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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.

This case is based on a project carried out in a tertiary care hospital of the Northeastern region of India for a period of eight months and is written by Dr Ankit Singh, Dr Meenal Kulkarni and Mr Avinash Poojari. The case was developed with the help of the hospital’s management team, disguised on request as Mr Raghugopal Ramalinga (Chief Hospital Administrator), Mr Suresh Kumar (Chief Engineer), Ms Linney Krubah (Chief Nursing Superintendent), Dr Premanand Ale (Chief Medical Superintendent) and Mr Srikrishna Shukla (Chief Finance Officer).

This case is about Trident Hospital, which faces issues pertaining to oxygen supply. Oxygen supply at Trident Hospitals is through three options as highlighted in the case, but due to the lack of preventive maintenance and no risk assessment done for the crucial medical oxygen, interruptions and additional work for the staff became a common phenomenon. The existing situation can lead to patient harm or death and can attract medico-negligence suit against the hospital, threatening the overall existence of the hospital. The hospital administrator is currently viewing the problem from only the cost perspective, which is a high-risk and a short-term approach.

Students pursuing full time/part time/diploma programme in health-care management, hospital administration/hospital operations; and undergraduate and post-graduate level students.

The assignment is to design a plan that aligns patient satisfaction scores with quality care metrics. The instructor’s manual (IM) introduces models for designing and implementing a strategic plan to approach the quality improvement process.

This is a field research case. The author(s) had access to the Chief Operating Officer (COO) and other members of the management team, meeting with them on numerous occasions. Cleveland Clinic Florida (CCF) provided the data included in the appendices. Additionally, relevant hospital data, also included in the appendices, is required to be made public on Centers for Medicare and Medicaid Services (CMS) databases. Accordingly, all data and information are provided by original sources.

Osmel “Ozzie” Delgado, MBA and COO of CCF was faced with a dilemma. Under the new CMS reimbursement formula, patient satisfaction survey scores directly impacted hospital reimbursement. However, the CCF patient satisfaction surveys revealed some very unhappy patients. Delgado pondered these results that really made no sense to him because CCF received the highest national and state rankings for its clinical quality at the same time. Clearly, patients were receiving the best medical care, but they were still unhappy. Leaning back in his chair, Delgado shook his head and wondered incredulously how one of the most famous hospitals in the world could deliver such great care but receive negative patient feedback on CMS surveys. What was going wrong and how was the hospital going to fix it?

This case is designed for graduate Master’s in Business Administration (MBA), Master’s in Health Sciences Administration (MHSA) and/or Public Health (PA) audiences. While a healthcare concentration is useful, the case raises the generic business problems of satisfying the customer to increase brand recognition in the marketplace and displacing competition to increase annual revenues. Indeed, the same analysis can be applied in other heavily regulated industries also suffering from a change in liquidity and growth occasioned by regulatory change.

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 learning outcomes of this paper is as follows: to analyse the drivers, mediators and threats of commoditisation. To critically evaluate the merits of different marketing options that may be employed to avoid commoditisation. To critically assess the branding-focussed or customer-focussed strategies that could be used. To develop appropriate strategies for Biotronik SA to counter commoditisation in the future.

The case begins with the protagonist and managing director of Biotronik SA, Robbie Nel, brewing over a new industry development. One of the leading private hospital groups has sent an open invitation to medical device suppliers to tender, where the lowest-priced products will win shelf space in their cathlabs. Robbie has to decide whether to sacrifice Biotronik SA’s profit margins to win the tender or risk not being stocked in their cathlabs. Or, he must find an alternative non-price-based strategy to pursue. The medical device industry is facing increasing price pressures from various stakeholders in the device-purchasing process. The decision to purchase is no longer the responsibility of specialist physicians alone. International and local market trends indicate that the medical device industry is threatened by commoditisation. Robbie has to make a decision on changing the Biotronik SA business model and strategy in response to these macro trends.

This teaching case is aimed at postgraduate students, particularly those pursuing MBA, EMBA and Postgraduate Diploma programmes, as well as specialist masters and executive education. The students should have some work experience to comprehend and assess the case from a practical perspective.

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 8: Marketing.

Stan Kent, vice president of pharmacy at NorthShore University HealthSystem, is faced with the challenge of seasonal planning for the influenza vaccine. The supply received by the multilocation healthcare system is unreliable in terms of timing and quantity. As part of improved planning, Kent is contemplating a new contract with NorthShore's major supplier of flu vaccines. The options under consideration include fixing either the date of delivery or the quantity delivered. The main decision involved in either option would be how much vaccine to order. The case also provides details about the seasonal influenza epidemic in the United States, illustrates operational complexities of the U.S. flu vaccine supply chain, and provides a brief description of the various channels used to distribute flu vaccine to end consumers.

The main objective of the case is to illustrate supply chain decision making when there is an unreliable supply (in contrast to the usual case of uncertain demand). A secondary objective is to make students think about appropriate internal (within sector) and external (other sectors) benchmarks to evaluate the performance of a health commodity supply chain.

Impact investing, Social entrepreneurship.

MBA, EMBA, Executive Education.

CareCross Health describes the impact due diligence leading up to an investment into CareCross Health by impact investor Palm Capital. The case follows the protagonist, Caitlin Stevens, CEO of Palm Capital, as she identifies CareCross Health as a potential investment target, performs an initial screening of the company and visits the company and its sites as part of an in-depth impact due diligence.

By the end of this case, the student should be able to consider the critical steps associated with conducting an impact due diligence; understand the challenges associated with conducting an impact due diligence, with a particular focus on due diligence in an emerging market scenario; analyse a potential impact investment, in this case CareCross Health, and make a preliminary recommendation on whether the investment is viable from an impact perspective; identify the trade-offs between private sector and public sector provision of services to low-income groups, and consider unintended consequences in analysing the impact of a social enterprise; and prepare possible scenarios and weigh the potential outcomes of various arrangements to ensure alignment of investor objectives.

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 1: Accounting and Finance.

Need for preventive health care: To comprehend the contribution of preventive health care in improving the health quotient. Sri Sathya Sai Sanjeevani Hospital (SSSSH) and its initiative is an apt example of the wonder which preventive care can bring in the context of rural health. Community participation: The case can be instrumental in showing the pathway to encourage community involvement in mainstream health by promoting the holistic model of SSSSH that understands mothers and children's health profile and needs, especially in the unreached rural segments of an emerging economy like India. Importance of healthy childhood: World Health Organization (WHO) promotes the school health programme to prevent health risks among children by inculcating healthy behaviours during childhood. The successful SSSSH model proves that it is implementable by integrating comprehensive health education modules in the existing institutions for medical care.

The challenge of a healthy childhood is inadequate availability and accessibility of quality care. Non-awareness of the parents is also a significant reason for the children who miss the benefit of a happy childhood. While much is planned by the Government and some part of it being executed, this case highlights the effectiveness of the maternal and child health programme executed by the Sri Sathya Sai Sanjeevani Hospital (SSSSH). This initiative fulfills the dire need of ensuring the preventive healthcare component leading to safe motherhood and safe birth of healthy children. Further, the case is also the culmination of pin-pointed innovative awareness activities such as school health screening and the Divine Mother and Child Health Program (DMCHP). It opens up the discussion on the current model of health care followed by SSSSH, Raipur, and its impact in the local areas to decide on its expansion across the country for nationwide implementation.

Bachelors in Business Administration, MBA, Executive MBA, Post Graduate Diploma in Healthcare Management

Teaching notes are available for educators only.

CSS 2: Built Environment.

Diagnostics services in India were growing at 20% annually with billing of USD 3.4 billion. With WTO's GATS, foreign competition was arising. Dr. Lal PathLabs had formidable brand recognition and Dr. Arvind Lal was wondering whether to accept private equity and induct management professionals to keep pace with competitors through acquisitions or greenfield or sell out. He worried over loss of proprietary control. The industry practice of incentivizing doctors for referrals meant that acquisitions brought perverse incentive systems. The choice of compromising ethics or inventing another business model had to be made alongside whether to expand in India or abroad.

First National Healthcare (FNH) runs a large network of hospitals and has worked to systematically reduce waiting times in its emergency departments. One of FNH's regional networks has run a successful marketing campaign promoting its low ED waiting times that other regions want to emulate. The corporate quality manager must now determine whether to allow these campaigns to be rolled out and, if so, which waiting time estimates to use. Are the numbers currently being reported accurate? Is there a more accurate way of estimating patient waiting time that can be easily understood by consumers?