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The role of American corporations as purchasers of health insurance for their employees has changed dramatically over the past several decades from a passive stance to an aggressive purchasing and policy-making role. The transformation has caused purchasers to question the appropriateness of their health benefit interventions for legal, ethical, and financial reasons. Recent research about the role of "medical necessity" in California managed care decision making reveals a number of problems purchasers face and describes solutions recommended by some purchasers to those problems.

Managing an organizational transformation is a risky and difficult endeavor. This article examines the lessons learned from the transformation of the Veterans Health Administration (VHA), one of the largest agencies in the federal government. The transformation, which has proven to be highly successful, has focused on changing the agency from a health care delivery system emphasizing inpatient-oriented tertiary care to a health care delivery system that can meet the growing needs of veterans for outpatient-oriented primary care. The VHA's experience reveals the importance of selecting leaders whose qualifications match the needs of the transformation, developing a coherent transformation plan, maintaining a focus on key transformation goals, and managing external changes to complement internal ones. In addition, the VHA's experience reminds us that a transformation often raises significant issues concerning employee training and education, communication with frontline employees, and the balance between centralized control and operating unit flexibility.

A recent report from the Institute of Medicine has focused attention anew on the incidence of medical errors in the health care industry. While there is a relatively large body of research on how organizations can operate in a highly reliable manner, and thus avoid such errors, little of that work has been done in the health care field. This article discusses the ways in which the health care industry has failed to meet systematically the standards for achieving high reliability, based in part on two existing theories about the management of high-hazard environments--High Reliability Organization Theory (HROT) and Normal Accidents Theory (NAT).

This initial module was meant to clarify how the course would be useful to students who would be starting PSFs, working for them as an employee or contractor, managing them, or hiring them from the client side.

Concerns itself with the strategic dynamics which influence organizations externally.

The way in which PSFs organize themselves to leverage strategic capabilities is imperative in achieving high performance.

Focuses on how the internal processes connect strategy with implementation.

It is imperative for the internal systems and processes to be connected to the external processes of client management, competitive adaptation, and service delivery.

Emphasizes the skills and values that we believe successful professionals possess: change management and leadership skills, a proactive career management approach, effective processes of giving and receiving feedback, a clear ethical perspective, balance between private and professional lives, and the ability to cope with ever increasing demands on one's time.

Discusses strategies for balancing private and professional life.

Margaret McLaughlin has just begun her new appointment as the Dean of Health Professions at the College of St. Catherine in Minneapolis/St. Paul, Minnesota. As an education leader, her charge is to develop Minnesota's health care workforce for the future. She is approached by members of her nursing faculty, who want her to consider launching their very own nurse-practitioner-run clinic. Typically, clinics have been run and directed by physicians. The faculty have suggested four options for the kind of clinic they might run, and McLaughlin must advise them on a course of action. Teaching Purpose: Students will select the kind of nurse practitioner clinic that would be most appropriate for the College of St. Catherine. The analysis will begin by examining the context in which the college is operating and discuss the major criteria that need to be used in making this decision. They will consider the move "up-market" for nurse practitioners' over time, as they have taken on more responsibilities similar in nature to those of a physician. Specifically, students will discuss how nurse practitioners' work has changed over time and the regulations, technological innovations, patient needs, and infrastructure developments that have encouraged this change. Finally, students will debate whether it would make sense to launch their own clinic. They will choose among four options for how the clinic might look, whom it would serve, and how it would be organized.

Jeff Taylor, founder and CEO of Monster.com, ponders how his online site, the leading career site on the web, can continue its dominance (60% share in 1999) and growth on the Internet. Monster.com had just launched a nationwide branding campaign on television and entered a four-year deal with AOL. A rewritten version of an earlier case.

Education services target public schools to assist the school with technology and services that will improve their communication with students, parents, and the community. There is also the goal of increasing scores of measured learning. How does a small company do this? How do they operate nationally with contract employees and maintain a consistent level of service and performance?

A cornerstone of manufacturing practice has been to separate complex tasks into simple ones for economies of scale, and service industry practice has followed a variation of this principle by splitting up high and low customer contact activities to cut costs. Low-contact activities are removed from front office jobs, standardized, and centralized in some remote back office to achieve scale economies. Here, the authors question this principle; the choice of how to organize back office work carries strategic implications. Their model provides four approaches illustrating different strategies, based on data from a study of retail bank lending operations and using examples from other service industries. The decoupling of front- and back-office operations hinges not only on cost but whether the service firm's strategy is one of cost leadership, dedicated service, premium service, or cheap convenience. Each distinct strategy poses a different set of trade-offs and important managerial issues. Decoupling can be eschewed to decrease costs, or embraced to enhance responsiveness in the front office.

Gateway has opened retail stores to differentiate itself from its competitors (e.g., Dell). Describes how the company has created an excellent service experience, but has struggled financially as a result.

Four Seasons has a love/hate relationship with technology, including the best Web site in the industry. This case examines how a leading service delivers high-tech/high-touch, and looks at its progressive human resource strategy.

Supplements the (A) case. A rewritten version of an earlier case.

Supplements the (A) case. A rewritten version of an earlier case.

Sotheby's has taken 50% of its business by volume to the Internet. How do the economics change? How do logistics and customer support needs change? What leverage does the Internet provide this established bricks-and-mortar auction house?

This collection of readings illustrates the importance of service and logistics in e-commerce, focusing on e-Toys' disastrous 1999 holiday season.