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Companies integrated to the community

If you are long time reader of our entries, you'll recognize the recurring theme of “companies integrated into the community. It's not a statement against national or international chains, but a conclto have something big, with experience in other communities? We don't deny that experience is goodm ir that there should not be a degree of standarization and uniformityin the processes. The problem is commitment and responsibility toward the community, not just compliance with it's customers. We'll focus the discussion fron the social and economic standpoints.

Some time ago, a voice memo from a manager in an insurance company was leaked on social media explaining why it was better to send biopsies to a neighboring country for processing and diagnosis because it was faster and cheaper. This made many pathology labs upset in this country and the insurance company had to issue a written apology to contain the damage. We as a company, since that date have severed ties with that insurance company.

The problems of this dynamic, that of sending pathology specimens out of the country ,are evident and we've grouped them into several points:

1) Custody chain. From the moment a sample of tissue or cells is taken from a patient, there is a legal (and moral) chain of responsibilities among those involved: the operating room staff, the messenger that takes the samples from there to the pathology laboratory, and the pathology laboratory itself.

1.a) The mobilization of these samples outside the community poses a risk that can be damaged or lost from point A to point B to point C.

1.b) If the processes are always running, production costs will be increased because each specimen would be an individual commission, or a large segment of the market would have to be monopolized to achieve sufficient volume of sample shipments to minimize expenses, creating in the process a monopoly. On the contrary, if what's desired is to send an economic lot, then the response time is sacrificed in sensitive cases such as certain types of cancer, which harms the patient.

1.c) When outsourcing services to another community, national or foreign, certain portfolios are killed, such as intraoperative consultations (frozen sections), because no laboratory will operate just waiting to receive a case in an eventual consultation, hindering the capacity of surgeons change behavior at the same surgical time.

2) Currency mobilization. The movement of money is important if you want to see the long-term picture.

2.a) A company that is not integrated into its community will always extract currency from the community, impoverishing it.

2.b) A company that is integrated into its community, even if it has to bring consumables from abroad, will be able to attract and maintain the currencies in the community itself through investment, payroll, donations, improvements and managing the facilities and payment of taxes, between many other lines of expenses.

2.c) “Integration” requires more than just profit in the community or create jobs, because the company will have participate in projects that help the development of the community, such as teaching, research, development of new products and services, collaboration with other community entities as in education or social sectors.

3) Custom fit. Each community has its particular combination of features. You can share some characteristics with other communities, but never all in the same way or magnitude.

3.a) A large company that has to satisfy many communities, will logically have to establish a “one size fits all” policy, leaving some aspects of the service unsatisfied in most communities.

3.b) Medium and small businesses, and microenterprises, have fewer processes to standardize or standardize, allowing them to experience ways to provide new and better services adapted to the characteristics of their community.

4) Legal (and moral) responsibility. A company integrated to its community cannot avoid its responsibility because to continue operating, it must respond to failures in its service. A company outside the community can always contain the damage, closing operations and moving to another community.

5) Uniformity and coonformity. The pillars of fast food companies have been to provide a uniform service in all their branches, aspiring to comply with their customers. This has infected the rest of the economic sectors, creating a distant and depersonalized attention, which imposes its standards on the consumer.

So, no standardization?

Nowadays, the mere process standardization is implemented as a quality control, which works well to manufacture parts but which cannot always be adapted to the communities. In health, there are attention sides that are not mere physiological parameters, such as cultural concepts or language, that cannot be universal in a company that aims to cover different geographical regions.

Therefore, it is not that we advocate against an internal quality control program, but in believing that mere standardization is quality control. One can standardize certain aspects of care, not all. Nor can you impose a standard that works in one community, in another community where it could be harmful, much less try to increase profit margins in the same way in different regions.

Vertical integration for quality control

When we started this laboratory, like anyone in our province or in the country who decides to start a health care enterprise, we adapted to the market by finding a variety of products of very different qualities, very inconsistent and adapted for other conditions. Clear examples were formalin for biopsy tissues and fixative solutions for cell preparations (so-called "pap smears").

This, in turn, made it difficult for us to produce preparations of a consistent or uniform quality. At that time, my concept of "quality control" was very vague and my biggest criticism is that it was a standardization of processes, rather than a clear way to raise the quality itself. I did not understand then, and it was only after an article on statistical quality control in cervical and vaginal cytology, that quality measurement is one thing and corporate strategies to arrive at a uniform, desirable product is another.

In vertical integration, the mother company creates several daughter companies that it controls and which in turn provide it with all the raw material to allow it to produce a product or service, creating a kind of monopoly, because the daughters only work for the mother and these companies do not provide materials to other competitors of their mother. This would be possible, I don't know if ethical or practical, if we were a large chain of laboratories, but we use the concept aimed at maintaining a standardization of processes and obtaining a product that is, within a standard deviation, uniform.

The type of vertical integration was "backwards", as I explained in the example above. There are no other companies except this one, but we started to produce our own formalin and cellular fixative based on the experiences in the field that we acquired throughout the years of operation. The doctors and clinics that use our services were pleased, because we took away the expense of having to purchase them and that expense was borne by us. This allowed us to use the containers that we consider appropriate, the amount of formalin that we consider necessary for the average of the samples, as well as the type of formalin that allows the best fixation and then the performance of special tests on the processed tissues.

In the same way, when we began to see the cytologies, we began to notice that many cases could not really be examined satisfactorily because a variety of water-based fixatives were used that did not really fulfill their function and we assumed at the time that it was due to dilution of the product in the hands of its users, not because the product was defective. We did some research and after a phase of experimentation and development, we were able to formulate an alcohol-based preparation that allowed us to produce uniform preparations for our environmental conditions and personal preferences.

This control over the variables that affected the final product, increasing the standardization of the preparations. This capacity presented a competitive, cost-effective advantage.

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