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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 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 subject areas are business communication, human resource management and health care.

The case was designed for use in a first-year MBA-level course in business communication but would serve well in a course for executives or for advanced undergraduates. It might also be assigned in general management courses to evoke discussion on communication skills required in sensitive and critical situations; human resource courses; and course on health care.

Palliative care is a specialized medical care focussing on improving the quality of life of patients suffering from life-threatening illnesses. It addresses symptom management and psychosocial and spiritual concerns of the patient and its caregivers. With the intent to alleviate the sufferings of terminally ill patients, Rajbala Foundation, a non-government organization (NGO), works at the psychosocial and spiritual levels. While training their volunteers in effective palliative care communication, it often encounters challenges such as socio-cultural variations, organizational challenges, appropriate verbal and nonverbal communication, etc. This teaching case focuses on the communication challenges faced by the volunteers of Rajbala Foundation. It would lead to a broader discussion on communicating empathically during critical situations. The case has a focus on NGOs, and non-profit organizations, public sector management, health-care management and human resources management. There is significant literature on communication skills for medical practitioners in palliative care. As an increasing number of NGOs step in to provide the second level of care to critically ill patients in non-physical domains, there is a need to understand the role of effective communication for such care providers. This case deals with non-medical care providers in palliative care; the issues of communication they face as they interact with patients; and the skills they require to address the emotional and spiritual needs of patients and their families.

The aim of this case is to raise awareness of the complexities involved in the communication process during an emotional and sensitive interaction. It aims to encourage volunteers involved in palliative care to reflect on good communication practices when communicating with patients and family members. After reading this case, the students should be able to discuss the complexities involved in the communication process when communicating in situations with high emotional involvement; understand the core elements of emotional interactions for effective practice; and emphasize the need for the development of communication skills within palliative 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 6: Human Resource Management

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 subject areas are strategy, general management, health-care management, change management and inclusive growth model and application of technology to manage health care.

The case can be used to teach challenges in managing change in a health-care facility.

Tata Memorial Centre (TMC) is dedicated to provide best health-care services in the field of cancer cure. TMC established its credentials for service, education and research, which contributed to it being rated among the ten best hospitals year on year. Starting from humble moorings, TMC has grown to an institution of high repute from an 80-bed hospital to a 700-bed hospital. TMC held a number of pioneering efforts, which included bone marrow transplantation, external beam radiotherapy (linear accelerator), tumor tissue bank and bio-imaging to name a few. The management team of TMC had ensured that the growth had been orderly and appropriate to the changing needs of the community. Managing a hospital with disparate skill sets in the face of ever-increasing demand for services had always been a challenge in itself. As a government-run facility and well funded by the trust, TMC offered excellent services and post-operative care to the patients. So, it became imperative for the hospital to adopt technology to improve its hospital services and maintain transparency. Patients came to the hospital from different states in India and across the globe. TMC registered international and national patients online. Online medical reports were checked before the patients visited the hospital. TMC has developed an e-system that will allow patients around the world to send their tissue samples that are suspected to be cancerous for medical advice to the hospital. This case study is developed to provide insights into the transformation of TMC into an e-health-care service and explains the process of change management.

They are to provide insights into the challenges in health-care management, to illustrate the challenges faced by organization in implementing information and communication technology- managing change and to bring about best practices in the case organization and find solutions to the following questions: What are challenges faced by health-care officials in providing health care using new technological innovations? How can hospitals equip themselves with new technology? With the advent of improved and modern communication methods, medical practices and cases are more easily shared. Cases are discussed, recorded and, in many cases, put up for general public viewing through the electronic media. How can hospitals manage change? How can hospital administrators manage speed of delivery, quality healthcare, innovation and brand image?

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.

This case, “One Mission, Multiple Roads: Aravind Eyecare System in 2009” is a sequel to the earlier case, “Aravind Eyecare System: Giving Them the Most Precious Gift” (BP 0299). It describes the new challenges facing AECS in 2009. It presents the strategic choices facing a mission driven organization like AECS. For its future growth it had the option of several paths. Following any of these paths would not dilute its mission and yet it could not pursue all of them at the same time. It would have to prioritize them. The case encourages participants to develop criteria for this prioritization.

The case is designed to be used with the digital business model framework developed by Peter Weill and Stephanie Woerner of Massachusetts Institute of Technology (MIT) (Weill and Woerner, 2015) and is referred to as the W & W framework. This approach provides a useful structure for thinking through the strategic options facing environments ripe for digital transformation.

Research for this case was conducted through face-to-face interviews with the protagonist, as well as through a review of their business planning documents and other data and documentation provided by the founder. Some of the market and industry data were obtained using secondary research and industry reports. Interviews were digitally recorded and transcribed to ensure accuracy.

The case follows the story of Kurt Waltenbaugh, a Minnesota entrepreneur who shared the dream of using data analytics to reduce costs within the US health-care system. In early 2014, Waltenbaugh and a physician colleague founded Carrot Health to bring together their personal experience and expertise in both consumer data analytics and health care. From the beginning, they focused on how to use data analytics to help identify high-risk/high-cost patients who had not yet sought medical treatment. They believed that they could use these insights to encourage early medical interventions and, as a result, lower the long-term cost of care.

Carrot’s initial success found them in a consultative role, working on behalf of insurance companies. Through this work, they honed their capabilities by helping their clients combine existing claims data with external consumer behavioral data to identify new potential customers. These initial consulting contracts gave Carrot the opportunity to develop its analytic tools, business model and, importantly, to earn some much-needed cash flow during the start-up phase. However, they also learned that, while insurance companies were willing to purchase data insights for one-off market expansion projects, it was much more difficult to motivate them to use data proactively to eliminate costs on an ongoing basis. Waltenbaugh believed that Carrot’s greatest potential lay in their ability to develop predictive models of health outcomes, and this case explores Carrot’s journey through strategic decisions and company transformation.

This case is intended for either an undergraduate or graduate course on entrepreneurial strategy. It provides an effective introduction to the unique structure and constraints which apply to an innovative start-up within the health-care industry. The case also serves as a platform to explore the critical criteria to be considered when developing a digital transformation strategy and exposing students to the digital business model developed by Weill and Woerner (2015) at MIT (referred to in this instructor’s manual as the W&W framework). The case was written to be used in an advanced strategy Master of Business Administration (MBA) class, an undergraduate specialty health-care course or as part of a health-care concentration in a regular MBA, Master of Health Care Administration (MHA) or Master of Public Health (MPH). It may be taught toward the end of a course on business strategy when students are building on generic strategy frameworks and adapting their strategic thinking to the characteristics of specific industries or sectors. However, the case can also be taught as part of a course on health-care innovation in which case it also serves well as an introduction to the health-care payments and insurance system in the USA. Finally, the case can be used in a specialized course on digital transformation strategy in which case it serves as an introduction to the MIT W&W framework.

The case is particularly well-suited to students who are familiar with traditional frameworks for business strategy and business models. The analysis builds on this knowledge and introduces students interested in learning about the opportunities and challenges of digital strategy. Equally, the case works well for students with clinical backgrounds, who are interested in how business strategy can influence changes within the health-care sphere. Finally, an important aspect of the case design was to develop students’ analytical confidence by encouraging them to “get their hands dirty” and to carry out some basic exploratory data analytics themselves. As such, the case requires students to combine and correlate data and to experience the potentially powerful combination of clinical and consumer data. Instructors should find that the insights from these activities give students unique insights into the potential for of data analytics to move health care from a reactive/treatment ethos to a proactive/intervention ethos. This experience can be particularly revealing for students with clinical backgrounds who may initially be resistant to the use of clinical data by commercial organizations.

This is a field-researched case about a nonprofit organization, the Accelerated Cure Project (ACP), dedicated to accelerating advances toward a cure for multiple sclerosis (MS). Inspired by the successful open source software development platform, ACP brings the strengths of that platform into the medical research and development environment. At the opening of the case, Robert McBurney, an Australian scientist with extensive experience in the biotech world, has been named CEO. McBurney and his team want to use ACP's bio-sample and data Repository to drive innovation in the search for the cure for MS by fostering collaborative research and development across research institutions, pharmaceutical and bio-tech companies. To encourage such collaboration ACP waives its rights to potentially lucrative Intellectual Property. This decision to foster collaboration at the expense of revenue sources appears problematic, since ACP does not have the staff or resources to undertake fundraising at the scale needed to fund current projects. ACP chooses to serve instead as an open access research accelerator making an impact on the field by functioning as an innovation driver rather than a profit maker. Is this an innovative recipe for success in finding a cure for MS or a recipe for financial disaster for ACP?

Interviews provided the primary source of data for this case. Four semi-structured interviews were conducted with the CEO of ACP, the Vice President of Scientific Operations, and a member of the organization's Board of Trustees, a collaborating university researcher, and the President of a bio-tech company working with ACP. Interview data was supplemented with additional information from ACP's web site, news reports, McBurney's comments at Suffolk University's Global Leadership in Innovation and Collaboration Award event, and follow-up conversations.

This case is intended for use in an undergraduate course examining strategic management issues midway through the term. The case discussion can center on issues relating to: first, the development of the business model; second, revenue resources and fundraising. Students are expected to spend two to three hours of outside preparation reviewing concepts of change leadership and the collaborative enterprise business model. They should read the case materials and brainstorm options for improved change leadership. The case can be taught in one two-hour class period.

The purpose of this case is to introduce students to the strategic management and funding challenges faced by an organization that is using a non-traditional business model in an increasingly complex environment. As a result of discussing this case, students should be able to: first, examine strategic organizational strengths, analyze opportunities created by business, market and environmental factors, and strategize to minimize weaknesses and to address threats identify an organization's strategic focus; recognize and recommend options at crucial decision making junctures in a business situation; second, assess an organization's revenue model; analyze how this model can be improved; third, analyze the functionality and sustainability of an organization's business model.

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.

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 6: Human Resource Management.

This case analysis will make the audience aware of the sudden nature of the crisis, specifically the transboundary crisis. They will be introduced to the concepts of participative leadership and situational leadership. Majorly the audience would learn to remain composed in times of crisis and comprehend how a circumstance can transform a participatory leadership style into a situational leadership style. The case will allow the audience to brainstorm how to take innovative decisions to manage a crisis situation. The primary objectives of the case are as follows: ■ to understand a transboundary crisis and its characteristics to deal with it; ■ to visualise the application of participative and situational leadership and evaluate and analyse the most suitable leadership style during an unknown crisis; ■ to make the students aware of how to remain composed in times of crisis and, for instance, implementing the change of leadership styles per the situation's requirement; and ■ to make students learn to design innovative decision-making strategies to develop a crisis management plan for managing future crises.

The case highlights the successful management of the crises faced by a multi-specialty hospital named “Shukan-Caring Lives”, established in 2017 in Vadodara city of Gujarat, India. The case revolves around the Chief Operating Officer, his executive management body and the paramedical and medical staff of the hospital, who dealt with the grave Corona crisis. This case shows how the change in leadership style from participative to situational leadership style could manage the situation by taking brilliant initiatives and providing insightful solutions with a lot of dedication, showing how situational leadership can deal with the transboundary crisis.

The case is an excellent example of a transboundary crisis for any organisation and demonstrates a novel idea of transforming the participative leadership style into a situational leadership style as and when the need arises. The topics of transboundary crisis and management crisis can be taught in strategic management. At the same time, leadership styles and transformation of leadership style can be covered in organisation behaviour. Management development programmes can also include such kinds of cases to give exposure to crisis and its management. The target audience would be PG management students, management executives and senior-level managers in various courses.

Teaching notes are available for educators only.

CSS 11: Strategy.