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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 case is particularly well suited to entrepreneurship, marketing, technology, innovation, or strategy courses.

This teaching case is aimed at postgraduate students in management or business programmes.

This case follows the Kenyan healthcare tech company Savannah Informatics as they contemplate how the company will continue to grow in a post-pandemic world. Savannah is the market leader in electronic claims validation solutions for the Kenyan healthcare system. Their flagship product, the digital platform Slade 360, allows health insurers, healthcare providers, and patients to share claims information for health services in real time, drastically reducing payment transfer times, incidents of fraud, and account errors. The Covid-19 pandemic and the subsequent lockdown mandates from the Kenyan government have reduced short-term revenues by driving down hospital visits for citizens overall, but they have also created a demand for telemedicine and more online healthcare solutions. CEO John Muthee and his co-founders are left to consider their options for growing Savannah Informatics: expanding into new markets, creating more solutions for their insurance and provider customers in Kenya, or diversifying.

Identify the key challenges facing Savannah

Analyse the organisation using the 5Cs model (company, customers, competitors, collaborators and context) and VRIO (value, rarity, imitability, and organisation) analysis

Assess the growth opportunities available to Savannah and make recommendations

For discussion of social entrepreneurship in middle-income economies, emerging markets generally and Africa, specifically, Quali Health presents interesting questions about entrepreneurial funding, scaling and the interplay between social entrepreneurial activities and the informal sector.

South Africa’s primary health outcomes do not correspond to the country’s spending on public health, with South Africa ranking among the worst globally in the incidence of tuberculosis, HIV prevalence, infant mortality and life expectancy. In part, this poor outcome can be explained by high inequality in access to healthcare, which reflects South Africa’s grossly skewed income and wealth distributions, with the bulk of the country’s population reliant upon an underfunded, inefficient and poorly managed public health system. This substandard service for the working poor in South Africa’s townships with high population densities offered a profitable entrepreneurial opportunity to provide affordable and effective primary care with vast gains in quality and outcomes improved dignity for patients. After receiving her MBA, physician and entrepreneur Dr Nthabiseng Legoete self-funded the launch of Quali Health in 2017. The business model set out to disrupt healthcare delivery for South Africa’s poorest citizens. Drawing patients from the working poor in Diepsloot, Quali Health’s inaugural site was cash flow positive within five months when the facility hit only 30% of installed service capacity. With quick success, Dr Legoete faced the strategic question of how fast to scale and finance the expansion. She also considered a new micro-insurance product for her clientele.

For discussion of social entrepreneurship in middle-income economies, emerging markets generally and Africa, specifically, Quali Health presents interesting questions about entrepreneurial funding, scaling and the interplay between social entrepreneurial activities and the informal sector.

Teaching notes are available for educators only.

CSS: 3 Entrepreneurship.

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 of this study include: recognizing the strategic inflexion points and related business and strategic perspectives in the life of an organization; understanding sources of sustained competitive advantage and connect it with resource-based view for internal analysis; applying dynamic capability theory to identify capabilities that help an IT company stay relevant in an IT sector characterized by VUCA (an acronym for volatility, uncertainty, complexity and ambiguity) environment; analyzing the multi-dimensional and multi-contextual challenge an organization faces, or is likely to face, in the foreseeable future and the possible ways it addresses or should address them; evaluating strategies adopted at various points of an organization’s journey for their effectiveness; and helping a company co-create value for its customers.

This case of Nitor Infotech Private Limited (Nitor), a mid-sized software product outsourcing company, outlines its decade-long journey, highlighting its achievements. While the company has consistently grown by leveraging its expertise in software product engineering and its domain knowledge in the healthcare segment, it entered into a stage of its life cycle where it had to develop a long-term strategy to effectively compete in the product engineering market. Nitor’s strategy was built around product engineering and outsourced product development. The two major choices for a software company were either to develop its own product and thereby own the intellectual property (IP) or to develop modules which would be part of a product that would be owned by a client. In the latter case, the IP would be held by the client. So far Nitor chose to follow the second option by developing components for its client’s products. Although this strategy allowed it to develop expertise in a particular domain, and serve different customers in a particular market, the chances of a competitor attacking its position was high. On the other hand, if it developed its own product, it can create its own brand name and can sell packaged software to several different customers. However, the challenge with the latter is that the cost of marketing could be very high. The choice for the company in the future is to decide on selecting a specific strategy to expand its international business.

This case is appropriate for an undergraduate and postgraduate management course in the area of strategic management. The level of difficulty can be from medium to high depending on the learning level. Knowledge of management fundamentals is not a prerequisite but is desirable for case analysis.

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

In early 2004, residents of Inglewood, California, a working-class community just outside Los Angeles composed primarily of African- and Hispanic-Americans, were preparing to vote on a referendum that would change the city charter to allow Wal-Mart to build a supercenter on a huge, undeveloped lot in the city. Walmart had put forward the measure after the city council refused to change the zoning of a sixty-acre plot on which it held an option to build. Numerous community and religious groups opposed Wal-Mart's entry and campaigned against the referendum. Walmart promised low-priced merchandise and jobs, but these groups were skeptical about the kinds of jobs and compensation that would be offered, the healthcare that would be provided to employees, and the broader impact Walmart would have on the community. Inglewood was a pro-union community, so there was also opposition based on Walmart's anti-union position. On April 6 Inglewood residents voted to reject the referendum by a margin of 60.6 percent to 39.9 percent. Though smaller, less organized, and with fewer resources than Walmart, this coalition of community and religious leaders had defeated the global retailing behemoth.

After students have analyzed the case they will be able to (a) appreciate the importance of nonmarket factors to execute growth and market entry strategies, (b) understand how the decisions of political institutions depend on the issue context and the alignments of coalitions of interest, (c) formulate and assess strategies to overcome nonmarket barriers to entry.

GE Healthcare was on a continuous lookout for investing into new and innovative super value products for the Bottom of the Pyramid markets in India. After launching its first successful super value ECG machine Mac 400, GE had recently launched its twenty-fifth super value product a PET CT machine. Serving the BOP markets has its own unique challenges that may be different for each product that is placed in the market. However, GE has so far successfully sailed through all the challenges and developed a steep learning curve about BOP markets. However, it is now facing the challenge of ensuring sustainability of product pipeline. The company is also keen to exploit the opportunities for reverse innovation that super value products have provided. The company also wants to assess the disruptive impact of these products in domestic medical device markets as well as markets outside India.

Manufacturing, Western management theories and Japanese management practices.

This case can be used in project management or management-related courses at tertiary institutions at Undergraduate and Postgraduate level.

This case provides students with an opportunity to find out what make Toyota so successful in manufacturing through its famous production system as well as the underlying Toyota Way principles. All students are expected to understand the Toyota Way model with a balanced view that goes beyond a set of lean tools such as just-in-time. This case opens a historical account for the Toyota Way model by connecting with possible Western management theories and Japanese management practices.

It is expected to significantly benefit students with industry experience with the intention of initiating appropriate changes in their own industry and/or organization by applying what they have learnt from the Toyota Way, through bridging with Western management theories.

Teaching notes.

After discussing this case, students will be able to understand the challenges faced by social entrepreneurs in starting a health-tech start-up in Africa; create and evaluate lean business models of health-tech companies as a social enterprise; evaluate how health-tech start-ups were developing innovative business models and supply chain networks to make prescription drugs accessible and available in Africa; understand how inorganic growth strategies can help health-tech start-ups scale up; and evaluate what promises investors were seeing while investing in social enterprises in the health-care sector in Africa and what social wealth they were creating.

In August 2022, Gregory Rockson (Rockson), social entrepreneur and founder of for-profit health technology (health-tech) social enterprise in Ghana, mPharma, stated that he had plans to replicate the company’s business model, which provided people access to drugs and at affordable prices, to other African nations, beyond the company’s existing footprint. However, analysts pointed out that the fragmented drug supply chain and poor regulation in the health-care market across Africa could act as a challenge for mPharma to replicate its business model successfully across the African continent. People in Africa were forced to pay higher prices to buy life-saving drugs due to the continent’s fragmented drug supply chain. To add to their woes, pharmacies struggled to keep life-saving and life-sustaining medicines in stock. Often, patients traveled miles to a pharmacy only to find out that the drugs they needed were not in stock. In addition to this, the markets were flooded with counterfeit drugs. And the Covid-19 pandemic only exacerbated the situation. mPharma managed the prescription drug inventory for pharmacies and drug suppliers using its proprietary vendor management information system. By using the technology infrastructure it had built, the company connected patients, pharmacies and hospitals through a cloud-based software. The system enabled doctors to track in real-time which drugs were available and at which location, thus giving patients reliable access to medicines. Patients registering with mPharma with their prescriptions and medical history received an alert on their mobile phones notifying them where the drugs they needed were available. mPharma bought drugs from major drug manufacturers such as Novartis International AG, Pfizer Inc. (Pfizer) and Bayer AG, on behalf of the pharmacies. This enabled the pharmacies to save on the up-front costs of stocking the drugs, reduced supply constraints and ensured availability of drugs to consumers in these underserved markets. The company had a consignment model wherein member pharmacies had to pay only for what they sold. Most pharmacies forecast the number of drugs they needed and purchased them from mPharma at pre-agreed rates. The company took the inventory liability to prevent pharmacies from going out of stock. As mPharma used its purchasing power to buy drugs in large quantities from drug manufacturers and suppliers, it was able to help patients realize cost savings of 30% to 60% in the purchase of medicines. mPharma was focusing on achieving its ambitious goal of dominating the health-care market in Africa in future. However, analysts felt that the company would face challenges related to poor regulation in the health-care market, high prices of drugs and the fragmented pharmacy retail market in the continent.

This case is intended for use in MBA/MS level programs as part of a course on Social Entrepreneurship, Sustainability, Business Model Innovation, Disruptive Business Models, and Supply Chain Management in the Drug Industry.

Teaching notes are available for educators only.

CSS 3: Entrepreneurship.

Health Management and Leadership, Marketing Social Causes, Strategy, International Business.

Post-graduates, Practitioners.

General Electric has been operating in the Middle East, North Africa (MENA) region for over a century. GE is committed to corporate citizenship having launched ecomagination in 2005 and healthymagination in 2009. For sustainability, GE believes that both innovation and localization are critical. This case deals with contextualization of breast cancer campaign for the Kingdom of Saudi Arabia through healthymagination. Rania Rostom, Communications Director, Middle East, North Africa and Turkey region, GE, reviews the campaign implemented and looks at roll-out across the MENA region. The situation is unique, as breast cancer strikes women in the region ten years earlier than the West, and the cultural context does not allow the discussion of the topic in public. One of the peculiarities of this region was the high penetration of social media and its large adoption rate by the young. GE used a unique Facebook campaign to drive awareness on the topic, encourage screening appointments, seek treatment and reduce the discomfort associated with the process.

On completion of utilizing the case study as an exercise, students should be able to gain case-specific skills – critically examine the importance of the consumer behavior, health marketing, marketing strategy and aspects of international business in the Middle East, KSA, in particular, and demonstrate this by analyzing real regional/world examples using complex theoretical frameworks; identify examples of best practice and explain the dynamics toward consumer behavior, health marketing, marketing strategy, international business with reference to a range of theoretical models and apply these in a meaningful way to the MENA region – discipline-specific skills – synthesize and critically evaluate a corpus of academic literature and government reports on consumer behavior, health marketing, marketing strategy, international business – and personal and key skills – reflect on the process of learning and undertake independent/self-directed learning (including time management) to achieve consistent, proficient and sustained attainment; work as a participant or leader of a group and contribute effectively to the achievement of objectives in the field of consumer behavior, health marketing, marketing strategy, international 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.