Entrepreneur journal: Jon Weiner, CEO, OR International

TORONTO (Reuters) - Jon Weiner co-founded the New York-based startup OR International LLC (www.orintl.com) with the goal of exporting a higher-quality American brand of healthcare throughout the world, with a primary focus on improving patient treatment. In just six years ORI has opened the state-of-the-art specialty hospitals in the UK, Africa and Cyprus. The following is Weiner's five-day entrepreneur journal, exclusively for Reuters.com:

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Day 1: Monday, May 10

Arrive in Botswana from the UK. Meeting with Bokamoso's (name of the Botswana hospital) Dr. Nancy Chescheir, chief medical officer, and Dr. Bob Corder, head of emergency service on the fundamental goal of achieving first- world quality performance at affordable costs for Botswana health plans through re-thinking elements of care at each step of patient pathways. They point out the competitive issue of more thorough and therefore more expensive outpatient and assessment visits than patients are used to, though overall episode costs are substantially lower, for example because of much lower use of cesarean sections in favor of vaginal births, and, in general, lower lengths of stay. I agree to consider re-pricing of outpatient vs. procedure/inpatient care so out-of-pocket costs are less of a barrier to seeking what amounts to more efficient and higher quality service overall. We are putting in place what amounts to re-engineered care protocols that would embody cost-effective practices and embedding them in the hospital information system will be at least a two-year challenge. Help from the hospital's Clinical Advisory Committee will be critical - and the tasks involved should be of substantial interest to individual committee members who are leaders in surgical and medical specialties in the U.S. and UK.

I had a meeting with Alan Baudry, a consultant working full time at the hospital on supply chain issues. He believes there is at least 2-3 percent of revenue savings from further standardization of supplies and do-it-ourselves case packaging. Need to move forward with bar-coding applications for managing down inventories and curtailing stock out issues-should reduce staff devoted to supplies in the clinical areas and central stores. Good instance of technology reducing costs and improving quality simultaneously and logical, natural add on to our hospital information system, but we need to clean up the supply charge master to take advantage of this opportunity, which could take several months.

Day 2: Tuesday, May 11

Official opening of the hospital. Ceremony in a tent in the parking lot to limit disruption of patient care. Chief of the tribe that donated the land for the hospital, president of Namibia (bordering Botswana to the west), chair of the Bokamoso board and Botswana's health minister all speak. The central theme is that our technologically sophisticated hospital should be a centerpiece for a regional health care ‘hub.' President of Botswana and virtually all members of the cabinet attend the three-hour ceremony and hospital tour. There is genuine surprise at the range of facilities - tour included diagnostics, laboratories, trauma center, ICUs and specialty facilities for dialysis and other treatments. They confirm their commitment to work with us at a high government level to smooth licensing of specialty nurses who are U.S. ex-pats - a continuing problem for us.

I had dinner with a board member who is on the executive committee and the HR subcommittee of the board. I set out the proposition that the hospital should be explicitly positioned as a place for training a country elite in healthcare, just as Debswana - a giant mining company located in Botswana and a joint venture of the government and De Beers - has been a training ground for many individuals now in positions of responsibility and influence in the country (including the hospital's CEO). She made the point that while extensive skills transfer was, of course, most important, people should not lose sight of the fact that an institution designed to meet international standards of care should, quite naturally, have ex-pats at various levels indefinitely. Agreed to set out an HR strategy document that would help achieve consensus on this long-term quite sensitive matter.

Day 3: Wednesday, May 12

Went to Johannesburg and met with senior consultants to the South African Department of Health and to several provincial ministries of health. I set out the proposition of a ‘hospital in a box' that is district hospitals or specialized health facilities (e.g., tuberculosis facilities) that would have reasonably standard designs, be pre-fabricated (at least for the technically sophisticated portions), fully equipped, and with an in-place hospital information system embodying sensible protocols of care as a means of dealing economically with extensive health infrastructure investments. I agreed to a joint presentation of the concept for 2-3 provinces. We reached a general agreement that it would be tough going to take over management of large, failing public hospital institutions and make a success of things.

During my trip I met with a cardiac surgeon who proposes to organize a group of South African specialists to round out our doctor complement in Botswana. Since we have an ‘integer' problem - tough for us to have half a specialist - help from a cadre of visiting South African specialists could make sense. Their thought is to work jointly with us as well in providing specialty services to government hospitals in Botswana.

Day 4: Thursday, May 13

I met with eye surgeon who has a private eye hospital in Johannesburg who would like to work with us in expanding ophthalmology services to retinal and other care with visiting doctors from his hospital. The general notion of visiting sub-specialists to Bokamoso from South Africa is attractive provided we can make economic use of whatever required specialty equipment.

I had a phone conversation with a surgeon from the University of Pretoria who is also the head of the medical council that licenses doctors in South Africa. He expressed interest in joining our Clinical Advisory Board, which has chairs of departments from leading medical schools in the U.S. A South African presence could be important, especially in considering education programs at Bokamoso. Most of our general medical officers are already, or would like to continue their education at South African university programs.

I next met with Chartwell, a South African company that finances affordable housing for middle-income families in Africa (supported in part by the Dutch government) to see if there was any interest in them re-financing and managing our 100 units of staff housing on site at Bokamoso. They expressed substantial interest and we will follow up.

Day 5: Friday, May 14

I arrived back in the UK to meet with the CEO of St John's and St. Elizabeth's hospital to explore ways our UK company could work with them. I agree to consider some joint work on a new operating room suite that would focus on orthopedics (hand and shoulder work now a specialty with them) to become a sports medicine center. A high- efficiency center would appeal to doctors who could do more cases and to private patients who prize high quality and efficient use of time. We also explore urology specialty - a ‘men's center - though a very high-tech approach gives them pause.

I spent the afternoon in discussion with UKSH (UK Specialty Hospitals Ltd) chief executive, Fiona Calnan and chairman of our South West company, Robin Smith, on ways to present our clinical approaches in future competitive tenders. We agreed a substantial and detailed exposition of selected clinical protocols for our major case types would best communicate how we have taken 30-40 individual best practice elements for each case type into an agreed detailed approach to each phase of the case, with appropriate order sets for diagnostics and therapies and detailed roles for staff, indicating how each best practice element contributes to faster case turnovers and evidence- based quality outcomes. In addition we agreed that we should set out in detail our approach to clinical governance which, using these protocols, gives much faster reaction loops - faster identification of problems with clinical staff or procedures and much faster implementation of remedial steps than typical of NHS (UK National Health Service) hospital processes.