1.2 What advice would you give Rod? Rod Dowling is the chief executive of the North Island Hospital (NIH) in New Zealand. His clinical directors had just submitted a report for some new laser technology that treats kidney stones.

This would require a capital outlay of NZ

$1,500,000, for equipment that would only be needed two and a half hours per week. While this seemed to make little financial sense, the medical case was compelling.

Lithotripsy is the diagnosis and treatment of kidney stones. The traditional treatment involves radiography to locate precisely the stone or stones in the patient’s kidney and then surgical removal under a full anaesthetic. Both these treatments are not without risk and require four to eight days’ post-operative recovery. However, these operations can be carried out routinely using the existing theatres, urologists, nursing staff and equipment.