Archelle Georgiou, MD

By Archelle Georgiou.

“So, how was China?”

We recently returned from China and Vietnam and have been asked this question many times by curious friends, family, and colleagues.  Recognizing that we live in a world of soundbites and that no one really wants to hear every detail about our fourteen day trip, I’ve responded by focusing on the experiences and observations that had a lasting impact on how I think.  There were three: one is personal, one is political, and one is professional.

Personal: While “Made in China” is present on everything from chatchkas to clothing labels to housewares, and although China’s thriving economy is a frequent topic in the business world…I simply wasn’t expecting to see their ultra-modern infrastructure.  I went to China with a visual image that was pre-Mao.  Shame on me.  Instead, I saw 14 story shopping malls, a Shanghai skyline best described as “New York on steroids,” an efficient and clean subway system, and construction cranes on every square block. While analysts predict an economic and building bubble that will deflate soon…there is national confidence that China’s  5 Year Plan (for 2011-2015) will address these risks.  Take a look at the well-defined, measurable goals regarding their economic targets, innovation, the environment, people’s livelihood, social management, and reform.  The Plan is translated into action down to the individual citizen level to assure that they achieve their goals.  We may not agree with socialist/communist ideals, but step back for a moment and imagine how much progress the US would make if we had a unified plan regarding our nation’s advancement.

How was China? A strong world power.   Never again will I refer to China as an “emerging economy.” They have emerged, and there are a few things that the US can learn from them.

Political: In Vietnam, our guide whisked us to Ho Chi Minh’s tomb, and proudly announced, “We are a communist country.”  Well versed in his country’s history, Happy (yes, that was really his name) gave described, in depth, how communism liberated the Vietnamese from the French.  As usual, we peppered him with as many questions as he would tolerate about life in, what we presumed to be, a classless society.   He was understandably cautious in how he represented the government, and his standard response to many questions, such as “How much corruption is there?” was “That is a sensitive question that I cannot answer.”  Recognizing there are pros and cons to any ideology, we looked forward to hearing about their health care system and how it was designed to offer equitable access to care.  We were shocked when he explained that only those who have money can afford health insurance, and only those who have insurance get health care. Everyone else struggles. I was distraught. “What?! How can this be? How can a fundamental need not be provided in a communist country?” His response? “That is a sensitive question that I cannot answer.”

How was Vietnam?  Physically beautiful but politically contradictory.   I have since learned that Vietnam (and China) have a “socialist market economy”–in other words, they have both the political and social disadvantages of communism as well as the economic disadvantages and disparities of capitalism.

Professional: During the annual business planning cycle of US businesses, it is typical for managers to request a budget to hire more staff.  In most cases, the proposed employee increase is trimmed, slashed, or completely eliminated with subsequent grumbling about the “impact on service and innovation.”  Sound familiar?

While we were in China, I paid particular attention to staffing.  In a nation with almost unlimited opportunity to hire due to low labor costs,  I paid special attention to whether more people resulted in better service.  My observations were far from a formal analysis..but, here’s what I saw:

  • Staffing levels were 3-4 times higher than in the US. Example: In a casual US restaurant, there is typically 1 host who greets and seats customers. In China, there were 4:
    • At the entrance to the restaurant.  Responsibility: open door
    • In front of the hostess stand.  Responsibility: ask for number of people in the party
    • Behind the hostess stand:  Responsibility: assign the table
    • Beside the hostess stand:  Responsibility: lead guests to their table

The service was adequate (but not extraordinary) as long as we had ordinary, predictable requests.  But, when we strayed from the norm—service collapsed.  When we tried to order a plain bowl of rice for Zoe in a restaurant with rice-based dishes, we created a bit of chaos.  The waitress called the supervisor who called the manager.  After fifteen minutes of huddling, they were unable to serve a plain bowl of rice since it wasn’t specifically listed as a menu item. An overflowing chafing dish of plain rice was 20 feet away in the buffet line.  We gave up.

This scene, with different details, was repeated multiple times each day. (No, we were not being difficult Americans.) While our daughter lived in Shanghai,  she was in the bed/mattress section of a department store and asked where she could find bed pillows. The bed salesman had absolutely no idea…and was unable to help figure it out.

The employees did not seem are complacent, uncaring, or intentionally inflexible.  Instead, they just couldn’t think or act outside the boundaries of their tiny, narrowly defined scope of responsibility.  I realized, for the first time, that excess labor isn’t necessarily a solution to better service. Rather, it can drive inefficiency and dilute accountability for the entire consumer experience.

How was China? A culture that fosters order and compliance versus risk-taking.  Yes, they can copy couture fashions before they are off the runway, and reproduce the newest Apple device before Steve Jobs is off the stage, but the lack of flexibility and, consequently, little problem solving, translates into a larger national issue for China: lack of innovation.  The government, however, has recognized this risk,  and the 5 Year Plan includes investments in R&D with a goal to  achieve 3.3 patents per 10,000 people. 

What was my overarching takeway, or, should I say takeout? Our trip was analogous to a Chinese feast that offers a disparate array of exotic foods that I never imagined eating. Similarly, our trip offered a disparate array of impressions and observations that disrupted some of my long held beliefs. I am still digesting it…though with a little heart burn.

Originally posted on Archelle on Health on July 20th.

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