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Tomaino Arm Care Network

Dr. Tomaino's Blog

Exceeding the sum of the parts

August 10th, 2008
We've all heard the phrase, "The total exceeds the sum of the parts." In our case I would say, "Our value exceeds the sum of our parts." Obviously, this violates basic algebra, but it does, indeed, relect a fundamental truth regarding "value creation." Competetive advantage often entails more than better internal processes and systems or superior intellectual capital (although it may). While being a market leader may be the by product of scale advantages and other operating efficiencies, what cannot easily be duplicated, arguably, is "performance culture" or an enterprises "brand" --embedded in every parcel of its offering.

At Tomaino Orthopaedic Care our team embraces a "High performance-High commitment [HPHC]culture ." If you read my very 1st blog (Small is the new big) I mention that being small enables versatility and nimbleness. We don"t embrace the status quo. When every member of an organization not only buys into a HPHC culture but is assigned accountability for continual improvement, it is almost guaranteed that an offering will continue to improve--to meet the expectations of the customer.

So--while I may intuitively know that my team is commited to delivering superlative care to our patients, I also must empower each and every patient to share with us how we might become even better. Providing exceptional care is a moving target.
And, therein lies the basic ingredient to creating an offering with a value that exceeds the sum of its parts.



The company I work for is Productivity driven. They are also Performance driven. They are also Quality and Safety driven. Looking at each of these it would seem that one has nothing to do with the other. They really don’t unless one or more of them reaches a tipping point that will intern skew the others.

We have a productivity goal that is set for us by Corporate based on customer orders. We must achieve this goal every day or risk falling behind and losing the customer. Along with these goals we have to maintain certain preset performance levels to remain fiscally viable. If we spend too much to make the product (labor/overhead) we lose profit. Our quality goals are set both internally and externally by the customer. If we can’t make a ‘perfect’ product they won’t buy it. The orders we need for production will be gone. Wrapped around all of this is maintaining a safe environment.
To sum it up we have to be able to ‘produce’ a ‘quality’ product ‘safely’ and ‘efficiently’.

What we have found is that each of these has its own ‘tipping point’.
When we are functioning at optimal levels for production and labor force all of these areas are ‘green’ in our charts. People are happy that the work is coming through the doors and they like their jobs. During periods of low order volume, like last winter, we decrease our employee volume. Those left, had a tendency get into a mode of ‘automatic’. They sort of just cruise through the day in autopilot and they aren’t sure of their jobs. During these periods we saw product quality go down and injury rates go up. We get the same effect under the opposite circumstances. Later in the spring, order rates mushroomed. We had to increase the labor force with unskilled labor to accommodate. Once again, due to the lack of training and shifts that increased to 12hrs, we saw quality go down and safety incidents go up.

To a customer look in, our ‘brand’ no longer looks very appealing.

The same policies must apply to medical facilities. If patient volume is too low, they will shed staff or close, affecting patient care. If they set their pace to make the most profit by pumping through the most patients, they will be understaffed with the same affect on patient care. While maintaining this balance, physicians must check their own quality ‘patient care’ or lose the important thing…US.


July 17th, 2009 @ 4:14 pm

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