Small Business Blog

Archive for October, 2009

CMS suggests that the cost of a single surgical site infection represents between $63,000 and $180,000.  If one were to average the results of the four hospitals in high-income countries as reported in the NEJM article, implementation of this simple and mundane protocol represents two less infections per 1000 surgeries.  Now do the same math for other complications such as retained foreign objects ($63,000), or infection after CABG ($299,000) and the picture is quite compelling.  In today’s austere financial climate doing the right thing is also good business.

“Regardless of whether it’s a “bundle,“ a checklist, or a protocol, not every healthcare facility that tries to implement these standardized practices succeeds, and they seem very surprised when they don’t.”

Checklists often appear intuitively easy – in fact many of us used two common checklists as we prepared to feast during the holiday season.  A grocery list is a great example of a “read-and-verify” checklist, while a recipe is a “read-and-do” checklist.  If you want to ensure that your meal will be a success, and save time and money by avoiding additional trips to the store, you use the checklists. 

Using a checklist makes sense beyond the kitchen and many clinicians have learned over time to make their own checklist.  Whether it’s a surgeon triple checking that she has the correct lens for the correct patient, or the nurse ensuring that all meds are administered to the patient on time, various informal checklists are used every day in hospitals across the country.  With such obvious face validity, success should be simple: just find one that works somewhere else, make it policy that it be used, drop it off in the OR, and watch outcomes improve. If only it were that easy.

LifeWings Partners, LLC has been helping innovative healthcare organizations implement standardized processes for ten years.  In our work from New York to California, we’ve learned some very important lessons about successfully implementing standardized, evidence-based, high reliability processes.  Here are ten important lessons you shouldn’t ignore, and while they’re written for checklists they apply to any standardized process:

Everyone’s responsible: Compliance is a team issue and anyone on the team from the newest OR tech to the most seasoned surgeon is responsible to hold all other team members accountable for the proper use of the tool they created and collectively agreed to use.  Given that there is joint responsibility, successful implementation requires a strong endorsement, or better yet a mandate, from leadership, MEC, and others.

Someone’s responsible: There must be one member of the OR team who is ultimately responsible for completion of the checklist.  This person must be empowered to “stop the line,” and held accountable for doing so, until the checklist is properly completed.

Physicians must lead: Aside from patients, physicians have the most to gain from the correct use of a checklist and their behavior sets the tone for the OR. Yes, getting physician buy-in is hard work – sometimes even painful. It can be done. The secret is good data, constant communication, an appeal to what matters most to physicians (their patients’ well being), and strong leadership.

Physician leadership must demand that physicians lead: It’s so important that it deserves mentioning again.  Medical staff really can’t “sit this one out.”

Make it organic: “Drop In” checklists never work. There’s no buy-in or investment in its success. The people that will actually use the checklist must understand the clinical need, and then create, or modify, the tool that facilitates the work here. The World Health Organization agrees, advising “The checklist is not intended to be comprehensive.  Additions and modifications to fit local practice are encouraged.”  There are no shortcuts on this step, and all disciplines must be involved in thoughtful dialogue about what will keep the patient safe.

Persistence required: Checklists are NEVER perfect the first time they are used. The clinical team must know going into the checklist building process that it is an iterative process.  This process is sometimes known as “kaizen,” a) adopt a standard for the work, b) adhere to the standard, c) continually refine the standard, and d) repeat steps a, b, and c endlessly.

Design matters: In fact, it is extremely important if you want your checklist to be used consistently and reliably. The checklist should be: a) Simple and intuitive to use; b) Easy to see and to read, using the fonts and font sizes consistent with the best science on the design of checklists; c) Inclusive of amplifying information (expanded checklist) to clearly define expectations and roles; and d) Designed to minimize distraction from clinical priorities.

Adopt a culture of discipline: Even the perfectly constructed checklist imposes nothing – it is just a tool designed to “hardwire” the right behaviors at the right time, making it easy to do the right thing and hard to make a mistake.  A checklist doesn’t impose discipline, rather it flourishes in a leadership environment where compliance is rewarded and non-compliance is promptly addressed with coaching and significant negative consequences for continued non-compliance. Implementing a checklist without the proper leadership actions is a futile and frustrating experience.

A paradigm shift: Many professionals think that a checklist is “good for those who need it.”  This mindset springs from the idea that “a medical error hasn’t happened to me (because I’m really good, and very careful), so it can never happen to me.” A safer mindset is that “Use of a checklist is the hallmark of a true professional.” Unfailing use of well-designed checklist becomes part of your personal ethos and to skip the use of this valuable tool would be unthinkable – just as failing to scrub your hands prior to surgery would be unthinkable in the modern era.  The motivation for use is intrinsic, not extrinsic.  To put things in perspective, imagine that you were sitting on an airplane and the pilot said, “Ladies and gentlemen, I’m Captain Smith and I’ve been flying airplanes for 27 years without an accident.  Today I’ve decided that I don’t need to use the checklist because I’m very good, and very careful.”  What would you feel?  What would you do?  As a professional pilot with twenty-seven years of accident-free flying I would urge you to get up out of your seat, calmly collect your belongings, and walk off the airplane!

The time is now: There’s never a convenient time to implement a new process.  The excuses, and costs to patients (preventable morbidity and mortality), for delaying implementation are increasingly unacceptable.  Plan, educate, create, and implement… then do the hard work of following through with continuous measurement, refinement, and improvement.

Change is never easy. The cost of not changing is too dear.  Margaret Meade provides us this assurance: “Never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it’s the only thing that ever has.”

If you’re fed up with looking for legitimate internet business ideas and home based business opportunities, don’t give up just yet! There are many internet business ideas and options that do pay well, but many people simply give up after learning they need to put in some time and effort to get them started. The internet has made it easy for anyone to build a valuable home business, but few people have the marketing savvy and knowledge to make their dreams of working from home come true. The key to success online is choosing the right internet business ideas and making sure you know how to work each system to your advantage. Here are just a few of the top internet business ideas that actually pay, and pay well when you work hard to build your own entrepreneurial venture:

Paid Surveys

Hundreds of companies around the world are offering top dollar for people to complete market research surveys and submit them on time. While many companies have turned out to be scams, others do offer a legitimate work at home business opportunity; knowing which ones to join is the first step to your success, and you can generate a lucrative part-time income after you learn which companies to work for. A few of the popular companies in the U.S. and Canada include Survey Club, TheNetPanel, and Global Survey Group. All of these are free to join , and offer variations of cash, gift cards, coupons, and discounts depending on the type of survey you complete and your level of activity.

eBay Businesses

Launching an eBay business has become a popular way to make money, and you don’t even need to stock inventory in order to start generating an income! You can become an eBay reseller where you sell products on behalf of a company in the form of an affiliate program, but you also have an option to set up your own online store where you buy and ship products. eBay businesses are quickly becoming a lucrative home business opportunity for many people, and all you need to get started is an eBay ID and seller’s account.

Resale Products Sites

Resale products can take the form of digital products and information, giving you a chance to promote and build a profitable online store without stocking inventory at all. These types of internet business opportunities help you build generate income by earning a commission on sales; you can choose the different types of products to sell on your site, and focus on marketing and promoting them in order to complete the sale.

Affiliate Programs

Affiliate programs can be a highly lucrative internet business opportunity because they can lead to a residual income with less and less effort over time. If you are involved with an affiliate MLM program, you’ll start to generate revenue each time someone else joins your down line. This can be a very effective way to build an online business, and is quickly becoming a popular choice for many people who dream of working from home.

From paid surveys to resale product sites, there are many ways to build a profitable online business in a few short months. With hundreds upon thousands of internet business ideas to choose from, it can be challenging to find the right match. Take the time to explore one or a few different home based business opportunities, so you are investing your time and energy in the right venture.

1. Living Funds – Unless you are one of the very lucky few, your business will not be profitable from the word go. Remember, it took even mighty Google a couple years to even find funding to make a serious effort at becoming an Internet giant. How much money do you have set aside for living expenses? Six months to a year is a good range if you will be working full time on your new business.

2. Time – Running your own business can be incredibly rewarding. That being said, it is going to take a lot of your time. Do you have a family? Kids? Other time obligations? You can expect to spend 10 to 12 hours a day during the first year getting up and running, so make sure you have the wiggle room to handle it.

3. Business Form – When starting out, you need to determine what form your business will take. Will it be a corporation, limited liability company or just a sole proprietor. The decision is primarily one of risk. The bigger the chance of getting sued, the more you should consider undertaking the expense of a corporation or limited liability company.

4. Taxes – Uncle Sam wants and gets his money. Every business plan needs to account for tax issues. You might live in a state that has a favorable tax climate for business, but then again you may not. Some of the best money you can spend when starting out is to find a good accountant. They can save you a bundle. The best accountant is a proactive one. By proactive, I mean they work with you to put together plans on how to save on your taxes at the beginning of each year. Find one and spend the time to get it right.

5. Passion vs Profit – People are often looking for the “best” business idea. This is a mistake. The best business idea is the one you are very interested in. If you love fishing, start a business that has something to do with fishing. You should generally avoid starting a business because you think you can make a lot of money. It is going to take a ton of work, so go with something you are passionate about so you can get through the tough times.

If you take these factors into account, you will be well ahead of many people that start their own businesses. Find something you are passionate about, be prepared and your chances of success will be much better.

If you’re a business professional and you’re ready to try something new, think about writing a business book. Writing a book about your expertise in a specific industry or even business in general is an excellent way to expand your business and branch out into speaking and consulting. It lets you try something new, but you don’t have to completely abandon the field you’re in.

The Booming How-To Market

How-to books are very popular—there’s always one or two on the bestseller list—and many people like reading books to learn more about their own industry, learn about industries that are new to them, find ways to advance their careers, and figure out how to deal with difficult business situations, like having a boss or a co-worker that they don’t get along with. Some people read nothing but how-to and self-help books. With thousands of topics to write about and a growing interest in self-improvement, your possibilities are endless!

Modern Printing Technology Makes Publishing Easy

In the past, publishing your own business book was expensive and time consuming because getting book ready to print and finding a reliable, inexpensive printer required lots of research and work. Plus, self-publishers had to guess how many copies they were going to need.

But these days you can offer print-on-demand copies of your book, which means the book isn’t printed until someone buys it. Or you can offer your business book in a downloadable PDF format so that printing costs are avoided altogether and people can start reading your book immediately after buying it.

Get Industry-Specific

If you have years of experience in one particular industry, then you can write a business book that describes the steps that you took to be successful in that industry and the mistakes you learned from along the way. You can help people who are just starting out to overcome the learning curve, and learn how to follow your steps themselves so that they can achieve the same kind of success that you did.

Plus, many companies looking for ways to save money use well-written industry-specific business books as training materials. You could even offer to customize certain parts of your business book to meet the specific needs of a company if they buy a set number of books.

Writing a Book is Easier Than You Think

The writing task is often overwhelming to people, but you can start small. Books don’t have to be extremely long to be popular. You can write a short, fifty- to 100-page e-book about some aspect of business that you have a lot of experience in and test the market by selling it directly on the web. You can also use an e-book format to write business books for specific businesses, like training manuals or other how-to books or guides.

What Are You Waiting For?

Writing a book not only allows you to try something new, but if you are creative in how you write the book and how you market the book, the venture can be very profitable. If you’re ready to move on and try a different career but you don’t want to start over in a new industry, take the experience and credentials that you have and try writing about that industry instead of just participating in it. You will get a chance to branch out, do something different, and still use all the years of experience that you have built up.

Although you probably do a lot for your business advertising, you might want to look at other options. It is always good to branch out. You can check around and see what else you might be able to do to reach other areas of the population.

If you are attempting to build up some recognition for your business then you need to get some communication or rapport going with your current and possible customers. To do this easily you can get people used to your logo through repetition. Big companies with deep pockets can use the TV and ads to do this. With a smaller budget you can do the same thing through the use of promotional products.

When you do advertise you have to think about the message that you use. You are putting out promotional items all over the place, but what are they saying about your company. If you are only putting your logo or business name on your products you want to make sure that they give just a bit of info. If your business name makes sense and explains what the business is then you are good. But when you have a cute or funky name it might not explain itself enough. You might need to add a little more info.

Is it bold or unique in some way? Remember the purpose behind advertising is to catch people’s attention, and so the more unique looking promotional products and other advertisements are, the more notable they will be. Make your message something that they can’t miss and it will send them right to your door.

Business advertising needs to be unique, intriguing and frequent to get the job done. Take your business advertising to the next level and start creating a stir about your business.

Cash register? Check. Employees? Check. Zip Ties? Wait a second. Zip ties were not on the small business checklist. Until now.

Many small business owners are already using zip ties to bundle cords and cables in their stores or home offices. But zip ties have a myriad of uses, offering convenience and affordability in the pursuit of the American dream.

Dry Cleaners

Multiple pieces from the same customer can be secured with a simple zip tie. Cleaners can keep their racks organized and customers can avoid misplacing an item. An extra dose of customer service will keep a store a cut above the rest.

Jewelers

Necklaces, rings, and other accessories are easily fastened to their tags through the use of a zip tie. Lock the tie on the back of the tag. Then cut the excess tie to help display the product with a crisp, sharp presentation.

Florists and Vineyards

Some plants need a little help while they grow. Orchids, grapevines, and the like can be attached to sturdy apparatuses with zip ties. Effective yet inconspicuous, zip ties allow the plant be the main event.

Retail Store Owners

Zip ties make excellent fasteners to hang signs announcing a sale or other announcement. The marvelously robust zip ties aren’t going anywhere soon and neither will store signs.

Farmers

Connecting stall mats, constructing wire chicken cages, bundling tools – the possibilities are endless for the working farm. Zip ties can be used to temporarily replace broken lock on a gate or while preparing loads for the farmers market.

Zip Ties, while humble in appearance and simple in function, are remarkable gizmos that can save small business owners time and money.