The scarlet hospital was, in many ways, prepared to compete even before the upgrading of the highway. Timothy's philosophy of continuous quality improvement and excellence is proof of this. While there are some facets in its operations that may have to be changed to compete effectively on the broader market, the culture of quality at the facility will be among its most significant advantages. The opening of the highway poses a new dynamic to the competitive environment; however, it does not wholesomely disadvantage Scarlet. Notably, Human relations and customer loyalty that results from superior services are one of the greatest assets in the health care business (Zhou et al., 2017) . In response to this assumption, the scarlet hospital has invested heavily in its infrastructure, human resources, and image, resulting in high-quality services. This implies that those who have been receiving care at the facility understand this and are loyal due to those services.
Lack of competition in capitalistic markets has always been associated with low-quality care; this has not been the case with Scarlet hospital. However, the lack of competition may have slowed the offensive and marketing aggression that is synonymous with competition. The Scarlet Hospital may suffer from aggression unless it rolls out a counter-strategy. Quality care is also costly, and cheaper services from the Salem facilities are likely to draw some clients away from the hospital (Nair, 2018) . The catalog of services available in Salem may also be a potential area of competition, especially if there are services available in Salem but unavailable in Scarlet Hospital. The panic and relentless advertisements in radio and newspapers, in a way, indicate the lack of perfect preparation by the scarlet hospital.
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Complacency and the illusion of an insulated market are great undoings for any healthcare provider, as in the case study above. At all times, a hospital must be on the lookout on new trends and competitive strategies being employed by other facilities. While quality care is critical, the types of services, pricing, ease of accessibility, and convenience also play an integral role. The false illusion of an insulated market blinds the executive from keenly following on the changing dynamics of the market. It can easily make an organization concentrate on sharpening one edge and unknowingly forsake other integral areas that gives the hospital a competitive advantage. In insulated markets, suppliers and other players are likely to be working under the same illusion (Nair, 2018) . The implication is that there are many products that the hospital could be receiving at way higher prices, and once the highway opens, this may change. The lack of participation in the broader market may mean that the costs of services at an isolated facility like Scarlet, though of high quality, maybe overpriced. Low prices are thus a much-anticipated relief that can easily cart away many clients. To stop out shopping, health facilities should ensure they have positioned in a way that their prices are competitive, even with facilities that do not pose any immediate challenges.
Michael Porter's five forces help analyze the competition of a business aiding in determining its viability or lack thereof. A deep and proper understanding of the competitive environment is the first tool for designing any new strategies (Renko, Sustic, & Butigan , 2011) . Contextualizing the emerging forces within the opened up environment helps the executives chose a more feasible course of action. One of those strategic areas for review, as highlighted in the five forces, is the suppliers. While there is a threat of new entrants working against Scarlet, the bargaining power of suppliers will be greatly affected as well. Due to the enclosed nature of the city, the suppliers have been experiencing challenges bringing their products into this town, making them fewer and expensive. With the new market, more suppliers are expected and thus a likelihood of cheaper goods. The low prices can be passed on to consumers as low priced services. As regards the competitive rivalry as exhibited in the billboards and newspaper adverts, both Scarlet and competing hospital might have to stick to them until the new status quo is created.
The SWOT analysis is another critical tool in informing the adjustments that ought to be considered. The existing customer loyalty is one of Scarlet’s main strengths. A significant weakness in Scarlet is its pricing models that are likely to be higher, noting that it has zero competition. In contrast, the hospitals in Salem have been regularly competing amongst themselves, competition in most cases results in highly reduced prices of goods (Westra et al., 2017) . The opening up of Salem creates the opportunity of in shopping as it simultaneously creates the out shopping threat. Ideally, Scarlet ought to not only focus on the need to stop a possible out shopping but also on how to develop and maximize the in shopping. These strengths help build confidence while the opportunities broaden the team’s perspectives. The entire analysis helps burst the bubble of fear that has predominantly been interpreted as a future looming disaster. The opening up of Salem is advantageous in several ways when viewed through the SWOT tool.
The balanced scorecard model helps translate organizations' visions and objectives in actual and actionable steps (Baporikar, 2016) . For Scarlet, the balanced score card helps appreciate the value the procurement department will draw from opening up of the city. The newer perspective is important as it allows Timothy Rogers and the executive to have a broader and more realistic perspective of the hospital. Going through each of the objectives of the organization as required in the card makes it possible to prioritize the areas that must be focused on and what timelines each action is supposed to take. It also the hospital to have a balanced approach towards addressing the oncoming aggression while still delivering to the current customers. The scorecard helps grasp the financials across all the departments. A proper view of the financials informs what departments can avail finances for the needed impromptu marketing campaign. The balanced scorecard; thus, helps identify priority areas, set actionable decisions, and evaluate them for the advancement of the facility.
For survival and growth, Scarlet Hospital must employ a multi-layered strategy that guarantees its continuity and expansion, even with the opening of the city. The increased mobility of persons and goods between these two cities ought to be approached as a threat and an opportunity. It is taking every step to minimize the danger and every step to maximize the opportunity. A merely defensive strategy, as initially proposed by the Chief executive, may prove to be a burdensome idea that may not be helpful (“Gaining Legitimacy, Knowledge Creation and Hospital Survival,” 2017) .The board should therefore prepare both to expand its territory and to defend it.
To retain its clients, the organization ought to appeal to its long history and tie the city's opening to a promising future together. The hospital can let the existing customers know that the opening of the town will mean faster deliveries of supplies to the hospital and, thus, quicker services. Scarlet could also sell the idea of reduced prices of several services and even the possibility of new visiting consultants from the neighboring cities. This can be channeled through client emails to reach the target market, which will supplement the mainstream media presence (Kamra, 2020) . The key idea is to create a perspective that the city's opening offers more good to the facility. This is also in line with the excitement that the town is probably in since they will now be connected to the larger cities.
Advertisements on billboards along the highway and even in Salem ought to be made to increase in shopping. Scarlet should consider the possibility of opening an outpatient facility in Salem through which it can move patients to the Grove for inpatient care. Collaborations with smaller facilities in Salem could also suffice (Westra et al., 2017) . Taking a defensive and offensive position helps redefine competition, with the facilities in Salem also forced to be defensive.
References
Baporikar, N. (2016). Holistic Approach for Balanced Scorecard as Managerial Decision Making Tool. International Journal of System Dynamics Applications , 5 (1), 31–42. https://doi.org/10.4018/ijsda.2016010103
Gaining Legitimacy, Knowledge Creation, and Hospital Survival. (2017). Journal of Public Health Issues and Practices , 1 (1). https://doi.org/10.33790/jphip1100102
Kamra, V. (2020). Improving patients loyalty: A guide for healthcare service providers and policymakers. International Journal of Healthcare Management , 1–9. https://doi.org/10.1080/20479700.2020.1752992
Nair, G. K. (2018). Dynamics of pricing and non-pricing strategies, revenue management performance, and competitive advantage in the hotel industry. International Journal of Hospitality Management . https://doi.org/10.1016/j.ijhm.2018.10.007
Renko, N., Sustic, I., & Butigan, R. (2011). DESIGNING MARKETING STRATEGY USING THE FIVE COMPETITIVE FORCES MODEL BY MICHAEL E. PORTER - CASE OF SMALL BAKERY IN CROATIA. International Journal of Management Cases , 13 (3), 376–385. https://doi.org/10.5848/apbj.2011.00074
Westra, D., Angeli, F., Carree, M., & Ruwaard, D. (2017). Understanding competition between healthcare providers: Introducing an intermediary inter-organizational perspective. Health Policy , 121 (2), 149–157. https://doi.org/10.1016/j.healthpol.2016.11.018
Zhou, W.-J., Wan, Q.-Q., Liu, C.-Y., Feng, X.-L., & Shang, S.-M. (2017). Determinants of patient loyalty to healthcare providers: An integrative review. International Journal for Quality in Health Care , 29 (4), 442–449. https://doi.org/10.1093/intqhc/mzx058
