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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 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 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.

Focuses on a simple question: should Zimmer develop a gender-specific artificial knee? The decision is complicated because while the idea seems to make sense, there is little clinical evidence that a gender-specific knee produces superior patient outcomes, and orthopedic surgeons are likely to be skeptical of the innovation.

To teach new product strategy and growth strategy, and introduce students to the medical device industry.

A midsize community hospital must choose a strategy to compete with an expanding regional rival. The strategy, focused on acquiring patient volume, includes expanding investment into integrated care, setting the reimbursement structure for revenue collection, and moving to a capitation-based payment system. The case presents an evaluation of revenue models to select that which best supports a given business strategy.

This case is designed to introduce a health care audience to financial analysis. It provides a straightforward introduction to hospital financial-statement ratio analysis and hospital operating statistics, so it can also serve to introduce any audience with a business or medical background to hospital finance.

Executives at biotechnology firm Genzyme are debating funding a clinical trial for a new version of a medical device called Synvisc. The trial is expensive and the odds of success are not high, but the upside is substantial. The case presents a common business question: invest or not? The case forces students to think about customer insights, wrestle with a number of complex issues, and evaluate the financials of the decision.

The case is ideal for teaching financial analysis and decision making. It can also be used to teach marketing, new product strategy, and healthcare industry management.

The reading and discussion on case will enable participants to appreciate importance of reward management in performance management system for both employee and organizational good; to develop insight on the effect of perceived discrimination on the motivation of employees; to internalize the effect of perceived unjust, subjective, non-communicative, non-transparent policies on the behavior and productivity of employees and overall organizational culture and climate; and to comprehend the importance of HR and OB issues with respect to performance management system for the benefit of employee morale, motivation and organizational culture.

The effectiveness of an employee is the key factor for the employer. All the profit that the company or the organization makes depends on the employees’ productiveness. The case needs to be understood in the overall context of performance management system (Ferreiraa and Otley, 2009) with focus on elements of appraisal and compensation via rewards and recognition as per objective standards. Performance management systems (PMSs) is a more general descriptor if the intention is to capture a holistic picture of the management and control of organizational performance. Performance management policies and practices refer to the processes of setting, communicating and monitoring performance targets and rewarding results with the aim of enhancing organizational effectiveness (Fee, McGrath-Champ and Yang, 2011). PMS includes both the formal mechanisms, processes, systems and networks used by organizations, and also the more subtle, yet important, informal controls that are used (Chenhall, 2003; Malmi and Brown, 2008). Otley (1999) proposed a framework which highlights five central issues which need to be considered as part of the process of developing a coherent structure for performance management systems. The five areas addressed by this framework include identification of the key organizational objectives and the processes and methods involved in assessing the level of achievement under each of these objectives, formulating and implementing strategies and plans, as well as the performance measurement and evaluation processes, process of setting performance targets and the levels at which such targets are set, rewards systems used by organizations and the implications of achieving or failing to achieve performance targets and types of information flows required to provide adequate monitoring of performance. While the case touches upon all the aspects of the PMS framework, it revolves round the reward episode and elaborates on the way it affects all stakeholders, those who got the benefit, those who felt discriminated and those were mere observers to the episode. Objective performance appraisals are needed to ensure that every employee produces the best performance and that the work performed is rewarded with reasonable increases in pay scales or special additional allowances or incentives. This system carries crucial importance as it helps managers to decide which rewards should be handed out, by what amount and to whom. Additionally, performance appraisals may increase an employee’s commitment and satisfaction (Wiese and Buckley, 1998) The case readers need to notice that when organizations fail to follow objective appraisal or reward standards, the same rewards become a cause of contention. The reward which was handed over to the employees in this case was in addition to the annual appraisal. Though the role of rewards has been well-recognized in motivating the employees to continue performing at high level and encourage others to strive for better performance, what needs to be recognized that rewards’ per say does not serve purpose. They need to be dealt within the context of performance management system. Using rewards to favor or discriminate a few employees by using subjective standards backfires and does no good as the person who is favored cannot take pride in it and is not motivated to perform better or equally well as he/she also knows that the work has no relation to the reward, it is personal favor, on the other hand, the one who is discriminated feel discouraged and demotivated to perform. Rewards have the potential to both help and harm the organization if dealt in a callous and careless manner. Use of rewards to favor or discriminate certain people due to subjective preference can be suicidal for the organization and irreparably damage the trust of the employees in the management. It has been well stated that fairness and objectivity are the core principles using an assessment of the nature and size of the job each is employed to carry out (Torrington et al., 2005). If any organization decides to include rewards as a motivating mechanism, it needs to cull out unambiguous and transparent criteria for rewarding. If employees perceive procedural or distributive injustice from the management, it is not only detrimental for the employee’ relations and teamwork, it also tarnishes the reputation of the organization and jeopardizes the culture of the organization. Reward management needs to be closely related to performance appraisals, job evaluations and overall performance management systems. The current case elaborates on one such instance where unjustified inequity in reward system not only disturbed the employees concerned but it had bred a negative image of the organization among other employees too, organizational citizenship was replaced with contempt and feeling of apathy.

Post graduate students and working professionals can benefit from this study.

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

Human resource management.

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.

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 teaching objectives of the case study will enable the students as follows: to recognise the challenges of information technology (IT) implementation in the health-care sector associated with employee resistance, to apply the technology acceptance model for analysing the degree of employee resistance, to relate the utilisation of Kotter’s 8-step change management approach in successful IT implementation in the health-care sector and maintenance of employee productivity and to classify the leadership traits reflected by the leaders in training the 600 diverse employee population of Al-Ain hospital.

The case highlighted the predicament the government-owned Al-Ain City Hospital, United Arab Emirates, faced following the surge in the incidences of COVID-19 in the country in March 2020. The hospital management decided to initiate the work-from-home arrangement as a non-pharmaceutical intervention of handling the spread of the disease amongst its employees. Fatima Almur, the Information Technology Director in Al-Ain Hospital, asked the Application Support Manager, Aysha Shahwan, to deploy some IT tools significant for remote support to patient care within two weeks. Shahwan faced significant challenges in deploying the IT tools in two weeks given the diverse workforce, with the majority of them having limited knowledge in operating the tools, and hence, their apprehension in the usefulness of the tools. Besides, Shahwan had to deploy some advanced tools for easy and secured access to the electronic health record, telemedicine and telecommuting using mobile phones, tablets or PCs. The deployment of these advanced tools would be jeopardised by employee acceptance and consequent dwindling productivity. Considering the issue of employee acceptance of the change and their limited knowledge, Shahwan had, therefore, to develop training frameworks to boost the former’s perceived usefulness and ease-of-use of the IT tools. Will Shahwan successfully deploy the advanced IT tools to enable the hospital staff, including medical staff and departments, to ensure efficient patient care from a remote location? Will she be able to train the 600 employees across genders, ages and knowledge, use the IT tools and safeguard them from common software threats like email phishing and ransomware? Will the hospital be able to sustain its vision of quality patient care using advanced technologies through this new arrangement of remote support amidst the pandemic when patients are more?

Undergraduate business management.

Teaching Notes are available for educators only.

CSS 10: Public sector management.