1.  Service value chain is a process used to identify primary and secondary activities that add value to the final product and then analyze these activities to reduce costs or increase differentiation ( ). It is an illustration of the organization’s internal activities that contributes to end product. Through this process, companies are able to determine what processes are the most useful in their success and what areas they need to focus more attention on. The ultimate goal in this process is to identify the most competitive aspect of the service or product provided and improve it. This is done by examining five key concepts: inbound logistics, operations, outbound logistics, marketing and sales, and service (Beers, 2018). Improvement in any or all of these categories will increase profit.
As the US health care system transitions toward a value-based system, providers and health care organizations will have to closely scrutinize their current processes of care (Sharan, Schroeder, West & Vaccaro, 2015). This is an ideal situation to utilize a value chain analysis process. This will help organizations identify and eliminate inefficient methods in patient care processes and minimize wastes resulting in better quality of care at more affordable cost. The value chain method looks beyond the actual cost of a product and further analyzes how it is used within the practice and the long term gains or losses associated with it. Value chain analysis does have some disadvantages which can lead to more time consuming tasks.  Some of the difficulties involve gathering data, identifying the tasks or functions that can add perceived or real value, and developing and deploying the plan without compromising the company’s vision/mission (Smart Sheet, n.d.).
One way to improve the value chain analysis method is to hire external sources to conduct the internal examination. When internal stakeholders use the value chain they are more likely to have difficulty connecting, or “linking” each of the five activities together to fullfil their vision. An external source will add a fresh perspective to the organization and utilizing skilled professionals can add insight to how the five activities relate and “link” together.
Beers, B. (2018). Value chain analysis: what are the advantages and disadvantages? Investopedia. Retrieved from
Sharan, A.D., Schroeder, G.D., West, M.E., & Vaccaro, A.R. (2015). Understanding a value chain in health care. Journal of Spinal Disorders and Techniques, 28(8):291-3. doi: 10.1097/BSD.0000000000000319.
Smart Sheet. (n.d). Comprehensive guide to value chain analysis with examples by industry. Retrieved from

2.  Appreciative Inquiry provides a strategic approach of open dialogue designed to help organizaitons and partners to create a shared vision for the future.  Appreciative inquiry consists of 5 phases: define, discovery, dream, design, and destiny.  Some of the advantages of implementing and using appreciative theroy in organizations is that it provides high engagement,  utilizes rewards and recognition, and creates a shared vision with the organizaiton and its stakeholders.  Bunshaft (2018) examines how organizaitons can use different strategies to engage employees, stakeholders, and the organizaiton as a whole to improve best practices which include appreciative inquiry. Moreover, this analysis displays an improvement in better employee engagement and drive better customer service.  Appreciative inquiry is a great alternative in improving an organization’s strategy to improve because it creates a shared vision amongst all parties involved directly within the organization.
Bunshaft, J.A. (2018). The quest for employee voice and the role of appreciative inquiry. AI Practitioner. 20(3). 46-51. DOI:  10.12781/978-1-907549-36-6-8
Miller, M.G., Fitzgerald, S.P., Murrell, K.L., Preston, J. & Ambekar, R. (2005) Appreciative inquiry in building a transcultural strategic alliance.  Journal of Applied Behavioral Science. 41(1). 91‐110. Retrieved from

Retail Clinics-Disruptive innovation in Healthcare delivery
Background: Healthcare in the USA is most expensive compared to other developed countries. The trajectory of increasing healthcare cost is believed to be unsustainable. Several efforts have been proposed to bend the cost curve of healthcare. The Affordable care Act (ACA) was a government attempt to reform healthcare. The ACA prescribed that; payments for healthcare services should shift from payments for quantity of services to quality and efficiency of services provided; investment in technology, reduction in waste and abuse and reduction in payments to providers.
Comprehension: Technology has revolutionized many industries and makes their products more affordable and thus accessible to more customers by coupling cost reducing technologies with innovative business models to deliver increasingly affordable and accessible products, and services but not so in health care (Hwang, J., Christensen, C., M. September, 2008). Most technological enablers in healthcare have failed to bring about lower costs, higher quality, and greater accessibility because healthcare lacks appropriate business model (Hwang, J., Christensen, C., M. September, 2008). The present healthcare delivery is based on Solution business model which relies on highly trained and skilled providers to deliver both simple and complex healthcare services, this drive up the cost of simple medical services. A business model that separates complex healthcare services that needs high skill professionals from simple healthcare services that needs less skilled professionals like physician extenders will reduce the cost of the simple services. The retail health clinics are intended to do just that. The introduction of these clinics is disrupting how healthcare is being delivered despite the resistance from the physician and hospital groups.
Application: Disruptive innovation enables upstart companies to deliver more affordable and accessible solutions and to upstage once-dominant firms often before those firms and their leaders realize what was going on. Canon did it to Xerox by bringing slower but less costly tabletop photocopiers to the market; Toyota did it to General Motors by introducing less stylish but cheaper models and IBM did it to DEC by introducing microprocessors to personal computers instead of main frame computers (Hwang, J., Christensen, C., M. September, 2008). Taking simple healthcare services out of hospitals and clinics managed by highly skilled physicians into simple set ups like minute clinics managed by physician extenders such as nurses and physician assistant will lower the cost of such services, improve the quality and makes the services more accessible.
Analysis The structure of our healthcare delivery at the moment is complex and intertwined. Our payment system with third party payers inform of insurance makes it difficult for patients to choose where and how their care is delivered. However, the new interest in healthcare services by big companies such as  Google and Amazon will forced the necessary reform needed, these companies have the necessary financial power to invest in the technology and structure required. Walmart, CVS and Rite Aids are front leaders in this disruptive innovation (Diab, L. April 27, 2015).
Synthesis: While it is possible to move healthcare services that can be managed by physician extenders to clinics managed by the extenders, there is risk of segregated care therefore a new system where everyone must belong to a healthcare group that house each person’s medical information from where all providers can access patients information when needed should be established. The providers will frequently update the patient’s data. Each citizen should have the power to manage their health insurance fund by having the ability to shop for their care wherever they believe they will get the best quality care at an affordable rate.
Evaluation: The challenge with implementing the new system is that it will need a significant improvement in healthcare information system that will allow all the systems to be able to communicate with each other, capital investment is needed. The pros are that it will increase competition, reduce cost of care, reduce waste and improve quality.


One disruptive innovation in healthcare and one that continues to develop is the Electronic Health Record or EHR used in many hospitals and provider offices.  The EHR stores and documents all patient health information in electronic format to minimize the use of paper charts.  Furthermore, it allows the sharing of health information between patient providers associated in treatment and patient care. Some advanced systems of the EHR also allow patients to message their provider team directly with any questions regarding treatment plan. In addition, patients can request appointments, view MD progress notes and reports, and request their own physical records.  The EHR has emerged in light of recent healthcare technology research and innovations to create a more dynamic and fluid healthcare system.  Beforehand, it was very hard for healthcare providers to obtain medical information for patients seeking treatment options from different specialists.  With EHR, patients and providers have easy access to quickly retrieve medical records and document everything in one single patient chart.
Baird, A., Davidson, E. Mathiassen, L. (2017). Reflective technology assimilation: facilitating electronic health record assimilation in small physician practices. Journal of Management Information Systems. 34(3).664-694. DOI:  10.1080/07421222.2017.1373003


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