11th Ebola Outbreak 2020 - New & Total Cases

I started paying attention to the 11th Ebola outbreak in the DRC (Democratic Republic of Congo) digging for stats from headlines I could find.  I have been using the University of Minnesota Center for Infectious Disease Research & Policy data at https://www.cidrap.umn.edu/Node/64 since August which publishes every time a new case occurs (if errors identified please provide sources for correction).

I do not see a simple visual trend anywhere so again I created my own below.

Cases seem to have tapered off and hopefully will come to an end soon.

20200930 Ebola Outbreak 11.jpg

CEMEX’s Strategic Mix Business Turnaround:

Example how a commodity seller can become a solution provider growing market share.

CEMEX is one of the rare firms executing lean business strategy beyond the merger & acquisition stage.

Article here: https://www.strategy-business.com/article/00325

unedited notes, I HIGHLY recommend reading the article. Twice.

  • Also leveraged mergers & acquisitions including entering new businesses in ready-mix concrete and aggregates

Strategy

long track record in lean operations (“ruthless operating efficiency”) evolved to become one of the most successful companies from an emerging market, and developed a high level of customer responsiveness. It delivers cement within 20 minutes of receiving an order in many locales. Its international business strategy enabled CEMEX to grow rapidly during the 1990s and early 2000s, when it became one of the biggest cement companies in the world.

  • while maintaining consistently high profitability levels. (In 2014, the company reported US$2.7 billion EBITDA on revenues of $15.7 billion.)

 

get good at postmerger integration, and extract more value out of those assets than the former owners.

 

“Enforcing is really the right word. A good example is the emphasis we put on closing the books on the 1st or 2nd day of every month. A lot of managers initially wondered why it was so important to do this. They thought nothing would be lost if they did their closings on the seventh or eighth day. But we believed that having that information readily available would increase the likelihood that managers would make the right decisions. And the practice had a very high-level overseer: Mr. Zambrano himself, into whose email inbox all of these reports flowed. This was not subject to negotiation.”

 I have several key point & more notes, read the articles a few times and make your own

Calgary zone covid19 cases only to date August 30, 2020

As reported daily by Alberta Health. They finally responded to one of my questions on twitter about why there is so much of a difference between their daily published numbers and their trend chart. AHS replied “covid19AB cases may fluctuate between daily increases and net increases due to amendments and updates during investigations; this can include transferring out of province cases and resolving the status of probable cases.”

I asked if this means the daily reported #’s are what was identified in Alberta that day, and if Alberta Health is updating for residents testing positive out of province, and subtracting people visiting AB that test positive here, and have heard nothing for 10 days.

Still waiting on responses to my other questions from months ago as well, not expecting a response to them either.

Trend charts based on AHS daily #’s:

20200830 Calgary zone covid19 cases.jpg

Calgary zone TOTAL Confirmed cases to date

20200830 Calgary zone covid19 NEW cases only.jpg

Calgary zone covid19 NEW cases to date

20200830 Calgary zone covid19 ACTIVE cases only.jpg

Calgary zone ACTIVE cases to date

Senior Management's Willingness Determines Success or Failure

Michael Balle is an excellent resource to learn from:

“Lean systems are really about establishing the conditions for learning - this is the key to a deeper understanding of lean.”

“From a leadership point of view this requires balancing the focus between today (solve problems now or you won’t have a tomorrow) and tomorrow (worry about the next product or you won’t have a tomorrow either). This never is simple and, again, can be learned only through experience.”

“In the end, the success or failure of any serious effort hinges on THE WILLINGNESS OF” senior executives “TO ADOPT revolutionary…”

great comment also: “people confuse a system to produce value more efficiently with a system to add value: continuously develop people to find better ways”

Lead with Lean page.jpg

check out his online content and book

management values to live by

Business management values to live by:
- Customer satisfaction over company internal interests
- Problems are learning opportunities, not occasions for blame
- Shorter lead-times are better than longer ones
- Teamwork over individual heroes
- Fixing problems as they occur over working first and fixing later

Full article: Michael Ballé identifies a set of lean management values to live by

https://planet-lean.com/michael-balle-identifies-a-set-of-lean-management-values-to-live-by

Lean Thinking in Sports - NFL

I’ve shared several examples of lean thinking in sports previously to help management & employees see how it applies everywhere.  (not sure if I’ve put any in the blog though, feel free to request)

 

Here’s a short example from someone else:

Lean Frontiers and Karl Swanke, former Green Bay Packers offensive lineman in the National Football League

 

“Nobody performs well enough on their own to overcome lack of teamwork."

https://leanfrontiers.com/kata-and-sport-a-winning-combination

Calgary zone covid19 case update to July 31, 2020

Calgary zone covid19 cases July 31.jpg

Confirmed cases still increasing however recent spike 2 weeks ago seems to have tapered.

Calgary zone covid19 NEW cases only July 31.jpg

Active cases increased for 2 weeks then decreased last week. Mandatory masks start Aug. 1st we’ll see if it has any impact.

Calgary zone covid19 ACTIVE cases only July 31.jpg

Still no proper response from Alberta Health on any questions I’ve asked, they just give me the same link over & over which lacks the information I requested; I also pointed out June 25 the trend chart does not match daily active & confirmed case numbers they published. Here’s the 1st example I sent them:

Alberta Health Reported numbers 2020-07-17.jpg

AHS published 5785 confirmed cases on July 17, the date of this screenshot.

Yet the July 22 trend chart reports

July 17 having 5883 cases.

What accounts for 98 case the difference?

Alberta Health Reported numbers 2020-07-22 1246.jpg
Alberta Health Reported numbers 2020-07-22 1250.jpg

They did not respond to this example. Here’s another: July 30 reports 6470 confirmed cases

20200730 1724 AHS Calgary zone covid19 reported #s.jpg

However the trend chart on August 2 shows a different number of cases on July 30, it says 6499.

20200731 Alberta Health Reported #s Calgary zone.jpg

What accounts for the 39 case difference?

I noticed the numbers are often different so I’ve done a few screen shot examples to have them account for the difference.

The World’s Cheapest Hospital Has to Get Even Cheaper.

Cancer surgery for $700, a heart bypass for $2,000.

This is particularly interesting to me as it is managed differently from lean healthcare and still profitable. I’m curious how adding an element of cross training to increase staff flexibility would affect it. For those who think lean is the answer, stay open minded, there may be much to learn here.

Points for my notes:

“A pulmonary thromboendarterectomy. in the U.S., the procedure can cost more than $200,000. Shetty did it for about $10,000 and turned a profit.”

“outcomes for patients meet or exceed international benchmarks. Surgery for head and neck cancers starts at $700.

Endoscopy is $14;

a lung transplant, $7,000.

a heart transplant will set a patient back only about $11,000.”

“investment bank Jefferies estimating that it can profitably offer some major surgeries for as little as half what domestic rivals charge.”

“In 10 years, India will become the first country in the world to dissociate health from affluence.
India will prove that the wealth of the nation has nothing to do with the quality of health care its citizens can enjoy.”

“he learned that the cause of their complications was simple:
The patients couldn’t afford the protein their bodies needed to mend.
So he began handing out hard-boiled eggs;”

“upskilling or task-shifting.”

“the average Narayana surgeon performs as many as 6 times more procedures annually than an American counterpart.”

“surgical gowns are procured from a local company for about a third of the cost of international suppliers.
The tubes that carry blood to heart-and-lung machines are sterilized and reused after each surgery; in the West, they’re thrown away.
The machines themselves, along with devices such as CT and MRI scanners, are used well past their warranties, kept running by a team of in-house mechanics.”

“Whereas preparing a U.S. surgical theater for the next patient can take 30 minutes or more, Narayana has gotten the process down to less than 15

  • this is some interesting SMED even if not via a rapid improvement practice, curious how they reached this and if efforts are continuous

“in part by keeping turnaround teams with fresh instruments, drapes, and other supplies on immediate standby, ready to roll the moment a room is available.
Even patients’ families are part of the upskilling model. Narayana trains them to bath patients and change bandages in the hospital, as they’ll do when they get home.”

  • this is excellent

"the retail cost of a heart bypass, its most common operation, down to $2,000, about 98% less than the U.S. average."

“mortality rates are comparable to or lower than those in the developed world, at least for some procedures.”

“also outperforms Western systems in results for valve replacements and heart-attack treatment”

“it may become a model not only for competitors in India but also for Western health-care operators, which are trying desperately to contain costs. Nowhere is this more true than the world’s most expensive health-care market, the U.S.”

  • has this healthcare been transplanted anywhere?

Full article link: https://www.bloomberg.com/news/features/2019-03-26/the-world-s-cheapest-hospital-has-to-get-even-cheaper

Covid19 Cases Jump in Calgary - July 20 update

Calgary zone covid19 cases Jul 20.jpg

Last weekend confirmed cases increased 104, +35/day average

This weekend confirmed cases increased 311, +103/day average, 199% higher than last weekend.

(For some reason AHS has stopped reporting weekend #’s also, so they’re averaged over the weekend)

Calgary zone covid19 ACTIVE cases only Jul 20.jpg

Active cases started climbing again July 10 when they had been steady around 228;

on Friday they were 385 and today (Monday) 553.

Calgary zone covid19 NEW cases only Jul 20.jpg

AHS reported #’s show new cases have jumped in Calgary zone from 75 during the week July 7-10 to 166 new cases during last week, a 121% increase.


Adopting Toyota Philosophy Saves Healthcare Business

link to article below

2001 startup Nurse Next Door (NND)

  • NND identified these processes through a customer survey that asked two questions:

  1. On a scale of one to 10, how would you rate our services?

  2. What is your biggest reason for giving us this score?

  • feedback helped NND recognize

  • many of its practices were a waste of effort "We used to think customers wanted our caregivers to show up in uniform" The company provided home-care staff with a uniform allowance, paid for cleaning the uniforms, and was about to draft policies governing the wearing of uniforms, as well as an enforcement protocol. "Then we found out our customers didn't care"

  • A bigger concern proved to be that the company's invoices were too confusing - a 45-minute fix that improved its customer satisfaction score by 20%.

http://www.vancouversun.com/life/adopting+toyota+philosophy+saves+healthcare+business/5633334/story.html

Corporate Strategy execution example

Pivoting Just-In-Time with Hoshin Kanri at Toyota

by Mark Reich

5/26/2020

a management system that allows the organization to quickly and effectively adjust its priorities while engaging the team

article here:

https://www.lean.org/common/display/?o=5248&utm_campaign=Hoshin%20Online&utm_content=130204140&utm_medium=social&utm_source=linkedin&hss_channel=lcp-91948

Dairy Farmer Decides to Bottle His Own Milk Rather than Dump It. Sells Out in Hours.

Great story, hoping more farmers & producers can do the same:

“a 300-year-old, cream-line dairy farm, where a farmer is working around the clock to bottle his own milk after his processor told him to dump it. Locals are lining up to support him.

full story here:

https://returntonow.net/2020/05/04/pennsylvania-dairy-farmer-decides-to-bottle-his-own-milk-rather-than-dump-it-sells-out-in-hours