Program Objectives
The following list represents the Key Program Objectives (KPO) for the Appleton Greene Clinical Process Improvement corporate training program.
Clinical Process Improvement – Part 1- Year 1
- Part 1 Month 1 Internal Analysis The first stage of the program is to understand the history, current position and future outlook relating to Clinical Process Improvement, not just for the organization as a whole, but for each individual department, including: customer service; e-business; finance; globalization; human resources; information technology; legal; management; marketing; production; education and logistics. This will be achieved by implementing a process within each department, enabling the head of that department to conduct a detailed and thorough internal analysis to establish the internal strengths and weaknesses and the external opportunities and threats in relation to Clinical Process Improvement and to establish a MOST analysis: Mission; Objectives; Strategies; Tasks, enabling them to be more proactive about the way in which they plan, develop, implement, manage and review (GSCD), within their department. These constitute general departments, which would be appropriate for the majority of healthcare service organizations, but clients can determine their own departments in order to ensure that the program specifically relates to their organization. For example, a typical hospital could incorporate the following 24 departments: Appointments Office/Central Booking; Accident & Emergency; Day Hospital; Day Procedure Unit; Endoscopy; Eye Centre; Hemodialysis Unit; Intensive Therapy Unit; Labor Suite; Physiotherapy; Radiology; Occupational Therapy; Out Patients – Ante Natal; Appliances; Audiology; Dental; Gynecology; Main Out Patient Department; Orthodontics; Orthopedics; Out Patient Department (Main); Podiatry (Chiropody); Physiological Measurement; Pain Clinic.. For the purpose of this workshop, we will retain the original 12 departments, unless individual clients specify otherwise.
- Part 1 Month 2 Select Project & Explain Reason Identify which area or department requires improvement. Is the customer care getting poor reviews? Identify the Key Performance Indicators that show there is an actual problem. For instance, the average handle time is too high in the last quarter compared to the average handle time and so on. Try to identify the reasons leading to poor performance. Remember everyone is involved in Kaizen, so you need to visit the call centre, meet the customer care representatives face to face and ask them to share the problems faced and reasons for unproductivity. You might come to know that with expansion of services, more manpower was needed but was not provided resulting in work pressure. Or they were not given proper training about the products and services resulting in confusion.
- Part 1 Month 3 Set Goals Based on the initial data you have collected, set goals for improvement. While setting goals, try adhering to the SMART model i.e. the goals should be Specific, Measurable, Achievable, Relevant, and Time Bound. For example, your goals could be to hire 50 new customer reps in a month, hold exhaustive training sessions twice a week and reduce average handle time from 5 minutes to 3.5 minutes.
- Part 1 Month 4 Prepare Action Plan Now is the time to prepare a detailed action plan by involving all the stakeholders. If the goals require efforts by the HR department, team leaders, staff or any specific department, involve them in preparing a detailed action plan. Try to answer the below 5Ws and 1H while doing so. The point is that it is fact and data-driven and encompasses all the relevant criteria like time and ownership. WHY are we undertaking this project? WHAT are we going to do? WHAT date is required? WHO is responsible for each task? WHO should be involved? HOW must it be accomplished? HOW do we review? WHERE do we find relevant data and facts? WHEN must a task be complete?
- Part 1 Month 5 Gather The Data We need hard facts and reliable data to recognize the patterns. Is the lower conversion on your site a seasonal fluctuation or has it been a downhill after the introduction of new interface? Data collected for the past few years helps you arrive at reliable conclusions. You can use multiple data collection tools like interviews, online surveys, telephonic chats, field studies, and so on to collect the data. Kaizen recommends visiting the shop floor (the place where actual operations take place) to see for yourself the operation in action and identify problem areas. In lean manufacturing, this concept is called gemba meaning “the real place”. Gemba kaizen suggests that whenever a problem occurs, visit the site and gather data from all sources. This is the place where the best improvement ideas will come. Collect data for all the KPIs you have identified like lead time, cycle time, average handle time, and so on.
- Part 1 Month 6 Analyze The Facts You can use seven basic Quality Tools at this stage for data analysis and presentation: 1. Checklist- A checklist or a check sheet is a simple way to analyse data. Rather than relying on memory, use a checklist to remember the things that need to be done or items that need to be obtained. 2. Control Chart- Are your processes under control or out of control? Use Control Charts to show how processes are changing over time. A control chart has a center line (average), an upper limit line and a lower limit line. Plot your data on this chart and compare the same with these lines to draw conclusions. 3. Flow Chart- Visually represent the steps in a business process as it moves through various departments using a flow chart. This removes any confusion and the process is clear to all. 4. Histogram- Show the variation in sets of data using Histograms. A histogram is often confused with a bar graph but unlike bar graph, in a histogram there are no spaces between bars. 5. Scatter Diagram- Scatter Diagrams are basically line graphs but with no line. It is used to see whether a relationship exists between two items. Plot the cause on X axis and the effect on Y axis and interpret the data accordingly. 6. Cause and Effect Analysis- While analysing and visually presenting the data, one can use the Cause and Effect Analysis diagram also known as “Fishbone” diagram. Place the problem at the mouth of the fish and list the possible causes on the branches or bones of the fish. Have main categories like people, equipment, policies, and procedures as the branches and put sub-causes on the sub-branches. It is a great visual to clearly see all major and minor causes of a problem. 7. Pareto Analysis- You may also use Pareto Analysis, a statistical technique based on the 80/20 rule. According to this rule, 80% of the problems are caused by just 20% causes. While doing Pareto Analysis, you score each problem, group related problems together, and focus all your efforts on the most important causes while ignoring the smaller ones.
- Part 1 Month 7 Develop Solutions After collecting and analysing the data, it’s time for all team members to have an open brainstorming session to develop solutions to the problem. You need to follow all rules of brainstorming like participation by all, no criticism of any idea, no judgmental looks, and no limitations on the number of ideas a person can share. You can follow the most popular brainstorming techniques to have a fruitful discussion round.
- Part 1 Month 8 Test Solutions The solutions developed in the previous stage need to be tested and their effectiveness measured.
- Part 1 Month 9 Ensure Goals Are Satisfied Are the goals set in the first stage being met with the solutions suggested? If not, you need to develop more effective solutions or you need to reevaluate the goals set earlier. So you need to go back to reassess your goals and see which goals were achieved and which were not.
- Part 1 Month 10 Implement Solutions The success in trial phase now needs to be implemented fully to bring about Kaizen- change for good. The new way becomes the standard way and this becomes the baseline for further improvement. Maintain a standard operating sheet that will be followed by all. The standard operating sheet will lay out the work sequence to be followed, time in which the task must be finished, the inventory needed for smooth operation and safety guidelines.
- Part 1 Month 11 Monitor Solutions Once the solutions have been implemented successfully, they need to be monitored over a sustainable period of time in order to evaluate and assess internal strengths and weaknesses and external opportunities and threats. Use Key Performance Indicators (KPI) to evaluate and assess performance on an ongoing basis.
- Part 1 Month 12 Continuous Improvement Kaizen is a continuous process – a mindset for continuous improvement. So in this stage you need to keep monitoring the solutions, improvise them and as bottlenecks emerge, repeat the cycle once again- Plan, Do, Check, Act. This should become a culture, a habit so that you never stagnate and keep improving and improving.
This service is primarily available to the following industry sectors:
Healthcare
The health care industry incorporates several sectors that are dedicated to providing health care services and products. As a basic framework for defining the sector, the United Nations’ International Standard Industrial Classification categorizes health care as generally consisting of hospital activities, medical and dental practice activities, and “other human health activities.” The last class involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health facilities, patient advocates or other allied health professions. In addition, according to industry and market classifications, such as the Global Industry Classification Standard and the Industry Classification Benchmark, health care includes many categories of medical equipment, instruments and services including biotechnology, diagnostic laboratories and substances, drug manufacturing and delivery. For example, pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States. The United States dominates the biopharmaceutical field, accounting for three-quarters of the world’s biotechnology revenues.
The quantity and quality of many health care interventions are improved through the results of science, such as advanced through the medical model of health which focuses on the eradication of illness through diagnosis and effective treatment. Many important advances have been made through health research, biomedical research and pharmaceutical research, which form the basis for evidence-based medicine and evidence-based practice in health care delivery. For example, in terms of pharmaceutical research and development spending, Europe spends a little less than the United States (€22.50bn compared to €27.05bn in 2006). The United States accounts for 80% of the world’s research and development spending in biotechnology. In addition, the results of health services research can lead to greater efficiency and equitable delivery of health care interventions, as advanced through the social model of health and disability, which emphasizes the societal changes that can be made to make populations healthier. Results from health services research often form the basis of evidence-based policy in health care systems. Health services research is also aided by initiatives in the field of artificial intelligence for the development of systems of health assessment that are clinically useful, timely, sensitive to change, culturally sensitive, low burden, low cost, built into standard procedures, and involve the patient.
There are generally five primary methods of funding health care systems:
1. general taxation to the state, county or municipality
2. social health insurance
3. voluntary or private health insurance
4. out-of-pocket payments
5. donations to health charities
In most countries, the financing of health care services features a mix of all five models, but the exact distribution varies across countries and over time within countries. In all countries and jurisdictions, there are many topics in the politics and evidence that can influence the decision of a government, private sector business or other groups to adopt a specific health policy regarding the financing structure. For example, social health insurance is where a nation’s entire population is eligible for health care coverage. This coverage and the services provided are regulated. In almost every jurisdiction with a government-funded health care system, a parallel private, and usually for-profit, the system is allowed to operate. This is sometimes referred to as two-tier health care or universal health care.
Health care in the United States is provided by many distinct organizations. Health care facilities are largely owned and operated by private sector businesses. 58% of US community hospitals are non-profit, 21% are government owned, and 21% are for-profit. According to the World Health Organization (WHO), the United States spent more on health care per capita ($9,403), and more on health care as percentage of its GDP (17.1%), than any other nation in 2014. Despite being among the top world economic powers, the US remains the sole industrialized nation in the world without universal health care coverage.
Health care in the United Kingdom is a devolved matter, with England, Northern Ireland, Scotland and Wales each having their own systems of publicly funded healthcare, funded by and accountable to separate governments and parliaments, together with smaller private sector and voluntary provision. As a result of each country having different policies and priorities, a variety of differences now exist between these systems. Despite there being separate health services for each country, the performance of the National Health Service (NHS) across the UK can be measured for the purpose of making international comparisons. In a 2014 report by the Commonwealth Fund ranking developed-country healthcare systems, the United Kingdom was ranked the best healthcare system in the world overall and in the following categories: Quality of Care (i.e. effective, safe, coordinated, patient-oriented), Access to Care, Efficiency, and Equity. The UK’s palliative care has also been ranked as the best in the world by the Economist Intelligence Unit. On the other hand, in 2005-09 cancer survival rates lagged ten years behind the rest of Europe, although survival rates continue to increase.
The nation of Austria has a two-tier health care system in which virtually all individuals receive publicly funded care, but they also have the option to purchase supplementary private health insurance. Care involving private insurance plans (sometimes referred to as “comfort class” care) can include more flexible visiting hours and private rooms and doctors. Some individuals choose to completely pay for their care privately. Healthcare in Austria is universal for residents of Austria as well as those from other EU countries. Enrolment in the public health care system is generally automatic and is linked to employment, however insurance is also guaranteed to co-insured persons (i.e. spouses and dependents), pensioners, students, the disabled, and those receiving unemployment benefits. Enrolment is compulsory, and it is not possible to cross-shop the various social security institutions. Employers register their employees with the correct institution and deduct the health insurance tax from employees’ salaries. Some people, such as the self-employed, are not automatically enrolled but are eligible to enrol in the public health insurance scheme. The cost of public insurance is based on income and is not related to individual medical history or risk factors.
Education
It has been argued that high rates of education are essential for countries to be able to achieve high levels of economic growth. Empirical analyses tend to support the theoretical prediction that poor countries should grow faster than rich countries because they can adopt cutting edge technologies already tried and tested by rich countries. However, technology transfer requires knowledgeable managers and engineers who are able to operate new machines or production practices borrowed from the leader in order to close the gap through imitation. Therefore, a country’s ability to learn from the leader is a function of its stock of “human capital”. Recent study of the determinants of aggregate economic growth have stressed the importance of fundamental economic institutions and the role of cognitive skills. At the level of the individual, there is a large literature, generally related to the work of Jacob Mincer, on how earnings are related to the schooling and other human capital. This work has motivated a large number of studies, but is also controversial. The chief controversies revolve around how to interpret the impact of schooling. Some students who have indicated a high potential for learning, by testing with a high intelligence quotient, may not achieve their full academic potential, due to financial difficulties. Economists Samuel Bowles and Herbert Gintis argued in 1976 that there was a fundamental conflict in American schooling between the egalitarian goal of democratic participation and the inequalities implied by the continued profitability of capitalist production. Many countries are now drastically changing the way they educate their citizens. The world is changing at an ever quickening rate, which means that a lot of knowledge becomes obsolete and inaccurate more quickly. The emphasis is therefore shifting to teaching the skills of learning: to picking up new knowledge quickly and in as agile a way as possible. Finnish schools have even begun to move away from the regular subject-focused curricula, introducing instead developments like phenomenon-based learning, where students study concepts like climate change instead. Education is also becoming a commodity no longer reserved for children. Adults need it too. Some governmental bodies, like the Finnish Innovation Fund Sitra in Finland, have even proposed compulsory lifelong education.
The United States spends more per student on education than any other country. In 2014, the Pearson/Economist Intelligence Unitrated US education as 14th best in the world. In 2015, the Programme for International Student Assessment rated U.S. high school students No. 40 globally in Math and No. 24 in Science and Reading. The President of the National Center on Education and the Economy said of the results “the United States cannot long operate a world-class economy if our workers are, as the OECD statistics show, among the worst-educated in the world”. Former U.S. Education Secretary John B. King, Jr. acknowledged the results in conceding U.S. students were well behind their peers. According to a report published by the U.S. News & World Report, of the top ten colleges and universities in the world, eight are American (the other two are Oxford and Cambridge, in the United Kingdom).
Pharmaceutical
The pharmaceutical industry is responsible for the development, production and marketing of medications. Thus, its immense importance as a global sector is inarguable. In 2014, total pharmaceutical revenues worldwide had exceeded one trillion U.S. dollars for the first time. North America is responsible for the largest portion of these revenues, due to the leading role of the U.S. pharmaceutical industry. However, as in many other industries, the Chinese pharmaceutical sector has shown the highest growth rates over previous years. Still, the leading pharmaceutical companies come from the United States and Europe. Based on prescription sales, NYC-based Pfizer is the world’s largest pharmaceutical company. In 2017, the company generated some 52.5 billion U.S. dollars in pure pharmaceutical sales. Other top global players from the United States include Johnson & Johnson, Merck & Co., and AbbVie. Novartis and Roche from Switzerland, GlaxoSmithKline and AstraZeneca from the United Kingdom, and French Sanofi are the European big five. Branded, patented medicines by far make up the largest share of pharmaceutical revenues. Humira, an anti-inflammatory drug, generated over 18.4 billion U.S. dollars of revenue worldwide in 2017. Oncologics continue to be the leading therapeutic class based on revenue. In 2017, cancer drugs made 81 billion U.S. dollars of revenue globally. Other major therapy classes were pain drugs and antidiabetics. More than any other industry, the pharmaceutical sector is highly dependent on its research and development segment. Some pharmaceutical companies invest 20 percent and more of their revenues in R&D measures. The United States is a traditional stronghold of pharmaceutical innovation. The origin of most new substances introduced to the market can be traced back to the United States. Because of the steady loss of patent protection, the invention of new drugs is of vital importance for the pharmaceutical industry. Revenue losses due to patent expiry often are very significant, as can be seen with Pfizer’s Lipitor from 2012 on.
The global pharmaceutical industry revenue is forecasted to reach an estimated $1,226.0 billion by 2018, with good growth over the next five years (2013-2018). The industry is expected to register growth led by aging population, changing lifestyles, hectic daily activities, unhealthy eating habits, increasing incidence of chronic diseases across the entire global population providing growth opportunities for the industry players. The industry is engaged in discovery, development, manufacture, and marketing of prescription drugs. Industry products include ethical drugs and consumer healthcare but animal healthcare drugs are not included. The global pharmaceutical market faces major challenge from increasing investment and strict regulation. Changing lifestyles and the fast socio-demographic shift due to urbanization in both developed and growth markets globally are expected drive the demand. The ability to create new technology and innovative drugs is a key driver for success in this market. North America is projected to lead the pharmaceutical industry. Vaccine industry is expected to record the highest growth during the forecast period. ROW industry is expected to witness the highest growth during 2013-2018. Government initiatives in Brazil to encourage drugs industries by providing free pricing policies and special financial investment options will attract the industry players. APAC holds good growth potential for the future.
Biotechnology
The global biotechnology market is expected to reach USD 727.1 billion by 2025, according to a new report by Grand View Research, Inc. The emergence of certain key themes in the biotechnology market is expected to drive growth in this industry to a lucrative extent. These key themes include regenerative medicine and genetics in diagnostics. Presence of a plethora of companies focusing on the development of regenerative therapies is anticipated to drive sector growth through to 2025. Technological advancements pertaining to the penetration of artificial intelligence in this industry is expected to fuel progress with potential avenues. The companies are engaged in unleashing machine learning in order to understand individual cancer cases, while recommending clinical trials. Supportive government (and its allied agencies) policies related to synthetic biology is a major growth impacting driver in this sector. Developed economies such as UK and the U.S. are critically monitoring and funding synthetic biology R&D initiatives. For example, in 2010, a six months’ review of synthetic biology headed by a panel of expert scientists was enforced by the U.S. President and subsequently conducted a hearing of the Energy and Commerce Committee exclusively concerning synthetic biology.
Biotechnology uses biological systems or living organisms for the development of its products, mostly biopharmaceutical drugs. The key regions for the global biotech industry are the United States and Europe. As of 2015, about 670 public companies and over 200 thousand employees in these regions generate some 133 billion U.S. dollars of biotech revenue. The United States is the leading global biotech player, with almost 108 billion U.S. dollars of revenue and the industry’s total market capitalization of some 890 billion U.S. dollars. More than 130 thousand people are employed by U.S. public biotechnology companies. The San Francisco Bay Area has the highest concentration of biotech companies within the United States, and accordingly also the highest biotech revenues. Since 2014, Gilead, from Foster City, California, is the world’s largest pure-play biotechnology company, overtaking long-time leader Amgen, also based in California. Of the top five biotech companies globally, four are from the United States. Since the acquisition of U.S.-based Genentech in 2009, Swiss pharmaceutical company Roche has the highest biotech revenue worldwide. However, Illinois-based company AbbVie is the manufacturer of the best-selling biotech drug – Humira. Cancer drugs make up the largest part of biopharmaceutical research and development. Biotechnology is also used in agriculture, mostly in form of genetically modifying crops to make them more resistant or more fruit-bearing. This issue is much discussed because of the possible consequences for the environment and human health. The United States is the country with the highest acreage of GM crops worldwide. For example, some 76 percent of all U.S. corn acreage is genetically manipulated. Top companies in the GM crop segment are Monsanto, Syngenta and Bayer CropScience, for example.
Manufacturing
In the past decade, the global economy has improved significantly, the developing countries are doing better than a decade ago and are contributing significantly to the global product output. The United States still holds the title of the world’s largest economy estimated at $18 trillion, China ranks second at $11 trillion, while Japan ranks third at $4.4 trillion. The three countries account for an estimated 45% of the global economy. The Chinese economy is rising at a speedy rate, and the Centre for Economics and Business Research (CEBR) forecasts that by 2029 the Chinese economy will surpass the US as the world’s largest economy. The rise of China’s economy can be directly attributed to the increase in the country’s output. The global economy is set to witness a 3.5% rise by the end of 2017 and 3.6% in 2018.
China has the world’s largest industrial output. In 2016 it is estimated that the country produced $4.566 trillion of industrial output. Strong factory output, stable retail sales, and an ever-growing export market have helped propel China meet its economic expectations. In the third quarter of 2017, the GDP grew by 6.8%. The industrial output grew by 6.6% in September 2017 compared to a year earlier. In 2016 china exported goods worth $2.342 trillion, it was only surpassed by the European Union which exported $2.659 trillion. The European Union ranked just behind China with an industrial output of $4.184 trillion.
Despite being the largest economy, the United States ranked behind China and the European Union in terms of industrial output. In 2016 the U.S industrial output totalled $3.602 trillion. In the same year, the U.S exported goods worth $1.620 trillion. The third quarter of 2016 witnessed a real output of $1.92 trillion the highest ever in a quarter since the Great Recession of 2008. The manufacturing sector employed more than $12.4 million in March 2017. The largest exports by the US were transportation equipment, chemicals, electronics and computers, and non-electrical machinery.
Japan ranks third in the global ranking, and Asia’s second state. A decade ago, Japan was the second largest economy until it was surpassed by China. In the recent past, Japan’s economy economic might has been put into question particular after the nuclear meltdown in Fukushima and its demographic composition. In 2016 Japan’s total industrial output was $1.368 while its export revenue totalled $683.85. Japan has the largest public debt as a percentage of the GDP, a situation that is preventing the private investments in the country. The disparity in productivity in the various sectors of the economy continues to widen hindering the growth of the export-oriented economy.
Germany is Europe’s largest economy and the fourth largest in the world. It is also Europe’s largest industrial producer. In 2016 Germany’s industrial output totalled $1.050 trillion. Germany witnessed the highest surge in industrial output in August 2017, the largest since 2010. The growth in industrial output is expected to be solid throughout the third quarter of the year. The manufacturing output increased by 3.2% as industries churned out more consumer and intermediate goods. The automobile industry was the key driver behind the surgeon industrial output.
Since the beginning of the millennium, India has proved itself as an economic powerhouse. The country has emerged to be the world’s fastest economy according to the CSO and the IMF. The world’s seventh largest economy is expected to be among the three top economies in the next two decades. The Indian economy is expected to grow by 6.7 percent for the year 2017-18. By the end of 2018, the figure is expected to rise to 7.2 percent. The manufacturing industry is among strong pillars. In 2016 the country’s industrial production produced about $672 billion. Between April and June 2017 the economy grew by 5.7 percent year-on-year.
Although not among the ten largest economies, South Korea’s industrial output continues to grow and ranks better some top economies. In 2016 the industrial output totalled $531 billion. The industrial output rose 2.7 percent year on year in August, bolstered by growth in the technological, manufacturing, and automobile industries. Asian’s fourth-largest economy has witnessed a surge in exports of chipsets and exports to China which grew by 13.5%. The consumer index grew by 1.8% as of October 2017 compared to the same time a year ago.
The United Kingdom is Europe’s second largest industrial producer after Germany. In 2016 the UK produced $505 billion from its industries. Britain’s choice to leave the EU has left uncertainties in the economy as scholars and economists try to examine impacts of the move on the economy. Industrial output in the UK has maintained a 23-year boom streak leading to the growth of the wider economy. The automobile industry grew by 3pc while the mining and quarrying grew by 0.7pc in September. Industrial outputs in France and Italy totalled $478 and $442 billion respectively.
The United States is still the world’s largest economy with a nominal GDP of $18 trillion. The European Union ranks second with $16.8 trillion while China ranks third with $11.2 trillion. Japan and Germany rank third and fourth respectively with $4.4 and $3.5 trillion respectively. The UK, France, India, Italy, and Brazil complete the top ten in the order. Nigeria is Africa’s largest economy with a GDP of $569 Billion followed by South Africa at $350 billion. Tuvalu is the world’s smallest economy with a GDP of $38million, Montserrat ($63m), Kiribati (180 m), Nauru ($182m), and Marshall Islands ($209 m) complete the five smallest economies.
Methodology
Clinical Process Improvement – Harvard Review
Within both ambulatory and inpatient settings, there is mounting
pressure to improve quality, safety and efficiency. The key question, is
how? Attendees will leave this corporate training program with
evidence-based quality and safety strategies to enable them to
effectively execute these approaches for sustainable daily practice. A
360-degree education is unique to this program, delivering diverse
perspectives relating to:
Healthcare Quality
• Maintaining Qualifications for CPPS, CPHQ and CPHRM
• Addressing barriers to a culture of collaboration
• Achieving better results on quality metrics
• Preventing healthcare provider burnout through resilience
• Peer-to-peer assessment
Patient Safety
• Utilizing Ambulatory Safety Nets in order to prevent missed and delayed diagnoses
• Innovative transparency efforts to promote disclosure and a culture of safety
• Encouraging non-punitive error reporting to promote the highest-quality care
• Supporting patients and providers with communication and resolution programs
Medication Safety
• Responding to the Opioid Crisis with advances in addiction management
• Improving medication safety to reduce risk of adverse events
• Maintaining safe care during national medication shortages
• Developing clinical decision support tools to improve electronic health record functionality
Innovative Care Delivery and Re-design
• Equity in healthcare
• Standardizing care to improve outcomes with sustainable clinical pathways
• Rethinking care delivery method
• Population health management solutions
Process Improvement and Change Management
• Engaging staff to incorporate change management systems into practice
• Utilizing project charters to define goals
• Increasing the value of process improvement initiatives
• Sustaining high performance through reliable processes
Leadership
• Aligning senior leadership, management, and frontline caregivers to deliver safe and effective care
• Engaging leadership in risk mitigation and compliance strategies
• Advancing successful quality and safety committee structures
• Developing a supportive model of shared accountability with Just Culture
Quality and Safety in Primary Care and Cancer Care Settings
• Leveraging analytics to transform care
• Aligning clinical, financial, operational and research resources
• Improving patient experience using non-traditional sites of healthcare delivery
• Extending healthcare access through telehealth
Industries
This service is primarily available to the following industry sectors:
Healthcare
The health care industry incorporates several sectors that are dedicated to providing health care services and products. As a basic framework for defining the sector, the United Nations’ International Standard Industrial Classification categorizes health care as generally consisting of hospital activities, medical and dental practice activities, and “other human health activities.” The last class involves activities of, or under the supervision of, nurses, midwives, physiotherapists, scientific or diagnostic laboratories, pathology clinics, residential health facilities, patient advocates or other allied health professions. In addition, according to industry and market classifications, such as the Global Industry Classification Standard and the Industry Classification Benchmark, health care includes many categories of medical equipment, instruments and services including biotechnology, diagnostic laboratories and substances, drug manufacturing and delivery. For example, pharmaceuticals and other medical devices are the leading high technology exports of Europe and the United States. The United States dominates the biopharmaceutical field, accounting for three-quarters of the world’s biotechnology revenues.
The quantity and quality of many health care interventions are improved through the results of science, such as advanced through the medical model of health which focuses on the eradication of illness through diagnosis and effective treatment. Many important advances have been made through health research, biomedical research and pharmaceutical research, which form the basis for evidence-based medicine and evidence-based practice in health care delivery. For example, in terms of pharmaceutical research and development spending, Europe spends a little less than the United States (€22.50bn compared to €27.05bn in 2006). The United States accounts for 80% of the world’s research and development spending in biotechnology. In addition, the results of health services research can lead to greater efficiency and equitable delivery of health care interventions, as advanced through the social model of health and disability, which emphasizes the societal changes that can be made to make populations healthier. Results from health services research often form the basis of evidence-based policy in health care systems. Health services research is also aided by initiatives in the field of artificial intelligence for the development of systems of health assessment that are clinically useful, timely, sensitive to change, culturally sensitive, low burden, low cost, built into standard procedures, and involve the patient.
There are generally five primary methods of funding health care systems:
1. general taxation to the state, county or municipality
2. social health insurance
3. voluntary or private health insurance
4. out-of-pocket payments
5. donations to health charities
In most countries, the financing of health care services features a mix of all five models, but the exact distribution varies across countries and over time within countries. In all countries and jurisdictions, there are many topics in the politics and evidence that can influence the decision of a government, private sector business or other groups to adopt a specific health policy regarding the financing structure. For example, social health insurance is where a nation’s entire population is eligible for health care coverage. This coverage and the services provided are regulated. In almost every jurisdiction with a government-funded health care system, a parallel private, and usually for-profit, the system is allowed to operate. This is sometimes referred to as two-tier health care or universal health care.
Health care in the United States is provided by many distinct organizations. Health care facilities are largely owned and operated by private sector businesses. 58% of US community hospitals are non-profit, 21% are government owned, and 21% are for-profit. According to the World Health Organization (WHO), the United States spent more on health care per capita ($9,403), and more on health care as percentage of its GDP (17.1%), than any other nation in 2014. Despite being among the top world economic powers, the US remains the sole industrialized nation in the world without universal health care coverage.
Health care in the United Kingdom is a devolved matter, with England, Northern Ireland, Scotland and Wales each having their own systems of publicly funded healthcare, funded by and accountable to separate governments and parliaments, together with smaller private sector and voluntary provision. As a result of each country having different policies and priorities, a variety of differences now exist between these systems. Despite there being separate health services for each country, the performance of the National Health Service (NHS) across the UK can be measured for the purpose of making international comparisons. In a 2014 report by the Commonwealth Fund ranking developed-country healthcare systems, the United Kingdom was ranked the best healthcare system in the world overall and in the following categories: Quality of Care (i.e. effective, safe, coordinated, patient-oriented), Access to Care, Efficiency, and Equity. The UK’s palliative care has also been ranked as the best in the world by the Economist Intelligence Unit. On the other hand, in 2005-09 cancer survival rates lagged ten years behind the rest of Europe, although survival rates continue to increase.
The nation of Austria has a two-tier health care system in which virtually all individuals receive publicly funded care, but they also have the option to purchase supplementary private health insurance. Care involving private insurance plans (sometimes referred to as “comfort class” care) can include more flexible visiting hours and private rooms and doctors. Some individuals choose to completely pay for their care privately. Healthcare in Austria is universal for residents of Austria as well as those from other EU countries. Enrolment in the public health care system is generally automatic and is linked to employment, however insurance is also guaranteed to co-insured persons (i.e. spouses and dependents), pensioners, students, the disabled, and those receiving unemployment benefits. Enrolment is compulsory, and it is not possible to cross-shop the various social security institutions. Employers register their employees with the correct institution and deduct the health insurance tax from employees’ salaries. Some people, such as the self-employed, are not automatically enrolled but are eligible to enrol in the public health insurance scheme. The cost of public insurance is based on income and is not related to individual medical history or risk factors.
Clinical Process Improvement – Kaizan
Doing the Impossible
Achieving tangible process improvement in the clinical setting is neither magical nor impossible. The use of Kaizen, in particular, is a short-term intense action that makes processes more reliable and less wasteful while encouraging legitimate and meaningful employee involvement.1 During Kaizen, understanding the flow of information and people allows the “impossible” to become surprisingly apparent. Knowing this, let’s dive deeper into the idea of transforming the “impossible” into realistic solutions. For example, a radiology special procedures room needed to speed up the change-over process before the next procedure, yet everyone seemed extremely busy, giving off the impression that each person was going as quickly as possible to achieve the best results. The hospital nurses, who insisted that improvement was impossible, only saw the rushed chaos when making their assessment – how much faster could everyone really move to achieve better performance?
Since the busy change-over provided the illusion of productivity, an observer had to look at the interactions among each individual part to analyse how it flowed to find the challenges to the process. The initial steps of this Kaizen discovered these silent threats, so addressing them became the next stage in locating realistic ways to speed up the process. To get the radiology room performing at its best, the leaders (physician, nurses, and tech staff) charted the process in its entirety with the help of a time study, spaghetti chart, and other Kaizen tools. By the end, the leaders were able to minimize the 30+ minute process to 22 minutes, while also removing the need for an additional nurse – saving time, resources, and costs.
What this anecdote hopes to demonstrate is that, like a magic show, a hospital’s “impossibilities” can be an illusion. While hospital leaders are bombarded by people who all seem to have “the solution” to one problem or another in the clinical setting, each of these offered solutions only muddles the process of finding the best answer. Kaizen, however, gets the best out of everyone, allowing clinical leaders to do the “impossible” with proven industrial tools.
Assessing the Clinical Setting
In assessing the clinical setting, progress is made by having the hospital staff identify the biggest time wasters and processes that lead to inefficiencies. These processes can be examined and new procedures can be tested. Before attempting to make changes, however, a Kaizen requires a strategy and a clear vision, so answering some fundamental questions about the nature of the organization can help a Kaizen team locate its mission. Fundamental questions: • What is the purpose of the organization? • What is the value proposition of the company? • Why does it exist? • By what means and principles will the vision be obtained? • How is success toward that purpose measured?
Three Perspectives: Time, Space & Concurrent Sequence
To get a clearer picture of what is occurring in a given process or system, the three perspectives of time, space and concurrent sequence should be analysed to spotlight improvement opportunities. Here, multiple perspectives help to paint visible pictures to “impossible” problems. While observing the department in motion, address the following questions: • How long does it take? • What kinds of defects or errors might occur at this step in the process? • What do you have to do to get ready to do the next case? • How many can be done in a day? • What triggers the work? • What preventative actions or rework occurs to handle defects?
Value Stream Mapping
One tool for observing current processes relies on value stream mapping (VSM). VSM shows how materials, people, equipment, methodology, and measures interact over time to create value for the customer. VSM illuminates the flow of physical events while keeping disruption and confusion to a minimum. Although VSM may end up looking like a convoluted mess to the untrained eye, the map is a very powerful way to identify problems and constraints for Kaizen topic selection. Since the map has the potential to be over-drawn, remember that the intent of the map is to enable people to see how time and resources are lost along the path of the work flow. This map allows techs, RNs, physicians, or surgeons the ability to become engineers, seeking to drastically reduce time, complexity, and errors in each step of a clinical process.
The Value of Physician-Led Teams
In response to healthcare reform, hospital LEADERS have been trying to reduce costs while maintaining quality patient care. However, knowing only the basics of Kaizen can bring a hospital more harm than good. To attain true Lean transformation, the type thriving in both industrial and clinical settings, Kaizen needs to be done as a long-term project with the help of an expert Kaizen facilitator and the support of the entire medical staff. One mistake in the broader clinical community is that anything done to cut costs may be considered “Lean,” including staff elimination. True Lean methodology, however, focuses on continuous improvement and the genuine respect for each worker – not their elimination. Here, respect means wanting to see everyone excel, increasing staff morale through cross-level buy-in.
Kaizen promotes using the creative minds of people at all levels of the organization, so one person or one job type cannot represent the “hero” of the group. Still, in the clinical setting, special attention should focus on physician involvement – a key factor that influences a protocol’s clinical acceptance and long-term sustainability. A clinical Kaizen team consists of a variety of hospital staff, but without physician buy-in, many Kaizen teams find that their process improvement goals get blocked by physicians who are unwilling to change. While physicians’ participation hinges on many factors, studies suggest that physicians are reluctant to participate in process improvement projects due to fear of hospital motives and lack of time, and these barriers impede the success of process improvement efforts.2 To counter such reluctance, executive leadership should enact company-wide initiatives for process improvement based on successful Lean principles used in other industries.
When hospitals have access to extensive in-house process improvement resources, including the expertise of senior leadership and transitional leaders in operations and management, they gain a stronger culture of “Lean Thinking.” Whether trying to combat low case volume, high wait times or poor staff satisfaction, physicians who establish quality as priority and who work in a quality focused culture have the greatest ability to organize the resources necessary to support ongoing Lean transformation. Only then can hospitals significantly differentiate themselves from their competition as they strive to continually optimize efficiency and the utilization of resources.
Overcoming Fear of Change
Even though this paper focuses on Kaizen in the clinical setting, it’s good to remember Lean thinking from its start at Toyota in the 1930s. At Toyota, their continual small improvements (Kaizen) added up to major benefits: faster delivery, lower costs, and greater customer satisfaction.3 Today, as noted in the Harvard Business Review, all levels of hospital staff are “radically increasing the effectiveness of patient care and dramatically lowering its cost by applying the same capabilities in operations design and improvement that drive the famous Toyota Production System.”4 Through Kaizen, “impossible” problems become visible, thereby reducing a leader’s anxiety when making decisions to forward a hospital’s growth and success. When hospital leaders have access to in-house process improvement resources, they no longer need to seek out multiple, outside consultations because leaders finally have the tools at hand to generate novel solutions to dynamic problems–an option, before Kaizen, that truly once seemed impossible.
References
1. Cooper, M. (2008). Kaizen sketchbook: A comprehensive illustrated field guide for lean transformation. Lake Forest, IL: Moffitt Associates, LLC. 2. Weiner, B., Shortell, S., Alexander, J. (1997). Promoting clinical involvement in the hospital quality improvement efforts: The effects of top management, board, and physician leadership. Health Services Research. Retrieved from http://findarticles.com/p/articles/mi_m4149/is_n4_v32/ai_20123544/ 3. Kaizen History. QualitiAmo. Retrieved from http://qualitiamo.com/en/improving/kaizen/history.html 4. Spear, S. (2005). Fixing health care from the inside, today [Abstract]. Harvard Business Review, 83(9), 78-91.
Program Benefits
Customer Service
- Customer experience
- Stakeholder improvement
- Customer care
- Collaborative research
- Collective integration
- Continuous improvement
- Knowledge sharing
- Interactive communication
- Process improvement
- Proactive analysis
Operations
- Process decentralization
- Performance improvement
- Process improvement
- Time effective
- Cost effective
- Performance analysis
- Continuous improvement
- Quality management
- Project execution
- Interactive research
Management
- Stakeholder performance
- Improved information
- Proactive decision-making
- Effective globalization
- Global localization
- Collaborative research
- Process improvement
- Performance improvement
- Effective leadership
- Litigation reduction
Curriculum
Clinical Process Improvement – Part 1- Year 1
- Part 1 Month 1 Internal Analysis
- Part 1 Month 2 Select Project & Explain Reason
- Part 1 Month 3 Set Goals
- Part 1 Month 4 Prepare Action Plan
- Part 1 Month 5 Gather The Data
- Part 1 Month 6 Analyse The Facts
- Part 1 Month 7 Develop Solutions
- Part 1 Month 8 Test Solutions
- Part 1 Month 9 Ensure Goals Are Satisfied
- Part 1 Month 10 Implement Solution
- Part 1 Month 11 Monitor Solution
- Part 1 Month 12 Continuous Improvement
Testimonials
Healthcare
“Appleton Greene does not provide solutions, they enable their clients to find the right solutions. This is achieved by an innovative and flexible approach to learning which is refreshing. Knowledge is transferred through the implementation of tangible business processes, which are sensitive to ever-changing client requirements. The experience is rewarding.”
A quotation taken from a client reference within the Healthcare industry.
Education
“Empowerment is the art of corporate training. If we are able to make people feel empowered through knowledge transfer then they are better equipped to progress. Appleton Greene embodies empowerment as an integral part of all of their programs and this is what makes them so appealing.”
A quotation taken from a client reference within the Education industry.
Pharmaceutical
“As an industry, we are used to investing heavily in long-term product development. We also accept that the majority of products which we develop in will never be produced. We accept that as long as a few products are commercially viable, then this will usually provide our organization with sufficient profit contribution for business sustainability. However, our investment in various Appleton Greene programs has in all cases provided a tangible return on investment. This is simply because they are all targeted towards improving business processes and any improvement, no matter how small, is instantly felt and appreciated.”
A quotation taken from a client reference within the Pharmaceutical industry.
Biotechnology
“Appleton Greene appears to attract very creative and imaginative people and then provides them with a structured approach to product development and implementation. This must be a very rewarding experience for it’s trainers and consultants. Anything that helps our employees to tap into their creative side is always welcome and it certainly helps sometimes if this is initiated using an independent external perspective.”
A quotation taken from a client reference within the Biotechnology industry.
Manufacturing
“Successful growth on a global scale is determined by the quality of strategic partnering or strategic alliance management. Appleton Greene has been a real find in terms of corporate training services because their flexibility and international coverage makes them a valuable asset to have.”
A quotation taken from a client reference within the Manufacturing industry.
More detailed achievements, references and testimonials are confidentially available to clients upon request.
Locations
This service is primarily available within the following locations:
Vienna AT
Austria is one of the 14 richest countries in the world in terms of GDP (Gross domestic product) per capita, has a well-developed social market economy, and a high standard of living. Until the 1980s, many of Austria’s largest industry firms were nationalized; in recent years, however, privatization has reduced state holdings to a level comparable to other European economies. Labor movements are particularly strong in Austria and have large influence on labor politics. Next to a highly developed industry, international tourism is the most important part of the national economy. Germany has historically been the main trading partner of Austria, making it vulnerable to rapid changes in the German economy. However, since Austria became a member state of the European Union it has gained closer ties to other European Union economies, reducing its economic dependence on Germany. In addition, membership in the EU has drawn an influx of foreign investors attracted by Austria’s access to the single European market and proximity to the aspiring economies of the European Union. Growth in GDP accelerated in recent years and reached 3.3% in 2006. In 2004 Austria was the fourth richest country within the European Union, having a GDP (PPP) per capita of approximately €27,666, with Luxembourg, Ireland, and Netherlands leading the list. Vienna was ranked the fifth richest NUTS-2 region within Europe (see Economy of Europe) with GDP reaching €38,632 per capita, just behind Inner London, Luxembourg, Brussels-Capital Region and Hamburg. Growth has been steady between 2002–2006 varying between 1 and 3.3%. After hitting 0% in 2013, growth has picked up a little and as of 2016 sits at 1.5%. Trade with other EU countries accounts for almost 66% of Austrian imports and exports. Expanding trade and investment in the emerging markets of central and Eastern Europe is a major element of Austrian economic activity. Trade with these countries accounts for almost 14% of Austrian imports and exports, and Austrian firms have sizable investments in and continue to move labor-intensive, low-tech production to these countries. Although the big investment boom has waned, Austria still has the potential to attract EU firms seeking convenient access to these developing markets.
Vienna is the federal capital and largest city of Austria, and one of the nine states of Austria. Vienna is Austria’s primate city, with a population of about 1.8 million (2.6 million within the metropolitan area, nearly one third of Austria’s population), and its cultural, economic, and political center. It is the 7th-largest city by population within city limits in the European Union. Until the beginning of the 20th century, it was the largest German-speaking city in the world, and before the splitting of the Austro-Hungarian Empire in World War I, the city had 2 million inhabitants. Today, it has the second largest number of German speakers after Berlin. Vienna is host to many major international organizations, including the United Nations and OPEC. The city is located in the eastern part of Austria and is close to the borders of the Czech Republic, Slovakia, and Hungary. These regions work together in a European Centrope border region. Along with nearby Bratislava, Vienna forms a metropolitan region with 3 million inhabitants. In 2001, the city center was designated a UNESCO World Heritage Site. In July 2017 it was moved to the list of World Heritage in Danger. Apart from being regarded as the City of Music because of its musical legacy, Vienna is also said to be “The City of Dreams” because it was home to the world’s first psychoanalyst – Sigmund Freud. The city’s roots lie in early Celtic and Roman settlements that transformed into a Medieval and Baroque city, and then the capital of the Austro-Hungarian Empire. It is well known for having played an essential role as a leading European music center, from the great age of Viennese Classicism through the early part of the 20th century. The historic center of Vienna is rich in architectural ensembles, including Baroque castles and gardens, and the late-19th-century Ringstraße lined with grand buildings, monuments and parks. Vienna is known for its high quality of life. In a 2005 study of 127 world cities, the Economist Intelligence Unit ranked the city first (in a tie with Vancouver and San Francisco) for the world’s most livable cities. Between 2011 and 2015, Vienna was ranked second, behind Melbourne. In 2018, it replaced Melbourne as the number one spot. For eight consecutive years (2009–2016), the human-resource-consulting firm Mercer ranked Vienna first in its annual “Quality of Living” survey of hundreds of cities around the world, a title the city still held in 2016. Monocle’s 2015 “Quality of Life Survey” ranked Vienna second on a list of the top 25 cities in the world “to make a base within. The UN-Habitat classified Vienna as the most prosperous city in the world in 2012/2013. The city was ranked 1st globally for its culture of innovation in 2007 and 2008, and sixth globally (out of 256 cities) in the 2014 Innovation Cities Index, which analyzed 162 indicators in covering three areas: culture, infrastructure, and markets. Vienna regularly hosts urban planning conferences and is often used as a case study by urban planners. Between 2005 and 2010, Vienna was the world’s number-one destination for international congresses and conventions. It attracts over 6.8 million tourists a year.
London UK
London has always been a commercial city and today enjoys the status of having one of the largest city economies in the world. The city thrives in trade and commerce and has a vibrant culture seeped in commerce. It has a GDP of over £565 billion, which is about 17 percent of the UK’s total GDP. The size of its economy is larger than that of several European nations. The Port of London handles 48 million tonnes of cargo every year. The nature of London’s economy has undergone change over the years. While manufacturing industries held the dominant position during the nineteenth century and the early parts of the twentieth century, service industries, especially financial and business services are now the dominant sector. Of the total £37 billion annual export of goods and services, financial and business services account for about £15.5 billion. London is the home to many banks and financial institutions and has the maximum number of foreign banks in any city. The city is also a major center for forex trade. London trades more US dollars than New York does, and more Euros than all other cities in Europe combined. The service sector employs 3.2 million people in London, which is about 85 percent of all jobs available in London’s service industries. Out of this, the financial sector alone employs about 1.25 million people, or about one in every three jobs available. The manufacturing and construction industry, in contrast, employ half a million residents of Greater London, which is about 11 percent of the employable population of Greater London. London is also a vibrant center for arts and fashion, film, media, design, law and computing industries. E-commerce and related industries ranks amongst the fastest growing sectors in the city’s economy. Tourism is another important sector with high growth potential. London is today the center of operations for almost two out of every three Fortune 500 companies and the European hub for one out of every three large global conglomerates. Several well-known businesses such as HSBC, Barclays Bank, Virgin, BBC and many others have their headquarters at London. The London Stock Exchange is the largest in the world, and accounts for about 32 percent of all global transactions.
The London Plan encapsulates the blueprint for the development of London’s economy. This plan aims to position London as the best city in the world and focuses on specific strategies and plans towards this end. The plan identifies growth sectors such as e-commerce, tourism and environmental industries and lays down sustainable and inclusive plans for the overall development of the economy. The London plan recognizes e-industry or internet based businesses as one of the fastest growing sector and with potential to offer much growth. The Plan envisages an effective Information and Communications Technology (ICT) infrastructure and measures to support innovation, to promote creative and environmental industries. Specific plans towards such a strategy include:
Providing affordable broadband access for everyone in London. Providing support measures to mitigate the social, economic, transport and environmental costs of e-infrastructure works such as ducting and installing wireless computing equipment. E-enabling new residential and commercial developments. Specific measures of e-enabling include making provisions for ducts, incorporating fiber cables in the design and more. Providing high quality yet affordable business premises and incubator units that promote business and increase synergy between business and research
The London plan recognizes tourism as a growth sector and aims to enhance London’s image as an attractive tourism destination. The plan also pays attention to developing key infrastructure projects and supporting bids for other major international events. Environmental industries are another key growth area for the future. The London plan envisages support in the form of funding, market development, promotions, land use policies and more to encourage such industries. It promotes the development of environmental friendly business clusters and targets sustainable methods such as recycling to process 85 per cent of London’s waste within its boundaries to generate green business opportunities. Such initiatives aim to develop London’s economy and make it the world capital of business.
Boston MA
A global city, Boston is placed among the top 30 most economically powerful cities in the world. Encompassing $363 billion, the Greater Boston metropolitan area has the sixth-largest economy in the country and 12th-largest in the world. Boston’s colleges and universities exert a significant impact on the regional economy. Boston attracts more than 350,000 college students from around the world, who contribute more than US$4.8 billion annually to the city’s economy. The area’s schools are major employers and attract industries to the city and surrounding region. The city is home to a number of technology companies and is a hub for biotechnology, with the Milken Institute rating Boston as the top life sciences cluster in the country. Boston receives the highest absolute amount of annual funding from the National Institutes of Health of all cities in the United States. The city is considered highly innovative for a variety of reasons, including the presence of academia, access to venture capital, and the presence of many high-tech companies. The Route 128 corridor and Greater Boston continue to be a major center for venture capital investment and high technology remains an important sector. Tourism also composes a large part of Boston’s economy, with 21.2 million domestic and international visitors spending $8.3 billion in 2011; excluding visitors from Canada and Mexico, over 1.4 million international tourists visited Boston in 2014, with those from China and the United Kingdom leading the list. Boston’s status as a state capital as well as the regional home of federal agencies has rendered law and government to be another major component of the city’s economy. The city is a major seaport along the East Coast of the United States and the oldest continuously operated industrial and fishing port in the Western Hemisphere.
The financial services industry is important to Boston, especially involving mutual funds and insurance. In the 2017 Global Financial Centers Index, Boston was ranked as having the ninth-most competitive financial center in the world and the fourth-most competitive in the United States. Boston-based Fidelity Investments helped popularize the mutual fund in the 1980s and has made Boston one of the top financial centers in the United States. The city is home to the headquarters of Santander Bank, and Boston is a center for venture capital firms. State Street Corporation, which specializes in asset management and custody services, is based in the city. Boston is a printing and publishing center. Houghton Mifflin Harcourt is headquartered within the city, along with Bedford-St. Martin’s Press and Beacon Press. Pearson PLC publishing units also employ several hundred people in Boston. The city is home to three major convention centers—the Hynes Convention Center in the Back Bay, and the Seaport World Trade Center and Boston Convention and Exhibition Center on the South Boston waterfront. The General Electric Corporation announced in January 2016 its decision to move the company’s global headquarters to the Seaport District in Boston, from Fairfield, Connecticut, citing factors including Boston’s preeminence in the realm of higher education. Boston is home to the headquarters of several major athletic and footwear companies including Converse, New Balance, and Reebok. Rockport, Puma and Wolverine World Wide, Inc. headquarters or regional offices are located just outside the city.
Washington DC
Washington has a growing, diversified economy with an increasing percentage of professional and business service jobs. The gross state product of the District in 2010 was $103.3 billion, which would rank it No. 34 compared to the 50 states. The gross product of the Washington Metropolitan Area was $435 billion in 2014, making it the sixth-largest metropolitan economy in the United States. Between 2009 and 2016, GDP per capita in Washington, D.C has consistently ranked on the very top among U.S. states. In 2016, at $160,472, its GDP per capita is almost three times as high as that of Massachusetts, which ranked second place in the country. As of June 2011, the Washington Metropolitan Area had an unemployment rate of 6.2%; the second-lowest rate among the 49 largest metro areas in the nation. The District of Columbia itself had an unemployment rate of 9.8% during the same time period. In December 2017, 25% of the employees in Washington, D.C., were employed by a federal governmental agency. This is thought to immunize Washington, D.C., to national economic downturns because the federal government continues operations even during recessions. Many organizations such as law firms, defense contractors, civilian contractors, nonprofit organizations, lobbying firms, trade unions, industry trade groups, and professional associations have their headquarters in or near Washington, D.C., in order to be close to the federal government. Tourism is Washington’s second-largest industry. Approximately 18.9 million visitors contributed an estimated $4.8 billion to the local economy in 2012. The District also hosts nearly 200 foreign embassies and international organizations such as the World Bank, the International Monetary Fund (IMF), the Organization of American States, the Inter-American Development Bank, and the Pan American Health Organization. In 2008, the foreign diplomatic corps in Washington employed about 10,000 people and contributed an estimated $400 million annually to the local economy. The District has growing industries not directly related to government, especially in the areas of education, finance, public policy, and scientific research. Georgetown University, George Washington University, Washington Hospital Center, Children’s National Medical Center and Howard University are the top five non-government-related employers in the city as of 2009. According to statistics compiled in 2011, four of the largest 500 companies in the country were headquartered in the District. In the 2017 Global Financial Centers Index, Washington was ranked as having the 12th most competitive financial center in the world, and fifth most competitive in the United States (after New York City, San Francisco, Chicago, and Boston).
New York NY
The economy of New York City encompasses the largest municipal and regional economy in the United States. Anchored by Wall Street in Lower Manhattan, New York City has been characterized as the world’s premier financial center. It is home to the New York Stock Exchange and NASDAQ, the world’s two largest stock exchanges by both market capitalization and trading activity. In 2012, the New York metropolitan area generated a gross metropolitan product (GMP) of over US$1.33 trillion. The Combined Statistical Area produced a GMP of over US$1.55 trillion. Both are ranked first nationally by a wide margin and being roughly equivalent to the GDP of South Korea. The city’s economy accounts for most of the economic activity in both the states of New York and New Jersey. Manhattan is the nation’s leading center of banking, finance, and communication. It is home to the New York Stock Exchange (NYSE) on Wall Street. Many of the world’s largest corporations are headquartered in Manhattan. The borough contained over 500 million square feet (46.5 million m2) of office space in 2015. This makes it the largest office market in the United States. Midtown Manhattan, with nearly 400 million square feet (37.2 million m2) that same year, is the largest central business district in the world. New York City is distinctive for its high concentrations of advanced service sector firms in the law, accountancy, banking and management consultancy fields. It is the top global center for the advertising industry, which is called “Madison Avenue”. Silicon Alley, is New York’s broad-spectrum high technology sphere, continues to expand. Finance, high technology, real estate, insurance, and health care all form the basis of New York’s economy. The city is also the nation’s most important center for mass media, journalism, and publishing. Also, it is the country’s preeminent arts center. Creative industries such as digital media, advertising, fashion, design and architecture account for a growing share of employment. New York City possesses a strong competitive advantage in these industries. Despite declining, manufacturing remains consequential.
The economy of the State of New York is reflected in its gross state product in 2015 of $1.19 trillion, ranking third in size behind the larger U.S. states of California and Texas. If New York State were an independent nation, it would rank as the 12th or 13th largest economy in the world, depending upon international currency fluctuations. However, in 2013, the multi-state, New York City-centered Metropolitan Statistical Area produced a gross metropolitan product (GMP) of nearly US$1.39 trillion, while in 2012, the corresponding Combined Statistical Area generated a GMP of over US$1.15 trillion, both ranking first nationally by a wide margin and behind the GDP of only twelve nations and eleven nations, respectively. New York City and the surrounding New York metropolitan area dominate the economy of the state. Manhattan is the leading center of banking, finance, and communication in the United States and is the location of the New York Stock Exchange (NYSE) on Wall Street. Many of the world’s largest corporations locate their home offices in Manhattan or in nearby Westchester County. Manhattan contained over 500 million square feet (46.5 million m2) of office space in 2015, making it the largest office market in the United States, while Midtown Manhattan, with nearly 400 million square feet (37.2 million m2) in 2015, is the largest central business district in the world. The state also has a large manufacturing sector, which includes printing and publishing and the production of garments, furs, railroad rolling stock, and bus line vehicles. Some industries are concentrated in upstate locations also, such as ceramics and glass (the southern tier of counties), microchips and nanotechnology (Albany), and photographic equipment (Rochester). New York’s agricultural outputs comprise dairy products, cattle and other livestock, vegetables, nursery stock, and apples.
Personal Profile
Mr Chicles is an approved Certified Learning Provider (CLP) at Appleton Greene who is a business leader and strategist with broad experience in the global multi-industrial, aerospace and defense sectors. He is a seasoned operational leader of global industrial businesses, leading transformational strategies in highly competitive markets.
As a senior, C-suite strategist for multiple major industrial corporations he has led multiple mergers, acquisitions, divestitures and restructurings, as well as corporate break-ups and spin-offs. He has a distinguished track record of successful transformations of complex organizations in dynamic and uncertain market conditions while engendering the trust and buy-in of employees, customers, vendors, owners, corporate leadership and boards of directors.
A highly engaged leader at the personal and team level he has demonstrated the ability to engender effective senior teams and boards. He’s also an active mentor, teacher and community leader.
Mr Chicles is an active board member with AES Seals, global leader in sustainable reliability engineering, and Micro Technologies Inc, an electronics and advanced manufacturing company. He is a principal partner with ProOrbis Enterprises®, a management science consultancy with premier clients such as the US Navy and PwC, as well as the principal of Xiphos Associates™, a management and M&A advisory. Recently, he served as Board Director and Chairman of Global Business Development with Hydro Inc. the largest independent pump and flow systems engineering services provider in the world.
He was President of ITT’s Industrial Process / Goulds Pumps business segment a global manufacturer of industrial pumps, valves, monitoring and control systems, and aftermarket services for numerous industries with $1.2 billion in revenue, 3,500 employees and 34 facilities in 17 countries. Preceding this role he served as Executive Vice President of ITT Corporation overseeing the creation of a newly conceived ITT Inc. following the break-up of the former ITT Corporation to establish its strategy and corporate functions such as HR, communications, IT and M&A, building the capabilities, policies and organizations for each.
He joined ITT Corporation’s executive committee as its strategy chief in 2006 and instituted disciplined strategic planning processes and developed robust acquisition pipelines to respond to rapidly changing markets. Created successful spin-offs of 2 new public corporations Exelis Inc. and Xylem Inc. ITT Corporation was named one of “America’s Most Respected Corporations” by Forbes for exemplary management and performance during his tenure there.
Before joining ITT, Mr Chicles served as Vice President of Corporate Business Development and head of mergers and acquisitions for American Standard / Trane Companies, where he initiated and closed numerous transactions and equity restructurings globally.
Additionally, he created and led the corporate real estate function which entailed more than 275 real estate transactions around the world.
He began his career at Owens Corning rising through the ranks in various operational roles to Vice President of Corporate Development.
Recently, he taught advanced enterprise strategy at Stevens Institute of Technology as an adjunct professor and still supports start-ups through the Stevens Venture Center. He continues to be active as the Founding Board Member with several successful start-up technology businesses and non-profit organizations. A community leader, Mr Chicles has held the role of President of the Greek Orthodox Cathedral in Tenafly, N.J., He also led trips abroad to Cambodia and Costa Rica to build sustainable clean-water solutions and affordable housing.
His formal education includes earning a Masters of Business Administration from The Wharton School at the University of Pennsylvania, and a Bachelors in Finance from Miami University.
(CLP) Programs
Appleton Greene corporate training programs are all process-driven. They are used as vehicles to implement tangible business processes within clients’ organizations, together with training, support and facilitation during the use of these processes. Corporate training programs are therefore implemented over a sustainable period of time, that is to say, between 1 year (incorporating 12 monthly workshops), and 4 years (incorporating 48 monthly workshops). Your program information guide will specify how long each program takes to complete. Each monthly workshop takes 6 hours to implement and can be undertaken either on the client’s premises, an Appleton Greene serviced office, or online via the internet. This enables clients to implement each part of their business process, before moving onto the next stage of the program and enables employees to plan their study time around their current work commitments. The result is far greater program benefit, over a more sustainable period of time and a significantly improved return on investment.
Appleton Greene uses standard and bespoke corporate training programs as vessels to transfer business process improvement knowledge into the heart of our clients’ organizations. Each individual program focuses upon the implementation of a specific business process, which enables clients to easily quantify their return on investment. There are hundreds of established Appleton Greene corporate training products now available to clients within customer services, e-business, finance, globalization, human resources, information technology, legal, management, marketing and production. It does not matter whether a client’s employees are located within one office, or an unlimited number of international offices, we can still bring them together to learn and implement specific business processes collectively. Our approach to global localization enables us to provide clients with a truly international service with that all important personal touch. Appleton Greene corporate training programs can be provided virtually or locally and they are all unique in that they individually focus upon a specific business function. All (CLP) programs are implemented over a sustainable period of time, usually between 1-4 years, incorporating 12-48 monthly workshops and professional support is consistently provided during this time by qualified learning providers and where appropriate, by Accredited Consultants.
Executive summary
Acquisitive Growth
In today’s context of changing markets, technologies and business models, and in conjunction with historic levels of available capital, acquisitive growth has emerged as an increasingly compelling approach to transformational growth. However, as has been empirically proven growth through acquisitions is fraught with pitfalls and inherently risky. Successfully acquisitive growth requires the confluence of many factors that go beyond the traditional phased steps of a typical process. In my experience success is a function of bringing together the elements of people, processes, and technologies into a set of capabilities that are custom-made for an organization’s particular strengths, circumstances and aspirations. Winning in today’s dynamic markets demands bold, unique and sustainable strategies. The following are the stages of such an approach that I have found to create high probability, profitable growth that stands the test of time.
Additionally, while the M&A industry has many advisors available, they tend not to be operating executives who have lived through all the elements I will lay out below. Many simplistic guidelines exist, however what its clear is that the difference between success and failure with acquisitive growth is not in rote adherence to some set of processes, rather it is found in the combination of process discipline and strong application of experiential, practical knowhow. The nature of this knowhow is to apply and allocate the elements below in a smart, efficient manner to achieve exemplary outcomes for the specific client’s unique situation and circumstances.
Strategy Development: Whether at the corporate level or in a specific business unit, clients would be taken through steps to clarify the markets and segments where they currently compete and where they want to go in the future, what differentiates them from competition, where capabilities need to be refined or built, and the various functional elements (e.g. systems, processes, structures, etc.) critical to sustain profitable growth. Approach would be a combination of review of current strategies/capabilities, interviews and facilitated discussions and structured workshops. Outcomes might be a strategy to bring a particular business into a new growth phase or to meet changing competitive environments, or at the enterprise level might entail “platform building” whereby new businesses, sectors or legs are build from the ground up through foundational initial acquisitions and subsequent organic and inorganic initiatives.
Market Focus: Where will we hunt for acquisition targets? If a company allows too-wide of a scope will find themselves suffering from expensive resource drains/distractions and/or dilute efforts. Therefore, following the alignment of enterprise/business strategies the process will seek to focus the market segments and the business criteria to qualify a company to be elevated to possible target.
Research Possible Targets: Simply put, take the descriptions and criteria from above and create lists of potential targets that might fit. Each such company is researched for available information, any currently available knowledge the client might have, etc. Output is a gross list of possible targets.
Target Approach: Utilizing a number of possible approaches, one that is appropriate for the client is determined. For example, some companies may have business development or sales teams who could participate in this stage, or on the other hand for reasons such as confidentiality, resource scarcity, etc this might need to be put into the hands of specific individuals (senior executives, dedicated M&A executives, 3rd party services, etc.). Each company is different, so this is an exercise of matching needs with capabilities. The objective is to screen the gross target list to elminate those who have “killer facts” such as big contingent liabilities, prohibitive complexity such as a company with a complex ownership structure, our any other aspects that renders a target not acceptable for the next step.
Cultivation: This is a very critical part of the overall process. The essence of this authentic, genuine and meaningful relationship-buidling which requires a combination of individuals with certain skill-sets to ‘sell’ the prospects on being acquired, patience and persistence. I have many approaches, processes and techniques that I have and continue to use to great effect in this regard. Output is a short list of interested targets who have moved to active discussions and in-person meetings.
Target Assessment: During the cultivation phase as it gets more advanced, a critical success factor for effective acquisitive growth is the ability to narrow the list with limited amounts of information. This is important because the next phase is quite intensive so any company can not practically thoroughly assess all such targets. In other words, how does a client gain the insights needed to do this? Some might consider this the ‘phase I due diligence’ whereby, prior to the engagement of expensive resources such as lawyers, accountants, etc., an overview of a target’s current status is determined. Through structured and open discussions, the client engages in discussions with the targets to learn as much as possible..
Preliminary Offer: Structuring of a term sheet or letter of intent based on finding to date. Depending on these findings, certain terms may be included to lay out a) value expectations; b) focus for due diligences and commitment to support it; and c) various legal terms typical for these agreements. This tend to be non-binding agreements meant to establish exclusivity of dealings for a period of time, high level terms that both parties agree to, and confidentiality. Given my background, I have the abilility to craft these documents with minimal legal cost.
Due Diligence: This is yet another element of acquisitions that can take several different forms. Depending on the situation and capabilities of both clients and targets, due diligence activites tend to have different scopes and approaches that match each particular circumstance. A simple example would be a private company target versus a public company. With the latter, sellers often limit potential acquirers to only publicly available information whereas private companies may have limited information at their disposal. Therefore, each approach must be designed for purpose, with the output being a customized plan for a particular target. This leads to both more efficient and cost effective processes as well as deeper insights to help with final decisions.
Deal Making: After the due diligence phase, and with a set of terms already agreed, the negotiations begin to finalized the terms of value, liabilities and the myriad legal and busses considerations that must be addressed and finalized. Whether as chief negotiator or as a trusted advisor to the same, I would bring my experience and talent to bear on this phase as well as some structured approaches/guidelines.
Integration Planning: Concurrent with the commencement of due diligence, full attention is required to determine the structure, resources, plans and teams for post-closing integration. Specific approaches and processes would be employed here to ensure that a proper integration leader is named (critical), robust but prioritized integration plans (e.g. IT and Finance integration might be a first priority for some companies), organizational and assimilation plans, and specific actions in several other area. Among the more difficult and critical elements of integration is culture. While culture is a key consideration in the pre-offer phases, it tends to be among the more challenging aspects to successful acquisitions and an area where experience from a career of hands-on accountability of acquisitions brings valuable insights. Several pro-active approaches can be introduced to the clients to determine which is best to employ with any particular integration.
Execution: From plans to execution requires much more than a roadmap. While such roadmaps are critical, it is the confluence of leadership and human capital, prioritized focused actions to achieve specific results, and finally sustainable integration to bring into the client’s company the full potential of the value creation possible. Tools exist and can be created to provide structure and management support to achieve this consistently.
Important And Strategic Elements Of A Growth By Acquisition Approach
This program has thus far concentrated on the role that acquisition strategies play in driving growth.
However, this assumes that the acquisitions are carried out properly on its own. Experience has shown that acquisitions may both produce and destroy value, with the execution of the transaction typically making the difference.
The following are crucial and strategic elements that support successful acquisitions:
• Considering strategic fit: Purchasing merely for the sake of purchasing is little more than management hubris. The target businesses should in some manner meet the needs of the buyer’s company strategy (i.e. product or service line, geographic reach, etc.).
• Addressing culture fit: Due to cultural mismatches between the two merging organizations, some of the largest mergers in history have failed. It is important to take into account a company’s culture because it directly affects how it creates value.
• Doing thorough due diligence: This guarantees that the buyer “looks beneath the hood” of the company they are buying and that the price they are looking to pay for the company reflects its intrinsic value.
• Integration: Even when the share purchase agreement’s ink dries, the deal is not finalized. The two businesses must now start an integration process to ensure that they grow into something greater than the sum of their individual parts.
Advantages Of Growth Acquisition
10 advantages of expanding your company through acquisition
If you’re deciding whether to enter into an acquisition contract, you might wish to take into account the following list of acquisition benefits:
1. Strengthens a failing business
The company you work for might be going through a period of underperformance, and an acquisition might be the answer. The ability to work together as a team rather than alone may be a key factor in the business’ success. As you get to share resources with the company you’re merging with, this can assist keep the business from failing.
2. Secure financing for growth
By making an acquisition, a company might gain access to money or other important assets that it might not otherwise have at its disposal. You can easily acquire these assets with the aid of an acquisition. The firm and its employees may benefit from collaborating with a company that has sufficient resources because the development of the enterprise is the ultimate objective.
3. Have access to skilled personnel of high caliber
An acquisition can aid in boosting both the amount and quality of employees who are knowledgeable about the demands of the company. The experienced staff often stays on the firm payroll after an acquisition is completed so they can integrate. Their business acumen contributes to the companies’ success after the merger.
4. Expand the company’s market.
The corporation may diversify its offerings of goods and services as a result of the acquisition. You can make a variety of goods and distribute them to various target consumers. An acquisition often aids in a company’s development and growth.
5. Increase market influence
When you enter a new market, making an acquisition might help you combine market forces and exercise control. The synergy it offers increases your market presence and market share. If you plan to establish branches or subsidiary businesses, an acquisition may assist you lessen competition and preserve market dominance.
6. Make sure more capital is available.
Because the company is now larger after an acquisition, access to cash is improved. Higher cash and funds are available and accessible as a result of the arrangement. Amountable capital may be extended to both companies according on the agreement the companies come to when making the purchase.
7. A decrease in training expenses
Through an acquisition, your company may be able to cut internal training costs by using resources from the other acquired company. The cost of employee training is not necessary if the acquired firm develops its resources. You can use the company’s resources, depending on their state of development, to train other employees so they can develop their skill set.
8. Boost the competitiveness of your business
A purchase can take care of the requirement to adhere to higher standards as a result of the development in technical advancements. By joining forces with a smaller company that possesses the required technologies, a larger corporation can maintain its competitive position. Long-term gains from this may accrue to both businesses.
9. Lower production expenses
If you can use another company’s production facilities, facilities, and storage space, merging with them can save your production expenses. Building these kinds of facilities can be expensive, but if the business expands, it might be necessary. Sharing resources could significantly affect the budget and production costs.
10. Enable you to fulfill stakeholder expectations
Stakeholders could have expectations for the company’s growth, and making an acquisition is an effective strategy to achieve such expectations. An purchase increases the likelihood of investment returns, which may gratify the stakeholders. The pressure from the stakeholders can be handled more easily by making an acquisition, and you can even surpass their expectations.
What To Watch Out For During The Entire Acquisition Growth Process
Investigating less evident problems within the target company is the goal of the due diligence procedure.
This ranges from contracts with sizable clients that are about to expire to potential legal proceedings resulting from past business decisions.
But there are a few things that the buyer should watch out for on a more strategic level.
They consist of the following:
• Culture: Even if this phrase keeps coming up, it is crucial to the success of M&As. The culture of the target company should be thoroughly researched by prospective buyers in order to have a sense of what they are getting into.
• Competitive Edge: Is the target company “plain vanilla” or does it engage in any activities that offer it a competitive advantage (which we’ll define as the capacity to produce above-market value over the long term)?
• Leadership: Would the target company’s leadership complement your own leadership team in a positive way? Spend some time with them while conducting your research to see whether this might be the case.
• Possibilities: Are there any prospects that the target firm can take advantage of that your business won’t be able to in the near future? Let’s say it’s because of a service or product line they offer that is expected to see rapid expansion.
• Synergies: Where do your two companies’ synergies lie? Are they really complementary, or does purchasing the target company actually run the danger of causing some of your company’s income streams to be cannibalized?
Program Objectives
The following list represents the Key Program Objectives (KPO) for the Appleton Greene Acquisitive Growth corporate training program.
Acquisitive Growth – Part 1- Year 1
- Part 1 Month 1 Business Assessment – Assessments can be incredibly valuable tools for organizations of all sizes. A comprehensive assessment methodology can help you evaluate your organization across multiple dimensions. But what are business assessments, what do they entail, and what are the benefits? Business assessments can help you identify areas of improvement and potential acquisitive growth. By taking a comprehensive approach, you can get an accurate picture of your organization’s strengths and weaknesses. Assessments can also help you develop actionable plans to improve your business. At their core, business assessments are all about providing clarity. When you’re feeling overwhelmed by the day-to-day details of running a business, it can be difficult to step back and get a clear picture of where your company is headed. That’s where assessments come in. By taking a comprehensive look at your company’s strengths and weaknesses, you can develop a clear road map for success. Assessments are an essential part of any business plan. By evaluating your company’s strengths and weaknesses, you can develop a roadmap for growth. Furthermore, assessments can help identify areas where your company may be at risk. By addressing these risks early on, you can avoid potential problems down the road. In addition, assessments can help you benchmark your company’s performance against others in your industry. This benchmarking process can give you valuable insights into areas where your company may need to improve. Ultimately, regular business assessments are a crucial tool for any organization that is looking to grow and thrive.
- Part 1 Month 2 Strategic Aspiration – A Winning Aspiration defines the purpose of your enterprise, its guiding mission and aspiration, in strategic terms. The first choice of the strategic choice cascade is winning aspirations. Here we ask, “what is our winning aspiration.” Strategically, our winning aspiration defines our purpose. Aspirations are a view of the future. Qualified with “winning,” it is the ideal future that we strive to achieve. Unless you deliberately set out to win, it is impossible to do so. A business that only wants to participate rather than succeed will invariably fall short of making the difficult decisions and large investments necessary to succeed. Aspirations that are too modest rather than lofty are much more harmful. Most businesses fail because they have low expectations.
- Part 1 Month 3 Segment Focus – Every company aspires to grow. But, in a market where competition is fierce, inorganic business growth requires insight and innovation. Segmenting the market and customers is among the most effective techniques to promote acquisitive growth. Yet as numerous businesses have shown, artful segmentation can result in a significant competitive advantage. The purpose of segmentation is to inform your marketing approach. Using this method, it is feasible to recognize and categorize groups of potential clients based on their shared preferences, needs, and interests. This method effectively identifies the demographics most likely to value a specific good or service you provide. Furthermore, it may assist you in positioning that service so that it outperforms that of your rivals.
- Part 1 Month 4 Targeted Offerings – Everything the market offers, be it products or services or any experience, is known as a market offering. Market offerings are also divided among themselves based on the nature of the offering. Read along to understand the role and value of market offerings. Individuals within a market have different wants and needs. As a result, businesses in the market offer various products and services. The ultimate aim of businesses is to fulfill all the varying wants and needs of the population. Providing better target offerings and standing out in the market will eventually lead to more loyal customers and a broader customer base. People expect businesses to add value to their lives in various ways, precisely the purpose of market offerings – satisfying customer needs.
- Part 1 Month 5 Target Pool – The purpose of this workshop is to map out the offerings that one wants to develop or enhance for the focus segments defined by WDP3. A target pool is at the intersection of Targeted Offerings and Focused Segments. For example, if your strategy is focused on growing a currently manufactured product beyond your existing markets, you’ll want to know all the players who make these products in the markets where you don’t currently play but aspire to. In this simple case, the target pool would be derived by researching the current suppliers in these focus segments and profiling them for certain things such as size, channels to market, etc. The approach of this workshop is to take the Targeted Offerings and in a way and ‘map’ them with the Segment Focus areas we developed previously. In reality you might only need to do one or few of these approaches, but the workshop can develop the understanding and skills to do this work, which is in essence synthesizing the ‘strategic play’ associated with any acquisitive growth program.
- Part 1 Month 6 Target Identification – Target identification in acquisitive growth is the process of identifying potential companies or assets that align with the strategic objectives of the acquiring company. It involves conducting comprehensive research, market analysis, and due diligence to evaluate various factors such as financial performance, growth potential, synergies, industry trends, competitive landscape, and cultural fit. The goal is to identify targets that offer strategic value and can contribute to the acquirer’s growth, profitability, market position, or diversification objectives. This process requires careful evaluation, consideration of risks, and alignment with the acquiring company’s overall M&A strategy to ensure successful integration and value creation.
- Part 1 Month 7 Target Approach – All business investors are “financial” investors – the real question is how “strategic” is their ability to leverage the assets of the target. Providing practical guidance on approaching a business target and conducting initial due diligence depends on the investor’s criterion, competencies, and execution bandwidth. At this point, you will have identified a target or group of targets and you are attempting to learn enough about the target to determine whether to proceed with developing a meaningful indication of interest. Of course, an active seller is likely prepared for the sale process and represented by an advisor who is postured to provide the financial and operating information necessary for investors to quickly determine the suitability of a deal (i.e., a pitchbook and defined protocols for communication and information access). However, many desirable targets may not be seeking a sale because business conditions are favorable, and their businesses have been managed to provide options to the owners regarding continued independence and turn-key ownership and management succession. If the former, you, as a prospective buyer may have already pinged on the radar of the seller, and if the later, you have mined for target opportunities and are ready for the next step to accomplish an acquisition.
- Part 1 Month 8 Deal Approach – The M&A landscape is becoming increasingly competitive and the balance of power is shifting further in favour of buyers. For attractive businesses, however, sellers may wish to make divestments through an auction process which is designed to elicit competitive bidding among interested parties to facilitate the sale of a business or stake in a company at the highest price and on the best possible terms. Not all transactions require collaboration between the buyer and the seller, however. In many instances, an auction is still a better approach than a negotiation. The trick is in knowing which process to use when. To make that choice, you need to clearly understand your potential buyers, the characteristics of the asset in question, your own priorities, and the relative importance of speed and transparency to obtaining the best price.
- Part 1 Month 9 Cultivation – (non-auction)
- Part 1 Month 10 Cultivation – (organized process)
- Part 1 Month 11 Confirm Target – Assuming initial contact and conversations go well, the acquirer asks the target company to provide substantial information (current financials, etc.) that will enable the acquirer to further evaluate the target, both as a business on its own and as a suitable acquisition target. After producing several valuation models of the target company, the acquirer should have sufficient information to enable it to construct a reasonable offer; Once the initial offer has been presented, the two companies can negotiate terms in more detail.
- Part 1 Month 12 Talent Assessment – Talent decisions can be made with less precision, discipline, and data but frequently require more complexity than other integration decisions (such as decisions about goods, markets, or customers). M&A leaders must “up their game” in talent assessment if they want to succeed. In the end, the acquirer must decide if current employees from the target (the acquired company) are the most qualified to carry out the goals of the new organization.
Acquisitive Growth – Part 2- Year 2
- Part 2 Month 1 Talent Strategy – There are numerous tactics available for talent acquisition. But not every organization benefits from every method or strategy. When developing your strategy, consider the following factors: industry, size, development trajectory, types of positions, leadership, and more.
- Part 2 Month 2 Integration Strategy – The process of integrating a buyer and seller to the extent required to realize the anticipated benefits from a merger or acquisition is known as an M&A integration. An M&A integration plan outlines the merger’s goals, top priorities, performance indicators, non-negotiables, and scope.Getting agreement among your leaders on the integration strategy is the first stage in an M&A integration. At least two to three months before the deal closes, they should make it clear.
- Part 2 Month 3 Business Plan – Lack of a business strategy before an acquisition is one of the main mistakes that many M&A practitioners make. When considering an M&A, the business strategy is a vital resource. It provides comfort to those funding the deal that the reasoning behind it is sound and that the decision to acquire is not being made on a whim, as well as a roadmap for what you’re looking for in a business acquisition.
- Part 2 Month 4 First 90-Day Plan – HR must be quick and efficient when acquisition is at the core of a company’s growth strategy. The first 90 days are crucial for the organisation’s long-term performance as well as for the retention of individual employees. We can win hearts and minds by day 90 and have a better probability of them becoming productive team members if we have a robust acquisition plan.
- Part 2 Month 5 Valuation – One of the biggest challenges in negotiating a business acquisition is typically price haggling. The intricacy of business valuation makes this more challenging because a fair value cannot be determined without thoroughly examining the company’s financial data, sales trends, customer and supplier base, and many other factors.
- Part 2 Month 6 Synergy Analysis – A significant driver of value in M&A transactions is the potential for establishing synergies. A synergy is the idea that two businesses might be valued more highly when united than when valued separately. Knowing the possible synergies in an M&A transaction is crucial to any agreement, for both the buyer and the seller.
- Part 2 Month 7 Due Diligence (Foundational – Foundational due diligence is an organization’s baseline due diligence requirements that they must have on file for every vendor relationship, regardless of risk level, in order to do business with them. With origins in the private-sector world of business and finance, the term “due diligence” refers to the process through which an investor (or funder) researches an organization’s financial and organizational health to guide an investment (or grantmaking) decision. The decision to fund or not to fund is based upon a balance of objective data analysis, insight into the general state of organizational health and stability, and intuition. A sound and thorough due diligence review is the process through which all the factors that make up that equation are uncovered and understood. It is the process in which a program officer seeks the “truth” about an organization. Foundation program officers are faced with multiple challenges in assessing whether to recommend a grant to their board or decision-making committee. First, they must ascertain whether and to what extent the proposed activity coincides with the foundation’s guidelines and priorities. Next, they must assess the worth of the proposed activity itself — does it advance the fi eld, provide needed services or generate new learning? If the proposal survives this initial scrutiny, it must then be weighed for its relative merits beside many other worthy proposals. This process requires a great deal of skill and sensitivity. Due diligence protects a foundation’s investments and reputation and advances its mission and overall strategy.
- Part 2 Month 8 Due Diligence (Business Plan) – When you receive a proposal on your desk, the first step of proposal review is generally a consideration of the alignment of the applicant organization and proposed project with your foundation’s guidelines and interests. If this initial review is positive, due diligence typically commences with broad research and information gathering to provide a good understanding of the organization, how it fits into the field and the way in which this project will advance your foundation’s strategy. You might also contact colleagues for their view of the organization and its work. Then, you move on to get to know the applicant on a deeper level, including interviews with some combination of the executive director, board chair, other board members and staff members key to the proposed project. Each of these activities is covered in depth in this tool.
- Part 2 Month 9 Deal-Making (Direct Negotiation) – Direct negotiations are a deal making process in which an agency may contact a single contractor of its choice to submit a quote or tender without having first gone through a genuine competitive process.
A variation to an existing contract can also be a direct negotiation. Bargaining between buyer and contractor is a critical element of the process. The objective is to reach agreement on all terms and conditions and to obtain the goods and services at a price that is fair and reasonable to both the contractor and the agency. Direct negotiations are not intended to avoid competition or to discriminate against any organization and must be conducted in a manner consistent with the standards of behavior and requirements. A suitable assessment, based on comprehensive knowledge gained through specific market research, will need to be made to justify direct negotiation. - Part 2 Month 10 Deal-Making (Auctions) – Many (if not most) complex deals between buyers and sellers—from home sales to purchasing auctions to corporate mergers—qualify as auction deal making. Deal making (auctions) give sellers the opportunity to avoid making the difficult tradeoffs of traditional negotiations or auctions— competition versus value creation, for example, or many versus few bidders. In fact, sellers can take the best of both worlds— negotiations and auctions—to ensure they get a great deal. Auction deals have the following features: 1. One-on-one negotiations. At some stage of the deal making process, the seller engages one or more buyers in private discussions about the asset on the table. 2. One or more rounds of bidding. The seller also pits potential buyers against one another in an auction. 3. Several, but not too many, potential buyers. Deal making at auctions need enough parties to spark an auction but not so many that one-on-one negotiation would be difficult for the seller to manage. 4. Process ambiguity. In a traditional auction, the seller determines the process (whether there will be a single round of bidding or multiple rounds, for instance), and buyers are passive participants. In auction deal making, by contrast, the process is up for grabs. Buyers can try to shape the process to their advantage, as in the case of an auction contestant who approaches a seller about negotiating privately to move beyond the single issue of price. In general, whether you are the process setter or a bidder in an auction that has features of a negotiation, don’t assume that the rules are set in stone. Instead, change the game by thinking about how you can influence the rules, parties, and assets to your advantage.
- Part 2 Month 11 Documentation – The paperwork phase of a merger or acquisition is crucial. It might be regarded as the merger and acquisition process’s soul. With due diligence complete, parties make the final decisions on moving forward to execute the transaction. For legal teams, this comes with several responsibilities. Corporate or pre-clearance filings must be made in advance of the closing date. These include merger filings, amendments, ordering of good standings, or issuance of bring-down letters.
- Part 2 Month 12 Communications – An increase in M&A activity indicates a potential deal for entrepreneurs, business owners, and C-suite executives. In the event that a tempting deal is successful, it would be advisable to view an employee communication plan as a crucial component.
Methodology
Acquisitive Growth
It’s challenging to make this kind of acquisition successful. Seven fundamental operating principles are used by profitable corporate and financial purchasers, according to research. Almost all phases of the acquisition process, from the selection of candidates through post-merger management, are impacted by these ideas.
• Insist on cutting-edge operating tactics.
• If you can’t identify the leader, don’t make the deal.
• Provide top executives with significant incentives.
• Connect pay to variations in cash flow.
• Accelerate the rate of change.
• Encourage lively interactions between the board, managers, and owners.
• Employ the top acquirers.
Insist On Cutting-Edge Operating Tactics
High-profile leveraged buyouts like those of Duracell International, Uniroyal, and RJR Nabisco have garnered a lot of attention since the early 1980s. Prices, clever financial arrangements, and bargaining strategies have received a lot of attention. However, the other 2,200+ buyouts that took place during that time period and the fundamental changes in operational procedures that led to profitable outcomes for many of those businesses have received little attention. Although many observers think that LBO enterprises find hidden treasures in the market, more often than not, they only concentrate on enhancing operations.
Two acquisitions, Sunglass Hut International and Snapple Beverage Corporation, show that operating performance—rather than financial leverage, market timing, or industry selection—is the main driver of value creation in successful acquisitions.
Desai Capital focused on accelerating sales growth and developed a new strategy to achieve so when it acquired Sunglass Hut. By acquiring smaller stores in turn and introducing a new store model, Sunglass Hut has expanded from 150 locations to more than 800 since the initial acquisition in 1988. This growth has led to an astounding 37% yearly return. The business introduced a broad product selection rather than depending on two or three popular lines, replaced clerks with limited knowledge of sunglasses with educated customer-service specialists, and implemented a low-cost regional approach.
Another illustration of operating improvements is the 1992 purchase of Snapple by renowned financial acquirer Thomas H. Lee Company. Snapple launched an aggressive growth strategy based on quick global expansion and product range extensions shortly after the takeover. The business immediately established its production and distribution network since it anticipated that rivals will soon release their own natural teas and fruit juices. It entered into contractual agreements with bottling and distribution businesses that had excess production capacity, allowing it to launch its product one year before major rivals like Fruitopia (from the Minute Maid division of Coca-Cola Company) and achieve a competitive advantage.
As the Snapple case demonstrates, innovative operating methods help acquirers succeed in fiercely competitive markets like the American food and beverage sector. The takeaway: Don’t limit your search for success to high-growing industries.