When Everything Is a Priority: Restoring Strategy Execution Under Competing Initiatives

Darren Dolcemascolo

Client Context

A mid-sized medical device manufacturer operating in a highly regulated, innovation-driven market had built a strong reputation for product quality and clinical impact. Growth pressures, margin expectations, and increasing regulatory complexity pushed senior leadership to pursue aggressive operational and strategic improvements simultaneously.

The organization was well-led, well-funded, and ambitious. Leadership teams were intelligent, committed, and deeply invested in improving performance. The issue was not lack of opportunity—it was an abundance of it.

The Strategic Challenge

At the enterprise level, the organization had launched multiple improvement initiatives at once, including: - Manufacturing and supply chain optimization - New product introduction acceleration - Cost reduction and margin expansion programs - Quality system enhancements - Digital and data initiatives

Each initiative had a compelling business case and significant potential ROI. Taken individually, every effort was rational. Collectively, they created unintended consequences.

What Leadership Was Experiencing

Despite strong intent and significant investment, execution began to degrade:

Initiatives competed for the same leadership attention and scarce expert resources

Some efforts worked at cross purposes, creating friction rather than leverage

Priorities shifted frequently as issues surfaced elsewhere

Teams hesitated, waiting for clarification on what mattered most

Leaders felt increasingly busy—but less effective

The organization was not failing to execute strategy. It was executing too many strategies at once.

The Hidden Cost of Competing Priorities

The impact was subtle but material:

Decision latency increased as tradeoffs were revisited repeatedly

Resources were spread thin, reducing speed and depth of impact

Local wins failed to compound into enterprise results

Frustration grew as teams delivered effort without clear payoff

Most importantly, leadership credibility began to erode—not because decisions were wrong, but because they did not hold under pressure.

The Executive Insight

The turning point came when leadership recognized a fundamental truth:

Strategy execution fails not when priorities are wrong—but when too many priorities are treated as non-negotiable.

The organization did not need better ideas, stronger business cases, or more initiative discipline. It needed a decision framework that forced explicit tradeoffs and protected focus.

The Engagement Focus

EMS Consulting Group worked with senior leadership to restore strategic execution discipline without slowing ambition.

The focus was not on choosing “winners and losers” arbitrarily, but on establishing clarity around: - Which initiatives truly mattered now - Which could wait without destroying value - Which were fundamentally incompatible if pursued simultaneously

This required elevating the conversation from project management to enterprise decision-making.

What Changed

Leadership shifted from managing initiatives to governing strategy execution:

A small number of enterprise priorities were explicitly declared

Competing initiatives were sequenced rather than parallelized

Resource commitments were made visible and honored

Decision rights were clarified to prevent informal renegotiation

Leaders aligned their behavior to reinforce focus, even under stress

The result was not fewer ideas—but greater strategic integrity.

The Results

With focus restored:

Execution speed increased across the highest-value initiatives

Resource contention declined as tradeoffs became explicit

Teams regained confidence in leadership direction

Strategic initiatives began to compound rather than collide

By doing less at once, the organization achieved more of what mattered.

Why This Matters to Executives

In medical device organizations, opportunity is rarely scarce. Attention, credibility, and execution capacity are.

When leaders allow every high-ROI idea to become a top priority: - Strategy fragments - Execution slows - Value erodes quietly

When leaders enforce focus: - Tradeoffs become a source of strength, not conflict - Execution accelerates - Strategic intent survives operational pressure

For this organization, the breakthrough was not better execution—it was better strategic choice under constraint.

Confidentiality Note
The client name and specific contextual details in this case study have been anonymized to protect confidentiality. The situations and leadership dynamics described are representative of actual client engagements.

About EMS Consulting Group
EMS Consulting Group advises senior leaders on strategy execution, enterprise prioritization, and decision-making under complexity. We focus on helping organizations convert ambition into results by enforcing clarity, focus, and leadership discipline where it matters most.

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