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The learning objectives have been prepared following Bloom’s taxonomy (Bloom et al., 1956). After completing the case study, the students will be able to identify and recall the prerequisites necessary for establishing a pathology laboratory. (knowledge); analyze the micro- and macroenvironmental factors considered by Mr Sabihul Haque in the development of the strategic plan for Healthcare Laboratories (HCL) (knowledge and application); explain the key components of the Porter’s value chain and their significance in the operation of HCL (comprehension and evaluation); use the TOWS analysis to map the internal strengths, weaknesses, opportunities and threats of HCL (application and synthesis); and analyze the challenges faced by protagonist in managing HCL and generate suggestions for addressing the challenges (analysis and synthesis).

HCL, an enterprise established in 2018 in Sahdeo Khap, Gaya, Bihar, India, aims to provide high-quality pathological diagnostic services in semi-urban and rural areas. This health-care initiative is pioneering, offering pathology services to make high-quality, low-cost diagnostic services accessible in rural India. In rural settings, numerous health-care hurdles make it challenging for individuals to access the care they need. Since its inception, HCL has expanded its reach to connect more areas, facilitating diagnostic services for people in remote regions. The establishment of laboratories in semi-urban areas aims to reduce patient travel time, costs and health risks by bringing services directly to their doorstep. Haque, the chief executive officer of the lab, grappled with multiple challenges, including selecting an appropriate location for the lab, recruiting and retaining skilled workforce, managing logistics supply, collaborating with local health-care providers, dispelling the stigma among the population that superior services are only available in cities and enhancing health literacy in rural communities. Following numerous meetings with Ms Ummati Naiyyer, head of operations, they worked collaboratively to address these challenges, developing a blueprint and future plan to operate services in rural areas. This case study provides insights into the obstacles faced by HCL striving for success in rural areas. It elucidates the beneficial application of the Porter’s value chain, along with an analysis of macro- and microenvironmental factors. Unique challenges such as societal stigma and mistrust are specifically emphasized. Students engaging with this case study will enhance their problem-solving skills through brainstorming and providing recommendations, contributing to potential solutions for HCL’s difficulties.

The teaching notes for the HCL case is designed to enhance the learning experience of undergraduate and graduate students within the context of the course. This case study serves as a valuable teaching tool, allowing students to apply theoretical knowledge to real-world scenarios in the health-care industry. The notes provide a framework for instructors to facilitate discussions, encourage critical thinking and promote a deeper understanding of key concepts related to establishing diagnostic laboratories in rural areas.

Teaching notes are available for educators only.

CSS3: Entrepreneurship.

The subject area is entrepreneurship.

Graduate and executive education level in leadership, entrepreneurship and strategic management are used to discuss leadership, entrepreneurship and strategy in health services.

This case talks about the passionate journey of a pediatrician practicing in the Mumbai city of India, who as an individual private practitioner is contributing to the fulfilment of the global health agenda and the fourth Millennium Development Goal (MDG) – “reduce child mortality”. His vision is to make quality and affordable expert pediatric care accessible to all the individuals, right from pre-birth to adulthood. Surya Mother and Child Care Hospital (SMCH) is being strengthened as a nation-wide network of mother and child hospital offering patient/consumer-centric integrated collaborative quality care, and it needs to be seen how this model can be made sustainable as it enlarges in scale for the future.

The case is structured to achieve the following learning outcomes: to understand about effectuation as a logic for entrepreneurial success through the lens of Dr Avasthi and his venture SMCH; To understand and apply Porter’s Principles of value transformation that essentially focus on outcome-driven cost-efficient work practices in a collaborative integrative fashion, where transformation must come from within (some practices suggested can be applied to the Indian Healthcare Services Delivery systems); to critically analyze the overall strategic position of SMCH as an organization and its competitive environment; to discuss the factors influencing health-care delivery capacity build up, given the MDGs 2015, Every Newborn Action Plan and Indian Newborn Action Plan framework, as applicable to India; and to discuss and analyze mechanisms for future sustainable service delivery options for SMCH. Although each of these principles is important, possibly, the instructor could emphasize and encourage more discussions on potential models of shared partnerships that can help quality health-care services reach the unreached and the incorporation of technology in achieving this. The learning process can also facilitate discussions about leadership qualities in the creation of health-care entrepreneurs, for the “Change That They Would Want To See”.

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

CSS:3 Entrepreneurship.

Organisational behaviour; Leadership; Organisational development; Public–Private partnership; Health care management; Public health.

Masters students in Business Administration, Post Graduate Diploma, Clinical Training of Medical Professionals, Health Leadership Programme.

Prof Jannie Hugo, the protagonist in the case, was considering his dilemma of aligning the multiple partners involved in public health care. A high level of collaboration was required of a multitude of stakeholders in developing the Daspoort clinic into a pilot site for the Tshwane district’s implementation of the National Health Insurance system. In addition, the re-engineering of primary health care with the focus on the patient and community orientated approach were launched on this site.

Gaining insight into international and national landscapes and principles of health care systems. Critically analyse the role of technology in delivering innovative health and social services. Present judgment of Prof Jannie Hugo’s contextual leadership effectiveness in enhancing collaboration between the multiple stakeholders and recommend next steps.

2 × DVDs on Vimeo, Slides and teaching plan with discussion or exam questions with model answers.

CSS 7: Management Science.

The subject areas are strategy, general management, health-care management, change management and inclusive growth model and application of technology to manage health care.

The case can be used to teach challenges in managing change in a health-care facility.

Tata Memorial Centre (TMC) is dedicated to provide best health-care services in the field of cancer cure. TMC established its credentials for service, education and research, which contributed to it being rated among the ten best hospitals year on year. Starting from humble moorings, TMC has grown to an institution of high repute from an 80-bed hospital to a 700-bed hospital. TMC held a number of pioneering efforts, which included bone marrow transplantation, external beam radiotherapy (linear accelerator), tumor tissue bank and bio-imaging to name a few. The management team of TMC had ensured that the growth had been orderly and appropriate to the changing needs of the community. Managing a hospital with disparate skill sets in the face of ever-increasing demand for services had always been a challenge in itself. As a government-run facility and well funded by the trust, TMC offered excellent services and post-operative care to the patients. So, it became imperative for the hospital to adopt technology to improve its hospital services and maintain transparency. Patients came to the hospital from different states in India and across the globe. TMC registered international and national patients online. Online medical reports were checked before the patients visited the hospital. TMC has developed an e-system that will allow patients around the world to send their tissue samples that are suspected to be cancerous for medical advice to the hospital. This case study is developed to provide insights into the transformation of TMC into an e-health-care service and explains the process of change management.

They are to provide insights into the challenges in health-care management, to illustrate the challenges faced by organization in implementing information and communication technology- managing change and to bring about best practices in the case organization and find solutions to the following questions: What are challenges faced by health-care officials in providing health care using new technological innovations? How can hospitals equip themselves with new technology? With the advent of improved and modern communication methods, medical practices and cases are more easily shared. Cases are discussed, recorded and, in many cases, put up for general public viewing through the electronic media. How can hospitals manage change? How can hospital administrators manage speed of delivery, quality healthcare, innovation and brand image?

Teaching notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

CSS:11 Strategy.

The first three years of operation of the West Kendall Baptist Hospital (WKBH) in Miami, Florida provided a “poster child” for efficient and cost effective healthcare delivery to the West Kendall community that it served. The hospital leadership and management team exemplified a quality-oriented staff that moved as a cohesive and dedicated organization. WKBH exceeded every budget prediction and showed a profit in year 3, well before expected. Then came the winds of regulatory change. With the passage of the Affordable Care Act (ACA) and the attendant imposition of new reimbursement metrics, the picture at WKBH changed almost overnight. By the first quarter of 2016, WKBH started to lose money in excess of budget predictions despite its increased patient admissions, careful financial planning, expense reductions, quality service, and excellence in patient care delivery. A serious financial crisis was looming with little relief in sight. The hospital management team began to search for solutions.

The research methodology includes collecting quantitative data: original financial statements and financial data from WKBH, as well as qualitative data: interviews of hospital administrators and historical information.

Graduate capstone course in a finance course; masters in health administration; and/or the MBA program.

While it is clear that the ACA was designed with all good intentions, it has created substantial and perhaps, unanticipated financial burdens for caregivers. These issues are not only faced by WKBH. Most hospitals could relate to one or more of the four questions examined as part of this learning process. Graduate MBA students worked with the hospital to identify, define, focus, and resolve difficult quantitative and qualitative issues faced by the hospital as a result of major changes in the regulatory environment with the passage of the ACA. This case focuses upon the current reimbursement environment that has only recently emerged as a result of the implementation of the ACA.

The learning outcomes are as follows: identify and evaluate the impact of risk factors for health-care organizations during crisis; evaluate the role of different organizational factors in building resilient health-care organizations; define organizational resilience in a health-care context; and apply the effect-strategy-impact resilience framework.

September 2022 found Ranjan Thakur, the Hospital Director at Manipal Hospital, Jaipur (MHJ) reflecting on MHJ’s resilience toward future health-care crises. MHJ was established in the capital city Jaipur of the Indian state of Rajasthan in 2014, as a 225-bed multispecialty unit of the nationally renowned Manipal Health Enterprises Ltd. As the Hospital Director, Thakur had been responsible for navigating his team and the hospital through the multiple health-care related challenges exacerbated by the multiple waves of the Covid-19 pandemic in a large Indian state with a sizable rural and semiurban population. Though Thakur and his team of doctors had worked through the vulnerabilities of their health-care ecosystem, mapping the risks and mitigating the same, Thakur asked himself if they had done enough. He wondered how a health-care institution such as theirs could sustain effective health-care delivery during future crises situations to deliver high-quality health care to the vulnerable communities. Had they effectively mapped MHJ’s vulnerabilities and built resilience into the hospital’s functioning? The backdrop of the case is public health in the state of Rajasthan (Jaipur), and the case is rich in detailing social factors such as behavior issues of patients, doctors and nurses; operational factors such as standardization of treatment and standard operating procedures, availability of resources, clinical concerns; leadership and management of the hospital through the pandemic. This case can be used by instructors to teach organizational resilience building in the health-care context.

Graduate- and executive-level courses in managing change during crisis in health-care context; health-care management/leadership.

Teaching notes are available for educators only.

CSS 7: Management Science.

Provincial Industries has decided that the time has come to expand internationally. In this case and the activities along with it, individuals will need to consider different attributes or factors in each category evaluated. These categories include: business climate, communications, financial services, health services and “Quality of Life”, infrastructure, and transportation. This evaluation will decide the new international office location.

The subject areas are family-owned business, entrepreneurship and strategic management.

The target audiences for the case study are BBA and MBA students and management trainees who are interested in learning about family-owned business and the problems faced by them when generations change. This case can be used to teach concepts in family-owned business and strategic management courses in the context of emerging markets. The case also introduces the problems faced by a traditionally operating organization which has to change to survive in the market. The case can be used to teach senior management teams participating in executive education programs on how problems arise in family-owned business. To successfully work with this case study, students need to have the basic theoretical understanding of family-owned business.

Sree Subramania Ayurvedic Nursing home (SSANH), one of the most reputed Ayurvedic treatment centers in Kozhikode, Kerala in India, was converted into its present form in 1974 from Thekkayil Vaidyasala by Thekkayil Rajaratnam Vydiar. The latest addition to this family run nursing home is Dr Sananad Ratnam, who in continuity of his family tradition studied Ayurveda. Dr Sanand wanted to rethink the positioning of the 400-year-old family business system with an objective to increase the number of people served by SSANH. He is armed with ambitious plans to expand SSANH and increase the volume of patients served. Dr Sanand’s father, the second partner of SSANH, was not quite supportive of this idea. His father felt that the increase in scale without compromise in quality was impossible in Ayurveda. Dr Sanand felt handicapped with problems such as lack of marketing strategies, lack of standard managerial procedures, lack of innovation in processes and, more importantly, conflicting ideologies between father and son in the family-owned business. To address these problems, Dr Sanand has recently hired the services of a consulting firm. This case highlights how SSANH, in spite of being in an advantageous position, is unable to exploit its full potential. Further explaining the different ways in which different generations perceive business, this case invites the attention to the dilemma: Should the business proceed with its expansion plan? If it decides to expand, how it should convince the previous generation of the family that the expansion plan accommodates their concerns.

After completion of this case, students would be able to: gain a perspective on the problems faced by a family-owned business which has successfully survived for decades; understand how a family-owned business functions differently from other business models; evaluate different ways in which the organization can look to solve the dilemma by considering the different stakeholders in question; and apply the result of the literature on family-owned businesses to understand the dynamics of business of this specific setting, i.e. one that has a rich heritage, is in an emerging economy and is a family-owned business.

Teaching Notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

CSS 3: Entrepreneurship.

The reading and discussion on case will enable participants to appreciate importance of reward management in performance management system for both employee and organizational good; to develop insight on the effect of perceived discrimination on the motivation of employees; to internalize the effect of perceived unjust, subjective, non-communicative, non-transparent policies on the behavior and productivity of employees and overall organizational culture and climate; and to comprehend the importance of HR and OB issues with respect to performance management system for the benefit of employee morale, motivation and organizational culture.

The effectiveness of an employee is the key factor for the employer. All the profit that the company or the organization makes depends on the employees’ productiveness. The case needs to be understood in the overall context of performance management system (Ferreiraa and Otley, 2009) with focus on elements of appraisal and compensation via rewards and recognition as per objective standards. Performance management systems (PMSs) is a more general descriptor if the intention is to capture a holistic picture of the management and control of organizational performance. Performance management policies and practices refer to the processes of setting, communicating and monitoring performance targets and rewarding results with the aim of enhancing organizational effectiveness (Fee, McGrath-Champ and Yang, 2011). PMS includes both the formal mechanisms, processes, systems and networks used by organizations, and also the more subtle, yet important, informal controls that are used (Chenhall, 2003; Malmi and Brown, 2008). Otley (1999) proposed a framework which highlights five central issues which need to be considered as part of the process of developing a coherent structure for performance management systems. The five areas addressed by this framework include identification of the key organizational objectives and the processes and methods involved in assessing the level of achievement under each of these objectives, formulating and implementing strategies and plans, as well as the performance measurement and evaluation processes, process of setting performance targets and the levels at which such targets are set, rewards systems used by organizations and the implications of achieving or failing to achieve performance targets and types of information flows required to provide adequate monitoring of performance. While the case touches upon all the aspects of the PMS framework, it revolves round the reward episode and elaborates on the way it affects all stakeholders, those who got the benefit, those who felt discriminated and those were mere observers to the episode. Objective performance appraisals are needed to ensure that every employee produces the best performance and that the work performed is rewarded with reasonable increases in pay scales or special additional allowances or incentives. This system carries crucial importance as it helps managers to decide which rewards should be handed out, by what amount and to whom. Additionally, performance appraisals may increase an employee’s commitment and satisfaction (Wiese and Buckley, 1998) The case readers need to notice that when organizations fail to follow objective appraisal or reward standards, the same rewards become a cause of contention. The reward which was handed over to the employees in this case was in addition to the annual appraisal. Though the role of rewards has been well-recognized in motivating the employees to continue performing at high level and encourage others to strive for better performance, what needs to be recognized that rewards’ per say does not serve purpose. They need to be dealt within the context of performance management system. Using rewards to favor or discriminate a few employees by using subjective standards backfires and does no good as the person who is favored cannot take pride in it and is not motivated to perform better or equally well as he/she also knows that the work has no relation to the reward, it is personal favor, on the other hand, the one who is discriminated feel discouraged and demotivated to perform. Rewards have the potential to both help and harm the organization if dealt in a callous and careless manner. Use of rewards to favor or discriminate certain people due to subjective preference can be suicidal for the organization and irreparably damage the trust of the employees in the management. It has been well stated that fairness and objectivity are the core principles using an assessment of the nature and size of the job each is employed to carry out (Torrington et al., 2005). If any organization decides to include rewards as a motivating mechanism, it needs to cull out unambiguous and transparent criteria for rewarding. If employees perceive procedural or distributive injustice from the management, it is not only detrimental for the employee’ relations and teamwork, it also tarnishes the reputation of the organization and jeopardizes the culture of the organization. Reward management needs to be closely related to performance appraisals, job evaluations and overall performance management systems. The current case elaborates on one such instance where unjustified inequity in reward system not only disturbed the employees concerned but it had bred a negative image of the organization among other employees too, organizational citizenship was replaced with contempt and feeling of apathy.

Post graduate students and working professionals can benefit from this study.

Teaching Notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

Human resource management.

This case is best taught in a first-year MBA finance course and with a series of cases based on cash flow analysis. Its primary objective is to portray the major differences in project analysis for nonprofit organizations compared to for-profit companies and to highlight the unique issues relevant in a health care environment. Students must decide, based on cash flow analysis and nonfinancial factors, whether or not to propose a long-term acute care hospital (LTAC) project to the board of directors of the U. Va. Health System. Students must use the assumptions outlined in the case to create a cash flow analysis and then compute a net present value (NPV) calculation and internal rate of return (IRR) for the project. After assessing the base-case results and sensitivity analysis of the assumptions driving those results, students must decide if the project should be taken to the board of directors.