Monday, December 11, 2006

Technology helps hospitals move towards ‘paperless’ zone

Nice to hear/read about the hospitals looking to use technology. This is one of the industries that serves the mankind directly, i always felt that technology can be used to enhance quality of service in the hospitals, be it a small one or a huge hospital.
But at the end of the day we need to see how effective it may turn out to be for the 700 million population in India(~70%) who are rather not so economically strong to get the benefits of these resources.
One good thing is that we are atleast trying to reach there soon.

FANCY a paperless hospital? It may not relieve pain, but carrying a smart card embedded with personal details and a doctor’s notes could reduce the amount of paper that patients carry to the hospital. That vision is yet to materialise. Bandwidth availability and faster IT adoption could make it a reality in the not-sodistant future in at least a few hospitals in India.
On the road to that promising future, India has suddenly seen a spurt in quality healthcare over the past few years, with world-class hospitals like Wockhardt Hospitals, Asian Heart Institute, Apollo Hospitals and Fortis Hospitals, coming up. In these hospitals, as with most new service offerings, it is the information technology backbone that is at work behind the scenes, ensuring that the quality of services and treatment is of the highest order.
Says Vishal Bali, CEO, Wockhardt Hospitals: “Today, digital information is at the core of healthcare delivery in India and diagnosis is becoming more and more information-led.”
What would healthcare and IT have in common? A lot, it would seem. The CT scans, MRIs, 3D and other images are now exclusively the domain of high-tech healthcare machines. The use of semiconductors in healthcare devices (like digital monitors, MRI, CT scan machines and so on) is at $2 billion a year and this is increasing at 17-20% a year. Companies like GE, Philips, Siemens work closely with chip-makers like Texas Instruments and others to embed medical devices with semiconductors.Various vital signs monitors hook up directly to the central hospital servers, allowing doctors to monitor patients remotely. Finally, massive state-of-the-art servers, like the HP-Compaq ML 350, which can store up to 1.2 terabyte of data, are used to house all possible images and information about the patients.
Broadly, IT is used in hospitals in three different ways — in providing hospital information systems (HIS) which looks after hospital administrative functions as well as patient records; in enhancing the delivery of treatment and post-treatment monitoring, and finally in better overall service offering to patients.
Adds Anshuman Khare, IT-Manager, Asian Heart Institute, “We have to create a system with proper backup clusters so that no data is lost.” So what is the exact process that takes place once a patient is admitted to a hospital? On admission, the details of the patient are immediately put on to the network. The paperwork is minimal, and restricted to the doctor’s assessment of medical record and treatment. Every ward has a secretary that would feed these details onto the patient’s record, and subsequently, every single input provided to the patient, whether it’s an X-ray, a path lab report or a MRI scan, is logged in. Thus, various departments of the hospitals are also integrated with the HIS. Additionally, all reports are available to doctors on hospital networks, who needn’t be physically present at the patient’s bedside. Philips and GE have helped greatly in remote monitoring — they’ve designed machines that monitor vital signs and feed them directly into the servers, which allow doctors to check on their patient from several different locations.
It’s here that data security also comes into place, because hospitals don’t allow all doctors to view patient files. Remote monitoring, according to hospital executives, will become a more prominent feature in hospitals which focus on intensive care of patients.

Bring in futuristic outlook to bridge consumer, marketer chasm

IN ONE of his books, Richard Koh draws a parallel between the theory of relativity and its impact on business. Einstein said the speed of light was constant, and it follows that if two observers are travelling at different speeds, they won’t agree that on the precise time that anything happened. There is no absolute reality, everything is relative.
He compares this with business life and leads on to an interesting point. He says “for precisely the same reason mentioned in the theory of relativity, the organisation’s perspective of what the customer wants will always be different from the customer’s perspective. And it will be wrong in proportion to the distance of the decision-making executive from the customer front line.”
I was thinking on why this happens. One reason is because the customer is himself changing all the time, and the best service providers are merely playing catch up with the customer’s needs, if at all. Organisations go great lengths understanding the needs of the customer, only to find the needs have changed by the time the product or service is out. One way to time this is to get away from “understanding” the needs of the customer to “anticipating” the needs. Now this is a paradigm shift and it will take skill, wits and bets. The challenge is this:
when you ask customers what they want, you are as likely to get a correct answer as the clues in an Agatha Christie. I read somewhere that when Xerox came up with the concept of Xerox machines and did a survey of secretaries they were told the product had no future as carbon was doing as well. Yet, to take an informed bet of the needs of the future is what is required going forward.
The other way to bridge this is to take decision making and product planning from the top/middle of the hierarchy to the bottom of the hierarchy. We make products, and when it comes to deviations, the front end refers it to the bosses, a time consuming process which the customer puts up with. Meanwhile, the customer facing team is not feeling very good facing the customer. One American humorist Dave Barry makes the point tellingly on behalf of a frontline staff: “The most hated group in any large company is the customers. They don’t know about our company procedures or anything about you do, which drives you crazy. At the same time your bosses, who are idiots and who don’t have to talk to customers, tell you day in and day out that the most important person in the world is the customer”.
I think eventually the decision-making will move to the customer himself, at the choice of the customer channel, time and terms. For example, if a product programme allows for a margin of 20% to be brought in by the customer, chances are, eventually, the customer will drag and drop his kind of collateral on a computer screen, and walk away with a zero margin.
It’s not just the way the organisation understands needs, its also the way they profile their customers. The Ford Edsel was the most brilliantly designed car in automobile history of those days, yet it flopped miserably. They learnt the hard way that they had segmented the market by income… the way it was segmented for decades, while the market was giving way to segmentation by lifestyles. In designing products for customers, the biggest clash will come from the “creator fetish”. We all know its technology that is powering change, and we make products and expect customers to love our creation. In his book, “Crossing the chasm”, Geoffrey Moore points out that after the early adopters, there is a major barrier to be crossed, what Moore calls the chasm. The chasm is there because the mainstream market is not impressed with technology per se, they want to see value; and not just appreciate the plaything for technophiles. Its only then that customers let that technology into their lives.
Once the chasm is bridged, and consumers see value, there will be a movement from “impossible” to “inevitable”… two extreme ends of the spectrum . The speed will surprise even the diehard optimists. For example today consumers don’t mind scratching codes and “sms”ing codes to the service provider… since they get to speak wireless .. because its value. In fact, the journey from impossible to inevitable will be sooner than expected.
The author is executive director, ICICI Bank

Tuesday, December 05, 2006

Saudi Arabia's global investor: An interview with Prince Alwaleed

The biggest individual foreign investor in the United States discusses the pace of reform in Saudi Arabia, his investments, and the future of Islam.

Kito de Boer

Web exclusive, December 2006

His Royal Highness Prince Alwaleed Bin Talal Bin Abdulaziz Alsaud—or Alwaleed, as he’s known in the Middle East—is a highly successful international investor, a member of the Saudi Royal family (and nephew of the king), and the biggest individual foreign investor in the United States. He first came to prominence in the West in 1991, after paying $590 million for a 14.9 percent stake in then-struggling Citicorp (now Citigroup). His investment quickly became worth billions of dollars when the US financial giant pulled itself back from the brink of bankruptcy and resumed its profitable growth. Most recently, he has attracted headlines by teaming up with Bill Gates to back a $3.7 billion management buyout of the Four Seasons Hotels and Resorts.

Alwaleed’s business empire today includes extensive direct investments (in real estate, banking, retailing, industrial, media, and construction) in Saudi Arabia and elsewhere in the region—such as private holdings centered on his Kingdom Holding (KHC) projects—plus a range of significant minority interests in some of the world’s more prominent companies. Besides Citigroup (where his shareholding now stands at 3.6 percent), his holdings include Fairmont Hotels and Resorts, News Corporation, Time Warner, the Walt Disney Company, Canary Wharf (in the United Kingdom), Apple Computer, and Motorola. Alwaleed is estimated to be one of the wealthiest people in the world.

His significance, though, goes well beyond his business and financial career. A self-described “bridge” between Arab and Western cultures, he combines a traditional Muslim outlook with a passion for market-driven economic and social reform. Alwaleed prowls Wall Street and business boardrooms during the week yet spends his weekends dispensing charity to the Bedouin at his tented desert camp near Riyadh. He finances mosques in his native Saudi Arabia while promoting the cause of women as earnestly as any campaigner in Europe or the United States—proudly pointing out, for example, that one of the pilots of his private plane is a woman.

In this conversation with McKinsey director Kito de Boer in Paris, Alwaleed discusses the pace of reform in Saudi Arabia, global investment flows, and the debate that must take place within Islam.

The Quarterly: How would you compare what’s happening in the Gulf today with the last oil boom, in the 1970s?

Alwaleed: Last time round we rushed into a lot of construction projects, and I think some things then were done haphazardly, but the countries of the Gulf have learned from those mistakes. Governments are now trying to do things properly and with more precision. Much of the basic infrastructure—airports, roads, universities, et cetera—was put in place in the 1980s and 1990s, so political energies in Saudi Arabia can now be devoted to things that will impact the social structure, such as reducing unemployment, building houses for the poor, and other good causes.

A big achievement, in my view, has been the debt reduction program in Saudi Arabia, which has brought down public-sector debt from 118 percent of GDP at its peak to around 40 percent today, with a target of eliminating it completely by the end of 2007. It’s important that the bulk of the excess money be channeled into new industries with added value that can give us a good income in the future.


The Quarterly: How do you feel about the pace of economic reform in Saudi Arabia? Could the oil bonanza be an excuse to slow things down?

Alwaleed: Although some observers assume that the brakes will be put on political reform because of the new oil wealth, I honestly don’t believe this to be the case. For sure, I would like some things to be quicker. First, bureaucracy needs to be cut. When the law establishing the Saudi Arabian General Investment Authority [SAGIA] was enacted, the idea was that it would encourage one-stop shopping for international investors, but I am not certain we are seeing that happen. There is also a need for more competitive tax laws. We have to compare ourselves not only with the rest of the region but with Eastern Europe, Latin America, and Africa. It is a very tough climate for inward investment, and we have to go further than lowering the capital gains tax to 20 percent, from 40 percent. Finally, there are the labor laws, which—although less important than the first two issues—are still not clear enough.

The Quarterly: From the outside, Saudi Arabia sometimes seems to struggle to turn reform ideas into action because, unlike, say, in Bahrain or Dubai, no one person or institution appears to be driving the agenda. Is that fair?

Alwaleed: In the years when he was crown prince and since he became king, a year ago, King Abdullah has initiated major political, social, and economic reforms. In general, Saudi Arabia is now looked at favorably by international investors. We see that in the many companies locating there. King Abdullah would like to move faster, but for him it’s like moving a big yacht—it takes time to turn it round.

The comparison between Saudi Arabia and the Gulf countries, whether it be Dubai, Abu Dhabi, or Bahrain, is not right. These are all city or emirate states, whereas Saudi Arabia is a giant country with a lot of different constituencies: the Islamic constituency, the political constituency, the royal family, the conservatives, and the Bedouin. On top of that we are at the vanguard of Islam, and we have the wider Muslim population of the world—1.3 billion people—looking to us for leadership. To move in Saudi Arabia, with all these entrenched interests, is very difficult.

That’s not to say I’m a defender of the status quo. Far from it. I’m frustrated that women can’t drive—we’re the only country in the world where they can’t—and that while it’s legal to buy a videotape and see it on the small screen, we don’t have any cinemas. These may be cosmetic issues, but they’re important.

The Quarterly: Are you worried that some of your neighbors in the Gulf are moving ahead more quickly?

Alwaleed: Saudi Arabia is the anchor of the region, just as Germany, France, Italy, and the United Kingdom matter economically much more than Slovakia, Poland, or Greece in Europe. I don’t agree that we will be left behind, but we have to take lessons from what is happening now in, say, Dubai and Abu Dhabi. It is quite possible to be politically conservative and at the same time to encourage reform. In Saudi Arabia we have to unlink political conservatism from economic liberalism. There are still some hiccups in this respect.

The Quarterly: Is the balance changing between conservatives and modernizers?

Alwaleed: There is certainly a tension, but the king and the government are very much proreform, and they are moving ahead. I’m not saying they are not conservative too—they are. I am conservative, I am a Muslim, I pray five times a day, but I’m economically and socially very liberal. I don’t see that as a conflict. In my judgment the conservative role is shrinking, or at least not getting stronger, and the king is taking a strong stance against this group. What the US government is doing in Lebanon, in Palestine, and Iraq, though, is not advancing the liberal cause.

The Quarterly: Are events in those territories a cause of instability in the Gulf region? What are the main risks for businesses as you see them?

Alwaleed: I think the Gulf region has learned by now to deal on the economic front with the hot spots around us. While a big benefit comes from the price of oil, the investment boom at the moment is very real. Clearly, terrorism is a risk, but the risk is diminishing. In Saudi Arabia we were not geared up for antiterrorism at the time of 9/11—we were never a police state—so we have been on a learning curve on how to combat terrorism. I am not saying terrorists have been eradicated, but I would say to Western people that the matter is under control and we are weeding them out before acts are committed. The political situation in the region, meanwhile, is very stable.


The Quarterly: Turning to investment matters, do you think the pattern of global capital flows is changing? As an international investor, where do you see the most attractive opportunities in the next few years?

Alwaleed: There’s no doubt that after 9/11 and after the Dubai Ports [DP World] debacle, many investors from our region, including the government of Saudi Arabia and other governments in the Gulf, have been thinking of putting more of their money into Europe, India, China, and the Far East in general. At the end of the day, politics is mirrored in economics and finance; US attitudes toward the Arab and Islamic worlds and toward the Dubai Ports deal have had a negative effect, though not on me.

I can’t put numbers on any of this, but I have seen the trend for some time in the communications I have with other investors. When the Bank of China asked Kingdom Holding to be the Saudi investor in their bank, we received subscriptions for the first $2 billion within three days. Actually, we were oversubscribed.

At the same time, a lot of capital is being invested in the local economies of the Gulf. In the past several months, I have met five or six chairmen of US banks and investment banks that are lining up to come to Saudi Arabia, to open branches and serve the corporate sector and high-net-worth individuals. Studies say that in excess of $1 trillion could flow into the budgets of the Gulf economies in the next two years, even with oil at around $60 a barrel, and if there were to be a slowdown in the world economy the transfers would be huge.

The Quarterly: Apart from oil and property, what other industries do you see emerging in Saudi Arabia over the next five to ten years?

Alwaleed: At the end of the day, any country has to invest where it has an economic edge. During the first boom, Saudi Arabia announced that it was going to be self-sufficient in wheat. Yet we had none of the components that make agriculture feasible in a country—an abundance of water, cheap labor, or soil. We were importing labor, and we were digging wells to find water before exhausting them. That policy was a blunder. As a derivative of the oil industry, petrochemicals is one sector that is likely to be very important. Banking and financial services too. We are planning to build an international financial center in Riyadh to compete with the rest of the Gulf region, though it remains to be seen if it will be successful. Islamic tourism is another potential area for expansion, though I don’t think we’re talking about tourism in the international sense.

The Quarterly: What changes have you been making—or do you intend to make—in the asset allocation of your own global portfolio?

Alwaleed: After 9/11 my investments in the United States actually grew, not just tactically, but strategically. Because of Kingdom’s restructuring ahead of our IPO, we have not really invested a lot recently in the Middle East region. But we intend to invest tens of millions of rials in Saudi Arabia in various sectors, including airlines, real estate in Jeddah and Riyadh, and banking. Elsewhere in the Gulf, we are opening Four Seasons properties in Bahrain and Abu Dhabi and will end up with ten hotels in the region in the next two to three years. But we will not expand in other areas for the sake of expanding—we want to consolidate what we have now.

The Quarterly: Can you tell us about your extensive media interests? Besides the investment angle, is this a way for you to change perceptions of Islam in the West and, indeed, of the West in the Middle East?

Alwaleed: That is a good question. My media investments are worth about $5 billion to $6 billion and are divided into Middle East assets, which are grouped around the Rotana brand and include six television channels and the Islamic channel Alresalah, magazines, radio stations, and a stake in LBC Satellite (LBCSAT); and international interests, which include Time Warner, Walt Disney, and News Corporation, in which we are the third-largest shareholder. In the second phase of going public, we may have another IPO for our media entities.

I must say adamantly that we do not try to influence the political direction of our international media interests. However, given our alliance and strong relationship with the owners of certain entities, like Mr. Murdoch’s Fox News, we try to build bridges and discuss things with them in a logical and pragmatic way. We only ask for the chance to be heard. We are not asking them to be pro-Iraq, pro-Palestine, or pro-Islam, but we are asking them to be neutral.

Most media outlets in the Arab world—at least the print and TV ones—reflect the wishes and the dreams of their governments. So we are not so worried about that.

The Quarterly: What else can be done to bridge the gap between Muslims and the West?

Alwaleed: Through Kingdom Foundation we have established a $20 million Islamic studies program at Harvard University and a $20 million Center for Muslim-Christian Understanding at Georgetown University, in addition to our funding at Exeter University in England. We have set up the only two American centers in the Middle East, at the American University of Beirut and the American University in Cairo, donating $5 million and $10 million, respectively. At the request of President Chirac we have supported the Islamic wing of the Louvre, in Paris, and I am discussing with universities in the United Kingdom the opening of new Islamic-Christian-Jewish centers.

We put our money—more than $100 million—where our mouth is, but it’s going to take a long time to have any effect.

The Quarterly: What can be done to change hard-line attitudes in the Middle East? Do you share the view that education reform has a key part to play in the next few years?

Alwaleed: Our curriculum in Saudi Arabia is old and obsolete—I say that openly—and we need to do more. In schools we need more science, more English at the elementary level, more mathematics, and more emphasis on the Internet, reflecting the world we live in now. Things are moving a bit in universities, but it’s still the same story. On the religious side, the Ministry of Islamic Affairs has issued a circular that promotes moderate preaching in mosques and takes out anything related to the so-called enhancing of terrorist acts against Judaism and Christianity.

The Quarterly: What misunderstandings between Saudi Arabia and the West most frustrate you?

Alwaleed: In the West, and specifically in the United States, any act of terrorism by a Muslim is blamed on the entire Muslim community. In response to a recent attempted terrorist plot in the United Kingdom, for instance, the president of the United States talked of Islamic fascism. One or 2 people, or 20 people, or 100, or even 1,000 may fall into that category, but you can’t make a general statement about 1.3 billion people. I acknowledge that we have problems inside our Islamic community, but putting all Muslims into one pot and implying Islam is a terrorist religion adds fuel to the fire. This polarization between Islam and Christianity is very dangerous. There is very little difference between Islam, Christianity, and Judaism—they all believe in one God, one day of judgment, and a scripture that teaches about heaven. OK, one says the Bible is the word of God, the other that the Koran is the word of God. There are differences, but we are so close.

The Quarterly: A prominent Middle East editor said recently, “Not all Muslims are terrorists, but all terrorists are Muslim.” Is there a debate within Islam about the way things are going?

Alwaleed: I know that. Not all Muslims are terrorists; unfortunately, most terrorists in Russia, Thailand, the United Kingdom, and Spain are Muslim. I acknowledge that, but we have an issue with that internally in the Muslim community, and this is very dangerous talk for many people. In my view we need a major reform movement in the Arab and Islamic world to change perceptions. We are where the Catholic Church was when it controlled Europe, in the Middle Ages, and the political agenda succumbed to the religious agenda. But who is going to do it? I worry that things may have to get worse before we go in that direction, just as they got really nasty in Europe in the Middle Ages. That’s why I’m doing my best, with others, to bridge the gap, to think about the curriculum, and to take initiatives in the academic arena.

The Quarterly: Have you thought about doing something for Muslims in the region, equivalent to the Harvard and Georgetown foundations?

Alwaleed: It is very delicate to have something within the Islamic community. Right now we only have the Arab Thought Foundation, and while we are thinking of an opportunity ourselves, something new would have to be done by the government. We are seeing some indications, such as the recent conference in Mecca, that the debate is beginning, and it is important that the West should understand this. But we are living in history now. There is a beautiful Koranic verse that says God does not change people unless they change what they have inside them. In 100 years we will see what is happening—5 to 10 years is not enough. Look how long it took for Martin Luther to bring about change in Europe. It is not going to happen in the Middle East unless we have a strong reformer to take the lead.

The Quarterly: Kingdom Holding has been a pioneer in promoting women. Tell us about that, and what is happening generally in the country at the moment?

Alwaleed: I am Islamically conservative—I will do anything to help people, especially in the Islamic community—but I believe in the women’s cause, not just for their sake, but for the sake of the economy and for Saudi Arabia. You cannot have a population that is 50 percent female and have it account for only 4 or 5 percent of productivity. In my company I am trying to set an example. And what I do gets monitored because I have a relatively high profile. I have, for example, hired the first lady pilot, the first lady flight attendant, and the first lady jockey. And I use my media outlets to promote that. The jockey went to the Emirates, and all they talked about was her, even though she didn’t win. On television the pilot pointed out that she was not permitted to drive on the roads, but she could fly a plane and look down on everyone from the air.

Not many others are following at the moment, and a lot of Saudi women are frustrated as a result. But things are changing and will have to change more.