One Bad Decision Can Cost a Hospital Millions

Things can go wrong without the right team in place

I recently read an article that was attempting to explain the cost overrun experienced by a hospital during the launch of their new EMR. The article was clear on what caused the overrun but failed to communicate why the decision was made that created the cause.

In many hospitals, emotions can run high fueled by attitudes of resistance to change. The pressures and stress associated with go-live can be a challenge to manage; however, allowing those forces to affect decision-making can have lasting adverse financial effects. When all planning, budget, constraints, and common sense that should be applied are set aside, you can almost always expect the worse. It may feel like appeasement is the right thing to do to relieve the stress, but it may not be the best thing. Sticking to the plan, and staying within the budget should always be the guiding factor that drives decisions even when the pressure is great.

It’s unfortunate, but some decisions are based on problems that may not exist at all but are only perceived based on excessive negativity. Having an experienced team in place that can help make decisions based on fact is vital.

Negotiating Skills Do Pay Off!

When doing logistics, treat it like it’s your money

Getting one of the best hotels in the city to give you the lowest rate with great concessions is excellent. In this agreement, the hotel managed the flight itineraries and provided transportation to and from the airport. They supplied one large conference room for orientation and then surprised us in the contract with a complimentary welcome reception for 120 guests with heavy hors-d’oeuvres. Provided two fifty-six seat luxury buses and several shuttles to transport consultants to the training facility and back. They also agreed to use their shuttles to take those consultants that worked within two miles of hotel to work and back each day. Everything listed above was in the price of the rooms $105.09 with tax. Note, this took a huge burden off the consulting firm, and the savings were passed on to the hospital.

When a hospital hires a consulting firm, that consulting company should put forth all effort to save money, not spend money. Creating a positive cost variance (CV) indicates the consulting firm is in fact on your team. Negotiating for the best price is good, but getting the most value for the lowest price is better.

Consultants Saved the Day!

Good consultants can mean the difference between success and failure

I sat in an auditorium with over three hundred consultants when the speaker invited to the podium the senior implementation project manager. “Dr. So and So has overseen the EMR implementation of nineteen plus hospitals please give him a round of applause.” Wow, nineteen projects that’s impressive. However, it turned out to be a challenging project in many areas but mainly with significant workflow issues.

Although it is confusing why this happens, it is clear the leadership was out of touch. Seeking someone with excellent qualifications can be attractive for any hospital, but having someone with the insight that can eliminate problems before they exist is priceless. I am not sure why this project manager didn’t know this.

Fortunate for everyone the consultants came with the experience and knowledge necessary to handle these types of issues. Jumping into action and based on past experiences they began the process of educating the staff and leadership on what works. This go-live would have never survived without the tremendous efforts of the consultant.

Estate Tax Planning & Family Limited Partnerships

The general partner(s) manage the assets contributed to the family limited partnership. Limited partners generally have no rights with respect to the assets held by the FLP. The lack of Marketability and the fractional ownership of the limited partnership interests held by the limited partners are two of the well-established reduction principles that diminish the value of the taxable estate. The discounts allowed by the restricted rights provides for the reduction in the value of the assets held by each limited partner, but also increases the amount of annual tax-free gifting that can be attained. The current high marginal estate tax rates allow for wise and prudent planning which is necessary to preserve the family’s wealth.

Centralized Management of Family Assets
When using a corporation as the general partner, the general partner controls all of the assets in the partnership. This corporation can also employ family members and others. It will call meeting, conduct training sessions and facilitate wealth management. With a corporate general partner, continuity must be ensured even in the event of the husband and wife.

Minimize Probate
By using an FLP, the time and expense of probating an estate can be greatly reduced. When a Living Trust is also used, then there is no probate. Living Wills are not public record and therefore no one but those involved in the family know of its contents.

Cure Title Defects
The procedure for transferring assets to an FLP can help with the discovery of title defects. This can be a significant issue for real estate assets if not discovered and corrected.

Signs of Poor Taxi Service

find it easier to travel on a daily basis now. The lines between traditional taxi services and ride sharing services have blurred. This assimilation has increased expectation for ride sharing services to operate more like a professional cab service.

For a smooth and non-stressful ride, it is recommended to watch out for these red flags before a service is hired.

Unusually high fares
Cut throat competition has forced transport sector to drive innovation and continue reducing fares. This has been true for taxi services too. Unless there is a shortage of drivers due to high demand or premium services being offered, there is no incentive to pay extra.

Questionable maintenance
Good taxi services walk the extra mile. They often partner up with local bodies to have their cars certifiably inspected for faults. This translates into a safe and relaxed environment for its customers and repeats business. Any taxi service failing to ensure such maintenance regularly will naturally lose credibility.

Resistance towards technology adoption
Without a shred of doubt, technology has become one of the most integral parts of our lives. Without it, our complex ecosystem will collapse. A good taxi service tries to stay ahead of the curve and employs latest technologies. While this does increase their cost in the short term, it brings more revenue in the longer term. As a rule of thumb a good taxi company will employ at a bare minimum: –

– GPS tracking

– online bookings

– dedicated platform for drivers and customers

– email confirmation

Inflexible payment solutions
In an ever digitalizing economy, less people are carrying cash with them for daily settlements. While a bad taxi service turns blind eye to this, good taxi services see opportunity to retain and expand existing customer base. As such, they offer customers the convenience of paying via not only credit cards but cash and even wallet systems.

Non-existent or poor customer service
A substandard taxi company does not feel obligated to ensure customer satisfaction. Instead, it operates on a basic, no-frills business model. An important pillar of customer satisfaction is during service or after sale service. This is done to ensure that customers have an option to provide feedback or complaint about the service. The underlying idea is to empower users to speak directly to a company representative; to share positive feedback or raise concern.

A taxi service operating without customer service could potentially turn out to be the single biggest red flag. It goes on to display the concerned company has for its users.

Unprofessional drivers
Demonstrating professionalism for a driver is myriad of, rather subjective, intangibles. Being a professional driver is not simply about driving fluidly but also ensuring customer accompanied does not feel uncomfortable in any way. A good taxi company should, therefore, have a system of metrics in place to rate the performance of its drivers.

The list is not exhaustive in any form. Indeed, many of the indicators might be trivial to one person but a deal breaker for other. At the end of the day, the service that focuses its energies on customer convenience and facilitation is likely to triumph over others. If you need the best taxi service then make sure that they don’t have bad signs.

Ballet Shoes and Pointe Shoes and More Flexibility

Summer Intensives offer a chance for increased flexibility. After your first morning class, you are partially warmed up for the rest of the day. That is, unless you are resting in between classes in highly air conditioned environments. I recommend not to do that. A cool but not cold place, perhaps shady outdoors somewhere, is better.

Also, allow your ballet shoes and pointe shoes to dry as much as possible in between classes, they will last longer, and will not lose that exactly right fit so soon. Having two pairs of each helps, if you can do that.

Intensive training in ballet means intensive use of the flexor muscles. Battment tendu, grande battment and developpe en avant mean heavy use of the iliopsoas (hip flexor) muscles. Without constant stretching, this tension will compromise your turnout, as the tension at the side of the hips will counter the thigh’s ability to rotate outwards. It will also lessen the flexibilty of the low back and front of the hip, in doing an arabesque.

A standing lunge done in between exercises will relieve the tension building up in the hip flexors and postural muscles. Finding exactly the right balance between strength and stretch is what creates power in your work.

One of the best ways to stretch for a good arabesque is at the corner of the studio where you can hold on to one barre, while placing yourself in your ideal arabesque position with your working leg on the barre of the other wall behind you. If there is a lower barre, use it so as to get an upright back position. Do a demi plie repeatedly, holding the position well-placed.

If there is no corner with barres, get a fellow student to hold your hands to keep you upright, and place your leg on the barre behind you to do your demi plies.

A wonderful stretch regimen for dancers is yoga. My favorite is “Ali McGraw – Yoga Mind & Body”. It is a few years old but still available. It is not for beginners, but dancers will love it. The positions are easy for most dancers, and give fantastic relief to muscle tension. Done in the evening it will leave you stretched and ready to sleep.

A more active stretching routine is the “Classical Stretch” series. On a lighter class schedule day, or on a no-class day, the “Athletes’ Intense Stretch” will get rid of the muscle tension while still allowing muscle recovery.

If you are recovering from injury, both of the above may be helpful, but please consult with your doctor, teacher or trainer as to whether you are ready to do these routines.

Losing electrolytes and dehydration can cause muscle tension and cramps. Real sea salt on your foods, calcium/magnesium supplements and “All 12” cell salts are a great help. Celery is one of the saltiest foods you can eat, organic, multiple mineral salts, and it is a hydrating food too – a perfect snack in between classes.

Marketing Prints

In the past lithography and traditional printing methods were used if the artist wanted to market reproductions of original artwork. While effective, these methods had serious drawbacks:

First and foremost, a high output number would compromise the value of any reproduction. Second, the quality of 4 color copies limited the color rendition of such reproductions. Also, the choice of substrates was dismal compared to giclée. The advent of high-end digital printmaking has opened a new world for artists: more paper choices, better color, limited production.

On a pure marketing standpoint, artists who have shows and lectures can now suggest giclees to potential buyers. Collectors in particular want to buy art that is not made in mass quantities. When buying a giclée they are assured to possess something rare and exquisite.

Giclees are well established in the art world; they are bought and sold in world class auctions as well as in galleries. Many museums display giclees.

Listen to your clients: I recently had a call from a portrait artist. She has a business where customers come to her for family portraits she makes on watercolor paper. She had a few inquiries regarding making copies so that more than one household could have the portrait of their loved ones. At the same time they asked for a quality print, possibly on the same paper. We reproduced the original and it was virtually impossible to distinguish it from the giclée. Now the artist was happy to make additional income and the families had as many portraits as they wanted!

No matter what the market is, whether it consists of commissioned art or not, high quality reproductions can generate an additional stream of income given the proper marketing.

How can you increase the value of your artwork?

One proven method is to create posters (It has been done for a long time by artists and photographers) and sell the posters at art shows. This creates a buzz and facilitates the selling of your work in a poster format to be displayed in various locations. A well designed poster is one of the best advertisements!

Second, create art and make high quality giclée reproductions without ever selling your originals. Make for example an artist proof edition of 25, sign it and release it as the only art available.

If you wish to be able to sell your original you can do so and still increase the value of your art. Start with small limited editions. As soon they are sold out the value will increase. Always establish and maintain a personal relationship with every past, current and potential buyer of your art! Buyers connect emotionally with the art as well as the creator. They will be more receptive to collecting more work if they feel a bond.

Use the Internet

Create a website with a portfolio so people can see the art. Add the URL to business cards, posters, postcards etc. Optimize the site for keywords you want to target (i.e. abstract paintings, oil paintings of flowers, portraits on oil etc.)

The artist is encouraged to pre-sell the complete limited edition if a LE is decided. It is a good idea to track the collectors and notify them when the particular edition is sold out. Another advantage of having a website is to create a newsletter notifying people of limited edition publication as well as accomplishments and new art. These practices reinforce the added value of their current (or potential) purchase. Last but not least, ask for a Certificate of Authenticity from the printmaker.