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In December 2004, Donald Berwick, MD, president and CEO of the Institute for Healthcare Improvement (IHI), challenged U.S. hospitals to reduce unnecessary deaths by 100,000 within the following 18 months. By the end of this 18 month period, over 3,100 hospitals enrolled in the "100,000 Lives Campaign," representing more than 70 percent of U.S. hospital beds. Calculations estimated that approximately 123,000 preventable deaths were avoided in participating hospitals. The case describes the state of quality in the healthcare industry, the history of the IHI, and the IHI's efforts to bring modern quality practices to health care. After seeing pockets of improvement, the IHI launched the 100,000 Lives Campaign in an effort to stimulate large scale change. The campaign approach incorporated lessons from political campaigns and social activism. The operation of the campaign is described. The impact of the campaign on hospitals is also discussed, with particular emphasis on one hospital that used the campaign as the basis for fundamental transformation.

In 1993, Nuria Chinchilla had recently completed her doctoral thesis at IESE Business School in Barcelona, on the topic of organizational turnover, with no particular focus on women, flexible work arrangements, or work-family issues. She chose to remain at IESE, where she had worked since the early 1980s as an assistant professor. By 2003, just over a decade later, she had attained the rank of full professor, had founded the International Center of Work and Family at IESE, and was generally acknowledged to be a leader if not the leader in workplace flexibility and work-family issues internationally, attending conferences all over the globe and being extremely visible in the media. Many observers echoed the comments of Gloria Renom, a deputy in the Catalonia parliament: "for a long time, Nuria has been considered the leading authority in the field of work-life balance." Renom attributed Nuria's success to a good understanding of the themes involved and intense preparation for the challenges she faced. Indeed, how else to explain Chinchilla's remarkable ability to influence others and to use a number of levers of power extremely successfully? It was not clear how Chinchilla had accomplished so much in so short a time, and what else she might do to be even more effective in obtaining changes in workplace flexibility in the future. And there was another interesting aspect to her career. Chinchilla seemed to have largely surmounted the trade-offs faced by so many people in positions of power-the apparent need to choose between having influence and being true to one's values and beliefs, as well as the choice between one's work and the rest of one's life. How had she been able to accomplish this?

This five-case series, sold as a package, presents an opportunity for students to understand that having the leadership mindset is not about going from crisis to crisis, but anticipating and shaping your organization. Through four case scenarios, students learn the need to recognize when there is a crisis situation, explore problems that often occur when issues are ignored, and take appropriate actions to remedy the situation. In the (A) case, students become a member of the senior executive team at Treading H2O Inc., a water-treatment equipment company located in the Midwestern United States, at a meeting to discuss a recently released World Health Organization (WHO) report. The statement announced that there was indication of human-to-human transmission of the Avian Flu in rural China near Shanghai. The company's regional sales manager sent information stating that the Chinese government had closed off access to the region?a key area for sales. On top of that, there are several Treading H2O employees in the same area. Students must determine what, if anything, needs to be done.

This five-case series, sold as a package, presents an opportunity for students to understand that leadership mindset is not going from crisis to crisis, but anticipating and shaping your organization. Through four case scenarios, students learn the need to recognize when there is a crisis situation, explore problems that often occur when issues are ignored, and take appropriate actions to remedy the situation. In the (B) case, one month has elapsed since executives at H2O Inc., first learned of an Avian Flu outbreak in China and Indonesia. More cases have surfaced in Europe and now the United States. The leadership team meets to discuss the contents of an e-mail from the plant manager. The team must now prioritize what needs to be done based on the latest challenges.

This case focuses on the financial difficulties faced in the US from August to December 2006 as well as their roots in subprime lending. After briefly discussing how mortgages were structured and traded in the pre-1990 period, it describes subprime mortgage lending, as well as other innovative mortgages issued in the 1990s. It also discusses how these mortgages were packaged into securities, and who ultimately came to own these claims and their attendant risk. The case then describes the pain inflicted by raising foreclosures, as well as the financial market ramifications of the rise in mortgage delinquencies. It also chronicles the response of the US and European central banks to the unfolding financial difficulties. Lastly, the case lays policies that have been proposed to deal with either the consequences or the causes of the crisis. These include policies for reforming the supervision of the financial system, changing bankruptcy rules and regulating mortgage finance. Some attention is paid to the role of credit rating agencies in the crisis, and in the financial system as a whole.

Spreadsheet Supplement for case 708042.

Spreadsheet Supplement for case 108038

This note defines the concepts of business model and the value loop. It also introduces business model representations and proposes four tests for evaluating business models in isolation. This is the first note in a series of three written for the HBS elective course "Competing through Business Models."

In 2007, Allstate was the number two property and casualty insurer in the USA, and had enjoyed five years of rapid profit improvement. The question facing CEO Thomas J. Wilson was how to maintain the momentum. This case tracks the evolution of Allstate's strategy over 20 years, examining the logic behind the strategic changes, and the challenges of implementing them. It identifies sources of inertia from within the organization and from without, and summarizes the strategic issues facing Allstate in early 2007.

"Wal-Mart's Use of Interest Rate Swaps" recounts Wal-Mart's use of interest rate swaps to hedge the fair value of its fixed-rate debt against changing interest rates. This case provides students with a foundation for understanding the use of and accounting for more complex derivatives. Specific issues raised include: (1) the financial statement impact of hedge accounting, (2) motivations for using derivatives, including the potential role of accounting standards, and (3) the degree to which financial statement and MD&A disclosures are sufficiently informative about the risks associated with financial instruments.

In the highly competitive information technology outsourcing industry, Cognizant Technology Solutions has developed a strategy to differentiate itself by emphasizing building very close client relationships through its "Two-in-a-box" (TIB) model. This model is based on having two people share complete responsibility for the client. In the U.S. or Europe, the "on-site" person, along with his or her relationship management team, is responsible for understanding the client's needs, obtaining projects and properly scoping out the work. The "offshore" person in India or elsewhere, along with his or her delivery team, is responsible for completing the project in a high quality and timely way. The same top- and bottom-line metrics are used to evaluate the performance of both the on-site and offshore managers. This strategy (as opposed to ones based on things like low cost and innovation used by Cognizant's competitors) is intended to build deep and strong client relationships that will maximize Cognizant's "share of wallet." One interesting aspect of TIB is Cognizant Business Consulting, a 1,700-person group which advises clients in the context of helping them develop IT solutions for their business challenges. More recently, and as the next evolution of the TIB model, Cognizant is developing what it calls "Cognizant 2.0" or C2. C2 is a delivery platform based on Web 2.0 technology that enables Cognizant to subdivide work into tasks that can be allocated wherever in the world the best resources within Cognizant exist based on cost, expertise and availability while at the same time maintaining collaboration and integration to ensure timely and high quality delivery.

Juliana Azevedo Schahin, a local marketing director for Procter & Gamble in Sao Paulo, had worked closely with Tarek Fahahat, a regional executive based in Caracas, to solve the growth and profitability problems of P&G Brazil. They did so through the creation of lower-cost versions of two premium products which reached BOP (bottom of the pyramid) consumers--an approach not considered then as a company strategy. The case follows Azevedo and Farahat through their steps in helping to conceive the change, sell it to senior management, and implement it. The true test comes when the subsidiary wants to extend the model to its third and largest category, laundry care, which had also struggled. But Azevedo did not oversee that business in Brazil, and Farahat worked in another category in Caracas. Her country colleagues go to her to learn more about the success of the first two products. Now the question is whether this is a one-time wonder or an innovation that should be diffused to other products and geographies.

Supplements with the (A) Case.

Although biofuels had been used for many years (from 1980 to mid-2007, an estimated 2 trillion miles were driven on ethanol-blended fuels in the United States), it was not until the late 20th and early 21st centuries, with dwindling oil supplies, the threat of global warming, and unrest in the oil-rich Middle East that people began thinking of them seriously as alternatives to petroleum-based fuel. Biofuels were also considered better for the environment than gasoline because they produced far less carbon monoxide, carbon dioxide, sulfur dioxide, and particulate matter, and fewer toxic contaminants, hydrocarbons, and volatile organic compounds. This note describes biofuel production and the many effects its increasing use had on the energy supply, agriculture, and the environment. The use of biofuels was not without controversy, and this note is a good starting point for students who can be asked to research further and identify and discuss the issues presented by biofuel use.

The diamond industry has been subject to significant change. There is increased competition from low-wage countries such as India and China, the concern about blood diamonds, and policy issues affecting the viability of trading diamonds. In this case, we study how Antwerp's dominant position in the diamond trade is being challenged and eroded. The case offers a good opportunity to introduce and discuss comparative advantage and relate it to Heckscher-Ohlin type of trade.

The alcohol cooler (refreshment) market in Canada was already crowded, but the marketing manager at Vincor believed there was still room for a new entrant, provided it was sufficiently differentiated. The case provides market research information on which the decision-maker relies to develop a product positioning. Trade-offs need to be made between various positioning options and costs. The case deals with marketing issues from the perspective of the brand manager launching a new product.

A search fund is a pool of capital raised to financially support the efforts of an entrepreneur, or a team of entrepreneurs, to locate a privately held company for acquisition. This study, as well as its predecessors in 1996, 1998, 2001,2003, and 2005 portrays the aggregate profile of search funds and the entrepreneurs who formed them, and evaluates the investment returns generated by first-time search funds to their original investors. Together, these studies reflect changes in the characteristics of search fund entrepreneurs and the performance of their funds over time.

In 2007, corporate governance became a well-discussed topic in the business press. Newspapers produced detailed accounts of corporate fraud, accounting scandals, excessive compensation, and other perceived organizational failures-many of which culminated in lawsuits, resignations, and bankruptcy. Central to these stories was the assumption that somehow corporate governance was to blame. That is, there was a functional failure in the system of checks and balances established to prevent abuse by executives. This case explores the various corporate governance systems that have been adopted in the United States and in various countries in Europe and Asia. The issues of control, director independence, auditor independence, dual-board versus unitary-board structure, comply-or-explain, and legislative versus market-driven solutions are explored. Readers are asked to evaluate what governance systems or elements they consider to be most effective. Plentiful examples--including Johnson & Johnson, BMW Group, Michelin, Heineken, Toyota, Samsung, Posco, PetroChina, Infosys, and many others--are used throughout as illustration.