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Lean manufacturing or lean production is a practice that considers the expenditure of resources for any goal, other than the creation of value for the end customer, to be wasteful and thus a target for elimination.

you need to look at how in fact you can build that hospital in a way that will provide for the most efficient staff processes

lean construction is an adaption of lean manufacturing principles and practices to the design and construction process

As part of this new approach, Dyble said the ministry of health is also moving forward on a different way of managing capital projects. According to Dyble, capital boards have been created to provide an overarching look at the capital program for big projects with a cost of more than $50 million. They look at how much is being spent on rehabilitation and projects, to make sure the best possible capital projects are provided in the future. The project board is made up of senior members from Ministry of Health Services, the health authority, Partnerships BC and the Ministry of Transportation and Infrastructure.

And while estimates put the cost to Canadian tax coffers at $6-$7.8 billion per year, the effect on developing countries is far greater, said Haroon Akram-Lodhi an economist and professor of international development at Trent University. "The amount of capital flight from sub-Saharan Africa is absolutely huge and it's all going into these tax havens," said Akram-Lodhi, one of the signatories of the letter. "This is reducing the ability to fight poverty on a global scale." The letter, made public on the eve of this week's global anti-corruption summit in London, calls on world leaders to act against financial secrecy both in tax havens and at home. "To lift the veil of secrecy surrounding tax havens we need new global agreements on issues such as public country-by-country reporting, including for tax havens. Governments must also put their own houses in order by ensuring that all the territories, for which they are responsible, make publicly available information about the real 'beneficial' owners of company and trusts." On Monday, Transparency International Canada issued a parallel call for the Canadian government to make its own corporate registry more transparent.

There is a pressing need for the Government of Canada to take concrete steps to address the ability of some Canadians to shield themselves, and their financial activities, from Canadian authorities," said Peter Dent, president of Transparency International Canada. "That some can rig the system to hide their wealth, whether amassed legally or not, is not merely unjust. It also masks corruption and harms global development by siphoning off revenues that could be directed to education, health care and infrastructure," Dent said in a statement. While the growing movement to crack down on tax havens has been spearheaded by the richest countries through the Organization of Economic Cooperation and Development, the negative effects of depleted government revenues hit the poorest countries the hardest. Uganda, an East African country which has often been described as a "donor darling," remains stuck in a cycle of poverty largely due to its inability to provide state services, said Akram-Lodhi.

They don't collect enough tax (because) multinational corporations evade their fair share," he said. While the U.K. government collects 25 per cent of its GDP in tax revenue, Uganda is only able to get 11 per cent, according to World Bank statistics. Instead of having to wait longer for a new subway, low tax revenue has far graver consequences in the developing world, he said. "Tax avoidance in Canada doesn't lead to people going hungry. Tax avoidance in sub-Saharan Africa leads to people dying of hunger. It's that clear," said Akram-Lodhi. "It's criminality that ruins people's lives." Another signatory of the letter, Peter Dietsch, a professor of philosophy and economics at the Université de Montréal, said the Panama Papers have "opened a window of opportunity for action." Describing the underlying conflict over tax havens as being between people who have capital and those who don't, Dietsch said anti-tax haven forces are growing.

"There's now a growing coalition of individuals without capital who pay their taxes and small and medium enterprises who don't have resources to move their assets abroad." Canadian signatories A. Haroon Akram-Lodhi, professor of international development studies, Trent University. Peter Dietsch, professor of philosophy, Université de Montréal Hashmat Khan, professor of economics, Carleton University Kiari Liman-Tinguiri, president of IEDAS Inc., Ottawa Patricia E. Perkins, professor, faculty of Environmental Studies, York University Toby Sanger, senior economist, CUPE

Americans who can't afford their life-sustaining medications are the victims. They're being killed by the profit incentive of capitalism.

Paul Buchheit

t follows that humanity’s very provision for the universal human life necessities that have evolved over millennia are blinkered out by the life-blind value measures of what is miscalled ‘the economy’. Everything that makes a society civilised or liveable is excluded from view – life-protective laws including sufficient minimum wages and environmental regulations, common water and sewage systems for all, free movement pathways and life spaces without cost to use, non-profit healthcare and disease-prevention by public institution

public income security from disemployment, old age and disability, primary to higher education without multiplying debts, family housing, food and life means assistance for children without sufficient parental money, and public libraries and arts facilities with accessible books, films and works of art and art creation. This is more or less a complete index of the collective life capital bases modern society has evolved, but all are dismantled by the global corporate disorder to maximally profit from.

Just now in Ontario this arrangement would appear to have hit a wall. Having negotiated a four-year deal offering average annual fee increases of 2.5 per cent, the Ontario Medical Association executive was dismayed to find it rejected by nearly two-thirds of its members, who complain it does not make up for cuts in fees imposed last year. How things should have broken down to this extent need not detain us here. But it does perhaps point to the need to find another way.

Because doctors' fees, as such, are not the issue. To be sure, they are part of the puzzle: at $11.5 billion annually, they are roughly one-fifth of Ontario's health-care budget. But all the hard bargaining in the world isn't going to rescue Canada's health-care system from the fiscal cliff to which it is headed. Much more important than doctors' fees are doctors' decisions, as the gatekeepers dictating how resources are allocated within the system: how many tests are ordered, what procedures are done, and so on.

The problem is that decisions about treatment are too often divorced from decisions about budgets. Governments set a budget constraint at the macro level, which filters down through the various regional health authorities and local health networks the provinces have seen fit to establish. But doctors typically do not: they make whatever they can bill. And the incentives of feefor-service are to perform as many surgeries and other treatments as they can. Absent changes in those incentives, simply capping fees isn't going to change much.

You can see why doctors felt the need to organize. Governments had set themselves up as sole purchasers of medical services. The idea was supposed to be that they could exploit that monopoly power to drive down costs. But it didn't quite work out that way: politicians in need of re-election, it seems, do not make terribly tough negotiators (who knew?). It was always easier to pass the problem on to the next government, or the next generation - or, as federal governments got in on the act, Ottawa. In consequence, health-care spending skyrocketed through much of the 1970s and 1980s.

Traditionally, doctors have been paid per service, while hospitals have been funded on a block grant basis. The key to reform is to turn this around: giving groups of doctors a fixed amount per patient, with which to purchase services from hospitals, clinics and other providers, that is on a per-treatment basis. Paying doctors a lump sum localizes the budget constraint, forcing doctors to take account of costs in decisions on treatment; paying hospitals per service makes it possible for lower-cost competitors to undercut them.

Even in the more recent wave of cuts following the last recession, these have been largely untouched. As documented in a new study by the C. D. Howe Institute

("Hold the Applause: Why Provincial Restraint on Healthcare Spending Might Not Last"), governments have largely resorted to the familiar public-sector strategy of starving the capital account to feed the operating account: while capital spending has been sharply curtailed, physicians' fees have not.

This is not sustainable in the long run - as new doctors enter the profession, and most of all, as the population ages. As it is, provinces are now spending more than 40 per cent of their budgets on health care; by 2030, a recent Fraser Institute paper projects the number will have risen to nearly 50 per cent. Yet wait times continue to mount: at more than 18 weeks, on average, from GP referral to treatment, they are nearly twice what they were 20 years ago.

Clearly the answer does not lie in more money, least of all more federal money: for every additional dollar in federal transfers the Howe study's authors find that provincial health spending increases by 36 cents. But neither is the answer ever stricter doses of austerity - any more than one would improve a car's mileage by putting less gas in the tank. Rather, what's needed is systemic reform, altering the way that public funds flow through the system, and how the different players within it are remunerated.

Only with the onset of the early 1990s recession, and particularly the sharp cut in federal transfers as Ottawa tried to stabilize its finances, was there the first serious effort at retrenchment. But as the fiscal crisis eased, and particularly after the 2004 health-care accord, with its massive 10-year increase in federal transfers, whatever impetus for reform there might have been dissipated. Rather than "buying change," most of the new money went to increases in provider compensation.

In sum, rather than doctors and governments negotiating with each other at one gigantic bargaining table, what we need are lots of little bargaining tables, at which providers can haggle with each other.

doctors are reportedly earning 25 per cent more under capitation than they were under fee-for-service

total annual funding to family physicians went up by 32 per cent between 2006-07 and 2009-10

The path out of a $16-billion deficit, more or less endorsed by all three provincial parties in the recent election, revolves largely around flattening health spending increases

Despite this increased attachment, the chance of being seen in a timely way did not improve. Ontario's primary care models require evening and weekend clinics and on-call duties, and penalize practices for out-of-group primary care visits; therefore, these findings are unexpected. While many factors are likely involved, Ontario's auditor general noted two major faults: not establishing mechanisms for ongoing monitoring and evaluation, and not enforcing practices' contractual obligations, especially for after-hours care

The access bonus is reduced by outside primary care use but not by emergency department visits. Physicians responding rationally to such a financial incentive would logically direct their patients away from walk-in clinics and toward emergency departments. The access bonus also strongly discourages healthcare groups from working together to provide late evening and night coverage because all parties would lose financially. An incentive that costs more than $50 million annually should be structured to align better with health system needs.

A recent systematic review found insufficient evidence to support or not support the use of financial incentives to improve the quality of care (Scott et al. 2011).

Ontario's reforms occurred in the absence of routine measurement of primary care within practices, groups or communities and with limited accountability for how funds were spent.

Ontario adjusts capitation for only age and sex, whereas most other jurisdictions further adjust for expected healthcare needs, patient complexity and/or socioeconomic disparities (e.g., the Johns Hopkins Adjusted Clinical Groups http://www.acg.jhsph.org/). That may be why Ontario's primary care capitation models have attracted healthier and wealthier practices (Glazier et al. 2012).

Community health centres care for disadvantaged populations with superior outcomes (Glazier et al. 2012; Russell et al. 2009) and could play a larger role in Ontario's health system.

Unlike some other jurisdictions (National Health Service Information Centre for Health and Social Care 2012), Ontario has no routine measurement of primary care at the practice, group or community levels. It has no organized structures, such as the Divisions of General Practice in Australia (Australian Department of Health and Ageing 2012) or the Divisions of Family Practice in British Columbia (2010), that can help practices come together to improve care. It has also failed to hold practices accountable for their contractual obligations, including after-hours clinics.

In Ontario, there was little relationship between incentive payments and changes in diabetes care (Kiran et al. 2012), nor were there substantial improvements in most aspects of preventive care despite substantial incentives (Hurley et al. 2011). Similar cautionary tales about pay-for-performance can be found elsewhere in the health system (Jha et al. 2012).

Access to primary care has proven to be challenging in Canada, leaving it behind many developed countries in timely access and after-hours care, and more dependent than most on the use of emergency departments (Schoen et al. 2007).

A strong primary care system is consistently associated with better and more equitable health outcomes, higher patient satisfaction and lower costs (Starfield et al. 2005).

Nova Scotia Government & General Employees Union president Joan Jessome, who represents the majority of Capital Health nurses, said Glavine is attempting to hide the fallout of legislation.

Many nurses are leaving because they weren’t given a say about their representation under the new provincial health authority, not because of propaganda, said Jessome. “They’re fed up.”

An arbitrator’s decision Friday will all but certainly place all nurses with the Nova Scotia Nurses’ Union.

NDP health critic Dave Wilson said Glavine should acknowledge that some of the Liberals’ moves since coming to power are hurting health care. More focus should be placed on workplace concerns and staffing levels rather than union reorganization, he said.

Glavine said steps continue to address shortages, including adding seats at nursing schools and a proposal at Dalhousie University to condence the nursing program from four years to three.

Cerberus Capital Management bought a Catholic hospital system in Boston, now Steward Health Care, and Oak Hill Capital Partners, another private equity player, established a partnership with Ascension Health to buy Catholic hospitals.

Even health insurance companies could be possible buyers.

Insurers need to think about combining with hospitals and doctors so they can be more of a one-stop shop, said John Nelson, a Moody’s executive who also worked on the report.

35 buyouts of hospitals or chains of facilities in the last two and a half years by private equity firms

Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the cost of its medical staff

HCA decided not to treat patients who came in with nonurgent conditions, like a cold or the flu or even a sprained wrist, unless those patients paid in advance.

In one measure of adequate staffing — the prevalence of bedsores in patients bedridden for long periods of time — HCA clearly struggled. Some of its hospitals fended off lawsuits over the problem in recent years, and were admonished by regulators over staffing issues more than once.

inadequate staffing in important areas like critical care

Many doctors interviewed at various HCA facilities said they had felt increased pressure to focus on profits under the private equity ownership. “Their profits are going through the roof, but, unfortunately, it’s occurring at the expense of patients,” said Dr. Abraham Awwad, a kidney specialist in St. Petersburg, Fla., whose complaints over the safety of the dialysis programs at two HCA-owned hospitals prompted state investigations.

One facility was fined $8,000 in 2008 and $14,000 last year for delaying the start of dialysis in patients, not administering physician-prescribed drugs and not documenting whether ordered tests had been performed.

Claiming he provided poor care, the other hospital did not renew Dr. Awwad’s privileges. Dr. Awwad is suing to have them reinstated.

“If you were a for-profit hospital with investors and shareholders,” said Paul Levy, a former nonprofit hospital executive in Boston unaffiliated with HCA, “there would be a natural tendency to be more aggressive and to seek more revenues.” Executives at profit-making hospitals are “judged in greater measure by profitability” than the administrators of nonprofit hospitals, he said.

some of HCA’s tactics are now under scrutiny by the Justice Department. Last week, HCA disclosed that the United States attorney’s office in Miami has requested information about cardiac procedures at 10 of its hospitals in Florida and elsewhere.

HCA’s cardiac business is extremely lucrative, and the Justice Department has requested reviews that HCA conducted that indicate some of the heart procedures at some of its hospitals might not have been necessary and resulted in unjustified reimbursements from Medicare and other insurers.

Small and nonprofit hospitals are closing or being gobbled up by medical conglomerates, many of which operate for a profit and therefore try to increase revenue and reduce costs even as they improve patient care. The trend toward consolidation is likely to accelerate under the Obama administration’s health care law as hospitals grapple with what are expected to be lower reimbursements from the federal and state governments and private insurers.

Columbia/HCA became the target of a widespread fraud investigation in the late 1990s, which led to one of the largest Medicare settlements ever.

HCA wanted to attract more patients to its emergency rooms, and it did. Annual visits climbed 20 percent from 2007 to 2011. But while emergency departments are often a critical source of patient admissions, they are frequently money-losers because many patients do not have insurance. HCA found a solution: it figured out how to be paid more for the patients it was seeing.

Nearly overnight, HCA’s patients appeared to be much, much sicker.

No one has accused HCA of up-coding, or billing for more expensive services that were not needed — one of the complaints made against it a decade ago.

The acting head of Medicare is Marilyn B. Tavenner, a former HCA executive who left there in 2005 to become the secretary of Health and Human Resources in Virginia.

Several former emergency department doctors at Lawnwood Regional Medical Center in Fort Pierce, Fla., said they frequently had felt compelled to override the screening system in order to treat patients.

When the doctors failed to meet the hospital’s goals for how many patients should be considered emergencies, “they really started putting pressure on.”

Regulators in several states have taken HCA hospitals to task over screening out patients too aggressively, including situations where the screening missed serious conditions.

“Staffing is critical,” said Courtney H. Lyder, the dean at the UCLA School of Nursing and an expert on wound care. “When you see high levels of wounds, you usually see a high level of dysfunctional staff,” he said.

HCA owned eight of the 15 worst hospitals for bedsores among 545 profit-making hospitals nationwide, each with more than 1,000 patient discharges, tracked by the Sunlight Foundation using Medicare data from October 2008 to June 2010.

an examination of lawsuits shows bedsore problems have been persistent at several HCA facilities

The hospital was cited twice by Florida regulators, in 2008 and 2010, for having inadequate numbers of nurses on its staff to oversee wound care for patients.

I am the B.C. representative to the Canadian Homecare Association

small army of trained women and men (1,200 in the South Island alone) travelling each day to sometimes eight or nine clients. The work starts as early as a 6: 30 a.m. and can run as late as 11 p.m. As well, there are the dedicated souls who stay overnight or "live-in" for three or four shifts with our most frail clients, often those who are palliative.

On a typical day in the capital region, more than 700 community health workers are on the road. They travel, collectively, 7,000 kilometres and visit 3,000 clients.

Isobel Mackenzie is CEO of Beacon Community Services, a non-profit that delivers home support to clients on the South Island in partnership with VIHA.

the ministry could not provide the auditor with a cost-benefit analysis or a description of the criteria used in the selection

we did not see any evidence why (the ministry) did not follow its normal process for entering into an agreement with a health care provider or seek broader consultation on partnering with other organizations

The ministry also directed SHR to begin paying Amicus the rate of $185 per bed daily for 100 beds from the day that the facility opens - which is expected to be next month - notwithstanding how many are occupied, the report says, calling that a "significant departure" from the norm.

the capital portion of the daily rate - which is almost $48 of the $185

neither (the ministry) nor (SHR) could provide us any written analysis to support that funding longterm beds in this new way is cost-effective for the province

the proponent approached the government with the idea for the "pilot project"

McMorris pointed to a "huge need" for long-term care beds in the Saskatoon Health Region

That’s supported by a recent cost comparison of private and semi-private hospital rooms conducted by Dr. Anthony Boardman, professor of business administration at the Sauder School of Business at the University of British Columbia in Vancouver (Journal of Benefit-Cost Analysis 2011; 2[1]:article 3). It found that private rooms were vastly superior on financial counts, as improved infection control, along with heightened privacy, improved sleep and fewer preventable medical errors contributed to reduced lengths of hospital stay. Taking everything into consideration, Boardman calculated the “net social benefit” (benefits minus costs) of a bed in private room compared to a semi-private room was about $70 000.

As compelling is research showing that single-occupancy rooms actually lead to higher hospital occupancy rates (Bobrow M, Thomas J. 2000: Building Type Basics for Healthcare Facilities. p. 145–57). Because of the need to isolate patients with nosocomial infections, hospitals with multi-bedded rooms can only reach a maximum occupancy of 80%–85%.

Compensation, including wages, represents approximately 70% of the districts/IWK operational costs.

In dollar terms, the size of all of that post-recession debt is staggering. Some fear that when interest rates return to normal, governments will face crippling debt-servicing costs. But the scope of the problem is a matter of significant debate in policy circles. Experts do agree that whether or not government debt is a serious problem depends on where you live. Government books in Western Canada are relatively healthy. East of Manitoba however, debt is already forcing hard choices. Political debate over government finances is typically focused on the annual bottom line, which shows whether there is a annual surplus or a deficit.

Economists say the often overlooked - but far more important figure - is the size of government debt in relation to the size of the economy. As a percentage of gross domestic product, the net debt of all provinces and territories has grown to 28.6 per cent in 201314 from 20.5 per cent in 2007-08. The federal debt grew to a peak of 33.3 per cent in 2012-13 from 29.2 per cent in 2007-08. That's nowhere near the 67.1 per cent debt levels reached by Ottawa in 1995-96, when The Wall Street Journal warned that Canada was at risk of hitting the "debt wall." The size of the federal debt has already started to decline, reaching 32.3 per cent in 2013-14. The 2015 budget forecast that the federal debt-to-GDP ratio will reach prerecession levels by 2017 and decline further to 25 per cent by 2021. The debt picture among the provinces varies dramatically.

Alberta and Saskatchewan are currently facing hard times owing to low oil prices, but they are the darlings of Confederation when it comes to low debt. Alberta had no debt at all as of last year. The real debt troubles can be found in Central and Atlantic Canada. Quebec's net debt is the largest, at 50 per cent of GDP, followed by Ontario, at 38.4 per cent, and Nova Scotia at 37.7 per cent, using figures for 201314. While Quebec announced a balanced budget this year, Ontario's deficit was up slightly to $10.9-billion last year. Ontario insists the deficit will be erased by 2017-18.

Provincial governments are responsible for programs such as education and health care that can affect people more directly than federal programs. Spending restraint is easier said than done. The 2015 budget season has coincided with student protests in Quebec, New Brunswick and Nova Scotia, while Ontario is dealing with labour unrest from teachers' unions. Many provinces have also been negatively affected by a recent change to the federal health-transfers formula. The move to per-capita funding won out over arguments that the average age of provincial populations should be factored into the equation. Some of the most indebted provinces also face the most challenging demographics, with a shrinking ratio of younger workers to cover the costs of growing numbers of older citizens. The Parliamentary Budget Officer has said that while federal finances are sustainable over the long term, the provinces are facing structural shortfalls that will demand spending cuts, higher taxes or both. University of New Brunswick economics professor David Murrell said the return to surpluses in Ottawa will likely rekindle pressure from the provinces for more generous transfers. Shrinking deficits, growing debt

Provincial finance ministers are quick to pat themselves on the back over shrinking deficits and balanced budgets, but economists urge Canadians to view these claims with a bit of skepticism. Accounting methods vary across the country, making comparisons difficult. Unlike the federal government, provinces generally present two sets of books: an operational budget and a capital budget. Boasts of balanced budgets are in reference to operational spending. A province's overall debt could still be rising on the capital side even though the government is in an operational surplus. Supporters of this accounting method - including Calgary Mayor Naheed Nenshi - argue that it separates good debt from bad debt: Using debt to build public assets such as roads and bridges is better than slipping into the red to pay for public service salaries and other operational costs.

Critics such as tax-policy expert Jack Mintz have warned this approach allows provinces to play "hide the deficit." Charles Lammam, director of fiscal studies with the Fraser Institute, a conservative think tank that regularly warns about the dangers of mounting government debt, agrees that claims of improving budget balances can be misleading. "This is a real problem in places like British Columbia and Ontario," he said. "It doesn't seem like the growth in government debt will let up." Mr. Lammam's research found that Canadian governments - including municipalities - spend more than $60-billion a year servicing debt, which is about the same as the entire cost of providing primary and secondary education across the country. Ontario's recent budget said a one-point increase in interest rates would cost the government $400-million. "There's a real risk that provinces like Ontario, provinces like Quebec, can be subject to this very negative situation where they're paying even more to service their outstanding debt," he said. The new debt debate

Doing so requires the business community to engage with the Department of Foreign Affairs, Trade and Development and EDC in the effective design and implementation of the government's new initiative. Done well, this initiative could leverage Canada's strengths in finance, natural resources, infrastructure construction and engineering to catalyze private investment that will accelerate the global push toward the United Nations' Sustainable Development Goals (SDGs). The initiative could also build on the skills and experience of Canada's large immigrant communities to strengthen trade and investment links with emerging and frontier markets - countries that are now responsible for the lion's share of global growth, but where Canada's business presence is tiny.

Senior fellow at the Jeanne Sauve Foundation and visiting scholar at Massey College in the University of Toronto. He tweets at @BrettEHouse. In its 2015 Economic Action Plan, the federal government announced its intention to create a $300-million, five-year "development finance initiative" to partner with private capital to create growth and jobs in low-income countries. The budget document anticipates that this initiative - to be located within an expanded Export Development Canada (EDC) - will provide a mix of financing, technical assistance and business advisory services to enterprises operating in line with the government's international assistance priorities.

As outlined in a submission to Parliament last summer by the Centre for International Governance Innovation and Engineers Without Borders, the experiences of Canada's G7 counterparts offer some important lessons for Ottawa's initiative. An effective initiative should address market failures; that is, it should fill gaps in the financial system that prevent good projects, sound businesses and effective entrepreneurs from obtaining the financing they need on reasonable terms. A classic example would be the situation of new immigrant entrepreneurs: They know their former countries well, they are ideally placed to build links between Canada and their birthplaces, but their lack of Canadian credit history makes it difficult for them to gain access to affordable borrowing to grow their businesses. Ottawa's new initiative will need to be empowered with a full range of financial tools - a variety of lending instruments, a mandate to take equity positions, the ability to write guarantees, the option to underwrite insurance products - that it can tune flexibly to take projects from their early days to full bankability.

It needs to be risk-loving and clear-eyed about the fact that some projects will fail, and maintain a long horizon on investments that typically take many years to pay out returns and development impact. This new development finance initiative should also embrace open competition. The most successful DFIs work with the most effective firms on the most innovative projects.

They're not limited to working with their own nationals. Both Canada and developing countries will benefit most if this initiative is made accessible to the best people, ideas and execution. Finally, Canada's new development finance initiative needs to take poverty reduction just as seriously as profit generation. Most other DFIs do this imperfectly, at best; some don't even monitor the impact of their projects on development. This makes no sense. Development is good for business and business can be good for development.

Five years from now, development gains will be just as important as profits in making the case for renewed funding of this initiative. All these lessons need be adapted to both the needs of Canadian business and Canada's specific development objectives. The Canadian Chamber of Commerce and Canadian Council of Chief Executives have both been important supporters of this project. Now it's time for the businesses that stand to benefit directly from this initiative to get involved ensuring its success.