Monday, July 28, 2014

Carter Woodsons Legacy

According to, “a role model is a person whose behavior, example, or success is or can be emulated by others, especially by younger people.” (Role Model) Role models play an important part of career success strategies. For as long as I can remember I like to take the time to emulate the good things about others. I have always had the perspective of why try to do something on my own why not look at what other people have done and take from their experiences. I have always looked at things in the form of characteristics because there are things about people I don’t like.
According to, “a career is an occupation or profession, especially on requiring special training, followed as one’s lifework” (Career) Success according to, “is the favorable or prosperous termination of attempts or endeavors; the accomplishment of one’s goals.” (Success)   In my lifework goals, I think of four major items, Family Life, Education, Career, and Money. To me these items while they are not directly career oriented they drive the way that I think about what a successful career looks like. I enjoy a career in the hopes of entertaining a stable family life. Since money is the primary tool derived from work I think of my career as my opportunity to create stability. I look at my education as a precursor for a successful career.  I know the explanation sounds simple but in order for me to attain my version of career success all of the factors must be taken into account.
When it comes to success I think of Carter G. Woodson. Woodson’s lifework revolved around the history and Education of African Americans. Woodson was born in 1875 to sharecropper and former slaves during the Reconstruction era in New Canton Virginia.
As the first son of nine children he would work as a sharecropper and a coal miner to help his family. Woodson learned to read using the Bible and his father’s newspapers in the evenings. (Vox) The thing I admire most about Woodson was his persistence and dedication to accomplish his goals.
While working in the coal mines Woodson would read to Oliver Jones and the illiterate coal miners in exchange for food and knowledge from Oliver Jones. The miners would share stories of the Civil War, Reconstruction, and politics as well as, “trials and battles … for freedom and equality.” (Mertens) I could only imagine how this inspired Woodson to pursue a formal education.
After three years as a miner at the age of 20 Woodson enrolled in Huntington’s black high school, and graduated in two years. (Mertens)  Woodson would then go on to complete degrees at Berea College, though running out of money after his first year in school Carter Woodson would teach, and work for the US government as an education superintendent in the Philippines. (Carter Godwin Woodson) He went on to University of Chicago, to complete a bachelor and masters degree and a Harvard Ph.D. (Carter Godwin Woodson) Carter Woodson had gone from being a sharecropper, miner, scholar, teacher, principal, editor, dean of college, and author.
One of Woodson’s professors at Harvard, Edward Channing asserted that, “the Negro had no history.”  (Vox) “Despite his scholastic success, Woodson scorned the education then available to most blacks, believing it taught only submission and self-loathing. (Mertens) Woodson would form the Association for the Study of Negro Life and History. He then published his first issue of the Journal of Negro History. Woodson would continue to correct mis-education by lecturing, publishing textbooks, and writing for newspapers and magazines. He sent curriculum kits to help schools observe Negro History Week. He hoped that studying the achievements of their predecessors would inspire young African Americans with a sense of possibility. Throughout his career Woodson would build a network of philanthropists, black professors, teachers, school children, church groups, women’s clubs, fraternities, and black-history clubs in every major city.  (Mertens)
What makes Woodson a role model to me is the fact that he first had the self determination to achieve his educational goals despite a lack of structure; running out of money and coming from a difficult background he persisted and eventually graduated. He was the second African American to earn a Ph.D. from Harvard. A study from the BLS estimated that in 2001 about 1% of the workforce held a Doctorate degree. (BLS Occupational Outlook Quarterly 2002/2003) Whether it’s getting an education, or working a job, determination and focus are key traits that I believe deliver success.  Carter G. Woodson did not stop with his own educational attainments he went on to push education on a national level, and more importantly to me Woodson created a  legacy that survives today about the possibility of achievement.

Carter Godwin Woodson. (2014). The website. Retrieved 02:44, Jul 27,
Career (2014). Unabridged. Retrieved July 27, 2014, from
Jones, E. (2003, January 1). Beyond supply and demand: Assessing the Ph.D. job
market. . Retrieved July 27, 2014, from
Mertens, R. (2008). Legacy. The University of Chicago Magazine. Retrieved July
27, 2014, from
Role Model. (2014). Unabridged. Retrieved July 27, 2014, from
Success. (2014). Unabridged. Retrieved July 27, 2014, from website:
Vox, L. (2014). Carter G. Woodson Biography. African-American

Tuesday, July 22, 2014

Outpatient Surgery Centers

I have watched this video about outpatient surgery. In Oklahoma City it seems that some of the outpatient surgery can be done at a fraction of the costs.

I don't know that I can agree with the political tones of the video, I do think that they have a point when the prices differences are illustrated. Why have prices gone beyond as high as twice to ten times the cost?

The physician (Dr. Smith) points out that the third party insurance payers are to blame. The physician then points out that  administrators and larger hospitals like the new regulations because the regulations are hurdles that small companies cannot afford to overcome. When most people assign blame for the high prices of surgery they go back to Kenneth Arrow and his concepts.

Kenneth Arrow states there are a few problems with the economics of healthcare

  • Unpredictability-My Translation You don't know when you will get sick
  • Barriers to Entry- My Translation higher fees because it takes a lot to become a doctor
  • The Importance of Trust- My Translation healthcare providers need to be trusted which cost people that need healthcare more money
  • Asymmetrical Information- My Translation normal people are not as smart as doctors
  • Idiosyncrasies of Payment- My translation because normal people don't know as much as doctors and we use insurance companies as long as the bill is paid we don't care about the cost

Dr. Smith then states that one of the signs of crony capitalism is the consolidation of firms and that there is a lack of free-market capitalism at play. When you examine the health industry in the United States one would quickly see that a majority of the hospitals are run by not for profit entities. According to the American Hospital Association roughly 20% of the hospitals are for profit hospitals. 

Without the places like the Surgery Center of Oklahoma we can expect to start spending more time waiting on care. I hope concepts like this Outpatient Center can  disrupt the old model of outpatient surgery.

I ran across this video and saw a glimmer of hope in what I think is innovation in the world of healthcare and ultimately more affordable healthcare.

Wednesday, July 9, 2014

After thoughts of supply chain strategy

I have opened an article reviewing supply chain strategy. Having worked in supply and distribution over the course of almost a decade I believe this article is spot on when it comes to the complexity of supply chain. In most cases I have witnessed first hand. Supply chain operations are an after thought. Because supply chain is an afterthought there is an opportunity for people that specialize in supply chain solutions to take over the delivery of said services. I would even argue that the bar is not high when it comes to delivering theses services. If one were to look across the industry there are a wide variety of 3PL or Third Party Logistics and even 4PL or Fourth Party Logistics. The most interesting would be 4PL in that they do not own any assets themselves. The question that comes to mind is how is it that an organization that owns no assets can compete with an organization that has immediate assets at their disposal to complete the job?

Supply chain strategies: Which one hits the mark? 
According to the Article there are four main drivers affecting supply chain design.
1. Demand variation or demand profile. This is simply the stability and consistency of the manufacturing assets and workload, and consequently is a main driver of production efficiency and product cost.
2. Market Mediation costs. Market mediation costs are costs associated with the imbalance of demand and supply. Examples are product price markdowns to compensate for excess supply, and lost sales when demand exceeds supply. 
3. Product lifecycle, which is continually getting shorter in response to the speed of change in technology, fashion, and consumer product trends, affects the predictability of demand and market mediation costs. Consequently it, pushes companies to increase the speed of product development continuously  renew their product portfolios.
4. Relevance of the cost of assets to total cost becomes critical in industrial sectors where business profits are highly correlated with the asset-utilization rate. Companies fitting this profile must assure high utilization rates, often to the detriment of working capital and service levels. In industries where the relevance of the cost of assets is low, companies may choose strategies that focus on responsiveness. In these cases, the asset-utilization rate falls between high and low, but responsiveness to unexpected demand is high, increasing customer satisfaction and reducing market mediation cost.

I remember working for a company that did manufacturing work. As the company made plans to consolidate operations they struggled on the back end of supply chain. As an everyday worker the challenges we would be faced with would be finding locations to store product. I don't mean a little bit of product I mean a lot of product. We had an excess of renting trailers where product would sit for months at a time I remember walking the parking lot and opening up the doors to over 150 trailers with a flashlight and clipboard to give updated statuses of the location of trailers and the product that was on them. To make things even more complicated we had over 5 different warehouses spread over at least 3 towns 2 counties and two states. If the strategy had occurred prior to consolidation there would have been triggers for phases of the operations to happen.

Phase one might consist of locating several warehouses to alleviate the lack of storage based on estimates from prior operational indicators. Secondly if I were to purchase/rent additional trailers I would have understood how the information would have been able to be tracked in the current inventory system. In this particular instance one shift would have an issue with available trailers and report the trailer as inoperable. The following shift would call in maintenance to get the trailer fixed and maintenance would not be able to locate the trailer and the trailer would not get fixed until a series of calls. Another point of friction would be that within the county there were not enough warehouse locations suitable for additional storage.So not only was there an issue with locating trailers there would be an issue on returning product from a satellite warehouse to the shipment point. There had to be a significant cost to transporting the product outside of the county to return to the point of shipment. There was an additional issue of locating product once the product was located in the satellite warehouses. There weren't any official locations setup in those satellite warehouses so product might be mixed in with other product or the final count might not be accurate.

So as I reflect on the mentioned scenario and the article I read.

Considering demand variation upon consolidation. There was absolutely no demand forecasting available with a measurable footprint. After working there some of my questions are about operational information. I remember going into an interview asking a 3PL logistics house what their operational numbers look like. Ie. what does your operational footprint look like? How many people across the organization understand the information? What does your inventory turnover look like. If these questions are not understood and known by management then as a worker you can expect to spend a lot of time scrambling putting out fires. As a manager you cannot expect  your leadership to make significant gains because they too are putting out fires. As a young military officer I learned that routine operations have to completed routinely otherwise when significant changes come you will not be able to react accordingly.

                 Sixty percent of the art of command is the ability to anticipate; forty percent of the art of command is the         
                     ability to improvise.
                 -Brigadier General S.L.A. Marshal

Considering market mediation costs, to me this means that you are able to anticipate operational levels based on customer demand or cost of raw materials. In the same time I worked there was a big issue with buying some of the raw supplies. The contracts for raw materials had an unexpected increase to the point where we did not anticipate. I imagine the company I worked for had a serious consideration for exiting the business. When you combine an increase in prices for raw materials and complications with supply operations it is no wonder I don't see as much market share from this business in the same businesses.

Considering product life cycle the business I worked for was a consumer good but, it has not been affected by any new technologies in the product line. The main driver of the business is cost of the end product. In the end I believe the business lost a significant share of their market.

Considering the assets products that were made had a decent amount of cost associated with production and need a high utilization rate.

As a young military officer I believe their operational understanding makes them able to have an impact on supply chain. Even though the terminology is slightly different. Their ability to analyze change and communicate the ensuing change is available from day one. They would be able to apply the leadership learned in making tentative plans when the information is available. They would be able to understand that the impact of operations and where to look for issues. I think that the internal operations of these organizations could be lacking in the development of business processes. What I'm referring to is the SOPs of the organizations and workflows. Are there standards to how the company operates? Are there up to date instructions on how the job occurs? Are there training methods in place to make sure that people can perform the functions of the job. In the military these are referred to as mission essential tasks. If I am new to an organization I'm going to look to see if someone brand new to the organization can take over with minimum instruction or instruction with written form and continue the job/process. Then is the standard applicable to the process? How do you know that you are getting the job done in a manageable amount of time? These questions and viewpoints if measured are what can make the difference between an effective strategy and daily operations of supply chain.

Thursday, July 3, 2014

What's going on?

I have taken a few weeks off of blogging because I was finishing up a term in school. I have since walked in my graduation even though I have two more electives to take. So now the question is how do I make the huge leap?

A long time ago I started as a Computer guy, I was in Future Business Leaders of America (FBLA) I was a 17 year old kid where I was able to compete in a computer application competition where we had to do Word Processing, Spreadsheets, Databases, and Presentations. I was able to travel to Orlando Courtesy of Metro Tech Vocational Centers.  This is where I kind of had the idea that I wanted to go into business.

After graduating high school, I did not have a clue. My father asked me what I was going to do with myself. I quickly envisioned me working at McDonald's for the rest of my life. So I decided I better get with the program. After enrolling I went through all of the long lines and I was told that I need to withdraw because I didn't have enough money. Unfortunately my father and mother had been out of work due to a union strike at the local manufacturing plant. So I applied for a few scholarships and was able to get a scholarship as well as financial aid. The caveat was that I had to major in science or mathematics. Anyone that knows me knows that I didn't like math. I put my business aspirations to the side and pursued a computer science degree.  I ended up changing to business after taking a Micro-Economics course over the summer.  When I returned to school my friend Chuck told me about his summer with the Marine Corps.

So I ended up graduating and earning a Commission in the United States Army Medical Service Corps. After Graduation I worked as a Gold Bar Recruiter before going to the Officer Basic Course (OBC). I completed the course as the Honor Squad Leader. This means that my squad had the highest combined scores PT, Test, etc. I worked in infantry operations as well as clinical operations. When I left the military I went to work as a distribution/shipping supervisor. I figured I had been working in logistics anyways so I took the job I found out about through a recruiting firm. Much like I did in undergraduate school I did what I thought I had to do in order to keep charging forward. Little did I know that was not exactly where my interest were. I worked in warehousing for about 7 years off and on.  Once I decided to go back to school, I was nervous due to my math skills as well as I had been away from school for a while. 

Last week I completed my graduation walk for my MBA. I thoroughly enjoy learning about business, but much like the military, most people know me as an operations/distributions guy versus a healthcare guy.  So I need a strategy for getting back into the healthcare field or perhaps an analyst role.

My take on Healthcare Strategic Planning

When I think of Hospital Strategic planning I think of long term planning.  According to a Case study of Community Hospital Healthcare System: A Strategic Management  Case Study  of some of the operational aspects are a formulation of vision, mission statements, internal and external analysis, generating, evaluating and selecting appropriate strategies for a healthcare organization. ( Choudhary 2012)

The Steps in Strategic planning according to Nowicki are:
1.    Validate Mission and Strategic Interpretations
2.    Assess the External Environment
3.    Assess the Internal Environment
4.    Formulate the Vision
5.    Establish Strategic Thrusts
6.    Identify Critical Success Factors
7.    Develop Core Objectives
8.    Develop the Strategic Financial Plan (Nowiki 2011)

I think that Strategic Management in Hospitals when I look at the TCOs:
·         Given that healthcare is pluralistic in the way it is financed, formulate a plan to address the issues surrounding third-party payments: payment methodologies of government healthcare programs, complex receivables management, managed care requirements, and corporate compliance plans.
·         Given the trend toward creation of integrated health service systems, distinguish the rationale for merger, acquisition, and joint-venture activity among health service organizations. In specific case examples, identify the business and financial considerations of such decisions for the organizations involved.
I think that healthcare and third party payments are an evolving enterprise. According to an Article titled The Evolving Role of Third Parties in the Hospital Physician relationship. “The rising cost of healthcare and the changing technologies combined with population density. Rising costs have led public payers and managed care organizations to push for ambulatory care and more consumerism.”   (Burns 2007)

Secondly “Technological evolution and population density have allowed procedures once performed only in general hospitals to be conducted in surgical centers. This trend has split the market in competition for patients.”  (Burns 2007)

Step One: Validate Mission and Strategic interpretations
This mission statement of University of Oklahoma Health Sciences Center is as follows:
The mission of the University of Oklahoma Health Sciences Center, as a comprehensive academic health center, is to educate students at the professional, graduate, and undergraduate levels to become highly qualified health services practitioners, educators, and research scientists; to conduct research and creative activities for the advancement of knowledge through teaching and development of skills; and to provide continuing education, public service, and clinical care of exemplary quality. (OUHSC 2014)
Here are the strategic statements of University of Oklahoma Health Center:
·         Propel the OUHSC and the state to regional and national prominence in research and development
·         Bridge the gap between bench and bedside
·         Rapidly translate new discoveries into new treatments
·         Promote further economic development for Oklahoma and continue to meet the health care needs of the state.  (OUHSC 2014)

So when I look at the mission statement and the strategic statement I can see the progression of a research institute with a regional and national prominence. Secondly the idea of pushing research into new treatments is a factor.  The plan is a five year plan where four key areas; cancer, diabetes, neuroscience/vision and infectious diseases/immunology of research are targeted. The healthcare facility has over $377 million allocated towards capital projects. Just from viewing the website one can see the first two bullets in practice mentioned by the California Management Review. (OUHSC 2014)

Step two: Assess the External Environment
The external environment was assessed by the hospital as well as the Oklahoma City Chamber of Commerce. The comparative study evaluated Oklahoma City against Birmingham, Alabama; Dallas, Texas; Kansas City, Kansas and Missouri; Louisville, Kentucky; St Louis, Missouri and Illinois; and Saskatoon, Saskatchewan, Canada. This was completed by the Battelle Technology Partnership Practice in September 2005. The study was completed to analyze the biotechnology industry.  (GOKCC 2005)
According to Nowicki in Introduction to the Financial Management of Healthcare Organizations, “the first part of the external assessment should include national trends. The second part of the external environment assessment should include a determination on the direction of the local market.” (Nowicki 2011)

Step three: Assess the Internal Environment
Within the highlight of the about webpage there is a mention of how the University of Oklahoma has one fo the only primary centers in the world for genome studies, OUHSC is home to one of the few departments of geriatrics in the nation that conduct basic research in aging. (OUHSC 2014) According to the Bio Ready and Bio Strong highlights Oklahoma City out of the reports six cities was second in producing Bio Science degrees behind St. Louis.

Step four:  Formulate the vision
Formulation of the vision is a process by which the facility is communicating a message both internally that is inspiring, clear, challenging, preparing for the future while honoring the past as well as easily translated into action. (Nowicki 2011) When I read the about webpage at the University of Oklahoma Health Sciences Center I see the evidence in their statements about where they plan to be.” The plan targets and builds upon existing research and clinical strengths to achieve a vigorous economy and healthier future for all Oklahomans. Previous research strategies boosted total sponsored awards at the OUHSC from $10 million in 1982 to $139 million in 2009.” (OUHSC 2014)
Step five: Establish Strategic Thrusts
Establishing Strategic Thrusts means setting goals, which are broad statements of significant results that the organization wants to achieve related to the vision. Based on the reports and the research of external factors I see the strategic thrusts at University of Oklahoma Health Sciences Center are: Building an OU Cancer Institute, the Harold Hamm Oklahoma Diabetes Center, and the College of Allied Health. (OUHSC 2014)

Step six: Identify Critical Success Factors
Critical success factors are organization specific, but most healthcare organizations will include critical success factors. Some of the critical success factors according to Nowicki are in the area of medical staff profiles and activity levels, accessibility indicators, or quality indicators. With the OUHSC the plan is to add 100 faculty members.  (OUHSC 2014)

Step seven: Develop Core Objectives
The seventh step is to develop primary, core objectives that support the strategic thrusts or goals. Across the OUHSC organization the objectives or strategic statements encompass the objectives. (Nowicki 2011) The objectives are to build the four areas of cancer, diabetes, infectious disease and immunology as well as recruit 100 faculty members.

Step eight: Develop the Strategic Financial Plan
The strategic financial plan is three to ten years out. It is the financial quantification of a series of strategic planning policy decisions that answer whether the organization can make progress toward accomplishing its strategic plan over the next few years. (Nowicki  2011)

Alternate views
According to California Management Review:
 Executing Strategic Change Strategy execution is concerned with firstly, creating a portfolio of change programs that will deliver strategy; and secondly, it involves attracting, allocating, and managing all the necessary resources to deliver these change programs.  It is becoming more critical to organizations’ long term success to excel at strategy execution: those that do will outperform their peers by a wide margin. (Franken 2007)

·         According to the article the first thing is that businesses have to be ready for the change of the business market, “according to customer wants, needs and priorities.”
·         The second reason is the, “increased complexity of organizations.”  Today’s organizations across multiple functional, organizational, and geographical boundaries.
·         The third reason is the demands of  successfully executing complex change programs with the demands of managing today’s performance are based on reward schemes based on today’s performance.  This means that managers have less time to dedicate time to one set of demands exclusively.
·         The fourth reason is the low levels of involvement of a large number of managers across all functions at an early stage of strategy execution.
·         The fifth reason is the difficulty of securing resources to execute the strategy. There are a large number of concurrent change programs. As such resources are limited and the competition for control and maintaining those resources is fierce. (Franken 2012)

According to Becker Hospital Review 70% of Hospital Strategic Initiatives Fail: How Hospitals Can Avoid Those Failures. The main contributor to the failure of strategic planning according to the article is due to communication.  (Becker 2012)
An alternate view asks Is Strategic Planning Still Relevant? Some of the problems that limit the effectiveness of strategic planning are:
·         Failing to involve the appropriate people
·         Conducting Strategic Planning Independently of Financial Planning
·         Falling Prey to Analysis Paralysis
·         Not Addressing the Critical Issues
·         Assuming that Established Objectives Take Care of Themselves
·         Failing to Achieve Consensus
·         Lacking Flexibility and Responsiveness to the Dynamic Environment
·         Ignoring Resistance to Change (Zuckerman 2007)

Technology Solutions
According to Digitizing the Healthcare System some of the newer benefits from healthcare digitization are:

·         More complete information available for treatment decisions
·         New and more efficient options for patient interaction
·         Enhanced ability to demonstrate performance consistent with regulations and recognized professional standards
·         Potential for reduced operational costs and more effective use of resources (Commission on Systemic Interoperability 2005)

When I look at the University of Oklahoma Health Sciences Strategic plan I did not see how the plan involved technology as a goal. This does not mean that technology has not been included in the strategic process. I believe this could be under the title of examining the external and internal environments. According to an HealthIT article some of the ways to include technology are:
·         Think about the patient experience
·         Consider best practices
·         Remember the staff experience
·         Don’t forget about social media
·         Employ integrative planning (McNickle 2012)

These two dynamics speak to TCO H or the integration of health service systems; I think a rationale is consolidation of care for the patients in a fragmented system. As the Technology merges and patient care needs, and wants are evolving. There is new legislation from the Government when it comes to healthcare that impact the way these healthcare organizations perform their strategies going forward meaningful use of electronic health records  and ICD10 codes come to mind.  The shifts in technology are changing the operational tasks of organizations as well as changing the dynamics of the relationships between traditional organizations and the patients.   The market of healthcare includes technology as component of delivery. According to some of the benefits include quality of care as well as a fewer deaths and fewer problems of care ( 2014) If 70% of initiatives fail due to a lack of communication, improved integration of technology can help eliminate some of the barriers and improve communications.