Strategic decision-making in healthcare organizations: it is time to get serious.

New and continuing environmental demands and competitive forces require healthcare organizations to be increasingly careful in thinking about their strategies. They must do so in a highly unusual (multi-actor) marketplace where a variety of system interdependencies complicate decision-making. A good strategy requires an attempt to understand the real, as distinct from the perceived, environment, and is characterized by explicit tradeoffs along three dimensions: service or program variety, patient needs, and patient access.