Health care historically has been a very siloed field that's organized around medical specialties - urology, cardiac surgery, and so forth - and around the supply of these specialty services. The patient is the ping-pong ball that moves from service to service.

So companies have to be very schizophrenic. On one hand, they have to maintain continuity of strategy. But they also have to be good at continuously improving.

If all you're trying to do is essentially the same thing as your rivals, then it's unlikely that you'll be very successful.

Companies operating in urban communities have a tremendous ripple effect.

Finally, strategy must have continuity. It can't be constantly reinvented.