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The case is designed to be used with the digital business model framework developed by Peter Weill and Stephanie Woerner of Massachusetts Institute of Technology (MIT) (Weill and Woerner, 2015) and is referred to as the W & W framework. This approach provides a useful structure for thinking through the strategic options facing environments ripe for digital transformation.

Research for this case was conducted through face-to-face interviews with the protagonist, as well as through a review of their business planning documents and other data and documentation provided by the founder. Some of the market and industry data were obtained using secondary research and industry reports. Interviews were digitally recorded and transcribed to ensure accuracy.

The case follows the story of Kurt Waltenbaugh, a Minnesota entrepreneur who shared the dream of using data analytics to reduce costs within the US health-care system. In early 2014, Waltenbaugh and a physician colleague founded Carrot Health to bring together their personal experience and expertise in both consumer data analytics and health care. From the beginning, they focused on how to use data analytics to help identify high-risk/high-cost patients who had not yet sought medical treatment. They believed that they could use these insights to encourage early medical interventions and, as a result, lower the long-term cost of care.

Carrot’s initial success found them in a consultative role, working on behalf of insurance companies. Through this work, they honed their capabilities by helping their clients combine existing claims data with external consumer behavioral data to identify new potential customers. These initial consulting contracts gave Carrot the opportunity to develop its analytic tools, business model and, importantly, to earn some much-needed cash flow during the start-up phase. However, they also learned that, while insurance companies were willing to purchase data insights for one-off market expansion projects, it was much more difficult to motivate them to use data proactively to eliminate costs on an ongoing basis. Waltenbaugh believed that Carrot’s greatest potential lay in their ability to develop predictive models of health outcomes, and this case explores Carrot’s journey through strategic decisions and company transformation.

This case is intended for either an undergraduate or graduate course on entrepreneurial strategy. It provides an effective introduction to the unique structure and constraints which apply to an innovative start-up within the health-care industry. The case also serves as a platform to explore the critical criteria to be considered when developing a digital transformation strategy and exposing students to the digital business model developed by Weill and Woerner (2015) at MIT (referred to in this instructor’s manual as the W&W framework). The case was written to be used in an advanced strategy Master of Business Administration (MBA) class, an undergraduate specialty health-care course or as part of a health-care concentration in a regular MBA, Master of Health Care Administration (MHA) or Master of Public Health (MPH). It may be taught toward the end of a course on business strategy when students are building on generic strategy frameworks and adapting their strategic thinking to the characteristics of specific industries or sectors. However, the case can also be taught as part of a course on health-care innovation in which case it also serves well as an introduction to the health-care payments and insurance system in the USA. Finally, the case can be used in a specialized course on digital transformation strategy in which case it serves as an introduction to the MIT W&W framework.

The case is particularly well-suited to students who are familiar with traditional frameworks for business strategy and business models. The analysis builds on this knowledge and introduces students interested in learning about the opportunities and challenges of digital strategy. Equally, the case works well for students with clinical backgrounds, who are interested in how business strategy can influence changes within the health-care sphere. Finally, an important aspect of the case design was to develop students’ analytical confidence by encouraging them to “get their hands dirty” and to carry out some basic exploratory data analytics themselves. As such, the case requires students to combine and correlate data and to experience the potentially powerful combination of clinical and consumer data. Instructors should find that the insights from these activities give students unique insights into the potential for of data analytics to move health care from a reactive/treatment ethos to a proactive/intervention ethos. This experience can be particularly revealing for students with clinical backgrounds who may initially be resistant to the use of clinical data by commercial organizations.

Depressive symptoms are a risk factor for loneliness, while sources of perceived social support from family and friends are protective factors; however, the complex mechanisms behind these factors have not been examined among health-care employees in Portugal. The purpose of this study is to evaluate the indirect effect of perceived social support from family and friends on the association between depressive symptoms and loneliness.

Health-care employees (n = 279; 242 female and 37 male) from 12 health-care institutions in Portugal participated in this cross-sectional study. The SPSS program with PROCESS macro (Model 6) was used to test the hypothesis regarding the indirect effect analysis.

Bootstrap analysis found that family as a source of social support had an indirect effect in the relationship between depressive symptoms and loneliness. Similarly, depressive symptoms had a significant indirect effect on loneliness through the indirect role of social support from friends. Moreover, it was found that the relationship of family and friends as sources of social support mediated the association of the aforementioned variables.

The findings of this study underscore the important role of depressive symptoms on perceived social support from family and friends, leading to loneliness, which is a public health concern among health-care employees in Portugal.

The apex planning body of India, NITI Aayog launched an Aspirational District Programme (ADP) in January 2018. The programme aimed to the quick and effective transformation of 112 (14%) districts of the country. This programme is considered as world's biggest result-based governance initiative having reached up to 250 million people. It is based on a ranking that is done on monthly basis. This ranking is based on 49 KPIs across six broad socio-economic themes.

The study attempts to inquire and assess the progress made by 112 Aspirational Districts under Financial Inclusion, Skill Development and Basic Infrastructure theme from the inception of the programme to June 2022 (i.e. 54 months). Instead of ranking districts with delta rank or composite scores, the study divorce from NITI Aayog's methodology of monthly delta ranking. The study explores 8 indicators under the basic infrastructure theme and 16 indicators under the financial inclusion and skill development themes. For this purpose, the study explores the availability of individual household latrines, drinking water, electricity and road connectivity. Districts are also tracked for the number of Internet-connected Gram Panchayats, and panchayats with Common Services. Every district is provided with the target as per national development priority, the study makes an effort to grasp the distance of each district from the national target. This allows researchers to develop a scale Very Far, Far, Near, Very Near, Achieved with descriptive statistics techniques. Juxtaposing the scale with timelines results in a pattern of progress made by these 112 districts.

This study investigates the role of leadership and cultural transformation in facilitating Lean Six Sigma (LSS) practices in clinical pharmacy settings to reduce medicine waste within the UK National Health Services (NHS).

A systematic literature review on Lean Six Sigma in health care was conducted to develop an analytical framework. This was followed by a qualitative case study of an English NHS trust to test the framework, exploring pharmacists' adoption of LSS practices and their impact on staff behaviour, focussing on leadership decisions and organisational culture.

The research highlights the significance of leadership’s prioritisation in waste reduction efforts and its influence on staff engagement. It also examines the intricate relationship between leadership decisions, education and training, resource allocation, and the prevailing clinical culture, which shapes pharmacists' behaviours and attitudes towards LSS practices and waste reduction.

The study’s focus on a single NHS trust limits the generalisability of the findings, suggesting the need for further research across different healthcare settings.

The study recommends a cultural transformation, earlier training, and reformation in service strategy to enhance the adoption of LSS practices and contribute to a more sustainable future for the wider health services.

Effective medicine waste management prevents harm and helps address the current NHS medicine shortage. The NHS can allocate resources efficiently, ensure timely treatment, and prepare for future disruptions by implementing the proposed framework.

We developed a leadership model for the NHS to reduce medicine waste, offering a novel approach to addressing the challenge of medicine waste through leadership and cultural transformation.

This research investigates how to optimize storage location assignment to decrease the order picking time and the waiting time of orders in the staging area of low-temperature logistics centers, with the goal of reducing food loss caused by temperature abuse.

The authors applied ABC clustering to the products in a simulated database of historical orders modeled after the actual order pattern of a large cold logistics company; then, the authors mined the association rules and calculated the sales volume correlation indices of the ordered products. Finally, the authors generated three different simulated order databases to compare order picking time and waiting time of orders in the staging area under eight different storage location assignment strategies.

All the eight proposed storage location assignment strategies significantly improve the order picking time (by up to 8%) and the waiting time of orders in the staging area (by up to 22%) compared with random placement.

The results of this research are based on a case study and simulated data, which implies that, if the best performing strategies are applied to different environments, the extent of the improvements may vary. Additionally, the authors only considered specific settings in terms of order picker routing, zoning and batching: other settings may lead to different results.

A storage location assignment strategy that adopts dispersion and takes into consideration ABC clustering and shipping frequency provides the best performance in minimizing order picker's travel distance, order picking time, and waiting time of orders in the staging area. Other strategies may be a better fit if the company's objectives differ.

Previous research on optimal storage location assignment rarely considered item association rules based on sales volume correlation. This study combines such rules with several storage planning strategies, ABC clustering, and two warehouse layouts; then, it evaluates their performance compared to the random placement, to find which one minimizes the order picking time and the order waiting time in the staging area, with a 30-min time limit to preserve the integrity of the cold chain. Order picking under these conditions was rarely studied before, because they may be irrelevant when dealing with temperature-insensitive items but become critical in cold warehouses to prevent temperature abuse.

Although the quality of health-care infrastructure and equipment influences patient’s overall health-care experience, health-care infrastructure and equipment are not always managed and maintained with the attention required. This is due mainly to the complexity of health-care infrastructure and equipment and shortage of maintenance budget. This study aims to determine if patient’s satisfaction of core health-care business is mediated by the quality of health-care infrastructure and equipment.

This cross-sectional study comprises 622 adult patients at the Physician OPD and Polyclinic of Komfo Anokye Teaching hospital, Tamale Teaching hospital and Cape Coast Teaching hospital in Ghana. Structural equation model Smart PLS was used to analyse the data.

The study results showed that the quality of health-care infrastructure and equipment has a positive significant influence (mediation) on the relationship between health-care delivery and patient’s satisfaction as well as the relationship between adequacy of health-care resources and patient’s satisfaction. However, it was shown not to have a positive significant influence (mediation) on the relationship between quality of health-care personnel and patients’ satisfaction as well as health-care administrative process and patient’s satisfaction.

First, the study findings are centred on cross-sectional data, which capture the opinion of the patients at a specific time period instead of over a period of time. Consequently, in future, though difficult to achieve, a longitudinal study can be piloted to provide more insight. Second, the data was collected from only one country (Ghana); thus, the ability to generalise the results may be a challenge.

The implication of this study is that there is the need to prudently maintain hospital infrastructure and equipment in good working condition as it has a positive effect on patients’ satisfaction of their overall health-care experience.

Most studies have concentrated on patient’s health-care experience. This study extends the knowledge of patient’s health-care experience by determining the mediating role of quality of health-care infrastructure and equipment on the relationship between patient’s satisfaction and core health-care business. There are limited studies of such nature in Ghana. Therefore, this study will provide invaluable empirical data for the health-care sector of a developing African country.

Efficiency and quality are primary factors for the survival of health systems. The evaluation of the efficiency of the healthcare system is a crucial component of promoting long-term health policy actions. Healthcare capacity indicators provide a basis for evaluating and comparing the performance of different healthcare organizations. Intrinsic quality indicators are Donabedian (1980)’s structural and process elements of quality of healthcare. This study aims to integrate capacity and intrinsic quality indicators of healthcare while measuring the efficiency of provinces by using radial and non-radial efficiency measurement techniques.

Efficiency analysis performed in Turkey from 2015 to 2020 by performing input-oriented radial, nonradial, and super-efficiency estimates for 81 provinces of Turkey by incorporating capacity and intrinsic quality indicators into the different model specifications.

Radial and nonradial efficiency results have an increasing trend over the study years obtained from the efficiency models showing high average scores obtained from the models that include intrinsic quality of care indicators. Statistically significant mean rank differences are observed between different radial efficiency models for all study years (p < 0.001). Negative and moderate level correlations were observed between radial efficiency results and quality of care indicators (r < 0.70).

Under long-term centralized health policies, increases in efficiency result in decreased intrinsic quality of care indicators. A better synthesis of health system capacity and intrinsic healthcare quality indicators is necessary to generate evidence-based health systems.

During the 1990s, Italian healthcare organisations (HOs) underwent a process of corporatisation, and the most innovative HOs introduced the balanced scorecard (BSC) to address the need for broader accountability. Currently, there is a limited understanding of the dynamics and outcomes of such a process. Therefore, this study aims to explore whether the BSC is still considered an effective performance management tool and analyse the factors driving and hindering its evolution and endurance in public and non-profit HOs.

We conducted a retrospective longitudinal analysis of two pioneering cases in the adoption of the BSC: one in a public hospital and the other in a non-profit hospital. Data collection relied on accessing institutional documents and reports from the early 2000s to the present, as well as conducting semi-structured interviews with the internal sponsors of the BSC.

We found evidence of three main categories of factors that trigger or hinder the adoption and development of the BSC: (1) the role of the internal sponsor and professionals’ commitment; (2) information technology and the controller’s technological skills; and (3) the relationship between the management and professionalism logics during the implementation process. At the same time, there is no evidence to suggest that specific technical features of the BSC influence its endurance.

The paper contributes to the debate on the key factors for implementing and sustaining multidimensional control systems in professional organisations. It emphasises the importance of knowledge-based assets and distinctive internal capabilities for the success of the business. The implications of the BSC legacy are discussed, along with future developments of multidimensional control tools aimed at supporting strategy execution.

The primary objective of this article is to examine current procurement, inventory control and management practices in modern healthcare, with a particular focus on the procurement and management of surgical supplies in a prominent public, highly specialized healthcare sector.

This study was conducted in three phases. In Phase 1, the study team interacted with various hospital management stakeholders, including the surgical hospital store, examined the current procurement process and identified challenges. Phase 2 focused on selecting items for a detailed study and collected the qualitative and quantitative details of the store department of the healthcare sector chosen. A detailed study analyzed revenue, output/demand, inventory levels, etc. In Phase 3, a decision-making framework is proposed, and inventory control systems are redesigned and demonstrated for the selected items.

It was observed that the demand for many surgical items had increased significantly over the years due to an increase in disposable/disposable items, while inventories fluctuated widely. Maximum inventory levels varied between 50 and 75%. Storage and availability were important issues for the hospital. It is assumed the hospital adopts the proposed inventory control system. In this case, the benefits can be a saving of 62% of the maximum inventory, 20% of the average stock in the system and optimal use of storage space, improving the performance and productivity of the hospital.

This study can help the healthcare sector administration to develop better systems for the procurement and delivery of common surgical items and efficient resource allocation. It can help provide adequate training to store staff. This study can help improve management/procurement policies, ordering and delivery systems, better service levels, and inventory control of items in the hospital business context. This study can serve as a pilot study to further investigate the overall hospital operations.

This study can help the healthcare sector administration develop better systems for procuring and delivering common surgical items and efficient resource allocation. It can help provide adequate training to store staff. This study can help improve management/procurement policies, ordering and delivery systems, better service levels and inventory control of items in the hospital business context. This study can serve as a pilot study to further investigate the overall hospital operations.

This study is an early attempt to develop a decision framework and inventory control system from the perspective of healthcare inventory management. The gaps identified in real hospital scenarios are investigated, and theoretically based-inventory management strategies are applied and proposed.