I dont always like to put up quotations..but this one is real good

A mind once stretched by new thoughts can never regain its original shape." -Albert Einstein

Scale up your enterprise..

'Startups thrive in an environment of chaos where multiple tasks are done, undone and re-done often times guided by just a leap of faith. Decisions are taken in quick time without long (boring?!) meetings typically by a small team of extremely committed and passionate people. Systems, processes and procedures are considered inhibitors to their competitive advantages of speed and innovation. But as the startup grows, the lack of systems and processes start inhibiting growth; indeed, the company can implode before long without adequate attention and focus on having and implementing systems and processes. These processes and procedures relate to every functional area of the startup and these functional areas cannot scale, operate efficiently and effectively without the right systems. And the management team cannot manage the growth of the company if they cannot measure and track activities, people, money, time, contracts and documents among other things. '

Sanjay Anandram

Motto for a start up ...

The foundation in turn is determined by the company culture and the quality of the people. The culture must value discipline, diligence and data. Discipline to ensure that systems and procedures are implemented and followed; Diligence to ensure that the systems are continuously working as they should across the company; Data to ensure that the quality of decision making goes beyond pure leap of faith.

Excerpt from a post from : Arun Natarajans blog.
http://startupjourney.blogspot.com/

Article 21 Indian Constitution

Health as one of the Fundamental Human Right, has been accepted in the Indian Constitution. Although Article 21 of the Constitution requires the State to ensure the health and nutritional well being of all people, the Federal Government has a substantial technical and financial role in the sector. Due to growing importance of healthcare industry, it has been conferred with the Infrastructure status under section 10 (23G) of the Income Tax Act,

Quite impressed : Scouting For The Ideal Business Model

http://www.expresshealthcaremgmt.com/200604/coverstory01.shtml

Author : rita_dutta@rediffmail.com

An impressive read,current and pertinent thoughts,well adorned with snippets from market mavericks.
A follow up three years down the line on strategies which worked and which didnt would really help.

Comment : Buisness week article on innovation channels..

How Whirlpool Puts New Ideas Through the Wringer
http://www.businessweek.com/innovate/content/aug2009/id2009083_452757_page_2.htm


Dr.Anshul Govila MD Aug 9, 2009 4:38 AM GMT This article makes me think whether hospitals and the healthcare industry could use such a strategy.The channels of formal research in medicine are getting clogged by two much peer pressure and back biting.Whats is required is an independant neutral assesment of an idea, adequate and timely funding , cost evaluation and and final application.A hospital could benefit from a 'Chief Innovation Officer'.A senior clinician maybe to whom all the other innovative clinicians report.I would love to here from physicians who have such an successful existing model of research and innovation in their hospital.

Likert scale

A Likert scale (pronounced 'lick-urt') is a type of psychometric response scale often used in questionnaires, and is the most widely used scale in survey research. When responding to a Likert questionnaire item, respondents specify their level of agreement to a statement. The scale is named after Rensis Likert, who published a report describing its use (Likert, 1932).

Sample question presented using a five-point Likert Scale

A typical test item in a Likert scale is a statement. The respondent is asked to indicate his or her degree of agreement with the statement or any kind of subjective or objective evaluation of the statement. Traditionally a five-point scale is used, however many psychometricians advocate using a seven or nine point scale.

Ice cream is good for breakfast

1. Strongly disagree
2. Disagree
3. Neither agree nor disagree
4. Agree
5. Strongly agree

Likert scaling is a bipolar scaling method, measuring either positive or negative response to a statement. Sometimes a four-point scale is used; this is a forced choice method since the middle option of "Neither agree nor disagree" is not available. Likert scales may be subject to distortion from several causes. Respondents may avoid using extreme response categories (central tendency bias); agree with statements as presented (acquiescence bias); or try to portray themselves or their organization in a more favorable light (social desirability bias).

Scoring and analysis

After the questionnaire is completed, each item may be analyzed separately or in some cases item responses may be summed to create a score for a group of items. Hence, Likert scales are often called summative scales.

Responses to a single Likert item are normally treated as ordinal data, because, especially when using only five levels, one cannot assume that respondents perceive the difference between adjacent levels as equidistant. When treated as ordinal data, Likert responses can be collated into bar charts, central tendency summarised by the median or the mode (but not the mean), dispersion summarised by the range across quartiles (but not the standard deviation), or analyzed using non-parametric tests, e.g. Chi-square test, Mann-Whitney test, Wilcoxon signed-rank test, or Kruskal-Wallis test.^[1]

Responses to several Likert questions may be summed, providing that all questions use the same Likert scale and that the scale is a defendable approximation to an interval scale, in which case they may be treated as interval data measuring a latent variable. If the summed responses fulfils these assumptions, parametric statistical tests such as the analysis of variance can be applied. These can be applied only when the components are more than 5.

Data from Likert scales are sometimes reduced to the nominal level by combining all agree and disagree responses into two categories of "accept" and "reject". The Chi-Square, Cochran Q, or McNemar-Test are common statistical procedures used after this transformation.

Consensus based assessment (CBA) can be used to create an objective standard for Likert scales in domains where no generally accepted standard or objective standard exists. Consensus based assessment (CBA) can be used to refine or even validate generally accepted standards.

Level of measurement

The five response categories represent an Interval level of measurement.

Rasch model

Likert scale data can, in principle, be used as a basis for obtaining interval level estimates on a continuum by applying the polytomous Rasch model, when data can be obtained that fit this model. In addition, the polytomous Rasch model permits testing of the hypothesis that the statements reflect increasing levels of an attitude or trait, as intended. For example, application of the model often indicates that the neutral category does not represent a level of attitude or trait between the disagree and agree categories.

Blake and Mouton: The Managerial Grid

The Managerial Grid

Blake and Mouton set out to apply the ideas of behavioural scientists such as Rensis Likert American educator and organizational psychologist Rensis Likert (pronounced 'Lick-urt') (1903–1981) is best known for his research on management styles.

He developed Likert Scales and the Linking pin model. to the practice of management. They built on studies conducted at Ohio State University and the University of Michigan in the 1940s which attempted to identify the behavioural characteristics of successful leaders. Blake and Mouton identified two fundamental drivers of managerial behaviour as concern for getting the job done, and concern for the people doing the work. They argued that, on the one hand, an exclusive concern for production at the expense of the needs of those engaged in production leads to dissatisfaction and conflict, thus adversely affecting performance; but that, on the other hand, an excessive concern to avoid conflict and maintain good relationships is also detrimental to the achievement of goals and objectives.

In order to provide a framework for describing management behaviours, the two variables of "concern for production" and "concern for people" were plotted on a grid showing nine degrees of concern for each, from 1 indicating a low level of concern, to 9 indicating a high level of concern. Five positions on the grid represent five differing managerial behaviour patterns.

The model is represented as a grid with concern for production as the X-axis and concern for people as the Y-axis; each axis ranges from 1 (Low) to 9 (High). The resulting leadership styles are as follows:

• The indifferent (previously called impoverished) style (1,1): evade and elude. In this style, managers have low concern for both people and production. Managers use this style to preserve job and job seniority, protecting themselves by avoiding getting into trouble. The main concern for the manager is not to be held responsible for any mistakes, which results in less innovative decisions.

• The accommodating (previously, country club) style (1,9): yield and comply. This style has a high concern for people and a low concern for production. Managers using this style pay much attention to the security and comfort of the employees, in hopes that this will increase -performance. The resulting atmosphere is usually friendly, but not necessarily very productive.

• The dictatorial (previously, produce or perish) style (9,1): control and dominate. With a high concern for production, and a low concern for people, managers using this style find employee needs unimportant; they provide their employees with money and expect performance in return. Managers using this style also pressure their employees through rules and punishments to achieve the company goals. This dictatorial style is based on Theory X of Douglas McGregor, and is commonly applied by companies on the edge of real or perceived failure. This style is often used in case of crisis management.

• The status quo (previously, middle-of-the-road) style (5,5): balance and compromise. Managers using this style try to balance between company goals and workers' needs. By giving some concern to both people and production, managers who use this style hope to achieve suitable performance but doing so gives away a bit of each concern so that neither production nor people needs are met.

• The sound (previously, team) style (9,9): contribute and commit. In this style, high concern is paid both to people and production. As suggested by the propositions of Theory Y, managers choosing to use this style encourage teamwork and commitment among employees. This method relies heavily on making employees feel themselves to be constructive parts of the company.

• The opportunistic style: exploit and manipulate. Individuals using this style, which was added to the grid theory before 1999, do not have a fixed location on the grid. They adopt whichever behaviour offers the greatest personal benefit.

• The paternalistic style: prescribe and guide. This style was added to the grid theory before 1999. In The Power to Change, it was redefined to alternate between the (1,9) and (9,1) locations on the grid. Managers using this style praise and support, but discourage challenges to their thinking.

Synergogy

Blake and Mouton also developed their own educational theories on how best to teach Grid theories and concepts in the work group context. These are described in the book Synergogy published in 1984. The term 'synergogy' was coined by Blake and Mouton, and describes a systematic approach to learning that leads team members to learn from each other in a co-operative and participative way. Synergogy, defined as "working together for shared teaching", was contrasted to pedagogy, where instruction is given by a teacher, and andragogy, where the teacher acts as a facilitator. Four synergogic learning designs were developed to provide a structure for the process of learning. The 'Team Effectiveness Design' and the 'Team Member Teaching Design' relate to the acquisition of knowledge. The 'Performance Judging Design' relates to the development of skills. Lastly, the 'Clarifying Attitudes Design' concerns awareness and development of appropriate attitudes. Techniques employed include individual preparation, presentations, multiple choice and true/false tests and team discussion. The role of the learning administrator is limited to making sure that the learning design is effectively implemented. These methods were first used by Blake and Mouton to teach university courses but were later adapted to workplace training sessions.

You can see disparate managing styles in a hospital and place your mangers accordingly .

Nano Ganesh,Ossian Agro Automation

Indian farmers use mobile phones to control irrigation
Developer of the technology Mr. Santosh Hiralal Ostwal
July 23, 2009, 12:50 AM — IDG News Service —
Mobile Operator Tata Teleservices is testing technology that allows farmers to use their mobile phones to remotely monitor and switch on irrigation pump sets in far flung locations.
The technology, called Nano Ganesh, is being tested in two villages in the Indian state of Gujarat.
In India, where the electricity supply is erratic, farmers often walk several kilometers to where their irrigation pumps are located, only to find that there is no electricity available, Lloyd Mathias, chief marketing officer of Tata Teleservices, said on Wednesday.
By dialing a code number from his mobile phone to a wireless device attached to the pump, farmers can now remotely monitor the electricity supply, and also switch the pump on and off, Mathias said.
The technology for this application was developed and is manufactured by Ossian Agro Automation in Pune in western India. To use the service, the farmer pays Tata Teleservices 2,700 rupees (US$56) for the device attached to the starter on the pump and another 2,000 rupees for the mobile phone, as well as monthly service charges. The mobile phone can be used by the farmer for other communications as well.
Voice communications and SMS (Short Message Service) on mobile phones are getting commoditized, and as in urban markets, customers are looking for value-added services, Mathias said. By introducing technology and services appropriate to rural markets, Tata Teleservices plans to differentiate itself in these markets, and increase customer "stickiness", he added.
The company already uses mobile phones to deliver education content, and agricultural information relevant to rural communities. It has tied up with specialist organizations to provide the content, Mathias said.
India had 109.7 million rural mobile subscribers at the end of the first quarter, up by 17.8 percent from 93.15 million users in the fourth quarter of last year, according to the Telecom Regulatory Authority of India (TRAI).
Rural wireless subscribers accounted for 28 percent of mobile subscribers at the end of the first quarter, TRAI said.
The rural market is seen as the next opportunity for mobile service providers and handset vendors. The key to these markets is the ability to offer appropriate local content and services, Kamlesh Bhatia, a principal research analyst at Gartner said.
Nokia, for example, launched its Life Tools service in June, after a pilot project in the Indian state of Maharashtra. The service offers agriculture information, education, and entertainment targeted at people in both rural areas and small towns.
It is not difficult to sell the concept of mobile phones in rural markets, but operators need to boost their revenue in these low-margin markets with other services besides voice, Bhatia said.
Value-added service revenue from rural markets will grow slowly, because customers in these markets will be concerned about the ease of use of new technology and the price for these services, Bhatia said. Many farmers are not technically savvy and are still getting used to using a mobile phone, let alone try out enhanced features and services, he added.
There are currently about 14.1 million irrigation pumps across India, Mathias said. Tata Teleservices plans to roll out the service across the country, once it tests consumer acceptance in the two villages in Gujarat, he added.
The company expects to increase revenue from current customers, as well as add new customers by offering specialized rural services, Mathias said.

Cheer on India ,Soon healthcare will leap into mobile handsets and then using that into rural India

India's Internet Users

'Global Online Population Forecast, 2008 to 2013',
the report noted that emerging markets like India would see a growth of 10 to 20 per cent by 2013.
"In some of the emerging markets in Asia such as China, India and Indonesia, the average annual growth rates will be 10 to 20 per cent over the next five years (2008-13)," the report said.
India's number of Internet users was estimated to be 52 million in 2008.

Reframing the Healthcare Debate in Business Terms

Harvard Business Publishing :Reframing the Healthcare Debate in Business Terms
Karen Berman and Joe Knight

The issues, concerns, and variables involved in finding solutions to the healthcare crisis are too numerous to list. Joe has been involved with healthcare issues for a number of years and in 2007 he was asked by the U.S. Chamber of Commerce to testify before the U.S. Senate finance committee on the subject of healthcare.
Here, we'd like to begin to consider how a business might think about possible solutions. There are two frames that we think are interesting to consider. The first is how innovation and costs are typically related.
In most industries as innovations occur costs come down dramatically. For example, in the personal computer industry, costs have gone down year after year as technology has improved. Innovation is driven by a variety of factors, such as improved speed and functionality. But it is also driven by a desire on the part of consumers and businesses to reduce costs. The consumer reaps the benefit of a less expensive product, which then becomes more accessible. And the business can improve its profit, increase its market share, and offer a more affordable product.
In healthcare, innovation also is driven by a variety of factors, especially the desire to increase our ability to diagnose and treat disease, improving the quality of life — clearly an important driver. However, innovation could also be driven by a desire to reduce costs. But in healthcare, it typically isn't. New treatments and improved procedures can be more expensive, not less. Why? In part because the consumer (the patient) isn't paying for the services. So, the consumer, who is choosing to "buy" the service, doesn't consider the price of the service. All he may pay is his co-pay. So, he may think, "Why not? It doesn't matter how much it costs." So the innovators in healthcare aren't rewarded for lowering costs because that is not the variable that people demand. People demand a better test, a better treatment and so on. But if consumers also knew the costs, and they had to "pay" for it (more on that in a bit), then there would be a demand for innovation to reduce costs, along with improving care.
The second frame we'd like to consider is how insurance typically works in other industries.
Let's look at both auto and homeowner's insurance. We purchase that insurance to protect us from catastrophic risks. The insurance company underwrites the risk and we pay a premium for their protection. When we experience a serious loss to our home (fire) or auto (collision) the insurance steps in to cover our losses. We ourselves, though, pay to maintain our cars and homes. Maintenance costs are not covered by insurance. The market handles the cost and pricing on maintenance and up-keep on our homes, and auto and homeowners' insurance covers us when unusual crises come along.
Medical insurance covers both maintenance and catastrophic health issues. And, because medical costs aren't fully borne by the consumer (except for a co-pay that isn't related to the market price of the service) we as consumers can't gauge whether the service is worth the cost or even demand that innovation bring the cost down. We don't spend time managing it. And that means we very well might overuse the service, because we don't really have to pay for it. The result is that the price of services isn't market based (think supply and demand, costs, etc.) Insurers end up raising premiums to cover higher costs and usage.
Joe is an owner of Setpoint Systems Inc., a business based in Utah. Setpoint has struggled with the issue of health insurance costs for years. It had some employees or their families with severe health problems, and its health insurance premiums skyrocketed. In 2004, when Health Savings Accounts or HSAs, were introduced, Setpoint immediately signed up. They provided the company with a way to intelligently manage healthcare costs, allowing Setpoint to save dramatically on premiums and also saving employees thousands of dollars. Setpoint was even able to contribute substantially to its employees HSA accounts because of the premium savings.
HSAs also have features that drive cost innovation and mimic other types of insurance — consumer involvement in costs and payment of maintenance services.
In a future blog we'll look in more in detail at Setpoint's experience with its HSA plan and the pros and cons of HSAs.

My comments

It is credible for the authors to condense the complex healthcare paradigm in to two simple notions.
Cudos.
I particularly like the piece on health care maintainence .It is true that some people pay more attention to maintain their health than the others.But it is also true that 'lifestyle illnesses' are just a subset of the whole realm of disease.Malignancy and congential disorders top the charts when we see the cost of care.People are born into these diseases dont acquire them after a lifetime of abuse( barring malignancies related to lifestyle issues).Subsidising a gym memberhip might help ,but more important is a closely knit physician-patient relationship at the primary health care level.For that primary health care should be free for all .Secondary health care insurable .And Tertiary health care pay for service.
This is not a universal antidote ,but thought leaders should start thinking on these lines.
Second is the drive to reduce costs in healthcare.We have to start from the medical companies backwards.Medical device makers and drug companies have always enjoyed a benefit of doubt .A benefit which says that they all work towards improving either diagnoses or treatment and all work towards making it affordable.This is far from the truth .Some innovations are cannibalistic .Dont add value but help generate parallel channels of revenue for health care firms.Some innovations are cheap to implement but then are marketed and maintained at a high price as they become revenue earners for the firms.For example ,It is difficult to understand why the price of surgical suture has not gone down over the years though their has been so much innnovation in production ,lean thinking in supply chain management and general decrease in cost of labour by outsourcing several parts of production .
Again on similiar grounds ,it is also difficult to understand why the cost of medication in India is one tenth of that in the States .( a simple paracetamol tablet used as an example ) .What multiplies the cost of medicine.Production ,licencing or just simple legislature.
It is time for debate .A debate which engages physicians ,health regulators ,health care device makers from the third world .A world which is resourceful and simple.And their is cross seeding of thought and action over internationsl boundaries.

How micro-finance institutions beat nationalized banks

26 Jul 2009, 0528 hrs IST, Swaminathan S Anklesaria Aiyar , ET Bureau

In his Budget speech, the FM hailed bank nationalization as visionary and revolutionary . Yet, nationalized banks have, by and large, not reached
the poor. However, micro-finance is now reaching people whom nationalized banks could not. Households getting micro-credit now outnumber poor households. Outstanding micro-finance loans total 80 million. Some borrowers have multiple loans, so net beneficiaries may total 60 million households. This is more than the 55 million poor households, and more than a quarter of India’s 220 million households. Of course, many poor households are still left out, while non-poor households have got loans. MFIs have yet to reach or saturate large areas in India. But they are spreading fast across most states. I am a co-promoter of three MFIs: Arohan in Kolkata, Sonata in Allahabad and Mimoza in Dehra Dun. Within 39 months of existence, Arohan has reached 100,000 poor women. The three MFIs together have 2,50,000 borrowers, and within three years should reach one million people. In another three years they may reach one million each. I am astounded that small ventures can scale up so fast. When launched, these MFIs expected to lose money for four years. But they broke even after two years, because loan defaults were below 0.5% against the expected 2%. Once, MFIs started with loans of Rs 3,000 in the first year, going up to Rs 4,000 in the second year, and so on. But now some MFIs start with Rs 10,000, go up to Rs 15,000 the next year, and so on. They charge around 30% interest. This looks usurious. But moneylenders lend at 50% or more, seize the land of defaulters and make them bonded labourers. MFIs, by contrast, rely on group lending for repayment. If one member of a joint lending group defaults, the others cannot get credit, so they put social pressure on the defaulter to pay up. Credit card companies charge an annual fee plus interest at around 30%. MFIs, like credit-card companies , give small, unsecured loans, and their interest rates are no higher . In both cases, the interest rate reflects the high cost of handling very small loans. Some advocates claim that micro-loans convert poor women into entrepreneurs and greatly reduce poverty. Alas, that’s a gross exaggeration. Loans of Rs 5,000 at 30% interest cannot end poverty.

Many studies (like a recent one of Hyderabad’s slums by Bannerjee, Duflo, Glennerster and Kinnan) show no short-term link between microcredit and
poverty or consumption. Only one in five loans
in Hyderabad created new businesses. Still, beneficiaries spent more pushcarts and cooking pans (for new businesses) and less on tobacco and alcohol. Localities with MFI branches had onethird more businesses than others. In due course, this could have a significant impact on poverty. Poor people have demonstrated an appetite for micro-loans
, and repay them. This proves there is a great demand , and that it’s viable. Even if it does not reduce poverty immediately , mere access to finance is a boon. Banks lose heavily in small loans to the poor — their wages are five times higher than in MFIs, and politicians encourage poor borrowers to default. These two problems, plus corruption, sank the Integrated Rural Development Programme, which provided subsidized micro-credit through nationalized banks in the 1980s. Banks now give loans to MFIs (classified as a priority sector), which then lend to the poor. This raises interest costs, but has proved viable. New problems are cropping up with MFI expansion. Without technical assistance, some businesses fail. Competition in some states is so intense that MFIs accuse rivals of stealing their clients through unethical offers. Some women have borrowed from four or more different MFIs, and could get into debt traps, which also hit MFIs through higher defaults. Moneylenders are said to have entered the MFI business, using thugs rather than group loyalty to enforce payment. Some private equity funds are investing in MFIs, fuelling misgivings that these have become purely commercial and shed their original social mission. These misgivings are legitimate but exaggerated. Micro-finance will always differ from commercial ventures in one respect — the loans go almost entirely to women. Although many husbands appropriate the money, MFIs nevertheless confer status and power on women in a country with oppressive male domination . That’s a huge social change. In Bangladesh, where micro-finance originated, female empowerment has spurred higher women’s education and falling fertility. Mullahs have attacked MFI offices as threats to traditional male and religious dominance. Even if micro-finance does not create instant poverty reduction, it creates profound social and gender changes. That makes it doubly inclusive. For that reason alone, micro-finance achieves what nationalised banks cannot.

My comments
There are two things I agree to and two I don't .The cynicism first.
Microfinance in rural india is as old as India itself.To simply taint rural money lenders and go ahead without regarding their contribution to the microfinance sector in India is probably naive.The Rastogi's from Lucknow,the Marwari's from Calcutta ,The pathan's etc have all been lending and recovering microcredit loans since ages.The terms of finance and methods of recovery does not always involve strong men .Infact ,Mohammad Yunus's Grameen is also a defaulter on the human rights agenda when you consider how they recover their loans.Though group loyalty is used significantly ,things go raw if you lift the viel off your eyes. This is a little write up on the same.http://mindmarinate.blogspot.com/2009/07/capitalist-inside-philanthrope.html
A rider on is .Microfinance probabably did not originate in Bangladesh .It was a spin off of the Mughal Tehsildari.Later picked up by the Lala's of India.
Now ,the two affiramative points.
Definately ,microfinance can be as bad a debt trap as any regular loan .Especially if the debtors get involved in multiple loans from multiple organisations.Also on several occassions the rural female is used as a front for the loan procurement.Just as many panchayats elect the female representative to make a 'puppet panch'.
Second the appetite for micro loans in the poor is also well established.These loans are often used in the sowing season to buy grain ,in the harvest season to transport the crop to the market, in the wedding season to wed the daughters off and then finally also for small ventures.

Brutus ...

"Had you rather Cæsar were living, and die all slaves, than that Cæsar were dead, to live all free men? As Cæsar loved me, I weep for him; as he was fortunate, I rejoice at it; as he was valiant, I honour him; but, as he was ambitious, I slew him." -- Act III, Scene II, Julius Caesar

Friends, Romans, healthcare insurers, lend me your ears. I come to bury health plans, not to praise them. If you read the pivotal scene cited above, in which Brutus explains why he slew the beloved Julius Caesar, he explains that while the man may have had many fine qualities, he simply couldn't be allowed to live--since his lust for power was far too great. And that, my friends, is where things may stand with the commercial health industry as it exists today.

---Anne Zeiger Fierce Healthcare

Insight from an Old timer:Thanks Mr Michael Lewis

I chanced up on this comment in a Fast Company article...I ve been trying to get on touch with the author...registered on Fast Company and all ...till then just "Warm Regards Mr .Lewis...."

I really like the words in italics below...curt and true.

ACCORDING TO THE FEDERAL GOVERNMENT TOO MUCH OF AMERICA’S GDP IS SPENT ON HEALTH CARE.

BUT THE FEDERAL GOVERNMENT CREATED THE PROBLEM:
Decades ago the government passed ‘pay or play’ tax incentives that encouraged employers to provide employees with health insurance.
And America was hooked on health care the way junkies get hooked on smack. The dealer gave free samples until the client was hooked.
When I was young America was the world’s wealthiest nation. And employer provided health insurance paid 100% of medical costs. Because it was free it was abused. Mom took children to the emergency room for a rash and to the doctor for a small cut. Demand was artificially high.
Cost shifting provided for the uninsured. Patients with good insurance policies and wealthy patients with no insurance policies received inflated invoices to cover the costs of those who could not pay. Health care providers and hospitals robbed from the rich to provide health care for the poor.
It is instructive that during the time when America enjoyed great wealth the Federal Government expressed no concern for the plight of the uninsured!
But over time manufacturing jobs moved overseas and were replaced with lower paying service economy jobs. Consequently, employers offered health insurance with less coverage and higher deductibles and co-pays.
Were factory jobs lost because America could not compete with manufacturers in countries where government paid for health care? Regardless, American leaders would not raise tariffs to level the playing field and signed GATT and NAFTA into law!
And America’s leaders permitted millions of ‘illegal’ aliens to cross the border to do work American’s would not do. Our schools educated their children, our State governments gave them drivers licenses, our banks granted them mortgages and our hospitals provided them health care.
BOGUS SOLUTION
Now that America is the worlds biggest debtor nation the Federal Government has decided the plight of the uninsured is unconscionable and universal coverage is a moral imperative.
But this is not about the 46 million uninsured. It is about assuring health insurance companies’ market share and health care professionals expected incomes and lifestyles.
The health system in America has been based on a larger and more affluent generation of young policy holders offsetting the health cost of middle aged and seniors. This formula is being upset by the WWII baby boomers generation approaching retirement and the global recession.

President Obama wants every American citizen to be required to buy a health insurance policy. He compares it to the requirement that motorists purchase auto insurance. But while driving is a privilege, life and the pursuit of happiness is a right!

Where in the Constitution or Bill of Rights is the Federal Governments authority to require the purchase of a health insurance policy as a condition of having been born?Where is freedom when government has the power to tell you how to spend after tax dollars? What distinguishes disposable income from taxes?
As for the proposal that the IRS be charged with fining citizens who do not purchase a health insurance policy, since the federal government just prints more paper money to pay debt why is taxation or the IRS even necessary. Just shutdown the IRS and transfer its budget to indigent care!
FREE MARKET IS THE SOLUTION
Is providing health care an enumerated power or responsibility of the Federal Government?
The Federal Government lacks any authority to preach fiscal responsibility. It has exhibited none in my lifetime and has reduced the wealthiest nation on the planet to world’s biggest debtor nation.
But Ma and Pa citizen have had to balance a checkbook their entire lives. The solution is to return control of health care spending to them.
Pass a law making it illegal for an employer to offer health insurance as an employee benefit. End wage stagnation and give employees raises instead.
Doing away with group health insurance and forcing insurance providers to compete for individual business will permit cost conscious Ma and Pa to shop for the best deal, like they do auto insurance. Then the free market will bring costs under control!

The capitalist inside the philanthrope

The Under belly of Grameen

My Bangladeshi barber has another story to tell about 'Grameen'.The more i told him about my days in Churni the more he told me about the misery and prostratism Grameen Bank has brought on the masses in Bangladesh .

Maybe I am not focusing on the macroeconomic picture but the anecdotes brimming on the lips of the regular Bangaldeshi are quite vulgar. 'A literal Blood sucker' the other barber chimed in when he heard the name Mohammad Yunus.

So why so much angst .I thought Mohd Yunus would be a celebrated 'Bangla' bhai.More Like a war hero, a man who helped build a nation .Received the highest accolades a western man can bestow . At least that is what you gather about him from the media.So why would there be such a disparate opinion.Why would not one but all Bangaldeshi's present in the saloon vehemently disgrace Mr Yunus.

Quite simply because Grameen is a modern day feudal establishment.There is nothing new in microfinance that the Mughals have'nt employed over the ages.The concept of Zamindari ,Jahagirdari brew up with the Mughals.The village rich gave money to the poor s.Both sustainance money and money to do business.

All looks well on the giving end.The issue is how do they behave when it comes to collecting this money with interest.

So if a farmer cant pay up on time.They would take his land,his cow, his daughter.And not necessarily in that order.

Grameen probably does not go as far as the daughter bit.But yes, if you cant make up your weekly installment they do take away whatever they can .The tin roof covering your little house is a particularly appealling commodity .So is your cattle heads . Or your house in case you cease to exist before you pay your due.

The way micro finance in rural areas works is like this. When you take money from 'grameen' .They pool you in to a group of ten debtors.The ten of you pay back a pooled amount in weekly installments and weekly installments alone.If any one of the ten peers defaults , 'grameen' does not accept the payment .This creates incredible peer pressure to pay on time.If you do not succumb to that, they take your roof away.

That should also be acceptable if you are going to take a loan .You would say.You should bear the repercussions of defaulting.I would say why not.

The question to ask is that why should this loan be at a 30 percent interest rate.Is the operational costs for such banks so high that they have to ask for a 3o percent interest rate.Or is the bad debt so significant that it has to be pricey .Or is there hidden capitalist within the hide of philanthrope .

Well the model has been so successful that not only has Mr Yunus catapulted to glory but also to a rather decent personal fortune.

More to come ..as I learn more...maybe I am completely wrong.

This is the link to my previous post on Grameen and Alex Counts

http://mindmarinate.blogspot.com/2009/05/grameen-bank-alex-counts-president-and.html

Anne Zieger ,Fierce IT

Something Close to my heart.
I couldnt have expressed it better.

Digital records are good, but what about all that paper?
By Anne Zieger

Electronic medical records are a unique proposition. While just about any IT installation has to integrate with existing databases or networks, very few are crippled without uploading a bunch of data stored on paper. Right now, physicians and hospitals with EMRs are forced to use ad-hoc solutions when they want to access paper records, but that approach isn't sustainable.
Today, some tech-savvy physicians are capturing the records they need for a particular patient with their iPhone or a handheld document scanner, a short-term solution that has some value. And hospitals can manually pull records when needed by a particular provider, such as an emergency services team, if the patient's history isn't in their EMR.
The thing is, adding manual or patient-specific processes to the mix does nothing to standardize the process of bringing past records online. In fact, looked at one way, they actually make the health system's problems worse, as any additional layer of processes can only add confusion to the mix. For example, if a doctor photographs a patient record, there's no way to update it, which undermines their ability to respond to changing patient needs.
While I have no hard data on this, my sense is that most providers have decided to punt, relegating the issue of paper records to the "we'll handle it someday" bin. It's telling that on the vast exhibit floor at HIMSS this year, OCR scanning and document management solutions weren't very common. Vendors have their ear to the ground--they have to in order to survive--and know what their customers are worried about. Apparently, they aren't being deluged with requests to get that paper-based data online.
I'd argue, however, that the humble, time-consuming grunt work of getting paper records into your clinical data systems is just as important as putting the systems in place. If the purpose of installing those systems is to offer rich data to physicians--and to HIE partners--it makes no sense to only provide information that gets entered after your EMR gets cut over to production status.
Sure, digitizing paper-based data of any kind is a pain in the neck, requires a host of moderately-skilled coders who may require close supervision and costs a great deal over time. Worse, over the short term the efficiencies you generate may rebound more to health insurance companies, who save money as you get more efficient.
Still, it's just about impossible to meet the goals of a digital health record without including history and context. After all, there's no point in truncating medical data if the idea is to make a complete picture available to everyone. So it's time to bite the bullet and get those massive piles of paper charts online. Just grit your teeth and get it done; you'll be glad that you did. - Anne

Types of workflows...Can patient workflow fit into such a simle model ..its like an I with several spikes

Plant types
There are four primary types of plants in the TOC lexicon.
Draw the flow of material from the bottom of a page to the top, and you get the four types.
They specify the general flow of materials through a system, and they provide some hints about where to look for typical problems.
The four types can be combined in many ways in larger facilities.
I-Plant: Material flows in a sequence, such as in an assembly line. The primary work is done in a straight sequence of events (one-to-one). The constraint is the slowest operation.
A-Plant: The general flow of material is many-to-one, such as in a plant where many sub-assemblies converge for a final assembly. The primary problem in A-plants is in synchronizing the converging lines so that each supplies the final assembly point at the right time.
V-Plant: The general flow of material is one-to-many, such as a plant that takes one raw material and can make many final products. Classic examples are meat rendering plants or a steel manufacturer. The primary problem in V-plants is "robbing" where one operation (A) immediately after a diverging point "steals" materials meant for the other operation (B). Once the material has been processed by A, it cannot come back and be run through B without significant rework.
T-Plant: The general flow is that of an I-Plant (or has multiple lines), which then splits into many assemblies (many-to-many). Most manufactured parts are used in multiple assemblies and nearly all assemblies use multiple parts. Customized devices, such as computers, are good examples. T-plants suffer from both synchronization problems of A-plants (parts aren't all available for an assembly) and the robbing problems of V-plants (one assembly steals parts that could have been used in another).
For non-material systems, one can draw the flow of work or the flow of processes and arrive at similar basic structures. A project, for example is an A-shaped sequence of work, culminating in a delivered project.

I have never let my schooling interfere with my education.

Mark Twain (1835 - 1910)

Isnt that credible...something mentioned in 'a beautiful mind' to that affect too

personality types.applies to so many surgeons i know...wondering where i fit

Here are the worst of the toxic personalities out there and how to spot them:

1. Manipulative Mary: These individuals are experts at manipulation tactics. Is a matter of fact, you may not even realize you have been manipulated until it is too late. These individuals figure out what your 'buttons' are, and push them to get what they want.
Why they are toxic: These people have a way of eating away at your belief system and self-esteem. They find ways to make you do things that you don't necessarily want to do and before you know it, you lose your sense of identity, your personal priorities and your ability to see the reality of the situation. The world all of a sudden becomes centered around their needs and their priorities.
2. Narcissistic Nancy: These people have an extreme sense of self-importance and believe that the world revolves around them. They are often not as sly as the Manipulative Marys of the world, but instead, tend to be a bit overt about getting their needs met. You often want to say to them "It isn't always about you."
Why they are toxic: They are solely focused on their needs, leaving your needs in the dust. You are left disappointed and unfulfilled. Further, they zap your energy by getting you to focus so much on them, that you have nothing left for yourself.
3. Debbie Downers: These people can't appreciate the positive in life. If you tell them that it is a beautiful day, they will tell you about the impending dreary forecast. If you tell them you aced a mid-term, they'll tell you about how difficult the final is going to be.
Why they are toxic:They take the joy out of everything. Your rosy outlook on life continues to get squashed with negativity. Before you know it, their negativity consumes you and you start looking at things with gray colored glasses yourself.
4. Judgmental Jims: When you see things as cute and quirky, they see things as strange and unattractive. If you find people's unique perspectives refreshing, they find them 'wrong'. If you like someone's eclectic taste, they find it 'disturbing' or 'bad'.
Why they are toxic: Judgmental people are much like Debbie Downers. In a world where freedom rings, judgment is sooo over. If the world was a homogeneous place, life would be pretty boring. Spending a lot of time with these types can inadvertently convert you into a judgmental person as well.

5. Dream Killing Keiths: Every time you have an idea, these people tell you why you can't do it. As you achieve, they try to pull you down. As you dream, they are the first to tell you it is impossible.
Why they are toxic: These people are stuck in what is instead of what could be. Further, these individuals eat away at your self-esteem and your belief in yourself. Progress and change can only occur from doing new things and innovating, dreaming the impossible and reaching for the stars.
6. Insincere Illissas: You never quite feel that these people are being sincere. You tell a funny story, they give you a polite laugh. You feel depressed and sad and they give you a 'there, there' type response. You tell them you are excited about something and you get a very ho-hum response.
Why they are toxic: People who aren't sincere or genuine build relationships on superficial criteria. This breeds shallow, meaningless relationships. When you are really in need of a friend, they won't be there. When you really need constructive criticism, they would rather tell you that you are great the way you are. When you need support, they would rather see you fail or make a fool of yourself.
7. Disrespectful Dannys: These people will say or do things at the most inappropriate times and in the most inappropriate ways. In essence, they are more subtle, grown up bullies. Maybe this person is a friend who you confided in and usesyour secret against you. Maybe it is a family member who puts their busy-body nose into your affairs when it is none of their business. Or maybe, it is a colleague who says demeaning things to you.
Why they are toxic: These people have no sense of boundaries and don't respect your feelings or, for that matter, your privacy. These people will cause you to feel frustrated and disrespected.
8. Never Enough Nellies: You can never give enough to these people to make them happy. They take you for granted and have unrealistic expectations of you. They find ways to continually fault you and never take responsibility for anything themselves.
Why they are toxic: You will spend so much time trying to please them, that you will end up losing yourself in the process. They will require all of your time and energy, leaving you worn out and your own needs sacrificed.

All of these personalities have several things in common.
1) the more these people get away with their behavior, the more they will continue.
2) Unfortunately, most of these people don't see that what they do is wrong and as a result, talking to them about it will fall on deaf ears, leaving you wondering if you are the crazy one.
3) Most of these people get worse with age, making their impact on you stronger with time.

Ian Weston SVP, Special Projects Dow Jones NY

US health care is expensive because the free market with
low price elasticity ensures that the standards and expectations are set
by those with the most to spend.

Tiered services and price differentiation are not really practical
propositions in health care owing to the nature of the cost structures
and services provided—so we have a system that provides exemplary
health care to those that can pay for it, but struggles to provide
acceptable ‘regular’ service that is affordable to the average
citizen.


So much clarity of thought..in the western elite..quite surprised to note that

this is a response to MC Kinsey report.on how health care spending in the poor is increasing in the states...

a nice one liner from my child hood friend Preetinder Brar from chandigarh ..

I'm often a loser because winning over fools is impossible.....

a nice one liner from my child hood friend Preetinder Brar from chandigarh ..

I'm often a loser because winning over fools is impossible.....

Straight back from MECOM 09

the whole meeting was a sham ...fortunately three talks got canceled ......i couldn't have taken them either..fortunately bumped into some interesting people...a Mrs Medha Bhaskar..whos a health care writer...a Mr Bilal Mahommad ...an technocrat whos come up with a startup to provide mobile healthcare...thats is healthcare with the use of mobile phones...some major biggy at DU who wants to give everybody in the hospital a free black berry........a guy called mike with Ascom who claims 60 percent of dutch hospitals use their mobile gadgets..

all in all a very fruitful day ..met up with a bunch of bombay ites...Ajay ..something a mallu who is the vice chairman for BS technologies...bald shetty look alike with a pleasant smile..they flew in from bombay to attend this meeting...

cant say more about the day ..

More from Andrew Prozes: CEO Lexis Nexis

You can’t simply intuit what customers want, or rely on sporadic, undisciplined feedback. You’ve got to have a methodology. We’re big believers in an approach for measuring customer service called Net Promoter Scores (NPS), which I introduced into the organization to measure just how happy customers are.
NPS is much more straightforward and simple than other ways of measuring customer satisfaction. Surveyed customers offer a response, on a 1 to 10 scale, to the question, Would you recommend us to others? They are then grouped into three categories: Promoters, Passives, and Detractors. The percentage of Detractors is subtracted from the percentage of Promoters to arrive at the NPS. The simplicity of the methodology leads to clarity on what steps need to be taken to improve quality.


Isnt that how we should manage our social and buisness relationships on a day to day basis............

Andrew Prozes : CEO LexisNexis

'Dont look at information as a the product itself.What you have to offer is a 'workflow solution ',which incorporates all type of content into a single source that can be assessed from any number of search parameters.'

This is what i think the GIPM project should head towards....

ill talk more on the GIPM ..the graphic interface for patient management as we learn more and apply more..

Nimesh Mehta : Batch of 09 ISB Hyderabad

'It is amazing what you can accomplish if you do not care who gets the credit........'

I bumped into Nimesh at Bombay University .For some reason we sat down and had a pepsi together.We' ve been online pals since then .Nimesh has a penchant for putting up quippy one liners on his Gmail chat pop up ....this is one of the many ..ill put more as he continues to spill gyan ...

C K Prahalad : A good article from Fast Company

"If you want new ideas, you have to push yourself into the periphery," he says.



Can C.K. Prahalad Pass the Test?
By Jennifer Reingold

It's all the potato's fault. C.K. Prahalad might still be ensconced in his old life as revered management guru. He might still be teaching strategy to rapt MBAs and senior executives at the University of Michigan, still driving home each night to his lush 60-acre spread in suburban Ann Arbor. He might still be charging top dollar to advise companies -- paid richly to scare the bejesus out of powerful CEOs and, in the process, to help save them from ruin.
Instead, about five years ago, Prahalad read a book about the history of the potato and how its eventual spread transformed the world. Somehow, it made him think differently about the Internet. Just as international trade had fostered the potato's growth, the Internet would foster the global diffusion of individual power -- and that would transform the world.
The connection is perhaps obvious only to Prahalad. But that's his way. "If you want new ideas, you have to push yourself into the periphery," he says.
Prahalad's periphery is a nondescript office in San Diego overlooking a parking lot and a dusty dry canyon. Since April 2000, the 60-year-old has been chairman of a small, profitless high-technology company called Praja Inc. And he is doing what many executives of small, profitless high-technology companies do these days: He's working the phones, offering to fly up to the home of a GM executive (a potential customer) for a quick meeting. He's crisscrossing the globe in search of funding. He's agonizing over layoffs. And, oh yeah, one other thing: With this modest, 30-plus-person company, he is also trying to change the world.
This is the story of a man who had it all and decided that it wasn't enough. Instead of slowly lowering the flame on a white-hot career, Prahalad has lit an entirely new flame. He has taken a leave from Michigan, dramatically scaled back his consulting work, put up several million dollars to get Praja going, and moved his family to San Diego. "He's taking financial risk, professional risk, reputational risk, and personal risk," says B. Joseph White, dean of the University of Michigan Business School. And yet, adds White, "it's totally in character."
What Prahalad wanted was a new, huge challenge. Not incidentally, he also wanted to create a laboratory for the application of the ideas that he had been preaching to others.
This is a personal test, the latest step in a search for self-knowledge that has defined Prahalad's life. "I was in a very good zone of comfort," he says. "And I felt that this opportunity was so large that I needed to experiment with it myself. What we're selling is a new way to run a business. Our ultimate motivation is to make a difference."
The collapsing economy has made that job tougher than Prahalad had ever imagined when he abandoned his life in Ann Arbor. Yet now he appears more committed than ever to Praja's ideals and technology. "You have to have faith," he says. "You cannot lead if you don't believe."
"Consumers do not have much share of a voice. Now they do."
What's in a name? In Sanskrit, praja means "common people." Prahalad and cofounder Ramesh Jain, the company's 52-year-old CEO, say that it is the inverse of the word raja, which means "nobility." It is not, they insist, a play on Prahalad and Jain, despite employee jokes to the contrary. At its most basic, Praja is a high-technology company that allows people to personalize their own experiences on the Internet -- whether as a sports fan, a student, a data analyst, or a farmer. Its platform, ExperienceWare, organizes data by context, rather than by time or written words, sorting such information as text, video, audio, and sensory data. Prahalad and Jain think the implications of the process are cosmic.
"The problem so far has been data as information," says Prahalad. "We are still operating as if we never left Gutenberg. If you look at keyword searches, the document is still going to be the organizing idea. But now the metaphor is not going to be the document -- it's going to be the experience."
Prahalad, a mustachioed, bespectacled, slightly round man, fills the room when he speaks. He is a contagiously high-energy guy. His language, while complex and academic, is sprinkled with expressions meant to draw in the listener. "Is it not?" he asks often. "Okay?"
Prahalad says that Praja will facilitate the most profound impact of the Internet: the empowerment of the individual. The Internet is rapidly democratizing information, and the effects are mind-boggling -- from the rise of global antibusiness activism to the organized cells of consumers everywhere. "Consumers did not have much share of voice," he says. "Now they do. There is a fundamental transition that is taking place -- from a firm-centric society to a consumer-centric society."
In a consumer-centric society, says Prahalad, everyone -- even the poorest of the poor -- can gain more control over their own life. "Why don't people have economic opportunities? Because there's no information. You don't know what the price of fish is in the next village. The large-company Internet business models, the Internet poor, the new business models -- they're one big circle. They all interact with one another. But we have to make this a business issue."
And that is exactly what Prahalad has signed on to do.
"What is the next challenge in life?"
One of the few decorations in Prahalad's sparse office is a beautifully illustrated old map -- a gift from friend and collaborator Gary Hamel. "Can you tell me what country that is, Jennifer?" booms Prahalad, always the professor. I'm stumped, as I tend to be continuously with this man. He smiles broadly and turns the map around. Then I see that it is a map of India, tilted at a 90-degree angle. This, I realize, is Prahalad in a nutshell. Turn an idea sideways. It's the theme of his life. It's how you get from potato to Praja.
One of nine children of a well-known Madras judge and Sanskrit scholar who wrote and edited 40 books, Prahalad (that's his first name, actually; C.K. stands for Coimbatore Krishnarao, the names of his town and of his father, respectively) was born to study. But early in his career, he managed people. A brilliant student of physics, he was recruited by the manager of the local Union Carbide battery plant. He promised his father he'd try it for a year, then return to school to get his PhD.
Only 19 at the time, Prahalad turned the factory sideways. One day, after noticing that many temporary workers were using old or torn gloves (managers doled out new gloves according to seniority), Prahalad had a thought: Why not distribute new gloves to the workers who handled the most dangerous stuff instead? Impressed, Prahalad's boss decided to mentor the young upstart, often bringing him management books to read and quizzing him about them later. Prahalad calls his Union Carbide experience a major inflection point in his life, and he still cherishes the gold chain that his workers bought for him when he left -- four years later. "I learned about the extraordinary wisdom of ordinary people," he says.
Prahalad then went to the Indian Institute of Management (IIM), where he fell in love with Gayatri, a young psychology student at a nearby university. After five years spent trying to win their families' approval (the union went against tradition), the couple married and left for Harvard, where Prahalad wrote a PhD thesis on multinational management in just two and a half years. They then returned to India, where he taught at the IIM. But this was the 1970s, and the fervently nationalistic India had little use for a globally oriented thinker. With his ideas under constant political attack, Prahalad decided he had no choice but to return to the United States. The Prahalads arrived in Ann Arbor with $18.
Maybe because he had nothing to lose, Prahalad didn't play it safe. He became known on the Michigan campus as a maverick who avoided publishing in the traditional journals in favor of venues that he thought would have more of an impact. He ruffled feathers. As an assistant professor, he was approached by a major company with an invitation to consult -- an opportunity that every young business academic yearns for, especially if he has two young kids. He agreed, but he demanded $1,000 a day. Shocked, the client withdrew the offer. Gayatri was horrified. "We need the money," she gasped. But for Prahalad, it was a matter of getting the respect that he felt he deserved. A month and a half later, another company sought his services. This time, he asked for $3,000 a day. And he got it.
In 1981, Prahalad met Gary Hamel, then a young student in international business. Their relationship, which would become a remarkable, decade-long collaboration, was much like Felix and Oscar on intellectual crack. Prahalad preferred a full-bodied cabernet and a good book in his study to working a crowd. Hamel was the voluble one, and the two became known around the university for knockdown, drag-out intellectual-sparring sessions that lasted long into dinner.
Much of their most influential work appeared in the Harvard Business Review. Their May 1990 article, "The Core Competence of the Corporation," became one of HBR's most widely reprinted pieces ever. A subsequent book, Competing for the Future (Harvard Business School Press, 1994), was heralded as one of the great business books of the 1990s. The work lifted both men into the top ranks of business thinkers, earning them millions in royalties and speaking fees.
Soon after, Prahalad had his potato epiphany. The timing coincided, more or less, with an invitation from his friend Jain, an entrepreneur and former Michigan professor who, at the time, was teaching at the University of California at San Diego. Jain, who was experimenting with sports television, asked Prahalad to look at his artificial-intelligence technology. The software allowed viewers to watch the Super Bowl from any perspective, even those not actually filmed by the network's cameras. Prahalad had no interest in sports, but the experience enthralled him. "The technology eliminated the tyranny of the few over the many," he says.
Prahalad had put money into Jain's first two companies, Imageware and Virage Inc. Now he was sinking the first installment of an investment that eventually totaled at least $3 million into the newly formed Praja. Jain became CEO. But, he says now, "it was very clear that there were lots of business issues that I didn't understand as well as I could have." Eventually, he asked Prahalad to help him run Praja. "If you want to build the company the way that we want it," he told Prahalad, "the leadership should come from you and me." To his colleague's surprise, Prahalad said yes. "After he decided," Jain recalls, "I said, 'As a friend, I want to know why you are doing this.' He said, 'Ramesh, neither you nor I need a company to maintain our current lifestyle. But what is the next challenge in life?' "
"What would happen if this power became commonplace?"
For Prahalad, Praja's challenge -- and so, his -- is twofold. One: Make it through the tough times, build a successful business, and use the technology invented by Jain in a transformational way. Two: See what it's like to take your own management medicine.
At its simplest, Praja's technology offers a very quick way to build applications and to organize all kinds of information, from sensory data to video to text to audio information. Praja is focusing on two areas: knowledge sharing and data analysis. Analysts at General Motors, for example, are using the company's technology to compare sales data from different countries and time periods. Need to contrast, say, Saab sales and Ford Explorer sales in Brazil in March? That's just the sort of calculation that GM used to spend weeks on. With ExperienceWare, it's instantaneous.
Meanwhile, Praja is experimenting with knowledge management at Zurich Financial Services, where it has created a virtual, cross-cultural learning community that brings together senior executives from all over the planet. Participants can use video, text, or other information to compare projects or management problems, untethered by place, time, or even language. "It is still a work in progress, but it has been very well received," says Gunnar Stokholm, head of business development at Zurich Financial Services.
It is one thing, of course, to enable an online executive confab -- and quite another to build something that touches the world. But it is the broadest implications of this concept that get Prahalad excited. In a world where information is available to everyone and not segmented by language or even literacy, Praja's technology could be used to help not just executives but also the rural poor. Strategies for containing breakouts of contagious diseases could be shared, globally and in real time, across languages and technologies. Says Jain: "A lot of things that we are going to be developing will be revolutionizing in different ways. We're making language irrelevant."
This is the vision -- one of bringing the power of information to everyone -- that drives both Prahalad and Jain. "This company was started with the basic assumption that we would empower people to be themselves, to experience life on their terms," says Prahalad. "Then you take the next step and ask, 'What would happen if this power became commonplace, rather than only for the wealthy?' The moment you ask that question, staring in your face are 4.5 billion people. How do you help ordinary people understand how to exercise their power? More interestingly, how do you get large companies to understand that if they don't, they'll have no social legitimacy left?"
Just before joining Praja, Prahalad and fellow professor Stuart Hart, from the UNC Kenan-Flagler Business School, circulated a draft of a paper called "Raising the Bottom of the Pyramid: Strategies for Sustainable Growth." They argued that the 4 billion poor people at the bottom of the economic structure represented a valid, vibrant market for goods and services -- and that large multinational companies could make big profits by meeting their needs. "The challenge for managers is to visualize an active market when what exists is abject poverty," they wrote. "With all due respect to the importance of wetlands, it is like visualizing a theme park where you see only swamp."
It's kind of a contrarian idea. Until now, the rural poor have been considered unable to sustain a market, unlikely ever to get enough disposable income to buy anything that a big western company would want to sell. But in India, Prahalad found companies making money hand over fist by selling to the poor. The idea that informed capitalism could help the world's downtrodden got him really, really excited. "It brought a fire and a passion to C.K. that goes beyond what I'd seen before," says Hart.
This is, in ways not yet completely clear to anyone, Praja's future. But it's not the present. These days, Praja is marketing exclusively to big companies. Prahalad and Jain are scrambling for a third round of funding. (Together with board members, the two recently kicked in $3 million to keep the company going until the fall.) But Prahalad's grand vision must wait. "You cannot solve the world's problems in a small company," he says. "The goal is not to say that we are going to do it anyway, with or without money. It's a nice, brave thing to say, but very soon you'll be running out of cash."
"They have to go through the valley of death"
For a taste of what it's like to have C.K. Prahalad running your company, flash back to September 1999, at the University of Michigan's Executive Education Center. Prahalad prowls the rows of nervous managers attending Michigan's renowned four-week leadership program, seemingly feeding off of the anxiety in the room. He is lecturing on the 16th-century standoff between Cortes and Montezuma -- a metaphor for the struggle between startups and established companies. A master teacher, Prahalad lulls his students into thinking that they know the answers to his constant barrage of questions. Then, slowly, he removes the veil, allowing them to see that they are wrong.
In an hour, the students go from confident blusterers to humbled novices. Only at the end does Prahalad guide them from utter confusion to a new level of understanding. "They have to go through the valley of death," he says. It's another of Prahalad's core beliefs: Only when you are challenged, unsafe, out of your zone, can you find self-knowledge.
This is how Prahalad approaches potential Praja clients, often companies he once advised. "It's amazing, the way he can captivate the upper-level executives -- and tell them that they're crap," says Joe Kosco, director of business development at Praja. "He gets their attention, and then he says, 'This is how we're going to fix it.' " He treats his own employees the same way. Dealing with Prahalad, they say, is like playing chess with Bobby Fischer. " C.K. is an academic with stage prowess," says Robert Martindale, a business-development manager at Praja. "I feel like I'm getting a PhD."
Prahalad is Praja's enforcer-cheerleader, roaming the halls and challenging anyone he meets: "Do you believe yet? You don't believe, do you? Do you?" He is focused in a way that most of his employees can't even fathom.
His idea of time off is taking a long walk with Gayatri -- and then working some more. His enormous new home in Rancho Santa Fe boasts a pool, along with access to a golf course and a tennis court -- none of which he uses very often. He and Jain spend nearly every Saturday together working. Prahalad even tried to convince Jain to move into the mansion next door. "He argued that we could save a lot of time if we didn't drive to work separately," laughs Jain.
All of this leads to a strange dynamic within Praja: What do you do when your boss knows more about every aspect of your job than you do? How do you make a sales presentation if everyone in the room is staring at the other guy? Prahalad is acutely aware of this contradiction. To avoid being perceived as the blowhard executive who knows it all, he is always asking for feedback on what he could have done better. He's sincere about this: It is a way for him to learn -- and learning, after all, is something that Prahalad does well. He even asks me several times during my visit, and again after my return, for a report card: "How can I be a better manager?"
The question betrays Prahalad's own zone of discomfort. He is most at ease when teaching, and he views Praja very much as his classroom. But Praja is, of course, also a business, and the professor has had to wrestle with what it means to actually manage a for-profit organization.
Prahalad admits that the desire of his employees to know exactly what their roles are was one of the things that surprised him most about running a company. And for someone who is used to delivering the message only to top executives, the amount of time that he had to spend explaining his vision took him aback. Some employees fret that with Prahalad's insistence on constant learning, Praja may be moving too slowly.
Prahalad has learned by now that some of his big-company prescriptions don't fit here. "The negative side of a small company is that there are no dampers," he says. "Just because you can make a change quickly, the temptation is to act. Speed is nice to have, but going faster to hell is not how I want to run a company. I want somebody to keep pushing the organization. I also want somebody to say, 'Let's be thoughtful about getting this done right.'
"My role," he continues, "is to balance the tension."
"In great growth times, anyone can lead"
It was a foggy, sleepy day in Seattle, though you wouldn't know it from the electricity surging through the conference hall last October. C.K. Prahalad, professor and entrepreneur, had just described his vision of using technology and innovative strategy to market to the world's poor, and the crowd at the Creating Digital Dividends conference was on its feet. "We have company think, not consumer think," he thundered. "What we make is not what they want."
The problem juices Prahalad -- and it shows. Even as he focuses on strengthening Praja, he speaks regularly on the digital divide. He helped persuade Carly Fiorina, CEO of Hewlett-Packard, to launch what HP calls its World e-Inclusion initiative. But that's the gauzy future. Right now, Praja faces an environment that's downright poisonous for startups and a capital market that is essentially dead. Many potential customers are slow to commit to buying anything, let alone a new platform that requires a whole new way of thinking.
In late February, Prahalad and Jain refocused the company on marketing its core technology, relying on system integrators to build specific applications. It also laid off more than a third of its staff. "I would be lying if I said that I was emotionally and mentally prepared for this," Prahalad says.
There was a learning experience here too -- but not the kind that Prahalad had hoped to have. "Especially in troubled times, leaders must behave like emotional and intellectual anchors," he says. "You must steady the organization and have a passionate belief that what you are doing is important. I never realized how critical that was in times of turbulence."
What is so fascinating about Prahalad is that amid the gloomy tidings, he seems more energized than ever. Praja may be fighting for survival, but Prahalad has yearned for a test like this: "Leadership is about what you do when the going gets tough.
"It is the bamboo that bends in heavy winds that has another day to live," he continues, reciting an old Indian saying. "The trees that don't bend get uprooted."

The Wharton Business Plan Competition O9 : Thoughts

Out of the eight finalist in the Wharton Business plan competition 09 ,four had plans for the healthcare sector .A telepresence glucometer which looks like a watch , a software platform to book and re-book patients to increase show rates,a artificial eye whos pupils dilate, an a device to measure wound depth .Guess what thats 50 percent.So is the rest of the sectors sleeping when it comes to innovation or is it that health care innovation has become a fad. More so the latter I think .



The funny thing is that everybody on that side of the atlantic ( read America ) believes that health and health care reform is their prerogative.The populace who suffers the most probably should be the one calling the shots.America today stands as the biggest distributors of calorigenic food to the world.And probably the biggest consumer too.
A country which is squashed by the weight of its obese teenagers ,stands watching for every health care innovation that can earn it a buck on .


It is'nt a surprise then ,that the machine to monitor wound depth got the prize.Why wouldnt it.It is a cash cow.It costs 35000 dollars, has a bunch of patents , probably a researcher whos done is Phd on wound depth , a group of physicians who would love to sell you the idea that if you dont measure wound depth ..how the hell will you heal the wound. A bunch of physicians who want to retrain the whole world and tell the physicians all over that the way you treat diabetic wounds is wrong.Another gimmic to reinvent the wheel for all of us.My sarcasm cant pour out any more........... .These are the new American Association of Diabetic Wound Guidelines ...and these are the recommendations from a Multi Center Randomised Control Trial on wound depth management and .....here is the evidence based current practices for diabetic wounds....and here..is the saviour..the machine to measure wound depth ...a must in a every new clinic ..a must in every new establishment which is accredited .........The new bar is set in wound care.Meet it or you will lose your accredition ..........The 35000 dollars it costs...is incidental expenses. You should be able to foot the bill....If you can t how will we run this trillion dollar economy .



Well the fact that the first prize goes to the NIR diagnostics team which are behind this device just shows the contorted mind set .The man who was selling prevention was over ruled by the man who was selling treatement .The man who was selling the watch with a glucometer to make patients more aware of the narrow breadth of control they have to maintain on their blood sugar ,was the man closer to science .His device costs a lot less and will prevent the huge chain of events which will eventually lead a diabetic to get a diabetic ulcer .But then if you prevent them ..how the hell will the drug companies ..the wound care product companies and all the other intermediaries ( read : VAC pump machine makers, Trial coordinators, Accredition agencies ) who feed off these wounds make enough money .



If this competition represents a populist thought ,its a pity that the ever pervasive capitalist sentiment of the west shines so shamelessly on health care .


The link to the competition site:
http://bpc.wharton.upenn.edu/index.html

Grameen Bank: Alex Counts : President and CEO of Grameen Foundation : Cornell 88 ,Fullbright Scholar to Bangaladesh, Worked for CARE ,Learnt bengali

Those of us who have grown up un the affluence underestimate the abilities of the poor and what is learned in survival mode.

The poor work for themselves or not at all.

Intentional motivation of the poor.

Grameen Bank wiki link http://en.wikipedia.org/wiki/Grameen_Bank

Alex Counts : http://www.grameenfoundation.org/who_we_are/our_people/staff/alex_counts_president/