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Supplement for case HKS147

This case describes the task that confronted Coast Guard Captain Suzanne Englebert, the staff point-person who led an initiative to develop new regulations intended to improve the security of the nation's ports from terrorist attacks, in the wake of the September 11, 2001 attacks. It is intended for use in a strategic management class. Students are challenged to weigh an array of political, practical, legal, and technical considerations in assessing Englebert's approach. The case provides students with the background information they need to discuss the challenges inherent in tightening port security, including: basic information about the economic import of maritime trade, the range of conditions at US ports, the nature of international shipping and regulation, the particular problems posed by containerized shipping, and the kinds of terrorist attack foreseen by security experts. This case also describes several initiatives, undertaken in parallel, to improve port security immediately after 9/11, including immediate protocol shifts in the international ports, and bilateral negotiations with the largest ports outside the United States. The case introduces Englebert and describes her role in the Coast Guard's simultaneous efforts to work with US legislators to create a domestic port security law and with international partners in the International Maritime Organization to create a worldwide port security regime. The case ends with Englebert facing her next herculean task: to turn the mandates of the new federal law into specific, concrete regulations in just a few months' time. The case was designed as a companion piece to a dvd, case number: 1946.9. Case number 1946.0

This case describes a health care town hall meeting that was derailed by vocal protesters. The case was designed for a very specific teaching purpose: to discuss a variety of alternatives to the tried and true town hall meeting format which, the sponsoring professor believes, is not only quite vulnerable to disruption, but is not a terribly effective or democratic way to involve the public in local decision making, to begin with. Underlying the case is a belief that those who organize public engagements should be deliberate about: 1) the purposes of a public meeting: what a public meeting aims to do 2) the strategy of recruiting participants: who participates 3) the organization of discussion and decision making 4) the extent to which conclusions of the meeting will influence policy or public action The case itself provides a lively starting point for the conversation by describing how a modest Tampa meeting about local health care was overtaken by opponents of national health care reform. The case also provides as context background about the decision by Democrats in 2009 to sponsor health care town hall meetings across the country, in an effort to boost public support for health reform-an effort that was subverted when the meetings became the target of large, vocal, anti-health reform protests. HKS Case Number 1939.0

This case poses the question: given what was known at the time of its adoption, in February 2009, was the federal Health information Technology for Economic and Clinical Health Act good public policy? The HITECH Act, included in President Barack Obama's federal stimulus bill, was intended to introduce major incentives to encourage the spread of heath information technology throughout the U.S. health system. The case is ideal for a policy analysis class. The case assumes no special knowledge of the health care system or information technology, and provides students with several categories of background information: * The central criticisms of the US health system, and why health IT proponents thought health IT was an essential ingredient in solving these problems. * Evidence that use of health IT in the United States lagged behind (1) the health care systems of other industrialized nations and (2) the use of IT in other information-heavy US industries. * The reasons health care providers were not, on their own, investing in health IT at the level advocated by proponents. * Mixed evidence as to the advantages of health IT for US health care providers that had already adopted it. * The history of federal action (administrative and legislative) on health IT as of February 2009 and arguments, pro and con, for a more aggressive federal role. * A summary of the HITECH Act as proposed by the Obama Administration. The case equips students to stand in the shoes of Congressional decision-makers (or their advisers) in February 2009, and argue why they might either support or oppose this piece of legislation. The case may be used on its own. It may also be used as the first part of a two-case unit with HKS Case 1938.0, "B. Inciting a Computer Revolution in Health Care: Implementing the Health Information Technology Act." HKS Case Number 1937.0.

This case, ideal for strategic leadership classes, poses the question: given the ambitious goals of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act and the hurdles to its successful implementation, how should incoming National Coordinator for Health Information Technology David Blumenthal proceed? The case describes Blumenthal's resources, most notably: *$27 billion in Medicare and Medicaid incentives to hospitals, physicians, and other eligible providers who invested in ""certified"" electronic health systems *$2 billion in other funds to address specific obstacles to widespread acquisition of health IT systems. *Broad regulatory authority to define ""meaningful use"" and set certification criteria. It also describes Blumenthal's major challenge: to persuade thousands of hospitals and hundreds of thousands of doctors that health IT systems were worth the time and trouble it would take to buy them and integrate them into daily clinical practice. Small, cash-strapped community hospitals and individual practitioners constituted a particular concern. Finally, it describes the nature of Blumenthal's regulatory task: to define meaningful use quickly and to strike the right balance. Define meaningful use too strictly, and large numbers of health care providers might turn down the proffered incentives. Define it too loosely, and the expensive federal initiative would deliver little more than the market would have produced anyway. The case may be used on its own. It may also be used as the second part of a two-case unit with HKS Case 1937.0. This case includes an 8:00 min. video where David Blumenthal talks about challenges he faced, in particular when dealing with individual practitioners who didn't have the bandwidth to adopt electronic health records. Blumenthal explains the arguments he used to persuade them, and reflects more broadly on the timing and stages of this transition to "get information flowing in the healthcare system.

This three-part case study presents the initial problem, the thinking, the politics, and the design negotiations that produced New York City's "NYC Acquisition Fund" in August 2006. The case concludes with a brief round-up of performance data and commentary from the Fund's first two and a half years of operation. The NYC Acquisition Fund was created to deliver loans to small and nonprofit affordable housing developers, allowing them to compete with market-rate developers to buy property in New York City on the open market at a time of rampant speculation, rapidly rising prices, and fierce competition. It represented a groundbreaking effort to use public sector funds and authority, together with foundation capital, to leverage hundreds of millions of dollars in loan capital from private lenders. In September 2008, the Fund was named a winner of the annual Innovations in American Government competition, sponsored by the Ash Institute for Democratic Governance and Innovation at the Harvard Kennedy School, which declared it a "national model." HKS Case Number 1907.0

This sequel reveals which actions the County took, and describes the outcome of each in brief. It also includes two exhibits: a summary of the "goals and actions" outlined in the adaptation section of the 2007 King County Climate Plan and a list of executive orders intended to reduce the county's contribution to global warming. In addition to addressing certain generic leadership challenges-how to navigate the difficult intersection of politics and science, how to think about uncertainty, how to plan for the long term, how to prove effective on both local and national stage-the case has the advantage of introducing readers to a compelling contemporary public issue, sure to grow in urgency worldwide. HKS Case Number 1906.1

This public leadership case puts students in the shoes of King County Executive Ron Sims, the top elected official in Washington State's largest and most diverse county. The year is 2005, and Sims wishes to take a high profile leadership role on the climate change issue-locally and on the national stage-by tackling the nearly uncharted realm of "adaptation," preparing at the local level for impacts of climate change considered inevitable. In addition to addressing certain generic leadership challenges-how to navigate the difficult intersection of politics and science, how to think about uncertainty, how to make an argument for long term investments, how to prove effective on both local and national stage-the case has the advantage of introducing readers to a compelling contemporary public issue, sure to grow in urgency worldwide. The case details the array of considerations that went into Sims' decision to take on the adaptation issue, including a brief summary of a concurrent local debate about designing a new wastewater treatment plant to deliver reclaimed water to customers in the future, if needed. HKS Case Number 1906.0

This case sequel is a shorter, more focused, "decision-forcing" version of The Turnaround Artist: Craig Coy Tackles Political Influence at Massport (Case Program, 1896.0). Like its more comprehensive counterpart, it addresses a set of decisions facing Craig Coy, a business executive, retired Coast Guard officer, and former White House security adviser, when he was named executive director of the Massachusetts Port Authority, or "Massport," on April 11, 2002. The appointment came at a time of significant turmoil at Massport, the state authority responsible for managing Boston's Logan International Airport and several other regional transportation resources. The two airline jets hijacked in the attack on the World Trade Center in New York City on September 11, 2001 had departed from Logan. Massport had not been responsible for the security practices that had allowed the terrorists to board the jetliners with weapons, but the authority had, in recent years, repeatedly come under fire for political excesses and patronage. These long-tolerated vagaries-when vaulted into the national spotlight-suddenly appeared tawdry and intolerable to state officials and lawmakers. Coy's mandate, when hired a few months later, was to stop to the excesses of the past, to improve safety and security, to run the Authority in businesslike fashion-in sum, to effect a "cultural turnaround." This case describes a string of choices Coy had to make early in his tenure that pertained to the people-management side of his challenge. For example, Coy had to decide the extent to which he wanted to fire top managers at the authority and bring in his own team. He had to find a way to signal the shift to new priorities. And he had to decide what to do when elected officials-whose support was crucial to Massport in a number of respects-called up and asked the authority to hire their constituents. HKS Case Number 1901.1

Craig Coy, a business executive, retired Coast Guard officer, and former White House security adviser, was named executive director of the Massachusetts Port Authority, or "Massport," on April 11, 2002. The appointment came at a time of significant turmoil at Massport, the state authority responsible for managing Boston's Logan International Airport and several other regional transportation resources. The two airline jets hijacked in the attack on the World Trade Center in New York City on September 11, 2001 had departed from Logan. Massport had not been responsible for the security practices that had allowed the terrorists to board the jetliners with weapons, but the authority had, in recent years, repeatedly come under fire for political excesses and patronage. These long-tolerated vagaries-when vaulted into the national spotlight-suddenly appeared tawdry and intolerable to state officials and lawmakers. Coy's mandate, when hired a few months later, was to stop to the excesses of the past, to improve safety and security, to run the Authority in businesslike fashion-in sum, to effect a "cultural turnaround." The case takes a comprehensive look at Coy's approach. He immediately focused the authority on a major, challenging initiative; instituted a number of classic business reforms; and drew a sharp line in the sand with respect to political favors. Coy also had to confront some of his own assumptions about what it meant to act in Massport's best interests. Was it always best to leave politics at the door? This was Coy's impulse. But in certain situations, he reluctantly came to accept that a more complex stance was required. HKS Case Number 1896.0

Under pressure from the European Union, which had admitted Italy to the "Eurozone" hesitantly, on condition that the country control its deficit spending and reduce its high public debt, the central government in Italy initiated dozens of cost-cutting programs in the late 1990s and early 2000s. One such program aimed to economize, to the tune of billions of euros, on public procurement of goods and services. The program's first priority was to identify products and services bought widely by public agencies at every level of government, and consolidate them into nation-spanning mega contracts. By aggregating public sector demand in this manner, analysts had reasoned, Italy's public sector could greatly increase its market leverage and win big discounts from suppliers. This appraisal proved correct-but also politically explosive. In November 2003, Italy's Minister of Economy and Finance ordered a temporary halt to the program to give political and administrative leaders a chance to figure out what to do. This decision-forcing case allows students to consider how Italy might have averted this political backlash, and challenges them to propose how the government might adjust the project in ways that address the concerns of the critics, but still allow it to improve procurement efficiency and reduce its costs. HKS Case Number 1925.0

Under pressure from the European Union, which had admitted Italy to the "Eurozone" hesitantly, on condition that the country control its deficit spending and reduce its high public debt, the central government in Italy initiated dozens of cost-cutting programs in the late 1990s and early 2000s. One such program aimed to economize, to the tune of billions of euros, on public procurement of goods and services. The program's first priority was to identify products and services bought widely by public agencies at every level of government, and consolidate them into nation-spanning mega contracts. By aggregating public sector demand in this manner, analysts had reasoned, Italy's public sector could greatly increase its market leverage and win big discounts from suppliers. This appraisal proved correct-but also politically explosive. In November 2003, Italy's Minister of Economy and Finance ordered a temporary halt to the program to give political and administrative leaders a chance to figure out what to do. HKS Case Number 1925.1

The spring of 2005 marked a tricky juncture for the leaders of a program designed to improve health care access for thousands of residents living in impoverished, isolated settlements just north of the Mexican border in the Lower Rio Grande Valley and also for the Robert Wood Johnson Foundation, which had provided the program with a four-year startup grant, due to expire in a few months time. The project leaders wanted to keep the Integrated Health Outreach System (IHOS) alive, but were not sure how to fund it. In addition, frustrated by aspects of the project's design, they wanted to reorganize and refocus the program. The Robert Wood Johnson Foundation, meanwhile, had gone through an internal organizational change that had significantly changed RWJF's approach to charitable giving. In general, the Foundation was no longer funding "safety net" programs like IHOS, but had moved toward broader, systemic, collaborative efforts to address the root causes of poor health in vulnerable populations. But the RWJF administrators recognized that the plight of the IHOS clients was extreme. In addition, they knew that resources on the border were scarce. In practical terms, that meant the Foundation was reluctant to cut off the IHOS funding at least not until IHOS could stand on its own feet. HKS Case Number 1852.0

The spring of 2005 marked a tricky juncture for the leaders of a program designed to improve health care access for thousands of residents living in impoverished, isolated settlements just north of the Mexican border in the Lower Rio Grande Valley and also for the Robert Wood Johnson Foundation, which had provided the program with a four-year startup grant, due to expire in a few months time. The project leaders wanted to keep the Integrated Health Outreach System (IHOS) alive, but were not sure how to fund it. In addition, frustrated by aspects of the project's design, they wanted to reorganize and refocus the program. The Robert Wood Johnson Foundation, meanwhile, had gone through an internal organizational change that had significantly changed RWJF's approach to charitable giving. In general, the Foundation was no longer funding "safety net" programs like IHOS, but had moved toward broader, systemic, collaborative efforts to address the root causes of poor health in vulnerable populations. But the RWJF administrators recognized that the plight of the IHOS clients was extreme. In addition, they knew that resources on the border were scarce. In practical terms, that meant the Foundation was reluctant to cut off the IHOS funding at least not until IHOS could stand on its own feet. HKS Case Number 1852.0

In this executive leadership case, the activist superintendent of Virginia's affluent Fairfax County public school district, Daniel A. Domenech, is faced with a complex, politically-loaded policy dilemma. At issue is admissions policy for the county's popular and prestigious magnet high school, the Thomas Jefferson High School for Science and Technology (TJ). TJ is so highly sought-after that only one in six applicants is accepted. The case is set in 2001. In the past 16 years, the admissions policy at TJ has made a pendulum swing: heavy reliance on a single standardized exam in 1985; the addition of an affirmative action program in 1990; the elimination of that program in 1998, in the face of political pressure and anxiety over a "reverse discrimination" law suit. As the case opens, TJ is fast losing diversity. The liberal-leaning School Board has instructed Domenech to come up with a way to restore that diversity, but without sacrificing the school's strong academic reputation or making the school system legally vulnerable. After painstaking effort, Domenech and his administrative team have come up with a plan that aims at geographic diversity within the county, rather than racial and ethnic diversity per se. But, faced with an angry reaction from parents from the "overrepresented" neighborhoods, the Board has quickly backed away from the plan. That leaves Domenech back at square one, trying to find a solution that will broaden the range of students at Jefferson in a way that is fair, effective, and legally safe-but also politically palatable.

When a public sector agency decides to privatize a large government function (as opposed to a more discreet job), the process of negotiating the service contract becomes a more complex and far-reaching endeavor. This case study describes the dilemmas that surfaced when a government agency in British Columbia-the Ministry of Provincial Revenue-negotiated a 10-year, $750 million contract for non-tax revenue collection to EDS Canada, a subsidiary of the Texas-based Electronic Data Systems corporation. The appeal of the deal, from the public sector perspective, was that it transferred the risk of upgrading an outmoded, under-resourced system to the private sector. The appeal to the private sector was that it allowed the company to recover costs and make a profit by taking a share of the financial benefits that resulted from the upgrade. But negotiating the ins and outs of the contract for this ambitious project was to prove a formidable-nearly an insurmountable-hurdle for two organizations that inhabited different cultures, held different assumptions, and pursued different mandates. For example, what profit level was reasonable? Should the company be required to reveal its costs to the government? To what extent should the details of the contract be public, if at all? In what areas-if any-should public officials be able to regulate the firm's business practices? And how should either party be held accountable for its contractual promises? The case was developed for a Kennedy School course on public-private partnerships. It affords students a balanced, inside look at the nitty-gritty dilemmas of both the public and private sector negotiators. HKS Case Number 1835.0

This case study tells the story of San Jose, California, one of the first 27 cities in the country to participate in a federal domestic preparedness program. Between 1997 and 1999, a specially created city task force mounted several full-scale terrorist attack exercises, but-despite the best of intentions-found all of them frustrating, demoralizing, and divisive, creating ill will between the exercise planners and the first responders. In response, the San Jose task force took a step back and analyzed their situation. In place of traditional full-scale exercises, San Jose drew on several existing prototypes to create a new "facilitated exercise" model that emphasized teaching over testing, and was much better received by first responders. For teaching flexibility, the case has been divided into three parts. The main case describes San Jose's early experience, ending at a crucial moment, when the task force was forced to face the fact that its approach was not working. It is designed to spark a class discussion about what seems to be going awry, and how the problems might be solved. HKS Case Number 1815.0

This case study tells the story of San Jose, California, one of the first 27 cities in the country to participate in a federal domestic preparedness program. Between 1997 and 1999, a specially created city task force mounted several full-scale terrorist attack exercises, but-despite the best of intentions-found all of them frustrating, demoralizing, and divisive, creating ill will between the exercise planners and the first responders. In response, the San Jose task force took a step back and analyzed their situation. In place of traditional full-scale exercises, San Jose drew on several existing prototypes to create a new "facilitated exercise" model that emphasized teaching over testing, and was much better received by first responders. For teaching flexibility, the case has been divided into three parts. Sequel 1 is a continuation of the main case study (1815.0) and is designed to be read in the middle of class. It describes the new facilitated exercise model in brief. Students could then be asked to assess the approach taken by San Jose. HKS Case Number 1815.1

This case study tells the story of San Jose, California, one of the first 27 cities in the country to participate in a federal domestic preparedness program. Between 1997 and 1999, a specially created city task force mounted several full-scale terrorist attack exercises, but-despite the best of intentions-found all of them frustrating, demoralizing, and divisive, creating ill will between the exercise planners and the first responders. In response, the San Jose task force took a step back and analyzed their situation. In place of traditional full-scale exercises, San Jose drew on several existing prototypes to create a new "facilitated exercise" model that emphasized teaching over testing, and was much better received by first responders. For teaching flexibility, the case has been divided into three parts. Sequel 2 is a continuation of both the main case study and Sequel 1(1815.0; 1815.1) and is designed as a "take away," to be given out at the end of class. It includes the reflections of the emergency service providers in San Jose about the facilitated exercise model. It would also be possible assign students to read all three parts before class, and to hold a retrospective discussion about how San Jose analyzed and responded to its problem. Funding provided by the US Centers for Disease Control and Prevention through the National Preparedness Leadership Initiative. HKS Case Number 1816.1