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John Crowley, CEO of Novazyme Pharmaceuticals, a start-up biotechnology firm developing an orphan drug to treat a rare lysosomal storage disorder from which his children suffer, must choose between a partnership and a buyout to have sufficient funds and support to get the drug to the market. Accompanying this dilemma are questions relating to Novazyme's clinical trial strategy, marketing, sales, production, and pricing. This case introduces students to the FDA drug approval process and government-supported financial inducements to develop drugs for small patient populations. Also provides insight into the nature of strategic relationships in the biotechnology and pharmaceutical industries.

Intermountain Health Care (IHC), an integrated delivery system based in Utah, has adopted a new strategy for managing health care delivery. The approach focuses management attention not only on the facilities where care takes place but also on physician decision making and the care process itself, with the aim of boosting physician productivity and improving care quality, while saving money. This case explores the challenges facing Brent James, executive director of the Institute for Health Care Delivery Research at IHC, as he implements new structures and systems (including a data warehouse for care outcomes, electronic patient records, computer workstations, clinical data support systems, and protocols for care) designed to support clinical process management across a geographically diverse group of physicians with varying levels of interest and dedication to IHC. Also highlights an innovative strategy for creating and disseminating knowledge at the individual and organizational levels to maintain high standards in care delivery.

Istituto Clinico Humanitas is a newly built private hospital, south of Milan, Italy, that has attained unusual profitability while treating public system patients. The hospital was built and is managed by Techosp, a subsidiary of Techint, a global engineering and consulting firm. Techosp created a design and management system that emphasizes optimizing patient throughput and utilization of all of the hospital's facilities. Physicians are all fully employed and have a significant financial incentive to maximize efficiency. The executive team is now considering whether to affiliate with the University of Milan medical school and, in effect, become Italy's first private academic medical center. The general manager must consider the effect of this affiliation on the hospital's performance.

QuickMedx has created a chain of small kiosks, located in drugstores and shopping malls in the Minneapolis area, that cater to patients with a limited range of very simple primary care conditions. Service is rapid and cheap and patients wait only a few minutes to be seen. The kiosks provide an alternative to the primary care physician's office and the emergency room. Clinical care itself is highly standardized and is delivered by nurse practitioners whose decisions are governed by detailed protocols. The company is now considering its expansion strategy. Should it increase the number of kiosks or widen the currently restricted range of conditions treated?

Scientific knowledge surrounding diabetes mellitus has grown over the last century to include its cause, treatment, and prevention strategies. However, the type and level of care that patients receive is suboptional. This case examines the forces in industry, knowledge, education, public policy, and reimbursement that drive the management of this disease and the potential for innovation in the management of other chronic diseases.

Cardiac surgery is one of medicine's modern miracles. In an operating room no larger than many household kitchens, a patient is rendered functionally dead while a surgical team repairs or replaces damaged arteries or valves. Each operation requires incredible teamwork--a single error can have disastrous consequences. In other words, surgical teams are not all that different from the cross-functional teams that have become crucial to business success. The challenge of team management these days is not simply to execute existing processes efficiently. It's to implement new processes as quickly as possible. But adopting new technologies or new business processes is highly disruptive, regardless of the industry. The authors studied how surgical teams at 16 major medical centers implemented a difficult new procedure for performing cardiac surgery. The setting was ideal for rigorously focusing on how teams learn and why some learn faster than others. The authors found that the most successful teams had leaders who actively managed the groups' learning efforts. Teams that most successfully implemented the new technology shared three essential characteristics. They were designed for learning; their leaders framed the challenge so that team members were highly motivated to learn; and an environment of psychological safety fostered communication and innovation. The finding that teams learn more quickly if they are explicitly managed for learning poses a challenge in many areas of business. Team leaders in business tend to be chosen more for their technical expertise than for their management skills. Team leaders need to become adept at creating learning environments, and senior managers need to look beyond technical competence and identify leaders who can motivate and manage teams of disparate specialists.

It's no secret that health care delivery is convoluted, expensive, and often deeply dissatisfying to consumers. But what is less obvious is that a way out of this crisis exists. Just as the PC replaced the mainframe and the telephone replaced the telegraph operator, disruptive innovations are changing the landscape of health care. Nurse practitioners, general practitioners, and even patients can do things in less-expensive, decentralized settings that could once be performed only by expensive specialists in centralized, inconvenient locations. But established institutions are fighting these innovations tooth and nail. Not only is this at the root of consumer dissatisfaction with the present system, it sows the seeds of its own destruction. The history of disruptive innovations tells us that incumbent institutions will be replaced with ones whose business models are appropriate to the new technologies and markets. Instead of working to preserve the existing systems, regulators, physicians, and pharmaceutical companies need to ask how they can enable more disruptive innovations to emerge. If the natural process of disruption is allowed to proceed, the result will be higher quality, lower cost, more convenient health care for everyone.

Reviews the current literature on the consumers of health care, primarily patients. Discusses their stated preferences, the sources of information they use in making their selections of plan and provider, and their behavior.

Entrepreneur Nassib Chamoun has created an innovative anesthesiology device that monitors patients' consciousness levels during surgery. This case tracks how Chamoun and his executive team built the infrastructure of the company and actively managed the adoption process through product design and development, clinical trials, close work with regulatory agencies, selection of appropriate lead users, and active management of the learning process for the lead users. Now faced with a relatively unfavorable market and increasing competition, Chamoun must decide how to increase current and future adoption of the monitor. Three options are presented: contracting for OEM deals with large, well-established distributors; expanding the range of services offered to include other aspects of the perioperative process; and exploring the use of the monitor in other clinical areas such as Alzheimer's.

Outlines the growth of an innovative diabetes disease management organization from 1994-99. Having demonstrated the success of their model in managing diabetes populations in Texas and New York State, the CEO and president must decide the future strategy of the company and figure out where their core competencies lay. Options include focusing on the current model (which is based on developing strong patient-caregiver relationships and on immediate access to clinical data via database technology), branching into online health assessment tools, or conducting research on health and cost outcomes for pharmaceutical, medical device, or insurance companies. Illustrates the importance of aligning incentives of clinicians, hospitals, and patients to effect behavior change. Students can discuss the types of financing markets in which the company's model will work best, who is best suited to provide this type of disease management, and who should pay for it (e.g., physician, hospitals, pharmacists, insurance companies, or outside providers).

Describes the death of a cancer patient in one of the nation's premier cancer treatment centers and examines the organizational and process characteristics that may have contributed to the medical error.

Examines the implementation of a new patient care delivery model at Massachusetts General Hospital. Uses clinical and financial data to examine different choices for staffing non-physician health care professionals and to understand the challenges of managing change across multiple professions in the hospital environment. Recently promoted to senior vice president of Patient Care Services, Jeanette Ives Erickson must decide whether a model for patient care delivery is the best way to improve care and reduce costs in the midst of extreme budget pressures and a rapidly changing health care environment.

Describes the introduction of capitation by a managed care company and the challenges of managing financial risk in the Medicare population. Focuses on the relationship between the health plan and physicians.

A review of the use and effectiveness of financial incentives in changing physician behavior.

Reviews the issues underlying the rate of error in medical practice and discusses the range of potential management interventions to decrease the risk of error.

Presents an overview of managed care. Describes the relationship between provider and insurance companies, examines the implications for consumers, and discusses financial arrangements and operational characteristics commonly observed in the industry. Also provides a background to other HBS health care cases.