Internet Business School
When I studied at UCL Business School London, I loved it. This paper I wrote which was awarded a distinction, 70%+. I’ve also studied many other programs online and now believe in studying for modules. I will be looking at Internet Business School as an option over bricks and mortar.
Keep up to date on my Newsletter.
In this essay I look at the OCB as a platform and Dr Shingleton’s practice, and look at their current issues and growth within both entities. I analyse the management and structure, and the organisation from a commercial and strategic point of view whilst making recommendations using ‘The Evolution and Revolution as Organizations Grow’ by Larry Greiner (Appendix 1).
It appears that Dr Singleton’s practice is systematic and gives staff autonomy, as does OCB. Dr Singleton has a standardised process that everyone in his team has to adhere to, which allows him to process operations very efficiently whilst always gaining feedback to improve his service. That said, he does have issues with delegation and has staff that are cross-trained, which conflicts with his industrial-styled system that he has developed, which iterates to deliver best outcomes for patients. With that autonomy this would result in the practice becoming frantic, with staff in confusion.
This explicit model also translates into positive results as Dr Singleton outperforms his peers at OCB by 4.2 times for patient surgeries and only uses 6.5 hours compared with his colleagues’ 4.5. This is a 33% increase in productivity in comparison. In fact, he knocks them out of the park on every metric (Appendix 2).
OCB’s implicit model translates to a platform that allows opthamologists autonomy to run their practices as they see fit, taking away the information system and administrative tasks from the doctors’ business. The issue with this is the consistency with OCB’s brand; furthermore, diluting Shingleton’s work as well as OCB in the marketplace.
OCB being standardised at the office administration/support level is exceptional and has the potential to be scalable, however the autonomy that they provide for doctors may have worked in the early stages of growth but not in time to review the business as a whole. This is causing friction as the businesses have grown to within the ranges of phase 2-3 and is evident that delegation and control need to be refined and anticipate further growth phases (Appendix 3). Shingleton is also letting go of controls where he “prefers” Cape Cod as a practice and missing his Friday meeting in Boston with the team (Appendix 4) therefore displaying a lack of management. This is poor management skills on Dr Shingleton’s part – an irrational decision as the revenues are much lower in that location. From 1999-2004 the revenue has increased, has doubled from 1994-1999 and stabilised to 21% in 2003-2004. Is this the best use of Dr Shingleton’s time commercially? That said, he is losing control by missing his Friday meeting in Boston.
From the Larry Greiner growth model (Appendix 5) Shingleton’s business is ranging between growth phase 2-3. He has all five pillars of phase 2 in his practice and elements of phase 3. He also isn’t driven by money – stating instead that God put him on earth to do this (Appendix 6). This could be an issue if we analyse growth from an economic point of view as he doesn’t appear to be concerned with commercialism. However, this could be the right time to implement change as Shingleton is starting to feel lethargic from the demands of the practice, so now could be opportunistic as he wants to train others with his gift (Appendix 7) and he mentions at the outset he would be interest in growth and serving patients (Appendix 8).
This loops between autonomy, delegation and control in the growth phases (Appendix 9). The negative impact of no change would eventually lead to a commercial impact on both businesses, OCB and Dr Shingleton.
There is also a commercial treat from Medicare’s reimbursements and the demographics being poor and mature – they won’t have the cash to pay. That said, the market for ophthalmologists is huge at $12.2bn, with OCB’s headcount at 18 ophthalmologists. This is more reason to look at a new structure to optimise what is there, from process to technology and their current real estate.
My recommendation would be for Dr Shingleton and OCB to collaborate with their explicit and implicit models. Currently we have two frameworks that have worked successfully (Appendix 10) side by side but now have grown to the next growth phase of a business and need to be redefined. I suggest a synthesis of both business models, which should be standardised throughout OCB and rolled out through the organisation at the Dr level. There is risk as the other Dr’s may not want to follow this as they have had their autonomy and feel like slaves (Appendix 11). This could be achieved by redesigning the office layout as I approximate the waiting area is 20% of the total floor area. There could be at least another operating room which is a revenue producer as there are way too many seats in the reception area in comparison to an operation room (Appendix 12).
This is very low risk and if we use half of Shingleton’s 31 patient levels with a rate of $746 (2004) price per operation (Appendix 13) x 16, this would equate to $11,963 per day x 5, $59,680 x 48 weeks per year (allowing for holidays) which would equate to $2.9m of revenue.
OCB is a functional operation whilst Dr Shingleton also has a philosophy in his practice (Appendix 14) that keeps them on track for their mission. For OCB to scale they need to think about what they stand for before performing my recommendation. Even if OCB doesn’t want to scale in order to remain where they are in the market they will need to implement this structure otherwise they will erode their position via reputation and fragmentation in the marketplace.
Appendix 1: Evolution and revolution as organization grow by Larry Greiner
Harvard Business Review May–June 1998
Appendix 2: Ophthalmic Consultants of Boston. P22. Exhibit 12.
Appendix 3: Harvard Business Review Evolution and Revolution, P.5 The five phases of growth
Appendix 4: Ophthalmic Consultants of Boston. P12. Paragraph 4.
Appendix 5: Harvard Business Review Evolution and Revolution, P.5 The five phases of growth
Appendix 6: Ophthalmic Consultants of Boston. P12. Paragraph 7.
Appendix 7: Ophthalmic Consultants of Boston. P1. Paragraph 3.
Appendix 8: Ophthalmic Consultants of Boston. P12. Paragraph 7.
Appendix 9: Harvard Business Review Evolution and Revolution. P.5 The five phases of growth
Appendix 10: Harvard Business Review Evolution and Revolution, P.6 Paragraph 2
Appendix 11: Ophthalmic Consultants of Boston. P12. Paragraph 7.
Appendix 12: Ophthalmic Consultants of Boston. P.21. Exhibit 10.
Appendix 13: Ophthalmic Consultants of Boston. P19. Exhibit 5. Price
Appendix 14: Ophthalmic Consultants of Boston. P.5. Exhibit 5.