The application of information technology to healthcare promises significant benefits, particularly with regard to innovations in improving both clinical and administrative processes. However, to date, few studies have been devoted to understanding the process of implementing a hospital's clinical and business systems and the drivers of success. In this article, we describe a major HIT implementation undertaken by The Christ Hospital (TCH). Specifically, we report on TCH's efforts to separate from a well-established, multi-facility healthcare delivery network and move toward providing world-class patient care on its own. Here, we examine how different stakeholder perspectives, rather than causing conflict, were capitalized on via a collaboration-intensive process. These stakeholders included administrators, physicians, nurses, and other hospital staff, as well as external vendors and TCH's consulting partner. This project is unique due to the speed and spirit of collaboration with which it was accomplished. Our findings have a number of generalizable lessons for practice and implications for research.

Many serious medical errors result from violations of recognized standards of practice. Over time, even egregious violations of standards of practice may become "normalized" in healthcare delivery systems. This article describes what leads to this normalization and explains why flagrant practice deviations can persist for years, despite the importance of the standards at issue. This article also provides recommendations to aid healthcare organizations in identifying and managing unsafe practice deviations before they become normalized and pose genuine risks to patient safety, quality care, and employee morale.

Two significant concerns in healthcare are spiraling costs and medical errors. These two concerns are correlated: eliminating medical errors leads to significant cost reductions. We provide an example, ThedaCare Inc., where both problems are improved by providing mechanisms that stop healthcare processes. While businesses often view having their processes stopped as a negative, increasing the stoppages, or creating process failures, is often a precursor to improved performance. A good rule of thumb is: if in doubt, stop. This concept of creating or engineering stoppages in the processes is linked to two "lean" concepts that come from the Toyota Production System: jidoka and poka-yoke. A spectrum of methods for stopping processes is discussed, ranging from warnings in the work environment to mechanical devices designed to stop processes and empower humans to stop the process. The preliminary results achieved at ThedaCare demonstrate the financial and medical improvements that may be obtainable from utilizing these methods.

Critics of the American healthcare system recite a long list of problems, including rising out-of-pocket costs, inconvenient access, overuse of emergency departments, uncoordinated medical records, and declining numbers of primary care doctors. To address these issues, some new venues have evolved, such as retail and urgent care clinics; however, the emergency department has become the only service provider available to all patients on a 24/7 basis. It is time to reinvent the system. The concept of patient-centered medical homes offers a structure for integrating innovations that can transform the delivery of healthcare. In this model, each patient develops an ongoing relationship with a primary care physician supported by a team of caregivers. An integral feature is the electronic medical record, which facilitates coordinated communication and decisions. Access expands beyond the traditional physician office visit to satellite services tailored to individual needs. Services center on whole-person care, including wellness and preventive counseling, as well as acute and chronic care. Adoption of the patient-centered medical home transforms healthcare delivery into a system that benefits everyone.

Consumer-directed healthcare promises to reduce costs and increase quality by expanding provider choice for prospective patients. High-deductible insurance, employer- or government-subsidized health savings accounts, transparent pricing, and accurate information on clinical performance help generate millions of patients shopping for healthcare. As in any other well-behaved market, when patients shop, there is a link between financial reward and value for the individual patient. Absence of price competition, agency problems, and high barriers to entry in local markets are market failures that currently break this link in U.S. healthcare. Consumer-directed health plans are already popular among many employers and have established a momentum that indirectly shapes discussion of reform by the Obama administration. Complexity of reporting clinical results, dependence of treatment success on at-home patient behavior, and scientific ignorance among consumers threaten delivery of results promised by theory. Successful implementation requires regulator attention to sophisticated data reporting that adjusts for clinical risk, avoidance of patient-focused marketing that leads to over-consumption, and adequate subsidy of health savings accounts. In the end, implementation shifts the locus of healthcare system control from cost-shifting negotiations between employers, providers, and payers to new-found purchasing power of prospective patients.

Life sciences and healthcare enterprises represent the largest industry in the U.S. economy. Given the importance of this sector, there is increasing demand for financial valuation of both publicly and privately held companies. At the same time, accurate valuation is particularly difficult in light of shifting business models, the current economy, intellectual property rights issues, continuous innovation in the sector, changing population demographics, quality issues, and government involvement in healthcare debate, discussion, and regulation. Herein, we examine the changing and increasingly problematic valuation of life sciences and healthcare enterprises that have obvious importance from a social welfare perspective.

There are an estimated 46 million Americans without health insurance and an even larger number for whom health insurance does not cover all needed medical services. These individuals and families have to rely more and more on government programs and physicians' willingness to provide uncompensated services, most often described by providers as charity care. Previous studies have shown a downward trend in the percent of physicians willing or able to provide charity care. We extend this research by examining the results of the Medical Group Management Association's Cost Survey of Medical Group Practices for 2005, 2006, and 2007. It is important to examine the uncompensated care reported by medical groups because groups have policies that may govern how much, if any, charity care their physicians provide. This survey data shows that, overall, the number of medical practices providing charity care continues to decline. The results and analysis of the survey data indicate that uncompensated (charity) care is being offered by less than half of medical practices, and at less than 2% of total gross charges. We examined the results by potential explanatory variables: population density, practice size, physician practice specialty, practice ownership structure, payer mix, and practice financial performance. Results were consistent across all categories; charity care is declining. These results have major policy implications for both the federal government and all state governments, especially in light of the current recession and proposed healthcare reform legislation.

Within the past 20 years, consumer advertising of prescription drugs has grown from a rarity to one of the most pervasive forms of consumer advertising, with ads for antidepressants and heart medications now as common as those for fast food and automobiles. At the same time, direct-to-consumer (DTC) advertising has attracted a growing chorus of criticism from consumer advocates, health professionals, and elected officials. This article explores the extent to which such criticism has merit and the extent to which it lacks soundness. Specifically, the article casts doubt on the charges that (1) DTC advertising is deceptive; (2) DTC downplays product risks; (3) DTC focuses on trivial or imaginary maladies; (4) DTC doesn't promote non-pharmaceutical solutions to health problems; (5) DTC harms the doctor-patient relationship; and (6) DTC is responsible for the rapid rise in drug costs.

By 2009, China's exports had increased dramatically from $250 billion in 2000 to a projected $1,500 billion in 2009. This enormous growth of exports severely damaged competing businesses in the advanced nations, particularly the United States and Europe. China's entry into the World Trade Organization (WTO) in 2001 guaranteed China's right to export to these nations, but at the same time the WTO required China to adhere to certain rules that sought to support fair trade and create a level playing field. Several broad subjects each gave rise to a series of trade disputes: the protection of intellectual property, health and safety concerns about China's products, labour and environmental standards, China's manipulation of their currency, and costs and prices determined by the government rather than free markets. This case examines each set of trade disputes and China's attempts to resolve them. Many disputes were embedded in cultural practices and ideological positions and so they might not disappear quickly. Shortcomings in China's legal and judicial system hampered enforcement. In addition, many rested on the government's desire to protect the interests of Chinese businesses and their employees, and so China might alter its practices only if confronted with credible retalitory threats. China's central government experienced the principal-agent problem where its wishes and decisions could be ignored by local governments and firms. Meanwhile, changes in industry structure within the advanced nations were altering the negotiation positions of Western governments. The case examines the WTO dispute resolution procedures and enforcement mechanisms that have been directed at China's trade disputes.

This note develops a comprehensive new set of concepts to understand buying processes of parents choosing among complex educational services using the example of Montessori private schools.

This note develops a comprehensive new conceptualization of the complex processes that accompany large scale high technology product/service bundles using the example of nuclear power plants.

This note develops a comprehensive new set of concepts to understand buyer behaviour for complex high technology consumer products using the example of notebook computers.

In early 2009 Andrew Sears, Executive Director of TechMission, a Christian social service nonprofit, faced a challenge known to many not-for-profit organizations, how to develop a sustainable organization, especially in an economic climate where charitable giving had declined. With limited resources and an expanding portfolio of programs, he had to balance three competing factors within TechMission: staying true to its Christian principles, sustaining its credibility in urban communities, and using technology as the driver for promoting social justice. Different initiatives presented different paths for potential growth. As well as determining the correct path, Sears knew that any path would require obtaining additional funding, potentially from secular organizations. The challenge was securing this funding in a tightening market and then allocating it to the initiatives that had the most potential. Additionally, it would be necessary to assure that all initiatives had the right programs, people and funding to move forward.

Within 10 months of Gregg Steinhafel's taking over as CEO at Target, the U.S. was mired in the most significant economic downturn in 50 years. Top competitor Wal-Mart had positioned itself well for the crisis, while Target's same store sales began to slide. While Steinhafel believed that Target's long-term strategy and positioning were right, he pondered a set of strategic and operational challenges. Did Target have the right mix of offensive and defensive tactics to weather the downturn and position itself for the economy's eventual recovery? How far could Target go in emphasizing low price-the "pay less" side of its slogan-without eroding the company's core promise of offering unique and upscale products that customers would not see at other low-priced retailers? Would the benefits of adding fresh food to Target's general merchandise stores outweigh the associated challenges?

In 2010, Corrections Corporation of America (CCA), the largest private prison operator in the U.S., was considering expansion options. The company's largest customers, federal and state governments, were under economic pressure to reduce the incarceration rate and lower operating costs, potentially jeopardizing CCA's profits. Should CCA follow its competitor's footsteps and expand overseas? Or could it count on an ever-increasing population of U.S. prisoners to fuel continued growth?

In the summer of 1931, Germany was struggling with a deepening economic crisis. Production had fallen, unemployment was high, and bank deposits and gold were being withdrawn from the country at a rapid pace, threatening the value of the German mark. The country's third largest bank, the Danatbank, was especially hard hit by the flagging economy and the flight of capital. By July, the Danatbank was on the verge of collapse, and the bank's charismatic and controversial senior partner, Jakob Goldschmidt, appealed personally to the government, the central bank, and his private banking rivals for a lifeline.

Sweden's Highland District County Hospital, similar to a community hospital in the US, undertook a major restructuring to integrate care delivery for medical conditions served by the Department of Medicine. Each subspecialty within the Department would form a single, co-located unit with its own budget that encompassed both inpatient and outpatient care. This case examines the experience of the Highland Gastroenterology Unit, comparing the delivery model for inflammatory bowel disease in 2001 and 2009, before and after the reorganization. The case can be used to examine health care provider strategy, integrated care delivery, and quality measurement. The case also profiles Sweden's single-payer health care system, allowing for a discussion of national health systems and health policy.

Describes the steps the vice-president of human resources takes in revamping an HR function that was noncooperative and, at times, competitive and introducing the company to the notion of HR as a strategic business partner. Explores changes made to the company's compensation, performance management, and succession planning processes.

In 2009 several companies were competing in the UK for a share of the fast-growing online grocery market, using two different business approaches. Ocado, a purely online grocer operated out of a dedicated distribution center. The company was founded by three former investment bankers in early 2000. By 2009 Ocado had grown from its original three founders to over 3,000 employees and was just about to become profitable. It faced competition from Tesco.com, the biggest online grocer in the world. Tesco, the UK's leading supermarket chain, had started an internet add-on to its regular business and used existing supermarkets to run its online operations. Learning objectives: This case compares Ocado and Tesco.com business models from a consumer proposition, operational efficiency, profitability and sustainability point of view. Participants will be challenged to think about the challenges online grocers face to meet shoppers' expectations, how operational choices impact the consumer proposition and what opportunities both companies have to further grow their business.

In 2009 several companies were competing in the UK for a share of the fast-growing online grocery market, using two different business approaches. Ocado, a purely online grocer operated out of a dedicated distribution center. The company was founded by three former investment bankers in early 2000. By 2009 Ocado had grown from its original three founders to over 3,000 employees and was just about to become profitable. It faced competition from Tesco.com, the biggest online grocer in the world. Tesco, the UK's leading supermarket chain, had started an internet add-on to its regular business and used existing supermarkets to run its online operations. Learning objectives: This case compares Ocado and Tesco.com business models from a consumer proposition, operational efficiency, profitability and sustainability point of view. Participants will be challenged to think about the challenges online grocers face to meet shoppers' expectations, how operational choices impact the consumer proposition and what opportunities both companies have to further grow their business.