Sunday, December 20, 2015

TOWS, or Modified SWOT, for an Obesity Medicine Practice

SWOT analysis is widely used for strategic planning. And the analysis tool is often employed by healthcare organizations. But a modified version of SWOT, called TOWS (pronounced "TOES"), may have some advantages.

In "SWOT," the "S" stands for STRENGTHS, the "W" stands for WEAKNESSES, the "O" stands for OPPORTUNITIES and the "T" stands for THREATS. In TOWS, the letters mean the same thing as they do in SWOT. However, the rearrangement of the letters is meant to motivate a slightly different analysis approach compared to how SWOT analyses are commonly done. Emphasis is placed on the external environment.

A "SWOT Matrix," shown below, is a 2x2 matrix. The matrix allows an organization to list the strategic conditions of the organization that show the organization's competitive health. For example, in the "SWOT" table below, we have listed one strength, one weakness, one opportunity and one threat for a fictitious obesity medicine (OM) practice. For a real practice, there would likely be more items listed for each array of the matrix.

Looking at the matrix, assume that the medical practice feels that one of its internal strengths is the board certified physician's Affordable Care Act (ACA) training. One of the practice's weaknesses is its inefficient patient flow. The practice views the ACA as an opportunity. But the practice feels that because most patients and potential patients see a primary care physician for weight loss treatment, rather than a physician who specializes in obesity medicine, the ACA also presents a threat.

                                                   SWOT Matrix
Internal Strengths (S)

1. Board certified OM physician has ACA training

2. ...
Internal Weaknesses (W)

1. Inefficient patient flow

2. ...
External Opportunities (O)

1. The ACA

2. ...
External Threats (T)

1. Most people seeking wt loss advice see primary care physicians not OM physicians

2. ...

TOWS is a modified version of SWOT. However, TOWS stresses the external Threats and Opportunities. The TOWS matrix, as shown below, is a 3x3 matrix where the SWOT matrix is a 2x2 matrix, as indicated above. The additional four arrays in the TOWS matrix allow the organization to show how the organization can use its internal strengths to take advantage of external opportunities and avoid or mitigate external threats. The 3x3 matrix also allows the organization to show what the organization needs to do to shore up its internal weaknesses to better address the external opportunities, and avoid or mitigate the external threats.

For example, since the physician has training in ACA, the practice feels that it can use the physician's knowledge to increase patient volume, since the ACA increases the market for overweight and obesity treatment.                                                        

                                                      TOWS Matrix

Internal Strengths

1. Board certified OM physician has ACA training
2. ......
Internal Weaknesses

1. Inefficient patient flow

2. Staff lacking ACA Knowledge
External Opportunities

1. The ACA

Actions that use S’s or take advantage of  O's

1. Use ACA to increase patient volume
Actions that strengthen W’s  or take advantage of O’s

1. Train staff on ACA guidelines and reimbursement
External Threats

1. Most people see primary care physicians not OM physicians

Actions that use S’s or avoid or mitigate T’s

1. Send introductory letters to other local physicians to get referrals

Actions that strengthen W’s or avoid or mitigate T’s

1. Document flows and Improve cross training


So, as you can see, while SWOT is useful, TOWS may be even more useful. It allows an organization to view the strategic health of the organization and to devise initiatives that can improve the organization's strategic health.

It should be noted that the TOWS matrix shown above is laid out to illuminate the similarities and differences between the SWOT matrix and the TOWS matrix. However, in practice the TOWS matrix may be laid out in a way to emphasize the threat-opportunity-weaknesses-strengths sequence.


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