“We’ve gathered a lot of information about our market, got multiple streams of advice about the best strategy for us, some of which are contradictory and we are in a turmoil now”.

The startup was offering early breast cancer screening service, a machine intelligence based non-invasive assessment, at low cost.

The strategy issue was about whether this Asian company should try to sell first in the US, or continue sowing seeds in its domestic market.

Being present in the US would provide the visibility and credibility the company needed in order to overcome fussy administration and old habits back home, but this would probably take years and swallow most of the capital.

In the meantime, thousands of Asian women would not be diagnosed in time and would eventually die.

On the other hand, insisting on developing business at home meant confronting a market padlocked by mammography practitioners and non-believers from Health Administration.

Without the US experience and legitimacy, chances to overcome cultural obstacles and bring this new technology to huge amount of women in high risk, was very low. Many lives would be lost.

How to make the best decision?

After exploring together the pros and cons of each option, defined priorities, listed and discussed obstacles, how to look at them, and overcome them, the CEO acknowledged the position of those opposed to the new technology. Instead of rejecting it, she finally found alternatives on how to gain visibility and deal with the administration.

The strategic choice could be made easily once the CEO realized she was trapped in a vicious circle and decided to step out:

I spend time and money in a foreign country where women have so many other options to get diagnosed, while I could save in the meantime 500 lives every day at home


I accept to reach out to the women that need us, but very slowly, because we are unable to break the straightjacket of habits and bureaucracy?


One of the solutions that emerged from our discussions was for the company to apply for FDA approval (American Food and Drug Administration) but refrain from starting a commercial activity in the US; this option was actionable in a short time, requested limited resources and was giving the company the strength and legitimacy it needed to develop its domestic market share at the same time. Fast.

Saving thousands of lives through early detection of breast cancer at low cost and with easy access was the very reason for this company to exist.

Accepting the slowness of the actual process was unacceptable.

Accepting an alternative solution obliging the company to abandon women in need, for 2 or 3 years, was just as unacceptable.

Sometimes, a well-established strategy is stumbling on unexpected obstacles; values can be colliding. In such cases, how do you think out of the box?