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If you have had a long spree of acquisitions and are a large hospital system do you think it is possible to have a philosophy of co-existence? Rather than having a singular definition and view of ‘who we are’ can you have multiple identities. For instance identify which hospitals in the system are going to be academics/research focussed and which are only going to focus on delivery of care. Make that distinction clear within the organisation and also to the community.

The hospital that you acquired should have been doing something right, which is why you considered a merger. Now having merged, it may not be the best idea to suddenly tell them that they were wrong all along and from now on they must do everything differently. As long as the fundamental philosophies are shared and the direction is agreed upon, I think individual cultural differences should be accepted, and even leveraged.

On May 1, 2019, Ankit commented on Public/Private Competition :

If you are looking at these large events more as a marketing opportunity, you could consider dropping down the prices significantly (you have a 40% cushion). Maybe have dialogue with the police and tell them that you want to do the events as a social responsibility and are not looking at it from a business perspective. The police can free up their resources for other needs.

Free marketing and visibility is in itself a huge gain. So try sacrificing margin on the actual delivery of services and position the whole activity as a CSR initiative. The police might not resent you and could in fact even cooperate.

On May 1, 2019, Ankit commented on Increasing Demand for On-Call Pay :

We have negotiated a higher reimbursement from the payers for emergency medical services and procedures. The added revenue is distributed among the medical and even the para-medical support staff that attends the call. No one wants to leave home in the middle of the night to attend a call by choice. So, if someone is doing that then they need to be compensated. Disparity in paying a certain group and not the other just causes dissatisfaction and resentment.

If a business perspective is sought to justify allocation of dollars towards IT as opposed to some other functions, I believe it would help in sub-classifying the IT projects into specific buckets: increasing operational efficiency (e.g. better utilisation of physician outpatient time), rationalising consumption (e.g. better inventory control and optimal procurement for better cashflow management) or clinical improvements. Each of these projects could then be assessed through an ROI lens. You could present the project to the leadership and an improvement project, where a better IT system or tool is a means to an end and not an end in itself. By re-framing the problem, you may have a better shot getting dollars allocated for your project.

On May 1, 2019, Ankit commented on New medical center concept :

I would re-visit the economics of imaging and diagnostics. There might be ways to lease CT Scan/MRI machines or arrive at a pay per use arrangement with the equipment vendors, if initial capex is a challenge. If there is a better experience and easier/faster access, I am sure you should find enough patients wanting to pay for their diagnostics. Besides Radiology, I would also do GI scopies, sleep studies and consider a large pathology referral lab. Not only can you be a complementary referral lab to several smaller private hospitals or health centers, but you could also open satellite collection centers and expand big way into Lab medicine.

43,000 sq. ft is a lot of space and you will be left with plenty even after doing all the above. As you say that (a) the location is in a very good district of Moscow, (b) you already have an experience with pediatrics and (c) there are people wanting to pay for plastic surgeries in that region (thus indicating they are willing to pay for personal experience and luxury) I would consider doing a very premium mother and child hospital with luxury birthing, a NICU and some pediatric care.