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The area of focus is on organization strategies, specifically in developing appropriate strategies for business expansion in a situation of high economic uncertainties.

This case is designed for advanced undergraduate in the business and management programs and students in the MBA programs. It is suitable for courses of organizational management, organization theory and design, strategic management, and managerial economics.

At the end of 2009, Kumpulan Perubatan Johor Healthcare Group was the largest public-listed healthcare service provider in Malaysia, with revenues of RM1.5 billion (approximately USD0.5 billion) and a net profit after tax of RM115 million (approximately USD38 million). The country was experiencing economic downturn, which affected demands of the affluent as well as medical tourism segments, which were the targeted market of the company. Datin Paduka Siti Sa'diah Sheikh Bakir, the group's CEO and her management team realized that the company needed to seek a new growth strategy. The case stimulates a discussion on the future strategy of a high-growth healthcare company that aspired to be the leading healthcare player in the region.

Understanding the process of analyzing an industry, as well as formulating strategies, enables case analysts to extend the practice of making strategic decisions to many business situations.

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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.

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Human resource management.

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”.

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CSS:3 Entrepreneurship.

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.

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CSS 3: Entrepreneurship.

Organizational diagnosis. The case addresses the issue of an outsider at a senior position in a family-run business.

MBA.

NCR-Delhi is a multi-specialty hospital in Delhi and is essentially a family-run business. Though it had done well in the early years since its inception, it had been plagued by many problems and had undergone many changes in management and processes. An outsider joined it as the Facility Director (FD) two years ago. In these two years, he introduced multi-directional changes. However, he has not been able to achieve a complete turnaround of the hospital. The major issues facing him are financial, operational and personnel-related issues. The hospital is currently in a major financial crisis, which has been causing delays in disbursement of salaries and creating resource crunches in daily operations. Most of the patients are government empanelled patients, and collection of payments from such patients usually takes at least three months. Employee attrition and customer satisfaction are also continuing challenges. Other issues include lack of proper support and interference from top management. The FD has been showing considerable prowess and capability in leading the organization, but has not been able to achieve the desired results owing to the above factors.

To understand the frameworks and process of organizational diagnosis; to understand the influence of change initiatives on organizational culture; and to understand the complexity of family business and what happens when an outsider leader joins family business.

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CSS 6: Human Resource Management.

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 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.

Fundraising, Marketing Strategy.

Undergraduate and Postgraduate.

Professional fundraising plays a key role in the operation and sustainability of various forms of organizations, particularly non-governmental organizations (NGOs). “Fundraising for Life” is the success story of a center that is totally dependent on fundraising to achieve its mission of lifesaving and treatment for children with chronic diseases regardless of their financial situation. This case sheds the light on the primary sources of contributions, the importance of an integrated development program, the mutual benefits of partnering with other entities and the challenges encountered in the fundraising endeavors in this developing and unstable part of the world.

The students will be able to explore the current practices used in fundraising as well as the marketing and communication strategies employed in nurturing and maintaining relations with potential donors and partners. They will also be able to explore the internal and external challenges and opportunities available for fundraisers.

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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.

India's diagnostics business valued at USD 10 billion was growing at 20% annually. Several players with different business models competed. Dr. Lal PathLabs, the world's largest histopathology centre led with a menu of 3,500 tests, 1,600 collection centres and 7,000 pick-up points. Its Initial Public Offer had been oversubscribed 33.41 times and the team at Dr. Lal PathLabs was excited about expanding its international footprint. Two overseas companies were incorporated in Netherlands and Nepal. Yet, there were enormous unmet needs in India alongside potential for public-private partnerships. Trade-offs over portfolio choice and regional versus international footprint needed thinking through.