Search results

In early 2014, recent Stanford University graduate Tyler Shultz was in a quandary. He had been working at Theranos, a blood-diagnostic company founded by Elizabeth Holmes, a Stanford-dropout wunderkind, for almost a year. Shultz had learned enough about the company to realize that its practices and the efficacy of its much-touted finger-prick blood-testing technology were questionable and that the company was going to great lengths to hide this fact from the public and from regulators.

Theranos and Holmes were Silicon Valley darlings, enjoying positive press and lavish attention from potential investors and technology titans alike. Just as companies like PayPal had revolutionized the stagnant payments industry and Uber had upended the for-hire transportation sector, Theranos had been positioned as the latest technology firm to substantially disrupt yet another mature sector: the medical laboratory business. By the start of 2014, the company had raised more than $400 million in funding, and had an estimated market valuation of $9 billion.

Shultz's situation was exacerbated by the fact that his grandfather, the highly respected former US Secretary of State George Shultz, was on the Theranos board and was one of Elizabeth Holmes's biggest supporters.

But Tyler Shultz worried about the customers he was convinced were receiving highly unreliable and often inaccurate blood-test results. With so much at stake, Shultz wondered how he should proceed. Should he raise his concerns with the firm's investors? Blow the whistle externally? Report to industry regulators? Go away quietly?

This case and its subsequent four brief follow-up cases are based largely on interviews with Tyler Shultz, and outline the dilemma he faced and the various steps he would take both to extricate himself from his unsavory position and let the public know the full extent of the deception at Theranos.

Five optional handouts are available to instructors to further discussion after the case has been debriefed. The handouts serve as additional decision points for the students if your class time permits.

The central lesson to be learned from studying the case is to understand the challenges and constraints posed by contextual conditions in designing contracts in public–private partnerships (PPP) for financing and delivering health care in emerging economies such as India.

Perverse incentives, along with contextual conditions, led to extensive opportunistic behaviors among involved agencies, limiting the effectiveness of otherwise highly regarded innovative design of the program.

India’s “Rashtriya Swasthya Bima Yojana” or National Health Insurance Program, launched in 2007 provided free health insurance coverage to protect millions of low-income families from getting pushed into poverty due to catastrophic health-care expenditure. The program was implemented through a PPP using standardized contracts between multiple stakeholders from the public and private sector – insurance companies, hospitals, intermediaries, the provincial and federal government.

Teaching Notes are available for educators only.

CSS: 10 Public Sector Management.

Roger Osayende, a former management consultant, must advise the Ministry of Health of Ektu, a fictional country in Central Africa, on how to implement a new point-of-care diagnostic test for infants with HIV. In Ektu, mothers often transmitted HIV infection to infants during pregnancy, delivery, or breastfeeding due to inadequate resources to invest in prevention efforts. The existing procedure to diagnose infants with HIV required collecting dried blood samples at more than two hundred healthcare facilities around the country and transporting them to a central laboratory in the capital for testing. This process was characterized by significant delays due to long transportation times, batching of samples in transportation and processing in the lab, and concomitant congestion in the lab. This delay resulted in loss to follow-up, that is, lost patients due to mothers not collecting their infants' results. A new point-of-care device was about to be introduced, which would obviate the need for this centralized processing and the resulting diagnostic delay. The key decision under consideration is where to place the devices to maximize their effectiveness.

Understand the importance of making public health decisions based on a data-driven, logical framework   Uncover the link between operational performance of the healthcare system and health outcomes at the population level   Appreciate the relevance of operational decisions in enhancing or diminishing the effectiveness of a medical technology   Use process analysis concepts to characterize various components of delays

The learning outcomes are as follows: How to establish credibility of data sources; measurement scales of data; the importance of descriptive statistics and generating the following based on the type of data: mean, median and standard deviation; graphical methods; and test for differences: t-test and analysis of variance.

The case is set during the COVID-19 pandemic and the South African Government’s response to the pandemic. A brief timeline is provided as part of the introduction to the case study, with the following being a timeline of the events: 14 March 2020, 114 South African citizens were repatriated from Wuhan the epicentre of the COVID-19 outbreak; 15 March 2020, South Africa’s President, Cyril Ramaphosa declares a National State of Disaster, and this includes various measures to protect against the spread of COVID-19, while the health-care system is geared up to deal with the pandemic. Among the measures implemented, travel bans from high-risk countries and closing of air-traffic, closing of land ports and banning of gatherings of more than 100 people; 23 March 2020, President Cyril Ramaphosa announced a national lockdown beginning on 27 March 2020 for three weeks; 9 April 2020, President Ramaphosa extends the national lockdown by a further two weeks. The World Health Organisation (WHO) had commended South Africa on the swift action taken to curb the spread of the virus. Individuals and organisational leaders are grappling to make sense of the spread of the virus, and the barrage of the information that is being communicated through multiple channels, formal and informal. To make sense of the information, the case is premised on getting access to the raw data and conducting the analysis based on the publicly available data. The central requirement of the case is to compare the number of positive cases per million, based on the population data contained in the data set, of South Africa to a comparable country.

Post-graduate students learning statistics as part of a degree programme. The case assumes no prior statistics knowledge and therefore is aimed at teaching the importance of the basics of statistical analysis and then progressing to tests for differences.

CSS 7: Management Science

Teaching Notes are available for educators only.