In response to the uncontrollable second wave of COVID-19 in the south Indian state of Telangana in April 2021, a few like-minded social activists in the capital city of Hyderabad came together to establish a 100-bed medical care center to treat COVID-19 patients. The project was named Ashray. Dr. Chinnababu Sunkavalli (popularly known as Chinna) was the project manager of Project Ashray. In addition to the inherent inadequacy of hospital beds to accommodate the growing number of COVID- 19 patients till March 2021, the city faced a sudden spike of infections in April that worsened the situation. Consequently, the occupancy in government and private hospitals in Hyderabad increased by 485% and 311%, respectively, from March to April. According to a prediction model, Chinna knew that hospital beds would be exhausted in several parts of the city in the next few days. The Project Ashray team was concerned about the situation. The team met on April 26, 2021, to schedule the project to establish the medical care center within the next 10 days. The case is suitable for teaching students how to approach the scheduling problem of a time- constrained project systematically. It helps as a pedagogical aid in teaching management concepts such as project visualization, estimating project duration, float, and project laddering or activity splitting, and tools such as network diagrams, critical path method, and crashing. The case exposes students to a real-time problem-solving approach under uncertainty and crises and the critical role of NGOs in supporting the governments. Alongside the Project Management and Operations Management courses, other courses like Managerial decision-making in nonprofit organizations, Health care delivery, and healthcare operations could also find support from this case.
Set in April 2017, this case centers around the digital technology dilemma facing the protagonist Dr. Vimohan, the chief intensivist of Prashant Hospital. The case describes the critical challenges afflicting the intensive care unit (ICU) of the hospital. It then follows Dr. Vimohan as he visits the Bengaluru headquarters of Cloudphysician Healthcare, a Tele-ICU provider. The visit leaves Dr. Vimohan wondering whether he can leverage the Tele-ICU solution to overcome the challenges at Prashant Hospital. He instinctively knew that he would need to use a combination of qualitative and quantitative analysis to resolve this dilemma.
Evidence based medicine (EBM) requires a level of maturity in the processes, both clinical and non-clinical, which is gained typically over years through consistent deliberate efforts. It is argued that the role of clinical leadership is critical to this. In addition, challenges of implementing EBM are easiest to surmount in single location organizations but complicate considerably when there are multiple distributed locations. While EBM is gaining momentum in health care systems of more developed countries, examples of successful implementation are few in India. Indian institutions face the unique challenge of sorting through multiple bases of foreign evidence (differing guidelines in the UK and U.S.) in addition to domestic evidence covering interventions less frequently used outside of India. The Tata Memorial Centre (TMC) is a pioneer in cancer care and research in India. Over several decades, they have developed an indigenous approach to development and implementation of Evidence based medicine, which has catapulted them into leading cancer hospitals in the world. Set in March 2016, this case study describes TMC's journey thus far with particular emphasis on changes in organizational design as key enablers. TMC's next frontier is to propagate this model of clinical excellence to other cancer hospitals in India through the formation of National Cancer Grid. The key challenge confronting Dr. Rajendra Badwe, Director of TMC, is can these other hospitals accelerate their journey based on the learnings from TMC or whether they will have to customize their approach based on their own operating context. More broadly, which elements of TMC's clinical excellence model are replicable in other hospitals and what organizational changes would be required to implement them.
The case describes the challenges related to topline enhancement faced by Sparsh Nephrocare, a growing chain of dialysis centers in India. In the early years of its operations (2010-2015), Sparsh grew mainly by opening new centers and focused on cost leadership to maintain profitability. However, as Sparsh's founders, Gaurav Porwal and Saurav Panda, look to raise Series B funding, they are faced with the challenge of how to fuel the next phase of growth at the existing centers. Any option worth investigating must ensure that the company's relationships with various stakeholders in a fragmented ecosystem are not adversely affected. This includes ensuring good outcomes for patients and preserving the autonomy of nephrologists and the importance of the hospitals that house these dialysis centers.
First National Healthcare (FNH) runs a large network of hospitals and has worked to systematically reduce waiting times in its emergency departments. One of FNH's regional networks has run a successful marketing campaign promoting its low ED waiting times that other regions want to emulate. The corporate quality manager must now determine whether to allow these campaigns to be rolled out and, if so, which waiting time estimates to use. Are the numbers currently being reported accurate? Is there a more accurate way of estimating patient waiting time that can be easily understood by consumers?
This case relates the genesis and evolution of vision centres (VCs) for primary eye care at Aravind Eye Care System (AECS). AECS, based in the south Indian state of Tamil Nadu, is the world's largest eye care provider. The case is based in 2014, exactly a decade after the first vision centre was opened, and evaluates the role of VCs in Aravind's outreach ecosystem. Community outreach programmes were an integral part of Aravind's model from the start and formed a central part of its vision of taking eye care to the community's doorstep. For many years, community outreach at Aravind was done through eye camps held in remote rural locations. Eye camps had worked extremely well for a long time. However, eye camps were not a perfect solution to Aravind's outreach goals for many reasons. Vision centres evolved as a way to address some of the shortcomings of eye camps, and both these outreach methods were employed in parallel. This case focuses on Aravind's vision centres and how they evolved over a decade, how they compare with the eye camps as a vehicle to attain Aravind's goals, and the opportunities and challenges ahead.
The case describes operations of one of the early entrants in the Online Grocery Delivery industry in India, AtMyDoorsteps.com (AMD). After having run the company for three years, the founder, Sushant Junnarkar, is looking for big ticket funding. As he prepares his pitch, he wonders whether his business is lucrative enough for investors. What changes could be possibly made to the existing model to improve profitability for the company? He intends to revisit some of the strategic and tactical decisions that he had made at the time of inception of AMD. Junnarkar's final decision would determine the fate of his pitch to investors and subsequently the future sustainability of his venture.
Manish Bhardwaj, co-founder of Innovators in Health, is contemplating setting up Aahan, a community based tuberculosis (TB) control program in rural India. The case describes TB diagnosis and treatment in the public and private healthcare sectors in India and the attendant challenges. A number of candidate interventions aimed at improving the existing system of healthcare delivery are presented at the end of the case, each one of which could form the core of Aahan. Students are encouraged to use operations management principles to quantify the potential public health benefits and costs of these interventions and prioritize them accordingly. Key concepts include process flow mapping, flow balance, Little's Law and selection of appropriate process measures based on the strategic objective of the process.
Mobile C.A.R.E. Foundation is a Chicago-based nonprofit that provides chronic asthma care to inner-city public school students using a community outreach model. The organization faces a lot of uncertainty in future funding, and executive director Steve Samuelson wants to undertake an operational improvement drive. Samuelson now faces the challenge of deciding which operational metrics most closely correlate with the organization's mission metrics and also have the usual desirable properties of process measures: actionable, real-time, and disaggregate.
Roger Osayende, a former management consultant, must advise the Ministry of Health of Ektu, a fictional country in Central Africa, on how to implement a new point-of-care diagnostic test for infants with HIV. In Ektu, mothers often transmitted HIV infection to infants during pregnancy, delivery, or breastfeeding due to inadequate resources to invest in prevention efforts. The existing procedure to diagnose infants with HIV required collecting dried blood samples at more than two hundred healthcare facilities around the country and transporting them to a central laboratory in the capital for testing. This process was characterized by significant delays due to long transportation times, batching of samples in transportation and processing in the lab, and concomitant congestion in the lab. This delay resulted in loss to follow-up, that is, lost patients due to mothers not collecting their infants' results. A new point-of-care device was about to be introduced, which would obviate the need for this centralized processing and the resulting diagnostic delay. The key decision under consideration is where to place the devices to maximize their effectiveness.
Stan Kent, vice president of pharmacy at NorthShore University HealthSystem, is faced with the challenge of seasonal planning for the influenza vaccine. The supply received by the multilocation healthcare system is unreliable in terms of timing and quantity. As part of improved planning, Kent is contemplating a new contract with NorthShore's major supplier of flu vaccines. The options under consideration include fixing either the date of delivery or the quantity delivered. The main decision involved in either option would be how much vaccine to order. The case also provides details about the seasonal influenza epidemic in the United States, illustrates operational complexities of the U.S. flu vaccine supply chain, and provides a brief description of the various channels used to distribute flu vaccine to end consumers.