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Mr. Nielsen says developing private-label products has required new skills for the company, such as managing quality control and meeting product safety regulations. But online feedback from customers who leave product reviews helps the company make improvements. For instance, Amazon lengthened its first private-label product -- a chaise lounge -- after customers said it wasn't comfortable for tall people.
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不論榮枯興替，20 世紀的故事，是我們的故事，也是你的故事，正將展現在你眼前，一部喧鬧的人類嘉年華，穿插既壯觀而驚駭的景象，俗豔而燦爛，暴虎憑河卻又豪氣干雲。
珍藏二十世紀
本書在於回顧所謂 20 世紀這 100 年間的生活。
20 世紀是個大成功，也同樣是個大失敗的時代；是個充斥著偉大與邪惡的想法的時代；更是企圖實現這些想法的善惡男女的時代。進步與退敗，仇恨與人道，有人莊嚴 地掌握一己的命運，也有人不能掙脫於不可知的絕望與困惑，黯然退卻。然而，歷史不是一本電腦小說，歷史從無他途，沒有替代方案。 不論榮枯興替，20 世紀的故事，是我們的故事，也是你的故事，正將展現在你眼前，一部喧鬧的人類嘉年華，穿插既壯觀而驚駭的景象，俗豔而燦爛，暴虎憑河卻又豪氣干雲。
作者簡介
彼德．詹寧斯（Peter Jennings）
美國 ABC 電視台晚間新聞主播，是美國最權威、最受尊崇的名主播，在電視新聞界已有逾 35 年的資歷，曾經採訪報導過本世紀的許多重大事件。
陶德．布魯斯特（Todd Brewster）
《珍藏 20 世紀》紀錄長片監製人，曾任《生活》雜誌編輯與撰稿人。
前言
．第 1 章：改變的種子（1901-1914）
．第 2 章：地雷爆炸（1914-1919）
．第 3 章：景氣榮光（1920-1929）
．第 4 章：天候惡劣（1929-1936）
．第 5 章：岌岌可危（1936-1941）
．第 6 章：環球夢魘（1941-1945）
．第 7 章：和而不平（1946-1952）
．第 8 章：大眾市場（1953-1961）
．第 9 章：走上街頭（1961-1969）
．第10章：徬徨年代（1969-1981）
．第11章：新的晨曦（1981-1989）
．第12章：機械大夢（1989-1999）
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柴俊林將飯店當作社區經營
俗話說「計畫趕不上變化」，這句話印證在柴俊林身上，頗為貼切。柴俊林大學唸的是電機系，研究所讀的是企管所，但進入職場的第一份工作，卻是銀行櫃台專 員。他以為，自己會在金融業待到退休，沒想到，3年前，他卻接下台中市全國大飯店副董事長職務，跨入一個完全陌生的領域，他的人生出現大轉彎。
從金融業轉戰飯店業
柴俊林是個道地的台中人，因為喜愛台中，他進入華信銀行的第一志願，也是選擇台中分行，即便後來請調到台北總行歷練，他依然每周五搭晚班車回台中、隔周一搭早班車回台北，這樣的生活持續了9年之久。
因為在台北總行信託部任職的關係，柴俊林結識了勤美集團董事長何明憲，「何董知道我是個愛家、顧家的人，這樣的男人是不會變壞人的」，柴俊林笑著說。
民國95年8、9月，當何明憲著手併購全國大飯店前，事先詢問柴俊林有沒有經營管理飯店的意願？當晚，柴俊林失眠了，「我最開心的是，有一個發揮的空間，還能回台中真是太棒了！」
柴俊林雖是飯店業的門外漢，但大老闆、何明憲卻對他說：「人對了，就對了！」何明憲的肯定，給了柴俊林全然的自信。
柴俊林只問了何明憲兩件事：要玩長期的還是短期的？有沒有充分授權？在得到「保證長期開發、完全充分授權」兩項明確答案後，柴俊林決定放手一搏、接受全新的挑戰。
民國95年10月20日，勤美集團取得全國大飯店100％股權，柴俊林當天便隻身赴任，何明憲給他的超級任務，就是著手改造經營飯店。
老店翻新 從重拾員工自信開始
全國大飯店為台中市第一家五星級飯店，於民國69年開始營運，共有306間客房，還有4間中西式餐廳。過去業界一直傳聞全國大飯店要出售，員工終日人心惶惶、士氣低落，當柴俊林接下這家台中市最老牌的飯店後，他決定從凝聚員工向心力、讓員工們重拾自信心著手。
柴俊林在接手後的第一個春酒宴上，對著員工說，「全國飯店將定位為台中市服務品質最好的飯店」。他說，服務業的快樂來自客人的肯定，「快樂打從心底，客人才能感受到」，所以，全國推動微笑運動、重視客人們的意見，柴俊林還親自上網看客人的留言，隨時改進、提升服務品質。
為了進一步提升服務品質，柴俊林2年前推出「啄木鳥」計畫，讓全國飯店280位員工免費在飯店吃飯、住宿，不過，每個員工在吃過、住過後，必須提出50個缺失，再交由人資部門整理，送到各單位作為改善參考。經過「啄木鳥」計畫半年來的改善，全國飯店的服務品質進一步提升。
「全國飯店想做台中市民的好朋友」，柴俊林說，3年來，全國陸續贊助了台中市政府的爵士音樂節、元宵燈會，9月也是市府「搖滾台中」活動的指定飯店。全國大力配合市府、積極參與藝文活動，「我們要讓台中市民感受到，全國飯店有心參與市民的生活。」
新點子不斷 老客人回籠
全國大飯店過去無論住房率或是業績，皆排名台中飯店業的末段班，歷經3年來的努力，去年卻一躍成為第2名。柴俊林對員工開心地說：「全國飯店拿到最佳進步獎，實至名歸。」
全國飯店的進步，不僅客人感受到了，除了吸引新客人上門外，老顧客也逐漸回籠了，就連何明憲也感受到全國飯店的進步，經常當著親朋好友的面前，對柴俊林讚譽有佳。
柴俊林說，3年前，當他與某企業主交換名片時，這位企業主看到他的頭銜時，當場表示：「全國飯店只是好停車，菜色卻沒變化！」客人的刺激，讓全國飯店餐飲部門動起來。
3年來，全國大飯店宛如「過動兒」，餐飲部每年平均舉辦30多場活動，以「全福樓」為例，陸續推出上海法租界、三國宴、山東宴、即將推出紅樓宴，菜色搭配歷史故事，獲得老顧客的好評。這位企業主後來再見到柴俊林，當場對他說，「全國飯店的菜色變化好大。」
今年以來，全國大飯店砸下逾億元，將飯店外觀與大廳、咖啡廳、國際宴會廳重新改裝，「拉皮」後的飯店，整個脫胎換骨，顯得更溫馨、舒適；下一步，全國的客房也將進行裝修，重新擁抱舊雨新知。
自從接任全國飯店副董事長後，過去一年休假多達100多天的柴俊林，如今每年休不到10天，他靠的是對這份工作的熱情，「我經營的不是一家飯店，而是社區經營」，他在心裡對自己承諾：「我要在全國大飯店待到退休為止！」
726
不堪長期虧損，台中榮總決定退出健保局的"總額給付制度"，院方批評，健保局每個月只讓他們請領兩億元，醫師看越多病人，虧損越多，他們逼不得已，只好實 施限量掛號，病患看病還要用搶的，尤其是慢性病患，掛不到號，就拿不到救命藥，醫生們看不下去，宣佈退出總額給付，未來改採"實際審查制"，看多少病人就 報多少的補助，保障病人的看病權。宣佈退出健保總額給付制度後，台中榮總加開31個診間，供民眾掛號，讓想看病的病患都可以來看，更不用再擔心掛不到號， 像是罹患風濕性關節炎的林小姐，他說之前為了搶掛號，常常半夜不敢睡覺。他們都是關節炎的病患，類固醇的藥不能斷，掛不到號，差點延誤病情，如今終於能順 利看病了。台中榮總說，健保局每個月只給他們2億元，病人再多，也無法請領錢，才會要求每位醫生，每天限量120位病患，減少虧損，但有病患拿不到藥，醫 生也看不下去，決定退出健保給付，改採審查制度，向健保局實報實銷。包括台大醫院及台北榮總早就宣佈退出，批評總額給付制度，讓大醫院常常拒收病患，做出 違背良心的事，現在台中榮總也退出，不再限制病人數量，醫生可以看病到半夜11點都沒問題。
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'Out of the Crisis' - The Deming Management Philosophy
Thu Sep 10, 2009 3:22pmCincinnati Seminar offers proven practices to survive and prosper
WASHINGTON, Sept. 10 /PRNewswire/ -- The W. Edwards Deming Institute(R) is
offering a management seminar next month that will provide participants with
critical knowledge to successfully navigate through today's crisis while
instituting practices to ensure long term success. Beginning on October 19th,
a two and a half day seminar, OUT OF THE CRISIS, will present the management
philosophy of the world renowned Dr. W. Edwards Deming.
(Logo: http://www.newscom.com/cgi-bin/prnh/20090612/NE31805LOGO )
This highly successful seminar, which draws on Dr. Deming's lifetime teachings
on quality and management, has been presented and attended all over the world
by those looking to adapt and thrive in a changing marketplace. It is
designed for a broad range of executives, managers and team leaders at all
levels interested in boosting productivity, thinking strategically and
creating an ongoing unique competitive advantage. "Whether you are a start-up
or established organization, these proven management practices will profoundly
affect your bottom line," says Deming's grandson, Kevin Edwards Cahill, Vice
President of The W. Edwards Deming Institute(R).
Why are Deming's ideas the answer? Dr. Deming ignited the worldwide 'quality'
revolution. In 1950, the Japanese, in an effort to revive their ailing
economy, invited Dr. Deming to Japan. Their industry was in complete ruins and
"Made in Japan" was synonymous with poor quality. Over the next three years,
management executives controlling 80% of the capital in Japan attended his
many seminars, and Deming ignited Japanese industry and their economy. In
recognition, the Emperor of Japan awarded Deming the highly coveted Second
Order Medal of the Sacred Treasure. Two decades later a highly acclaimed
documentary reintroduced him to America. Deming quickly became the voice of
quality worldwide.
What are the secrets of Dr. W. Edwards Deming and why are they so relevant
today? "Deming understood that quality was not only the answer but also the
outcome of better leadership, management and practice," says Cahill. "My
grandfather recognized and predicted the impending global crisis years ago."
Through their seminars, The Deming Institute identifies practices that create
problems in an organization and introduces attendees to effective management
practices that will lead them on a path to not only survive, but thrive.
Cahill adds, "We are reminding people of this proven approach. It is
available, ready to implement and vital for short term recovery and long term
sustainability. The time is now."
"Out of the Crisis," The Deming Institute's Cincinnati Seminar will feature
Deming Institute trained facilitators and will be held October 19-21, 2009 at
The Millennium Hotel in Cincinnati. (150 West Fifth Street Cincinnati, OH
45202) For more information, or to register, visit
www.deming.org.
SOURCE The W. Edwards Deming Institute
Kevin Edwards Cahill of The Deming Institute, +1-310-377-6308,
kevin@deming.org; or Media contact, Claire Sanders Swift, +1-202-333-3316,
claire@clairemedia.com, for The Deming Institute
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價格扭曲之下的初期假繁榮
旧车 |报废奖金：过大于功 (德国经济)
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We do not work independently, rather as part of a system – either organization or garden. According to quality expert Dr. Edwards W. Deming, people should have joy in their work. Deming believed “that the system within which they work should be designed to make this possible and to enable workers to reach their full potential to contribute to the enterprise, that the system is management's responsibility, that 85 percent of all quality problems are management problems (that is, symptoms of a malfunctioning system), and that organizations and their suppliers need to work together to optimize results for both.” (From July 16, 1995 Siam News, “The Three Careers of W. Edwards Deming,” By Michael J. Tortorella.)
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許多事情在別人看起來是不可能的 可是有人在其他地方做到了
我再20幾年前就過ㄧ本 CANON PRODUCTION SYSTEM (CPS)地日文書
前幾天獨底下這本 竟然發現這位日本社長真的向吳董這樣要求過CANON
有的甚至降為原來的25%
我寫這EMAIL 只是要大家思考 更深入思考 爲何他們CANON 在20年前的cps還不夠好
還需要大力整頓
- 市场价：
¥33.00
作者简介
编辑推荐
目录
序章 佳能模式的细胞式生产方式是意识改革的管理方法
从生产革新到意识改革的管理方法
发展成为结构性改革的“佳能流”
7年间利润率增长8.8倍
第一章 向细胞式生产方式和传送带生产方式的常识提出挑战
为什么必须实行细胞式生产方式?
细胞式生产方式和传送带生产方式随时代的发展而循环往复
细胞式生产方式和传送带生产方式没有效率上的差别
什么是传送带生产方式时代?
之后的全自动化生产
细胞式生产方式是制作产品的基本
细胞式生产方式的基本分类
传送带生产线
无传送带生产方式
U字型生产线(流程分割生产)
单人货摊式生产方式(单人生产)
货摊式巡回生产方式(单人生产)
巡回生产方式(单人生产)
细胞式生产方式最重要的是质量和熟练度(提高生产效能)
对于操作者的积极性有好的影响
细胞式生产方式能非常有效地削减设备成本
细胞式生产方式也有许多弱点
第二章 细胞式生产系统改变意识
若要引入细胞式生产方式，员工自发的意识改革不可或缺
从细胞式生产方式到细胞式生产系统
工厂的风气改革有目共睹
工厂的改革波及效果显著
首先干部要改变
“二传手”上司毫无用处
管理部门的合理化
目标设定要简单
给改善活动以成长的空间
提高同事之间的竞争意识
将紧张感带到日常生活中
给他们能一直工作下去的安全感
“觉醒”是关键
第三章 最快建成的生产线——美里事业部
第四章 秩父工厂——通过意识改革将
第五章 办公室也要用细胞式生产方式来改革
终结篇 用细胞生产系统改变经营
附录 佳能十年腾飞一郎咸平
……
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distiller
在ㄧ本介紹杜邦公司 談到SEAGRAM公司 把它當成是蒸餾水公司The Seagram Company Ltd. was a large corporation headquartered in Montreal, Quebec, Canada that was the largest distiller of alcoholic beverages in the world.
DAVID HSU說
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又一對企業怨偶 Ebay will sell a 65% stake in its Internet phone business to private investors, marking the end of an unhappy tech marriage. The deal values Skype at $2.75 billion.
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The 1997 Aisin fire was a fire which shut down one of the production facilities of the Toyota-subsidiary Aisin Seiki Co. on February 1 1997,[1] a Saturday. The event was notable as the factory was the main supplier of a motor part for Toyota cars. Due to the just in time stock keeping philosophy of the Toyota Production System (TPS), Toyota's car factories reportedly only kept four-hour stocks of the part [1]. However the event also provided an example of successful business relationships between Toyota and its suppliers, allowing the company to quickly manufacture replacement parts and limit the halt in production of its cars, so minimizing the losses from this event.
Contents[hide] |
[edit] The fire
The fire started before dawn on February 1 1997 at Aisin Seiki Co.'s Factory No. 1 in Kariya, Japan.[1] The cause of the fire was reportedly unknown [1]. The factory produced brake fluid proportioning valves (P-valves) which help prevent skidding by controlling the pressure on rear brakes, and are used in the braking system of all Toyota vehicles[2]. 99% of Toyota's P-valves were made at this plant, with Nisshin Kogyo Co. producing the remaining 1% [1]. With the factory out of production, it was estimated that Toyota would have to halt car production for weeks. The economic impact of this would have been huge for Toyota, the local economy and for Japan. It was estimated that each day Toyota production was halted would lead to a 0.1% decrease in Japan's industrial output.[1] However Toyota managed to get production restarted within 5 days.[1]
[edit] Recovery
Aisin, along with Toyota, set up a crisis room to deal with the problem of manufacturing new P-valves. The production of P-valves was complicated, and required specialised tools. Furthermore, different varieties of P-valves were in production. Toyota managed to get many of its suppliers to bring in additional engineers, and work overtime shifts, to help build machines to produce P-valves, as well as increase production of the components. Some of Toyota's suppliers, and their subcontractors, were persuaded to give priority to the production of P-valves. Even a sewing machine manufacturer was persuaded to help provide valves for Toyota. The first usable valves were delivered to Toyota on the Wednesday (February 5) following the fire, allowing production of cars to resume.[1]
[edit] Lessons from the fire
The fire and the subsequent production crisis held many lessons for Toyota. It showed them that their implementation of the Just In Time production system worked, and that they had "the right balance of efficiency and risk".[1] Toyota also learned to reduce the number of variations in its parts to make production easier as well as to reduce risk. Toyota's suppliers also had the benefit of increasing efficiency in their production as well as learning the lessons of building redundancy into their production methods. The efficiency with which production was re-established also showed the value of the Japanese keiretsu system, where businesses have "interlocking" relationships with each other. The loyalty shown by Toyota's suppliers to the company showed it the value of long-term business relationships: the companies reportedly did not ask what they would be paid for rushing out the valves; Aisin and Toyota later re-imbursed them for the work, including the valves, overtime and re-tooling of their machine, as well as providing a $100 million bonus to the suppliers involved.[1]
[edit] See also
[edit] References
- ^ a b c d e f g h i j "How Toyota Recovered From A Major Fire in Less Than a Week". Mirror of Wall Street Journal article. 1997-05-08. http://www.rbbi.com/company/toyota/fire.htm. Retrieved 2006-06-19.
- ^ Toshihiro Nishiguchi and Alexandre Beaudet (Fall 1998). "The Toyota Group and the Aisin Fire". MIT Sloan Management Review 40 (1): 49–59. http://sloanreview.mit.edu/smr/issue/1998/fall/4/. Retrieved 2006-06-19.
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On Leadership by James March,Thierry Weil
Don Quixote explained himself to Don Diego de Miranda" I have not as mad as foolish as I must have seemed to you... All knights have their own endeavors... since it is my fortune to be counted in the number of knight errant. I cannot help but attack all things that seem to me to fall within the jurisdiction of my endeavors.' (II, 17)
...I think that Quixote tells an organization leader that the good leadership combines an exuberance for life with a commitment in the prosaic duties of leaderhip that leadership is poetry and routine as well as action; that is beauty as well as truth, that appreciation of complexity as well as simplicity, that pursuit pf contradiction as well as coherence, the achivement of grace as well as control.
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Intermountain Healthcare: A model system?
Health care » Medicine driven by data means better outcomes - and lower costs. Why Intermountain may be a peek at America's future.
In the mid-1990s, only about 40 percent of heart surgery patients nationally were going home with the right medications -- beta blockers, anticoagulants and other potentially lifesaving drugs. Intermountain Healthcare's numbers were better, but not by much.
So, in 1997, a research team at the Salt Lake City-based nonprofit health system developed a low-tech solution: a mandatory two-page checklist to help doctors ensure discharged patients get exactly what they need.
It was a simple innovation, yet one that yielded impressive results. Within a year, more than 90 percent of patients were getting appropriate medications.
Readmission rates at its hospitals went down. Survival rates went up.
Making evidence-based medicine easy to practice is Intermountain's modus operandi. Do that, its top managers and clinicians say, and health care gets better -- and cheaper.
It is a strategy that's not going unnoticed.
Last week, a team from the federal Office of Management and Budget visited Intermountain to explore why this health system is among those pioneering better health care.
President Barack Obama has repeatedly singled out Intermountain, along with the Mayo and Geisinger clinics and other so-called "organized practices," for delivering high-quality care at below-average costs. They are "islands of excellence in the sea of high cost mediocrity" as one Dartmouth report puts it; standouts in a country where cost
and quality can vary wildly by geographic region.Utah's total health care costs per capita are the lowest in the country. The state is efficient even by international standards, its costs ranking below countries such as Norway, Denmark and France. The U.S. overall, meanwhile, spends more than any other nation.
The state's young, healthy population doesn't explain it all, said Greg Poulsen, Intermountain's senior vice president: "It's also practice style."
If the Intermountains, Mayos and Geisingers can deliver this kind of health care, Obama has said, so should the rest of America. And the country could reap huge savings in health care costs if it did.
Using Intermountain as a benchmark, the 2008 Dartmouth report says, the nation could reduce health care spending on acute and chronic illnesses by as much as 40 percent.
The report also said Intermountain has driven down unnecessary "supply sensitive care" -- or care that tends to be provided because hospital beds, doctors and specialized equipment are abundant, rather than because a patient clearly needs it.
If all providers were to achieve Intermountain's level of efficiency in limiting such care, they would see an estimated 43 percent reduction in hospital spending, Dartmouth said.
Donald Lappe, Intermountain Medical Center's chief of cardiology, said the health care system has "really engaged everyone -- physicians, nurses, administrators -- to an environment that is committed to best outcomes."
While some institutions "layer on" requirements from The Joint Commission -- an organization that accredits and certifies hospitals -- and others, he said, Intermountain has made them part of its mainstream care.
"When there is a right way, I believe our doctors -- to the best of their ability -- will deliver it the right way based on evidence-based medicine," said Lappe, who helped pioneer Intermountain's discharge protocol. "What we do as a cardiovascular clinical program is deliver tools that make it easier."
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A new strategy » When Brent James started working for Intermountain in the 1980s, he discovered that the same variations seen in the delivery of health care across geographic regions could be found within a single health care system.
Patients treated by Intermountain for nearly identical conditions often left with similar results.
But what happened during their hospital stays was surprising: The "volume" of care each received could be dramatically different. Some received a plethora of tests and procedures; others, not that much.
"It turned out to be a common problem in medicine," said James, executive director of Intermountain's Institute for Healthcare Delivery Research and vice president of medical research.
It was about that same time that James came across statistician and professor W. Edwards Deming's theories of management. Deming, whose work revolutionized Japan's post-war industrial sector, believed costs go down as the quality of processes goes up.
The idea was a no-brainer for business, James said, but a radical concept for the medical community, which thought more meant better.
He decided to put the idea to the test as part of a 1987 Intermountain study on hospital-acquired infections. Starting antibiotics two hours before surgery, doctors discovered, reduced the infection rate to 0.4 percent from 1.8 percent over a year's time.
And it saved nearly $1 million in health care costs.
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Getting HELP » Key to coordinating patient care, however, is the use of electronic medical records that routinely remind doctors and nurses of care guidelines, Poulsen said.
"We absolutely believe in best practices," he said, "and many of those are benefited by automation to make them work more consistently and effectively."
Built in the 1960s by cardiologist and medical informatics whiz Homer Warner, Intermountain's Health Evaluation Logical Processor (HELP) provides care guidance in 17 areas, ranging from diabetic care and blood ordering to acute respiratory distress-syndrome protocols.
What's more, it also codes data, allowing statisticians to conduct "reverse" clinical trials by examining historical trends in treatments and outcomes. This allows doctors to rely less on anecdotal evidence and more on hard science to determine what works -- and equally important, what doesn't.
The health system is now four years into a 10-year project with General Electric to develop a new health information technology program, called ECIS, which builds and expands on the strengths of Warner's technology.
"In most instances people are pushed in a gray area," Poulsen said, "and data makes gray areas less gray."
In 1999, for example, the American College of Obstetricians and Gynecologists advised against giving healthy mothers the option of arranging early deliveries. By not electively inducing births before 39 weeks of pregnancy, it said, the likelihood of complications could be reduced. The college warned that pre-term babies were at higher risk for a host of problems, including severe respiratory-distress syndrome.
But doctors and nurses resisted the new guidelines. From their vantage point, it was hard to see a problematic pattern, according to an Intermountain study published in the journal Obstetrics & Gynecology in April.
This made sense, considering that if an obstetrician performs 200 deliveries a year -- and 10 percent of his or her patients are electively delivered at 38 weeks -- statistics show only one baby would be admitted to the neonatal intensive care unit (NICU) each year.
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Better data, improved results » When Intermountain analyzed nearly 180,000 births, however, the data were startlingly clear: For babies born at 37 weeks, the incidence of severe respiratory-distress syndrome was 22.5 times higher than those born at 39 to 41 weeks. At 38 weeks, it was still 7.5 times higher. Other problems, such as pulmonary hypertension, admission to the NICU and hospital stays beyond five days, were also more likely.
"If no one ever gives you the scientific data to drive your decisions, you can be pretty comfortable not doing best practice. You just don't know," said Janie Wilson, operations director of Women and Newborn Clinical Programs, which in 2001 developed a program to curtail early-term deliveries.
Wilson's team met with OB-GYN departments and announced the intent to halt the practice. A patient-education brochure was created to explain the new policy. And an obstetric and delivery program, called StorkBytes, was programmed to capture data and trigger electronic alerts.
"It was very hard," said Wilson, who is also a registered nurse. "We found you really have to have physicians and nurses on the same page, and you have to make it easy to do the right thing."
Within six months of the initiative, however, the rate of early-elective deliveries at Intermountain hospitals dropped to 10 percent from 28 percent; eight years later, that number is less than 3 percent.
But something else happened, too: Intermountain lost money. By performing fewer early-term elective deliveries, the health system saw shorter lengths of stay. NICU admissions dropped. Patients received fewer lab tests, antibiotics and Caesarean-section surgeries.
"The bottom line to our cost was significant," Wilson said.
An analysis of the impact on the health system revealed it lost $3.3 million in net revenue between 2001 and 2005. And that was a conservative estimate, based only on length of stay in labor and delivery, Wilson said.
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Sound science, lost revenue » It wasn't the first time this had happened.
Identifying and implementing best practices in a number of areas -- deep-wound infections, adverse drug events and community-acquired pneumonia, to name a few -- meant the health care system was hemorrhaging millions.
It created windfall savings for insurers, James said, "and we were struggling financially."
Being a nonprofit helps, he said. So does having a board of directors and an administration that is "mission driven."
But it also begs the question whether Intermountain's success can be replicated by other for-profit and nonprofit institutions.
Payment reform, Poulsen said, will have to happen first, so health systems aren't punished for providing more effective clinical care.
"The incentives today are wrong," he said. "You almost have to make a conscious decision that you will overlook what's in your financial best interest in order to do what's effective, efficient and appropriate ... [and] you know you're asking a lot of human nature to do that."
When that happens, the country won't just get more Intermountains, Mayos and Geisingers, James said.
"We'll get a level of health care delivery this country just hasn't seen before in terms of the quality of care we offer to patients," he said.
And, he added: "It will be at a reasonable price."
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德国经济 | 2009.08.29
德国东西部经济差距明显缩小
2005年的时候，德国前联邦总理施密特在描述德国东部地区经济发展状况时曾将其比喻为"没有黑手党的意大利南部"。应该说，这一比喻是很 贴切的。当时意大利南部的经济实力同北部相比，水平只相当于北部的60%。而德国东西部经济水平的差距也大体如此。但是到了2009年，德国东西两部分地 区的经济差距已经明显缩小。德国经济研究所所长克劳斯·齐默曼在做出这一结论时说： "德国东部地区的生产能力和竞争能力都取得了明显进步。当地的基础设施建设也得到大踏步的发展。另外我们也注意到，前东德时期的非工业化已经彻底终止了， 地方经济竞争能力的提高已经带来世人瞩目的经济增长。"
柏林墙倒塌后的20年，德国政府向东部地区大量投资创建汽车生产工业的扶助性策略看起来已经结出累累硕果。现如今，东部地区的生产能力已经达到西部 78%的水平。如果做同样的比较，捷克的生产能力只达到德国西部30%的水平。尽管如此，人们还是会问，为什么德国东西部的差距还是存在呢？德国马格德堡 大学国民经济系教授卡尔-海茵茨·帕克分析说："东西部在生产能力上还存在四分之一的差距，在我看来，主要还是因为东部缺少拥有与西部有着同样创新程度 的、能在国际市场上创造同等价值的产品系列。"
Bildunterschrift: 柏林墙倒塌后20年的今天
东部地区缺少工业核心，企业规模都相对较小，德国西部的大型企业或者国际型企业一般都只在德东地区开设分厂。东部还只是西部工厂的一种延伸。诸如研 发、市场营销和领导这些高水平高要求的工作岗位主要还是集中在西部的康采恩总部那里。经济学家们认为，可以通过加强科研与经济的紧密结合，以及扶持创新型 企业东移等政策缩小两边的差距。应该以小而精为口号。但是东部地区现在还存在一个问题，这就是人口数量急剧下降。德累斯顿经济景气指数研究机构的耀赫·拉 格尼茨估计，东部地区人口数量已经减少了200万。拉格尼茨表示："这种情况必须当成一个问题来对待，要采取平衡性的策略来解决。这样考虑问题，就会自动 地涉及教育、提高生产力的措施、研究与开发这些领域，因为这些方面是能够真正帮助东部的基础。现在应该考虑的是怎样将地区人口变化变成积极的而不是消极的 因素。"
尽管目前还存在着一些尚待解决的问题，经济学家们对于柏林墙倒塌20年后今天德国东部地区的经济仍是给予了一个积极的评价。德东地区经济状况常常遭 到负面描述，经济学家们认为，这是因为人们从转型时期开始就对对东部经济期待过高，以及使用了错误的评估标准造成的。但是人们不应该忘记，由于受非工业化 政策所害，1992年德东地区的毛生产新增值只相当于西部的3%。而这些年的休整补偿性政策取得的成就却没有得到应有的评价。
作者：Sabine Kinkartz / 洪沙
责编：乐然
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