This document discusses investing in one's refractive surgery practice during an economic downturn. It recommends focusing on improving the customer experience through investing in staff ("people"), refining processes, instilling passion in employees, and promoting refractive surgery as an experience rather than just a good or service ("product"). The author argues this will differentiate practices and reward them handsomely when economic conditions improve.
Intersting article written some time ago by Robert Hennessy, GLOBAL Practice Team Leader – Pharma/ Health Care/ Life Science, ( http://aims-international.net/global-teams/health-care/find-a-leader )before he joined AIMS International.
Treating job applicants well creates ambassadors for companies’
images and brands, even if they don’t get hired.
Not responsive. Late for interviews. Unprepared. Complaints have been made about candidates, but now these phrases are being used for recruiters and hiring managers.
Intersting article written some time ago by Robert Hennessy, GLOBAL Practice Team Leader – Pharma/ Health Care/ Life Science, ( http://aims-international.net/global-teams/health-care/find-a-leader )before he joined AIMS International.
Treating job applicants well creates ambassadors for companies’
images and brands, even if they don’t get hired.
Not responsive. Late for interviews. Unprepared. Complaints have been made about candidates, but now these phrases are being used for recruiters and hiring managers.
Contact centers. avoid the waste but not the valueStephen Parry
CORE Profile: A Customer Purpose Framework for Contact Centers
The customer purpose defines value, and value defines meaningful work, everything else is waste. The organisation and its leaders need to know what to optimise, what to remove, what types of demand to increase, and what types of demand may present opportunities to create new products or services. Our research indicates that most operational managers and leaders think they know what waste is, but in reality what they consider to be value is in fact intuitional waste, habitualized by calling it value.
Most companies genuinely want to create value for their customers and sincerely believe that their customer-service operations are indeed doing that, but often they are simply restoring lost value caused by a failure to do something right the first time.
Customer service management under the new economic conditions – a time for focussharedserviceslink.com
As the world economic conditions change and spiral, can SSOs be as concerned about quality and service given the cost challenges? Can customers expect the same service or are they now demanding even greater service levels than before? What is there to do in this environment to even maintain status quo? This session will focus on bringing a balance to the customer - SSO relationship in these challenging times via focus on:
• Managing customer expectations better than before
• Maximising service levels via innovation and training
• Massaging the cost agenda to ensure delivery of promises to the customer
Consistently great customer service requires the right mix of People, process and technology.
This presentation will address the People factor; the Human Side of Customer Service, through 3 key areas:
1. The business case for service
2. Customer-centric DNA
3. The Employers' Golden Rule
BizPower training programs 2014 for business owners, managers, staff & indivi...BizPower
Business Workshops and Training to help owners, managers and staff. Topics include Assertiveness, Customer Service, Time Management, How to Improve Business Cash-flow, Performance Management, Coaching, Goal Setting & Goal Achievement, How to interview and select the right staff, negotiating, team building and Systemising your business. Workshops are delivered in Sydney, Melbourne, Perth, Adelaide, Canberra, Brisbane, Cairns, Darwin, Jakarta, Singapore & Malaysia.
Tom Mornement from Purple House HR discusses the role of the HR interim and the many challenges and opportunities this presents. He was joined by Yvonne Payne who gave her side of the story as life as a HR interim. Recently presented to the CIPD West of England Branch.
Keeing a lid on attrition - 5 Steps to manage attrtion in Shared Services Chazey Partners
Attrition is a common problem, not just offshore, but also onshore, as we see increased interest in keeping centers near the customer base. We’ve got some tips on managing turnover.
Access to this unique piece of content NOW! http://bit.ly/1a698tj
Head-to-Head Comparative Study of Two Optical Biometric Devices in Modern Cat...SM2 Strategic
Today's cataract surgeon has adopted non-contact optical
biometry as the standard of care in performing IOL calculations.
While modern formulae incorporate multiple variables as part
of their calculations, Axial Length and Keratometry readings
continue to be the inputs that are most influential in determining
IOL power. Some of the newer generation formulas such as
Holladay 2 and Olsen now incorporate more elements to help
increase accuracy.
Contact centers. avoid the waste but not the valueStephen Parry
CORE Profile: A Customer Purpose Framework for Contact Centers
The customer purpose defines value, and value defines meaningful work, everything else is waste. The organisation and its leaders need to know what to optimise, what to remove, what types of demand to increase, and what types of demand may present opportunities to create new products or services. Our research indicates that most operational managers and leaders think they know what waste is, but in reality what they consider to be value is in fact intuitional waste, habitualized by calling it value.
Most companies genuinely want to create value for their customers and sincerely believe that their customer-service operations are indeed doing that, but often they are simply restoring lost value caused by a failure to do something right the first time.
Customer service management under the new economic conditions – a time for focussharedserviceslink.com
As the world economic conditions change and spiral, can SSOs be as concerned about quality and service given the cost challenges? Can customers expect the same service or are they now demanding even greater service levels than before? What is there to do in this environment to even maintain status quo? This session will focus on bringing a balance to the customer - SSO relationship in these challenging times via focus on:
• Managing customer expectations better than before
• Maximising service levels via innovation and training
• Massaging the cost agenda to ensure delivery of promises to the customer
Consistently great customer service requires the right mix of People, process and technology.
This presentation will address the People factor; the Human Side of Customer Service, through 3 key areas:
1. The business case for service
2. Customer-centric DNA
3. The Employers' Golden Rule
BizPower training programs 2014 for business owners, managers, staff & indivi...BizPower
Business Workshops and Training to help owners, managers and staff. Topics include Assertiveness, Customer Service, Time Management, How to Improve Business Cash-flow, Performance Management, Coaching, Goal Setting & Goal Achievement, How to interview and select the right staff, negotiating, team building and Systemising your business. Workshops are delivered in Sydney, Melbourne, Perth, Adelaide, Canberra, Brisbane, Cairns, Darwin, Jakarta, Singapore & Malaysia.
Tom Mornement from Purple House HR discusses the role of the HR interim and the many challenges and opportunities this presents. He was joined by Yvonne Payne who gave her side of the story as life as a HR interim. Recently presented to the CIPD West of England Branch.
Keeing a lid on attrition - 5 Steps to manage attrtion in Shared Services Chazey Partners
Attrition is a common problem, not just offshore, but also onshore, as we see increased interest in keeping centers near the customer base. We’ve got some tips on managing turnover.
Access to this unique piece of content NOW! http://bit.ly/1a698tj
Head-to-Head Comparative Study of Two Optical Biometric Devices in Modern Cat...SM2 Strategic
Today's cataract surgeon has adopted non-contact optical
biometry as the standard of care in performing IOL calculations.
While modern formulae incorporate multiple variables as part
of their calculations, Axial Length and Keratometry readings
continue to be the inputs that are most influential in determining
IOL power. Some of the newer generation formulas such as
Holladay 2 and Olsen now incorporate more elements to help
increase accuracy.
Objective structured practical question (ospe) for FCPS MS amd DO examinee of...Anisur Rahman
1) I am Dr Md Anisur Rahman Anjum passed MBBS from Dhaka Medical College in 1987. Diploma in Ophthalmology (DO) from the then IPGM&R (now it is Bangabandhu Sheikh Mujib Medical University BSMMU) in 1993. Felllowship in Ophthalmology FCPS from Bangladesh College of Physician and surgeon in 1997. I am now working as associate professor in General Ophthalmology in National Institute of Ophthalmology Dhaka Bangladesh which is the tertiary centre in eye care in Bangladesh.
These OSPE are dedicated to the postgraduate student who are decided to build their carrier in ophthalmology. I hope that they will be benefitted if they solve these OSPE
National Ocular Biometry Course (NOBC) 2015 An echoslide presentation Anis Suzanna Mohamad
This powerpoint presentation is basically about ocular biometry. Echo presentation is one of the method to deliver infomation that obtain from the course we attend to other staff in our Ophthalmology Department.
7 ways to get more value from your precious customer insightMartin Wright
How often have you seen expensive research gathering dust; wasted and ignore? Insights capable of helping a company become fitter, more popular and richer crowded out by today’s urgent demands?
In this multi-channel, fast moving and competitive world understanding customers better has never been more important.
Here are seven things we do that help companies fully exploit the value locked in this rich resource. Some are simple, others require effort; all provide great value for money.
Assembling Your Staff
The practice of medicine is by far one of the most important fields in which people can work. Taking care of peoples health is such an important profession that it should have only employees who take pride in their job and want to come to work each week
Job Analysis Questionnaire
Name: ___________________________________
Job Title: __________Cashier_________________________
Department: _______________________________________
Supervisor’s Name: __________________________________
Supervisor’s Title: ___________________________________
1. SUMMARY OF JOB: In a paragraph, summarize the responsibilities and accountabilities of the job. Include to whom the position reports within the organization. This should provide a “snapshot” of the work this job does and how the job supports the organization’s goals.
Being a cashier requires that I welcome clients into the store. I also answer their questions such as the location of different grocery items. It is also my responsibility to give recommendations to the clients according to what they need. I will be helping the customer to pay for their grocery from the store, and keep the cash for the company until my working shift is finished, and I will pass all the cash, receipts and sales report to the accounting department.
2. EQUIPMENT: List any equipment, machines or tools (e.g. computer, cash register, fork lift) normally used or operated as part of the job.
The main equipment needed by a cashier are a desktop, phone, modern scanning equipment, and also a cash register.
3. JOB RESPONSIBILITIES: Create a comprehensive list of job responsibilities (duties). Categorize the responsibilities into relevant groupings. List the categories/responsibilities either in order of importance with the most important first or by the percentage of time the job focuses on that work.
My main responsibilities as a cashier include welcoming clients, answering their questions and also directing them and recommending different items that they need. I also operate the cash register, scanner and scales among other devices. It is also my responsibility to accept payment from buyers, ensure all prices and quantities are accurate and also print and hand a receipt to the clients. (Levine, A. L. A. G. (2015, May 20))
4. CONTACTS: Does this job require any contact with other departments or outside agencies? If yes, list each contact, describe the type of contact and reason(s) for the contacts, and the duties completed.
This job position requires contacts with the accounting department. The cashier is required to provide a financial transaction report to the accounting department of the business. It also links to the purchases department especially since it automatically updates the inventory. This is important to keep track of the stock as clients continue purchasing different items.
5. SUPERVISION: Does this position have supervise staff? If yes, describe the supervisory duties.
The cashier supervisors have the responsibility to supervise the retail employees. They conduct meetings in which they guide other retail employee on the best ways of handling their duties. They also take disciplinary action whenever it is necessary.
6. DECISION MAKING:
a. ...
If you don't want to sell below average, you have to assess additional qualitative features that make it more profitable. If sales numbers aren't enough, factors like profitability and unique dental practice features can diminish the inevitable impact of your overhead costs. But how can you boost them?
Julie Sykes, of Yorkshire based HR specialist consultancy JCS HR, explains the principles to ensuring you recruit the best, most appropriate, people for your business.
In any business, staff can have a critical impact on success, and this is particularly true in SMEs where employee numbers tend to be lower and therefore the impact of someone who is not giving their best, or who is not a good fit for their role, can be much greater.
Yet, given this fact, most small businesses – if they were being honest – would acknowledge that they are much less rigorous in the processes they apply to the recruitment of staff than those they apply if making a decision to invest a similar amount – or even smaller amount - of money in a piece of capital equipment.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
1. TODAY’S PRACTICE
It’s Time to
Invest
Today’s down economy is a window of opportunity.
BY SHAREEF MAHDAVI
Each year, a word or phrase emerges that
encompasses my current thinking about
refractive surgery and its role in society’s “Those that take the path less traveled
marketplace. In 2006, I explored the and seriously invest in their practice
theme of quality for Cataract &
Refractive Surgery Today’s columns. In will be handsomely rewarded.”
2007, customer experience dominated
most of the topics I covered. This year has been busy
with the preparation of new offerings (see The levels as part of enhancing the customer’s experience.
Premium Experience Network), so I will take a bye for “We just can’t afford it” is a common lament. Oh really?
2008. For 2009, the word that I think will stand out is This logic assumes that the inverse is true, namely that
investment. With the current economic turmoil (we you can afford to focus on the customer’s experience
have moved well past turbulence), you may find it a bit only when times are good. But, my intel says otherwise,
ironic that I would advocate investing in anything con- as rising procedural volumes give a sense of “every-
sidering the serious downdrafts that have reduced the thing’s just fine,” and a complacency sets in that takes
value of homes, stock indexes, and many individual the pressure away from striving to be better.1
retirement accounts. Let’s face it. Some practices will really suffer and may
Although refractive surgery’s bright spot this year not survive the latest body blow to the economy. Those
has been the growing demand for premium IOLs to that take the path less traveled and seriously invest in
correct presbyopia, 2008 has also been marked by a their practice, however, will be handsomely rewarded.
slowdown in the overall demand for LASIK, which will This claim is backed up by significant research that has
finish at 20% to 40% below the procedural volume of measured customers’ satisfaction across numerous pub-
2007. Given that we are in a down cycle, now is the licly traded companies that found that those with high-
right time to invest in two specific areas of your prac- er rates of customer satisfaction provided shareholder
tice. The first investment should be an internal focus: return that was considerably higher than the bench-
look at your practice and be willing to refine the assets mark index to which they belong (eg, S&P 500 index).2
to better meet the emerging paradigm around con- How do you create higher customer satisfaction in
sumers’ behavior. The second requires an external refractive surgery? It’s not by doing better procedures
focus: look at how you describe to patients their in- (the outcomes are already excellent) but by staging an
vestment in refractive surgery. improved customer experience. This act of staging ex-
periences has four specific requirements that can be
THE PR ACTICE summarized into the four key assets of the successful
Many practices I interact with are telling me that they organization: people, process, passion, and product
are struggling in the face of the softening demand for (B. Palmisano, oral communication, October 2006).
refractive surgery. Their instinct tells them to “cut, cut,
cut” in all areas of the practice that they do not consid- PEOPLE
er vital to the delivery of care. Expense cuts include The typical refractive practice is loaded with oph-
those soft skills needed to improve customer service thalmic tenure among its staff—employees who have
46 I CATARACT & REFRACTIVE SURGERY TODAY I NOVEMBER 2008
2. TODAY’S PRACTICE
learned to do a good job of checking patients in, per- care of customers while they are with your practice.
forming diagnostic tests, counseling candidates on the Deconstruct into discreet steps or stations each part of
pros and cons of refractive procedures, and assisting with a patient’s “visit,” such as telephone counseling/schedul-
surgery. They are the front-line workers who perform ing calls, reception, testing, one-on-one counseling,
many of the service-based activities that compose the doctor time, surgery, and postoperative visits. Within
practice’s operational flow. But, this mix of talent is too each one of these stations, you and your team should
often grounded in medical expertise so that it lacks bal- create three lists to answer the following questions:
ance in the newly required retailing know-how needed to • What should we never do?
effectively serve customers (which is what patients be- • What should we always do?
come when they pay directly for services). • If we had the resources, how could we “wow” the
patient?
This exercise will put you on the path to developing
“Allow trusted employees to use their procedures that will improve a patient’s overall experi-
brains when they enter the office and ence. For example, never yell the patient’s name from the
examination doorway. Always walk up and greet the
get rid of those who are ‘cancerous’ patient and then bring him to the examination/appoint-
to the morale of the team.” ment area. If time allows, offer to clean his spectacles while
he is worked up. Quite simply, there is no substitute for
working on the basics if you want to improve your cus-
The current economic slump is forcing many prac- tomers’ satisfaction. No shortcut or silver bullet exists that
tices to trim staff hours and/or headcount. It is, to be will cure bad processes.
blunt, a good time to get rid of bad employees, loosely
defined as those who are unwilling or unable to adopt PA SSI ON
the “customer centric” mentality that differentiates Because of the results achieved with refractive sur-
experience economy workers from service economy gery, you would expect your patients to become al-
personnel. As you re-evaluate your staffing needs, seek most evangelical about the remarkable procedure they
to retain and hire those employees who “wow” your just underwent and how it changed their lives. That
patients on a daily basis, who go above and beyond to expectation is unrealistic when you have employees
meet patients’ needs, and who don’t know the word no. who do not enjoy their job, complain about how they
Each surgeon knows in his gut which employees fail to are (mis)treated and how “catty” the workplace can
fit such a description, yet he often lacks the courage become, and resent being paid at (or below) market
required to part ways. I hope the current financial rates for their job. Poor employee morale cannot be
stresses force this issue to the surface, as I firmly believe hidden from customers, who may detect it instanta-
it is in the best interest of the practice and the affected neously yet often do not complain because of the his-
employees to help unmotivated, troublesome, and/or torically low standard of customer service within the
unprofessional staff members to move elsewhere in medical profession. Consider for a moment the legacy
their career. No one practices this better than Zappos term waiting room, and you will begin to understand
(Las Vegas, NV), an online shoe store with a 4-week new what I mean.
employee orientation. At the midpoint of that initial How does a practice install passion into its culture? It is
training, the CEO addresses the group and offers any- by making training and skill development a regularly
one in the room a bounty ($2,000, at last count) to scheduled part of its operating procedures and by recog-
leave the company then and there. The 10% of employ- nizing and rewarding employees’ behavior that is above
ees that take the offer are doing the company a big and beyond when acknowledged by your customers.
favor by leaving the establishment and not infecting the Allow trusted employees to use their brains when they
remaining strong employee culture that has vaulted the enter the office and get rid of those who are “cancerous”
company’s revenue.3 I dare you to try this in your prac- to the morale of the team. If you take care of your staff,
tice and see who takes you up on it. more than likely, they will take care of you. Abuse your
team, and you will suffer the consequences.
PRO CE SS
The processes so firmly in place inside the operating PRODUCT
suite are in many ways lacking outside it. Processes are How do we best define the procedures that compose
the “rules of engagement” that are designed to take refractive surgery? Are they goods, services, or experi-
NOVEMBER 2008 I CATARACT & REFRACTIVE SURGERY TODAY I 47
3. TODAY’S PRACTICE
TABLE 1. TIME SPENT WITH DIFFERENT PURCHASES
ON A COST-PER-MINUTE BASIS
Purchase (with key assumption) Cost Per Minute
Personal trainer (1 hour session @ $80.00) $1.33
Dining out $1.00
(fast food at $5.00 for 5 minutes, fine dining at $120.00 for 2 hours)
Netflix DVD rental (1 month @ $20.00, typical usage of five movies) $0.03
Movie ($10.00 for a 2-hour film) $0.08
Cell phones (monthly contract covering cell phone and e-mail) $0.03 to $0.06
(The cost is $100 per month for voice and e-mail [eg, BlackBerrya])
LASIK ($5,800 spread out over 16 hours per day for 10 years) $0.08 to $0.09
LASIK (same as above over 20 years) $0.04 to $0.05
a
BlackBerry (Research In Motion Limited, Waterloo, Ontario, Canada).
ences? It all depends on your point of view. LASIK, at its
core, is a service, an activity performed on demand by a “Unique and personal customer
surgical team. But, if you promote LASIK in a way that experiences are what will
devalues the service component (eg, all doctors are the
same), then LASIK becomes commoditized and looks differentiate your practice
more like an undervalued good than a highly valued in the long term.”
service. On the other hand, if you work to personalize
and customize that service so that patients perceive it
as unique, memorable, and “designed just for me,” the quiries regarding LASIK, may lead some to conclude
service gets elevated to the realm of experience. In addi- that the LASIK market is dead. This perception is mis-
tion, unique and personal customer experiences are leading, however, as people continue to go to work, still
what will differentiate your practice in the long term. go out, and live their lives. It took a doubling of the
price of crude oil during the past 12 months to yield a
BAD NEWS I S MI SLE ADING drop in gas consumption for the first time in 20 years.
Having covered the key assets requiring investment in the People are not stopping what they do; they are just
practice, let us now shift to further exploring this notion of doing it less—be it driving, dining, vacationing, pur-
experience and how—by changing the way we characterize chasing gifts, etc. We are in a downward cycle in con-
the nature of the investment in LASIK—you stand a much sumerism, which hurts retailers. Because retailers are
better chance of connecting to the needs of customers and desperate to sell their goods, they often reduce their
increase the likelihood they will put their money on the service component (eg, fewer staff members) and, in
table, in spite of all the bad news regarding the economy. the process, diminish the shopping experience. As I
Today’s evening news makes it seem that no one is write this article in mid-October, I have already begun
spending money. This, coupled with a decrease in in- hearing advertisements from retailers trying to lure me
50 I CATARACT & REFRACTIVE SURGERY TODAY I NOVEMBER 2008
4. TODAY’S PRACTICE
THE PREMIUM EXPERIENCE NETWORK
With premium LASIK and IOLs emerging as standard offerings in refractive surgery, many practices are seeking ways to
enhance their image as a first-rate provider in their community.
To address this need, SM2 Strategic (Pleasanton, CA) is launching a new offering, The Premium Experience Network, which
is designed to give surgeons and their key staff members the confidence and tools needed to charge premium fees as part
of staging a memorable experience for their patients.
This is a members-only, subscription-based Web site that is available to practices that believe in the need to improve
patients’ and employees’ overall experience as a means of differentiating their services and staying ahead in a crowded
marketplace.
Much like a magazine, this Web site will publish new content on a regular basis. Unlike a magazine, it will use multiple
media: video, audio podcast, and a blog as well as articles and tools that can be downloaded as training tools for staff.
Check out www.premiumeyesite.com for more information. Open enrollment has begun, and the first season of program-
ming will begin in mid-December 2008.
in for early Christmas shopping. I do not think this strat- I want to thank Steven Dell, MD, for convincing me
egy will work, as consumers are yearning not for goods to think more richly about LASIK as an investment
(as we already have one of just about everything we when he asked, “What other investment can you
need) or services (we already have our hair stylist, lawn make in your life that you will use every waking
service, and dry cleaning covered) but for experiences. moment?”4 As an investment, LASIK has traditionally
been judged on the costs associated with what it
replaces—spectacles and/or contact lenses. This con-
cept is okay, but it fails to account for the many con-
“As an investment, LASIK has traditionally sumers who are willing to settle for a less invasive
been judged on the costs associated with solution that sidesteps the perceived risks associated
what it replaces—spectacles with laser surgery.
and/or contact lenses.” COST PER MINUTE
Surgeons need a new set of comparables and a new
measuring tool by which to evaluate the LASIK invest-
I have stated that the way to build future demand for ment. I suggest we use a handful of common offerings
LASIK is to change the consumers’ fundamental experi- from the service economy: personal training, restaurant
ences that surround the surgical procedure itself. Doing dining, DVD rental membership (ie, Netflix, Inc., Los
so can help you tap into patients’ emotional needs that Gatos, CA), going to the movies, and cell phone usage.
are at play. For example, the logical discussion between Moreover, courtesy of the Experience Economy, in
patient and counselor about whether “to have or not to which the main currency is “time spent with the offer-
have” LASIK occurs after the emotional center of the ing,” you can re-evaluate these different offerings and
patient’s brain has weighed in on the matter. “It’s too LASIK by reducing their currency to a common denom-
expensive” or “I can’t afford it” are logical justifications inator, such as cost per minute.
for patients’ emotional reaction to their fear of trusting By using reasonable assumptions, you can reduce
their most precious sense to you, the surgeon. These the cost of most activities to what the consumer pays
same individuals, however, spend money on all sorts of on a per-minute basis (Table 1). Among the more
goods, services, and experiences that—when objectively expensive options is dining out; either fast or slow din-
compared to vision correction—do not provide nearly ing has the same cost per minute, which is a very high
the benefit derived from refractive surgery. one at $1.00 (assuming $5 for the typical McDonald’s
52 I CATARACT & REFRACTIVE SURGERY TODAY I NOVEMBER 2008
5. TODAY’S PRACTICE
meal lasting 5 minutes and $120 for the typical fine recent weeks has made people wonder if their mattress
dining meal lasting 2 hours). Membership-based DVD is a safer place than a bank to store their money. If we
rental is technically an experience offering, as you are enter a period of higher inflation, then even the value of
charged for membership rather than on a per-rental the interest earned in basic money market accounts will
basis. It works out to a relatively low $0.03 per minute erode; a higher inflationary environment should be a
(assuming a $20.00 per month membership and five stimulus to spend money today (when it is worth more)
movies watched that last 2 hours each). Going to the rather than at some point in the future (when inflation
movies is more expensive at $0.08 per minute when has eroded its value). What all this says to me is that
you pay $10.00 for a 2-hour film (previews included at LASIK or a premium IOL is perhaps the best investment
no extra charge). Cell phones, depending on usage and a person can make with his money, because it will not
the monthly contact, average between $0.03 and $0.06 lose value over time due to market fluctuation, interest
per minute. rates, or inflation.
Where does LASIK come in? Using a $5,800 cost spread
out over 10 years, the cost is $0.08 to $0.09 per minute. SUMM ARY
Because the customer receives utility for the investment I am not in a position to predict where the econo-
at every (waking) moment, we use 16 hours X 3,650 days my is headed, but it may be reasonable to assume
as the divisor into the cost. Viewed over 20 years, the that things will get worse before they get better. It will
cost per minute drops in half to the range of $0.04 to take a concerted effort, which I term investment, into
$0.05 per minute. Either of these is much cheaper than the practice and into its positioning to weather this
dining out and perfectly in line with other ways people economic storm. Rather than simply cut costs, you
spend their discretionary income. One might argue that should look closely at what you can do—especially
it is an unfair comparison, because you do not eat, watch when procedural volumes are down—in order to nail
movies, or talk on the cell phone all day long, but that is down processes with a team of passionate staff mem-
exactly the point. To echo Dr. Dell, there is no other in- bers. This way, you will be in a position to take your
vestment that pays dividends every waking minute of practice to new heights when the overall economy
every day. bounces back (as it always does). ■
INFINITE ROI Shareef Mahdavi is President of SM2 Strategic, a
I have not even touched upon the time-savings Pleasanton, California, firm helping medical manufac-
afforded by not having to care for and put in contact turers and providers create demand for new technolo-
lenses. Nor have I mentioned the performance of cer- gies. Mr. Mahdavi may be reached at (925) 425-9900;
tain activities without the need for vision correction, shareef@sm2strategic.com.
which may improve patients’ self-esteem and lead
1. Mahdavi S. Good–the enemy of great. Cataract & Refractive Surgery Today. April
them to try something new (eg, waterskiing) based on
2006;6(4):81-84.
higher self-confidence and less fear over losing a con- 2. DiJulius III, JR. What’s the secret to providing a world-class customer experience?
tact lens or pair of glasses. Separately accounting for New York, NY: John Wiley & Sons, Inc.; 2008.
saved time would vastly increase the “return per 3. Sullivan M. Building a customer-focused culture. Paper presented at: The Refractive
hour”—another metric, albeit much more difficult to IOL Symposium; September 27, 2008, Las Vegas, NV.
measure as it is based on personal experience—and 4. Dell S. The presbyopic consultation in refractive surgery practice setting. Paper pre-
sented at: The Refractive IOL Symposium; September 27, 2008; Las Vegas, NV.
create what can be thought of as “infinite ROI” once
consumers believe their upfront investment has been
recouped. For some patients, this occurs the moment SHARE YOUR FEEDBACK
they get up from the laser and can see clearly for the
first time without glasses. Would you like to comment on an author’s article?
Do you have an article topic to suggest? Do you wish
BE AT INFL ATI ON
Now, let’s view the LASIK investment in terms of the to tell us how valuable CRSToday is to your practice?
current economic turmoil the nation (and the world) is We would love to hear from you. Please e-mail us at
facing. In the past year, other investments of our money letters@bmctoday.com with any thoughts, feelings, or
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ping. The stock market is way down versus 1 year ago. questions you have regarding this publication.
Furthermore, the financial crisis that has erupted in
54 I CATARACT & REFRACTIVE SURGERY TODAY I NOVEMBER 2008