This case presents financial statements and selected rations for 14 unidentified healthcare organizations and asks that each set of financial information be matched with one of the following healthcare companies: a biotechnology firm, a community nursing company, a distributor (medical), a DME licensee and seller, a DME developer and seller, a home care provider, a hospital (diversified), an insurer, a lab/diagnostic firm, a medical device manufacturer, a nursing home operator, a pharmaceuticals company (branded), a pharmaceuticals company (generics), and a private practice.
This case presents financial statements and selected ratios for 14 unidentified healthcare organizations and asks that each set of financial information be matched with one of the following healthcare companies: a biotechnology firm, a community nursing company, a distributor (medical), a DME licensee and seller, a DME developer and seller, a home care provider, a hospital (diversified), an insurer, a lab/diagnostic firm, a medical device manufacturer, a nursing home operator, a pharmaceuticals company (branded), a pharmaceuticals company (generics), and a private practice.
In 2000, Dr. Gary Kaplan became CEO of the Virginia Mason Medical Center in Seattle, Washington. The hospital was facing significant challenges: It was losing money for the first time in its history, staff morale had plummeted, and area hospitals presented ardent competition. Considerable change was imminent. Within his first few months, Kaplan had rallied the organization around a new strategic direction: to become the quality leader in health care. What Kaplan and his administrators lacked was an effective tool to execute their strategy. Soon thereafter, a series of serendipitous events led to the discovery of the Toyota production system, and the Virginia Mason Medical Center became entrenched in an overwhelming challenge: how to institute a production model in health care.
Through its uniquely proactive approach to medical malpractice risk management, the Risk Management Foundation has decreased claims-and premiums-for the Harvard hospitals it insures. The RMF is the captive medico-legal insurer of the Harvard medical institutions and affiliated physicians. Over the last two decades, through a combination of active legal defense and medical error prevention, The RMF has successfully controlled the medico-legal costs of physicians practicing at the Harvard teaching hospitals; consequently, its insured physicians pay notably lower premiums than similar specialists outside the Harvard system. The RMF's success has been due, in large part, to the close working relationships it has cultivated with the insured physicians and hospitals. However, as the hospitals expand their networks into Boston's suburbs, new, less tightly affiliated doctors whose medico-legal risk is higher than those practicing at the hospitals are coming under RMF's umbrella. This case describes The RMF's approach to risk management and the challenges its managers face in accommodating these new physicians.
How will Newton-Wellesley Hospital (NWH) preserve its private practice tradition while remaining effective and competitive in a healthcare industry demanding increasing integration between physicians and hospitals? This is the decision facing Newton-Wellesley Hospital president Mike Jellinek in 2009, as several trends-higher costs and lower revenues, shifting workforce demographics, and changing reimbursement models-threaten to disrupt NWH's organizational model. Similar to other U.S. community hospitals, NWH has historically been staffed primarily with private practitioners; however, in recent years Jellinek has taken several steps toward further integration, such as hiring primary care physicians and hospitalists, and even proposing formation of a physicians' organization (PO)-a move its veteran private practitioners sharply oppose. In 2009, NWH is renowned for high-quality care and is financially strong; yet, given external pressures, most at the hospital agree that reforms are needed to improve the hospital's and physicians' profitability while maintaining highest-quality patient care. Diverging opinions over how to improve the hospital has exposed differences between some private practice physicians and the administration. The crux of their disagreement centers on one question: how to make the organizational changes required to keep NWH effective and competitive in the face of a diminishing revenue growth rate, while honoring its tradition of physician independence.
Intermountain Healthcare is a 21-hospital integrated delivery system serving Utah and southern Idaho that is nationally recognized for its highly structured approach to managing the quality of clinical care. This case describes Intermountain's system for improving clinical performance that makes use of the organization's extensive set of standardized clinical protocols and associated clinical process and outcome measures. The measures underpin a sophisticated set of financial incentives that are applied to both administrative and clinical staff. The case allows students to evaluate the strengths and weaknesses of financial incentives in clinical medicine.
Partners in Health is a Boston-based, not-for-profit that provides health care to people in some of the poorest regions of the world, including Haiti, Malawi, Rwanda, and Peru. In 1998, PIH established a program (PACT) in Boston to bring care to AIDS and TB patients who were not well served by existing care delivery systems. Describes PIH's programs in the developing world and the way in which lessons learned in these countries informed the design and management of PACT. Examines the balance between customized and standardized approaches to care and challenges students to examine their preconceived notions of the social role of a health care delivery organization. Dr. Heidi Behforouz, PACT's director, must decide whether a service design honed in developing countries can be rolled out more broadly in one the world's richest nations.
Madison Memorial Hospital is deciding between a variety of quality improvement strategies. Highlights quality improvement collaboratives--organized programs popularized by the Institute for Healthcare Improvement in which teams from multiple institutions work together to improve care in a specified topic area (e.g., infection rates)--as a potential strategy. Allows debate around the criteria for selection of quality improvement strategies. Also motivates the discussion of the effectiveness of collaboratives and more broadly, the effectiveness of intra-organizational versus inter-organizational approaches to improvement.
Describes the history of clinical computing at Boston's Beth Israel Hospital and the development, since the 1996 merger to form the Beth Israel Deaconess Medical Center, of an information system designed to support the delivery of patient care. The hospitals' CIO, John Halamka, MD, has overseen the development of an information system that places physicians at its center. Describes the design and function of five major components of the system: the On-Line Medical Record, ePrescribing, Physician Order Entry, the Emergency Department "dashboard," and the Performance Manager. Provides students with an opportunity to identify key design principles for health care information systems, and to discuss the unique implementation challenges that the health care delivery setting raises for CIOs and CEOs.
Considers the issues associated with running multiple business models--a private practice and an academic faculty practice--within the confines of the orthopaedics department of a single medical center. Students assume the role of Neela Wilson, Executive Director of Rittenhouse Medical Center, in managing the operational requirements of, and organizational tensions created by, these competing models. In analyzing the case, students have the opportunity to: (1) gain a better understanding of operational focus and the concept of a "focused factory" in health care, (2) consider the concept of a "factory within a factory" in the context of an academic medical center, and (3) build an appreciation of the managerial challenges associated with operating related, and often competing, business units within the same organization.
On February 1, 2003, the world watched in horror as the Columbia space shuttle broke apart while reentering the earth's atmosphere, killing all seven astronauts. Some have argued that NASA's failure to respond with appropriate intensity to the so-called foam strike that led to the accident was evidence of irresponsible or incompetent management. The authors' research, however, suggests that NASA was exhibiting a natural, albeit unfortunate, pattern of behavior common in many organizations. The foam strike is a prime example of what the authors call an ambiguous threat--a signal that may or may not portend future harm. Ambiguous threats differ from threats with obvious causes--say, a fire in the building--for which the response is clear. They also differ from unmistakable threats that may lack straightforward response paths (such as the frightening oxygen-tank explosion aboard Apollo 13). However, when the warning sign is ambiguous and the threat's potential effect is unclear, managers may choose to ignore or discount the risk. Such an approach can be catastrophic. Firms that do a good job of dealing with ambiguous threats do not improvise during a crisis; rather, they apply a rigorous set of detection and response capabilities that they have developed and practiced beforehand. In this article, the authors outline how to put such capabilities in place long before a crisis strikes. First, companies need to hone their teamwork and rapid problem-solving skills through practice. Second, they must learn to recognize weak signals, amplify the threat, and encourage employees to ask disconcerting "what if" questions in a safe environment. Finally, they should explore possible responses to threats through quick, low-cost experimentation.
Provides a detailed description of the way in which several improvements and innovations in clinical care were arrived at. Describes individual insights, how these were evaluated and validated, and how they were translated into improved medical practices. The changes in medical care include improvements in primary care, intensive care, and inpatient ward care. Detailed descriptions of each innovation are provided, along with a description of the processes of innovation, generation, and capture. It relates closely to Intermountain (A), which describes the organizational structure Intermountain has put in place to support these processes.
Follows on from the cases Istituto Clinico Humanitas (A) and (B). Describes the design and running of the new Humanitas Emergency Department. Istituto Clinico Humanitas has developed a very efficient operating system for dealing with elective (largely surgical) patients. By opening an emergency room, however, the institution is now called upon to care for complex and highly variable medical patients. Asks if the previous operating system is appropriate for this new patient population and in what ways might it require modification to meet these patients' unique needs. The concept of hospital-within-a-hospital is central to Humnitas' new design, and the case examines if this is feasible in this setting.
Discusses the challenges currently facing the U.S. health care delivery system. These challenges frame the problems managers of delivery organizations are currently facing. They include a burgeoning gap between demand and supply. Demand for health care services is increasing as the population ages, chronic diseases become more common, and medical technology increases. Yet, the supply of nurses and physicians is decreasing. Moreover, as both regulators and the general public become more interested in the quality of care delivered, there is evidence of substantial quality failures. In response to these challenges, regulators have introduced new forms of payment and financial incentives for doctors and delivery organizations, and managers have experimented with several new service models and delivery organization designs. They include the use of new professionals and other assistive personnel, such as nurse practitioners and physicians' assistants, in-store clinics, focused factories and concierge care.
In 2000, Dr. Gary Kaplan became CEO of the Virginia Mason Medical Center in Seattle, Washington. The hospital was facing significant challenges: It was losing money for the first time in its history, staff morale had plummeted, and area hospitals presented ardent competition. Considerable change was imminent. Within his first few months, Kaplan had rallied the organization around a new strategic direction: to become the quality leader in health care. What Kaplan and his administrators lacked was an effective tool to execute their strategy. Soon thereafter, a series of serendipitous events led to the discovery of the Toyota production system, and the Virginia Mason Medical Center became entrenched in an overwhelming challenge: how to institute a production model in health care.
Describes the 16-day final mission of the space shuttle Columbia in January 2003 in which seven astronauts died. Includes background on NASA and the creation of the human space flight program, including the 1970 Apollo 13 crisis and 1986 Challenger disaster. Examines NASA's organizational culture, leadership, and the influences on the investigation of and response to foam shedding from the external fuel tank during shuttle launch.
Duke University Health System has for the past five years operated a specialized clinic for the management of congestive heart failure, a very common and costly condition in the surrounding community. Nurse practitioners, whose work is guided by highly specified protocols and overseen by cardiologists, staff the multidisciplinary clinic. The chancellor of the health system views the program as a huge financial burden and an undesirable use of academic cardiologists' time. The case examines models of disease management; Duke's heart failure program operations, finances, and outcomes of disease management; and the relationship between its nurse practitioners and cardiologists.
The Foundation for Informed Medical Decision-Making has created an interactive videodisc system that provides patients with customized support regarding medical treatment or screening decisions when they face a choice between two equally effective courses of action. The videodiscs, known as shared decision-making programs (SDPs), were the result of considering grant-funded research into treatment outcomes and patients' preferences concerning varying medical treatments. Over a six-year period, the foundation has partnered with a variety of commercial firms to manufacture and market the SDPs. Despite robust evidence supporting the effectiveness of the SDPs and the enthusiastic response of early purchasers, the foundation has been unable to widely disseminate the product and faces major debt.
General Electric launched Bridges to Excellence Diabetes Care Link, a program through which enrolled physicians receive bonuses of up to 10% of their salary for delivering quality care to diabetic patients covered by a participating employer or health plan. A day later, the Wall Street Journal labeled the program a "bribe." The case explores this accusation and the assumption that purchasers and consumers must explicitly pay for quality in heath care. Also allows evaluation of a specific program from design (e.g., financial reward structure) to implementation (e.g., parties involved). The question of scalability arises, as does the criteria by which to judge success.