This case describes how Boston Medical Center, a hospital and safety net organization, changed its strategic approach to health equity after realizing that previous efforts were not sufficient to address the health disparities among their patients. In 2021, the Health Equity Accelerator was formed to coordinate this strategic approach, which adopted race-based disparities as their primary focus. Over three years the Accelerator demonstrated impressive reductions in racial and ethnic disparities in health outcomes among pregnant women and patients with diabetes. These results reinforced their drive to scale their innovative approach, and set an example for other institutions nationwide. However, scaling presented significant challenges: balancing replicable and standardized "off the shelf" solutions with distributing a "methodology" to enable other institutions to identify their own solutions to inequities in their patient population.
The case study examines the journey toward value-based healthcare at Karolinska University Hospital. The hospital's ambitious shift to a patient-centered care delivery model, accompanied by the construction of a new facility, encountered challenges such as high costs, staff dissatisfaction, and growing waiting lists. The departure of CEO Melvin Samsom in 2018 left the new director Bjorn Zoega with a budget deficit, discontented staff, and an outdated IT system. By 2023, however, Zoega had achieved a remarkable turnaround. Ranked among the top 6 international hospitals, the institution boasted a positive budget and had exceeded production assignments for three consecutive years. In 2023, Zoega pondered if his changes were long-lasting and how the Hospital should face new challenges such as an aging population and a shortage of qualified nurses.
In May 2022, Roche Group, one of the largest healthcare companies in the world, hosted its first ESG investor event focused exclusively on its efforts to impact access to healthcare. While Roche had recently set an ambitious goal to double the number of patients that had access to its innovative medicines and diagnostic solutions within ten years, it was not at all clear how the firm should structure its resource allocation criteria, performance evaluations, reporting and incentive systems to align efforts internally toward these goals. Group CFO and CIO Alan Hippe was presented with two options, none of which he was particularly enthusiastic about. One was to lower the hurdle rate for projects related to ESG issues, thus relaxing profit expectations. The alternative was to incorporate a set of minimum ESG requirements in all of Roche's new project proposals. In this case, however, the risk was to reduce the focus on ESG from a strategic priority to a compliance exercise. In the presentation shared with investors at the ESG event, access to healthcare had been positioned as Roche's greatest contribution to society. This type of public commitment required more than a compliance-level of effort. In September, Alan Hippe would sit down with the executive committee to chart a path for integrating ESG issues into Roche's project selection and business planning. Hippe went on to define three objectives for ESG at Roche, "we need to align on targets, we need to get resource allocation right, and we need to report both internally and externally."
Social determinants of health (SDOH) have gained significant attention in recent years. A growing body of research shows that a person's health is influenced by a large number of non-genetic factors, most of which operate outside the realm of health care and are directly attributable to socio-economic conditions. In the U.S., clinical and economic motivations have spurred health care providers, health insurance companies, local governments, and community-based organizations to take action to address SDOH. The fragmented structure of the healthcare industry has, on the one hand, stimulated innovation and experimentation. On the other hand, the lack of standardized measures to capture the effectiveness and efficiency of these interventions and the lack of loci to share information about best practices impede the identification and duplication of successful solutions. In this technical note, we describe the main players and their roles in the SDOH ecosystem, as well as the obstacles that hinder the development of successful, large-scale solutions. The note shines a light on the limitations of the current approach and highlights the potential of the U.S. SDOH ecosystem to succeed in addressing these important determinants of population health.
Early in August 2021, DaVita CEO Javier Rodriguez was assessing the ongoing impact of the COVID-19 pandemic on his firm, which provided life-sustaining kidney dialysis to roughly 240,000 people. Effective infection control practices and information sharing had ensured that no COVID case had yet been transmitted to patients or staff on DaVita premises. A strong corporate culture had fostered the commitment among DaVita staff and management to each other and to their patients that had enabled their successful collective response. But 18 months into the pandemic, unprecedented staff attrition, exhaustion, and the now rapidly spreading Delta variant had Rodriguez and other DaVita managers concerned that the traits that had sustained the firm to date were no longer enough.
The case follows the Children Cancer Hospital in Egypt, also known as Hospital 57357, as it goes through the roll-out of a new performance management system, which Dr. Sherif Abouel Naga, founder and CEO of the hospital, had championed. This was a critical juncture as the largest pediatric cancer hospital in the world was transitioning from a traditional, relatively informal operating style to a performance management system that was tightly structured and data driven. Dr. Abouel Naga had tasked a newly assembled management team with defining a strategy to ensure that 57357 remained a world leader in quality healthcare for children with cancer in an evolving and uncertain market landscape. While Dr. Abouel Naga was confident that a system that measured each individual's contribution to the strategy would make a difference in the overall performance of the organization, critics worried about how employees might respond to the tight structure that came with this system. How could they ensure there would still be plenty of room for creativity and innovation, which were so important in the delivery of care? Would the new system allow to adapt quickly to evolving market conditions without generating confusion among the staff?
The case complements Pasta Serafina (A) by describing the aftermath of a town hall meeting in which management had publicly denounced the absenteeism problem and challenged the employees to find a solution. In spite of the initial mistrust against management, the fear of an imminent plant closure coupled with the relief associated with finally being able to be heard by management, pushes the employees to act to contain the problem themselves. Within a short time, absenteeism hits record lows. Management, however, is left wondering about the sustainability of the new culture.
Plant management at Pasta Serafina, a pasta producer in the south of Italy, is struggling to contain employee absenteeism. While the misbehavior is concentrated in a minority of the workers, its effects impact not only the plant's performance, but also the climate and work environment. Embedded in institutional and legal environment that allows very little room for corrective action, and already dealing with persistent low margins, management decides to address the issue by asking the employees themselves to find a solution to the problem. The case exposes students to managerial challenges associated with curbing moral hazard and changing the company culture in a setting where standard legal and contractual tools, such as firing workers for performance or using incentives to influence behaviors, are not available.
This case describes the growth of Glenn Defense Marine Asia (GDMA) under the leadership of Leonard Glenn Francis. GDMA provided ship husbanding and logistical support services to the United States Navy when Navy ships visited various ports in Southeast Asia. The case details the role of ship husbanding in U.S. Navy operations and the contracting process for procuring ship husbanding services. In order to help win contracts, Francis developed relationships with an extensive network of U.S. Navy officers, often by treating them to lavish meals and luxury accommodations during port visits. He used this network of contacts to acquire confidential information about U.S. Navy ship operations and port visits, giving GDMA an advantage in bidding for contracts. The case relates how Francis and GDMA came under investigation for these tactics and allows for discussion of whether these tactics were potentially illegal and/or unethical. The (A) case concludes with Francis' arrest by U.S. authorities. The (B) case describes the aftermath of Francis' arrest, including the prosecution and sentencing of his co-conspirators and the termination of U.S. Navy contracts with GDMA. The (B) case further describes a U.S. Navy audit of contracting practices and changes implemented to prevent future unethical or corrupt contracting as had occurred on a widespread basis between GDMA and the U.S. Navy. This case supports a discussion of internal control practices to contain risk of fraud and misconduct.
Supplemental to case 120036 This case describes the growth of Glenn Defense Marine Asia (GDMA) under the leadership of Leonard Glenn Francis. GDMA provided ship husbanding and logistical support services to the United States Navy when Navy ships visited various ports in Southeast Asia. The case details the role of ship husbanding in U.S. Navy operations and the contracting process for procuring ship husbanding services. In order to help win contracts, Francis developed relationships with an extensive network of U.S. Navy officers, often by treating them to lavish meals and luxury accommodations during port visits. He used this network of contacts to acquire confidential information about U.S. Navy ship operations and port visits, giving GDMA an advantage in bidding for contracts. The case relates how Francis and GDMA came under investigation for these tactics and allows for discussion of whether these tactics were potentially illegal and/or unethical. The (A) case concludes with Francis' arrest by U.S. authorities. The (B) case describes the aftermath of Francis' arrest, including the prosecution and sentencing of his co-conspirators and the termination of U.S. Navy contracts with GDMA. The (B) case further describes a U.S. Navy audit of contracting practices and changes implemented to prevent future unethical or corrupt contracting as had occurred on a widespread basis between GDMA and the U.S. Navy. This case supports a discussion of internal control practices to contain risk of fraud and misconduct.
This case describes a setting in which the CFO of Bark Gift Shop Ltd., a gift items retailer, discovers an undesired pattern in the performance data suggesting that her shop managers that perform well during the first part of the year, purposely reduce their effort in the later part of the year. This pattern drives the CFO to reflect on the process by which she sets annual targets for shop managers and how those targets relate to various aspects of their compensation contract. Challenging targets, however, appear to be motivating for a sizeable amount of shop managers. In fact, many shop managers that repeatedly fail to meet the target appear not to be giving up and keep trying to achieve their challenging targets. Therefore, the CFO needs to strike the right balance between providing motivating targets and curbing the undesired behaviors that she just discovered. The case lends itself to a rich discussion of common performance management issues, such as target setting, performance metrics selection, and performance-based compensation design. In particular, the case exposes the students to the issue of target ratcheting. As the case includes a data base it provides ample opportunities for students to practice their analytical skills (producing and discussing descriptive statistics, regressions and interactions).