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This case study draws on interviews conducted with officials from the Rhode Island Department of Environmental Management (DEM), City of Woonsocket and Town of North Smithfield. Additionally, it pulls from relevant legal documents, recordings and minutes from meetings of the Woonsocket City Council and North Smithfield Town Council, City Council resolutions, state legislation and local press coverage.

From 2012–2017, the communities of Woonsocket and North Smithfield engaged in a protracted dispute concerning wastewater disposal. For 30 years, the two jurisdictions had maintained a signed service agreement. Following its expiration; however, Woonsocket imposed a new host fee on North Smithfield. Woonsocket needed to upgrade the facility to comply with mandates from the RI DEM. Over the next five years, leaders from both jurisdictions vociferously fought over the new fee. At the same time, leaders within communities experienced their own divisions. This case study highlights the challenges that decision-makers faced in both communities.

This case is appropriate for graduate and executive level courses in environmental policy, communication and leadership.

This is a selective annotated bibliography of the literature on Christopher Columbus from 1970 to 1989. The subject is particularly relevant considering the approach of the Quincentenary of the “discovery” of America in 1992. For that same reason, there has been an outpouring of literature on the subject since 1990, a significant subset of which contributes to are interpretation of Columbus the man, his voyages, and their impact on the new world. It is hoped that this more recent literature will be part of a subsequent annotated bibliography.

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.