External cost pressures are motivating the adoption of case management (CM) at Beth Israel Deaconess Medical Center (BIDMC), but several of the organization's key professional groups are working against it. President and CEO David Dolins must decide whether CM is needed, and whether it is compatible with the employee-and patient-centered culture upon which BIDMC has built its success. CM has been touted in the health-care industry as a way to coordinate the complex, multidisciplinary process of patient care, in hopes of controlling costs without reducing quality. CM creates a new role that stands above the established disciplines--physicians, nurses, and social workers--to coordinate their activities and oversee their performance. The case describes the threat posed by CM to the professional status of physicians, social workers, and nurses. It also explores the coordination mechanisms already in place--care paths, primary nursing, care-management teams, and information systems--and questions whether CM is needed.

A synopsis of the writings of Edgar Schein, Modesto Maidique, and B.J. Zirger on what organizational culture is, where it comes from, how it can be changed, and how it inhibits change.