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Hospitals are fertile ground for investigating questions of vertical integration because they have actually been long-time practitioners of outsourcing, but they lag behind general industry in terms of the degree to which outsourcing has permeated most hospital organizations. In the context of this section, outsourcing refers speci cally to services either directly or indirectly related to patient care and hospital administration. Sourcing of manufactured goods, supplies, and the like is considered ordinary in the course of their business and not included. Historically, outsourced functions have included only perceived noncore services such as food service, housekeeping, and security. Outsourcing statistics for hospitals are somewhat limited, but Modern Healthcare estimates that three-quarters of all hospitals outsource at least one function. According to the American Hospital Association, the nation s 4,927 community hospitals incurred about $416.6 billion in expenses in 2002.15 According to a comprehensive study of Veterans Hospital Administration (VHA), a hospital co-operative, of its members,



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Looking Back on Step Two At their last meeting, Dana and Marty agreed to rendezvous again after a couple of months to check in with each other. They meet for coffee on Friday afternoon. Okay, Marty, says Dana, Are you going to complain some more about this process, or have you found that it s beginning to solve some of the problems down in the warehouse Well, it s been painful, replies Marty. But I have to admit that it s making my job easier. I m able to plan my personnel in the warehouse to match the shipments. And here s what s really great since the inventory numbers on the portal are reliable, I don t have half my team counting inventory just to make sure we can fill standard orders. Everybody trusts what they see on the portal, and that makes everything go much more quickly. Yes, it s a relief to be able to trust those numbers on the portal, says Dana. I know I can commit to an order on the phone. If the portal says the inventory is there, I can sell it there and then. It saves so much time and bother. What s surprising to me, adds Marty, is that we are able to do all this at the same time that we hold less inventory I have open rack





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Separate assess tasks for the contracting strategy and the contracting plan as shown in Figure 9.1 need no further comment, but the nal assess task does. It provides a convenient place to pause and consider the issues associated with the contracting strategy as a whole as well as individual planned contracts developed to this point. The possibility of multiple contracts with many parties makes this overall integrative assessment crucial. For example, if the constraints imposed by other parties collectively put the project at risk in unacceptable ways, it may be worth explicitly addressing the possibility of stopping at this stage, or going back to rescope the strategy.

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If one has an asymmetric matrix A and still wishes to simplify the quadratic form this way, she can rede ne the matrix of the quadratic form as B = (1/2)(A + A ) and use x Bx as the quadratic form, which can be proved to be equal to x Ax. A simple practical method of determining whether a given quadratic form A is positive de nite in the modern era of computers is to nd its eigenvalues, and concentrate on the smallest eigenvalue. If the smallest eigenvalue l min(A) > 0, is strictly positive, the quadratic form x Ax is said to be positive de nite. Similarly, if the smallest eigenvalue l min(A) 0, which can be zero, the quadratic form x Ax is said to be nonnegative de nite. In terms of determinants, there is a sequence of determinants that should be checked to be positive de nite for the quadratic form to be positive de nite. We check. a11 a11 > 0, a21 a11 a12 > 0, a21 a22 a31 a12 a22 a32 a13 a23 > 0,. . . , a33

We saw in section 4.2.3 that the current value of the phase-to-phase short-circuit clear of earth is: I sc 2 = 3V n Z (1) + Z ( 2)

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