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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 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.

Dr. Phillip Hoopes, a LASIK surgeon, is considering how to respond to discounting by his competitors. He had built a high-end practice with costly advanced technology, but discounters had recently entered the market and other high-end practices in the area were starting to offer deep promotions in an effort to compete.

The central lesson to be learned from studying the case is to understand the challenges and constraints posed by contextual conditions in designing contracts in public–private partnerships (PPP) for financing and delivering health care in emerging economies such as India.

Perverse incentives, along with contextual conditions, led to extensive opportunistic behaviors among involved agencies, limiting the effectiveness of otherwise highly regarded innovative design of the program.

India’s “Rashtriya Swasthya Bima Yojana” or National Health Insurance Program, launched in 2007 provided free health insurance coverage to protect millions of low-income families from getting pushed into poverty due to catastrophic health-care expenditure. The program was implemented through a PPP using standardized contracts between multiple stakeholders from the public and private sector – insurance companies, hospitals, intermediaries, the provincial and federal government.

Teaching Notes are available for educators only.

CSS: 10 Public Sector Management.

Describes Myriad Genetics and its struggle to develop a genetic testing service while facing challenges from competitors and activist organizations. After Myriad's discovery of the BRCA gene, capable of genetic testing for breast cancer in women, Myriad needed to choose a strategy to provide this service to the public. With several major competitors offering similar services, intense media scrutiny, and a charged activist and political climate, a poor Myriad decision could have major repercussions.

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.

Delee founders aimed to change the way cancer radically was detected, monitored, and treated. They created CytoCatch™, a highly sensitive automated benchtop device for the rapid isolation and analysis of circulating tumor cells from blood samples to make this possible. Strategic alliances with Stanford University, Tecnologico de Monterrey, and UANL strengthened this innovative company’s purpose. Nevertheless, some questions arose when selecting a suitable business strategy to accomplish Delee’s vision. Liza Velarde, Delee’s CEO, was preparing the agenda for the company’s 2025 planning in November 2020. The journey has been challenging, and Liza Velarde faced critical decision-making milestones. What could be the most promising customer segment for her technology? What business model may work better for such a market? How can Delee reduce the time-to-market for their technology? Furthermore, how can Delee fund their development for the following years until FDA approves?

With the application of this case, the teacher aspires that students understand the following crucial insights: to understand the impact of a business model strategy, identify different possible business models, and explore options; in this sense, intellectual property can offer options to the strategy; to identify and analyze the gender gap in entrepreneurship and its strategic implications; and to identify the relevance of reducing the time to market for a technological product.

Gender inclusiveness in entrepreneurship.

Undergraduate and graduate-level.

Teaching notes are available for educators only.

CCS 3: Entrepreneurship.

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 learning outcomes of this paper is as follows: to analyse the drivers, mediators and threats of commoditisation. To critically evaluate the merits of different marketing options that may be employed to avoid commoditisation. To critically assess the branding-focussed or customer-focussed strategies that could be used. To develop appropriate strategies for Biotronik SA to counter commoditisation in the future.

The case begins with the protagonist and managing director of Biotronik SA, Robbie Nel, brewing over a new industry development. One of the leading private hospital groups has sent an open invitation to medical device suppliers to tender, where the lowest-priced products will win shelf space in their cathlabs. Robbie has to decide whether to sacrifice Biotronik SA’s profit margins to win the tender or risk not being stocked in their cathlabs. Or, he must find an alternative non-price-based strategy to pursue. The medical device industry is facing increasing price pressures from various stakeholders in the device-purchasing process. The decision to purchase is no longer the responsibility of specialist physicians alone. International and local market trends indicate that the medical device industry is threatened by commoditisation. Robbie has to make a decision on changing the Biotronik SA business model and strategy in response to these macro trends.

This teaching case is aimed at postgraduate students, particularly those pursuing MBA, EMBA and Postgraduate Diploma programmes, as well as specialist masters and executive education. The students should have some work experience to comprehend and assess the case from a practical perspective.

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 8: Marketing.

In January 2013, small biotechnology firm Orexigen was in the final stages of testing Contrave, a promising new pharmaceutical product for the treatment of obesity. At the time, Orexigen had no products in the market, so all its hopes of financial success rested on this new treatment. Contrave had proven to be highly effective in clinical trials, and Orexigen executives were confident it would receive FDA approval.

At the same time, a much larger pharmaceutical company was considering acquiring Orexigen. Because the decision to acquire would ultimately be a financial one, the project team from the large company had to complete a valuation for Orexigen's only significant product in its pipeline, Contrave. What was the new product actually worth?