In 2015, the new chief executive officer of Wichita County Health Center (WCHC) was evaluating his organization's strengths and weaknesses in light of a changing environment for health-care delivery in rural Kansas. WCHC faced three key issues: whether to sign a service agreement with Colorado-based Centura Health; whether to hire additional full-time nursing staff instead of paying high fees to an external staffing company; and identifying opportunities to grow its patient base. To assist with these three decisions, WCHC needed to conduct a strategic planning process using the strengths, weaknesses, opportunities, and threats (SWOT) framework.

Analyzing an organization using the strengths, weaknesses, opportunities, and threats (SWOT) framework generates crucial insights for decisions on major new initiatives. For example, when considering an acquisition or launching a new product or service, a SWOT analysis can raise warnings about customer sensitivities or gaps in expertise; alternatively, it can reveal new lines of business and unmet needs that may lead to new business opportunities. A SWOT analysis also serves as a typical first step in a broader strategic planning process. This technical note focuses on the use of a SWOT analysis in the healthcare sector, including recommendations for key questions to ask when initiating a SWOT analysis and advice for arranging information in a way that supports strategic decision-making. The SWOT approach has gained importance in the healthcare sector in recent years due to both market and policy shifts. Healthcare is a site for major reform as policy-makers seek to reduce costs and encourage innovation. Across the developed world and in many developing countries, better strategic decision-making is essential to healthcare providers and finance organizations as they care for ageing populations, seek to reduce the impacts of lifestyle-related diseases such as obesity, and work to manage expenses associated with treating chronic diseases.

After suffering severe complications from a relatively minor surgery at a California children's hospital in early December 2013, a young teenage girl was declared brain dead. However, to her family, the girl seemed responsive and they refused to accept the hospital's statement that their daughter was deceased. The hospital arranged visits with social workers and other staff in an attempt to help the family understand that their daughter was dead and, after three days, informed the family of its plan to move the teen's body to the morgue. The case quickly became a nationwide media event. The family acquired a noted lawyer to ensure the teen received the care the family thought was needed, while the hospital hired a public relations firm to become the hospital's voice in the issue, a move that might have exacerbated the problem. With such a complex and tragic crisis that rapidly unfolded, should the hospital have a policy in the event that family members disagree with an official medical diagnosis? How could the hospital have managed the aftermath of the teen's death and prevented a media embarrassment?

Leaders of the Romanian telecommunications agency must decide about a proposed international merger and how to structure bandwidth auctions critical to the telecoms market. The case is designed to teach about regulatory choices from the perspective of a regulatory agency, but it also describes the competitive standing of domestic and international telecoms providers in Romania and the challenges of operating as a "foreign" multinational, even in the European Union where protection of national champions is supposedly obsolete. Policy tradeoffs are developed among approving, delaying, or denying the proposed merger of domestic Romtelecom with Greek-based Cosmote. Likewise, tradeoffs are described for bandwidth auctions, notably among public transparency, maximizing revenue, preventing collusion, promoting efficient use of spectrum, broadening coverage, and fostering innovation in products and services.

Three years into a major public-private partnership between GlaxoSmithKline and Fiocuz, Brazil's principal health institute, the company assesses technology transfer and joint research under the agreement. GSK was selling its Synflorix vaccine (against pediatric pneumonia) at fixed prices even as it transferred technology and know-how to Brazil for eventual domestic production. At the same time, GSK was co-sponsoring research into a new vaccine for Dengue fever with the Brazilian government. GSK's management must consider whether the PPP provides strategic advantage to its consumer healthcare businesses in Brazil and to access other emerging markets as well as the risks posed by the aggressive product obsolescence built into the technology transfer agreement.

Supplement to "U.S. Healthcare Reform: International Perspectives," HBS No. 710-040, updating key events and disputes concerning the reform law, including the 2010 Congressional elections, legislative proposals, legal challenges, and responses by employers.

Brazil's new president, Dilma Rousseff, had announced plans to sustain GDP growth above 5 percent annually and continue the country's leadership role among emerging economies. Between 2003 and 2010, Brazil benefited from strong economic growth and stable policies under the Lula administration. Brazil also increasingly led the BRICs (the fast-growing countries of Brazil, Russia, India, and China) in multilateral negotiations, notably in the World Trade Organization's Doha Round. Yet Brazil's actions to enforce a compulsory license of a patented therapy for HIV/AIDS and its victory in a longstanding WTO dispute with the United States over cotton subsidies had created tensions with major trading partners. Entering office in January 2011, Rousseff had the opportunity to outline a new agenda for international trade. Specifically, she had to decide whether to seek completion of the Doha Round, which was in a stalemate due to disputes over global intellectual property rules and agricultural subsidies and tariffs, or to instead pursue regional trade agreements in South and Central America. Rousseff also pledged active government involvement in the economy, described in the case as "Brazilian capitalism," but it was unclear whether fiscal expansion coupled with conservative monetary policies would reduce bottlenecks to growth and further temper Brazil's high inequality.

Arcadia Biosciences is seeking to introduce genetically modified rice to China that will lower farmers' costs and generate environmental benefits through reduced greenhouse gas emissions. The case describes challenges facing this small agricultural biotechnology company, notably uneven enforcement of intellectual property in emerging market countries, and uncertainty regarding the provision and market value of carbon credits under international climate change agreements. In September 2008, Eric Rey, Arcadia's CEO, faces an inflection point concerning his leading technology, genes for nitrogen use efficiency (NUE) in rice. He can determine a price to charge for NUE seed based on savings to farmers from their reduced use of expensive nitrogen fertilizers. Or he can advance a plan to earn revenue from carbon credits allocated under the Kyoto Protocol to China for use of Arcadia's rice, because reduced nitrogen fertilizer use will lower greenhouse gas emissions. The case provides context on the company; describes advances in seed technologies focused on climate change and the associated resource issue of fertilizer use; and presents the strategic choices facing a start-up company operating at the intersection of business, agriculture, and climate change agreements.

This note analyzes disputes over intellectual property enforcement and agricultural trade barriers at the center of the Doha Round of World Trade Organization (WTO) negotiations. Fundamental principles of intellectual property rights and agricultural subsidies are described, along with the challenges of creating and operating multilateral institutions. The note begins with a brief history of multilateral negotiations under the General Agreement on Tariffs and Trade (GATT), then describes key events of the Doha Round that began in 2001, and the WTO's dispute settlement process. A stalemate has developed between developed and developing countries in WTO talks, leading to the proliferation of bilateral agreements. The note challenges readers to develop an informed position on global trade governance and the economic benefits and political tradeoffs associated with reduced trade barriers and the elimination of domestic subsidies.

The national economic implications of rising healthcare costs were poorly understood, even as the United States, Germany, and the United Kingdom instituted reforms in early 2010. Presenting opportunities for cross-national policy learning, this case describes the political economy of healthcare reform. In late March 2010, a major healthcare reform act was signed into law in the United States, expanding coverage and regulating insurers. However, it was not clear that expanding coverage would resolve a longstanding dilemma of rising costs for insurance and care. As the Department of Health and Human Services implemented the new law, it drew on lessons from Germany, which had implemented changes to regulated but competitive insurance and provider markets, and the United Kingdom, which had introduced market-style initiatives while keeping insurance and delivery under the National Health Service.

This case explores company strategy, business-government relations, and collective action challenges associated with international and domestic lobbying regarding regulation of the chemical industry. In the fall of 2006, a five-year legislative process for a major new law regulating chemicals in the European Union appeared to be nearing its conclusion. REACH, the Registration, Evaluation, Authorization, and Restriction of Chemicals, would create a new European Chemicals Agency, require companies to submit testing data on existing and new compounds, and restrict the manufacture of hazardous substances. Andrew Liveris, CEO of the Dow Chemical Company, has to decide whether the company should engage in direct discussions with the European Parliament and Commission, with the implication that the company can influence the regulations but also would have to support the final outcome. The case summarizes Dow's history, competitive dynamics in the sector, and regulation of the chemical industry before describing the REACH legislative process and various approaches to lobbying used by chemical companies, trade groups, and environmental NGOs.

This case describes how Denmark has balanced the impacts of globalization, including outsourcing and movement of labor with its social welfare offerings. Reforms implemented during the past two decades drove down unemployment, promoted new company formation, and put the country at or near the top of international polls on the ease of doing business. The case describes how Danes forged a consensus that embraced international trade and outsourcing while supporting continuous upgrading of workplace skills. In April 2009, the new Prime Minister, Lars Løkke Rasmussen, is balancing short-term responses to a global recession against longer-term planning for the Danish labor market and macroeconomy. Can Denmark keep its borders open to the free movement of goods, services, and labor while also sustaining the breadth of its welfare offerings?

This case explores regulatory, product testing, and business strategy at Targanta Therapeutics, a biotech company preparing its first new drug application to the FDA. In October 2007, Mark Leuchtenberger, president and CEO of Targanta - which has just held a successful IPO - weighs options for the approximately ten month review period after the company submits to the Food and Drug Administration. The case reviews Targanta's origins and "de-risking" of oritavancin, an antibiotic therapy for drug-resistant infections that was first invented at Eli Lilly and then spun out to InterMune before Targanta acquired it in late 2005. To highlight the impact of regulatory policy on business strategy the case then describes a set of choices facing the firm, including staffing a marketing and sales group, carrying out additional clinical testing to expand the approved indications, applying for European market approval, or keeping funds in reserve in the event that the FDA requests further data.

Arcadia Biosciences is an entrepreneurial California agricultural biotech company seeking to earn carbon credits by modifying commodity crops for use in China and India. Eric Rey, Arcadia's CEO, faced a strategic inflection point in early September, 2008. The company had a plan to share carbon credits allocated by the United Nations Clean Development Mechanism Executive Board to China, for use of Arcadia's rice varieties, since they enabled farmers to reduce nitrogen fertilizer use, in turn lowering greenhouse gas emissions. But the company's proprietary traits for nitrogen use efficiency, salt tolerance, and water use efficiency also had more conventional paths to market based on licensing deals to large seed companies. Alternatively, Arcadia could acquire a seed company and develop and market its seed directly. A different near-term growth area involved commercializing enriched safflower oil which had undergone several proof of concept tests and for which Rey foresaw a clear market in nutritional supplements and functional foods. The case provides context on the company; describes advances in crops genetics focused to climate change and associated resource issues of fertilizer use, water use, and soil salinity; and poses strategic choices for a start-up company operating at the intersection of business, agriculture, and climate change.

This note describes the history and regulation of clinical trials, managerial challenges related to pharmaceutical product testing, and current debates regarding prescription drug safety. Since clinical testing takes between five and seven years, and consumes up to 70 percent of a drug's total development costs, pharmaceutical and biotechnology leaders need to understand clinical trial management. Likewise, with a growing variety of new product introductions requiring pre-market testing, managers and analysts in many business sectors will benefit from understanding clinical trials.