City of Paris

This past Sunday was the first day of the Year of the Tiger. I thought I’d dust off my Sun Tzu strategy books in honor of the occasion and share some of the well-quoted principles that seem relevant to management issues today—particularly concerning people and motivation.

• People make things happen. And so business enterprises must be centered on people, and business leaders’ preoccupation is to mobilize the workforce to take action by motivating them. Central to this is the notion that when you have an empowered workforce, your opponents will defeat themselves—meaning that your team will be so strong that success will come naturally.
• Timing is everything. This begins with an inner calm, a focus and sense of purpose, which is conducive to a deliberate assessment of the surroundings and the patience to wait for the opportunity to take action, such as striking when competition least expects it, or knowing when to temper an overzealous team or energize a deflated one.
• Go with the flow. Just as the ancient military strategists stopped at a body of water and studied the ebb and flow to come up with a game plan, today’s managers need to harness the forces driving workers and customers to achieve behavioral changes with the least effort. And knowing yourself as well as you know your competition is the key to survival.

There are lots of reference sources on this celebrated ancient Chinese general, including Wikipedia pages. Sun Tzu’s Art of War is available for download for free. Or you can get relatively inexpensive bound volumes.

I was catching up with an old friend and telling her about my clients on the East Coast, in the Midwest and in Southern California. Then I explained how I work with my team—none of whom “reports” to work at my office. When I read the Financial Times interview with Professor Lynda Gratton of London Business School, who talked about the future of work, it all came together for me. Mine is a consultant’s view. People in the corporate environment no doubt will experience it in other dimensions and with different nuances.

Post-geographic. There was a time when only road warriors crisscrossed the country and perhaps the world to conduct business. Now, as the Internet makes more and more communication options open to more of us, working across geographic regions is accessible to anyone with a computer and optionally a phone. Now, global teams can collaborate easily on a day-to-day basis, adding that much more efficiency to the workplace.

Cross-cultural. I like being able to touch base with my colleagues in Europe in the morning and switch to speaking Chinese in the evening. Living in California gives me the flexibility to do all of this without working extraordinary hours. It opens up a broader array of resources and talents I can tap into, as well as business opportunities, not to mention the rewards of variety and intellectual challenge.

Multidisciplinary. If we can transcend geography and time zones, surely we can begin to reach beyond our comfort zones. Marketing communication professionals are accustomed to working with strategic and creative disciplines. We have been good at tapping into research, media, medical and scientific resources. Now, we can and should begin to tap into specialties such as behavioral sciences and refine our approaches to influencing perception and adherence.

A balancing act. The Blackberry makes it difficult for us to duck emails, especially when they are coming in a steady stream from different time zones. For me, it means disciplining myself to carve out downtime, so that I can stay fresh and effective. Likewise, cyber contacts cannot replace the face-to-face interactions and personal relationships that are the basis for trust and collaboration, not to mention just “getting on the same page.” Good thing I do like travel.

Always integrated. I think flourishing in this new environment is about weaving together different cultures, disciplines and perspectives. That’s where we can derive synergy and generate fresh ideas. Otherwise, we’d simply be working longer hours in more places, and that would be a pity.

Treatment costs of tens of thousands of RMB (equivalent to thousands of U.S. dollars) are out of reach for most citizens in China, and the drugs used are not necessarily on the national formulary and therefore not reimbursed. This leaves patients and hospitals in a quandary, and spurs debates about which government entity (i.e., the Ministry of Health [MOH] or Social Security) should pay. In late January, the MOH announced an increase in the reimbursement limit for both service fees and medication while encouraging citizens with financial hardships to seek help from local government units.

The H1N1 epidemic is still active in China. During the week of January 11-17, the 31 reporting provinces had a total of 1,556 cases, resulting in 27 deaths and 348 hospitalizations. As the Chinese New Year approaches, the MOH is recommending that higher-risk groups (e.g., the elderly, pregnant women, infants) refrain from traveling during the holiday season.

Four months after the implementation of an appointment system for outpatient visits in 49 category III (large, tertiary care) hospitals in Beijing, it is estimated that 1.23 million patients (or 13 percent of the total) took advantage of the system. This level of utilization falls short of the Beijing Health Bureau’s goal of 40 percent utilization for repeat appointments, 100 percent for dental (81.3 percent, actual) and routine prenatal visits (57.8 percent, actual) and 60 percent for post-discharge checkups. The vast majority of patients still opted to show up at the hospital when medical care was needed, and 42 percent of those who did make appointments did so in person at the hospital.

Why are Chinese citizens slow to adopt the new appointment system?

• Not enough telephone lines and operators. A survey showed that busy signals and limited choices of dates and times were some of the reasons that about a third of those who attempted to make appointments by telephone were dissatisfied. Yet, hospitals are reluctant to invest in a call center because they have little trouble filling physicians’ schedules.
• Lack of available appointments with top specialists. With the lack of a primary care (gatekeeper) function in China, access to top specialists is based more on the patients’ prowess in securing appointments rather than clinical need. Since specialists are a scarce resource, many hospitals are reluctant to fill these specialists’ schedules by telephone.
• Lack of triage to direct patients to appropriate department. The appointment system does not accommodate patients who rely on coming to hospitals to find out which doctor they need to see. Some hospitals have started telephone services staffed by healthcare professionals to guide patients through the process.
• Lack of standardized rules. Some patients complain about the different rules imposed by individual departments and/or specialists. To encourage participation by all departments and physicians in the appointment system, some hospitals are implementing rules to penalize departments and individual physicians that schedule fewer than 50 percent of appointments in advance. Penalties are in the form of demerits and pay cuts.
• The resale market for appointments and Internet bookings. About 3 percent of appointments are made online, and often by people who are reselling the appointment to a true patient. A prepaid appointment that costs 15 RMB can be sold for 400 RMB or more.

Clearly, managing patient expectations is a top challenge for hospitals. Should patients expect to see the doctor they want to see within a week or a month? Is it reasonable to reserve some appointment slots for walk-in patients? How much waiting time is acceptable? The reality is that the appointment system cannot solve the fundamental issue: There are 1.78 million specialist appointments available, and 12 million patients competing for them. In other words, only one out of 67 patients seeking to see a specialist will actually secure an appointment. This goes back to the problem of the lack of a gatekeeper system, as well as the general public’s lack of information about how to seek appropriate care and their tendency to default to big-name doctors and specialists.

Hepatitis B carriers in China hailed the announcement by the Ministry of Health on December 31 that positive hepatitis B status would no longer be a barrier to schools and employment as a significant breakthrough. This announcement came four years after the publication of hepatitis B prevention and management guidelines, which stated that hepatitis B is not transmitted through general day-to-day contact such as handshakes, sharing of meals or use of public restrooms. On the Internet, 175,453 exuberant comments were immediately posted.

In January, the “Notice Regarding the Protection of Rights of Hepatitis B Surface Antigen Carriers to Education and Employment” was published for public comment. The policy statement eliminates routine pre-entry or pre-employment screening of the hepatitis B panel, which in China includes surface antigen, surface antibody, e antigen, e antibody and core antibody, except when explicitly permitted by the Ministry of Health based on justifications provided by the educational institution or employer. Alanine aminotransferase (ALT) testing for evaluating liver function is, however, permitted under this new policy. Abnormal results will trigger additional testing and medical intervention as needed. (Does this sound a little like a loophole?) Additionally, the policy includes a provision for protecting the privacy of those tested, as well as public education on the modes of transmission of hepatitis B. The policy paper was issued jointly by the Ministry of Human Resources and Social Security, Ministry of Education and Ministry of Health. The public was given a week (January 21-27) to comment by email. As of last week, a newspaper in southern China had published an editorial that pointed out some of the fallacies of this new policy. Referring to the privacy provision, the editorial suggested that protecting the rights of the infected might result in an environment that breeds suspicion and discomfort. It also suggested that the new policy diminishes the independence of institutions and their right to make their own policy decisions.