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Public Health; Leadership; Organisational Development; Organisational Behaviour; Public Administration Management.

Postgraduate level for honours or masters programmes in courses on public health; executive leadership and management programmes; MBA level.

The case unpacks decentralisation as a means to promote and improve local decision-making and accountability through community participation and engagements. Ayanda Nkele was a programme manager in a health district in South Africa. He was faced with many challenges when trying to implement his programme, most of which were related to local authority, responsibilities and decision-making abilities at his level. This case describes briefly the South African health system. and how it functions. It describes the proposed changes to the health system and its transformation towards Universal Health Coverage. The decision space analysis as discussed in the case illustrates the types of decentralisation in the country and how this also applies to Nkele’s level.

Understanding the concepts and principles of decentralisation within the context of strengthening district health services, the re-engineering of primary health care (PHC) and rolling out a National Health Insurance in South Africa. Applying the “decision space” approach to analyse the extent of decentralisation. Grasping the requirement of leaders to be “contextually intelligent” and identify the important contextual variables to take into account when analysing public health care.

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 7: Management Science.

Marketing: New Service Launch; Relationship Marketing; Direct Marketing.

This case could be taught in marketing management, services marketing or strategy courses, in the product development or service launch modules at the graduate level; alternatively it could also be used in the promotion module for the illustration of direct marketing (DM) tool application; and it could also be used as a capstone case for the introductory Principles of Marketing course at the undergraduate level.

The case examines the launch of a new air ambulance service in Karachi, Pakistan; a venture of Akbar Group Jet services; Princely Jets (Pvt) Ltd. The case describes the first mover advantage of the service and the marketing strategy recommended by the Chief Executive Officer (CEO), Mr Ghouse Akbar. The major concern is whether the strategy is forceful and compelling enough to secure approval from the board. The major issues include the role of DM processes and relationship marketing tools to encourage a value-added premium service which had no precedence of demand and practice. Concepts to thrash out in class also include customer profiling and segmentation along with how best to create awareness and generate a sustainable basket of customers for the high-price value-added low-use service.

Discuss and illustrate the importance and benefit of market research information for making a decision; how to create awareness and customer recognition and cultivate demand for a new and unsolicited service; identify appropriate and effective promotion tools to achieve required customer demand, brand recognition and customer value; how to launch a premium priced unsolicited service in a niche market?; and exhibit the synthesis of the four P's in a new product launch marketing strategy.

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

Dr. Lawrence Frazier was an emergency room physician who was an employee of Honore Staffing Services of Baton Rouge, Louisiana. He worked at Methodist Health System hospital in Grant, Georgia. He had recently added the title of ER Medical Director and served as liaison between Honore staffing and the Methodist hospital. His additional duties included overseeing the other physicians which staff the emergency room. Methodist had a bonus system in place based on obtaining 31 patients’ satisfaction surveys each month. Dr. Frazier believed that the small sample lead to erroneous results and created problems for the physicians under his supervision. He wanted to change the data collection process (e.g. sample size collected, instrument), but encountered obstacles when he broached the subject with his hospital administrators.

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.

Regency Hospital Limited, a multi-specialty hospital in Kanpur, India was founded by Dr. Atul Kapoor in 1995. The hospital had grown over the years. However, there were a number of issues that were yet to be dealt with. The case describes the struggles that the founder went through in setting up this hospital. It presents the challenges from the perspective of the founder as well as the staff and doctors of the hospital. In the process, the case highlights issues on leadership, entrepreneurship, organizational culture, and management of change.

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.

In late 2012 Adeline Herzog Memorial Hospital in Castle Rock, Colorado, was facing a problem with patient satisfaction. The Press-Ganey scores for the third-floor nursing unit–the primary destination (70 percent) for patients admitted through the emergency department–were at the 15th percentile, and the key HCAHPS score for inpatients was well below the Colorado average. Over the past six months Jeri Tinsley, director of medical, surgical, and intensive care services, had made various changes to try to improve the patient satisfaction scores for her 32-bed unit, but the scores seemed stuck at an unacceptably low level.

Tinsley worried that if improvements were not made soon, patients would start “voting with their feet” and take their business to competing hospitals. As a registered nurse, Tinsley's expertise was helping people heal; it was not analyzing data. In particular, she was overwhelmed by the patient comments included in the surveys; she had no idea how to analyze them and could not decide which issues to address first.

After analyzing the case, students should be able to:

• Organize and analyze qualitative data using affinity diagrams

• Identify priorities using Pareto diagrams

• Identify which aspects of a problem are (1) within their control to solve, (2) within their influence to solve, or (3) outside their control to solve

Organize and analyze qualitative data using affinity diagrams

Identify priorities using Pareto diagrams

Identify which aspects of a problem are (1) within their control to solve, (2) within their influence to solve, or (3) outside their control to solve

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.

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?

Bottom of the Pyramid (BOP); social innovation and business modeling.

Undergraduate and graduate level management/business school students. It can be taught in marketing management and entrepreneurship/innovation courses.

LifeSpring Hospitals Pvt. Ltd is an expanding chain of hospitals that provide high quality health care to lower-income women and children across Andhra Pradesh. It is a 50-50 equity partnership between Hindustan Latex Ltd and the Acumen Fund. LifeSpring has demonstrated exceptional management principles, some of them being the most innovative and attractive ones. The entire focus of LifeSpring is on one particular niche: maternal care. Some argue about its strategy of not adopting diversification, but LifeSpring has proved its point by actually turning out to be a profitable business. The strategy of focusing on one niche has led to reduction in cost in terms of specialized doctors and the range of equipment needed to serve. Adding to the strategic strength of LifeSpring, its operations (management) is perfectly aligned with the organization's vision and quality is achieved via highly standardized procedures for maternal care service.

This case will cover two important aspects of BOP and social innovation. MBA students will investigate an innovative business model and apply their analytical skills to analyse the sustainability of the model.

Teaching notes and exercise for class-based discussion.