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A large, international benevolent association operating 22 children’s hospitals and four research centres in three countries has been negatively impacted by a number of external factors. The effect of the 2008 global financial crisis on its endowment funds coupled with rising health care costs and flat donations, have resulted in the hospitals running at a loss. To ensure the long-term viability of their not-for-profit hospital system, management feels it must present drastic options to delegates at its annual general meeting, including reconsidering the policy of providing free medical care to children regardless of their ability to pay, shutting down research facilities and closing over a quarter of their hospitals. While management is confident that the quality of care for pediatric patients will not be compromised, all of the options being considered will significantly impact hospital operations and the organization’s culture. For the first time in the 87 years of the organization’s existence, some very difficult options are on the table.

A large, international benevolent association operating 22 children's hospitals and four research centres in three countries has been negatively impacted by a number of external factors. The effect of the 2008 global financial crisis on its endowment funds coupled with rising health care costs and flat donations, have resulted in the hospitals running at a loss. To ensure the long-term viability of their not-for-profit hospital system, management feels it must present drastic options to delegates at its annual general meeting, including reconsidering the policy of providing free medical care to children regardless of their ability to pay, shutting down research facilities and closing over a quarter of their hospitals. While management is confident that the quality of care for pediatric patients will not be compromised, all of the options being considered will significantly impact hospital operations and the organization's culture. For the first time in the 87 years of the organization's existence, some very difficult options are on the table.

This case chronicles the challenges of establishing an innovative tissue bank service to accelerate the research and development processes of biotechnology and pharmaceutical companies worldwide. Asterand’s two major challenges involved achieving a standardized approach to collecting tissue samples in hospitals all over the world and achieving the highest possible quality of tissue samples shipped to their primary customer, Amgen. Despite the identified need for high-quality tissue samples, Asterand was experiencing multiple quality control problems in their processes and procedures. Tissue samples were being packaged poorly, labeled incorrectly or delivered at the wrong time or to the wrong place. Additionally, there were quality issues with the RNA analysis of the samples, which was a critical factor in the usability of the tissue sample for research and development of new therapies and drugs. <br><br><br><br>The head of pathology at Amgen’s California facility was threatening to terminate their existing order and communicate the failure of Asterand to all company employees, which would have a devastating ripple effect across the industry and likely destroy opportunities for any future orders with Asterand. If this happened, Asterand would not be able to secure contracts with customers and was at risk of losing investors and going bankrupt.

This case chronicles the challenges of establishing an innovative tissue bank service to accelerate the research and development processes of biotechnology and pharmaceutical companies worldwide. Asterand's two major challenges involved achieving a standardized approach to collecting tissue samples in hospitals all over the world and achieving the highest possible quality of tissue samples shipped to their primary customer, Amgen. Despite the identified need for high-quality tissue samples, Asterand was experiencing multiple quality control problems in their processes and procedures. Tissue samples were being packaged poorly, labeled incorrectly or delivered at the wrong time or to the wrong place. Additionally, there were quality issues with the RNA analysis of the samples, which was a critical factor in the usability of the tissue sample for research and development of new therapies and drugs. The head of pathology at Amgen's California facility was threatening to terminate their existing order and communicate the failure of Asterand to all company employees, which would have had a devastating ripple effect across the industry and likely destroyed opportunities for any future orders with Asterand. If this happened, Asterand would not have been able to secure contracts with customers and would've been at risk of losing investors and going bankrupt.

Riverside District Memorial Hospital is a small rural hospital that must work within an operational budget that is determined by the Ministry of Health and Long Term Care. This case identifies the emergence of concerns for patient safety related to medication administration, and the challenges of ensuring that professional services are maintained by the pharmacy department to serve patients admitted to hospital. The chief nursing executive must decide what steps should be taken to reduce medication errors, in the context of the complex relationships at Riverside.

Riverside District Memorial Hospital (RDMH) is a small rural hospital that must work within an operational budget that is determined by the Ministry of Health and Long Term Care in a Canadian province. This case identifies the emergence of concerns for patient safety related to medication administration, and the challenges of ensuring professional services are maintained by the pharmacy department to serve patients admitted to hospital. The chief nursing executive (CNE) must decide what steps should be taken to reduce this exposure in the context of the complex relationships in which RDMH exists.