10 Steps to Executive-Level Confidence

http://blogs.wsj.com/speakeasy/2013/10/15/10-steps-to-executive-level-confidence/?mod=trending_now_1

By Becky Blalock

Making the move from middle management to the executive suite requires a healthy dose of confidence. Executives have to make critical, wide-reaching decisions, often with limited information and time—then persuade others to execute those decisions. Self-assurance is a must.

Yet gaining confidence can be a struggle. The “Impostor Syndrome” is real:  researchers at Georgia State University found that 33% of the high-achieving adults they interviewed did not feel they deserved their success. The Imposter Syndrome meant that sufferers opted out of important career opportunities, to their financial and personal detriment.

Women in particular struggle with confidence. They often are less adept at moving forward after setbacks, reading temporary failures as permanent deficiencies, and they often have smaller professional social safety nets than men.

The good news is that confidence can be learned, like any career skill. Here are 10 steps that can have you operating from a place of power:

1) When in doubt, act. It’s the difference between running and stagnant water. When you’re stagnant, doubt and insecurities breed like mosquitoes. Dale Carnegie wrote that “inaction breeds doubt and fear. Action breeds confidence and courage.” Fear of failure can paralyze us, as we almost always overestimate the consequences. Build your confidence instead by taking action, often.

2) Do something outside your comfort zone each day. If we don’t stretch our comfort zones, they shrink. Constantly challenge and improve yourself, and you’ll become comfortable doing new things—and you will establish your identity (both to yourself and others) as someone who takes risks. Each new thing you try adds to your knowledge and skill base, and provides you with a foundation of competence. This is the bedrock of any successful career.

3) Put the focus on others. Choose to be conscious of others instead of self-conscious. Ask people questions. Turn conversations into a game where you try to find a connection with the other person. Give compliments generously, and volunteer to help others when you can. Looking for the best in others will help you see it in yourself.

4) Cultivate mentors. Their advice and connections are invaluable, plus you will make better decisions about opportunities thanks to their objective assessments of the pros and cons. And you will be much more willing to take risks knowing you have supporters who will help you get back up on your feet if you fail.

5) Keep self-talk positive. It’s hard to feel confident if someone puts you down all the time. It’s impossible if that naysayer is you. Watch how you talk to yourself. Is it how you would talk to a friend? If not, then make a change.

6) Eliminate negative people from your network. You absolutely need to invite and be receptive to constructive criticism if you want to grow as a professional and as an individual. But recognize that some people will never be happy with you or with life, and it is a waste of time to try to convince them of your worth.  What’s more, their sour outlook on life is contagious. Learn to identify these people quickly, and move on.

7) Take care of your health. Make time for exercise, and get enough rest. Your body must be physically ready to take on challenges.

8) Do your homework. Keep up-to-date on the news in your industry, and know your company and department inside and out. If you have a challenging task ahead, prepare and practice in your mind. Nothing builds confidence like knowledge and preparation.

9) Watch your body language. Your posture and overall appearance affect both your mental state and how others perceive (and thus respond) to you. If you want to be a leader, you have to dress and act the part. Stand and sit up straight, make eye contact, and remember to smile. Wear the professional clothing of your industry. Eliminate the telltale signs of nervousness: excessive twitching, closed-off posturing (crossed arms and legs, hunched shoulders), and shallow breathing.

10) Practice gratitude daily. In a recent study of how successful people spend the first hour of each day, the No. 1 response was investing time in thinking about the things for which they are most grateful. Starting your day by saying “thank you” for the good in your life makes it more likely that you will approach the day’s challenges with the proper perspective.

Like public speaking or leadership, confidence is a professional skill that can be improved. According to Dr. Peter Buckley of Georgia Regents University, “As you add experiences, you’re more likely to gain confidence. And with confidence, you will embrace new experiences.” Start growing your confidence today.

MANIFESTO: Mengintegrasikan Servis dan Sales

http://the-marketeers.com/archives/mengintegrasikan-servis-dan-sales.html#.Ul3CiNLry-l
 Sigit Kurniawan



Saat ini, banyak perusahaan yang menarik biaya tambahan untuk layanan servis yang sebelumnya digratiskan. Misalnya, dulu, bila kita membeli piano Yamaha ada tambahan kursus piano gratis. Namun, sekarang, kalau mau kursus, orang harus merogoh koceknya lagi. Tapi, kursus tetap laku karena kualitasnya lebih baik dibanding saat digratiskan.

Banyak servis yang dulu digratiskan lalu berbayar tapi tetap ramai peminat. Misalnya, meskipun banyak lounge eksekutif sekarang berbayar, tapi tetap dipenuhi oleh pelanggan. Hal ini membuktikan bahwa servis pun bisa dijual apabila dikelola dengan baik. Pertanyaan sederhananya, kalau bisa dijual untuk pelanggan, kenapa harus digratiskan? Tentu dengan catatan, pelanggan bakal menerima layanan yang lebih dibanding dengan saat digratiskan.

Pemikiran di atas berbeda dengan pemikiran dahulu yang memposisikan servis sebagai pelengkap produk. Sebab itu, lumrah bila ada servis gratis, seperti gratis biaya kirim, gratis makan pagi, dan sebagainya.

Ada pandangan yang mengatakan "ada uang, ada barang." Pandangan ini seolah mau mengatakan kalau Anda mau mendapatkan hal yang lebih dan berkualitas, Anda harus membayarnya lebih dulu. Di sisi lain, ada pandangan juga yang mengatakan yang gratis biasanya kurang berkualitas. Gratis sama saja dengan terlambat antar, gratis sering dilekatkan dengan penanganan yang asal-asalan, dan sebagainya. Sementara, orang lebih memilih mengeluarkan uang lebih untuk mendapatkan servis yang memuaskan.

Servis merupakan ajang cross selling dan up selling yang bisa memberi keuntungan. Bila kualitas servisnya asal-asalnya, bagaimana orang servis bisa menjualnya? Padahal, kalau orang servis itu sadar, ketidakpuasan pelanggan terhadap customer service bisa memengaruhi pemasukan pendapatan perusahaan tempat mereka bekerja. Sebab itu, penting sekali melatih orang-orang servis sebagai tenaga penjualan untuk belajar service excellence.

Untuk mengintegrasikan servis dan sales, ada beberapa hal yang patut di simak. Dulu, servis dianggap sebagai cost center. Sekarang, servis bisa diperlakukan sebagai profit center. Westin Hotel, misalnya, menjual bantal dan kasurnya kepada pelanggannya. Peminatnya banyak karena bantal dan kasur hotel tersebut terkenal dengan keempukannya. Lalu, beberapa toko buku sekarang menyediakan servis lebih kepada pengunjung toko dengan lounge atau kafe. Sekarang, banyak lounge dan kafe toko buku dikelola secara independen sehingga bisa mendatangkan profit yang lebih besar lagi.

How to Design a Bundled Payment Around Value

HBR Blog Network

http://blogs.hbr.org/2013/10/how-to-design-a-bundled-payment-around-value/

by Mary Witkowski, Larry Higgins, Jon Warner, Michael Sherman, and Robert S. Kaplan

The traditional fee-for-service reimbursement model is widely acknowledged to be a major driver of escalating health care costs. Because it rewards the volume of treatments, not the medical outcomes produced, it offers no way for the industry to reward its best providers and for patients to seek them out. It also penalizes cost reduction since eliminating unnecessary procedures leads to lower reimbursements.

For this reason, many health care practitioners and policymakers advocate a new bundled-payments model that reimburses providers with a fixed fee for delivering all the services required to deliver a complete cycle of patient care for a specific clinical condition. Bundled payments (BP) have the potential to reward providers that deliver more value to their patients — better outcomes at lower costs.

In practice, however, bundled payments have struggled to gain traction. One reason is many bundled-payment contracts use artificially short time horizons, not a complete cycle of care, which cause the contract to be similar to a traditional fee-for-service model. Another reason is these new contracts are negotiated at the payer-administrator level in a zero-sum cost-shifting process. Insurers strive to lower the prices they pay while the hospital’s contract administrators attempt to preserve top-line revenues. Physicians, left on the sideline while these new contracts are being forged, are further distanced from the new payment model because they often lack experience in measuring patient outcomes and have little confidence in their costs.

To understand how to address these concerns, an academic team from Harvard Business School brought together a group of orthopedic surgeons from the Boston Shoulder Institute and Harvard Pilgrim Health Care, a Boston-based insurer, to create a new BP model focused on patient value. While the final price for the contract has yet to be negotiated, we believe that the structure and development process used to create this bundle can inform other providers and insurers about how to create bundled-payment contracts that benefit all the stakeholders: providers, insurers, and, most importantly, patients.

The Motives of the Pilot’s Members

The Harvard researchers believed that their expertise in value-based health care delivery could help the physicians and the insurer construct a superior BP contract in which the insurer paid a lower price, providers preserved their financial margins, and patients enjoyed superior outcomes. Rather than a zero-sum negotiation, such a new contract would be a win-win for insurers, providers, and patients.

The surgeons (all physicians from Brigham and Women’s Hospital and Massachusetts General Hospital) participated because they wanted a reimbursement model that rewarded providers for delivering better medical outcomes for their patients at a lower cost. They were already measuring their patient outcomes and were in the process of introducing a costing approach that would enable them to participate in a new payments model.

Harvard Pilgrim agreed to join the effort because it recognized that traditional payment models were unlikely to help control rising health care costs. With regulators increasingly prone to challenge rate increases and employers unwilling to accept premium increases, the insurer felt that a BP model, co-created with clinicians, represented an attractive path for offering lower prices to its customers while preserving their access to the best providers.

The team has been meeting every two weeks over the past four months to design a BP model for a pilot project. The key elements of the project are the following:

Defining the Bundle

The working team selected damage to rotator-cuff tendons as the clinical condition to be bundled. Rotator-cuff repair (RCR) is a high-volume procedure with a definable cycle of care for which there is substantial variability in outcomes across physicians. Therefore, the team believed that RCR surgery offered an opportunity to improve outcomes and standardize treatment around best processes.

The team members wanted to define a cycle of care that corresponded to the medical condition of the patient. They selected a care cycle that starts with the initial pre-op appointment and concludes one year after the day of surgery. They agreed that this period would allow short-term surgical complications to emerge and be addressed within the bundle and that the recovery time would be sufficient to meaningfully measure patient outcomes.

The procedures and resources in the bundle would include pre-op appointment and testing, use of the operating room and facility services on day of surgery, surgeon, anesthesiologist and support staff, clinic visits, in-hospital drug and laboratory tests, and post-surgical physical therapy.

Two issues had to be addressed. First, although the bundle is tied to achieving measurable outcomes during the year, no business organization in any industry will wait that long for payment. Harvard Pilgrim agreed, therefore, to pay most of the bundled price 30 to 60 days after the surgical event; the remainder would be held back until the guaranteed outcome could be assessed at the 365-day mark.

The second issue was Harvard Pilgrim’s existing IT system, which had been designed to support the fee-for-service model. The insurer agreed to bypass the system and use manual procedures in the pilot study to track and bill patients and pay providers.

Selecting the Patient Population

The team’s goal was to be as inclusive as possible in specifying the patient population while incorporating the appropriate risk adjustments. The team identified a core group that would capture at least 80% of the potential RCR population. It also created risk-adjusted tranches to include patients who, based on medical evidence, had a higher intrinsic risk of failure due to medical comorbidities, age, body-mass index, and other factors and adjusted expected outcomes and a pricing differential for patients in each tranche.

Specifying Outcomes and Guarantees

The surgeons reviewed the clinical literature and their own research to select, with the insurer, the outcomes that matter most to patients. These included a mix of objectively measurable outcomes, such as rotator-cuff strength and the rates of complications that occur during operations, and subjective patient-reported outcomes such as pain, the ability to perform activities of daily living, and satisfaction with their outcomes.

The bundle incorporated the metrics in two ways. First, payments would be made to physicians and the hospital only if patients achieved specified minimal performance in each area. Second, if outcomes exceeded a more ambitious performance level, the insurer would make incremental bonus payments.

Such outcome-based guarantees and incentives are rare in traditional top-down bundled-payment contracts created without the input of frontline physicians. These contracts typically involve compliance with certain procedures (such as timely administration of pre-operative antibiotics) that may be easy to agree on and implement but may be peripheral to the ultimate patient outcome. The Boston Shoulder Institute surgeons and Harvard Pilgrim agreed that their set of metrics could provide patients better experiences and could be used to attract more patients to high-value providers.

To enhance transparency, the insurer intended to clearly communicate to patients, ahead of time, a price for the complete treatment cycle and the outcomes that could be expected. The physicians agreed to provide outcomes data to the insurer throughout the care cycle.

Ensuring Patient Engagement

Everyone recognized that the engagement of both patients and external professionals involved in the RCR cycle of care was critical for the project’s success. Toward that end, the Boston Shoulder Institute agreed to identify downstream physical therapists and to train, certify, and compensate them. The physicians also planned to conduct extensive patient pre-op education on narcotics, discharge, and physical therapy as well as provide 24-hour turnaround for all telephone calls, same-day office visits for urgent care, and a phone call from the physician’s office on the first day after surgery.

Harvard Pilgrim agreed to design new, innovative plans whose features included waiving such liabilities as co-payments if a member chose a high-value RCR provider for the surgery. The insurer expected to publicize the BP pilots through media and employer channels to attempt to drive increased volume to these high-value providers.

Estimating Costs

The Boston Shoulder Institute wanted to enter the negotiation with an in-depth understanding of all its costs over a typical RCR-care cycle, something that it could not learn from its existing costing systems. The Harvard Business School team helped the institute’s physicians and staff apply time-driven activity-based costing to measure the costs across the full cycle of care. They began by taking a careful inventory of resource needs and usage for each process in the cycle.

The figure “Initial Surgical Consultation” shows the detailed map for the first process. At each step in this process, the team identified the personnel and equipment required and measured the time consumed by each resource in performing that process step.

The team then accessed data from hospital and physician departmental budgets, the human resources system, and the equipment and facilities databases to estimate the “capacity cost rate,” the cost per minute of each person and piece of equipment used in the care cycle. It also calculated the cost of space used by each resource or clinical and administrative process. The team combined the time and cost estimates to obtain the total cost for surgical treatment of rotator-cuff tears.

Setting the Price

Going into the price negotiation, the Boston Shoulder Institute’s aim is to achieve better patient outcomes and thereby earn a margin over the actual costs incurred. This will come in several ways: the bonus payments for consistently producing superior outcomes; more business driven to them by the insurer because of the better outcomes; and, with a higher volume of patients, more cost-efficient processes. Harvard Pilgrim’s objective is to achieve a bundled price that represents a discount from its fee-for-service payments to facilities, clinicians, and therapists for the RCR care cycle (along, of course, with the superior outcomes). Looking down the road, it believes that if it can extend the new BP model to other conditions, it will be able to reduce its premiums and differentiate itself by offering superior, guaranteed outcomes.

Boston Shoulder Institute physicians and Harvard Pilgrim are now waiting for senior management at Partners HealthCare, the parent of Brigham and Women’s Hospital and Massachusetts General Hospital,  to review the proposed bundle and to negotiate the price for a trial period. The trial would allow the physicians, hospitals, and therapists to learn how to work together under the new arrangement and set the foundation for a long-term contractual relationship.

***

Throughout the project, the Harvard researchers have kept the discussions focused on the prize: aligning provider and insurer incentives to deliver more patient value. The interactions have given the providers confidence that the costs assigned to the clinical treatments were accurate and have assured the insurer that the provider’s costs will be be based on clinical best practices and high capacity utilization. Over time, as more provider organizations agree to outcome-based bundles, Harvard Pilgrim believes an informed market will introduce competitive pressures to sustain a fair sharing of value between providers and insurers.

All participants have been impressed by the collaborative ethos of the working group. Conversations are open and frank. Rather than a traditional negotiation about who bears which costs, the face-to-face interactions have built trust that is enabling the insurer and physicians to arrive at a win-win value-based solution.

Smart Rules: Six Ways to Get People to Solve Problems Without You

THE MAGAZINE
http://hbr.org/2011/09/smart-rules-six-ways-to-get-people-to-solve-problems-without-you

by Yves Morieux

Artwork: Jen Stark, Tri Angular, 2010, Acrylic paint on wood, 35" x 35" x 25"

Companies face an increasingly complex world. Globalization and technology have opened up new markets and enabled new competitors. With an abundance of options to choose from, customers are harder to please—and more fickle—than ever. Each day competitive advantage seems more elusive and fleeting. Even if you can figure out the right approach to take, what works today won’t work tomorrow.

The growth of complexity is reflected in businesses’ goals. Today companies, on average, set themselves six times as many performance requirements as they did in 1955, the year the Fortune 500 list was created. Back then, CEOs committed to four to seven performance imperatives; today they commit to 25 to 40. And many of those requirements appear to be in conflict: Companies want to satisfy their customers, who demand low prices and high quality. They seek to customize their offerings for specific markets and standardize them for the greatest operating return. They want to innovate and be efficient.

In and of itself, this complexity is not a bad thing—it brings opportunities as well as challenges. The problem is the way companies attempt to respond to it. To reconcile their many conflicting goals, managers redesign the organization’s structure, performance measures, and incentives, trying to align employees’ behavior with shifting external challenges. More layers get added, more procedures imposed. Then, to smooth the implementation of those “hard” changes, companies introduce a variety of “soft” initiatives designed to infuse work with positive emotions and create a workplace where interpersonal relationships and collaboration will flourish.

At the Boston Consulting Group, we’ve created an “index of complicatedness,” based on surveys of more than 100 U.S. and European listed companies, which measures just how big the problem is. The survey results show that over the past 15 years, the amount of procedures, vertical layers, interface structures, coordination bodies, and decision approvals needed in each of those firms has increased by anywhere from 50% to 350%. According to our analysis over a longer time horizon, complicatedness increased by 6.7% a year, on average, over the past five decades.

This complicatedness exacts a heavy price. In the 20% of organizations that are the most complicated, managers spend 40% of their time writing reports and 30% to 60% of it in coordination meetings. That doesn’t leave much time for them to work with their teams. As a result, employees are often misdirected and expend a lot of effort in vain. It’s hardly surprising that employees of these organizations are three times as likely to be disengaged as employees of the rest of the group—or that dissatisfaction at work is so high and productivity so often disappointing.

Companies clearly need a better way to manage complexity. In our work with clients and in our research, we believe, we’ve found a different and far more effective approach. It does not involve attempting to impose formal guidelines and processes on frontline employees; rather, it entails creating an environment in which employees can work with one another to develop creative solutions to complex challenges. This approach leads to organizations that ably address numerous fluid and contradictory requirements without structural and procedural complicatedness.

The approach incorporates a set of simple yet powerful principles. We call them “smart rules.” These rules help managers mobilize their subordinates’ skills and intelligence.

There are six smart rules. The first three involve enabling—providing the information needed to understand where the problems are and empowering the right people to make good choices. The second three involve impelling—motivating people to apply all their abilities and to cooperate, thanks to feedback loops that expose them as directly as possible to the consequences of their actions. The idea is to make finding solutions to complex performance requirements far more attractive than disengagement, ducking cooperation, or finger-pointing. When the right feedback loops are in place, cumbersome alignment mechanisms—ranging from compliance metrics to the proliferation of committees—can be eliminated, along with their costs, and employees find solutions that create more value.

Black Dogs: The State of Mental Health in the Workplace

http://www.ibtimes.co.uk/articles/512065/20131008/mental-health-mind-research-cbi-tv-celebrity.htm
 IAN SILVERA

Work can take a toll on your physical and mental well-being. According to mental health charity Mind, one in six employees experience mental health problems, including stress, anxiety and depression.

In fact, the organisation discovered that work is the most stressful factor in people's lives. More than a third (34%) of 2,000 respondents to the charity's survey published in March, for example, said their work life was "very" or "quite" stressful.

Work related mental health problems are an issue too important for businesses or employees to ignore. So in the run up to World Mental Health Day on Thursday, IBTimes UK takes a lot at the state of mental health in the workplace.

Stigma is a dangerous beast.

It can stop people addressing issues, however big or small. Mental health stigma is particularly hazardous. By making a sufferer feel insecure about highlighting their situation, workers with mental health conditions may never tell their employer about it. But, fortunately, mental health stigma is decreasing at work, according to one insurer.

Aviva's Health of the Workplace 2012 report revealed that just over a quarter (28%) of employees said they feel there is less stigma associated with mental health in the workplace than there was in October 2011. For those that feel that the stigma has decreased, just under half (48%) say it is because mental health is better understood.

In addition, more than a third (36%) of employees say that TV and press campaigns have helped remove the stigmas associated with mental health and 28% feel that celebrities' willingness to openly talk about their mental health issues have played a part.

But even though stigma is fading, stressed workers are suffering in silence and bosses are not doing enough to tackle the problem, according to Mind.

The organisation's latest survey, published in October, found that employees are expected to cope without mentioning stress at work and that nearly a third felt unable to talk to their line manager if they felt stressed.

So what can employees and employers do to help workers who are suffering?

Eugene Farrell says workers should be able to have conversations with their employers (Reuters)

Communication

A healthy working environment is one in which there is not only an absence of harmful conditions but an abundance of health-promoting ones, according to the World Health Organisation. That is why it is important for employees and employers to communicate mental health issues.

Eugene Farrell, of AXA PPP healthcare, says: "If people are in any kind of crisis, they should be able to seek appropriate help."

He adds: "It's down to culture and getting people to speak out. Just being able to have those simple conversations would be a huge benefit to organisations."

But what if an employee is reluctant or scared to highlight their mental health problems, how else can an employer help? Well, Dr Jill Miller, a research adviser at the Chartered Institute of Personnel and Development, argues that line managers are ideally placed to spot any early warning signs of mental health issues in workers.

"If someone is feeling stressed, anxious or distressed, there may be some behavioural signs that that could be a problem," Miller explains.

She adds: "But there there's no set things to look for because stress, anxiety and depression manifests themselves in different ways - some people may turn up to work late, some people may have stomach upsets."

The Work Foundation says flexibility helps combat stress (Reuters)

Action

Employers should offer employees some flexibility in their work schedule to manage mental health issues, according to the Work Foundation. The Work Foundation Body and Soul 2010 report argues that flexibility will make managing workers chronic physical and mental health conditions easier, as well as managing employees' workload.

Andy, a media professional who wished to remain anonymous, says his employer's flexibility helped him battle depression.

"Going to human resources was probably one of the best decision I've made," Andy explains.

"I was able to speak to a very highly qualified and very experienced professional on a one-to-one basis."

Andy says at the peak of his depression he could not do his jobs and his employer's assistance was key to helping him get back on track.

He adds: "I also felt that my employer was very sympathetic and they wanted to help me.

"I was able to get time off straight away, for instance, which enabled me to chill-out and get away from work. That breathing space allowed me to deal with my underlying issues."

Andy's employer is not alone in helping their employee with mental health issues. More than nine out of ten (92%) of organisations operate stress and anxiety management policies, according to Confederation of British Industry and Pfizer.

The 2013 CBI/Pfizer Absence and Workplace Health Survey, which gathered responses from HR practitioners and managers in 153 organisations across the UK's public and private sectors, found that two-thirds (68%) of larger businesses operate formal mental health policies, compared with just under a third (30%) taking an informal approach.

One such large employer is professional service firm Deloitte.

Former Prime Minister Winston Churchill described his depression as his

Black Dogs

The employer is working with mental charity SANE, to help reduce stigma around mental health and to encourage staff to come forward to tame their "black dog", a term Winston Churchill coined to describe his own depression.

The firm has sponsored a black dog statue, with the aim of helping people define their experience of the "invisible" condition, as well as promoting more open discussion, understanding and acceptance around mental health.

Deloitte has also founded the Mental Health Champions, a group of partners at the firm who have been trained to have the initial conversation with any employee who feels like they might have a mental health issues.

As well as that, the employer has an occupational health service on site and an employee assistance programme.

"I offer a confidential adviser service to people in the firm who might be worrying about suffering from a mental health issue," John Binns, an ex-partner at Deloitte, who suffered from depression in 2007, explains.

He adds: "There's quite a range of things that we have in place, which we have been building up over the last five years.

In between the hustle and bustle of everyday office life, workers' psychological well-being can be overlooked.

But it is very important that this does not happen. Thankfully, recent research is positive on mental health issue: stigma is declining and awareness is increasing. But there are some problems - like employees suffering in silence - that still remain.

It is imperative, therefore, that companies continue to help workers tame their black dogs.

Getting Big Results from a Small Business Unit

http://blogs.hbr.org/2013/09/getting-big-results-from-a-small-business-unit/
by Steven J. Thompson

Earlier this year Sun Yat-sen University, a well-regarded institution in Guangzhou in the Guangdong province of China, announced that the university and affiliated hospitals were entering into a novel collaboration with Johns Hopkins Medicine. The agreement would see Hopkins faculty working bilaterally with Sun Yat-sen’s medical faculty both in China and at Hopkins in order to help the university become a world-class biomedical research institute. The deal has significant implications for U.S. hospitals because, facing declining revenues, international collaborations like these offer a new path for growth.

It was the 30th major, revenue-producing, international healthcare collaboration for Johns Hopkins Medicine, with several more currently under negotiation — when the rest of the world combined has perhaps a few dozen similar partnerships. One reason Hopkins is outpacing others is because it created an agile satellite unit – Johns Hopkins Medicine International (JHI) – within the much larger parent organization solely dedicated to these projects.

JHI’s activities illustrate how large healthcare organizations, often bound by size, complexity and conservatism, may need to turn to satellite units if they are going to tap into the innovation and flexibility needed to explore new opportunities for growth. But to be effective, such units have to cultivate key differences from their parent organizations, while at the same time maintaining close ties to the mother ship and adhering to its main tenets.

The Sun Yat-sen project offers a good example of how JHI took advantage of its smaller size, specialization and agility to identify, structure and close an ambitious, unusual and potentially highly rewarding deal that might well have eluded the main organization. It’s well known how difficult it is for large U.S. companies to do business in China profitably, if at all, and even many of our fellow private academic institutions have struggled in their efforts to establish partnerships in China. Our success depends on a set of capabilities any healthcare organization will need in venturing into similar international deals. They must:

Seek out novel relationships and challenges. Large U.S. healthcare organizations like JHM tend to enter into types of partnerships that don’t require them to operate in a substantially new way such as with other large domestic healthcare institutions, or with local hospitals.  Our unit, however, is set up to be more attuned to different types of opportunities. We have staff on the ground throughout Asia and the rest of the world to network and look for potential collaborations like the one in Guangzhou, which, being far from Beijing and Shanghai, fell under everyone else’s radar. The proposition for this collaboration would have had most executives at large medical institutions scratching their heads — there are no clear models for how to help another university develop its research expertise. We didn’t have a model to work with either, of course, but we were willing to innovate and develop one from scratch to make the collaboration work. We routinely partner with private investors, ministries of health, non-healthcare corporations, and other players who aren’t part of typical healthcare deals with U.S. academic medical centers.

Maintain unusual expertise. JHM’s strong reputation in patient care, research and education provides us with an invaluable brand halo that opens doors and motivates partnerships, and defines our mission. But striking international deals calls for a range of other competencies that our parent organization and others like it would have trouble assembling and deploying. These include being familiar with the variation from country to country of social norms, healthcare traditions, religious influences, negotiating tactics, contract law, effective local sales and marketing strategies, media coverage, and political influence. How many healthcare organizations are equally comfortable dealing with government officials in Asia and royal family members in the Persian Gulf? Or are capable of predicting how the next election in a small, developing nation is likely to affect hospital revenues there? Our teams deal with these sorts of offbeat challenges every day, and if we don’t have a resident expert we know how to get one. Critically, for every region we have a dedicated manager capable of championing a project there.

Embrace risk. Hopkins’ reputation is its greatest asset. But it also leads to an organizational culture that tends to shy away from doing anything that risks denting that reputation in any way. A sound policy, to be sure, but one that can sometimes pull the organization away from potentially rewarding opportunities. Our unit also places a high priority on protecting our parent organization’s reputation. But because of our experience and focus, we’re better able to understand and manage the risks associated with international collaborations that JHM itself might be. For example, we allow some of the hospitals that collaborate with us in other countries to identify themselves as Johns Hopkins Medicine International “Affiliates,” but only when we’re intimately involved in setting up, monitoring and maintaining patient care and safety processes and standards. The joint research coming out of our Guangzhou collaboration will bear the Hopkins name, but only in those cases in which Hopkins researchers have played a meaningful role. We also structure our deals in phases, typically starting with pilot projects and moving gradually into more extensive and challenging levels, so that if we have misjudged the risk in a project we’ll catch it early and be able to step away before any real damage is done.

Move with agility.  John Hopkins Medicine is a massive, complex organization that prefers to move into partnerships with great deliberation, because a large number of decision-makers have to buy in, and because there’s more risk in acting quickly. But when a health ministry or a group of private investors in a small country give a big health care project a green light for funding, they’re not going to wait around for two years for a potential partner to sign on. So we’ve developed business processes that enabled rapidly pulling together a team to efficiently evaluate the Sun Yat-sen opportunity, perform due diligence, structure the deal, line up the resources needed to live up to our end of it, set up contracts, and present JHM — which still has to approve all our deals — with a solid, complete package that can be decided on relatively quickly, all within six months. It helps, of course, that we’ve earned the trust of JHM decision-makers over the years, that I myself am a senior vice-president of JHM in addition to my role leading the international innovation unit, and that we consult with key JHM executives every step of the way so that there are no surprises.

The result of these competencies is that our satellite unit has been able to help the mother ship extend its health care mission globally. That’s a huge payoff to the entire organization–even before factoring in the substantial revenues that have come along with these projects.

A Global Online Network Lets Health Professionals Share Expertise

http://blogs.hbr.org/2013/10/a-global-online-network-lets-health-professionals-share-expertise/
by Rebecca Weintraub, Aaron C. Beals, Sophie G. Beauvais, Marie Connelly, Julie Rosenberg Talbot, Aaron VanDerlip, and Keri Wachter

Dr. Junior Bazile, a Haitian physician, scrolled through his handheld device while walking through the wards of a district hospital in rural Malawi. He had recently commented on a discussion onGHDonline.org regarding critical gaps in the diagnosis and treatment of drug resistant tuberculosis. Hours later, he was reading detailed replies from a tuberculosis advisor in Azerbaijan and a medical officer at the World Health Organization. They shared recent publications and discussed the best strategies for how to ensure that patients are treated swiftly and their families and communities protected.

Five years earlier, providers like Dr. Bazile across the globe had a plethora of “how” questions: How do you diagnose recurrent tuberculosis? How do you design team-based care? How can community health workers extend care into the home? How do you design a hospital? But there was no means to obtain answers.

In response, our team at the Global Health Delivery Project at Harvard launched an online platform to generate and disseminate knowledge in health care delivery. With guidance from Paul English, chief technology officer of Kayak, we borrowed a common tool from business — professional virtual communities (PVCs) — and adapted it to leverage the wisdom of the crowds.  In business, PVCs are used for knowledge management and exchange across multiple organizations, industries, and geographies. In health care, we thought, they could be a rapid, practical means for diverse professionals to share insights and tactics. As GHDonline’s rapid growth and success have demonstrated, they can indeed be a valuable tool for improving the efficiency, quality, and the ultimate value of health care delivery.

The Launch

Creating a professional virtual network that would be high quality, participatory, and trusted required some trial and error both in terms of the content and technology. What features would make the site inviting, accessible, and useful? How could members establish trust? What would it take to involve professionals from differing time zones in different languages?

The team launched GHDonline in June 2008 with public communities in tuberculosis-infection control, drug-resistant tuberculosis, adherence and retention, and health information technology. Bowing to the reality of the sporadic electricity service and limited internet bandwidth available in many countries, we built a lightweight platform, meaning that the site minimized the use of images and only had features deemed essential.

As access to high-speed internet and handheld devices increased, new features were gradually added to include photos and video data. To foster reliability and engagement, the team decided that activity on the site would be transparent (i.e., there would be no anonymous postings) and moderators would lead the communities. They would stimulate and ensure quality discussions in the communities by reviewing GHDonline’s content daily for precision and accuracy. (We recruited over 30 experts to serve in that role.) The public could read the discussions and posts but only those who signed up could contribute to discussions. Members would sign up at no cost and would create a profile with their name, professional background, and optional photo.

Soon after the launch, a researcher in South Africa asked the tuberculosis community about the protocol for sputum induction — a procedure for diagnosing TB — in outdoor settings. In less than a week, over 20 experts from four continents shared their insights. The researcher followed the suggestions in building her facility’s new outdoor structure for sputum induction.

Even with early successes in terms of membership growth and daily postings to communities, user feedback and analytics directed the team to simplify the user navigation and experience. Longer, more nuanced, in-depth conversations in the communities were turned into “discussion briefs”— two-page, moderator-reviewed summaries of the conversations. The GHDonline team integrated Google Translate to accommodate the growing number of non-native English speakers. New public communities were launched for nursing, surgery, and HIV and malaria treatment and prevention. You can view all of the features of GHDOnline here (PDF).

Growing Participation

These improvements helped attract more participants: As of July 2013, GHDonline hosted 10,000 expert members — engineers, researchers, architects, policymakers, advocates, pharmacists, community health workers, physicians, managers, midwives, program officers, nurses, and social workers — across 170 countries and 10 public communities.

In addition to public communities, GHDonline launched private communities to accommodate global health groups with select membership, including time-limited working groups. As of July 2013, there were 50 private communities.

One, Clinical Exchange, which was launched in 2009 to link Rwandan physicians to Boston-based specialists, has proven incredibly valuable for improving health care delivery. A physician in Rwanda can log onto the GHDonline.org clinical exchange community via the web or send an e-mail to clinical@ghdonline.org to respond to or post a new case in the community. The physician can upload or attach photos of rashes, x-rays, CT scans, or videos.

All members subscribe to instant notifications of activity in the community or to daily or weekly digests. Community moderators select the instant notifications so they can ensure a specialist responds to clinicians in a timely fashion. All members agree to de-identify patients and follow HIPPA guidelines. Images are reviewed by the appropriate subspecialist. Radiologists post readings and formulate curriculum for general practitioners on common radiological findings. Each question that is asked and answered is archived in the community, thus generating an information and image library for training.

A member of the Clinical Exchange community posted a thorough patient history, physical-exam findings, and lab results for second opinions on a 56-year-old male presenting with a history of urinary retention, weight loss, and impotence. Within 20 hours, five clinicians from various specialties had responded. All the Boston and Rwandan doctors agreed on a diagnosis of multiple myeloma and recommended steroid palliation, a drug regimen, and steps for stabilization. As the patient’s condition improved, the doctor who started the discussion in the community submitted updates for members of the community and received further guidance.

Members and moderators have discussed hundreds of clinical cases and have shared over 400 resources, impacting clinical decision making in Haiti, Rwanda, and Malawi. Participating physicians in Boston have grappled with cases of leprosy and neglected tropical diseases and the complexities of end-of-life care.

Adapting to Demands

Unlike a static web page, the GHDonline platform can iterate on content, add discussions, and bridge expertise to respond to the changing landscape of health delivery. For example, after the earthquake in Haiti on January 12, 2010, GHDonline opened a new community to link organizations involved in the emergency response and local organizations in Haiti. In April 2010, the GHDonline team organized a virtual panel in the Health IT community and invited experts to discuss the data and technology needed to rebuild health systems in Haiti.

The success of this panel led to a series of “expert panels” — virtual, asynchronous, one-week conferences convening professionals across specialties to discuss pressing issues in health care delivery — and attracted panelists such as Rwanda’s minister of health and the director of the largest HIV clinic in the United States. (Here’s a list of panels). The increasing access to high speed Internet and mobile devices and applications has also facilitated the success of GHDonline.

Professional Development

As GHDonline.org has improved care for patients, it has also increased professional development and leadership opportunities for members who otherwise might be working in isolation. For example, Dr. Bazile began reading GHDonline daily in 2010. Since then, he progressed from a frequent consumer of community discussions to an active GHDonline user and educator across communities. (Here’s a biography of Dr. Junior Bazile and a graphic of his development as a GHDonline member).

GHDonline’s virtual communities have led to the creation of a broad knowledge base and a professional network. As its progress has demonstrated, virtual networks are ideal mechanisms to create and disseminate the next generation of tools and tactics to generate value for patients and populations.