Harvard business review november 2013 download

That lowers the costs—such as lost wages during time away from work, transportation expenses, and room and board—that often deter poor people from seeking health care even when it is free.

A hub-and-spoke architecture also helps create large volumes. By reducing the barriers to treatment, NH now carries out more open-heart surgeries and Aravind does more eye surgeries than any other hospitals in the world. In turn, this has increased physician productivity: At NH, each surgeon performs from to procedures a year, compared with to by U.

Similarly, Aravind doctors each perform from 1, to 1, eye surgeries a year, compared with an average of by doctors in the United States. As volume rises, doctors, equipment, and facilities are used more efficiently and costs fall. Higher volumes also allow these hospitals to reap economies of scale in purchasing medicines, supplies, and medical equipment. The hub-and-spoke configuration allows hospitals not only to lower costs but also to improve quality.

It does that by:. The high volume and sheer variety of cases attract talent to these hospitals; doctors can build their capabilities faster in them. All seven of the academic hospitals we studied recruit many of their doctors from among their students.

The caliber of the recruits, in turn, contributes to the high quality of outcomes at these hospitals. Unlike many U. For instance, at CARE Hospitals, angioplasty patients are assigned to one of three risk classes on the basis of objective criteria such as age, weight, medical history, and lifestyle, and a different protocol is followed for each, taking extra precautions for high-risk patients. The results are impressive: Whereas data suggest that one in angioplasty patients in the U.

The large number of patients that come for treatment enables hub doctors to focus on specific types of medical problems. As volumes increase, relatively rare conditions are treated often enough that doctors become world-class experts in those areas. This technique enables surgeons to perform the procedure without expensive heart-lung machines, which are rare in a developing economy. The method also leads to fewer complications, requires shorter hospital stays which results in a lower incidence of hospital-related infections , and allows patients to recover faster.

High patient volumes have allowed Indian doctors to master the technique over time. Examples abound of innovations sparked by the need to overcome constraints in emerging markets. Aravind has perfected the manual small-incision cataract surgery technique. It requires less sophisticated equipment and less seasoned surgeons and uses cheaper lenses than the phacoemulsification technique favored by U. CARE Hospitals and other Indian providers typically perform angioplasties by going in through the wrist rather than the groin, which takes more time to heal , allowing them to discharge patients the same day.

Deccan Hospital uses peritoneal dialysis, a home-based treatment for patients with chronic kidney disease that is substantially cheaper than hospital-based hemodialysis, the more common treatment in the United States. And LVPEI has developed technology that allows a single cornea to be sliced and used for more than one transplant patient.

By shifting tasks, the best Indian hospitals match the skill levels of their people with the basic requirements of tasks. Assigning doctors to tasks that nurses can do, for instance, not only raises costs but may also reduce quality; doctors are often less proficient at routine tasks than are nurses.

Indian hospitals have taken task-shifting to a new level by creating fresh categories of low-cost health care workers at one end of the spectrum and highly focused specialists at the other.

At the high-skills end of the spectrum, NH encourages general physicians to become specialists, and specialists to become super-specialists. It trains nurses to advance to the higher-skilled position of nurse intensivist, akin to a nurse practitioner in the United States. The exemplar hospitals maximize their efficiency by increasing the number of staff supporting their most skilled surgeons and specialists, radically extending their reach.

Each Aravind surgeon, for example, has help from six paramedics in the clinical domain and four assistants for administrative and support services.

Paramedics go to a village, screen patients, transport them to the spoke hospital, check their vitals, get tests performed, prepare patients for surgery, deliver postsurgical care in the ward, transport them back to the village, and provide follow-up care.

The surgeon performs only the actual procedure. To cut costs, U. When making decisions, seek ideas from diverse sources and test them with a wide network of contacts. A researcher is pressured to shift her focus from a promising pharmaceutical to dietary supplements. The goal of its founder in was to allow small and midsize merchants to set up shop on the internet very easily and to provide the kind of hospitality and customer service that even chain restaurants offer in Japan.

Rakuten hosts more than 40, merchants in Japan. To control the risk of quality or service problems, the company has a tight screening process for people who want to open a store on the site.

Many good strategies are complex and thus hard to understand. A proper analysis of Monsanto, for example, requires expertise in pharmaceuticals, agricultural chemicals, and agricultural biotechnology—but on Wall Street those three industries are analyzed separately. Zenger was intrigued by the possibility that complex or unique strategies are systematically ignored by analysts or undervalued by capital markets.

He and two colleagues undertook to investigate the question by examining all 7, companies that were publicly traded in U. They devised a way to measure uniqueness and complexity and counted the number of analysts covering each company. And although their uniqueness measure is actually associated with higher market value, this premium is, on average, lower than it would be if the company got more coverage.

CEOs who face the uniqueness challenge have two options: They can make strategic information more accessible—by issuing tracking stocks, marketing directly to investment banks, or paying for independent equity research—or they can find sympathetic investors who believe in the company, which may mean taking it private.

Most businesses rely on traditional capital-budgeting tools when making strategic decisions such as investing in an innovative technology or entering a new market.

These tools assume that decision makers have access to remarkably complete and reliable information—yet most strategic decisions must be made under conditions of great uncertainty. Why are these traditional tools used so often even though their limitations are widely acknowledged? The problem is not a lack of alternatives. Managers have at their disposal a wide variety of tools—including decision analysis, scenario planning, and information aggregation tools—that can help them make smart decisions under high degrees of uncertainty.

But the sheer variety can be overwhelming. This article provides a model for matching the decision-making tool to the decision being made, on the basis of three factors: how well you understand the variables that will determine success, how well you can predict the range of possible outcomes, and how centralized the relevant information is.

Getting to the right answer is a lot harder today than it was 10 years ago, Charan points out. Leaders have to contend with more variables and constituencies than ever before. Add Copyright Permission. Copyright Permission Qty:. Current Stock:. Buying for your team? See quantity pricing. Product : BR Pages: So how do you make sure the project succeeds? Managing Projects walks you quickly through the basics, including drawing up a realistic schedule and project plan.

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