This post was contributed by Seth Hardy, MD, member of the ACR Commission on Economics.
Operations management is the study of organizational sustainability. There are four pillars of operations known as competitive priorities: cost, quality, timeliness and flexibility. Effective management of these competitive priorities is how the organizations in which we work and do business become sustainable. Once you are aware of them, they become quite obvious in our everyday lives. Organizations that neglect all of these priorities typically cease to exist.
In the car rental market, we have Budget and Hertz. They clearly compete with each other using cost vs. quality. Enterprise with their “we’ll pick you up” promise utilizes the timeliness and flexibility dimensions to gain a competitive advantage. As for Rent-A-Wreck, there is a reason you will not find them at any airport you want to fly to.

ACR Maine delegation meets with Sen. Susan Collins (R-ME)
Our College purports that, “Quality is our Image.” Among the medical specialty societies with which we compete, the ACR’s stake in quality serves us very well. Every Hill Day, Senator Susan Collins (R-ME) is very generous with her time. She has made it clear that she listens to our ideas because they represent quality. The fact that they may bend the cost curve is a bonus. The access, respect and exchanging of concerns is based on an appreciation of quality. An organization that understands and exploits their competitive priority(ies), such as ACR does with its focus on quality, is hard to beat.
While the concepts of cost, quality and timeliness are understood to every child who has run a lemonade stand, flexibility as a priority is less obvious. However, if flexibility is well-understood, it is a very powerful space in which to compete. Certainly, if there were a Transformers car rental agency, I would carry their loyalty card in my wallet and toss the rest.
Charles Darwin tells us, “It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” As the frequency and amplitude of economic and regulatory change increases, we must be flexible in order to sustain our operations. Listen to Darwin carefully; he is not only claiming that flexibility is the most important competitive priority, he is also linking it to resiliency and survival.
As you work and do business, start to recognize and analyze which competitive priorities are being used, if any at all. If sustainability and resiliency are of value within your practice and life, contemplate which competitive priorities you are going to exploit and remember the value of flexibility.
I invite you to use the comments section below to share examples of where flexibility has helped your practice overcome a challenge.