company’s operation that is in a free market Essay Case Assignment
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company’s operation that is in a free market Essay Case Assignment
gregory velazco y trianosky
california state university, northridge
Definition of externality: a cost created by a company’s operation that, in a free market, does not appear on the company’s books.
polluted water caused by coal mining is one example
Several particularly difficult types of externalities
“Tragedy of the Commons”: individual pursuit of self-interest is collectively self-defeating; but the cost of individual pursuit of self-interest is not borne to any great extent by any individual company (e.g. overfishing in the North Sea)
moral of the story may be that forced agreement and forced follow-through are required to solve the problem (compare Joseph Stiglitz’s comment about the pervasiveness of externalities and how it creates problems for free markets in Wikipedia article on him)
Unpriced Natural Capital: natural resources that are consumed by corporations that do not pay for their use (see David Roberts, “None of the world’s top industries would be profitable if they paid for the natural capital they use,” http://grist.org/business-technology/none-of-the-worlds-top-industries-would-be-profitable-if-they-paid-for-the-natural-capital-they-use/ )
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The Perils of Partnering in Developing Markets How a health care provider addresses the risks that come with globalization by Steven J. Thompson
This article speaks about dealing with issues related to government mandated Read the following article and write a one page opinion paper stating: – Your overall opinion of the article – Two-to-Three things you learned from the article hiring and management practices. Answer the following: 1. How important is it for the investing partner to have some management control? 2. What could cause a multi-national company (GM for example) to be willing to give up managerial control? 3. What are the dangers of not being able to put home country based managers into the joint venture leadership positions? Post 1/2 to 3/4 page replies to the original posts of three other students
Michael Woods January 4, 2014 10:30 PM
Michael Woods January 4, 2014 10:31 PM
Ten years ago Johns Hopkins Medicine In-ternational, where I’m the CEO, joined forces with Anadolu, a Turk- ish charitable foundation, to build and operate a state-of-the-art medical center in Istanbul. The project’s success would depend on putting the right executives in place—managers experienced in the operational and clinical challenges that leading hospitals must face. Hopkins was prepared to draw them from within its own ranks, but Turkish law prohibits noncitizens from running hospitals. And ILL
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y e t f i n d i n g qualified Turk-
ish executives proved impossible. How could we manage a large, complex project in a country whose laws prevented us from hiring the right people for key leadership roles?
It’s hardly the kind of problem a health care CEO expects to encounter, but issues like this are a reality in today’s global market. As developing economies move up the industrialization ladder, their need for sophisticated, high-value ser- vices rises, too. But usually few, if any, lo-
cal business leaders have the expertise to provide the !nance, media, information technology, and other services required. That’s one reason why governments and enterprises in these countries increas- ingly seek to form joint ventures with top U.S. and European organizations; think of J.P. Morgan and the Union Bank of India, DreamWorks and China Media Capital, or Google and UOL Busca, in Bra- zil. And for the foreign partner, teaming up with a local entity can ease entry into a market that has considerable growth opportunities.
The Perils of Partnering In Developing Markets
How a health care provider addresses the risks that come with globalization by Steven J. Thompson
June 2012!Harvard Business Review!2COPYRIGHT © “#$” HARVARD BUSINESS SCHOOL PUBLISHING CORPORATION. ALL RIGHTS RESERVED.
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However, these partnerships can turn into nightmares, as Hopkins has learned. Having worked for 15 years on projects ranging from clinics to hospitals to major medical education and research centers in more than a dozen countries, including Chile, Lebanon, Panama, Singapore, and Turkey, we’ve seen several e”orts run o” the rails, or nearly do so, for many reasons. We’ve emerged from these early failures and challenges with a highly #exible model for collaboration that has led to signi!cant successes and enabled us to grow our busi- ness at a rate far beyond that of the U.S. health care market as a whole.
Hopkins collaborates with govern- ments, insurers, foundations, and health care companies. Because we’re a nonpro!t, we take only a minority equity position, or none at all. We operate less like partners
and more like consultants with an unusu- ally broad range of responsibilities and a high level of authority, and in a way that keeps us involved on an ongoing basis— and often puts our name on the front door.
Although the health care industry is unique in many ways, the challenges we’ve faced are likely to confront any ser- vices business seeking to expand in other countries through local partnerships. Here are some of the hurdles we encountered, along with the approaches that helped us clear them.
Filling the Local Talent Gap In the case of the Istanbul medical cen- ter, the mandate that the chief executive be a Turkish citizen left us without much control. And before long the hospital was plagued with quality problems: Patient safety procedures weren’t consistently
followed, operating rooms were over- or underbooked, and some physicians failed to adopt accepted evidence-based diagnos- tic and treatment procedures. Everyone in- volved was concerned about the slow pace of improvement, and some feared that the center would never be worthy of the Hop- kins imprimatur.
Even when the law doesn’t require that top managers be citizens, local part- ners often insist on it. We’ve learned that !ghting to put in our own top managers at the outset rarely pays. Instead we seek to strengthen our consultative position, team- ing our advisers with local executives and asking that they be given roles in which they can in#uence the process and culture. In the Turkish project, for example, we had a seasoned U.S. manager serving as the chief nursing o$cer—a critical post.
Usually within a year or two, local part- ners recognize that their own managers can’t provide the needed push for innova- tion and culture change, and we can start taking on top management functions. In Istanbul, the foundation soon agreed to give one of our managers the number two role—and dissolved the top position, leav- ing our executive in charge while remain- ing in technical compliance with the law. The project is now thriving.
It’s important to note that we don’t seek to run overseas projects long-term. It’s dif- !cult to !nd highly quali!ed U.S. personnel who are willing to accept a post in a devel- oping nation for even a few years, let alone permanently. And it’s almost impossible to !nd enough people to sta” three or 10 or 20 projects at once, which presents a serious obstacle to growth.
The solution we’ve discovered is two- pronged. First, our field managers focus not only on improving operations but also on mentoring local managers, with the aim of preparing them to take over within two to !ve years. In many cases we bring key lo- cal managers and professionals to our Balti- more facilities to see how they run. We also push to establish local training programs in everything from nursing leadership to hos- pital !nancial management to HR. Second,
we’ve set up a strong recruitment pipeline in Baltimore to attract more top U.S. talent to developmental health care and to pro- vide special training.
When Best Practices Collide With Culture In most developed countries, nurses, junior physicians, and other midlevel providers are now empowered to challenge the deci- sions of senior physicians when a patient’s health may be at risk, and that capacity has dramatically improved the quality of care. But in most of the countries where Hopkins has partnerships, the medical culture still clings to the old model, wherein no one ever questions a doctor’s judgment. We ran into this problem in Singapore (which, although not a developing country, is seek- ing to improve its health care delivery), in an oncology clinic we built and operated in partnership with the government. Noth- ing our managers said could change the situation.
The !rst thing we do when confronted with a culture clash is determine whether we really need to challenge the culture. Often we can !nd approaches that accom- plish our goals within the cultural con- straints. For example, after we discovered that male patients in some Persian Gulf hospitals were refusing to see female doc- tors, it was easy enough to inform patients of the doctor’s gender when scheduling appointments. Similarly, male doctors at some of the same hospitals learned that when examining and treating a married woman, they had to conduct all conversa- tion through her husband.
But we won’t compromise when patient health and safety are at stake. We solved the problem in the Singapore clinic by seed- ing the sta” with professionals who could lead by example—nurses from countries where those providers have more auton- omy. Their willingness to stand up to doc- tors initially shocked and even offended many sta” members. However, as people saw that patient outcomes were steadily improving, they began to come around, and the culture of deference receded.
Fighting to put in our own top managers at the start rarely pays. Instead we strengthen our advisory position.
!Harvard Business Review!June 2012
Think about the highlighted section in this column relation to reluctance of some people in developing countries to question a manager.
Evaluating the Opportunity
Assess the potential partner’s willingness to commit resources
Assess regional constraints—the regulatory environment, infrastructure, and so on
Work with the partner on a project plan and a business plan
Ensure that the partner has a clear understanding of and realistic expectations for the project
Getting Up To Speed
Engage experts from Hopkins to hire key personnel and to design processes
Establish training and mentoring programs for local managers and professionals
Set up clinical, operations, and financial performance metrics
Establish quality, safety, and e%ciency processes
Set a timeline for accreditation
Operating Over Time
Stabilize processes and create feedback loops
Transfer more responsibilities to local managers
Establish local education and recruitment pipelines
Establish regional marketing programs Consider new initiatives and expansion
Mitigating Risk Lending the Hopkins name to a hospital that delivers unimpressive care could sig- ni!cantly damage our 135-year-old brand— and that’s a real danger in developing areas, especially in a project’s early days. We have no control over many factors, including the quality of academic institutions, the sources of investment, the regulatory and judicial systems, and all the other infra- structure that can support or undermine long-term success. How do we know when a project will be worth the risk?
Choosing the right partner and learning how to read signs from the up-front negoti- ations are critical. Partners who are looking for a fast return on investment or merely seeking to capitalize on the Hopkins “halo” are anathema to success. We’ve learned how to pick up on the sometimes subtle signals that other parties’ goals aren’t
aligned with ours. For example, in the !rst meeting a good potential partner will focus on sustainable quality and commitment, not !nancial returns. For this reason alone, more than a third of our initial conversa- tions go no further.
When we do agree to a project, our con- tract speci!es the goal of obtaining accredi- tation from the Joint Commission Interna- tional or another organization that sets a high bar. We’ve found that in the absence of such objective judgment, partners may shrug off our exhortations for faster and greater change.
We used to plug away on projects that were heading in the wrong direction, but no more. We’ve become better attuned to signs that a partner isn’t honoring its com- mitments, or that government o$cials are putting up too many obstacles, or that the local sta” isn’t likely to step up. If we see
those signs, we immediately bring in out- siders, including experts from Baltimore, and rethink what we’re doing. So far we’ve never had to kill a project that was fully un- der way, but we’re prepared to if need be, and our contracts typically include a “ter- mination at convenience” clause.
Make no mistake: For all the risks, partnering on complex projects in devel- oping countries o”ers the potential of great rewards. For Hopkins, the rewards go be- yond the considerable financial upside. Our a$liates issue press release after press release trumpeting our facilities’ progress, and many local managers move on to posts in government health ministries and other in#uential bodies. When our projects pros- per, our brand prospers, and new opportu- nities come our way. HBR Reprint F$”#&A
Steven J. Thompson is the CEO of Johns Hopkins Medicine International.
A PROJECT CHECKLIST: How Johns Hopkins Sizes Up International Risk
If your concerns are modest, propose a smaller, months-long pilot consulting project If your concerns are serious, walk away
Look for cultural mismatches and adapt your processes Increase the number of Hopkins and other expat professionals Expand support to local managers If problems are significant, revisit strategic plans and consider replacing management If problems are severe, consider scaling back or killing the project
Strengthen training and mentorship Bring in experts from Hopkins to help solve problems Retool processes that are falling short Reinstate key Hopkins managers if possible Freeze or reduce the scope of activities until problems are solved Set up problem-solving forums with partners in other countries
If There Are Signs of Trouble:
June 2012!Harvard Business Review!4
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company’s operation that is in a free market Essay Case Assignment
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APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. 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The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper.
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