Do We Pay for Precision?

Posted on August 15, 2014

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Earlier this week, I had the occasion to visit Milwaukee.  The trip was a mixture of business and pleasure.

Including the airline arrival, I was able to sample four separate modes of transportation by limiting myself to the urban core during my stay.

What I noticed from each of the experiences was how drastically they differed based on my expectations and what I paid.

First, an airplane brought me to Milwaukee.  It cost $414 (plus $150 change fee due to an itinerary adjustment) and had two legs, pretty standard.  I was lucky to get a free bump up to business class on both legs in.  Still, the price was not a bargain before the change fee, and I had only experienced half of the trip.  Hold that thought.

Next, I took a taxi from the Milwaukee International Airport (MKE) to downtown for $35, including tip.  It was a fast and pleasant ride.  The cost was metered and exactly as the driver had predicted; a moderate expense and responsive, a “custom” solution; reasonable cost given the outcome.  As expected.

Then, I attended a baseball game and used a sponsored shuttle to do it.  The shuttle was free, but technically cost me lunch because I had to patronize a tavern to use the shuttle.  At $12 round trip, I was not complaining.  It only made a couple runs an hour, but it was fast and saved a lot of logistical headaches. A minimal cost and fairly customer-friendly; faster and better value.  Better than expected.

Then, I used the city bus to go seven miles across town for $2.25.  As a bonus, I was able to use a transfer ticket on my return trip, so my return was free.  Riders were a bit cranky because a driver switch created a delay, and although I was not in a rush, several drivers were worried about making their transfers and being late to work (hint of foreshadowing).  I was more than pleased with the ease of use, experience and price—even if it was tardy, and made a lot of stops in addition.  Least expensive, but slow with questionable ridership and modest comfort.  As expected.

Finally, I completed the return trip via airplane.  Before I even left MKE, I was late.  No business class upgrade.  An already tight connection in Atlanta was made impossible, but we were told “they will definitely hold the plane” twenty minutes since it was the last flight out.  They definitely did not.  AirTran has been an inspiration in the past, but not this time.  This soured my airline experience, and made it difficult to not feel snake-bitten.  In lieu of a comp’d hotel and next-day return trip, I elected to drive home at my expense. The most expensive and most painful experience; several snafus and disappointments.  Worse than expected.

The most expensive and least expensive options were the least precise and least pleasurable.  It appears there is a sweet spot between the premium and low-cost solution.  This is often what I see with healthcare capital projects.  When selecting a healthcare project team partner, I wonder how expectations and final project outcome match with cost?

Does Design-Bid-Build, aka ‘hard bid’, provide the expected value?  Is an RFP able to deliver ‘the best of both worlds’, quality and experience at a good price?  Is a legacy partner with a premium price tag always ‘a head above’ a newbie on your campus?  Is a negotiated deal protest-proof if it offers benefits no other teams can offer?  If a team is completely integrated and can pass along significant savings with proprietary thought leadership, does it even matter how the project is executed?

These are some of the questions healthcare systems may choose to address as they shop for their next capital project partner.  What you buy must hit your target.  Examine which project team you feel is the best tool for the job, and whether precision (performance) is what you are really buying.

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