Cost Reduction Initiatives Research Articles

Leveraging soft infrastructure for agricultural development: A policy perspective on technology adoption among agricultural extension officers in West Java

Technological advancements are transforming agriculture, yet adoption rates among agricultural extension officers, especially in regions like West Java, remain modest due to several challenges. This study applies the Technology Acceptance Model (TAM) to investigate factors influencing the adoption of agricultural technologies by agricultural extension officers in West Java. Specifically, we explore the role of socialization, training, access to technology, cost, perceived ease of use, and perceived usefulness in shaping behavioral intention and actual adoption. Data were collected from 295 agricultural extension officers via structured surveys and analyzed using SmartPLS 4 software. The findings indicate that socialization and training collectively enhance both perceived ease of use and perceived usefulness, while Technology Investment Worth specifically enhances perceived usefulness by emphasizing the value of the investment. Access to technology also plays a critical role in increasing ease of use perceptions. Both perceived ease of use and usefulness positively influence behavioral intention, which in turn is a strong predictor of actual adoption. The results provide valuable insights for policymakers aiming to increase technology uptake among agricultural extension officers, promoting sustainable agricultural practices through improved access, support, and cost reduction initiatives.

Logistics Business Intelligence and Performance of Courier Firms in Nairobi County, Kenya

The logistics function is a crucial cost driver for firms, particularly within the courier industry, where logistics expenses can account for up to 50% of sales revenue. This presents a significant challenge for Small and Medium Enterprises (SMEs) lacking the infrastructure to manage these costs. In Africa, the population of over 1.3 billion and a combined GDP of approximately $2.6 trillion contribute to substantial logistics costs, estimated at $3.5 trillion annually. Courier firms in Nairobi County, Kenya, face similar pressures, driving the need for improved logistical operations. Despite efforts to reduce costs, 67% of logistics cost-reduction initiatives fail due to poor execution, largely attributed to a lack of stakeholder involvement and supply chain visibility. This study, guided by the Resource-Based View (RBV) theory, aimed to examine the relationship between logistics business intelligence and the performance of courier firms in Nairobi County. Using a descriptive research design, data was collected from a sample of 72 courier firms, with findings indicating a weak but positive correlation between logistics business intelligence and courier firm performance. The study concluded that logistics business intelligence significantly influences performance, recommending investments in staff training, technological integration, flexible operational policies, and enhanced reverse logistics. Further research is suggested on logistics business intelligence in other sectors and the role of emerging technologies like artificial intelligence and blockchain in the logistics industry.

Expenditure mapping of pediatric imaging costs using a resource utilization band analysis of claims data

ObjectiveTo segregate imaging expenditures from claims data by resource utilization bands (RUBs) and underlying conditions to create an “expenditure map” of pediatric imaging costs. MethodsA Claims data for children enrolled in a commercial value-based plan were categorized by RUB 0 non-user, 1 healthy user, 2 low morbidity, 3 moderate morbidity, 4 high morbidity, & 5 very high morbidity. The per member per year (PMPY) expense, total imaging spend, and imaging modality with the highest spend were assessed for each RUB. Diagnosis categories associated with high imaging costs were also evaluated. ResultsThere were 40,022 pediatric plan members. 14% had imaging-related claims accounting for approximately $2.8 million in expenditures. Member distribution and mean PMPY expenditure RUB was respectively: RUB 0 (3,037, $0), RUB 1 (6,604, $7), RUB 2 – 13,698, $27), RUB 3 – 13,341, $87), RUB 4 (2,810, $268), RUB 5 (532, $841). RUB 3 had the largest total imaging costs at $1,159,523. The imaging modality with the greatest mean PMPY expense varied by RUB with radiography highest in lower RUBs and MRI highest in higher RUBs. The top 3 diagnoses associated with the highest total imaging costs were developmental disorders ($443,980), asthma ($388,797), and congenital heart disease ($294,977) and greatest mean PMPY imaging expenditures malignancy/leukemia ($3,100), transplant ($2,639), and tracheostomy ($1,661). DiscussionExpense mapping using claims data allows for a better understanding of the distribution of imaging costs across a covered pediatric population. This tool may assist organizations in planning effective cost-reduction initiatives and learning how imaging utilization varies by patient complexity in their system.

Unlocking Healthcare 4.0: Navigating Critical Success Factors for Effective Integration in Health Systems

The Fourth Industrial Revolution is transforming industries, including healthcare, by integrating digital, physical, and biological technologies. This study examines the integration of 4.0 technologies into healthcare, identifying success factors and challenges through interviews with 70 stakeholders from 33 countries. Healthcare is evolving significantly, with varied objectives across nations aiming to improve population health. The study explores stakeholders' perceptions on critical success factors, identifying challenges such as insufficiently trained personnel, organizational silos, and structural barriers to data exchange. Facilitators for integration include cost reduction initiatives and interoperability policies. Technologies like IoT, Big Data, AI, Machine Learning, and robotics enhance diagnostics, treatment precision, and real-time monitoring, reducing errors and optimizing resource utilization. Automation improves employee satisfaction and patient care, while Blockchain and telemedicine drive cost reductions. Successful integration requires skilled professionals and supportive policies, promising efficient resource use, lower error rates, and accelerated processes, leading to optimized global healthcare outcomes.

Airline Market Risks and Management Discussion and Analysis (MD&A): A Thematic Study

This research endeavors to assess airline executive decision-making coping with critical crises during the pandemic by scrutinizing the Market Risks and Management Discussion and Analysis (MD&A) sections within the 10-K financial reports. This study delves into the quarterly financial reports (10-Q) of Delta Air Lines (DAL) spanning from the 1st quarter (Q1) of 2020 to the second quarter (Q2) of 2023 and discovered primary challenges and market risks that were of concern to top executives. To underscore the significance of top executives’ decision-making activities within a chosen airline, this research project explores significant discussions disclosed in the financial reports. The findings show “revenue”, “cost”, and “fleet” were three most discussed topics while “liquidity, asset, and payable accounts”, “failing cost-saving strategies and poor Return on Investment (ROI)”, “policy changes in ticket cancellation and frequent flyer program”, “failing new technology”, and “proprietary data security” emerged as the top five market risks during the COVID-19 pandemic. Executives responded to these challenges by implementing corresponding strategies aimed at ensuring sustainability, such as labor downsizing, reforms to retirement plans, flight frequency reduction, simplification of aging fleets, cancellation of aircraft orders, cost-reduction initiatives, and adjustments to routes and hubs, among other measures. Noticeably, frequent flyer loyalty program remained lucrative.

Fuzzy Analysis of Financial Risk Management Strategies for Sustainable Public–Private Partnership Infrastructure Projects in Ghana

Public–private partnership (PPP) is a prominent tool for sustainable infrastructure development. However, the positive contributions of PPPs toward the attainment of sustainable, climate resilience and zero-carbon infrastructure projects are hampered by poor financial risk management. This problem is more prevalent in developing countries like Ghana where private investment inflow has plummeted due to the COVID-19 recession and poor project performance. Thus, this study aims to assess the key financial risk management strategies in ensuring sustainable PPP infrastructure projects in Ghana. The study utilised primary data from PPP practitioners in Ghana solicited through survey questionnaires. Factor analysis, mean scores and fuzzy synthetic analysis are the data analysis techniques for this study. The results revealed that sustainable and green funding models, effective cost-reduction initiatives, a competent team with committed leadership and emerging technologies and regulations constitute the key strategies for managing the financial risks of sustainable PPP infrastructure projects. Although future studies must expand the scope of data gathering, the findings of the study enrich the theoretical understanding of financial risks in sustainable investments in PPP infrastructures. Relevant remedies that will aid the development of practical financial risk management guidelines are also provided in this study for PPP practitioners.

(Invited) A Practical Approach to Model Development and Validation for High Performance SOFC and SOEC Systems

Bloom Energy’s mission is to power our planet with resilient, sustainable, and predictable energy. Bloom’s flexible, future-proof technology generates lower-carbon energy today, while laying the foundation for a net-zero tomorrow. As an early employee of the company, I helped create the framework, organizational structure, hired the teams and set the culture of leading product development and innovation through state-of-the-art modeling and data sciences. This framework has resulted in rapid innovation, Design for Manufacturing, Design for Reliability and Cost Reduction initiatives.The methodology used for rapid innovation and development of high-performance SOFC and SOEC systems is based on a combination of state-of-the-art modeling and data sciences. We use a variety of modeling tools to simulate the performance of our systems and to identify potential areas for improvement. We also use data from our test cells and from customer sites to optimize our designs.We have achieved significant success with this methodology. We have developed SOFC and SOEC systems that are among the most efficient and reliable in the world. We have also reduced the cost of our systems by nearly a factor of five since we started the company.In conclusion, we have developed a successful methodology for rapid innovation and development of high-performance SOFC and SOEC systems. This methodology has resulted in significant improvements in the performance and cost of our systems. We are confident that this methodology will continue to enable us to develop innovative and cost-effective energy solutions in the future.

The global ESG trend and adaptation opportunities in the emerging hydrogen economy: A corporate governance perspective

AbstractThe development of the hydrogen economy (HE) has become the main direction of climate-focused economic progress. Although the gap between the potential impact of energy companies and their actual willingness or ability needs to be bridged by corporate governance and economic policy, these dynamics are underrepresented in the literature. As environmental, social, and corporate governance (ESG) considerations could foster adaptation and developing hydrogen technologies, the goal of this systematic literature review is to explore the specific environmental and energy aspects of ESG and the adaptation opportunities which could contribute to HE development. Findings suggest that ESG as a new institution in the economy might be in line with national and international policies, but corporate efforts at improving environmental performance could be further oriented directly or indirectly toward hydrogen technologies, for example, through cost reduction initiatives, favourable taxation, or specific requirements for sustainability reporting. On the corporate level, external and internal change drivers could lead to strategic and governance adaptation measures in line with HE development policy. The study contributes to the literature through the intersection analysis of the global ESG trend and the development policy of the HE, which has been overlooked to date, especially from a corporate governance perspective.

Ratio Project Planning: cost optimization projects in the production phase

Nowadays, cost reduction, without compromising the quality and functionality of products, is a strategic issue for most companies. Therefore, companies must have adequate cost management systems and be prepared to implement cost reduction plans in order to maintain the desired levels of profitability. Many companies perform cost reduction initiatives in the form of a project, involving the necessary departments and employees to work towards a specific target cost or cost reduction goal. This research is on product cost optimization projects applied by companies that follow a lean approach. The studied company, a first-tier supplier of the automotive industry, developed a cost reduction methodology to be applied in the production phase named Ratio Project Planning (RPP). This methodology was analysed from a project management perspective. To turn it more effective and efficient, a dashboard that includes the performance indicators regarding RPP was developed and implemented. This tool supports decision-making, allowing real-time monitoring and better management of the whole process.

A192 Comparison of cost and outcomes of Sleeve Gastrectomy and Roux-en-Y gastric bypass before and 1-year after implementation of a clinical optimization cost reduction initiative

A192 Comparison of cost and outcomes of Sleeve Gastrectomy and Roux-en-Y gastric bypass before and 1-year after implementation of a clinical optimization cost reduction initiative

Engaging Frontline Physicians in Value Improvement: A Qualitative Evaluation of Physician-Directed Reinvestment.

PurposePhysicians can limit upward trending healthcare costs, yet legal and ethical barriers prevent the use of direct financial incentives to engage physicians in cost-reduction initiatives. Physician-directed reinvestment is an alternative value-sharing arrangement in which a health system reinvests a portion of savings attributed to physician-led cost reduction initiatives back into professional areas of the physicians’ choosing. Formal evaluations of such programs are lacking.MethodsTo understand the impact of Stanford Health Care’s physician-directed reinvestment in its first year (2017–2018) on physician engagement, adherence to program requirements around safety and fund use, and factors facilitating program dissemination, semi-structured qualitative interviews with physician participants, non-participants, and administrative stakeholders were conducted July-November 2019. Interview transcripts were qualitatively analyzed through an implementation science lens. To support contextual analysis of the qualitative data, a directional estimation of the program’s impact on cost from the perspective of the health system was calculated by subtracting annual maintenance cost (derived from interview self-reported time estimates and public salary data) from internal cost accounting of the total savings from first year cohort to obtain annual net benefit, which was then divided by the annual maintenance cost.ResultsPhysician participation was low compared with the overall physician population (n=14 of approximately 2300 faculty physicians), though 32 qualitative interviews suggested deep engagement across physician participants and adherence to target program requirements. Reinvestment funds activated intrinsic motivators such as autonomy, purpose and inter-professional relations, and extrinsic motivators, such as the direction of resources and external recognition. Ongoing challenges included limited physician awareness of healthcare costs and the need for increased clarity around which projects rise above one's existing job responsibilities. Administrative data excluding physician time, which was not directly compensated, showed a direct cost savings of $8.9M. This implied an 11-fold return on investment excluding uncompensated physician time.ConclusionA physician-directed reinvestment program appeared to facilitate latent frontline physician innovation towards value, though additional evaluation is needed to understand its long-term impact.

Competition Between Hospitals Under Bundled Payments and Fee-for-Service: An Equilibrium Analysis of Insurer’s Choice

Problem definition: We consider the quality competition between two hospitals under the plan of one insurer. The insurer aims to maximize the overall achievable quality in the system by selecting either the fee-for-service (FFS) or the bundled payment (BP) scheme to compensate each hospital. The demand, the costs, and the probability of successfully treating patients depend on a hospital’s chosen quality. Under such a setting, we use game theoretic models to study the choice of insurer and the impact of payment schemes on the equilibrium qualities of hospitals. Our models seek answers to the following questions. Is BP (FFS) payment scheme always associated with high (low) equilibrium quality? What factors affect the equilibrium qualities of competing hospitals and the choice of the insurer and how? Academic/practical relevance: Competing hospitals under same or different payment models from an insurer is rather common for healthcare delivery in the United States. However, there is a lack of understanding about the impact of payment schemes on quality outcomes from both the hospital’s and the insurer’s perspective. To the best of our knowledge, ours is the first paper to incorporate competition and the insurer’s perspective to study the impact of different payment models on quality. Methodology: Game theory, equilibrium analysis. Results: We show that BP (FFS) is not always associated with high (low) equilibrium quality and that the equilibrium qualities of the two hospitals are strategic complements. We characterize when the insurer might assign the BP to both hospitals, the FFS to both hospitals, or the BP to one and the FFS to the other hospital. Managerial implications: Our findings provide prescriptive guidelines to an insurer choosing payment models. We also show that a specific quality outcome is achievable not by choosing any payment model but by a careful design of its parameters. Our numerical studies show that hospital readmission reduction initiatives are most effective when run in conjunction with cost reduction initiatives.

Addressing critical failure factors and barriers in implementing Lean Six Sigma in Italian public hospitals

PurposeDuring the past few decades, Lean Six Sigma (LSS) in the health-care sector has received increasing attention from both researchers and practitioners because it plays an imperative role in quality improvement and cost reduction initiatives. Although researchers have often focussed on evidence of model effectiveness through the study of performance indicators, too little attention has been given to the factors that lead to implementation failure and the causal relationships among them. This study aims to investigate the factors that may inhibit the successful implementation of the method by focussing on Italian public hospitals.Design/methodology/approachThrough the use of the Delphi technique and fuzzy cognitive maps, this paper derives new and relevant results for researchers, hospital managers and policymakers.FindingsThe results show the factors with the greatest impact on LSS implementation and provide insight into the causal links and degrees of influence between critical failure factors and performance variables.Practical implicationsThe findings could be considered useful, in particular, to hospital managers and policymakers, who could leverage the suggestions derived from the study to address LSS implementation.Originality/valueThis work overcomes a gap in the literature related to the absence of studies on the causal relationships between factors that determine the success or failure of LSS implementation.

Does anyone know how much NHS operating rooms cost? A survey of operating room managers' knowledge of costs and data

Background/Aims Operating theatres represent a large proportion of NHS healthcare resources, so there has been focus on reducing costs in this area. This, in part, relies on managers having knowledge of the relevant costs in operating rooms. This study aimed to gauge the level of familiarity regarding costs among the various tiers of managers of NHS operating theatres, and if this information informed their decision making. Methods A semi-structured interview was administered to 12 finance managers, theatre managers and board members across 16 separate hospitals, representing six NHS trusts. Responses were reviewed through qualitative analysis by the authors. Findings The respondents showed very limited knowledge of operating theatre costs, with nearly all being unable to use cost data to inform either daily or longer-term strategic decision making. In particular, the costs of under- or over-running operating lists were not known. Conclusions The study suggests that heuristics of operating theatre management are, in practice, not influenced by costs. Instead, the resulting cost balance appears to be a passive consequence of decision-making based on other factors. This has significant implications for cost reduction initiatives and suggests an urgent need for improvement.

The effect of buyers’ socialization efforts on the culture of their key strategic supplier and its impact on supplier operational performance

This paper investigates if inter-organizational socialization mechanisms initiated by a buyer organization towards a strategic supplier can influence the culture within that supplier organization to ultimately improve supplier performance to the buyer. Using a quantitative sample of 279 UK companies from across a variety of industry sectors, statistical techniques were utilized to examine the effect of informal and formal socialization mechanisms on the culture of a strategic supplier as measured by their organizational practices and the subsequent supplier performance outcomes. It was found that both informal and formal socialization efforts by a buyer organization have a significant influence on the culture of the supplier organization as measured by their organizational practices. Socialization efforts by the buyer organization influence the organizational practices of the supplier to be more result-oriented, employee-centred, open, pragmatic to customer needs and market focussed. These organizational practices were found to positively influence supplier operational performance in the eyes of the buyer organization as measured by on time delivery, conformance to product specifications, flexibility to respond to changing customer needs and cost reduction initiatives. Modelling the influence of informal and formal socialization efforts by a buyer on the organizational culture of a key supply chain partner provides new insights to academics. Firstly, this work makes a significant contribution to the extant research on socialization in the supply chain literature. Secondly, it raises the importance of understanding the influence of culture on supplier operational performance. Although the study used a dyadic method to validate the cultural insights, our study only took a snapshot of culture at one point in time. Organization culture as displayed through organizational practices is a complex construct that changes over time. Therefore, to further understand the intricacies of organization culture, a longitudinal study would be useful in the future. Secondly, future studies could develop into themes such as the green supply chain and sustainability issues. Finally, our study was undertaken in the UK. It would be useful to replicate this study in a different setting, including Eastern countries. Organizations should engage early with their key supply base from a socialization perspective. The importance of joint away days, cross function teams alongside effective communication and on site visits have been fund to have a significant influence on shaping a high performance culture along the supply chain. Therefore, a buyers’ early understanding of their key supplier’s culture via these mechanisms appear critical for long-term supply chain success. Measuring supplier culture at the visible level of organizational practices removes the ethereal qualities often attributed to culture as a concept; buyers can influence supplier culture. This paper presents an empirically tested model which includes informal socialization, formal socialization, deconstructed organizational culture and supplier operational performance in a supply chain setting.

Characteristics of changeable systems across value chains

Engineering changes (ECs) are inevitable for businesses due to increasing innovation, shorter lifecycles, technology and process improvements and cost reduction initiatives. The ECs could propagate and cause further changes due to existing system dependencies, which can be challenging. Hence, change management (CM) is a relevant discipline, which aims to reduce the impact of changes. EC assessment methods form the basis of CM that support in assessing system dependencies and the impact of changes. However, understanding of which factors influence the changeability across value chains (VCs) is limited. This research adopted a VC approach to EC assessment. Dependencies in products and processes were captured, followed by risk (i.e. likelihood x impact) assessment of ECs using change prediction method (CPM). Four industrial case studies were conducted (3x automotive, 1x furniture manufacturing) to identify design (product) and manufacturing (process) elements with high risk to be affected by ECs. Based on the case results, characteristics were identified that influence changeability across VC. This contributed to the CM domain while businesses could also use the results to assess ECs across VC, and improve the design of products and processes by increasing their changeability across VC e.g. by proactive decoupling or reactive handling of system dependencies.

An Incentive to Innovate: Improving Health Care Value and Restoring Physician Autonomy Through Physician-Directed Reinvestment.

Many health care systems in the United States are shifting from a fee-for-service reimbursement model to a value-based payment model. To remain competitive, health care administrators must engage frontline clinicians in their efforts to reduce costs and improve patient outcomes. Engaging physicians and other clinicians is challenging, however, as many feel overwhelmed with clinical responsibilities and do not view cost reduction as in their purview. Even if they are willing, providing a direct financial incentive to clinicians to control costs poses ethical and legal challenges. An effective incentive in the current system must motivate clinicians to engage in creative problem solving and mitigate ethical and legal risk. Evidence suggests the most successful behavior change interventions in physicians are multifaceted and combine intrinsic motivators, such as increased autonomy, with extrinsic motivators, such as access to funding or social recognition. Two academic health centers-the University of Utah Health and Stanford Health Care-have begun experimenting with an alternative value-sharing arrangement. Physician-directed reinvestment is an explicit agreement in which a health care system reinvests a portion of savings attributed to physician-led cost reduction initiatives back into areas of the physician's choosing, such as capital investment, research, or education. Both organizations reported similar positive outcomes, including increased engagement from clinicians and administrators, sustained or improved quality of care, reduced costs of care, and benefits from reinvested funds. Many savings opportunities were previously unknown to administrators. Physician-directed reinvestment appears to effectively engage physicians in ongoing efforts to improve value in health care, although formal evaluation is still needed. This incentive structure may hold promise in other configurations, such as inviting nonphysicians to apply as project leaders (clinician-directed reinvestment) and expanding the program to nonacademic and ambulatory settings.

Fields of Tourism Innovation According to the Level of Investment

The aim of our study is to learn about the innovation models currently used by Spanish tourism companies and determine if there is any relation between the level of innovation and the sub-industry, the firms’ billing volume, how they manage their innovation efforts, the general innovation fields and the companies’ ranking of specific innovation focuses. Our findings reveal that hotels and tourist activity companies invest the most in innovation, while intermediation and transport firms and restaurants invest the least. However, there is no direct correlation between innovation investment levels and the different tourism subindustries. Contrarily, our results indicate that, as companies increase their billing volume, they dedicate greater resources to innovation. Similarly, though despite no significant difference, creating new products attracts more investments than technology in order to achieve differentiation. Also, the most innovative tourism companies apply significant resources to client orientation efforts while very few to cost reduction initiatives.

Predictive factors of high societal costs among chronic low back pain patients.

BackgroundSocietal costs of low back pain (LBP) are high, yet few studies have been performed to identify the predictive factors of high societal costs among chronic LBP patients. This study aimed to determine which factors predict high societal costs in patients with chronic LBP.MethodsData of 6,316 chronic LBP patients were used. In the main analysis, high societal costs were defined as patients in the top 10% of cost outcomes. Sensitivity analyses were conducted using patients in the top 5% and top 20% of societal costs. Potential predictive factors included patient expectations, demographic factors (e.g. age, gender, nationality), socio‐economic factors (e.g. employment, education level) and health‐related factors (e.g. body mass index [BMI], general health, mental health). The final prediction models were obtained using backward selection. The model's prognostic accuracy (Hosmer–Lemeshow X 2, Nagelkerke's R 2) and discriminative ability (area under the receiver operating curve [AUC]) were assessed, and the models were internally validated using bootstrapping.ResultsPoor physical health, high functional disability, low health‐related quality of life, high impact of pain experience, non‐Dutch nationality and decreasing pain were found to be predictive of high societal costs in all models, and were therefore considered robust. After internal validation, the models' fit was good, their explained variance was relatively low (≤14.1%) and their AUCs could be interpreted as moderate (≥0.71).ConclusionFuture studies should focus on understanding the mechanisms associated with the identified predictors for high societal costs in order to design effective cost reduction initiatives.SignificanceIdentifying low back pain patients who are at risk (risk stratification) of becoming high‐cost users and making appropriate initiatives could help in reducing high costs.

Commonwealth Engagement in Education: Prospects in the Era of SDGs

ABSTRACTThis paper analyses Commonwealth engagement in education against a background of issues, trends, and partnerships in education. It argues for reforms towards a ‘New Commonwealth’ that is fit for the 21st century; embracing the celebration of diversity and moving beyond the donor/recipient model of development. The relevance, effectiveness, and sustainability of education engagement by the Commonwealth are gauged in relation to the focus of the sustainable development goals (SDGs) on the indigenous, immigrant, refugee, and other disadvantaged populations. The paper explores education challenges facing these population groups and proposes some options or niche areas that may be considered for Commonwealth engagement in education. The first option is engagement in the influential Global Partnership for Education (GPE), where Commonwealth countries already operate, and synergies are possible with UNICEF, UNESCO, and the World Bank. Second is pan-Commonwealth ‘facilities’ for implementing bi-lateral projects. Third is Commonwealth Talent Academies to address youth unemployment and illegal migration. Fourth is using COL to enhance distance learning leadership. Fifth is a Commonwealth Teachers Exchange Scheme to ‘right-size’ teaching forces. Sixth is the Commonwealth Remittances Transaction Cost Reduction initiative. Viability of these options will depend on the appetite for reform towards a multi-polar Commonwealth with financial burden sharing.