Table 5 Identity strategies and associated pressures

Identity strategies

 • Construction of formal agreement on boundaries to respect and behavior to engage;

 • Convoy a strong cohesive identity;

 • Build normative networks, which are privileged connections between specialist doctors and product specialists.

In reaction to

 Heterogeneity of acquisition process

  • Some hospitals have highly structured and solicited units, others do not have this technological choice and rely on the administration that, most of the time, relies on the opinion of local doctor;

  • Public acquisition process can be tedious and counter-productive;

  • Acquisition processes are not as streamlined as with drugs;

  • Disproportionate efforts put into research and sales, versus efforts on evaluation and demonstration of the incremental benefit.

 Low fragmentation of system and challenging market cycles

  • Government direct almost all acquisitions where there can be negative evaluations or extensive administrative lengths;

  • Market cycles seem to be the major challenge and a major determinant for the valuation of an innovation and of a company.

 Changing perceptions

  • Actors were divided towards the attitude to adopt with company representatives and firm market actions;

  • A large part of product development concerns the quality of the actors or the interaction of these actors with each other.