This case explores the experiences of three Manhattan-based hospitals during Superstorm Sandy in 2012. Beginning with an overview of how the hospitals prepared in the months and days leading up to the storm, it focuses primarily on decisions made by each institution, as Sandy approached, about whether to shelter-in-place or evacuate hundreds of medically fragile patients -- the former strategy running the risk of exposing individuals to dangerous and life-threatening conditions, the latter being an especially complex and difficult process, not without its own dangers. Ultimately, each of the three hospitals profiled in the case took a different approach, informed by their differing perceptions of risk and other unique circumstances. The case illustrates the very difficult trade-offs hospital administrators and local and state public health authorities grappled with as Sandy bore down on New York and vividly depicts the ramifications of these decisions, with the storm ultimately inflicting serious damage on Manhattan and across much of the surrounding region.
When Dr. John Kitzhaber became Oregon's Governor in January 2011, the state faced a reported $2 billion deficit in the state's Medicaid budget. Consequently, Kitzhaber, working in partnership with his top health policy advisors and an array of stakeholders, undertook a multi-year effort to transform the state's Medicaid delivery system. At the time, that system consisted of separate managed care organizations for different kinds of providers; but in July 2012 the state unveiled its first coordinated care organizations (CCOs), local "umbrella" groups that would bring together an area's health care providers in a single managed care setting. The case details the effort to design, implement, and begin to evaluate CCOs. After providing background on the history of health care reform in Oregon and the recent passage of the federal Affordable Care Act, it overviews the effort to bring together an array of local stakeholders to develop a blueprint for CCOs, the subsequent focus on gaining approval for CCOs from the state legislature and federal government, and finally the process of implementing CCOs and beginning to gauge their impact. The case concludes in March 2015 when Governor Kitzhaber resigned amid concerns about the state's efforts to establish Cover Oregon, the organization set up to create the state's health insurance exchange under the federal Affordable Care Act.
In spring 2009, North Dakota experienced some of the worst flooding in state history. This case describes how the state's National Guard responded by mobilizing thousands of its troops and working in concert with personnel and equipment from six other states as well as an array of federal, state, and local stakeholders. Specifically, after providing background on the North Dakota National Guard and the state's susceptibility to flooding, the case captures how Guard officials developed and practiced a plan ("Operation Rollback Water") to respond to the floods and how they then had to adapt that plan as the crisis escalated and conditions changed. In particular, the Guard had to work with a large amount of federal resources that arrived amid the crisis, it had to respond to demands for extensive and rapid assistance from a range of municipalities, and it had to endure a prolonged event that taxed Guard members in the field and the operations and management team that supported them. The case concludes with an epilogue that describes how the Guard applied the lessons it learned from the 2009 floods in response to a similar disaster in 2011.
In spring 2009, North Dakota experienced some of the worst flooding in state history. This case describes how the state's National Guard responded by mobilizing thousands of its troops and working in concert with personnel and equipment from six other states as well as an array of federal, state, and local stakeholders. Specifically, after providing background on the North Dakota National Guard and the state's susceptibility to flooding, the case captures how Guard officials developed and practiced a plan ("Operation Rollback Water") to respond to the floods and how they then had to adapt that plan as the crisis escalated and conditions changed. In particular, the Guard had to work with a large amount of federal resources that arrived amid the crisis, it had to respond to demands for extensive and rapid assistance from a range of municipalities, and it had to endure a prolonged event that taxed Guard members in the field and the operations and management team that supported them. The case concludes with an epilogue that describes how the Guard applied the lessons it learned from the 2009 floods in response to a similar disaster in 2011.
In spring 2009, North Dakota experienced some of the worst flooding in state history. This case describes how the state's National Guard responded by mobilizing thousands of its troops and working in concert with personnel and equipment from six other states as well as an array of federal, state, and local stakeholders. Specifically, after providing background on the North Dakota National Guard and the state's susceptibility to flooding, the case captures how Guard officials developed and practiced a plan ("Operation Rollback Water") to respond to the floods and how they then had to adapt that plan as the crisis escalated and conditions changed. In particular, the Guard had to work with a large amount of federal resources that arrived amid the crisis, it had to respond to demands for extensive and rapid assistance from a range of municipalities, and it had to endure a prolonged event that taxed Guard members in the field and the operations and management team that supported them. The case concludes with an epilogue that describes how the Guard applied the lessons it learned from the 2009 floods in response to a similar disaster in 2011.
In summer 2010, unusually intense monsoon rains in Pakistan triggered slow-moving floods that inundated a fifth of the country and displaced millions of people. This case describes how Pakistan's government responded to this disaster and highlights the performance of the country's nascent emergency management agency, the National Disaster Management Authority. It also explores the integration of international assistance, with a particular focus on aid from the international humanitarian community and the U.S. military. Case number 2015.0
By the mid-2000s, Washington State's Department of Health (DOH) had earned a national reputation as an innovative and effective agency. But beginning in 2005, when newly elected Governor Christine Gregoire introduced a state-level performance management system - Government Management Accountability and Performance (GMAP) - DOH and other state entities found themselves having to regularly explain and justify their work through the newly established forum. Based on two similar, but smaller-scale programs - CompStat (created by the New York Police Department in 1994) and CitiStat (used by the City of Baltimore) - GMAP challenged public officials to analyze data in new ways and to rethink the kinds of results that they were accountable for delivering. This case provides background on GMAP's origins and on the general ways in which the initiative was managed, but it focuses primarily on DOH's efforts to comply with the new performance measurement requirements and to meet the expectations of the governor, her staff, and GMAP leadership. In exploring the benefits and challenges of the department's experience with GMAP, the case also raises questions about the applicability and usefulness of such a system for public health, which tends to address complex issues with objectives that are often difficult to quantify. Case number 1994.0
The December 26, 2004, Indian Ocean tsunami caused tremendous damage and suffering on several continents, with Indonesia's Aceh Province (located on the far northern tip of Sumatra Island) experiencing the very worst. In the tsunami's wake - and with offers of billions of dollars of aid coming from all corners of the globe- the Indonesian government faced the daunting task of implementing a massive recovery effort that could meet the expectations of donors and survivors alike. With this in mind, Indonesia's president established in April 2005 a national-level, ad hoc agency -- known by its acronym, BRR -- to coordinate reconstruction activities across the province. This case examines some of the core challenges BRR's leaders encountered as they moved to set up the agency and then proceeded to coordinate and execute a recovery process involving hundreds of domestic and international partner organizations and thousands of independent reconstruction projects. Case Number 2010.0
In 2006, with healthcare costs and the number of uninsured rising, Massachusetts passed landmark legislation that aimed to provide health insurance to everyone in the state. A product of bipartisan collaboration between a legislature dominated by Democrats and a Republican governor, the law contained several major innovations, including: mandates requiring residents to purchase health insurance and businesses to contribute toward employees' health care costs; programs to offer subsidized health insurance plans to low-income residents and to help wealthier individuals and small businesses buy coverage from private providers; and an expansion of the state's Medicaid program to cover more children in low-income families. This case explores some of the initial successes of the law's implementation, but also describes a number of challenges associated with it- not least of which was that within a year of the law's passage, Massachusetts, along with the rest of the nation, would endure a severe and protracted recession. Worsening economic conditions not only led to worries about the cost of expanding healthcare coverage, but also had serious implications for wellness initiatives and public health programs, which faced dramatic budget cuts. Exploring both the policy innovations of the law and the negative consequences of a poor economy, the case raises a number of points about the potential benefits of near-universal healthcare - while highlighting some officials' concerns that an overemphasis on expanding coverage could detract from other investments in public health programming. Case number 1995.0
In late 2008, government officials in Summit County, Ohio began to discuss the possibility of combining the county's three public health districts. These early discussions set the stage for more than two years of negotiations that eventually led to the consolidation of the health departments in late 2010 and early 2011. This case tells the story of why and how officials in Summit County combined their public health districts and includes an epilogue that describes the consolidated agency's first year of operations. Case number 1987.1
In late 2008, government officials in Summit County, Ohio began to discuss the possibility of combining the county's three public health districts. These early discussions set the stage for more than two years of negotiations that eventually led to the consolidation of the health departments in late 2010 and early 2011. This case tells the story of why and how officials in Summit County combined their public health districts and includes an epilogue that describes the consolidated agency's first year of operations. Case number 1987.0
Following the sinking of the Deepwater Horizon drilling rig in late April 2010, the Obama administration organized a massive response operation to contain the enormous amount of oil spreading across the Gulf of Mexico. Attracting intense public attention and, eventually, widespread criticism, the response adhered to the Oil Pollution Act of 1990, a federal law that the crisis would soon reveal was not well understood - or even accepted - by all relevant parties. This two-part case profiles the efforts of senior officials from the U.S. Department of Homeland Security as they struggled to coordinate the actions of a myriad of actors, ranging from numerous federal partners (including key members of the Obama White House); the political leadership of the affected Gulf States and sub-state jurisdictions; and the private sector. Case A provides an overview of the disaster and early response; discusses the formation of the National Incident Command (NIC), which had responsibility for directing response activities; and explores the NIC's efforts to coordinate the actions of various federal entities. Case B focuses on the challenges the NIC encountered as it sought to engage with state and local actors - an effort that would grow increasingly complicated as the crisis deepened throughout the spring and summer of 2010. Case number 1982.0
Following the sinking of the Deepwater Horizon drilling rig in late April 2010, the Obama administration organized a massive response operation to contain the enormous amount of oil spreading across the Gulf of Mexico. Attracting intense public attention and, eventually, widespread criticism, the response adhered to the Oil Pollution Act of 1990, a federal law that the crisis would soon reveal was not well understood - or even accepted - by all relevant parties. This two-part case profiles the efforts of senior officials from the U.S. Department of Homeland Security as they struggled to coordinate the actions of a myriad of actors, ranging from numerous federal partners (including key members of the Obama White House); the political leadership of the affected Gulf States and sub-state jurisdictions; and the private sector. Case A provides an overview of the disaster and early response; discusses the formation of the National Incident Command (NIC), which had responsibility for directing response activities; and explores the NIC's efforts to coordinate the actions of various federal entities. Case B focuses on the challenges the NIC encountered as it sought to engage with state and local actors - an effort that would grow increasingly complicated as the crisis deepened throughout the spring and summer of 2010. Case number 1981.0
When Indiana State Health Commissioner Dr. Judy Monroe learned of the emergence of H1N1 (commonly referred to as "Swine Flu") in late April 2009, she had to quickly figure out how to coordinate an effective response within her state's highly balkanized public health system, in which more than 90 local health departments wielded considerable autonomy. Over the next several months, she would come to rely heavily on relationships she had worked hard to establish with local health officials upon becoming commissioner -- but she and her senior advisors would also have to scramble to find new ways to communicate and coordinate with their local partners, who represented jurisdictions that varied considerably in terms of size, population demographics, resources, and public health capacity. Case Number 1974.0
On January 15, 2009, shortly after takeoff from LaGuardia Airport, US Airways Flight 1549 struck a flock of Canada geese. The geese were then sucked into the plane's twin engines, causing total engine failure and the loss of power. Case A of this three-part series recounts how over the following four minutes, Flight 1549's Captain Chesley "Sully" Sullenberger and First Officer Jeffrey Skiles grappled with a variety of extreme challenges. Not only did they have to keep the plane under control, but they also had to quickly decide whether they could make an emergency landing at a nearby airport - or find another alternative to get the plane down safely in one of the most crowded regions in the country. Cases B and C then describe how, after the plane landed in the cold waters of the Hudson River, emergency responders from many agencies and private organizations - converging on the scene without a prior action plan for this type of emergency - scrambled to both rescue passengers and crew and stabilize the aircraft as it began to move downstream. Case Number 1966