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In the late 1990s, home-based hospital care started to be introduced in the United States and worldwide. This initiative seemed to lower costs, improve quality of care, and have a generally positive impact on patients. In early March 2014, the director of performance improvement at a major U.S. hospital was asked to develop a proposal, including a business case and an outline of a pilot program, for a version of home-based hospital care for the hospital's patients. The director was expected to present his proposal at the monthly session of the health system leadership team on April 30, 2014. He knew that his proposal would have to take into account various factors such as location, medical condition coverage, patient eligibility, the critical data that needed to be collected, the appropriate means of data collection, and the length that the pilot study would need to last. He also knew that his proposal would have to include projected costs and the potential benefits of such a program -- the program had to make financial sense.

In the late 1990s, home-based hospital care started to be introduced in the United States and worldwide. This initiative seemed to lower costs, improve quality of care, and have a generally positive impact on patients. In early March 2014, the director of performance improvement at a major U.S. hospital was asked to develop a proposal, including a business case and an outline of a pilot program, for a version of home-based hospital care for the hospital's patients. The director was expected to present his proposal at the monthly session of the health system leadership team on April 30, 2014. He knew that his proposal would have to take into account various factors such as location, medical condition coverage, patient eligibility, the critical data that needed to be collected, the appropriate means of data collection, and the length that the pilot study would need to last. He also knew that his proposal would have to include projected costs and the potential benefits of such a program -- the program had to make financial sense.

The director of human resources must contend with internal and external pressures to make changes quickly and smoothly for the new year. She had been with the company for six months. In her capacity as director of human resources, she had spent her time establishing a baseline for the division so that she could then create a departmental vision and strategy for 2000. It would be one of the most interesting challenges of her career. Since joining, she had gained an understanding of the division's future direction from its leadership team. The team was under the direction of the division's new general manager.

The general manager must determine how to contend with a project overrun. The team had been working on their project for more than two years. In their presentation of the projected budget and schedule to the executives, the team identified a potential $1 million overspend in order to satisfy their contract. Their original budget was $3.5 million, of which $2.5 million was provided by the company. When the general manager questioned team members during the presentation about what had caused the overrun, he was amazed that the team was unable to respond.