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In late 2014, Dr. John Moore (CEO), Frank Moss (chairman), and Scott Gilroy (CTO) of Twine Health (Twine) had to resolve several challenges that threatened to restrict the widespread dissemination of its sole product, Twine. Twine was a cloud-based platform that enabled patients to create and manage chronic disease treatment plans in conjunction with their primary care providers and specialized coaches. Twine had already enjoyed impressive successes in early clinical trials and among early adopters. The issues Twine's leadership team had to address included identifying clinical care providers willing to pay for Twine, ensuring adoption and effective use by both patients and health care providers, adding capabilities to support the management of additional chronic diseases, and seamlessly integrating Twine with a client organization's electronic medical record (EMR) system and information technology (IT) infrastructure. The need to solve these problems had become more pressing since Twine was named a finalist in the Health Acceleration Challenge (HAC) sponsored by Harvard Business School and Harvard Medical School.

The case describes a program that CVS Health recently implemented to improve medication adherence, an important problem from societal, public policy, and firm perspectives. A test of the program, costing hundreds of thousands of dollars to implement, increased the proportion of adherent customers by 1.4 percentage points. Students are asked to quantify the system-wide economic benefit of this improvement and draw upon insights from behavioral science to examine approaches for boosting medication adherence.

Describes the challenges facing Dr. John Noseworthy, President and CEO, in implementing a long-term strategy for the growth of the Mayo Clinic-a leading academic medical center with a reputation for excellence in tertiary and quaternary health care. The case highlights the concurrent forces of regional and national competition and federal health care reform as factors complicating the plans of Mayo Clinic to grow through several channels. Students must ultimately decide whether Mayo Clinic should focus its future growth on its current areas of expertise (regional provision of integrated medical care and international provision of tertiary and quaternary care), new opportunities in a broader range of services and treatment channels (e.g., telemedicine, mobile health, enterprise learning and training for other health care systems), or some combination of these opportunities.

Seven years of research into how teams work shows just how great the benefits are when team members have lots of experience working with one another. Five steps can help managers take advantage of team familiarity, a surprisingly underutilized tool.

The case explores the challenges facing Massachusetts General Hospital concerning the adoption of a new infection control policy, which promises to improve operational performance, patient safety, and profitability. The new policy requires coordination between different departments within the hospital, namely the Emergency Department, the Infection Control Unit, and Admission Services. Students are initially asked to assess the operational, financial and clinical implications of the new policy. They are then asked to examine different approaches to its implementation.

A set of exercises and instructions to be used with the Process Simulator software made by Pro Model. These exercises allow students to investigate the impact of variable processing times on the performance of simple in-line processes. Includes color exhibits.

Considers whether New Balance, one of the world's five largest manufacturers of athletic footwear, should respond to Adidas' planned acquisition of Reebok-a transaction that would join the second- and third-largest companies in the industry. Highlights the unique aspects of New Balance's strategy-focusing on fit and performance by offering long-lived shoes in a wide variety of widths and eschewing celebrity endorsement of its products-and discusses New Balance's operations decisions to support that strategy. These include significant use of domestic manufacturing at a time when nearly all other competitors sourced finished shoes from Asian suppliers and an emphasis on improving inventory management for its network of small and large retailers. Set just after the announcement of the Adidas-Reebok transaction in 2005, with New Balance having recently initiated a companywide effort to improve operational performance through the application of concepts from lean manufacturing and the Toyota Production System. Asks students to consider whether New Balance should change aspects of its operations strategy in light of the consolidation among its competitors or whether the Adidas-Reebok transaction represents an opportunity for New Balance to emphasize the importance of moving forward with its current approach.

The case explores a deicing capacity expansion decision made by JetBlue at Boston Logan International Airport in the summer of 2010. The need for capacity expansion was driven by significant challenges faced during the previous winter combined with substantial scheduled growth for the upcoming winter.

As a business broadens over time, it can lose the operational edge that led to its original success. Core strengths atrophy, efficiency or quality suffers, and sharper rivals close in to take advantage of the loss of focus. In his classic article "The Focused Factory" (HBR May-June 1974), Wickham Skinner proposed that manufacturers whose product lines had proliferated create specialized units, each dedicated to a distinct task. To make this economically feasible, he suggested the plant within a plant, or PWP, model, whereby an existing facility is physically and organizationally divided into autonomous operations. Many organizations - from airlines to hospitals to department stores - have since adopted the model, in the form of focused units that share people, equipment, and other assets to some extent. But they've found it difficult to implement. That's because, the author writes, they don't give every unit narrowly defined objectives; they underestimate the challenges related to sharing resources; they don't fully consider to what degree best practices, knowledge, and talent should be shared; and they don't anticipate the political tensions that can arise. Huckman provides guidelines for setting clear objectives, getting the boundaries between units right, establishing rules for sharing, and customizing performance criteria. And, he says, leaders must continually remind units of their individual and collective goals and purposes whenever decisions about resources, performance measurement, and compensation are made.

Describes the Spine Center at Dartmouth-Hitchcock Medical Center, a multidisciplinary unit that offers patients suffering from spinal problems "one-stop" access to a range of providers including orthopedic surgeons, neurosurgeons, neurologists, medical specialists in physical medicine and pain management, mental health providers, and occupational and physical therapists. The Center was created to address what its founder, James Weinstein, M.D., saw as the uncoordinated and inefficient delivery of spinal care in the United States. The Center emphasized using non-surgical treatments (e.g., physical therapy and exercise, behavioral modification, pain-relieving drugs) as either a complement to, or substitute for, surgical procedures, and patients were actively engaged in the process of determining what type of care to pursue. In addition, Weinstein and his staff collected data from the Center's clinical practice to conduct academic research on the outcomes and cost-effectiveness of various approaches to treatment. The case allows for a critical analysis of the Spine Center's unique approach to care delivery and provides an opportunity to examine the applicability of this model in other clinical areas.

Considers the development of Amazon Web Services (AWS), a division of Amazon.com, Inc., specializing in the provision of web-based storage and computing services to web developers. The case focuses on the issues facing Andy Jassy, the head of AWS, in 2008 as AWS faces increased competition from established technology giants, such as Google, Microsoft, and IBM. Students are asked to consider whether entry into web services by Amazon, which had established its brand in retail, represented a prudent move by the company. The case provides an opportunity to highlight the benefits of AWS' variable pricing for developers and to determine where overlaps exist between Amazon's core retailing business and AWS. Students are also provided with an opportunity to discuss operational diversification and its limits within the AWS context.

Considers the situation facing David Barger, President and CEO of JetBlue Airways, in May 2007 as he addresses the airline's need to slow its growth rate in the response to increasing fuel costs and the effects of major operational crisis for the airline in February 2007. In 2005, JetBlue-typically viewed as a low-cost carrier (LCC)-made a move that is often considered antithetical to the LCC model. Specifically, JetBlue moved from a single aircraft type (i.e., the Airbus 320, or A320) to a fleet with two types of aircraft by adding the smaller Embraer 190, or E190. Students are initially asked to consider the impact of this decision on JetBlue's operations strategy and business model. They are then asked to consider how the reductions in aircraft capacity growth should be spread across the two plane types. This discussion hinges not only on issues of aircraft efficiency but also on those of operational focus and the ultimate competitive priorities of the airline as a whole.

Considers the situation facing Gary Gottlieb, president of Brigham and Women's Hospital (BWH), prior to the opening of BWH's integrated cardiovascular center. This case allows students to develop an appreciation of the strategic, financial, organizational, clinical, and physical aspects of integrating health care delivery around specific categories of disease. It provides an opportunity to evaluate BWH's approach to integration along all of these dimensions and to identify the nature of the tradeoffs that hospitals--specifically, academic medical centers--face as they attempt to create disease-specific models of integrated care. Finally, students have the opportunity to evaluate the degree to which integrated models of care can be developed within academic medical centers.

Describes an operational crisis for JetBlue Airways during an ice storm in the eastern United States in February 2007 and chronicles the airline's immediate response. Provides detail concerning the history of the airline from its founding in 1999 through the February 2007 crisis, which forced the airline to cancel more than 1,000 flights over the course of six days. In addition, discusses the initial response to the crisis by CEO David Neeleman and his management team. Students are provided with the opportunity to evaluate this response in terms of its impact on customer relations, growth prospects, and ongoing operations for JetBlue.

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.

Describes the reorganization of the drug discovery organization at Wyeth Pharmaceuticals and focuses on the decisions to: (1) centralize decision-making within drug discovery and (2) institute numerical metrics--jointly affecting all R&D scientists--for the progression of compounds through the Wyeth pipeline. Highlights issues concerning the degree to which scientific activity can be evaluated via numerical metrics, the extent to which R&D can be structured as a process, and the degree to which decision-making should be centralized in commercial R&D activities.

Considers whether New Balance, one of the world's five largest manufacturers of athletic footwear, should respond to Adidas' planned acquisition of Reebok--a transaction that would join the second- and third-largest companies in the industry. Highlights the unique aspects of New Balance's strategy--focusing on fit and performance by offering long-lived shoes in a wide variety of widths and eschewing celebrity endorsement of its products--and discusses New Balance's operations decisions to support that strategy. These include significant use of domestic manufacturing at a time when nearly all other competitors sourced finished shoes from Asian suppliers and an emphasis on improving inventory management for its network of small and large retailers. Set just after the announcement of the Adidas-Reebok transaction in 2005, with New Balance having recently initiated a companywide effort to improve operational performance through the application of concepts from lean manufacturing and the Toyota Production System. Asks students to consider whether New Balance should change aspects of its operations strategy in light of the consolidation among its competitors or whether the Adidas-Reebok transaction represents an opportunity for New Balance to emphasize the importance of moving forward with its current approach.

Considers whether BYD Co., Ltd., the largest Chinese maker of rechargeable batteries, should enter the Chinese automobile industry by acquiring Qinchuan Auto, a state-owned car manufacturer. Set just after BYD's initial public offering on the Hong Kong Stock Exchange in 2002, it describes the development of BYD's labor-intensive approach to battery manufacturing--an approach decidedly different from its more capital-intensive Japanese competitors and one that took advantage of the abundant supply of low-cost labor in China. Highlights the unique benefits and challenges created by BYD's operations strategy and asks students to determine whether the capabilities developed by the company in battery manufacturing can productively be applied to the automobile sector. Asks students to consider which, if any, aspects of BYD's operations constitute sources of sustainable competitive advantage for the company.

Considers whether the management of Procter & Gamble (P&G) Pharmaceuticals should adopt Web-based electronic data capture (EDC) as the default standard for the management of its clinical drug trials. Provides a detailed description of the existing paper-based process for clinical trial management at P&G and asks students to consider whether and to what extent the use of information technology--in the form of Web-based EDC--could improve that process. Highlights tensions surrounding the implementation of new technologies and considered potential barriers to implementation both within the firm and with other firms in the value chain. Finally, considers how a firm should structure relationships with external providers of new, process-related technologies.