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The information used in the case study was obtained from secondary sources, such as internal documents, reports, news, and organization websites. Three of the four authors played a hands-on role in the case.

The COVID-19 pandemic exacerbated the global challenge of hiring and retaining health-care workers. To address its own challenges, Mayo Clinic decided to fundamentally transform its 30-year-old tuition assistance program: from a model centered on the premise that tuition assistance was an employee benefit for professional development purposes, to one that was more driven to meet the business needs of the employer by preparing internal talent for important roles throughout the institution. Herein, this case study first describes how the COVID-19 pandemic impacted health-care organizations like Mayo Clinic. Next, this study provides details on the original employee tuition assistance program, and then, focuses on the reasons for its need to be changed. Afterward, this study introduces the new tuition assistance programs. Finally, this study follows with examples of how both Mayo Clinic and its employees navigated through initial challenges, such as resistance to change and lack of engagement. In sum, this case study provides critical insight into designing workforce education programs that provide professional development for meeting the workforce needs of the organization.

This case can be used as teaching material in relevant undergraduate- and MBA-level courses, such as human resource management, human resource development and compensation and benefits. This case allows students to critically analyze workforce education programs (e.g. tuition assistance programs) and to plan how to strategically align those with the workforce needs of the organization.

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.

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.

Addresses how flow times and capacity calculations can be made for a service process such as the Bariatric Surgery Center at a clinic. Highlights how these calculations can be made for a service process just as in any manufacturing setting. Discusses the notions of critical paths and bottlenecks and what factors affect both time and capacity. Also, discusses the relative profitability of two types of bariatric surgery, the goal being to link product profitability to the process.

The learning outcomes are as follows: identify and evaluate the impact of risk factors for health-care organizations during crisis; evaluate the role of different organizational factors in building resilient health-care organizations; define organizational resilience in a health-care context; and apply the effect-strategy-impact resilience framework.

September 2022 found Ranjan Thakur, the Hospital Director at Manipal Hospital, Jaipur (MHJ) reflecting on MHJ’s resilience toward future health-care crises. MHJ was established in the capital city Jaipur of the Indian state of Rajasthan in 2014, as a 225-bed multispecialty unit of the nationally renowned Manipal Health Enterprises Ltd. As the Hospital Director, Thakur had been responsible for navigating his team and the hospital through the multiple health-care related challenges exacerbated by the multiple waves of the Covid-19 pandemic in a large Indian state with a sizable rural and semiurban population. Though Thakur and his team of doctors had worked through the vulnerabilities of their health-care ecosystem, mapping the risks and mitigating the same, Thakur asked himself if they had done enough. He wondered how a health-care institution such as theirs could sustain effective health-care delivery during future crises situations to deliver high-quality health care to the vulnerable communities. Had they effectively mapped MHJ’s vulnerabilities and built resilience into the hospital’s functioning? The backdrop of the case is public health in the state of Rajasthan (Jaipur), and the case is rich in detailing social factors such as behavior issues of patients, doctors and nurses; operational factors such as standardization of treatment and standard operating procedures, availability of resources, clinical concerns; leadership and management of the hospital through the pandemic. This case can be used by instructors to teach organizational resilience building in the health-care context.

Graduate- and executive-level courses in managing change during crisis in health-care context; health-care management/leadership.

Teaching notes are available for educators only.

CSS 7: Management Science.

The purpose of this case study is to illustrate how Dianne Savastano, founder and CEO of Healthassist, Inc., a US-based health-care advocacy firm, successfully led her clients and team through the COVID-19 pandemic of 2020. To gather the data for this case study, the authors interviewed the protagonists, the members of her team and two clients. The authors read Healthassist Newsletters and the firm’s documents; and in fact, they included one Newsletter and several documents in the Exhibits of the case study. The authors conducted a literature review for articles in newspapers and journals about the newly developing field of “health-care advocacy,” a field which Savastano helped to create.

The authors illustrate how Savastano, using the five practices of exemplary leadership by Kouzes and Posner, in The Leadership Challenge, led her team through the pandemic of 2020. This is a story of a woman leader, using traits such as warmth, empathy, analysis and decisiveness, keeps her small business afloat when so many other firms collapsed in 2020.

The authors conducted seven interviews and literature searches on the topics of health-care advocacy; women leaders; leading through a crisis; and COVID-19.

The case study illustrates how a woman founder and CEO can lead her firm through a crisis.

This is an example of how a woman leader managed through the 2020 pandemic.

CSS 3: Entrepreneurship

Non-profit management and corporate strategy.

The case is appropriate for teaching undergraduate students, executive MBAs and graduate students. The case is useful for an overview of hospice and palliative care in the developed and developing world, and for class room discussions of external analysis of non-profit organizations' ecosystems, funding needs and industry analysis.

Hospice care in the developed parts of the world is well established but in most developing countries, there are no organized hospice care facilities. This case focuses on a charitable organization, Brthya – Add Value to Life (Brthya – AVTL), that established and operates hospice care in Chennai, India. The Indian context for hospice care, and the ecosystem needed to sustain ongoing operations, are described along with a summary of four different models of hospice care used in other parts of the world.

The case will help students to understand: what hospice care is and its various forms; management issues related to funding and operating hospice care in particular and a non-profit in general; ecosystems that make non-profits sustainable in emerging economies; and managing expansion and growth in non-profit organizations, in emerging economies and globally.

Teaching notes are available; please consult your librarian for access.

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.

Organizational Development; Change Management; Leadership; Healthcare Management Operations; Supply Chain.

MBA; Masters in Healthcare Management; Post-graduate Diploma in Leadership; MPhil in Strategic Leadership.

On April 16, 2016, the CEO of Prince Mshiyeni Memorial hospital, Kwa-Zulu Natal, South Africa, Dr Sandile Tshabalala reflected as he drove through the winding hills of the Cato range. In recent years, the hospital had been a subject of negative publicity with horror stories about patients collapsing while waiting for their medication at one of Durban’s largest hospitals. The case features a number of stakeholders and their demands and even threats. Contextual leadership intelligence requires accurate identification of relevant stakeholders and then involvement in solutions. The case illustrates how these demands had been listened to and how the stakeholders had been involved in finding solutions. A remarkable solution was to realize that the bottleneck at the pharmacy was actually caused by a problem early on in the process, for example, the late start of administrative staff who had to submit patients. A further solution was to utilize the primary health care clinics and even churches for dispensing chronic medicine.

Gaining insight and foresight into the operations and supply chain dilemmas in public health care. Developing understanding of the impact of various stakeholders in the healthcare sector. Understanding buy-in when leading change. Acquiring contextual leadership intelligence in the public health environment.

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.