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Elements of a Successful Turnaround Strategy

Hospitals/Health systems across the country are faced with increasing financial pressure including slow economic recovery, decreases in reimbursement, increases in uninsured or underinsured leading to increased bad debt write offs, and increased operating expenses.

Not surprisingly the result is more and more organizations that were financially sound find themselves either in financial distress or at least moving financially in the “wrong direction.” Turning around a hospital where finances are in decline requires extremely strong leadership from the top, ideally a CEO with prior experience leading a turnaround. This initiative needs to be supported by the hospital senior leadership team and board, and reinforced by engaged employees, physicians, and even members of the communities served by the organization.

Hospital turnarounds are not just about cutting costs. You can’t cut your way to long-term growth and profitability. You need to build programs that will financially support the hospital and meet the community’s needs through physician recruitment and capital investment. Cutting costs are a short term sometimes necessary endeavor, but long term success will only come from program volume and revenue growth.

It’s now essential in the current evolving environment to negotiate favorable contracts with insurers and other networks who control patient access and also consider the development of Accountable Care Organizations and other population health strategies. Finally developing key affiliations and networks with other hospital and healthcare providers are essential to strengthen your gaps in services and geographic coverage.

While no two turnaround situations are ever the same, just as no two sick patients are ever exactly the same, there are some common elements that all successful turnaround situations will have.

These elements includes the following:

  • A strong visionary CEO with proven experience in leading a successful turnaround.
  • A strong committed board that will support the CEO and put what is good for the long term survival of the hospital ahead of long-standing personal friendships and relationships and agendas and the short term pain and changes that may have to occur.
  • A good comprehensive and realistic turnaround action plan based on an in-depth assessment of the hospitals financial, operational, cost structure, market position and also physician and community perception and support. The plan should identify specific goals and objectives and actionable plans with quantifiable metrics and assignment of ownership.

Implementing the turnaround plan:

  • Implement plan with sense of urgency.
  • Monitor results and modify tactics where necessary.
  • CEO stays engaged / leads from “the front.”
  • Divides resources/removes obstacles/drive changes forward.
  • CEO and leadership team “walks the walk” and “talks the talk.”
  • Communication -- CEO establishes robust communication process so that employees & physicians are kept fully informed of changes occurring and why they need to occur and to gain their support for the long term benefit to the organization.
  • Publicize and celebrate the successes. Nothing breeds success, like success.

Going through a “turnaround” situation is one of the most stressful events for any healthcare organization to go through. With great visionary leadership and a good “plan” the organization will emerge not only more financially sound but with a “high performance” culture ready to move on new challenges.

You can see Davide Carbone's LinkedIn profile here

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Free seminar for leaders in healthcare July 24

Dear Network, We have our next webinar scheduled for 11a.m., Wednesday, July 24, Eastern Time (adjust for your own time zone). The same organization, AchieveIt, is hosting the webinar with the following organizations presenting: Aspirion Health Resources (Barry Mathias) and BrightWhistle (Jason Hopper). Please utilize the following link to register for this free webinar

As healthcare leaders continue to struggle with healthcare reform, many organizations are evaluating what is working within their organizations and looking to best practice solutions to achieve their goals and objectives. There are many niche companies in the market today that are experts in a very specific area, offering products, services and expertise that are not often found within an organization. These niche companies excel in the work that they do because of their more narrow focus and level of expertise and experience that they bring to an organization. This webinar will focus on two companies that you probably have not heard of, but are having a significant impact on the performance of their current and growing companies. In my daily discussions with healthcare executives, I realize that they do not have the time to scan the market to identify best practice solutions, so I thought that this is a service that I can provide to Wiederhold network. I think that you will find these two companies very intriguing and potentially a solution to some of your current challenges and opportunities. My hope is that bringing companies like Aspirion Health Resources and BrightWhistle to your attention will assist you in your work and hopefully save you time in looking for solutions. Please feel free to invite other members of your team to attend this special webinar. I look forward to having you join me on this webinar.

Best regards, Jim Wiederhold President Wiederhold & Associates

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Michael French adds international experience to the Wiederhold team

Michael French is an expert in interim work, both nationally and internationally. We have found that most of our clients have an interest in learning more about these particular areas. Michael will be part of our program and will spend time with our clients on both sides of these important opportunity areas. You will find a short bio on Michael French below reflecting on his expertise.

About Michael French

Michael French has more than 35 years of experience as an effective and communicative leader of for-profit and not-for-profit healthcare delivery systems as a CEO, COO and Hospital Administrator. He has achieved results through building trusting relationships with Boards, physicians, senior leadership and staff and actively engaging them in developing and executing strategic and operational plans. He has completed operational, quality and financial improvements in a variety of organizations ranging from a 100 bed acute care hospital to multi-facility integrated systems. For the past five years, Michael has been providing both domestic and international Hospital Interim CEO, turnaround and consulting services, specifically in California, the Middle East and Turkey. In addition to Interim CEO engagements, Michael has led operational turnarounds, performance improvement and due diligent projects.

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Chief Information Officer - Opportunity

Chief Information Officer - Opportunity

GCI has been retained for a CIO search for a Mid West based Healthcare System. The healthcare system includes ten hospitals, ambulatory surgery centers, imaging centers, an employed primary care physician network, assisted living facilities, commercial and Medicaid HMOs, home health care and hospice, durable medical equipment, retail pharmacy services, and a wholly-owned medical malpractice insurance company. The System has 17,400 employees and more than 20,000 network physicians.

The CIO will be a member of its President's cabinet, and reporting into the President & CEO.

Interested candidates please contact Kelly Goerlich, This email address is being protected from spambots. You need JavaScript enabled to view it.. Please note: we are NOT recruiters, but are assisting a recruiting firm in finding a viable candidate.

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Adding the second leg to the three-legged stool by welcoming Jim Morell

As promised, we are introducing another new program we have talked about for months. We believe that transition is more than just finding another job, it's learning new skills along the way. With the arrival of healthcare reform, we have developed the concept of the three-legged stool. Each one of these legs is extremely important for any healthcare executive to be successful in their careers. These are: quality, strategy and finance.

Our second program is focused on finance.
The process will work as follows. Each individual that we work with at the appropriate level will be assessed by our expert. Once the assessment is completed and reviewed by our expert, he will meet with that individual by telephone one-on-one. During that meeting he will review their results and make suggestions that may include additional training in the area of finance. If any additional training is needed, this individual can create an agreement with our expert. The assessment part will fall under the Wiederhold & Associates program. Any additional training will be handled by the individual and our expert.

I do not think anyone can disagree that finance will be a major focus of healthcare reform and that anyone who lacks in that area will have his/her challenges. We are very fortunate that we have located an expert in this area who brings a long history of success in healthcare. Let me introduce you to Jim Morell  Please review the short bio below.
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Jim Morellis an acknowledged industry leader with over thirty-five years’ experience as a consultant, administrator and patient care provider.  His knowledge, integrity, and objectivity are reassuring for organizations seeking to develop and implement winning strategies, improve operational performance, and plan for the most appropriate healthcare facilities and sites.

JCM Advisors, LLC (JCMA) and its predecessor firm Morell & Associates (MA)
JCMA is the preferred source for healthcare providers seeking a strategic advantage in today’s unsettling environment.  Jim integrates years of experience in strategy formation, operations improvement, facilities development, and financial feasibility to effectively formulate viable solutions for the toughest management challenges facing today’s healthcare organizations.  This experience is also helpful to vendors to the healthcare industry as well as the courts in the areas of bankruptcy and medical malpractice. Jim also applies these years of experience in his coaching of boards and management teams.

Ernst & Young, Chicago, Illinois
Jim was an up through the ranks Partner in the Healthcare Management Consulting Practice. Early in his career he worked in the finance practice performing financial feasibility studies primarily for hospital bond offerings. He eventually assumed responsibility for the review and sign-off on all of the demand note sections of each financial feasibility study issued by the firm. During this period of default risk every organization successfully met their debt obligations, much to Jim’s and the firm’s relief.

Following these assignments Jim assisted healthcare provider and vendor organizations in the development of their business strategies for a number of years. With this background Jim shifted his focus to the development and leadership of the firm’s operationally focused facility development practice. This consultancy looked at the site and facility needs of healthcare providers through the perspective of strategy formation, operations improvement, and financial performance. Throughout Jim’s tenure at E&Y he worked with both audit and non-audit client organizations ranging from academic medical centers to small rural hospitals, stand-alone hospitals to healthcare systems, faculty practice plans to small physician group practices, and for-profit as well as tax exempt providers located throughout the country.

In addition to his own consultancies and his tenure in public accounting, Jim has also provided management consulting services with two boutique healthcare firms.

Signature Leadership Qualifications
Jim serves as an Adjunct Faculty member at DePaul University, Chicago. He teaches the capstone Strategic Analysis course for both MBA and undergrad business majors at the Driehaus College of Business. As the capstone name implies, this is the final class for each student before graduation at both the MBA and undergrad levels. The curriculum is designed to bring the real world into the classroom with a curriculum that includes the following activities.

  • Classroom presentations and discussion focused on the text, the research project, the simulation, and career development
  • Text study and related quizzes
  • Research project designed to prepare the students for interviews through a comparative study of targeted firms of their choosing in the same industry. The analytics address each company’s strategy, operations, management reports, and financial statements looking for alignment or dissonance. Depending on the size of the class, students are required to make one or more presentations relative to their research.
  • Capsim computer simulation team competition. The students form teams to operate a high tech company. Each team competes against other teams in the class as well as against an equal number of computer operated teams. This exercise is designed to have the students work together to apply what they have learned in class, through their respective research projects, and the body of knowledge and experience they have developed to date in their careers. Each team makes a presentation discussing their performance at the end of the competition.

Jim is a former federal auditor having served as an Inspector General – Audit for the U.S. Army. During is active military service Jim conducted financial audits of hundreds of military units through the Office of the Inspector General, 2d Armored Division.

Jim is a frequent speaker at the ACHE’s Annual Congress on Administration, the AAHC’s Fall Conference as well as various national, state and local professional associations. Jim has published articles on a variety of healthcare management issues.

Prior to making the commitment to management consulting Jim served as an administrative resident and administrator at The Ohio State University Hospital & Clinics, now The Ohio State University Medical Center. Jim also worked as a certified nursing assistance at the University of Minnesota Hospital & Clinics, now the University of Minnesota Medical Center.

Education and Certifications

  • Jim holds a Bachelor of Arts in Economics and Psychology (with a focus in Organization Design) from Case Western Reserve University, Cleveland, Ohio and a Master of Science in Hospital and Health Services Administration from The Ohio State University, Columbus.
  • He is a Fellow of both the American College of Healthcare Executives (ACHE or the College) and the American Association of Healthcare Consultants (AAHC or the Association). He is a Past Chair of the Association’s Board and has chaired many of the Association’s committees. He is also a Past Chair of the College’s Consulting Special Interest Area, now the ACHE’s Healthcare Consultants Forum.
  • The program Jim has prepared for those individuals needing additional assistance in the development of their financial acumen is multi-disciplinary and based in part upon results of the 2012 WA Financial Acumen Survey, his experience across a broad range of healthcare organizations, and his work at DePaul University. Elements of the Financial Acumen program include an assessment process, a customized skills development plan, associated learning modules, as well as individual coaching and consultation.
  • This program is designed to be customized to best meet the needs and goals of the individual executive. The goals of the program are to (1) assist each executive in their preparation for their upcoming interviews and (2) provide the financial acumen tools necessary to more effectively lead their new organization through these turbulent times.
  • If you have any questions or comments. Please do not hesitate to reach out to me. On an additional note, we will offer Jim Morell's services beyond just those individuals involved in the Wiederhold & Associates transition/career development program.
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Your Career Needs A Rudder

Navigating Your Career Path

Over the past 20 years, we have all witnessed significant change in the healthcare industry, as well as the advent of the flavor of the month/week mentality. We react quickly to changes in thought without truly exploring the consequences of the change or reflecting on our current course. What’s more, we often don’t give that current course the time it needs to develop in order for us to know whether or not it will be successful. It has, at times, seemed as if so many found themselves looking and acting like a deer in the headlights or the boat floating wherever the wind or current would take it. Why? Are people trying to keep up with the changes/reform? Are they struggling to figure out how to comply? Regardless of how you view healthcare reform, the boats have found a sense of direction and the deer have scattered.

Read the full article as published by the Healthcare Executive.

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Insurance Exchanges and the Affordable Care Act

Wiederhold and Associates will from time to time be presenting articles on subjects of interest and importance from our clients, past clients and most active network members. Mark Phelps will address the very hot topic of insurance exchanges under the affordable care act. Mark looks forward to your comments on his article.
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Insurance Exchanges and the Affordable Care Act

With President Obama's reelection a part of history, the movement to implement the Patient Protection and Affordable Care Act (ACA) has been ensured. When the ACA was heard by the Supreme Court, one case under consideration was filed by the National Federation of Independent Businesses. 1 The arguments in that case concerned the issue of whether Congress exceeded its power by requiring most Americans to buy health insurance or pay a fine. This provision was known as the individual mandate. 2

That mandate, along with four other major approaches, was the reason the ACA was drafted to attack the problem of the uninsured in our society. 3 The other approaches to combat un-insurance in the ACA were: 1) guaranteed coverage in plans provided by insurance companies; 2) the mandate to individuals to obtain health insurance; 3) state-run health insurance markets, called “exchanges,” where individuals and small employers’ workers can shop for insurance packages; and 4) expansion of the federal-state Medicaid program of care for the poor and the disabled. 4

The theory of insurance exchanges in the ACA was to offer "one stop shopping" for individuals and small businesses with affordable coverage. 5 It would also be the only place for Members of Congress to obtain their health insurance. 6

Insurance exchanges offer individuals and small businesses the ability to pool risk and purchasing power and therefore pay lower rates. 7 Affordable Insurance Exchanges are also modeled to provide users with the ability to determine if tax credits are applicable or if the user can enroll in programs such as the Children's Health Insurance Program (CHIP). 8

Rules were published by the Department of Health and Human Services (HHS) on March 12, 2012 regarding Affordable Health Insurance Exchanges. 9 The operational date for the Exchanges is January 2014. The rules published in March 2012 included standards for the following:

  • The establishment and operation of an Exchange
  • Health insurance plans that participate in an Exchange
  • Determinations of an individual’s eligibility to enroll in Exchange health plans and in insurance affordability programs
  • Enrollment in health plans through Exchanges
  • Employer eligibility for and participation in the Small Business Health Options Program (SHOP) 10
  • Those rules also specified that exchanges will perform certain functions listed below:
  • Certifying health plans as “qualified health plans” to be offered in the Exchange
  • Operating a website to facilitate comparisons among qualified health plans for consumers
  • Operating a toll-free hotline for consumer support, providing grant funding to entities called “Navigators” for consumer assistance, and conducting outreach and education to consumers regarding Exchanges
  • Determining eligibility of consumers for enrollment in qualified health plans and for insurance affordability programs (premium tax credits, Medicaid, CHIP and the Basic Health Plan)
  • Facilitating enrollment of consumers in qualified health plans 11

Going into the Presidential election of 2012, individual states had a looming deadline of November 16, 2012 to notify the Department of Health and Human Services if they intended to set up their own insurance exchanges or enter into a state-federal partnership.12 At the request of state governors, HHS granted an extension until December 14, 2012 to respond to this deadline. 13 HHS clarified that there would be no further extensions of deadlines regarding the implementation of Exchanges in a Memorandum of Frequently Asked Questions (Memorandum) dated December 10, 2012. 14 This additional time gave state officials who were trying to determine whether there was enough political will, technical knowledge and time in their respective states to organize their own new health benefit marketplaces. 15

HHS further clarified in the Memorandum that if "a state plans to operate the Exchange in its state in partnership with the federal government starting in 2014", the state will need to declare "what partnership role they would like to have by February 15, 2013". 16 The deadline of February 15, 2013 has come and gone. We now know that the federal government will run 26 of the state health exchanges. 17 (Maine, New Jersey, Pennsylvania, Virginia, North Carolina, South Carolina, Georgia, Florida, Alabama, Tennessee, Ohio, Indiana, Mississippi, Louisiana, Missouri, Wisconsin, Texas, Oklahoma, Kansas, Nebraska, South Dakota, North Dakota, Montana, Wyoming, Arizona, Alaska) It also will partner with seven states, where state and federal officials take joint responsibility for the marketplace. 18 (New Hampshire, Delaware, West Virginia, Michigan, Illinois, Iowa, Arkansas) Seventeen states and the District of Columbia will take on the task themselves. 19 (Vermont, Massachusetts, Rhode Island, Connecticut, New York, Maryland, District of Columbia, Kentucky, Minnesota, Colorado, New Mexico, Utah, Idaho, Nevada, Washington, Oregon, California, Hawaii)

The legislative intent of the originally filed federal House of Representative bill for Obamacare in which the federal government would operate one large national insurance exchange may come close to reality with the latest actions of many of the states deciding to have HHS operate their exchanges by default. 20 It seems the Executive Branch of the government may ultimately have significant political power over setting up its signature legislative accomplishment. 21 Further, this will allow HHS to use economies of scale in creating a minimal number of template exchanges that many of the 26 states will use. 22

Mark T. Phelps is a healthcare attorney and an Assistant Professor in the Department of Healthcare Administration at Texas Woman’s University in Houston. He currently is working with healthcare clients on a consulting basis. If you have some interest in learning more about Mark, please Wiederhold & Associates know.

1. Kever, J., Only certainty from ruling on health care law is change, Houston Chronicle, 03-25-2012, from http://www.chron.com

2. Id.

3. Denniston, L., Analysis: Health care’s other mandate, December 19th, 2011, from http://www.scotusblog.com/2011/12/analysis-health-cares-other-mandate,

4. Id.

5. Affordable Insurance Exchanges, from http://cciio.coms.gov/proframs/exchanges/index.html

6. Id.

7. Id.

8. Affordable Insurance Exchanges, from http://www.HealthCare.gov

9. Affordable Insurance Exchanges: Choices, Competition and Clout for States, from http://www.healthcare.gov/news/factsheets/2011/07/exchanges07112011a.html

10. Id.

11. Id.

12. Adams, www.CQ.com, 11/9/12

13. Alonso-Zaldivar; More States Reveal Exchange Choices As Administration Extends Deadline; http://www.washingtontimes.com/news/2012/nov/16/states-reveal-their- choices-obamas-health-law/; 11-16-2012

14. Frequently Asked Questions on Exchanges, Market Reforms and Medicaid, Department of Health & Human Services, 12/10/12, from http://www.healthlawyers.org/News/Health20Lawyers20Weekly/Documents/12141 2/FAQs.pdf

15. Adams, www.CQ.com, 11/9/12

16. Frequently Asked Questions on Exchanges, Market Reforms and Medicaid, Department of Health & Human Services, 12/10/12, from http://www.healthlawyers.org/News/Health20Lawyers20Weekly/Documents/12141 2/FAQs.pdf

17. Kliff, It’s official: The feds will run most Obamacare exchanges, THE WASHINGTON POST, February 18, 2013

18. id.

19. id.

20. id.

21. id.

22. id.

 

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Launching the three-legged stool by welcoming Debra Honey

Message from Jim Wiederhold, president of Wiederhold & Associates

As many of you are aware, we are in the transition business, career development and executive coaching. We believe that transition should be an holistic approach meaning not just getting people through the transition to the next opportunity but adding skills and knowledge that will make them even more productive in the next opportunity. We have been talking up for several months the introduction of three new programs. The first one is ready to launch and we want to make you aware of it. With the arrival of healthcare reform, we have developed the concept of the three-legged stool. Each one of these legs is extremely important for any healthcare executive to be successful in their careers. These are: quality, strategy and finance.

Our first program is focused on quality. The process will work as follows. Each individual that we work with at the appropriate level will be assessed by our expert. Once the assessment is completed and reviewed by our expert, she will meet with that individual by telephone one-on-one. During that meeting she will review their results and make suggestions that may include additional training in the area of quality. If any additional training is needed, this individual can create an agreement with our expert. The assessment part will fall under the Wiederhold & Associates program. Any additional training will be handled by the individual and our expert.

I do not think anyone can disagree that quality will be a major focus of healthcare reform and that anyone who lacks in that area will have his/her challenges. We are very fortunate that we have located an expert in this area who brings a long history of success in healthcare. Let me introduce you to Debra Honey.

Debra HoneyDebra Honey is a visionary Nurse Executive with more than 30 years of progressively responsible and diversified Nursing Leadership experience. She excels at leading healthcare transformational change initiatives and promoting impeccable standards of care within the industry.

Honey Consulting, Inc.
Debra is President of Honey Consulting, Inc., a progressive, hands-on consulting firm offering practical solutions for opportunities and issues facing healthcare organizations today. She provides expertise in nursing services, nursing operations leadership, and operations support to assist and facilitate improvements in performance and outcomes. Debra also provides Chief Nursing Executive coaching and interim Executive Nursing support.

Catholic Health Initiatives, Denver, CO
Debra was previously Vice President for Clinical Operations and Clinical Leadership Development for Catholic Health Initiatives, a national not-for-profit healthcare organization comprised of 68 U.S. hospitals located in 19 states. In this role, she was responsible for nursing clinical operational support for system initiatives and market based organizations. She served as the Executive responsible for system-wide strategy for and implementation of clinical competency programs including competency assessment and staff development for all hospitals. She was a valuable clinical resource on a diverse set of national work groups and task forces.

Signature Leadership Qualifications
Debra is a member of the prestigious Robert Wood Johnson Executive Nurse Fellow Program, 2008 cohort, and her diverse leadership experience and areas of expertise include:

  • Overall Clinical Operations
  • Medical Staff Operations
  • Performance Improvement
  • Board Communication & Collaboration
  • Quality and Safety Initiatives
  • Accreditation & Regulatory Compliance
  • Patient and Staff Satisfaction
  • Service Line Assessment & Optimization
  • Staff and Leadership Assessment, Development, & Coaching

She earned valuable direct patient care experience working as a clinical nurse in critical care, emergency services, and surgical services. In addition, Debra taught Nursing at the diploma, bachelor, and masters levels.

Education and Certifications
Debra earned a Bachelor of Science in Nursing from the University of Tennessee at Chattanooga and graduated Magna Cum Laude. She holds a Master of Science in Health Administration from the University of Minnesota, Carlson School of Management. She is a Registered Nurse in the states of Tennessee and California.

Debra prestigious healthcare certifications include:

  • CENP - Certified in Executive Nursing Practice, American Organization of Nurse Executives
  • FACHE - Fellow Status, American College of Healthcare Executives
  • CPHQ - Certified Professional in Healthcare Quality, Healthcare Quality Certification Board

The program that Debra Honey has designed for those individuals needing additional training in this area will include the assessment process, an individualized learning plan, the learning modules, individual coaching and consulting, and simulations.

The program is designed to be customizable to best meet the needs and goals of the individual executive. Gaining expanded competencies and quality and safety in healthcare provides a demonstrable competitive advantage to senior executives in the field.

If you have any questions or comments. Please do not hesitate to reach out to us. On an additional note, we will offer Debra's services beyond just those individuals involved in the Wiederhold & Associates transition/career development program.

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Webinar: The Six Biggest Reasons Why Strategy and Execution Fail

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1-2:30 p.m. EST, Tuesday, March 26

What's more important to your organization than its strategic plan? Probably nothing. Plan and implement well, and you'll drive the organization to unparalleled success. One misstep, though, and it's game over. To help you create a culture of accountability and execution, we've identified the six most common ways your strategic plan will fail. Join AchieveIt Founder & Chief Execution Officer, Scott Regan, for this free webinar that will help you turn vision and goals into real, meaningful, and tangible results.

Register now for this free webinar:

Scott Regan is the founder and chief execution officer of AchieveIt, a technology firm that specializes in strategy development and execution management. AchieveIt provides cloud-based tools and applications that allow their clients to execute smarter, faster, and better. Before launching the firm in March 2010, Scott served as an independent consultant, as well as the executive vice president of the Juran Institute, a global consulting firm that assists organizations with achieving breakthrough improvements in quality.

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