Describes the major challenges facing Ralph Larsen, CEO of Johnson & Johnson since 1989, as he strives to maintain the company's decentralized management structure and at the same time keep the company competitive in the 1990s.

The main issue has to do with the lack of fit or incompatibility between the early environmental requirements for strategy and the cultural constraints on the organization. Describes the internal resistance to the proposed changes and top management's efforts to resolve the contradictory requirements of strategy and culture. A second major issue concerns the challenge facing a general manager who has been given responsibility for operationalizing the forced solution. Provides a brief background on Johnson & Johnson culture and the corporate systems and structures. A consolidated version of two earlier cases.