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Flevy Management Insights Case Study
Organic Growth Strategy for Residential Care Facilities in the Northeast US


There are countless scenarios that require Business Process Improvement. Fortune 500 companies typically bring on global consulting firms, like McKinsey, BCG, Bain, Deloitte, and Accenture, or boutique consulting firms specializing in Business Process Improvement to thoroughly analyze their unique business challenges and competitive situations. These firms provide strategic recommendations based on consulting frameworks, subject matter expertise, benchmark data, KPIs, best practices, and other tools developed from past client work. We followed this management consulting approach for this case study.

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Consider this scenario: A residential care facility in the Northeast US, specializing in senior care, is facing challenges in business process improvement, primarily due to outdated operational practices.

The organization has experienced a 20% increase in operational costs over the past two years, significantly impacting its profit margins. Additionally, it is grappling with external challenges such as a 30% increase in competition from new facilities and changing healthcare regulations, which have put additional pressure on maintaining compliance and quality of care. The primary strategic objective of the organization is to achieve organic growth by improving operational efficiencies and expanding its market share in the Northeast US through differentiated care offerings.



The residential care facility is currently at a critical juncture, where its future growth and sustainability depend on addressing operational inefficiencies and navigating a highly competitive and regulated market. The challenges suggest underlying issues with outdated business processes and a lack of strategic focus on innovation in care delivery. To secure a competitive edge, a thorough analysis and strategic overhaul are imperative.

Competitive Market Analysis

The residential care industry is experiencing rapid growth, driven by an aging population and increasing demand for senior care services. However, this growth is accompanied by heightened competition and regulatory scrutiny.

We begin our analysis by examining the competitive landscape and industry dynamics:

  • Internal Rivalry: High, due to the proliferation of residential care facilities offering similar services.
  • Supplier Power: Moderate, with a limited number of suppliers for specialized care equipment and pharmaceuticals.
  • Buyer Power: High, as families and seniors have a wide array of choices for care facilities.
  • Threat of New Entrants: Moderate, because while the market is attractive, regulatory barriers exist.
  • Threat of Substitutes: Low, given the specialized nature of residential care that cannot be easily replaced by other forms of senior living options.

Emergent trends in the industry include a shift towards personalized care plans and the integration of technology in care delivery. These trends indicate major changes in industry dynamics, presenting both opportunities and risks:

  • Increased demand for personalized care: This opens opportunities for facilities to differentiate their services but requires investments in staff training and technology.
  • Technological integration in care delivery: Offers the chance to improve operational efficiency and care quality, but poses the risk of significant upfront costs and resistance to change among staff.
  • Regulatory changes: Constantly evolving regulations present a challenge for compliance but also an opportunity to lead in quality of care and safety standards.

A STEER analysis highlights the importance of Socio-cultural, Technological, Economic, Environmental, and Regulatory factors influencing the residential care industry. The aging population and technological advancements are driving demand, while economic pressures and regulatory requirements pose challenges to profitability and operations.

Learn more about Competitive Landscape

For effective implementation, take a look at these Business Process Improvement best practices:

Process Automation & Digitalization Assessment (41-slide PowerPoint deck)
Strategic Process Improvement (180-slide PowerPoint deck)
Kaizen (254-slide PowerPoint deck and supporting PDF)
Business Process Improvement (BPI 7) (139-slide PowerPoint deck and supporting Word)
Business Process Reengineering (BPR) (157-slide PowerPoint deck and supporting PDF)
View additional Business Process Improvement best practices

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Internal Assessment

The organization possesses a strong reputation for quality care and a dedicated staff, but it struggles with outdated operational processes and technology adoption.

Our MOST Analysis reveals that the organization's Mission aligns with providing high-quality care, but its Objectives are not fully supported by its Strategies and Tactics due to operational inefficiencies.

Core Competencies Analysis indicates a need to strengthen areas such as process innovation, staff training in new technologies, and personalized care delivery to maintain competitiveness.

McKinsey 7-S Analysis points to misalignments between Strategy, Structure, and Systems, particularly in adopting modern operational practices and technologies that could enhance efficiency and care quality.

Strategic Initiatives

  • Business Process Improvement: Implement a comprehensive operational excellence program aimed at reducing costs by 15% and improving staff productivity. This initiative will create value by optimizing resource allocation and enhancing service delivery efficiency. Resources needed include process improvement consultants and technology investments.
  • Digital Transformation in Care Delivery: Introduce advanced care technologies such as telemedicine and electronic health records to personalize and improve care quality. The intended impact is to enhance patient satisfaction and operational efficiency. The source of value creation comes from improved care outcomes and operational agility. This will require investments in technology infrastructure and staff training.
  • Market Expansion through Service Differentiation: Develop and launch specialized care programs targeting underserved segments, such as dementia care. This initiative aims to increase market share by 10% over the next 3 years. Value creation stems from tapping into new customer segments with tailored services. Required resources include market research, program development, and marketing.

Learn more about Operational Excellence Process Improvement Market Research

Business Process Improvement Implementation KPIs

KPIS are crucial throughout the implementation process. They provide quantifiable checkpoints to validate the alignment of operational activities with our strategic goals, ensuring that execution is not just activity-driven, but results-oriented. Further, these KPIs act as early indicators of progress or deviation, enabling agile decision-making and course correction if needed.


Tell me how you measure me, and I will tell you how I will behave.
     – Eliyahu M. Goldratt

  • Operational Cost Reduction: Measures the financial impact of business process improvements.
  • Patient Satisfaction Score: A key indicator of the success in enhancing care quality through digital transformation and service differentiation.
  • Market Share Growth: Tracks the effectiveness of market expansion strategies.

These KPIs will provide insights into the effectiveness of the strategic initiatives, highlighting areas of success and opportunities for further improvement. Monitoring these metrics closely will enable the organization to adjust its strategies in real-time to maximize impact.

For more KPIs, take a look at the Flevy KPI Library, one of the most comprehensive databases of KPIs available. Having a centralized library of KPIs saves you significant time and effort in researching and developing metrics, allowing you to focus more on analysis, implementation of strategies, and other more value-added activities.

Learn more about Flevy KPI Library KPI Management Performance Management Balanced Scorecard

Business Process Improvement Best Practices

To improve the effectiveness of implementation, we can leverage best practice documents in Business Process Improvement. These resources below were developed by management consulting firms and Business Process Improvement subject matter experts.

Business Process Improvement Deliverables

These are a selection of deliverables across all the strategic initiatives.

  • Operational Excellence Roadmap (PPT)
  • Digital Transformation Strategy (PPT)
  • Market Expansion Plan (PPT)
  • Financial Impact Model (Excel)
  • Service Differentiation Framework (PPT)

Explore more Business Process Improvement deliverables

Business Process Improvement

The strategic initiative of Business Process Improvement was significantly bolstered by the application of the Value Stream Mapping (VSM) and Lean Six Sigma methodologies. VSM, a lean-management method, was utilized to analyze and design the flow of materials and information required to bring a product or service to a consumer. It proved invaluable in identifying waste and areas for improvement within the organization's operational processes. The team employed VSM in the following manner:

  • Mapped out the current state of key processes to establish a baseline for improvement.
  • Identified and categorized waste in each process, focusing on areas such as overproduction, wait times, and unnecessary movement.
  • Designed a future state map that eliminated these wastes and improved process flow.

Lean Six Sigma, combining Lean manufacturing methodologies and Six Sigma, was adopted to reduce variability and improve the quality of the organization’s output. This approach was instrumental in enhancing operational efficiency and care quality. Implementation steps included:

  • Formation of cross-functional teams to address specific process inefficiencies identified in the VSM exercise.
  • Utilization of the DMAIC (Define, Measure, Analyze, Improve, Control) framework to systematically improve and optimize processes.
  • Training key staff in Lean Six Sigma principles to ensure sustainability of improvements.

The integration of VSM and Lean Six Sigma into the Business Process Improvement initiative resulted in a 15% reduction in operational costs and a significant improvement in staff productivity. These methodologies not only helped in streamlining operations but also laid down a foundation for continuous improvement, driving the organization towards operational excellence.

Learn more about Continuous Improvement Value Stream Mapping Six Sigma Business Process Improvement

Digital Transformation in Care Delivery

For the Digital Transformation in Care Delivery initiative, the organization leveraged the Diffusion of Innovations (DOI) theory and the Agile Project Management framework. DOI, developed by Everett Rogers, was instrumental in understanding how the adoption of technological innovations could spread within the organization and its client base. This theory helped in planning the rollout of new technologies such as telemedicine and electronic health records. The process was as follows:

  • Identified early adopters within the organization and among the clientele to pilot the new technologies.
  • Monitored and documented the adoption process, using feedback to adjust strategies and increase the rate of adoption across the wider organization.
  • Developed targeted communication strategies to highlight the benefits and ease of use of the new technologies, addressing potential resistance.

Agile Project Management was chosen to manage the implementation of digital tools, allowing for flexibility and rapid response to feedback. This approach ensured that digital transformation initiatives could be adjusted as needed to meet user needs and expectations. Implementation included:

  • Organizing cross-functional teams to work on short sprints, focusing on rapid development and deployment of digital solutions.
  • Conducting regular review and planning sessions to assess progress and pivot as necessary based on stakeholder feedback.
  • Implementing a continuous delivery model to ensure that improvements could be made incrementally and efficiently.

The successful application of the DOI theory and Agile Project Management to the Digital Transformation in Care Delivery initiative resulted in enhanced patient satisfaction and operational efficiency. Through these frameworks, the organization was able to effectively navigate the complexities of introducing new technologies, ensuring a smooth transition and widespread adoption.

Learn more about Digital Transformation Project Management Agile

Market Expansion through Service Differentiation

The Market Expansion through Service Differentiation initiative was advanced through the use of the Resource-Based View (RBV) and the Product Lifecycle (PLC) model. RBV, a framework for identifying and leveraging organizational resources and capabilities to gain a competitive advantage, was pivotal in determining how the organization could differentiate its service offerings. The team applied RBV in the following way:

  • Conducted an internal audit to identify unique resources and capabilities that could be leveraged to develop specialized care programs.
  • Analyzed market needs to align the organization’s strengths with opportunities in underserved segments.
  • Developed strategic plans to capitalize on these unique resources, focusing on areas such as dementia care and post-operative rehabilitation services.

The PLC model was utilized to manage the introduction and growth of these new specialized care programs. This approach helped in understanding the stages that the new services would go through, from introduction to growth and maturity, and in planning marketing, pricing, and expansion strategies accordingly. Steps taken included:

  • Identifying the stage of the lifecycle for each new service and tailoring strategies to match.
  • Implementing targeted marketing campaigns to raise awareness and drive adoption during the introduction stage.
  • Monitoring service performance and customer feedback closely to make adjustments and extend the growth phase as long as possible.

The strategic application of the RBV and PLC model to the Market Expansion through Service Differentiation initiative enabled the organization to successfully enter new market segments, resulting in a 10% increase in market share over three years. These frameworks guided the organization in making informed decisions about which unique capabilities to leverage and how to effectively manage the lifecycle of new services, ensuring their long-term success in the market.

Learn more about Competitive Advantage Product Lifecycle

Additional Resources Relevant to Business Process Improvement

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Key Findings and Results

Here is a summary of the key results of this case study:

  • Reduced operational costs by 15% through the integration of Value Stream Mapping and Lean Six Sigma methodologies.
  • Enhanced patient satisfaction and operational efficiency by implementing telemedicine and electronic health records.
  • Achieved a 10% increase in market share over three years by developing and launching specialized care programs.
  • Identified and leveraged unique resources and capabilities to differentiate service offerings, particularly in dementia care and post-operative rehabilitation services.
  • Improved staff productivity significantly by training key staff in Lean Six Sigma principles and adopting modern operational practices.

The strategic initiatives undertaken by the residential care facility have yielded significant results, demonstrating the effectiveness of a comprehensive approach to business process improvement, digital transformation, and market expansion. The 15% reduction in operational costs and the significant improvement in staff productivity are particularly noteworthy, as they directly address the facility's challenges with operational inefficiencies. The successful implementation of telemedicine and electronic health records, facilitated by the adoption of the Diffusion of Innovations theory and Agile Project Management, has not only enhanced patient satisfaction but also operational efficiency, showcasing the potential of technology in transforming care delivery. However, the journey was not without its challenges. The initial resistance to change among staff and the significant upfront costs of technological integration highlight the difficulties in navigating digital transformation in a traditionally conservative industry. Additionally, while the 10% increase in market share is commendable, it also points to the highly competitive nature of the market and the continuous need for innovation and differentiation.

Given the results and the lessons learned, the next steps should focus on consolidating the gains while addressing the areas of improvement. First, ongoing training and support for staff to further reduce resistance to new technologies and methodologies are crucial. Second, exploring partnerships with technology providers could mitigate the financial burden of digital transformation and accelerate the adoption of emerging technologies. Third, a continuous focus on market research and customer feedback will be key in identifying new opportunities for service differentiation and expansion, ensuring the facility remains competitive in a rapidly evolving market. Finally, establishing a culture of continuous improvement and innovation will be essential in sustaining the gains achieved and driving future growth.

Source: Organic Growth Strategy for Residential Care Facilities in the Northeast US, Flevy Management Insights, 2024

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