Medical manufacturing leaders struggle to maintain their competitive position due to inefficient business strategies. The purpose of this multiple case study was to explore strategies that in vitro diagnostics (IVD) medical manufacturing's leaders have used to gain and maintain a competitive advantage in the global marketplace. Porter's competitive advantage theory was used to understand how IVD medical business leaders maintain their competitive edge. Data were gathered through interviews with a purposive sample of 3 IVD medical device leaders from companies in California, Connecticut, and New York who had run IVD medical businesses for at least 10 years and who attended a 2014 medical exhibition in Dusseldorf, Germany. To reduce the risk of bias in measurement, triangulation methods included a literature review and intensive analyses of the interview responses, participant observation notes, company websites, and organizational records. Data were analyzed using thematic analysis to find essences of the participants' perceptions. The themes were derived from coding and the number of references coded during the data analysis. Eight themes emerged representing strategies for improving competitive advantage: customer support; marketing, e-marketing, and branding; competitive collaboration; quality; cost structure; regulation; innovation; and information technology. The 8 general themes have been divided into 3 categories: cost leadership, differentiation, and focus strategies base on Porter's competitive advantage theory. Results can help U.S. IVD organizational leaders develop strategies to thrive and secure market advantages, which could provide the resources for creating new products and increasing employment opportunities.