Creating The Ultimate Healing Environment

Key Thought:

Building a hospital based on Evidenced-Based Design, integrated IT solutions and Patient Safety. How to do it?

Summary:

Case of OhioHealth building Dublin (Ohio) Methodist.

OhioHealth believed that a guiding principle in the construction effort was basing building design on the best available research to positively impact balanced scorecard measures of quality and safety; patient, family and staff satisfaction; operational efficiency; and financial performance.

Another guiding principle was an investment in cutting-edge IT that assist in improving patient safety, at the same time allowing the hospital to be digital, wireless and paperless to the maximum extent possible.

Dublin (Ohio) Methodist was build by paying attention to stress-reducing design and creating a patient/family-centered environment that improves safety while respecting privacy and dignity.

Evidence-based design features:-

- Rooms are acuity adaptable, allowing patients to remain in the same room regardless of level of illness eliminating intra-hospital transfer

- rooms are like-handed (what is on the left in one room is on the left in the next room); diminish the need for care providers to search for what they need for patient care

- rooms has access to natural light to reach nearly 90 percent of all occupied spaces

- windows in patient rooms partially open to let in fresh air

- a waterfall and trees in the lobby help to reduce stress among patients, families and hospital staff

- decentralized work station bring caregivers closer to their patients

- sound-absorbing ceiling tiles and a noiseless paging system create a quieter environment

Weaving IT into evidence-based design:

- patient's medical information is accessible via networked PC, wireless tablet PCs, and handheld devices

- no admitting department but has a group of people who perform the admitting function in the patient's room upon arrival

- single sign-on with biometrics reader

- integration of patient call lights, cardiac monitor alarms and bed exit alarms with wireless communication badge and earpiece worn by each caregiver

- use of computerized physician order entry (CPOE)

- digital ED and surgery management systems

- bed management system allows proper placement of patients quickly and sends messages to environmental services when beds need to be cleaned

- only hire employees who were willing to use IT

- physicians applying for privileges at Dublin Methodist agreed to be trained in and use the available technology

- employees are required to attend 8 weeks of training before hospital opened

Evidence-based design was led by The Center for Health Design, a leading research and advocacy organization. Before design and construction started, a design company Big Red Rooster completed a cultural report by conducting research about patients and staff perceptions of hospitals and the environment. The research was centered around traditional hospital cultures to help identify areas for improvement such as healthcare quality, patient satisfaction, staff retention, operational efficiency and productivity, and attracting more patients.

My Comments:

Many of these principles can and should be incorporated into our new hospital tower.

Reference: Creating the Ultimate Healing Environment: integrating Evidence-Based Design, IT and Patient Safety by Cheryl L. Herbert RN and Lamont M. Yoder RN FACHE, Healthcare Executive, SEPT/OCT 2008, p17-23.

Technology in Healthcare

Key Thoughts:

Each budget cycle, we struggle to produce a reasonable budget by maintaining or reducing total FTEs, reigning in other expenses, (optimistically) projecting market share growth, approving a handful of new business initiatives and, not infrequently, negotiating the negotiating the margin target downward.

Each year it gets more challenging to find new, material expense reduction or revenue generation opportunities.Short of dramatically altering service to the community and, thus, your organization's commitment to the community, what else is available to address the complex business challenges we continually face?

The current revenue and expense environment makes every miss tougher to accommodate, making the organization's ability to fulfill its challenges more difficult.

EMR - if we ask why invest in EMR, you will get a reflexive response citing the imperative to improve safety, enhance quality and lower costs. If we ask what was the decision making process used to allocate significant capital toward an EMR, or ask about its return on investment or specific improvements in patient safety and quality metrics the EMR has produced a couple of years down the road, or what organizational performance dashboard has changed and by how much due to their EMR implementation, the frequent response is an awkward silence - a scary reaction about an investment hat costs tens of millions of dollars and untold millions in consulting expenses and staff time to implement and support.

Traditionally, organizations has sorted technology needs based on cost and perceived priority. They also continued to invest in new technologies without a more comprehensive understanding of their hard and soft yields and their relative ability to accomplish the organization's goals - a key miss when the available resource pool with which to invest in any technology is increasingly challenging to fund.

What we need is an awareness of how to leverage technology to solve our more vexing business problems, a systematic thinking about how a given technology can be creatively and strategically harnessed as a tool to support a process and facilitate fundamental operational or organizational improvement. Which purchase, for example, will help improve market share and by how much? And, why is it superior to the other capital budget requests vying for funding?

Summary - a organized, thoughtful approach in harnessing technology for healthcare delivery:

1. A strategic focus for technology review

What is it that you want technology to accomplish our mission and strategic plan?

2. A framework for assessing a technology's value to the organization

An organized method to evaluate any given technology's potential to solve business issues that extend beyond readily available information about what the technology promises to do.

3. Knowledge of technology trends

4. Tools for finding and staging high-value technologies

Summary - emerging technologies that solves operation problems

Ergonomics - patient mobility devices such as lean-stand assisted lifts, sit-stand wheelchairs, lateral transfer devices, gait belts and repositioning devices, holds great potential to decrease workplace-related injury and disability, reduce costs and help ensure a healthier work force that can remain working

Wireless communication - consolidation of multiple platforms - electronic whiteboards allowing real-time tracking of patients, lab and ancillary results, room status, equipment status and triage state, RFID which tracks and records patient, equipment and staff movement throughout the facility

RTLS (real-time location system) - reduces hunting time for supplies, staff and patients

Point-of-care testing - moves testing to bedside, offering faster test results with fewer transportation-related errors. The ability to obtain quicker test results can increase efficiency and lead to shorter hospital stays and reduced complications

Modeling and simulation - used for training and credentialing, and facilities design

Remote patient management - increase the coverage of scarce specialists clinicians eg telemetry ICU. increasing life expectancy and the rise in chronic disease are driving development of new technologies such as sensors for independent living; remote disease monitoring of asthma, diabetes and congestive heart failure; remote device monitoring for cardiac implants and artificial joints; video-based care for stroke, psychiatric and dermatology patients, cell phone platforms for management, monitoring and testing; and TV, PC and robotic platforms for communication, education and information.

My Comments:

Technology plays a key role in improving healthcare delivery across the board. 'Innovation and care system transformation through technology are inevitable...Making this transition will require a willing ness to replace the standard practice of viewing technology as a capital budgeting decision with a a systematic, comprehensive approach for evaluating technology and its potential to address vexing business challenges and be innovatively leveraged in the service of mission and margin.

Reference: Technology in healthcare: leveraging new innovations by Marc G. Larsen FACHE, Healthcare Executive SEPT/OCT 2008, pg 9-14.

Strategy Execution & Leadership in Today's Uncertain Times

Key Thought:

A very popular topic at the moment in light of the financial crisis around the world today. Presented by Professor Paul Tiffany of University of California - Berkeley.

Summary:

- rationality is a western biased concept, there's a lot more at play particularly in Asian economies than hard, cold rational decision making - eg. fengshui, lucky numbers

- Risk management has always talked about pricing the risk, however, at some point, we moved to uncertainty, and that cannot be measured/mitigated using traditional understanding of risk or rational thinking

- things happen for a reason, people (customers) do not choose randomly, they choose for a reason, find out what is the reasons

- China will not be a dominant economy in the 21st century. Reason: innovation belongs to the second and third child, not the first. With China's one child policy, it will not work

- Interesting tidbit: UCB Nobel prize winners gets free parking. Greater incentive than money or position

- Paul Tiffany & associates will never recommend hiring first child as HR Director!

- On corporate structure, we optimize for effectiveness and efficiency, not suitable when we need to be flexible and responding to marketing changing condition

- Marxism concept: Marx was a change agent. Things happen oftentimes because of the environment condition, eg. Khmer Rouge. Kill everyone with glasses, start from a clean slate, too hard to change people

- Many CEO are Marxist and don't know it. Wholesale changes alienate the very people they are dependant on to make changes to turnaround company

- Hawthorne Studies - besides employees being more productive when being watched, recognition also improves productivity

- GURU - Geee...You are You, and being asked to pay for it.

- Values in a company is What You Are Willing to Reward

My Comments:

This presentation was part of HASS - KMDC Executive Series Co-Presentation. It was a useful synopsis of Strategic Planning and Execution. Good for those who are new to this area, unfortunately I am already familiar with most of it. Key thoughts I learned in these two days was Risk and Uncertainty. The networking was also fantastic.

Reference: Strategy Execution & Leadership in Today's Uncertain Times by Professor Paul Tiffany, Haas-KMDC Executive Series Co-Presentation, Dec 1-2, 2008.

Using X-ray Vision to launch Lean Six Sigma

Key Thought:

A short article taking the analogy of x-ray to start a Lean Six Sigma initiative. 80% of a survey says they failed to achieve their anticipated value!

Summary:

X-Ray Vision is performed by a small group of black belts consisting of 3 methodology common to other forms of process improvement.

1. Value Stream Mapping - team scan the enterprise and maps its processes to identify the biggest opportunities to cut costs by reducing wasted time and materials

2. Benchmarking - processes measured against benchmarks and establish performance improvement targets

3. Prioritising - team determines which improvements will yield the greatest results.

Only after this, does the company starts the traditional steps in Lean Six Sigma, Define, Measure, Analyse, Improve and Control (DMAIC).

The X-Ray process expose hard-to-see problems.

By reducing running costs and improve efficiency, a company will freed up much-needed capital and capacity. A company will then able to [pour these resources into innovative new products that reinforced its competitive strength.

Tips to initiative Lean Six Sigma (LSS)

1. Put strong players on the team and train them thoroughly.

2. Check progress regularly and establish a few simple success metrics.

3. Refocus the team if needed.

My Comments:

The value of LSS in companies is without a doubt. Nevertheless the high failure rate is a deterrent. If we do this, we need to be thoroughly prepared. We can certainly do with a more efficient operation to free up capital which we can invest in better technology and space.

Reference: X-Ray Vision by Klaus Neuhaus and Peter Guarraia, MIS Asia, May 2008, page 48-51.

Eight levels of analytics

Key Thoughts:

Using a categorization levels helps us identified where we are in terms of sophistication and advancement with analytical capabilities(or degree of intelligence).

Summary:

SAS defines the level of sophistication as follows:0

1. Standard Reports - I think we are very familiar with these ones

2. Ad Hoc Reports - we do a lot of this, but then forgets to follow up.  It also means disturbing our analyst to drop everything and tackle this for us.

3. Query Drilldown (or OLAP) - you can do some discovery on your own.  We have build some of these in Excel.

4. Alerts - we are not there with this one

5. Statistical Analysis - this we need to learn in the upcoming Business Forecasting Masterclass

6. Forecasting - the hottest development in this market space.  Dare we be laid back and not find out more.

7. Predictive Modeling - the holy grail of analytics?

8. Optimization - Go one better than predictive.

 

My Comments:

The levels to achieve if we want true business intelligence.  Go to the link and contemplate the questions and example given for each question for a true review on the state of analytics in your area.

Reference: http://www.sas.com/news/sascom/2008q4/column_8levels.html

p.s. you'll need to register to sas.com to access the page

Talent Overrated?

Key Thoughts:

What if talent is not necessary a predictor of success later in life?  This of course gives hope to the rest of us.  This book except has some interesting thing to say.

Summary:

The story opened with two smart guys fresh out of University (one from Dartmouth, the other from Harvard), voted "least likely to succeed" at Procter & Gamble.  These two guys are Steve Ballmer (CEO of Microsoft) and Jeff Immelt (CEO of GE).

"In studies of accomplished individuals, researchers have found few signs of precocious achievement before the individuals talented intensive training"

The author goes on to described Jack Welch and Bill Gates similarly as having no special gifts early on in their life.

Genomics likewise has not discover a piano-playing gene or investing gene or accounting gene.

Researchers however have converged on an answer.  It's called "deliberate practice", it's 'designed specifically to improve performance'.  A teacher is almost always necessary, to 'design [an] activity best suited to improve an individual's performance.'  Fathers who started designing their practice activities at early ages: Tiger Woods, Picasso, Mozart, Eli & Peyton Manning.

High repetition is another key feature, not just practice as we know it, but incredible number of repetition with specific goal in mind.  Deliberate practice is demanding mentality and just plain hard.

Continuous feedback is extremely important, that's why all have coaches, mentors, teachers.  Certainly not once a year appraisal!

So how to apply principles of great performance on your own? Self-regulation.

* Before the work - set goals.  The best performers et goals that are not about the outcome but rather about the process of reaching the outcome.

* During the work - self-observation. Top performers do this much more systematically than others do; it's an established part of their routine.

* After the work - self-evaluations.  The best performers judge themselves against a standard that's relevant for what they're trying to achieve.

* Post - excellent performers respond by adapting the way they act, while average performers respond by avoiding those situations in the future.

So where does the cycle starts?  The answers depend on your response to two basic questions:

1.What do you really want?

2. And what do yo really believe?

"What you really believe about the source of great performance thus becomes the foundation of all you will achieve...It shows that the price of top0-level achievement is extraordinarily high.  Maybe it's inevitable that not many people will choose to pay it.  But the evidence shows also that by understanding how a few become great, all can become better."

Read the full except on Fortune Oct 27, 2008 issue.

Reference: Why Talent is Over-Rated by Geoff Colvin, Fortune, Oct 27, 2008.

Book: Talent is Overrated: What Really Separates World-Class Performers from Everybody Else (Portfolio Books), Geoff Colvin

Organizational Storytelling

Key Thoughts:

Advocates for organizational storytelling (OS), a very compelling one at that. OS can increased level of understanding to a specific organization goal.

Summary:

3 reasons why it is different from normal storytelling. 1) Clear purpose why you are telling the story 2) the story is to support hard data 3) stories must be authentic.

OS helps today's leader bring emotion connection and personal credibility to the table. Research shows that the audience makes a far greater connection to the speaker's point when using stories.

Two books worth mentioned as reference text for OS. Lori Silverman, Wake Me up When the Data is Over: How Organisations Use Stories to Drive Results (hint: this book is in the Finance Library), and Annette Simmons, Persuasion Through the Art of Storytelling (still looking for this book in the bookshop!).

Not everyone is a natural storyteller. For this, there's training. One Thousand & One is cited as a consultancy firm that does this professionally.

Storytelling example one:

Sales manager struggles to get team to meet sales target. But the team members most hated this part of their job. Sales manager tell a story about a boy to hates brussels sprouts, and would push them to the side even though he knew his mother would make him eat it eventually. So he always ended up having cold brussels sprouts. One night he decided to eat them first and get them out of the way. He had a great response...

Storytelling example two:

A woman enjoy going to football each week. But she was too short to see. So one week she took a milk crate with her. Now she can see. She has a clear view until the rest decided to follow her. Now with 'milk crate' in hand, she uses the story to illustrate how we constantly have to look for the next 'milk crate', the next big thing to win the war for talent.

A short and effective article on organizational storytelling.

Reference: Tell Me a Story by Kylie Hansen, Intheblack, CPA Australia, June 2008, pages 42-45.

Special Book to Read

Normally I summarizes books and journals to share.  However, today I would like to share a book review by Tom Peters.  The book is called What Got You Here Won't Get You There by Marshall Goldsmith.  Since Tom has summarized it very well with very tantalizing nuggets of wisdom, I won't bother to add anymore except the permalink to the review.

http://www.tompeters.com/entries.php?note=010661.php

p.s. the book is in the Finance Division Library.  Good leadership stuff.

A Management Lesson from Sony Philharmonic Orchestra (yes, you are reading that correctly!)

Key Thoughts:

Once in a while, I come across a story so intriguing I just have to share it immediately. This is one of them. One of the key tenets of Toyota Lean principles is looking across industries to find inspiration to a problem. In a similar context, this story of Sony's American boss, Sir Howard Stringer is doing the same with management issues. And one of the perennial management issue is getting people to work across functions, across department.

Summary:

Sir Howard Stringer famously launched "Sony United" back in 1995 to break the silo mentality at Sony. The walkman guys do not talk to the Bravia guys, who in turn do not talk to the Cybershot guys. Change management was crucial, but it proved hard to dismantle. But when he attended the Sony Orchestra he found something to embody his message: "Here they were, right in front of me, engineers from all the company bound together only by their talent in music. If they managed to collaborate, why couldn't the organisation?"

The orchestra was founded by Stringer's predecessor, Norio Ohga, who was a former opera singer. Stringer in turn is a talented boyhood musician. Ohga has 'likened the job of company leader to that of a conductor, who brings out the best from diverse individuals."

So when Sir Howard was invited to the board of Carnegie Hall, he cajoled its executive director into hosting Sony Philharmonic Orchestra at Carnegie Hall. Through Sony's vast array of subsidiaries, he secured the principal guest conductor of the London Symphony Orchestra and Yo Yo Ma, famous cellist and Sony BMG to record it of course.

'When Sir Howard announced at Sony's management conference that the orchestra would be performing outside Japan, "I did not use it shamelessly, I wanted the symbolism to be self-evident," he says. The effect was swift, however. "We had a lot of calls and e-mails from people wanting to be members," says the orchestra's GM. More than 60% of the members are engineers.

Does it work? A recent orchestra rehearsals led to collaborations on noise cancelling headphones and home theatre amplifiers. Expanding this to other forms of networking activities has resulted in side projects in the weekend.

My comments:

I normally do not summarize webpages, but this was too good a story to just bookmark and file. Do we have silo problems? I'm sure we do, and I'm sure we have find a similar networking opportunities that will result in collaborations and innovation. i would seriously think about such possibilities as I sleep tonight.

Reference: Staff sing from one hymn sheet, Andrew Edgecliffe-Johnson, FT.com, [accessed: 14 October 2008] http://www.ft.com/cms/s/0/63bb4a52-96f1-11dd-8cc4-000077b07658.html?nclick_check=1

Using Business Process Management

Key Thoughts:

Computerization of current processes is not enough. Have we created new silos? I quote "Rather than relying on individual knowledge to make sure things get done, we can rely on an automated, documented process to get things done." Jazz Tobaccowalla, VP of IS, Wyeth

Summary:

As an organization that prioritize on investment in technology and system, digitization of processes is taking place in every aspect of the organization or soon will be. Obviously no organization, no matter how digitize they want to be, can have enough resources to tackle every automation or computerization software in one go. The best practice is to practice portfolio management for IT projects. So how do you decide? The key is to evaluate each IT project as a business process improvement, not a technology adoption for its own sake. 'They are driven by a business mandate, either born out of a regulatory requirement or an internal need.'

Good BPM software (article featured Metastorm BPM Suite) helps 'orchestrate processes that cross multiple computer systems, taking advantage of Web services and other integration technologies to route transactions from one system to the next.

The implementation of BPM mapping also help identify manual roadblocks. BPM software can help facilitate by 'providing e-mail notifications and reminders, in combination with Web-based forms, to prompt workers to perform those tasks and keep things moving'.

BPM is also helping Wyeth improve the efficiency of routine administrative processes. Wyeth can introduce business rules to initiate the workflow for seeking approval for payments. "The value is in the process consistency." "Rather than relying on individual knowledge to make sure things get done, we can rely on an automated, documented process to get things done" Jazz Tobaccowalla. "It gives us a consistent way of doing things and a way to capture knowledge--everything that we can lose when people leave or people forget."

Previously Wyeth IS team was focused on siloed, transaction system, and spend little time on what processes were valuable to the company. For example, "the BPM system can include process-monitoring rules that detect when a required approval is taking too long--perhaps because the responsible person is out sick--and notify another manager."

My comments:

We have looked at many different system doing different things, but BPM certainly fills a gap. It's not even in our list of IT projects in the medium term. Yet what the article is saying is something we need to address.

Follow up actions:

- To check out Metastorm and bring this up to the next Information Management Steering Committee.

Reference: Prescription for Success by David F. Carr, MISAsia, August 2008, page 16-18.

BLS for Healthcare Providers

Once in a while, we embark on something totally outside our comfort zone. So today I am summarizing my revision for my CPR certification tomorrow. Of course as a hospital administrator, I fully subscribe to getting as many people CPR trained as possible (in theory of course!). Click here's if you want to know more on what I'm talking about.

Things I need to remember for the course tomorrow!

CPR for Adults

• Check for response, call for help if no response
• Airway - open airways and check breathing, perform head tilt-chin lift, mouth-to-mouth or mouth-to-mask- Breathing - if not breathing, give 2 breaths, check chest rise (2x)
• Circulation - Check pulse
• Defibrillation - if no pulse, give compression (30 compression and 2 breath @ 100 compression/min). Continue cycle until AED or EMT arrives

CPR for Children (1 year of age to puberty)
Same for adult except for

• Amount of air for breaths
• More effort to deliver 2 breaths to make chest rise
• Depth of compressions
• Use 1-handed chest compressions for very small children
• 15 compressions and 2 breath for 2-rescuer Child CPR

Automated External Defibrillator

• Use AED when there's no response, no breathing, and no pulse
• Use Adult pads if child pads are not available
• One pad placed just below victim's right collarbone
• One pad placed to the left of the nipple, a few inches below the left arm pit

CPR for Infants

• Use two fingers
• Compression point just below the imaginary line between the nipples
• Compression depth is 1/3 to ½ the depth of the chest
• Check brachial artery pulse instead of carotid pulse

Adult Chain of Survival

• Early access
• Early CPR
• Early defibrillation
• Early advanced care

Pediatric Chain of Survival

• Prevention of arrest
• Early and effective bystander CPR
• Rapid activation of the EMS
• Early and effective advanced life support

Ok! Good luck to me for the exam!

Reference: BLS for Heatlhcare Providers Student Manual, American Heart Association. www.americanheart.org

Annual Budget in 10 Days! ???

Finally, a way to tackle the beast of annual budgeting! We have just started Parmenter's book on Key Performance Indicators, I did not realise he published a book that's even more valuable, Pareto's 80/20 Rule for Corporate Accountants. Gotta find this book!

Key Thoughts:

Based on Ch 3 of the book, it acknowledges that rolling quarterly planning is the way to go, but what to do when annual budgeting is around the corner. Use emotional drivers, not logical drivers!

Summary:

Emotional drivers to Senior Management - monthly budgets create meaningless month-end reports, loss months creating annual plan, huge cost involved, second guessing next year's performance, quarterly rolling forecasting and planning is best practice.

Emotional drivers to Finance Team - the most dreaded time of the year, create yardstick that are out of date before the ink dries, anxious about the reliability of the spreadsheets, non-available to in-house client during budgeting time, no value-add, frustrated with 'it's a timing difference commentary'

Strategies

- key strategic assumptions must be set before annual planning round starts

- Hold a 'budget preparation' workshop before you start - covers quarterly forecast, 3 days window, daily update to CEO

- CEO must stress poor participation is career limiting

- Budget Committee to have 3 days 'Lock-Up' - during lock-up, each BH has a set time to 1) discuss their financial and non-financial goals for the next year, 2) justify their annual plan forecast, 3) raise extra funding issues, 4) raise key issues

- never budget at account code level! WOW - insightful, - limit number of categories to <= 12, - Map account codes to these categories

- use payroll worksheet to avoid people cost errors

- Automate calculation categories where trend data is the best predictor

- Expand annual planning team

- Provide automated calculator for travel

My Comments:-

There's more useful advice here than all my years of trial and error (I started getting involve in budget in 1996!). A bit late in the year, but some of it is implementable this year eg. 3 days window and daily update to CEO

Reference: Timely Annual Planning Process: Ten Working Days or Less! by David Parmenter, Accountants Today, pg 20-23, September 2008.

Managing Risk & Enhance Performance in the 3rd Sector

Key Thoughts:

A different twist on the concept of Enterprise Risk Management which has become mainstream in the last few years. To enhance performance by implementing an effective Enterprise Risk management strategy, is interesting.

Summaries:

The author quoted AS/NZ 4360 which defines risk as 'the chance of something happening that will have an impact upon objectives', when put in this context, it makes a lot of sense. More so for NGOs and not-for-profit organization.

6 common risks were identified:

1. Strategic Management - non-alignment of performance vs strategy, ineffective communication, coordination and teamwork, insufficient collaboration, weak succession and business continuity planning, lack of diversity and depth in revenue sources, adverse impact from external forces and publicity, ineffective organizational structure with unclear roles and responsibilities, lack of 'signature' products or services-especially in overcrowded market, advocacy opportunities missed or poorly responded to, brand awareness declining, lack of measurable and sustainable outcomes.

2. Fund raising, marketing and communication - static donor base, donor retention declining (donor fatigue), ineffective donor communication and marketing, poor reputation, branding and publicity

3. Programming or service delivery - poor program design, inadequate capacity and capability to manage, non-compliance with donor requirement and government regulations

4. Financial management - poor cost management, inadequate cash flow management, suppression or overriding of internal controls, untimely and inaccurate reporting, lack of multi-year planning and budgeting

5. Human resource management - unable to attract competent and/or skilled staff, poor people management skills, insufficient resources to manage activities and priorities, unable to develop and enhance staff capability and capacity, lack of clarity in roles, responsibilities and accountabilities

6. Information management - ineffective Information Management System (no timely and accurate information produced), needs of users and biz requirements not met, erroneous, inappropriate or untimely decisions made, confidential/secure information leaked

3 Level of risks affect organizations

1. Strategic Risk

2. Tactical Risk

3. Operation Risk

The author also presented a table for tactical risk with possible ideas to perform a risk assessment exercise.

My Comments:

A common struggle we had was how to get started. The many specific pointers for NGOs is a great starter for us to do the risk assessment and take action based on the result of the exercise and go forward.

Reference: Manage Risk & Enhance Performance in the 3rd Sector by Patrick Ow, Accountants Today, page 31-33, September 2008.

Carlos Ghosn on People Management

Summary:

Get them motivated. Help them dream of adventure, visioning the destination. Where will we be in 5 years time? "Motivation, like trust, is not something you can command. it is a very personal response that people offer... or don't". "Ghosn believes that management's first priority is to establish a clear vision and a common long-term plan for the organization. A clear vision will determine strategies, guide action plans, direct performance and boost the motivation of all the people involved. Focused performance will produce measurable, positive results, which, in turn, encourage motivation, confirm unity of purpose, and prompt better performance.

"There is no secret formula for corporate revival, but there is one common denominator, the motivation of the people."

Ghosn's 3 rules

1. When people are motivated to perform, they can achieve remarkable things

2. Great people are just ordinary people with an extraordinary amount of determination

3. When ordinary people are determined to overcome their difficulties and prove what they can do, the results can indeed be great.

Reference: The Ghosn Factor, page 27-28, Miguel Rivas-Micoud, McGraw-Hill: Singapore, 2006.

The Explosion of Green

There's no longer any doubt that environmental friendly policies are mainstream in today's corporate world. As expected, and ironic, that the printed words, are burning up paper (the first thing the average person think about when you say environment friendly), writing about how we can be part of the 'revolution'.

So here's the first article that I liked on the topic, found in SASCOM 3rd Quarter 2008 issue entitled 'Five Strategies for Corporate Sustainability: accelerate green initiatives through awareness, leadership, technology, stakeholder involvement and innovation.

1. Increase your company's eco-awareness

Start by assessing your company's environmental impact in terms of tons of carbon, kilowatt hours or gallons of water. Then set realistic goals to reduce or offset those levels. Then use a green accounting methodology that you can trust. It should be auditable and the data points collected can be used for what-if decision making. Establishment of a specific governance body or a sustainability council to guide green investments is another way.

Cisco cited as an example, currently driving environmental initiatives in three areas: customer solutions, responsible operations and product stewardship, they are measured and monitored through an executive dashboard for sustainability.

2. Lead with green in mind

Your short-term and long-term planning should include an evaluation of environmental risks and opportunities. Leaders should report on progress regularly and actively manage to reach goals by integrating environmental outcome into business planning.

Adopt a corporate sustainability report and do it with internationally recognized standards such as the Global Reporting Initiative.

3. Involve stakeholders

Engage with your stakeholders to hold you accountable to your commitments for green initiatives. Customer advisory boards, nongovernmental organizations (NGO) and supplier panels can all provide direct feedback to prepare you for market forces and demand transparency in your green initiatives.

4. Invest in technology

Use your investment in a technology infrastructure that manages indicators and add green goals to the list of things you're already measuring.

You should also work to understand data correlations so you can identify which metrics are the most important to improving sustainability, capitalize on talents in your human capital, and improve transparency internally and externally. One such data is waste, waste in inventory also translated into sustainability wastages, in addition to the common measurements in energy and water.

5. Focus on innovation

The most important strategy is to innovate, to change paradigms, create new solutions and collaborate with customers in ways you never have before. Green leadership attracts talented people and capital to your organization, it will also draws new customers and retain existing customers.

Green is here to stay because of the constrained energy and labor markets. These 5 strategies combined can form a comprehensive management plan for sustainability. We don't have to do all in one go, but these strategies you choose to emphasize through greater investment of time and resources will offer unique value to your customers and shareholders - and for generations to come.

Reference: SASCOM Third Quarter 2008, p. 29-32. By Alyssa Farrell.

Knowledge Captured @#$%^&*()_+

I'm a knowledge treasure hunter, in this case primarily on things that connects to work, parenting and self development.

I've decided to start a blog to capture knowledge that I come across as useful.

So here goes the first blog!

I intend to use this primarily for myself, but if anyone reading this finds this useful, by all means, partake of the knowledge!  Just leave me a note that you have found something useful, accurate, not truth, boring whatever... this helps me to improve, of course.

Of course everyone works through a filter, usually influence by the context of who they are.

My context is CFO of a hospital, father to 3 girls and struggling with getting old, getting unfit and too many ideas with too little time to pursue them.  You can read about my musing about life in the other categories of this blog page.

So, let us launch this project...

Triple Play for Revenue Management Processes

About 10 years ago, my pastor called me a Resource Person. I guess that term has stucked, and I'm still at it, but not so much for Youth Ministry anymore, but for Healthcare Financial Management.

I came across this short write up about revenue management processes.

Title: Triple Play

Key thoughts: Revenue management process includes 3 components: price analytics, price optimization, and price execution.

Summary:

Price analytics looks at how your existing pricing is (or isn't) working

Price optimization then asks what your price should be, given market conditions and retrospective models. It involves complex pricing science and forecasts. It goes on to elaborate that if you need a 2.5% in price to reach a profit goal, you don't have to increase prices across the board by 2.5%. it's about power and risk...we'll increase price most where we have high power and low risk, and be most cautious where we have low power and high risk.

Price execution is what helps front line staff price a deal on the spot. It can pulls up the customer's transaction history along with his "willingness to pay" score and tell immediately what price the customer is likely to pay for the particular transaction. Staff can also see what similar customers are paying for the same transaction, and how fast-moving is the product.

My comments:

It will be interesting if hospital can look at revenue management with this 3 components. Right now we do a little of price analytics, has emphasize on price optimization (alas using very manual and intuitive methods, rather than a structured methodology) and price executive is plain reliance on pure instinct by front line staff.

Reference:

CFO Magazine, July/August 2008. page 16, intech by Yasmin Ghahremani.