Beyond Aesthetics: Campus Sheraton

I initially planned to title this post “Does Your Hospital Have Aesthetic Value?”. But after some careful thought I decided to title it “Beyond Aesthetics”. This is because I have discovered that a lot of hospitals are stepping up their look in terms of modern designs and buildings. This is especially so in the urban areas. Many though, in rural and semi-urban areas are still living in the past, providing services from dilapidated structures and unkempt premises.

I have always believed that a hospital building should be trendy (forgive me, I am still under 45), have wide corridors, neat and air-conditioned rooms, shiny floors, sparkling clean bathrooms, a pleasant fragrance, comfortable furniture, adequate lighting, spectacular landscape, an imposing signpost, functional ambulances, smartly dressed staff, state of the art facilities etc. This sounds like a five-star hotel. Well, I think the modern hospital should be a five star hotel and even more.

Back in school, we had a cafeteria complex that catered to the culinary needs of the entire campus. There were about 12 separate canteens called ‘Buka’ 1- ‘Buka’ 12. Sometime in my 4^th or 5^th year, Buka 1 was taken-over and became known as ‘Campus Sheraton’. The new management transformed the dingy lit canteen to a five-star hotspot. The furniture was changed to a more comfortable one; the exterior was re-designed, the interior was re-decorated and air-conditioned. But most importantly, the menu and service were drastically changed from what the other cafeterias were providing. The management employed waitresses who were smartly dressed, friendly and courteous. My wife and I still reminisce on those good old days as students when we went ‘tearing’ turkey wings, eating fried rice and drinking chilled coke at Campus Sheraton; all at the expense of our parents! The place sure wasn't cheap but the service and food was spectacular.

That is what ‘Beyond Aesthetics’ means; going beyond mere external beauty to provide profitable quality. While it is necessary to improve the outlook of our facilities, the focus should be more on provision of quality service at all times. The aim of every infrastructural project should be to enhance the experience of the patient and improve patient outcome. A beautiful building will attract patients but only consistent quality service will keep the patients.

There are several dimensions of quality which must be regularly assessed to determine how well you are doing on the quality scale. These are:

• ·        Timeliness
• ·        Completion
• ·        Courtesy
• ·        Accuracy
• ·        Mistakes

The time dimension of quality emphasizes promptness of service to patients. Patients should not be delayed unduly and adequate measures should be put in place to reduce patients waiting time to the barest minimum.

 Quality also means each task in the hospital process is properly completed. An incomplete or poorly performed task could affect the performance of the next task in the sequence.

Another quality dimension that must be regularly assessed is courtesy. Measures and standards of behavior should be set for hospital employees at employment, induction and at regular intervals during the period of their employment. It is unacceptable for hospital workers to be rude to patients whose basic need is emphatic help.

Accuracy is a dimension of quality that relates with hitting the mark in patient care. The incidences of misdiagnosis should be rare and far between.

Finally, mistakes should be avoided. Hospital managers should design measures to prevent mistakes e.g. use of checklists, adequate planning of duty rosters, putting name bands and marking surgical sites on patients going for surgery e.t.c.

These measures will improve quality and reduce litigation. In addition, ensuring quality service helps you move beyond aesthetics to actual profitability.

See you soon…..

Using Checklist to Improve Hospital Services

I must really apologize that I did not write this post as I had earlier promised. I have been on the road and it has really being hectic. 

However, here is my take on using checklists in healthcare settings.

A checklist is a list of items or points for consideration and action. Like its name, a checklist may be a list of things to check before you do something. A common example of a checklist is the aviation pre-flight checklist used by pilots. Before taking off, there is a list of things that every pilot must do regardless of his/her level of experience. This is done all the time. The purpose is to ensure that the plane is functioning properly before take-off and to prevent any future air mishap.

There are different types of checklists used in medicine. These include:

• ·        Procedure Checklist e.g. Surgical Checklist

• ·        Diagnostic Checklist e.g. Algorithms

• ·        Equipment Checklist e.g. Medical Equipment Checklist

• ·        Iterative Checklist e.g. Protocol for Monitoring Post-Op Patients

It is sad to note that a lot of errors take place in the healthcare industry on a daily basis; wrong surgeries are performed, wrong medication given e.t.c. Majority of these errors arise from lapses in concentration, distractions, or fatigue. Some are quite preventable.

In a recent discussion with a female physician, she said something like “we are doing quite well without checklists. Checklists will just add to the current paperwork burden that we have”.

 Before you nod your head in agreement, please consider the following:

• ·         Firstly, human beings are not infallible. Distractions, fatigue and concentration lapses lead to variability in service delivery. Variability leads to mistakes and mistakes can lead to severe disability or death (What physicians like to call iatrogenic). With the use of checklists, the hospital system is strengthened, peer review and assessment enhanced and variability reduced.

• ·        Secondly, you cannot remember everything or commit everything to memory. I am sure you can recall several instances that you forgot a critical step or item in a procedure. Using a checklist will make sure you don’t forget a thing. You become almost infallible.

• ·        Thirdly, different people follow different steps to perform the same procedure. Some steps may be necessary and correct; others may be unnecessary and incorrect. This results in a waste of time, resources, efforts or skills. This also causes variability which is an enemy of quality service. A checklist will thus help to standardize procedures, reduce waste, eliminate variability and improve quality.

I will illustrate with the case study below:

Dr. Wright is in the OR performing an elective C-section on Mrs. Gabo, a 42 year old primigravida. He has already extracted a 4.5kg male neonate. In the process, there is a deep tear extending from the anterior part of the lower uterine segment towards the posterior surface of the urinary bladder. In an attempt to close the uterus beginning at this “angle of sorrow”, the suture snaps. The scrub nurse is so jittery that he drops the replacement on the floor. That happens to be the last Chromic 2 suture available in the hospital. The only other available chromic suture is a Chromic 2/0. Dr Wright struggles and fumbles to use this to repair the tear. Unfortunately, Mrs. Gabo continues bleeding and eventually dies from severe hemorrhage.

A simple procedure checklist used at the beginning of the surgery could have prevented this death. An equipment checklist used before the commencement of the surgery could also have revealed the inadequate quantity of relevant sutures.  

The World Health Organization (WHO) developed a simple surgical safety checklist some years ago. This can be adapted and modified to suit local conditions. You can see it here.

Before developing any kind of checklist for your hospital, it is important you determine first and foremost the purpose of the checklist. What is the checklist meant to do specifically? 

Next, decide on the type of checklist that is needed to fulfill the given objective i.e. a procedure checklist, equipment checklist e.t.c.

Another important step in developing checklists is to involve the group of people to use the checklist in a brainstorming session. This group should also include experts/specialists in the area of need. Several different ideas may be considered during development. A checklist that is acceptable to all concerned should be the product of this session.

Of course, you also need to set benchmarks to help you determine the effectiveness of the checklist. This will enable you review the checklist periodically to ensure it remains relevant to your practice.

Please note that a checklist is as important in a private hospital as it is in a public hospital.

They should be a necessary part of any hospital. 

Thanks for reading. See you soon….

Using Algorithms to Reduce Waste in the Hospital

The issue of waste is a perennial problem in any organization. Waste is the failure and inability to use something wisely. It is the failure to maximize the potentials and value of a thing or activity.

I have previously written on excessive waiting time,re-work and poor ergonomics as sources of waste. Today, I will identify excessive processing/over-processing as a source of waste. I will also explain the role of algorithms in reducing this waste.

An algorithm is a logical step-by-step procedure for solving problems. When used in healthcare, it helps to set guidelines for critical activities in the hospital.

 Excessive Processing

Excessive processing is like placing a bucket under a running tap to fill it, yet refusing to turn off the tap when the bucket is full. The extra water added and the extra time spent is wasted in the long run. Examples of over processing could be excessive and indiscriminate use of antibiotics, sending patients for laboratory investigations that are irrelevant etc. Consider Jummai’s case:

Jummai is a 5 year old girl who was admitted for anemia secondary to severe malaria. On admission, her PCV was 17%. She was placed on an antimalarial drug and also received a unit of compatible blood. Her PCV rose to 20%. She became clinically stable and was even playing around the pediatric ward. She was scheduled for discharge. But Dr. James who just returned from his annual leave felt that she shouldn’t go home with a PCV of 20%. He decided to transfuse another unit of compatible blood. Unfortunately, she developed a transfusion reaction and spent an additional 6 days in the hospital consuming resources that should have been used on other patients!

We can deduce 3 reasons for excessive processing from Jummai’s story.

• ·        The employee may not really know what the exact standard of his work is going to be. For example, when is the right time to discharge a patient? Sometimes, doctors working in the same facility may disagree on the discharge date for patients under their care.
• ·        The internal standards used to determine quality may not reflect the true patient requirements. From the above case, Jummai’s PCV level alone was not a good indicator to determine her fitness for discharge or continual hospital stay.
• ·        Over processing may be a re-bound effect of rework (re-admission). Dr James may have had a previous experience where he had to re-admit a similar patient after discharge. Therefore to prevent re-work, he may have ended up over-processing.

An algorithm can be used to eliminate over processing. Here’s how it works:

• ·        Set clear standards (for any process) that reflect the actual patient requirement e.g. set parameters that if achieved by the patient will lead to discharge. The setting of standards involves the development of algorithms or protocols for certain situations.
• ·        Involve operational staff, unit leaders and top management in the development of algorithms.
• ·        Review every aspect of your hospital process to identify areas of excessive processing and remove such activities.
• ·        Ensure regular supervision of hospital personnel to ensure that they adhere to the hospital standards of performance.

Overcoming The Limitations of Private Practice in the Developing World

Private Medical Practice or simply Private Practice is defined as healthcare and medicine provided by entities other than the Government. Medical services in any country can be provided by:

·        Government

·        Non-Governmental/Not-for-profit organizations

·        Private (for-profit) Organizations

Private Practice falls into the third category. Private Practice involves the provision of medical services by an individual or group of individuals to the citizenry with the aim of meeting their health needs while maximizing Owner’s wealth in the process.

Despite the inherent potentials of private practice in the developing world, several factors have limited its growth.

1.     Inadequate Regulations:

I personally believe that this is the greatest problem plaguing the private sector in Nigeria and other developing nations. Most private hospitals do not meet minimum standards of practice because the regulatory bodies have been unable to perform their duties. Though there is an improvement in regulations in many of the urban areas, most rural areas are still poorly regulated. As a result of inadequate regulations, many patients are forced to receive poor health services in substandard facilities at the risk of their lives. 

The solution to this anomaly is quite obvious. There should be better regulation and supervision of health facilities by the relevant bodies across the urban and rural areas. This will ensure that only qualified personnel are allowed to man well equipped hospitals.

2.     Low Capital Base:

The private sector usually struggles with funding.  Many Hospital entrepreneurs fund their hospitals from personal savings and operate on a shoe string budget as shown above. This provides a small initial start-up capital for many private hospitals making it difficult for the proprietor to provide basic facilities or to improve on current standards. This low capital base also makes it difficult for private practitioners to employ qualified and experienced personnel.

To overcome this limitation, entrepreneurs and investors in developing countries should be encouraged to invest in the health sector. Banks and other financial institutions can also provide long-term funding to doctors who are willing to go into private practice.

3.     Poor Infrastructure and Equipment:

Infrastructure is often inadequate in private facilities. Key equipments may also be lacking. This poses a setback to the operations of private practitioners. It is hoped that with the infusion of more capital, the health sector can also overcome this limitation.

4.     Low Staff Quality:

Hospital personnel in private practice are often of poor quality. Most do not have proper training to fulfill their role in healthcare delivery. This is because Public hospitals pay higher wages and qualified personnel will naturally work for higher wages. This leaves only poorly trained and unqualified personnel for the private hospitals to choose from. 

Solving this problem may lie in the formation of larger hospitals by two or more doctors of like minds. These larger hospitals will have more resources and may be able to compete favorably with government facilities in the labor market.

On a final note, the limitations listed above can actually be overcome if physicians look towards Group Practice and Partnership. The present trend of sole proprietorship has being a setback to private healthcare development in Africa. It is time for physicians to put aside their egos and come together to form partnerships that will provide quality healthcare to the populace.

5 Important Factors to Consider Before You Open a Hospital In a Suburban Area (Part 2)

In this post, we will consider the 3 remaining factors in opening a hospital in a suburban area.

• Scope and Quality of Services

The scope of services spells out what you plan to do and what you plan not to do. It defines the services that will be offered to clients. It covers the range of competencies or skills you intend to put on display. To be successful, you should define the scope of service you are going to offer.

In defining your scope, ask yourself these questions; what skills do I have or intend to provide to the community? What services are already available in the community? Do I plan to improve on existing services, innovate or create something entirely different? What do the people really need? How will I differentiate my business from others already in existence?

Honest answers to these questions will help you define your scope. You will also be able to differentiate your services which will give you a comparative advantage over existing competitors. This makes your hospital distinct and attracts clients to try out your service for the first time.

When they do come, it is important to make a positive first impression to keep them coming back. This is where quality comes in to play.  Quality is the ability to provide service of the highest and finest standard at all times. 

Cost of Services

Many developing countries lack social security safety nets like health insurance; especially among the millions in the informal sector living in suburban areas. The cost of your services is therefore a decisive factor in determining patient turn out. Too low prices may be unprofitable. Too high prices may also be prohibitive and limit the patient inflow. Prices must therefore be set at an affordable rate for the majority of people. Though prices can be used to differentiate your services, it is wiser to remember that a suburban area has many residents who may not afford high prices.

The good news is many government workers also live in suburban areas and commute to the city daily. The uptake of health insurance among this group of residents is probably over 95%. In addition, there is a renewed drive by the government of developing nations to increase the uptake of health insurance among those in the informal sector. It will therefore be necessary for you to get your hospital registered with the National Health Insurance Scheme in your country. This gives you a steady flow of monthly income (called capitation) irrespective of patient turn out. What you need to do is to ensure as many patients as possible choose your hospital as their healthcare provider.

In addition, there are a few private sector individuals living in suburban areas who can afford their health bills. The bad news is many of them will rather go to bigger cities for health care because they erroneously believe that bigger cities have better doctors and better facilities. 

I recall an incidence I had while in Medical School. My Mum had a gynecological condition that required her to undergo an Examination under Anesthesia (EUA). I discussed with a friendly Gynecologist who had over 25 years experience behind him. But her elder sister (my aunt) would have none of it. Though, my school was located in a big city, her elder sister was a Chief Nursing Officer in a bigger city and felt her hospital could provide a better service. She requested that my Mum be taken to Lagos for an EUA!! Finally, I had my way and the helpful Consultant performed the procedure. I have seen this same scenario play out over and over again. Some patients always feel that because a city is bigger, it will have better health facilities than a suburban area. Though, there may be some truth in this belief, it is not always the case.

The question facing you is how to offer services at a cost that such people can appreciate and yet others can afford. You shouldn't be too cheap else they will think you are not giving them the best. In my opinion, this may be resolved in 3 ways.

a.  .   Define your target market and stick to it. Who would you rather cater to? The few private individuals or the many government workers and informal artisans?

b..    Do a market survey when developing your business plan. This will give you an idea of what your target patients will pay for particular services. Then look at the cost of providing that service. After which you can fix a price that may be acceptable to the majority of residents.

c.  .   Hire an advertising agency to help you brand your hospital. Create a brand for your hospital. Be known for something; Starbucks is known for good coffee, Google is known for search engines, Coca-cola is known for quality soft drinks. What will you be known for? Don’t forget that there is a chance that clients outside the suburban area may also access your services if you have a good brand.

Skill set

Finally, ask yourself the following questions. What skills do you possess? Can you provide the services you are promising to offer? Are you going to employ someone with the skills you intend to use? Though, you certainly cannot provide all the skills you need to function, but it is wise that you have training and certification in the core services of your business. This is because human beings are unreliable and the labor turnover rate in small scale hospitals in suburban Africa is quite high. You should therefore train to be a ready back up if for example, the Sonologist goes AWOL for two weeks.

Establishing a hospital in a suburban area can be a risky venture but the dividend is worth the risk. It is a venture worth getting into.

Best of Luck!!

5 Important Factors to Consider Before You Open a Hospital in a Suburban Area (Part 1)

Being a hospital entrepreneur is a bold step. Being a hospital entrepreneur in a sub-urban area even requires more boldness. A suburban area is a district or residential area at the edge of a large town or city. In many developed countries, suburban areas are well planned, residential and not as densely populated as central cities. Whereas in developing countries, suburban areas are typically unplanned, overcrowded and lack many basic facilities. An example of a suburban area is Nyanyan, a settlement close to Abuja, the Nigerian capital.

Being an entrepreneur requires confidence, skills, money and raw guts. In every business venture, there is always the fear of failure. But it should be noted that an entrepreneur’s boldness is not the absence of fear. Rather, it is the ability to move forward in spite of fear. Every business owner must find a way to channel the negative energy from fear into creating a positive drive towards business success. This drive ensures that the business thrives for years to come and even outlives the owner.

The first step to commencing business is to have a business plan. A business plan is a written document that outlines all your thoughts and plans for your business. It is like a cookbook that shows what you intend to do, how you intend to do it, who you will employ to do it, where you will locate your business and how you will finance your operations.

 Apart from the business plan, there are several practical factors you must focus on when planning to start a service-oriented business (like a hospital) in a suburban area. These factors can make the difference between success and failure. They are:

• ·        Your Location
• ·        The Customers
• ·        The Scope and Quality of your Services
• ·        The Cost of your Services
• ·        The Skill Set of the Entrepreneur

• Location

The location of any business is important; especially when you plan to operate in a suburban area. Sub-urban areas are characterized by a less complex road network than central cities. The major roads are usually very popular and are well travelled on a daily basis by most residents. As a result, businesses that are located along or close to these roads are usually well patronized. You must therefore avoid locating your business in ‘back end’ streets. Go for a location that is central, accessible and has high daily commuter traffic. This will make your hospital highly visible to the public and hopefully highly patronized.

In addition to location, the ambiance of your hospital is also important. This includes the atmosphere, the building(s), the grounds, the dressing and the attitude of employees. Patients will not usually see the product you offer since health is intangible. The ambiance is therefore a way for you to display your competence. Most people will rather visit a neat, upscale and trendy building manned by smartly dressed workers than a dirty, shabby and old looking building.

• Customers

Residents of suburban areas are mostly government workers, small scale business people, artisans in the informal sector and a few well paid private workers. It is worthwhile to always remember that a business cannot cater to every type of customer or service every niche in the market. For example, I once tried to hire a well-known Inter-city transport company to run intra campus shuttle services with their older buses. But the manager said something like ‘you can only make a significant mark on a hard surface when you consistently aim at one spot’.

 In other words, to make an impact in business, you require dogged and consistent focus on specific goals. You have to be focused and decide on your target market at the onset. Though, this may change with time because business is dynamic, but for starters, decide who you will cater for. A clear definition of your target market will streamline your thinking and help you make concise decisions on how you will attract them to your facility.

To be continued.......

WHAT DO GREAT BUSINESS LEADERS HAVE THAT THE REST OF US DONT? (Part 1)

Bill Gates who was recently named by Forbes Magazine as the richest man on planet Earth is a well known Leader in the Business World. Though I certainly cannot claim to have his level of experience or to have achieved the success he currently enjoys, I can confidently say that I have led a few people in my time. As a little known hospital administrator in 2003, I led a hospital from being a sub-standard facility with a bed occupancy rate of less than 50% to becoming a quality facility with a bed occupancy rate of over 85% in just 5 years and 96% in 10 years. In addition, the bed space rose from 10 to 35 in the 10 years I spent there.

 Having studied the likes of Bill Gates, Richard Branson, Aliko Dangote (Africa’s richest man) and others, I have come to this conclusion: whether you are a Leader of two, ten or a thousand, you need the same traits to be great and successful at what you do. It’s time to know some of them:

• ·        Passion

In medicine as well as in other professions, passion is needed to succeed. Passion is an intense enthusiasm that keeps you firing your throttle at full capacity even when you feel blue. CEO Mark Parker has been with Nike for over 30years. It takes passion to work at the same job for 30 years. No wonder he was named CEO in 2006. In 2013, his company was named the most innovative firm in the USA. A great leader must be passionate about his/her tasks because passion breeds commitment. And commitment will keep you dedicated and devoted to a cause. Passion is what will keep you going when sales are poor and competitors are closing shop. Passion is what will make you get up in the morning to go to work even when it’s a public holiday.

• ·        Determination

People like Bill Gates have an uncanny attitude to always succeed. One executive told the story of how he had beaten Bill Gates in a computer game 35 out of 37 times. They didn’t meet again until a month later. When they eventually met, Bill Gates beat him or tied with him on every single game they played from then on. He had spent one month studying the game so he could beat his opponent! That is determination. Great Leaders are always determined to see things work out. A great Leader should have a firmness of purpose and be ready to follow through on plans of action.

• ·        Guts

It is near impossible to have determination without having guts or courage. Every business involves risk taking. There are always periods of fear and uncertainty in life. Great Leaders have the guts to dare the seemingly impossible and do the unthinkable. Guts will stand you out from the crowd. Bill Gates had the guts to drop out of Harvard (!!!!) in 1975 to start a Computer Software Company with his friend, Paul Allen. Today, Gates is worth over $79.2 billion (according to the BBC).

• ·        Patience

There is a waiting period or gestation period for everything. For example, a computer must finish booting before it can be used. A great leader is one who is patient with self, people and processes. A great leader is wise enough to know when to be forceful and when to be calm. Every plan needs time to mature. A great leader must therefore learn to be patient. Aliko Dangote took a loan of N200, 000 (about $1000 today) from his uncle to start a business in 1977. In 2008 he was quoted as saying “I built a conglomerate and emerged the richest black man in the world….but it didn't happen overnight”. He was patient. Learn patience, it is a very important business virtue.

• ·        Vision

Vision is the ability to see into the future and decide where you want your organization to be. Great Leaders are visionary because they don’t only think outside the box, but they sometimes think with no box at all. When Bill Gates started Microsoft, people thought he was insane. Today, that “insane” vision is yielding billions of dollars yearly. When Richard Branson wanted to start Virgin Air, he wrote “my interests in life were from setting for myself huge apparently unachievable challenges and trying to rise above them”.

So, wanna be a great leader?

It’s time to develop passion; be determined to succeed; have the guts to do the impossible; apply patience when needed; and develop a vision beyond your competitors!

What do you think it takes to be a great leader? Share your thoughts……

4 WAYS OF ACHIEVING HOSPITAL GROWTH AND DEVELOPMENT

Growth is the process of being more mature. Growth can also be described as an increase in number, power, intensity and size. Development on the other hand is the process of change that enables growth to occur. Hospital growth is therefore the process of making your hospital larger, bigger and better through effecting necessary internal and external changes. There are four (4) major things you must consider before you decide to grow your hospital. 

Do you have the right people, the right processes and adequate controls to handle growth? Also, are you, the Hospital Entrepreneur ready to grow? You cannot grow your hospital without personal growth and development. You cannot grow beyond the level of your people, processes and control systems. So putting the right people, processes and controls in place will help you achieve and sustain growth. It will be foolhardy to buy a phototherapy unit when your facility lacks employees with the requisite skills to operate it. In addition, you must embrace continuous learning in order to grow. Thank goodness for the CPD courses introduced some years ago!

Hospital growth can be achieved in four ways:

·     1    Improvement

This means improving your processes, people and product (healthcare service). This is done through regular training of employees, as well as the formulation and implementation of relevant hospital policies.

·  2       Expansion

Through scaling or expansion i.e. doing what you are doing presently on a larger scale. For example, the hospital management could decide to build an additional ward or theatre. But note that you must have the right people and processes to manage the expansion.

Expansion can also be achieved by increasing your market share in a particular patient segment. For instance, an obstetrician/gynecologist may decide to go into the IVF market by adding IVF services to his/her current practice. One question to ask before embarking on expansion is “do we possess the necessary people with the required skills to pull this off?” This makes up your core competence. Your core competence gives you a competitive advantage over other facilities.

·  3       Innovation

Innovation is doing something really new or different for you. It means thinking outside the box or adapting something from a different industry into your practice. Innovation also means being creative. You could introduce innovation into your hospital processes by changing the way things were being done. Put on your thinking cap and get creative! Customers love seeing new things.

·     4    Acquisition

This is the act of obtaining something i.e. buying into/over another hospital or clinic. Again, before going ahead to acquire another facility, ask yourself if you have the right processes, people and controls to pull it off. Also, are adequate resources available?  What is the risk-benefit analysis?

After looking at your present hospital structure you may decide to adopt any of the four ways to move to the next level. Each method of growth carries inherent risks as well as enormous benefits.

Furthermore, there are five Hospital Growth tips you should consider:

·         Pace

When trying to grow your hospital, learn to pace things. Pace growth so that people, processes and controls can catch up with you. Just like a toddler learning to walk, don't take big steps at one time. Rather, take little steps on a consistent basis. That way, you will not outpace your people, processes and controls. Growth can be a stressful time for both management and employees, so go gently.

·         Focus

Have a strategic focus and don't try to do everything at the same time. Do more of what you do well. For example, if you are a good surgeon focus more on that. With time, you will develop a reputation for yourself that will invariably lead to increased patronage.

·         Culture

What are your values? Your values help to shape your organizational culture. Culture defines your habits and the way of doing things in your facility. Develop a good organizational culture and teach your people. Your culture may be a culture of excellence or a culture of promptness. Whatever it is, let your people know. Then, match growth with your culture because too much growth can dilute your organizational culture. I.e. if you bring in new people, they must imbibe your culture or else they will dilute it with their own practices.

·         Learn

Learn from your mistakes. A success is an ex-failure! A mistake in a thing makes you know one way of not doing that thing. When you notice something isn't working, stop doing it and try something else. Also, learn from people around you. Learn something beneficial from a different industry and transfer it to your business. That is a form of innovation.

• Collaboration

Finally, get your employees involved in the planning process. They are the ones at the front line of patient care. In addition, they are the ones to implement the decisions taken to create growth. It is therefore important that they understand the vision and how to achieve it.

Have a great week ahead.