh 37,20. Untuk setiap perawat triase tambahan per pasien ED, waktu tunggu untuk semua pasien lainnya dikurangi rata-rata 28,8 menit dan untuk setiap dokter tambahan per pasien ED yang menunggunya, waktu tunggu dikurangi 82 jam 34. PROTOKOL PERAWATAN BERBASIS TRIAGE DAN NURSE INITIATED WORKUPS Dalam literatur, protokol triase lanjut telah dilaporkan untuk mengurangi lama tinggal pasien, 38,39 mengurangi waktu untuk pengobatan nyeri, 40,41 meningkatkan kenyamanan pasien, 40,42 mengurangi waktu untuk antibiotik pada pasien yang dirawat dengan pneumonia, 43 penurunan penundaan Dalam melakukan EKG dan mengelola agen trombolitik untuk infark miokard, 44 dan menurunkan biaya yang terkait dengan pasien yang memerlukan pemantauan satu-ke-satu45. Hal ini juga telah ditunjukkan untuk meningkatkan throughput dan kepuasan karyawan, dan mengurangi kesalahan medis. Pelatihan staf perawat untuk memesan sinar-X pada triase sangat membantu dan memotong pasien selama sekitar 20 menit 21. Dalam studi lain, perawat triase memprakarsai radiografi menggunakan OAR menyebabkan penurunan yang signifikan secara statistik selama 20 menit di median ED LOS pada pasien tersier. Pusat perawatan 33. MELAKSANAKAN PELATIHAN CEPAT CEPAT Pembentukan jalur layanan jalur cepat yang efektif menurunkan waktu tunggu pasien, 47-51 peningkatan throughput pasien dengan ketajaman lebih rendah, 47-49,52-54 dan mengurangi tingkat LWBS47-49. Ini juga mengurangi penerimaan di rumah sakit, 53 penurunan pengujian dan biaya, 53 dan peningkatan waktu penyedia yang tersedia untuk pasien dengan tingkat ketajaman yang lebih tinggi 52. Keseluruhan durasi tinggal ED diperpendek, 47-49, 51-52, 54 kepuasan pasien meningkat, 55,56 Dan tidak berdampak negatif terhadap hasil klinis (kunjungan ulang atau kematian yang tidak terjadwal) 49,53,56. Keberhasilan sistem jalur cepat bergantung pada ketersediaan staf medis dan perawat khusus sambil mematuhi protokol kaku dari pasien yang dapat ditempatkan dengan tepat di area perawatan 58,59. Kegagalan untuk melatih area jalur cepat dengan petugas medis yang tepat mengakibatkan gangguan pada program jalur cepat 58. Hal ini biasanya muncul saat staf jalur cepat memberikan perhatian mereka kepada pasien di area perawatan ED yang lebih akut lainnya 59. Kumpulan pedoman jalur cepat Dapat ditemukan di sini: OBSERVASI UNIT Secara tradisional, pasien yang membutuhkan perawatan di luar jam pertama di gawat darurat (ED) telah dirawat di rumah sakit. Tekanan ekonomi untuk efisiensi dalam perawatan kesehatan telah menyebabkan kebutuhan akan strategi baru bagi mereka yang sulit untuk cepat mendiagnosis presentasi ED. Dengan demikian, unit observasi semakin menjadi komponen penting dari ED modern. Rata-rata lama ED yang tinggal untuk pasien ED yang di awali adalah 5,5 jam sedangkan rata-rata lama tinggal pasien rawat inap adalah 5 hari 60. Rumah sakit semakin banyak diteliti untuk pasien rawat inap yang lamanya tinggal satu hari atau kurang 61. Lama menginap Mendefinisikan subset dari pasien yang kebutuhan klinisnya melebihi apa yang dapat dicapai secara realistis dalam 6 jam kunjungan ED, namun jika dikelola secara aktif memerlukan waktu kurang dari 24 jam untuk dirawat di rumah sakit. Pasien 6-24 jam ini sering memenuhi syarat untuk unit pengamatan khusus. Unit perawatan observasi yang dikelola ED menurunkan pengalihan ambulans sebesar 40 dan mengurangi separuh angka pasien yang keluar tanpa terlihat 22. Kondisi spesifik yang sesuai untuk pengamatan adalah: Studi Nyeri Dada telah mengindikasikan bahwa sekitar 4 pasien dengan sindrom koroner akut secara tidak sengaja dipulangkan dari ED, seringkali karena ketidakpastian diagnostik62. Empat penelitian prospektif acak menunjukkan bahwa relatif terhadap penerimaan rawat inap, protokol nyeri dada dikaitkan dengan biaya yang lebih rendah, lama tinggal yang lebih pendek, dan pemanfaatan sumber daya yang lebih baik63-66. Dalam sebuah penelitian oleh penderita asma McDermott secara acak diacak ke perawatan unit observasi darurat gawat darurat (EDOU) selama 9 jam tambahan atau perawatan rutin rawat inap setelah pengobatan standar DE. Mereka menemukan bahwa 59 penderita asma EDOU dipulangkan di rumah dibandingkan dengan kelompok kontrol dimana semua orang diasingkan. Tidak ada perbedaan dalam kedua kelompok selama masa tindak lanjut dalam hal tingkat kambuh atau morbiditas berikutnya. Namun ada perbedaan yang signifikan dalam lama tinggal mereka (8,8 jam vs 59 jam), biaya (1202 vs 2247), dan kualitas hidup 67. Dierck melaporkan bahwa pasien gagal jantung dengan tekanan darah sistolik di bawah 160 mmHg pada presentasi ED dan Troponin jantung normal awal saya secara signifikan lebih mungkin dikeluarkan dari EDOU dan tidak mengalami efek samping 30 hari (kematian, masuk kembali, infark miokard, aritmia) 68. Dehidrasi Dalam sebuah penelitian observasional retrospektif kecil, diagnosis dehidrasi diidentifikasi. Sebagai risiko tertinggi untuk kunjungan kembali lebih awal ke ED dan selanjutnya masuk ke rumah sakit pada waktu pulang kembali 69. Oleh karena itu, pasien ini ideal untuk pengelolaan lebih lanjut di EDOU setelah resusitasi awal di ED. Serangan Iskemik Transien Ross melaporkan sebuah penelitian prospektif terhadap 149 pasien dengan serangan iskemik transien yang diacak untuk masuk rawat inap (kelompok kontrol) atau unit observasi ED untuk manajemen dengan menggunakan protokol diagnostik yang dipercepat 70. Semua pasien dengan serangan iskemik transien memiliki temuan normal pada Computed tomography (CT) kepala, elektrokardiografi, studi laboratorium dan tidak ada sumber emboli yang diketahui. Kedua kelompok memiliki perintah untuk pemeriksaan klinis serial, konsultasi neurologi, ultrasonografi dupleks karotis, ekokardiografi, dan pemantauan jantung. Pasien protokol diagnostik yang dipercepat dengan hasil pengujian positif diterima. Dibandingkan dengan kelompok kontrol rawat inap, pasien dalam kelompok protokol diagnostik dipercepat memiliki panjang total tinggal yang setengah lama (26 banding 61 jam), menurunkan biaya langsung total 90 hari (890 banding 1.547), dan klinis 90 hari yang sebanding Hasil. Pasien protokol diagnostik yang dipercepat lebih cenderung menjalani pencitraan karotis (97 versus 90) dan ekokardiografi (97 versus 73). Kedua kelompok memiliki tingkat kunjungan balik terkait yang serupa, stroke berikutnya, dan kejadian klinis utama. Fibrilasi atrium Selama 20 tahun terakhir, penerimaan di rumah sakit untuk atrial fibrillation telah meningkat sebesar 66 71. Subset pasien, mereka dengan atrial fibrilasi onset akut (lt48 jam) tanpa komplikasi, mungkin memenuhi syarat untuk perawatan dalam EDOU berdasarkan studi prospektif juga. Seperti pedoman praktik American Heart Association saat ini. Trombosis Trombosis Dalam Rekomendasi untuk pengobatan DVT oleh ACP dan ACCP menyatakan bahwa penanganan rawat jalan harus diberikan bila memungkinkan 72,73. Pendekatan ini terbukti hemat biaya, mengurangi biaya perawatan kesehatan dan lama tinggal di rumah 74-76. Dibandingkan dengan pasien rawat inap, mereka yang dirawat karena DVT di rumah memiliki tingkat aktivitas fisik dan fungsi sosial yang lebih banyak, dan menunjukkan tingkat pengembalian yang lebih cepat ke tingkat aktivitas sebelum kejadian 77-79. Mengintegrasikan banyak langkah penting yang berkontribusi terhadap pengelolaan DVT rawat jalan yang sukses seringkali memerlukan koordinasi beberapa terapi dan layanan. Shen melakukan penelitian kontrol acak prospektif terhadap pasien sinkop risiko menengah yang diacak ke unit sinkop yang ditunjuk atau penerima rawat inap setelah pengelolaan ED awal yang mencakup pemantauan EKG dan jantung 82. Protokol unit sinkop mencakup tanda vital serial, pemantauan jantung kontinyu untuk Sampai 6 jam Hasil penelitian ini menunjukkan bahwa pada saat pemberhentian dari ED, dugaan penyebab sinkop dibentuk untuk 67 pasien pada kelompok unit sinkop dibandingkan dengan 10 pada kelompok perawatan standar. Jumlah hari tidur di rumah sakit berkurang sebanyak 54 untuk pasien di kelompok unit sinkop dan hasil klinis 2 tahun, termasuk semua penyebab kematian dan sinkop rekuren, serupa antara EDOU dan kelompok kontrol yang diakui 82. IMAGING IN THE ED Penggunaan IV -kontras hanya untuk evaluasi pasien yang mengalami DE dengan nyeri perut telah terbukti memiliki sensitivitas dan spesifisitas yang tinggi untuk diagnosis penyebab umum sakit perut akut, seperti apendisitis akut, divertikulitis, dan SBO 29,30. Dampak pembatasan kontras PO pada pasien tersebut tidak hanya menurunkan DE LOS, namun juga memungkinkan dilakukannya konsultasi awal dan pengobatan definitif untuk pasien dengan patologi yang teridentifikasi, dengan waktu lebih dari 2 jam pada waktu yang diselamatkan untuk pasien yang memerlukan intervensi operasi. Tes waktu yang dipesan untuk tes waktu selesai adalah rata-rata 72 menit lebih pendek untuk pasien yang menjalani protokol kontras hanya kontras. Diharapkan bahwa penurunan ED LOS akan mendekati waktu yang tersimpan dengan tidak menggunakan kontras oral 31. Pemindaian CT keseluruhan tubuh secara utuh pada pasien trauma mengurangi waktu rata-rata di ED pada 8-35 menit dan waktu ke ruang operasi. Tetapi tidak mengurangi angka kematian dibandingkan dengan pencitraan selektif 32. CARING UNTUK PASIEN HALLWAY Untuk semakin banyaknya ED, solusinya adalah untuk memindahkan pasien stabil dan semi stabil dari tempat tidur ED yang berizin ke lorong ED yang bersebelahan, sehingga membebaskan tempat tidur ED resmi. Untuk pasien lain 46. Dalam keadaan ini, dokter ED menghadapi tantangan yang sulit. Mereka harus memberikan perawatan kepada pasien di lorong dengan dukungan menyusui yang tidak optimal dan kurangnya privasi, yang mencakup riwayat lengkap dan pemeriksaan fisik. Pasien mungkin tidak dapat dipantau secara tepat. Mengembalikan pasien yang baru diujicobakan kembali ke ruang tunggu sampai tempat tidur ED berlisensi tersedia memiliki risiko yang sama, karena tidak ada cara untuk mengamati atau memantau pasien secara langsung. Jenis pasien yang ditempatkan di brankar di lorong ED bervariasi menurut institusi dan mungkin berbeda di dalam institusi yang sama tergantung pada siapa yang bertanggung jawab pada saat berkerumun. Kelompok yang ditempatkan di lorong meliputi (1) pasien yang menunggu perawatan namun dianggap terlalu tidak stabil atau sakit untuk tetap berada di ruang tunggu, (2) pasien yang menjalani perawatan medis dan trauma aktif, namun tidak ada tempat tidur ED yang kosong tersedia, (3) pasien yang sedang berada Naik sementara menunggu transfer ke tempat tidur rawat inap atau pindah ke institusi lain, (4) pasien yang tiba dengan ambulans namun tidak memerlukan perawatan darurat segera, dan (5) pasien menunggu transfer ke fasilitas kejiwaan 46. PROTOKOL OVERCAPACITY Konsepnya berasal dari tahun 2001 Di bagian gawat darurat yang padat di Stony Brook University Medical Center di Long Island, tempat pasien menumpuk di ED karena tidak ada tempat tidur yang tersedia di lantai atas. Hal ini menyebabkan pesantren, yang pada gilirannya membuat ED semakin ramai dan kurang efisien. Dr. Peter Vicellio, seorang dokter darurat yang sedang berlatih dan direktur klinis departemen gawat darurat di Stony Brook di Long Island, mengakui bahwa menempatkan beberapa pasien di lorong rawat inap, akan membuat tempat tidur lebih cepat. Grant Innes dan kelompoknya melakukan penelitian yang fantastis mengenai protokol kelebihan kapasitas, sebuah studi sebelum dan sesudah yang benar, di institusinya 81. 8220 Protokol ini mengurangi lama tinggal pasien yang dirawat di gawat darurat sekitar 5 jam, dan dengan lebih dari 8.000 Penerimaan setiap tahun, ini membebaskan sekitar 41.000 jam waktu temu ED, 8221 mengatakan Dr. Grant Innes, ketua departemen gawat darurat di Rumah Sakit St. Paul8217s. 57 Berarti panjang ED tinggal untuk semua pasien yang dirawat turun dari 19 menjadi 14 jam, penurunan yang signifikan secara statistik. Panjang ED tinggal turun 9 jam, 1,6 jam, dan 9,2 jam untuk pasien medis, bedah, dan kesehatan mental yang diakui, masing-masing, perubahan yang juga signifikan secara statistik. Dan tinggal di rumah sakit dijatuhkan sekitar 1 hari untuk pasien medis, bedah, dan kesehatan medis yang khas, Dr. Innes mengatakan 57. Setelah OCP, tiba pasien yang diberi nilai 1-3 (emergent-urgent) pada skala Triase dan Akuitas Kanada Jarang tertinggal di daerah tunggu ED, dan penundaan ambulans off-load turun 26, katanya57. Referensi Bacaan lebih lanjut Zo Slote Morris. Adrian Boyle. Kathleen Beniuk. Dan Susan Robinson. Departemen darurat berkerumun: menuju agenda untuk intervensi berbasis bukti. Emerg Med J. 2012 Jun29 (6): 460-6. Doi: 10.1136emj.2010.107078. Epub 2011 Jun 7. J. Schull, M. Vermeulen, G. Slaughter, L. Morrison, dan P. Daly, Departemen Darurat berkerumun dan penundaan trombolisis pada infark miokard akut, Annals of Emergency Medicine, vol. 44, tidak 6, hlm. 577585, 2004. Hwang, L. D. Richardson, T. O. Sonuyi, dan R. S. Morrison, Efek dari departemen darurat berkerumun pada pengelolaan rasa sakit pada orang dewasa yang lebih tua dengan patah tulang pinggul, Journal of the American Geriatrics Society, vol. 54, tidak 2, hlm. 270275, 2006. B. Kulstad dan K. M. Kelley, kepadatan berlebih dikaitkan dengan penundaan intervensi koroner perkutan untuk infark miokard akut, International Journal of Emergency Medicine, vol. 2, tidak 3, hlm. 149154, 2009. C. Moskop, D. P. Sklar, J. M. Geiderman, R. M. Schears, dan K. J. Bookman, departemen Darurat yang berkerumun, konsekuensi, 1, konsep, dan konsekuensi moral, Annals of Emergency Medicine, vol. 53, tidak 5, hlm. 605611, 2009. Chaflin DB, Treciak S, Likourezos A, dkk. Dampak penundaan pengiriman pasien kritis dari departemen gawat darurat ke unit perawatan intensif. Crit Care Med. 200735 (6): 1477-1483. Weissman JS, Rothschild JM, Bendavid E, dkk. Beban kerja dan kejadian di rumah sakit. Med Care. 200745 (5): 448-455. 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Post navigation Top Posts amp Questions Recent Questions emDocs in your mailbox From the ArchivesStrategy Under Uncertainty The Idea in Brief Are you using traditional analytic toolsmarket research, value chain analysis, assessments of rivalsto inform your strategy Those tools work in stable business environments. But today were operating amid unprecedented uncertainty. Apply the old tools, and you risk formulating strategies that neither defend your company against threats nor leverage the opportunities uncertainty can provide. Instead, use analytic tools based on the level of uncertainty facing your company: Are you facing only two or three alternative futures Then use tools such as decision analysis. A wide range of possible scenarios Consider scenario planning. Armed with the right kind of information, select an appropriate strategyand execute it through savvy moves. For example, using scenario planning, financial-services provider Mondex International determined that the advent of electronic cash transactions could create a range of possible futures. Mondexs strategy Shape its industrys future by establishing what it hoped would become universal electronic-cash standards. Its moves Make big-bet investments in product development, complemented by more conservative pilot experiments to speed customer acceptance. As companies like FedEx and Microsoft have discovered, using the right tools to read the future enables you to avoid disastrous strategic investments while exploiting fresh opportunities. The Idea in Practice Confronting Uncertainty 1. Apply appropriate analytic tools to identify strategic options. If you envision: Only a few future scenarios Use: Option valuation models and game theory to establish relative probabilities of each outcome and gauge alternative strategies risks and returns Example: A pulp and paper company cannot observe or predict its competitors plans for expanding capacitywhich could strongly affect industry prices and profitability. Its decision whether to build a plant will hinge on rivals decisions. A limited number of competitor moves are likely. The company evaluates the inherent risks and returns for each scenario, using game theory to identify probable market winners and losers for each. If you envision: A wide range of futures Use: Technology forecasting and scenario planning to develop 45 possible scenarios Example: A consumer-goods company considering entering the Indian market develops multiple scenarios characterized by different variables, such as customer-penetration rates and latent-demand level. 2. Select a strategic posture. Strategic postures clarify your strategic intent. They can take three forms: Shapingdriving your industry toward a new structure of your devising and creating new opportunities. Hewlett-Packard shifted photo processing from stores to homes by offering high-quality, low-cost photo printers. Adaptingchoosing where and how to compete within the current industry structure. Many telecommunications service resellers pursue competitive advantage through pricing and effective execution rather than product innovation. Reserving the right to playmaking incremental investments to stay in the game without committing to a new strategy prematurely. Some pharmaceutical companies reserve the right to play in gene-therapy applications by buying small biotech firms with relevant expertise. 3. Build a portfolio of strategic moves. Use one or more of these moves depending on your strategic posture: Big betsmajor commitments (capital investments, mergers or acquisitions) that will generate large payoffs in some scenarios and large losses in others. Optionsmodest initial investments (pilot trials, limited joint ventures, technology licensing) that enable you to ramp up or scale back your investment later as the market evolves. No-regrets movesactions that pay off no matter what happens, such as cost-cutting initiatives and competitor intelligence. Chemical companies often use options to reserve the right to play when emerging technologies performance is uncertain. Rather than retrofitting old plants around an unproven new technology, they purchase options to license the technology within a specified time frame or retrofit a few facilities with the emerging technology. These small, up-front commitments position them to ramp up or discontinue development of the technology as its performance becomes clearer. What makes for a good strategy in highly uncertain business environments Some executives seek to shape the future with high-stakes bets. Eastman Kodak Company, for example, is spending 500 million per year to develop an array of digital photography products that it hopes will fundamentally change the way people create, store, and view pictures. Meanwhile, Hewlett-Packard Company is investing 50 million per year to pursue a rival vision centered around home-based photo printers. The business press loves to hype such industry-shaping strategies because of their potential to create enormous wealth, but the sober reality is that most companies lack the industry position, assets, or appetite for risk necessary to make such strategies work. More risk-averse executives hedge their bets by making a number of smaller investments. In pursuit of growth opportunities in emerging markets, for example, many consumer-product companies are forging limited operational or distribution alliances. But its often difficult to determine if such limited investments truly reserve the right to play in these countries or just reserve the right to lose. Alternatively, some executives favor investments in flexibility that allow their companies to adapt quickly as markets evolve. But the costs of establishing such flexibility can be high. Moreover, taking a wait-and-see strategypostponing large investments until the future becomes clearcan create a window of opportunity for competitors. How should executives facing great uncertainty decide whether to bet big, hedge, or wait and see Chances are, traditional strategic-planning processes wont help much. The standard practice is to lay out a vision of future events precise enough to be captured in a discounted-cash-flow analysis. Of course, managers can discuss alternative scenarios and test how sensitive their forecasts are to changes in key variables, but the goal of such analysis is often to find the most likely outcome and create a strategy based on it. That approach serves companies well in relatively stable business environments. But when there is greater uncertainty about the future, it is at best marginally helpful and at worst downright dangerous. Under uncertainty, traditional approaches to strategic planning can be downright dangerous. One danger is that this traditional approach leads executives to view uncertainty in a binary wayto assume that the world is either certain, and therefore open to precise predictions about the future, or uncertain, and therefore completely unpredictable. Planning or capital-budgeting processes that require point forecasts force managers to bury underlying uncertainties in their cash flows. Such systems clearly push managers to underestimate uncertainty in order to make a compelling case for their strategy. Underestimating uncertainty can lead to strategies that neither defend against the threats nor take advantage of the opportunities that higher levels of uncertainty may provide. In one of the most colossal underestimations in business history, Kenneth H. Olsen, then president of Digital Equipment Corporation, announced in 1977 that there is no reason for any individual to have a computer in their home. The explosion in the personal computer market was not inevitable in 1977, but it was certainly within the range of possibilities that industry experts were discussing at the time. At the other extreme, assuming that the world is entirely unpredictable can lead managers to abandon the analytical rigor of their traditional planning processes altogether and base their strategic decisions primarily on gut instinct. This just do it approach to strategy can cause executives to place misinformed bets on emerging products or markets that result in record write-offs. Those who took the plunge and invested in home banking in the early 1980s immediately come to mind. Risk-averse managers who think they are in very uncertain environments dont trust their gut instincts and suffer from decision paralysis. They avoid making critical strategic decisions about the products, markets, and technologies they should develop. They focus instead on reengineering, quality management, or internal cost-reduction programs. Although valuable, those programs are not substitutes for strategy. Making systematically sound strategic decisions under uncertainty requires a different approachone that avoids this dangerous binary view. It is rare that managers know absolutely nothing of strategic importance, even in the most uncertain environments. In fact, they usually can identify a range of potential outcomes or even a discrete set of scenarios. This simple insight is extremely powerful because determining which strategy is best, and what process should be used to develop it, depend vitally on the level of uncertainty a company faces. What follows, then, is a framework for determining the level of uncertainty surrounding strategic decisions and for tailoring strategy to that uncertainty. No approach can make the challenges of uncertainty go away, but this one offers practical guidance that will lead to more informed and confident strategic decisions. Four Levels of Uncertainty Even the most uncertain business environments contain a lot of strategically relevant information. First, it is often possible to identify clear trends, such as market demographics, that can help define potential demand for future products or services. Second, there is usually a host of factors that are currently unknown but that are in fact knowable that could be known if the right analysis were done. Performance attributes for current technologies, elasticities of demand for certain stable categories of products, and competitors capacity-expansion plans are variables that are often unknown, but not entirely unknowable. The uncertainty that remains after the best possible analysis has been done is what we call residual uncertainty for example, the outcome of an ongoing regulatory debate or the performance attrib-utes of a technology still in development. But often, quite a bit can be known about even those residual uncertainties. In practice, we have found that the residual uncertainty facing most strategic-decision makers falls into one of four broad levels: Level 1: A Clear-Enough Future. At level 1, managers can develop a single forecast of the future that is precise enough for strategy development. Although it will be inexact to the degree that all business environments are inherently uncertain, the forecast will be sufficiently narrow to point to a single strategic direction. In other words, at level 1, the residual uncertainty is irrelevant to making strategic decisions. Consider a major airline trying to develop a strategic response to the entry of a low-cost, no-frills competitor into one of its hub airports. Should it respond with a low-cost service of its own Should it cede the low-cost niche segments to the new entrant Or should it compete aggressively on price and service in an attempt to drive the entrant out of the market To make that strategic decision, the airlines executives need market research on the size of different customer segments and the likely response of each segment to different combinations of pricing and service. They also need to know how much it costs the competitor to serve, and how much capacity the competitor has for, every route in question. Finally, the executives need to know the new entrants competitive objectives to anticipate how it would respond to any strategic moves their airline might make. In todays U.S. airline industry, such information is either known already or is possible to know. It might not be easy to obtainit might require new market research, for examplebut it is inherently knowable. And once that information is known, residual uncertainty would be limited, and the incumbent airline would be able to build a confident business case around its strategy. Level 2: Alternate Futures. At level 2, the future can be described as one of a few alternate outcomes, or discrete scenarios. Analysis cannot identify which outcome will occur, although it may help establish probabilities. Most important, some, if not all, elements of the strategy would change if the outcome were predictable. Many businesses facing major regulatory or legislative change confront level 2 uncertainty. Consider U.S. long-distance telephone providers in late 1995, as they began developing strategies for entering local telephone markets. By late 1995, legislation that would fundamentally deregulate the industry was pending in Congress, and the broad form that new regulations would take was fairly clear to most industry observers. But whether or not the legislation was going to pass and how quickly it would be implemented in the event it did pass were uncertain. No amount of analysis would allow the long-distance carriers to predict those outcomes, and the correct course of actionfor example, the timing of investments in network infrastructuredepended on which outcome occurred. In another common level 2 situation, the value of a strategy depends mainly on competitors strategies, and those cannot yet be observed or predicted. For example, in oligopoly markets, such as those for pulp and paper, chemicals, and basic raw materials, the primary uncertainty is often competitors plans for expanding capacity: Will they build new plants or not Economies of scale often dictate that any plant built would be quite large and would be likely to have a significant impact on industry prices and profitability. Therefore, any one companys decision to build a plant is often contingent on competitors decisions. This is a classic level 2 situation: The possible outcomes are discrete and clear. It is difficult to predict which one will occur. And the best strategy depends on which one does occur. How to Use the Four Levels of Uncertainty Level 3: A Range of Futures. At level 3, a range of potential futures can be identified. That range is defined by a limited number of key variables, but the actual outcome may lie anywhere along a continuum bounded by that range. There are no natural discrete scenarios. As in level 2, some, and possibly all, elements of the strategy would change if the outcome were predictable. Companies in emerging industries or entering new geographic markets often face level 3 uncertainty. Consider a European consumer-goods company deciding whether to introduce its products to the Indian market. The best possible market research might identify only a broad range of potential customer-penetration ratessay, from 10 to 30and there would be no obvious scenarios within that range. Such a broad range of estimates would be common when introducing completely new products and services to a market, and therefore determining the level of latent demand is very difficult. The company entering India would be likely to follow a very different and more aggressive entry strategy if it knew for certain that its customer penetration rates would be closer to 30 than to 10. Analogous problems exist for companies in fields driven by technological innovation, such as the semiconductor industry. When deciding whether to invest in a new technology, producers can often estimate only a broad range of potential cost and performance attributes for the technology, and the overall profitability of the investment depends on those attributes. Level 4: True Ambiguity. At level 4, multiple dimensions of uncertainty interact to create an environment that is virtually impossible to predict. Unlike in level 3 situations, the range of potential outcomes cannot be identified, let alone scenarios within that range. It might not even be possible to identify, much less predict, all the relevant variables that will define the future. Level 4 situations are quite rare, and they tend to migrate toward one of the other levels over time. Nevertheless, they do exist. Consider a telecommunications company deciding where and how to compete in the emerging consumer-multimedia market. It is confronting multiple uncertainties concerning technology, demand, and relationships between hardware and content providers, all of which may interact in ways so unpredictable that no plausible range of scenarios can be identified. Companies considering making major entry investments in post-Communist Russia in 1992 faced level 4 uncertainty. They could not outline the potential laws or regulations that would govern property rights and transactions. That central uncertainty was compounded by additional uncertainty over the viability of supply chains and the demand for previously unavailable consumer goods and services. And shocks such as a political assassination or a currency default could have spun the whole system toward completely unforeseen outcomes. Those examples illustrate how difficult strategic decisions can be at level 4, but they also underscore their transitory nature. Greater political and regulatory stability has turned decisions about whether to enter Russian markets into level 3 problems for the majority of industries today. Similarly, uncertainty about strategic decisions in the consumer multimedia market will migrate to level 3 or to level 2 as the industry begins to take shape over the next several years. Tailoring Strategic Analysis to the Four Levels of Uncertainty Our experience suggests that at least half of all strategy problems fall into levels 2 or 3, while most of the rest are level 1 problems. But executives who think about uncertainty in a binary way tend to treat all strategy problems as if they fell into either level 1 or level 4. And when those executives base their strategies on rigorous analysis, they are most likely to apply the same set of analytic tools regardless of the level of residual uncertainty they face. For example, they might attempt to use standard, quantitative market-research techniques to forecast demand for data traffic over wireless communications networks as far out as ten years from now. But, in fact, a different kind of analysis should be done to identify and evaluate strategy options at each level of uncertainty. All strategy making begins with some form of situation analysisthat is, a picture of what the world will look like today and what is likely to happen in the future. Identifying the levels of uncertainty thus helps define the best such an analysis can do to describe each possible future an industry faces. To help generate level 1s usefully precise prediction of the future, managers can use the standard strategy tool kitmarket research, analyses of competitors costs and capacity, value chain analysis, Michael Porters five-forces framework, and so on. A discounted-cash-flow model that incorporates those predictions can then be used to determine the value of various alternative strategies. Its not surprising that most managers feel extremely comfortable in level 1 situationsthese are the tools and frameworks taught in every leading business program in the United States. Needed: A More Comprehensive Strategy Tool Kit In order to perform the kinds of analyses appropriate to high levels of uncertainty, many companies will need to supplement their standard strategy tool kit. Scenario-planning techniques are fundamental to determining strategy under conditions of uncertainty. Game theory will help managers understand uncertainties based on competitors conduct. Systems dynamics and agent-based simulation models can help in understanding the complex interactions in the market. Real-options valuation models can help in correctly valuing investments in learning and flexibility. The following sources will help managers get started: Scenario Planning. Kees van der Heijden, Scenarios: The Art of Strategic Conversation (New York: John Wiley amp Sons, 1996) Paul J.H. Schoemaker, Scenario Planning: A New Tool for Strategic Thinking, Sloan Management Review, Winter 1995. Game Theory. Avinash K. Dixit and Barry J. Nalebuff, Thinking Strategically: The Competitive Edge in Business, Politics, and Everyday Life (New York: W.W. Norton, 1991) Adam M. Brandenburger and Barry J. Nalebuff, The Right Game: Use Game Theory to Shape Strategy, HBR July-August 1995. System Dynamics. Peter N. Senge, Fifth Discipline: The Art and Practice of the Learning Organization (New York: Doubleday, 1990) Arie de Geus, Planning as Learning, HBR March-April 1988. Agent-Based Models. John L. Casti, Would-Be Worlds: How Simulation Is Changing the Frontiers of Science (New York: John Wiley amp Sons, 1997). Real Options. Avinash K. Dixit and Robert S. Pindyck, The Options Approach to Capital Investment, HBR May-June 1995 Timothy A. Luehrman, Whats It Worth HBR May-June 1997. Level 2 situations are a bit more complex. First, managers must develop a set of discrete scenarios based on their understanding of how the key resid-ual uncertainties might play outfor example, whether deregulation occurs or not, a competitor builds a new plant or not. Each scenario may require a different valuation modelgeneral industry structure and conduct will often be fundamentally different depending on which scenario occurs, so alternative valuations cant be handled by performing sensitivity analyses around a single baseline model. Getting information that helps establish the relative probabilities of the alternative outcomes should be a high priority. After establishing an appropriate valuation model for each possible outcome and determining how probable each is likely to be, a classic decision-analysis framework can be used to evaluate the risks and returns inherent in alternative strategies. This process will identify the likely winners and losers in alternative scenarios, and perhaps more important, it will help quantify whats at stake for companies that follow status quo strategies. Such an analysis is often the key to making the case for strategic change. In level 2 situations, it is important not only to identify the different possible future outcomes but also to think through the likely paths the industry might take to reach those alternative futures. Will change occur in major steps at some particular point in time, following, for example, a regulatory ruling or a competitors decision to enter the market Or will change occur in a more evolutionary fashion, as often happens after a resolution of competing technology standards This is vital information because it determines which market signals or trigger variables should be monitored closely. As events unfold and the relative probabilities of alternative scenarios change, it is likely that ones strategy will also need to be adapted to these changes. At one level, the analysis in level 3 is very similar to that in level 2. A set of scenarios needs to be identified that describes alternative future outcomes, and analysis should focus on the trigger events signaling that the market is moving toward one or another scenario. Developing a meaningful set of scenarios, however, is less straightforward in level 3. Scenarios that describe the extreme points in the range of possible outcomes are often relatively easy to develop, but these rarely provide much concrete guidance for current strategic decisions. Since there are no other natural discrete scenarios in level 3, deciding which possible outcomes should be fully developed into alternative scenarios is a real art. But there are a few general rules. First, develop only a limited number of alternative scenariosthe complexity of juggling more than four or five tends to hinder decision making. Second, avoid developing redundant scenarios that have no unique implications for strategic decision making make sure each scenario offers a distinct picture of the industrys structure, conduct, and performance. Third, develop a set of scenarios that collectively account for the probable range of future outcomes and not necessarily the entire possible range. Because it is impossible in level 3 to define a complete list of scenarios and related probabilities, it is impossible to calculate the expected value of different strategies. However, establishing the range of scenarios should allow managers to determine how robust their strategy is, identify likely winners and losers, and determine roughly the risk of following status quo strategies. Situation analysis at level 4 is even more qualitative. Still, it is critical to avoid the urge to throw ones hands up and act purely on gut instinct. Instead, managers need to catalog systematically what they know and what is possible to know. Even if it is impossible to develop a meaningful set of probable, or even possible, outcomes in level 4 situations, managers can gain valuable strategic perspective. Usually, they can identify at least a subset of the variables that will determine how the market will evolve over timefor example, customer penetration rates or technology performance attributes. And they can identify favorable and unfavorable indicators of these variables that will let them track the markets evolution over time and adapt their strategy as new information becomes available. At level 4, it is critical to avoid the urge to throw up your hands and act purely on gut instinct. Managers can also identify patterns indicating possible ways the market may evolve by studying how analogous markets developed in other level 4 situations, determining the key attributes of the winners and losers in those situations and identifying the strategies they employed. Finally, although it will be impossible to quantify the risks and returns of different strategies, managers should be able to identify what information they would have to believe about the future to justify the investments they are considering. Early market indicators and analogies from similar markets will help sort out whether such beliefs are realistic or not. Uncertainty demands a more flexible approach to situation analysis. The old one-size-fits-all approach is simply inadequate. Over time, companies in most industries will face strategy problems that have varying levels of residual uncertainty, and it is vitally important that the strategic analysis be tailored to the level of uncertainty. The old one-size-iumlnotts-all analytic approach to evaluating strategy options is simply inadequate. Postures and Moves Before we can talk about the dynamics of formulating strategy at each level of uncertainty, we need to introduce a basic vocabulary for talking about strategy. First, there are three strategic postures a company can choose to take vis-agrave-vis uncertainty: shaping, adapting, or reserving the right to play. Second, there are three types of moves in the portfolio of actions that can be used to implement that strategy: big bets, options, and no-regrets moves. Strategic Posture. Any good strategy requires a choice about strategic posture. Fundamentally, posture defines the intent of a strategy relative to the current and future state of an industry. Shapers aim to drive their industries toward a new structure of their own devising. Their strategies are about creating new opportunities in a marketeither by shaking up relatively stable level 1 industries or by trying to control the direction of the market in industries with higher levels of uncertainty. Kodak, for example, through its investment in digital photography, is pursuing a shaping strategy in an effort to maintain its leadership position, as a new technology supersedes the one currently generating most of its earnings. Although its product technology is new, Kodaks strategy is still based on a traditional model in which the company provides digital cameras and film while photo-processing stores provide many of the photo-printing and storage functions for the consumer. Hewlett-Packard also seeks to be a shaper in this market, but it is pursuing a radically different model in which high-quality, low-cost photo printers shift photo processing from stores to the home. The Three Strategic Postures In contrast, adapters take the current industry structure and its future evolution as givens, and they react to the opportunities the market offers. In environments with little uncertainty, adapters choose a strategic positioningthat is, where and how to competein the current industry. At higher levels of uncertainty, their strategies are predicated on the ability to recognize and respond quickly to market developments. In the highly volatile telecommunications-service industry, for example, service resellers are adapters. They buy and resell the latest products and services offered by the major telecom providers, relying on pricing and effective execution rather than on product innovation as their source of competitive advantage. The third strategic posture, reserving the right to play, is a special form of adapting. This posture is relevant only in levels 2 through 4 it involves making incremental investments today that put a company in a privileged position, through either superior information, cost structures, or relationships between customers and suppliers. That allows the company to wait until the environment becomes less uncertain before formulating a strategy. Many pharmaceutical companies are reserving the right to play in the market for gene therapy applications by acquiring or allying with small biotech firms that have relevant expertise. Providing privileged access to the latest industry developments, these are low-cost investments compared with building a proprietary, internal gene-therapy RampD program. A Portfolio of Actions. A posture is not a complete strategy. It clarifies strategic intent but not the actions required to fulfill that intent. Three types of moves are especially relevant to implementing strategy under conditions of uncertainty: big bets, options, and no-regrets moves. Big bets are large commitments, such as major capital investments or acquisitions, that will result in large payoffs in some scenarios and large losses in others. Not surprisingly, shaping strategies usually involve big bets, whereas adapting and reserving the right to play do not. Options are designed to secure the big payoffs of the best-case scenarios while minimizing losses in the worst-case scenarios. This asymmetric payoff structure makes them resemble financial options. Most options involve making modest initial investments that will allow companies to ramp up or scale back the investment later as the market evolves. Classic examples include conducting pilot trials before the full-scale introduction of a new product, entering into limited joint ventures for distribution to minimize the risk of breaking into new markets, and licensing an alternative technology in case it proves to be superior to a current technology. Those reserving the right to play rely heavily on options, but shapers use them as well, either to shape an emerging but uncertain market as an early mover or to hedge their big bets. Finally, no-regrets moves are just thatmoves that will pay off no matter what happens. Managers often focus on obvious no-regrets moves like initiatives aimed at reducing costs, gather-ing competitive intelligence, or building skills. However, even in highly uncertain environments, strategic decisions like investing in capacity and entering certain markets can be no-regrets moves. Whether or not they put a name to them, most managers understand intuitively that no-regrets moves are an essential element of any strategy. The choice of a strategic posture and an accompanying portfolio of actions sounds straightforward. But in practice, these decisions are highly dependent on the level of uncertainty facing a given business. Thus the four-level framework can help clarify the practical implications implicit in any choice of strategic posture and actions. The discussion that follows will demonstrate the different stra-tegic challenges that each level of uncertainty poses and how the portfolio of actions may be applied. Whats in a Portfolio of Actions Strategy in Level 1s Clear-Enough Future. In predictable business environments, most companies are adapters. Analysis is designed to predict an industrys future landscape, and strategy involves making positioning choices about where and how to compete. When the underlying analysis is sound, such strategies are by definition made up of a series of no-regrets moves. Adapter strategies in level 1 situations are not necessarily incremental or boring. For example, Southwest Airlines Companys no-frills, point-to-point service is a highly innovative, value-creating adapter strategy, as was Gateway 2000s low-cost assembly and direct-mail distribution strategy when it entered the personal computer market in the late 1980s. In both cases, managers were able to identify unexploited opportunities in relatively low-uncertainty environments within the existing market structure. The best level 1 adapters create value through innovations in their products or services or through improvements in their business systems without otherwise fundamentally changing the industry. It is also possible to be a shaper in level 1 situations, but that is risky and rare, since level 1 shapers increase the amount of residual uncertainty in an otherwise predictable marketfor themselves and their competitorsin an attempt to fundamentally alter long-standing industry structures and conduct. Consider Federal Express Corporations overnight-delivery strategy. When it entered the mail-and-package delivery industry, a stable level 1 situation, FedExs strategy in effect created level 3 uncertainty for itself. That is, even though CEO Frederick W. Smith commissioned detailed consulting reports that confirmed the feasibility of his business concept, only a broad range of potential demand for overnight services could be identified at the time. For the industry incumbents like United Parcel Service, FedEx created level 2 uncertainty. FedExs move raised two questions for UPS: Will the overnight-delivery strategy succeed or not and Will UPS have to offer a similar service to remain a viable competitor in the market Over time, the industry returned to level 1 stability, but with a fundamentally new structure. FedExs bet paid off, forcing the rest of the industry to adapt to the new demand for overnight services. What portfolio of actions did it take to realize that strategy Like most shaper strategies, even in level 1 situations, this one required some big bets. That said, it often makes sense to build options into a shaper strategy to hedge against bad bets. Smith might have hedged his bets by leasing existing cargo airplanes instead of purchasing and retrofitting his original fleet of Falcon minifreighters, or he could have outsourced ground pickup and delivery services. Such moves would have limited the amount of capital he would have needed to sink into his new strategy and facilitated a graceful exit had his concept failed. However, that kind of insurance doesnt always come cheap. In FedExs case, had Smith leased standard-size cargo planes, he would have come under the restrictive regulations of the Civil Aeronautics Board. And outsourcing local pickups and deliveries would have diluted FedExs unique door-to-door value to customers. Thus Smith stuck mainly to big bets in implementing his strategy, which drove him to the brink of bankruptcy in his first two years of operation but ultimately reshaped an entire industry. Strategy in Level 2s Alternate Futures. If shapers in level 1 try to raise uncertainty, in levels 2 through 4 they try to lower uncertainty and create order out of chaos. In level 2, a shaping strategy is designed to increase the probability that a favored industry scenario will occur. A shaper in a capital-intensive industry like pulp and paper, for example, wants to prevent competitors from creating excess capacity that would destroy the industrys profitability. Consequently, shapers in such cases might commit their companies to building new capacity far in advance of an upturn in demand to preempt the competition, or they might consolidate the industry through mergers and acquisitions. Consider the Microsoft Network (MSN). A few years ago, one could identify a discrete set of possible ways in which transactions would be conducted between networked computers. Either proprietary networks such as MSN would become the standard, or open networks like the Internet would prevail. Uncertainty in this situation was thus at level 2, even though other related strategy issuessuch as determining the level of consumer demand for networked applicationswere level 3 problems. Microsoft could reasonably expect to shape the way markets for electronic commerce evolved if it created the proprietary MSN network. It would, in effect, be building a commerce hub that would link both suppliers and consumers through the MSN gateway. The strategy was a big bet: the development costs were significant and, more important, involved an enormously high level of industry exposure and attention. In effect, for Microsoft, it constituted a big credibility bet. Microsofts activities in other areassuch as including one-button access to MSN from Windows95were designed to increase the probability that this shaping bet would pay off. But even the best shapers must be prepared to adapt. In the battle between proprietary and open networks, certain trigger variablesgrowth in the number of Internet and MSN subscribers, for example, or the activity profiles of early MSN subscriberscould provide valuable insight into how the market was evolving. When it became clear that open networks would prevail, Microsoft refocused the MSN concept around the Internet. Microsofts shift illustrates that choices of strategic posture are not carved in stone, and it underscores the value of maintaining strategic flexibility under uncertainty. Shaping strategies can fail, so the best companies supplement their shaping bets with options that allow them to change course quickly if necessary. Microsoft was able to do just that because it remained flexible by being willing to cut its losses, by building a cadre of engineers who had a wide range of general-programming and product-development skills, and by closely monitoring key trigger variables. In uncertain environments, it is a mistake to let strategies run on autopilot, remaining content to update them only through standard year-end strategy reviews. Shaping strategies can fail, so the best companies supplement their shaping bets with options that let them change course quickly. Because trigger variables are often relatively simple to monitor in level 2, it can be easy to adapt or reserve the right to play. For instance, companies that generate electricityand others whose business depends on energy-intensive production processesoften face level 2 uncertainty in determining the relative cost of different fuel alternatives. Discrete scenarios can often be identifiedfor example, either natural gas or oil will be the low-cost fuel. Many companies thus choose an adapter strategy when building new plants: they construct flexible manufacturing processes that can switch easily between different fuels. Chemical companies often choose to reserve the right to play when facing level 2 uncertainty in predicting the performance of a new technology. If the technology performs well, companies will have to employ it to remain competitive in the market. But if it does not fulfill its promise, incumbents can compete effectively with existing technologies. Most companies are reluctant to bet several hundred million dollars on building new capacity and retrofitting old plants around a new technology until it is proven. But if they dont make at least incremental investments in the short run, they risk falling too far behind competitors should the technology succeed. Thus many will purchase options to license the new technology within a specified time frame or begin retrofitting a proportion of existing capacity around the new technology. In either case, small, up-front commitments give the companies privileged positions, but not obligations, to ramp up or discontinue development of the new technology as its performance attributes become clearer over time. Strategy in Level 3s Range of Futures. Shaping takes a different form in level 3. If at level 2, shap-ers are trying to make a discrete outcome occur, at level 3, they are trying to move the market in a general direction because they can identify only a range of possible outcomes. Consider the battle over standards for electronic cash transactions, currently a level 3 problem since one can define a range of potential products and services that fall between purely paper-based and purely electronic cash transactions, but it is unclear today whether there are any natural discrete scenarios within that range. Mondex International, a consortium of financial services providers and technol-ogy companies, is attempting to shape the future by establishing what it hopes will become universal electronic-cash standards. Its shaping posture is backed by big-bet investments in product development, infrastructure, and pilot experiments to speed customer acceptance. In contrast, regional banks are mainly choosing adapter strategies. An adapter posture at uncertainty levels 3 or 4 is often achieved primarily through investments in organizational capabilities designed to keep options open. Because they must make and implement strategy choices in real time, adapters need quick access to the best market information and the most flexible organizational structures. Many regional banks, for example, have put in place steering committees focused on electronic payments, RampD projects, and competitive-intelligence systems so that they can constantly monitor developments in electronic payment technology and markets. In addition, many regional banks are making small investments in industry consortia as another way to monitor events. This adapter approach makes sense for most regional banksthey dont have the deep pockets and skills necessary to set standards for the electronic payment market, yet it is essential that they be able to offer the latest electronic services to their customers as such services become available. Reserving the right to play is a common posture in level 3. Consider a telecommunications company trying to decide whether to make a 1 billion investment in broadband cable networks in the early 1990s. The decision hinged on level 3 uncertainties such as demand for interactive TV service. No amount of solid market research could precisely forecast consumer demand for services that didnt even exist yet. However, making incremental investments in broadband-network trials could provide useful information, and it would put the company in a privileged position to expand the business in the future should that prove attractive. By restructuring the broadband-investment decision from a big bet to a series of options, the company reserved the right to play in a potentially lucrative market without having to bet the farm or risk being preempted by a competitor. How a Regional Bank Confronts the Uncertainties in Electronic Commerce Strategy in Level 4s True Ambiguity. Paradoxically, even though level 4 situations contain the greatest uncertainty, they may offer higher returns and involve lower risks for companies seeking to shape the market than situations in either level 2 or 3. Recall that level 4 situations are transitional by nature, often occurring after a major technologi-cal, macroeconomic, or legislative shock. Since no player necessarily knows the best strategy in these environments, the shapers role is to provide a vision of an industry structure and standards that will coordinate the strategies of other players and drive the market toward a more stable and favorable outcome. Mahathir bin Mohamad, Malaysias prime minister, is trying to shape the future of the multimedia industry in the Asian Pacific Rim. This is truly a level 4 strategy problem at this point. Potential products are undefined, as are the players, the level of customer demand, and the technology standards, among other factors. The government is trying to create order out of this chaos by investing at least 15 billion to create a so-called Multimedia Super Corridor (MSC) in Malaysia. The MSC is a 750-square-kilometer zone south of Kuala Lumpur that will include state-of-the-art smart buildings for software companies, regional headquarters for multinational corporations, a Multimedia University, a paperless government center called Putrajaya, and a new city called Cyberjaya. By leveraging incentives like a ten-year exemption from the tax on profits, the MSC has received commitments from more than 40 Malaysian and foreign companies so far, including such powerhouses as Intel, Microsoft, Nippon Telegraph and Telephone, Oracle, and Sun Microsystems. Mahathirs shaping strategy is predicated on the notion that the MSC will create a web of relationships between content and hardware providers that will result in clear industry standards and a set of complementary multimedia products and services. Intels Malaysia managing director, David B. Marsing, recognized Mahathirs shaping aspirations when he noted, If youre an evolutionist, its strange. Theyre the Malaysian government trying to intervene instead of letting it evolve. Shapers need not make enormous bets as the Malaysian government is doing to be successful in level 3 or 4 situations, however. All that is required is the credibility to coordinate the strategies of different players around the preferred outcome. Netscape Communications Corporation, for example, didnt rely on deep pockets to shape Internet browser standards. Instead, it leveraged the credibility of its leadership team in the industry so that other industry players thought, If these guys think this is the way to go, they must be right. Netscape relied on its credibility, rather than deep pockets, to shape Internet browser standards. Reserving the right to play is common, but potentially dangerous, in level 4 situations. Oil companies believed they were reserving the right to compete in China by buying options to establish various beachheads there some 20 years ago. However, in such level 4 situations, it is extremely difficult to determine whether incremental investments are truly reserving the right to play or simply the right to lose. A few general rules apply. First, look for a high degree of leverage. If the choice of beachhead in China comes down to maintaining a small, but expensive, local operation or developing a limited joint venture with a local distributor, all else being equal, go for the low-cost option. Higher-cost options must be justified with explicit arguments for why they would put the company in a better position to ramp up over time. Second, dont get locked into one position through neglect. Options should be rigorously reevaluated whenever important uncertainties are clarifiedat least every six months. Remember, level 4 situations are transitional, and most will quickly move toward levels 3 and 2. The difficulty of managing options in level 4 situations often drives players toward adapter postures. As in level 3, an adapter posture in level 4 is frequently implemented by making investments in organizational capabilities. Most potential players in the multimedia industry are adopting that posture today but will soon be making bigger bets as the industry moves into level 3 and 2 uncertainty over time. A New Approach to Uncertainty At the heart of the traditional approach to strategy lies the assumption that by applying a set of powerful analytic tools, executives can predict the future of any business accurately enough to allow them to choose a clear strategic direction. In relatively stable businesses, that approach continues to work well. But it tends to break down when the environment is so uncertain that no amount of good analysis will allow them to predict the future. Levels of uncertainty regularly confronting managers today are so high that they need a new way to think about strategy. The approach weve outlined will help executives avoid dangerous binary views of uncertainty. It offers a discipline for thinking rigorously and systematically about uncertainty. On one plane, it is a guide to judging which analytic tools can help in making decisions at various levels of uncertainty and which cannot. On a broader plane, our framework is a way to tackle the most challenging decisions that executives have to make, offering a more complete and sophisticated understanding of the uncertainty they face and its implications for strategy. This article is based on research sponsored by McKinseys ongoing Strategy Theory Initiative (STI). The authors would like to thank their STI colleagues for their significant contributions to this article. A version of this article appeared in the NovemberDecember 1997 issue of Harvard Business Review . Hugh Courtney is the dean and a professor of international business and strategy at Northeastern University8217s D8217Amore-McKim School of Business, and a former consultant at McKinsey 38 Company. Jane Kirkland is a principal with McKinsey in Pittsburgh, Pennsylvania. Patrick Viguerie is a director in McKinsey8217s Atlanta office and leads the firm8217s Strategy practice in the Americas.
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