Earn More by Exporting

Martha Montoya has found a way to grow her small business: She exports. While "exporting" conjures up images of vast shipyards and warehouses, Montoya, a comic-strip artist in Santa Ana, Calif., sells her colorful cartoon characters (shown in B/W) for use on snack packages in China, Ecuador, Colombia and other far-away places. She tells other entrepreneurs — no matter their business — to think about going global.

Read the inspiring article here.

Top 10 Best Blogs and Best Podcast of 2006

Although we did not win, we sure were happy to be nominated and make the cut. Thank you to all of you who voted for us. Your support means the world to us. Maybe next year MarketingSherpa will include a new category on "Global Marketing." Congratulations to all the winners. Way to go!

It's a Small Business World After All

Lou Hoffman used to share the common misperception that overseas markets are only open to the big guys like McDonalds, Coca-Cola and Proctor & Gamble. Not anymore. It's the little guys who are slowly taking over the planet.

Learn more about Lou's story and how you can go global too. Read the article here.

P.S. Voting ends today at midnight for the MarketingSherpa Reader's Choice Blog and Podcasting Awards ... see our nomination in category No. 9!

An Ode to ER Nurses...7/8

It takes a special nurse to be an ER nurse, and we may be losing a few more of ours. I received an email over the weekend, and you might want to consider it:

I just talked with another disaffected ex-E$$ent employee, and as we were discussing the ills of the hospital, he mentioned that the ER was about to lose a significant number of its nurses. He referred to it as the second wave, since we'd already gone through one change over.

I had heard that they were going to try to open the North Campus ER, and couldn't really figure where they would get the extra trained personnel, but now more were leaving? Not good.

On the floor, where it's generally calmer, and you can point a traveler to the various supplies, locations of equipment, etc. In the ER, you generally don't have the time to babysit, so a traveler is more of a liability than a help. Even someone floated from the floor, having a general idea of where things are, is not going to be in sync with the "flow" and what the standard procedures are.

A serious bottleneck was created when they were floating ER nurses to the floors--and got caught by an influx of patients. Now, they have a similar situation, only with nurses that they have to orientate as well. Want to bet on waiting times?

When I was there, there was always a few leaving, but it would seem like a good chunk of the corporate knowledge is walking out the door. But, since even Bonham pays nurses about $6 per hour more, the drive doesn't seem quite as far....

And for the lighter side, some truisms for those in the ER:

1. You Might be an ER Nurse if:
2. You consider a tongue depressor an eating utensil.
3. You have ever tried to identify what a patient ate last by examining the barf on your shoes.
4. You're at the grocery store, look down and notice you have at least 2 body fluids on you shoes and it doesn't bother you.
5. You've ever rolled your eyes when the 14 year-old says, "No, I've never had sex"?
6. You've ever told a confused patient your name was that of your co-worker and to HOLLER if they need help?
7. You've ever passed on the green stuff at the buffet because you are certain you suctioned it from a patient earlier?
8. You know it's a full moon without having to look at the sky.
9. You've developed a crease between your brows from trying NOT to inhale the various human secretions you've encountered over the years.
10. Eating microwave popcorn out of a clean bedpan is perfectly natural.
11. You've been exposed to so many x-rays that you consider it a form of birth control.
12. Your bladder can expand to the same size as a Winnebago's water tank.
13. You believe Tylenol, Advil, or Excedrin provides a large part of your daily calorie intake requirements.
14. You don't ask "frequent flyers" their history, you know it by heart.
15. You can keep a straight face when a patient responds, "Just two beers."
16. Your idea of a meal break is finishing your coffee before it gets cold
17. You've ever bet on someone's blood alcohol level
18. Discussing dismemberment over a meal seems perfectly normal
19. You believe in the aerial spraying of Prozac
20. You have encouraged obnoxious patients to sign out AMA so you don't have to deal with them any longer
21. You believe the government should require a permit to reproduce
22. You believe unspeakable evils will befall you if the word 'quiet' is uttered
23. You have used the phrase 'health care reform' to terrify your co-workers
24. You have witnessed the charge nurse muttering down the hallway, "Who's in charge of this mess anyway?"

French Blogging: Why (Global) Marketers Should Start Paying Attention

It was when The Global Small Business Blog was nominated and made the cut for the BIG MarketingSherpa Reader's Choice Blog and Podcasting Awards -- yes you read that right! -- for best in its class for category No. 9 Small Business Marketing (cast your vote of "Excellent!" for us ... deadline is Monday, June 26 at midnight) that I discovered Eric Kintz's The Marketing Excellence Blog. And what a blog it is. Here's an entry I particularly liked: French blogging -- why marketers should start paying attention.

The only thing missing from both the contest and Kintz's entry is this: global. Someday, everyone will have a worldview.

P.S. Since we are Chicago-based, we are trying to work with Oprah to see if Pontiac or maybe Peugeot will give each of you a new car for voting EXCELLENT for The Global Small Business Blog! There are no guarantees ... stay tuned.

Global Marketing 101 Lesson

Your global marketing test for today consists of two questions.

1). Why do most companies want to globalize their operations?
2). What’s the best way to reach global markets?

Find the answers here.

How to Take Your Small Business Global

Okay ... every once in a while I have to do a little shameless self-promotion and this is one of those times. Jennifer LeClaire did such a great job with this article for E-Commerce Times that I had to share it with you. It sings the gospel on globalization!

Read it here and then take action!

Note: I had to include a picture showing some skirts!

Make Globalization Work For You

The outsourcing trend almost killed Kalexsyn -- until its founders (pictured) made globalization work in their favor.

The timing could not have been worse for Robert Gadwood and David Zimmermann. After being laid off by drug giant Pfizer in 2003, the scientists founded Kalexsyn, a chemical research company in Kalamazoo, Michigan. Kalexsyn's plan was to help large pharmaceutical companies create new drugs by examining thousands of molecules to pinpoint the ones that had medicinal potential.

But by the time Gadwood and Zimmermann built a lab, bought equipment, and hired 10 employees, the strategy had become obsolete. "All of our customers disappeared," Gadwood says.

What did they do? Find out here.

And the saga goes on... 7/13

I received this email and had some qualms. I read the interview with the hospital's former CEO in the local paper and was going to email some of the folks that had been sending me the basis for my posts. Was curious about his departure. David Kreye was the new CEO, and I can't believe even he would do this. (Note: Apparently it was the facilities director that wrote in. I am duly corrected, and appreciate the input.)

My great uncle was one of the founding physicians at our little hospital and my father practiced there for nearly 50 yrs.

I managed the facility for nearly 22 yrs. and considered it my own and treated it as such. I guess you could say I cared about the place. Having grown up here makes you feel a part of a unique fraternity that honestly shares something with those who have come before.

At any rate, we were feeling the wolf's breath the past few years and in 2005 decided to look for someone to purchase us. Several look-sees came but no one bit. Along comes Essent in early 2005 and after much "due diligence" and careful research decide to buy us. Well the sale was consummated and on Oct. 11, 2005 they officially took over. The new CEO asked me to come up to his office that morning and said it was about to happen.

Not knowing what was in store I agreed to hang around. The first person to be escorted from the building was our HR person. In a brief span of time, almost 10% of our workforce was summarily erased from the books that morning. In short, they were not asked to join the new company.

Shortly after this a poll was taken throughout the hospital to create a new name for the hospital. After much suspense the official winner was "Southwest Regional Medical Center". Imagine that, a name overwhelmingly approved by the recently deposed board of trustees, the medical staff, the hospital staff, and the community at large! Think of it: A little hospital that has been known since the early 1930's as Greene Co. Memorial Hospital. WOW! what a leap of faith! Tim Leary would have been proud.

I could see the standards we have lived by would be slowly eroded in the name of "moving forward”. They do not like the speed at which the bureaucrats who regulate us proceed so they have chosen to circumvent their authority and proceed with total disregard.

The community meanwhile has recoiled at many of their activities and especially the continued release of many long-term dept. managers. These events have generated a great deal of doubt in their leadership. What would you think at seeing a want-ad for 3 new dept. manager positions at the same time from a hospital with only 54 beds? Perhaps this is the transition of converting from not-for-profit to for-profit.

I think our community expects more than this from an institution who has been a presence in various forms since 1907. I have seen many good people let go because they would not speak the party line. My concern is for the folks who go to this institution to receive medical care. Stay tuned, I think other things are in store for us...

I really have a problem with this: How someone could be so devoid of character as to parade the firing of staff before the administrator that had been there for over 20 years. Essent certainly knows how to pick 'em--how well we know, he was here first.

Oh, by the way, GCMH was a union shop. SEIU, if I'm not mistaken. Look for the union label....

Paris and Essent...6/16

Not that we can disassociate entirely from the rest of the E$$ent community (doesn't that phrase make you all warm and fuzzy), but I've probably spent more time than I should have on the other folks. However, it has gotten more corporate attention. It probably isn't going to be on Good Morning America (or 60 Minutes), but more people in the industry blogs are noticing our plight, and that could be what affects E$$ent's ability to grow: outside funding.

If the lenders had known that Crossroads was in such bad financial shape, there probably wouldn't have been an E$$ent at this point. That kind of begs the question: How profitable are they really, and how much is being siphoned from the profitable hospitals to keep the others looking good?

They have been cherry-picking, and scooping the really good deals. We weren't quite in that catagory, but they looked at us to do a couple things:

1. Doubling the number of beds. From just a numbers perspective, we had about the same number of licensed beds in our facilities as they had in the entire corporation.
2. Cash flow. There were enough blatant inefficiencies that needed fixing that they figured that most of the other problems could be fixed as easily. They were wrong.

But back to loans...you can't ask lenders to prop up losing hospitals, but you can ask for building funds, and point out that a hospital was doing poorly because of being 'under construction'. That would fit with buying a new PACs, while the portable x-ray machine in the ER looks like it's ready for the scrap yard...having two out of four x-ray machines down...or numerous hospital beds that can't be raised or lowered. And that would explain the need to transfer patients to floors that have working wall suction, rather than fixing the leaks...all while putting in flat-panel TVs.

Renting out floors at the North Campus kept that part of the facility from deteriorating from disuse, but it poorly disguises the fact that we formerly had two hospitals running at relatively high occupancy percentages--without the Dubois segment. Now we have empty beds even with that and having a South Campus floor down for 'renovation.'

The "Dallas drain" to Paris healthcare is significant, and damning. Next time you hear that your physician had surgery, or was hospitalized, ask them where they went...

Note: I used the South and North Campuses references purposefully. That's another thing they didn't 'get'....

The Thinking Man's Outsourcing

Globe Trotter CEO Brian Reale (center) outsourced his R&D (and himself) to Bolivia.

A surprising number of U.S. companies are sending their most complex activities overseas. Read the article here.

More from Greene.......7/23

More from Greene County Memorial Hospital (If we still call ours St Joe and Big Mac, I guess the same goes there....)

"I am a former employee of GCMH. There is no doubting the way I feel about Essent. I have never tried to hide it. I want to be very clear that I left the hospital, and was not asked to leave. All of this took place of a course of two months. Why? Well it goes like this.

Upon Essent's take over one of the very first things that was done was that every employee's records were gone through to see who was going to be weeded out. At that time decisions were made without any consultation of the Department Heads on who was going to be let go. I lost three very good employees and had no say in it. I was left with twelve employees--only three that actually had a clue about giving care in a rural community....

...As much as I hated to, I decided then and there that I would not stand back and watch what I spent 5 years of my life building go down the drain. And that is exactly what is going on. Our clinic, when I left in December of '05, had already lost 50% of its patients because of lack of care. E$$ent has not figured out that the reason people were being paid what they were being paid is because we have already proven that we are a valuable asset to our employers and the community.

...A lot of good people no longer work for that hospital. And I bet that will lead to its demise."

Weatherford should be dancing in the streets---if these new folks (CHS) haven't followed the same playbook. Only time will tell.

But this also shows that we were not the unusual case! I thought that Christus had been the spoiler, with the purchase of the North Campus, they effectively destroyed the chances of an easy transition, and made it into something out of the Inquisition.

Apparently ours hasn't been the only one, and looking back at the difficulties Essent had with the union in Mass, I would imagine one here would not be their favorite Christmas wish, but it hasn't been roses for the union folks out there, either. Maybe it was the same in all the E$$ent hospitals, and it's just that New Englanders are just quieter about things...somehow I don't think they're all that quiet--they were fairly loud when they invited the King of England to a tea party--in Boston Harbor! But that was a long time ago, and possibly that spirit of independence has been bred out of them.

Wonder what's up with the La Quinta? Heard that they had some issues with the permits?

Campbell Health Systems--6/21

UPDATE: Campbell Health Systems rejected the E$$ent overture and selected CHS to lease their hospital 6/8.

Campbell Health Systems seems like a nice, little, non-profit (county owned) hospital. They're apparently starting to look at the bottom line and worrying a bit. Probably thought that looking into a management deal, or a lease from a for-profit would reduce the drain to the taxpayers/government.

Our experience with an external management team was with what is now our "North Campus." They got into trouble when the folks from Presby-Dallas came in with an attitude that they knew how to fix things. They went from making a little to losing a lot. The hospital had a building program on track to expand the physician offices--that went off track when there was no need and plenty of vacancies. Raising rent and demanding 3-5 year leases didn't do them any favors. That actually started the cascading effect that landed us with Essent.

1. The Parker County Hospital District board of Directors will receive information from administrators, employees, and medical staff members of Paris Regional Medical Center, as well as, past and present members of the Paris Regional Medical Center regarding Essent Healthcare and other groups that have submitted proposals to lease Campbell Health System. The Parker County Hospital District Board of Directors will not vote on whether to lease the Hospital to any entity during this meeting. THIS IS AN INFORMATIONAL SESSION ONLY.

2. Executive Session: The Parker County Hospital District Board of Directors will enter into Executive Session Pursuant to Section 551.071 and 551.072 of the Texas Government Code. The following will be discussed:
A. Consultation with attorney regarding potential lease of real property located at 713 E. Anderson, Weatherford, Texas

3. Return to Open Session (There will not be a vote on any item)

4. Adjourn

In a way, you can't blame them, sloughing off the responsibility to a for-profit for making the changes that are needed puts a buffer between them and the actions (staff reductions, salary compressions, and the like) of their "tenant". And half million dollar expenditures for CTs kind of took the wind out of their sails, along with room modernizations. The sixth floor here probably impressed them--if so, they impress easily.

May I suggest that before they go down that road, which leads to an outright sale, they take a deep breath and look at other hospitals that have remained non-profit, but were able to make the changes in operation and attitude that would increase their efficiency. The largest barrier is the attitude that "we don't have to make a profit..." Sure you do, it's just the way you spend it that's different. On salaries, equipment, indigent care, or whatever, instead of dividends.

The organization that supports them is not a money tree, so self-sufficiency is the goal, not working on an allowance. Both parties resent it--the payers that they have to keep supporting it, the payees that they have to keep asking for it. Deep pockets help, but selling your soul to Essent doesn't.

They might do better there than in Paris, however. They were more comfortable in that size hospital--although Crossroads was that size and they were only profitable in one year out of five...and Wentzville, Mo has some interesting similarities to Weatherford. Hopefully they don't have the same fate.

A Quest for the Global Best: America

Globalization has been a boon for some U.S. service companies. Last year, a surplus of $58 billion in services was outsourced overseas. Here is a selection of recent data on cross-border trade from the Bureau of Economic Analysis.

Read the article here: America, At Your Service.

Opportunities in globalization

Smart innovation is key to long-term prosperity. Nations won't thrive by just accepting low pay.

The seed of globalization germinated 60 years ago at the University of Pennsylvania, where ENIAC, the first operational general-purpose electronic digital computer, was unveiled in 1946. That single 11-ton machine has spawned more than 200 million computers worldwide, a number growing at 20 percent per year. Its stepchild, the cell phone, has grown to more than 1 billion units in one-quarter the time, and that number will at least double in the next 10 years. We can now connect with anyone, anywhere, at any time. This on-demand world fulfills the vision of a "global village" Marshall McLuhan put forward in 1964.

Read Rocco Leonard Martino's provocative article in its entirety here.

Greene Co Revisited...6/9

The folks from Greene Co, PA have started finding the blog:

Essent Healthcare seems to have absolutely no moral compass to follow, and that sort of culture comes from the top. It's a shame that the residents of Greene County are now left to suffer with this sad choice for employment, and healthcare. Certainly, they need to become more aware of this ugly organization that has slimed its way into our community. Your blog is one way to accomplish at least that much.

And:

Hello. I just ran across your interesting, and insightful blog a few days ago. You've really hit the nail on the head regarding Essent's business model of oppression, and fear! I was an employee @ the old (and much better) Greene County Memorial Hospital in Waynesburg, PA. I simply cannot believe that our board of directors allowed such an amoral group to takeover the sole hospital into our county. In the board's defense, they weren't really heavy thinkers. :)

...I know many current, and an ever-increasing pool of ex-Essent employees who may have information that would interest you, and your blog readers. Are you interested in that sort of information? If so, I will point them in your direction.

Please let me know, and keep up the great work!!!

And I did, let him know, that is.

From the Patient Side...7/21

I get the average number of emails, trash with the treasures, but this one was so eloquent that I couldn’t avoid using it...besides, she starts out with a complement...

Someone who has the "Granite Fixtures" to drag all the cockroaches in the PRMC program out into the glaring light of day. May you be commended. Having been a patient in that ER and a Parent with a sick child there, it is undoubtedly gone down hill past the point of rock bottom and has begun to dig with a clam-shell steam shovel. Both of my kids were delivered at the woefully gone McCuistion, at the hands of the late and sorely missed Dr. A. Frank White, MD (glad this isn't paper there would be tear stains.) God rest his soul, he would be turning like a whirling dervish in his grave to see the medical care fall apart the way it has. L.P. McCuistion would be calling for the heads of the POWERS THAT BE to roll like bowling balls.

Medicine is supposed to be a service TO the people, NOT a SERVICING OF the PEOPLE!

If the people of Paris are smart they will use a little extra gas and go to Dallas or a lot extra and head south to Houston. With the choice no longer MRMC and St. Jo the people in Paris would do better going to one of the Vet Hospitals on the loop, they would get quicker care in the case of an emergency.

Some of the nurses are ok, others should be sent back to their rolls as Dominatrix and there they should stay. Yeah, you know who you are! The procedures and policy book at that hospital should be read a little more and not be used to even up a table leg! The Employee horror stories are many and diverse and if a book were written about all of the screw-ups and idiotic actions it would make War and Peace look like a pocket book!

For what it is worth the people of Paris should demand the closure of the PRMC campuses and find a bank to loan the city the money to make it a city owned medical care facility. If they don't, the lord high masters will close down and move out in a snit!

Thanks for letting me get this off my chest

And I did ask if I could publish it. Here was the response:

Frank,

You can use the whole bloody letter I wrote if you so choose! Tired of seeing the employees have to bend over and try not to smile. In the classic words of Frat boys in initiation, "Thank you Sir, May I have another".

If they don't have the hospital closed in the next 12-18 months it will be a God sent miriacle.