Tag Archives: financial

Baldrige-Based Health Care Reform?

Today’s Washington Post has an article by Minnesota senator Tim Pawlenty on the effective design of national health care reform, entitled “To Fix Health Care, Follow the States”. He argues that the federal government should model its initiatives after successful state-based systems that link outcomes to value:

In Minnesota, our state employee health-care plan has demonstrated incredible results by linking outcomes to value. State employees in Minnesota can choose any clinic available to them in the health-care network they’ve selected. However, individuals who use more costly and less-efficient clinics are required to pay more out-of-pocket.

Not surprisingly, informed health-care consumers vote wisely with their feet and their wallets. Employees overwhelmingly selected providers who deliver higher quality and lower costs as a result of getting things right the first time. The payoff is straightforward: For two of the past five years, we’ve had zero percent premium increases in the state employee insurance plan.

Minnesota has also implemented an innovative program called QCARE, for Quality Care and Rewarding Excellence. QCARE identifies quality measures, sets aggressive outcome targets for providers, makes comparable measures transparent to the public and changes the payment system to reward quality rather than quantity. We must stop paying based on the number of procedures and start paying based on results.

Pawlenty also notes that healthcare reform should not focus solely on access to health care, but also the cost and quality of the service – that is, the value that is delivered. The Malcolm Baldrige National Quality Award (MBNQA) Criteria for Performance Excellence provides a framework that has been tailored over 20 years by a huge collaboration of experts to help business, industry and the government better solve this kind of “wicked problem”. The Minnesota solution sounds like it has applied concepts very similar – if not identical – to those presented by the Baldrige Criteria.

When will the government employ the successful problem-solving frameworks it has developed itself (e.g. MBNQA) to solve its most pressing problems?

The New Competitiveness

AIG is falling. Bailouts are flying. All of the rules of business have changed, and the seismic shift is both electrifying and frightening. But there are opportunities to be embraced, and many of them are summed up in this article entitled “Why Small Companies Will Win in This Economy“. Here is my favorite part, a veritable mantra for the 2010’s:

Small is the new big. Sustainable is the new growth. Trust is the new competitive advantage.

Thanks to Betsey Merkel (Twitter: @betseymerkel) who initially Tweeted this. And thanks to Valdis Krebs (Twitter: @valdiskrebs) without whom I wouldn’t have seen Betsey’s insightful retweets and started following her too.

How Quality Makes You Recession-Proof

A couple days ago, Sonia Simone presented an article entitled “Four Old-School Reasons Why You Can Thrive in this Recession”. The general philosophy of her insights is straightforward:

It’s impossible to really see massive change when we’re still in the middle of it. But there are a handful of things you can bank on. One of them is that human nature doesn’t fundamentally change, even though the environment can change radically… So it might be time to think about the ancient traits that have helped entrepreneurs since the dawn of history, and how they relate to the emerging 21st-century economy.

americangothicShe presents four notions: self-reliance, great ideas, “the village is your customer”, and “it’s in your DNA”. The one I want to focus on is #3 (if you want to read about the others, please visit the full article). When the village is your customer, Simone notes, quality becomes the focal element of the production and customer service processes. Hundreds of years ago, and into the early decades of the 20th century, people knew their neighbors in the community who made the products and provided the services. Personal relationships would form between you and your baker, your pharmacist, your doctor, your grocer, and so on. If your grocer sold you rotten food, for example, he would violate a trust relationship that you had established over a long period of time. Not only would breaking this trust hurt his business, but it might hurt his feelings too if you shared your discontent with your neighbors or gave him a dirty look while walking down the street.

But times changed remarkably. By the late 20th century, production, consumption and service had all become anonymous – the guy who services your car is probably not someone you know personally, nor is your mailman a personal friend. As a result, less personal impetus to provide high quality translated into an organizational imperative to deliver high quality. Without the driving force from within to provide excellent products and services, the company would naturally become the enforcer of high quality. (And without this enforcement, well, it would be a roll of the dice whether you got high quality products and services or not.)

Now fast forward to 2009 and the Web 2.0 world:

the village is back. If we blow it, customers publicly rap on our window (with social media, blogs or Twitter) and give us a piece of their mind.

Once again, our reputation and our products are one and the same. What we create doesn’t have to be perfect, but it does have to show that we give a damn.

The inconvenient part is that the village isn’t stuck with you. If your baguette isn’t great, your customer can FedEx something from an artisanal bakery in Napa or Madison or Boca Raton.

The cool part, though, is that if you make something handmade (even if it’s delivered in pixels), personal, and/or magnificently useful, your village can and will find you. Whether you make homespun yarn or an interactive course on how to start a dog-walking business, your product can find its own profitable village of happy customers.

On a related note, my next door neighbor is a dentist. She’s been trying to get me to sign up as a patient at her office for a while, but I’m nervous (not because I don’t like or trust her,which I do, but because she’s a dentist). Every time she asks me when I’m going to make an appointment, and I nervously shirk, her response is usually pretty consistent: “Do you really think I’m going to hurt you, knowing that I have to look at you every day across the yard?”

The personal relationship is a driver for providing high quality. How can we make personal relationships a component of a quality-driven strategy?

Shocks to the System: Financial Meltdown and a Fragile Supply Chain

Just-In-Time (JIT) practices are a cornerstone of the fast-paced, 21st century globalized economy. But as the October 2008 financial meltdown has so starkly indicated, when just a few of the assumptions on which a critical system is based change, all hell can break loose. What effect could the economic crisis have on businesses that rely on JIT?

There are several scholars who have studied JIT in depth – the pros, the cons, and of course the implementation details. But one recent article stands out most, to me, as I try to gauge how the seismic shift might impact business. In 2006, Tony Polito (an Associate Professor in the Department of Marketing and Supply Chain Management at East Carolina University) published an article in the Journal of the American Academy of Business detailing the ubiquity and fragility of Just-In-Time practices. If you’re involved in a business that uses or depends on JIT, you should be aware of his conclusions – forewarned is forearmed! I’ll summarize them here to save you some time, so you can start thinking about the structural health and viability of your own business processes.

First of all, it’s important to recognize that JIT is indeed a cornerstone of business practice in the U.S. and abroad. Polito notes a 2001 survey in which 92% of manufacturers believed that JIT was critical, and a 1990 study showing that 98% of customers at that time expected “JIT treatment”. He remarks that “global corporations are mistakenly reliant on extensive supply chains that are disastrously under-buffered [by sufficient excess inventory].”

Polito calls out five “major constraints” on the JIT process:

  • Customer-Driven and Economic Conditions: “JIT savings are based on the implicit assumption that additional inventory is always available for quick delivery at the same price as old inventories.” Effective JIT also depends on capital availability, and relative stability of customer demand. In a challenged economic environment, capital is not as readily available to companies and consumers alike, and customer demand wanes.
  • Logistics: If transportation fails, so will your supply chain. This can happen not only as a result of economic turmoil, but also due to rising energy costs, labor disruptions like strikes, and catastrophic weather events like hurricanes and floods. The proposed solution is, again, to increase buffer stock.
  • Organizational Culture & Conditions: Worker-based collective decision making, trust, and decentralized control are also noted as essential ingredients for JIT. If the people doing the work don’t have the freedom to improve their own processes, the health of the JIT-based supply chain will suffer. Trust across international boundaries is also critical; foreign suppliers or recipients of product may unexpectedly change their policies to reduce risk, especially if credit is an ingredient in the business relationship.
  • Intractable Accounting & Finance Practices: After describing some specific roadblocks that disparate financial systems between supply chain partners can present, and calling out limitations based on financial accounting methods themselves, Polito recommends that improvement of processes prior to improvement of measures may help.
  • Small Supplier Difficulties: One of the criticisms of JIT is that it silently offloads costs from larger companies onto the smaller partners, and many small suppliers have implemented “JIT premiums” to offset this effect. Relaxing JIT requirements could have a positive effect on these members of your supply chain, which could also reduce your costs, so examining the pressures on your smaller suppliers is warranted in an economic downturn. There might be hidden opportunities for both sides.

What does this mean for managers? Among other things, increase long lead-time inventories, compare the costs of stockouts with the benefits of not having stockouts, re-examine the risks that your upstream and downstream partners may perceive, and assess the resilience of your smaller suppliers within an economic crisis. You might also think about resetting expectations with your customers regarding how quickly you can deliver.

Polito’s article is available on his web site at http://www.tonypolito.com/wri_jit5.pdf – I strongly encourage everyone to give it a read as it provides far more detail, and illuminating examples that are not presented here in my summary.


Polito, T. & Watson, K. (2006). Just-in-time under fire: the five major constraints upon JIT practices. Journal of the American Academy of Business, Cambridge. 9(1), March 2006, 8-13.