Ivey Publishing

Strategic Management of Health Care Organizations

Ginter, P.M., Duncan, W.J., Swayne, L.E.,7/e (United States, Wiley, 2013)
Prepared By Eunika Sot,
Chapter and Title Chapter Matches: Case Information
Chapter 1:
The Nature of Strategic Management

BRITISH NATIONAL HEALTH SERVICE REFORM
Anne Snowdon, Alexander Smith, Luca Pisterzi

Product Number: 9B14M045
Publication Date: 7/11/2014
Revision Date: 7/11/2014
Length: 16 pages

In 2012, a highly controversial bill was passed that called for major reform and restructuring of Britain’s government healthcare system, the National Health Service. Public opinion of the reform was both highly polarized and volatile. The Secretary of State for Health faces two tasks: addressing key issues to ensure successful implementation of the reforms and developing a plan to ensure both long-term and short-term success.

Teaching Note: 8B14M045 (7 pages)
Industry: Health Care Services
Issues: Leading change; health care; stakeholder management; government policy; United Kingdom
Difficulty: 4 - Undergraduate/MBA



SHRINERS HOSPITALS FOR CHILDREN
Karin Schnarr, Anne Snowdon

Product Number: 9B13M075
Publication Date: 6/24/2013
Revision Date: 6/24/2013
Length: 11 pages

A large, international benevolent association operating 22 children’s hospitals and four research centres in three countries has been negatively impacted by a number of external factors. The effect of the 2008 global financial crisis on its endowment funds coupled with rising health care costs and flat donations, have resulted in the hospitals running at a loss. To ensure the long-term viability of their not-for-profit hospital system, management feels it must present drastic options to delegates at its annual general meeting, including reconsidering the policy of providing free medical care to children regardless of their ability to pay, shutting down research facilities and closing over a quarter of their hospitals. While management is confident that the quality of care for pediatric patients will not be compromised, all of the options being considered will significantly impact hospital operations and the organization’s culture. For the first time in the 87 years of the organization’s existence, some very difficult options are on the table.

Teaching Note: 8B13M075 (10 pages)
Industry: Health Care Services
Issues: Governance structure; not-for profit; strategy formulation; staff retention; United States; Canada
Difficulty: 4 - Undergraduate/MBA



SOLUTIONS CARE ASSOCIATION: DEVELOPING AN INTEGRATED CSR STRATEGY
Vesela Veleva

Product Number: 9B11M004
Publication Date: 3/23/2011
Length: 19 pages

This case focuses on Solutions Care Association (SCA) — a nonprofit health care organization established in 2000 that quickly became a leader in environmental stewardship and social responsibility. With headquarters in Nevada, United States, the company had a strong mission and socially responsible culture, which helped attract talent and launch social and environmental initiatives. Despite its numerous achievements and awards, however, there was limited awareness internally and externally about these initiatives and their impact on business and society. In addition, the company did not have a comprehensive way to track and report these achievements. As an emerging leader of the integrated health care plan in the United States, Solutions Care Association had both the responsibility and the opportunity to be a model of what American health care should look like. With growing concerns over and scrutiny of the health care industry, there was no better time for Solutions Care Association to continue to strengthen its leadership position in addressing key social and environmental problems, such as providing affordable health care, reducing climate change impacts, phasing out toxic chemicals and creating a safe, culturally sensitive, and supportive environment for employees, patients, and suppliers.

Teaching Note: 8B11M004 (8 pages)
Industry: Health Care Services
Issues: Strategy Development; Communications; Health Care; Corporate Social Responsibility; United States
Difficulty: 4 - Undergraduate/MBA


Chapter 2:
Understanding and Analyzing the General Environment and the Health Care Environment

PFIZER: ENVIRONMENTAL AND BUSINESS BENEFITS OF GREEN CHEMISTRY
Vesela Veleva, Madhura Sarkar

Product Number: 9B15M043
Publication Date: 6/3/2015
Revision Date: 6/2/2015
Length: 19 pages

This case focuses on Pfizer, the largest research-based pharmaceutical company globally with sales of over $51 billion and operations in 175 countries in 2013. It introduces students to the field of green chemistry and discusses the business and environmental effects of such a strategy. While Pfizer has measured the benefits of green chemistry, communicating these externally has been challenging. In addition, manufacturers of generic drugs largely have not embraced green chemistry. As the first lead of Pfizer’s Green Chemistry team, the first of its kind in the industry, how will you prepare for a meeting with your team’s steering team to address progress and new initiatives? You will have to understand the complex market by, for example, identifying key drivers for other pharmaceutical companies, including generics, for adopting green chemistry. How should Pfizer communicate the impact of its sustainability efforts, including “greener” drugs, to the public?

Teaching Note: 8B15M043 (7 pages)
Industry: Health Care Services
Issues: Green chemistry; environmental management; pharmaceuticals
Difficulty: 4 - Undergraduate/MBA



ORGANIZATIONAL TRANSFORMATION AT THE CENTRE FOR ADDICTION AND MENTAL HEALTH
Anne Snowdon, Karin Schnarr, Alexander Kunsch

Product Number: 9B14M083
Publication Date: 7/17/2014
Revision Date: 7/17/2014
Length: 13 pages

In 1997, the Ontario Health Services Restructuring Committee mandated the merger of four facilities that treated patients with mental health and addiction issues to create what was later named the Centre for Addiction and Mental Health. This new centre, to be situated in Toronto, would provide support and clinical care to those suffering from illnesses such as schizophrenia, anxiety and mood disorders, as well as substance addictions. In 1999, the newly appointed chief executive officer and his management team have to present their recommendations to the board of trustees for implementing this complex merger. The plan will need to recognize and address significant infrastructure, strategic, organizational and stakeholder challenges. The merger will be a large change for vulnerable patient populations and their families, as well as the staff at the four merging organizations and the neighbourhoods bordering the new facility.

Teaching Note: 8B14M083 (12 pages)
Industry: Health Care Services
Issues: Mental health; stakeholder management; leading change; Canada
Difficulty: 4 - Undergraduate/MBA



SICKKIDS IN QATAR - RESPONDING TO A REQUEST FOR PROPOSAL
Anne Snowdon, Alexander Smith, Heidi Cramm

Product Number: 9B14M025
Publication Date: 4/7/2014
Revision Date: 4/4/2014
Length: 20 pages

In January 2005, the vice-president of International Affairs at the Hospital for Sick Children in Toronto, Ontario, must decide how to respond to a request for proposal from the Hamad Medical Corporation of Qatar. In order to reach its global mission of “Healthier Children, A Better World,” the Toronto hospital, which had an international reputation for excellence in pediatric medicine, had established an arm called SickKids International. In addition, it was anxious to find new ways to recover from an operating deficit caused by the aftershock of the SARS outbreak. Hamad Medical Corporation, a major state hospital medical supplier in Qatar, was looking for international centres that would want to partner with it in the development of what it hoped would become the best children's hospital in the Middle East. The vice-president understood the enormous benefits that the partnership had to offer but recognized the need for a comprehensive strategy to mitigate all of the associated risks, such as the difference in cultures between Canada and Qatar, the pressure on the Toronto hospital’s staff to make the project successful and the uncertain political and business environment in the Middle East. Should she recommend to her executive team that they go ahead with their first international request for proposal?

Teaching Note: 8B14M025 (6 pages)
Industry: Health Care Services
Issues: Globalization; health care; cross-cultural; leading change; Canada; Qatar
Difficulty: 4 - Undergraduate/MBA



TARGET SYSTEMS: CHALLENGES AND OPPORTUNITIES IN THE ELECTRONIC HEALTH INFORMATION SYSTEM ARENA
Michael J. Fratantuono, David M. Sarcone

Product Number: 9B12M090
Publication Date: 10/29/2012
Revision Date: 10/6/2015
Length: 19 pages

In the summer of 2010, the members of the business development team of Target Systems were carefully considering the possibility of entering the Electronic Health Information (EHI) systems arena. The company had both breadth and depth of experience in providing logistics, project management and information technology (IT) services to clients in the public and private sector. Although the employees of Target Systems were experts in a full range of IT services, no one in the company had deep expertise about the way IT applications were being used to manage patient care or administer health care organizations. The lack of expertise implied that a movement by Target Systems into the EHI systems arena would call for the company to simultaneously develop new products and services for a new set of clients –– to engage in growth by related diversification. That strategy would stand in contrast to the growth by concentration strategy the team had employed throughout company history. To pursue a diversification strategy the team would have to decide if it should provide services to regional health information organizations, hospitals or individual physicians’ practices. It would also have to decide whether it would cultivate new capabilities by investing in internal development or by seeking a strategic partner that was already operating in the arena. Ultimately, the way the business development team weighed the opportunities versus the challenges of adopting a new growth strategy in the context of a still uncertain external environment would strongly influence its decision as to whether or not the company should enter this new arena.

Teaching Note: 8B12M090 (16 pages)
Industry: Information, Media & Telecommunications
Issues: Strategy formulation; diversification; United States
Difficulty: 4 - Undergraduate/MBA


Chapter 3:
Service Area Competitor Analysis

EMBRACE (A): OPPORTUNITY IDENTIFICATION
Mridula Anand, Anand Nandkumar, Charles Dhanaraj

Product Number: 9B13M004
Publication Date: 4/16/2013
Revision Date: 4/16/2013
Length: 7 pages

AWARD WINNING CASE - Indian Management Issues and Opportunities Award, 2013 European Foundation for Management Development (EFMD) Case Writing Competition.The Embrace case series provides an engaging context to understand social innovation, by taking students through a sequence of critical decisions from opportunity analysis and market feasibility study to formulating a competitive strategy and developing business models for growth. The focus of the case is on an innovative idea to solve the problem of a high number of fatalities in premature births in rural India, and the potential for an affordable product.



The case is structured as a four-part series:

  • Part A: Opportunity Identification. The setting is an MBA classroom where five teams have been given five ideas and the students are asked to match each idea to each team. The focus is on how to identify and evaluate an appropriate opportunity given a unique entrepreneurial team, its composition, and its prior experience. Often, entrepreneurs discount the critical role that team-task fit plays in subsequent success.

  • Part B: Market Feasibility Analysis (9B13M005). The social problem associated with neonatal care in rural India is presented and the economics of providing reasonable care for premature babies is discussed. Is it possible to find an affordable and profitable price point, and make the project sustainable?

  • Part C: Competitive Strategy (9B13M006). The students are taken through an external analysis of the potential competition. This calls for a close analysis of what the competitive advantage of the venture is and whether it is sustainable. It forces the students to consider other available neonatal care options in the market, as well as to think about the IP issues they could face.

  • Part D: Building the Business Model (9B13M007). The team must decide between manufacturing the product in-house or outsourcing to vendors. Also, issues of distribution and sales require consideration.


Teaching Note: 8B13M004 (16 pages)
Industry: Health Care Services
Issues: Emerging markets; affordable innovation; business plan; social entrepreneurship; India
Difficulty: 5 - MBA/Postgraduate



CLOSING THE GAP - THE CHANGING HOME CARE ENVIRONMENT (A)
Rod E. White, Rida Elias

Product Number: 9B10M051
Publication Date: 7/9/2010
Length: 14 pages

The regulations in the home care industry are changing. The industry is moving toward consolidation and favouring large companies. Closing the Gap, a small home care provider in Ontario, reaches a crossroad. The company has three strategic options to choose from: (1) sell the company, (2) buy another company, or (3) grow organically. Given these conditions, students will be asked to conduct an industry analysis and help the chief executive officer (CEO) of Closing the Gap make the appropriate decision. In the (B) case, students will be asked to evaluate an acquisition possibility and advise the CEO whether the acquisition will be a successful one or not.

Teaching Note: 8B10M51 (22 pages)
Industry: Health Care Services
Issues: Industry Analysis; Strategic Decision Making; Health Care; Strategic Acquisitions
Difficulty: 4 - Undergraduate/MBA



MEDICARE AND DRUG-ELUTING STENTS
David M. Currie, Mark Arundine

Product Number: 9B05M053
Publication Date: 3/1/2006
Revision Date: 10/1/2009
Length: 12 pages

The U.S. Food and Drug Administration has recently approved a drug-coated stent for use in angioplasty procedures. The stent is expected to reduce the rate of repeat procedures due to restenosis, and to postpone the need for more invasive surgery such as coronary bypass. However, the drug-coated stent costs three times as much as an uncoated stent, which will increase the cost of the medical procedure. Public demand for the stent is overwhelming, because of the higher cost and huge demand, cost of medical care could increase dramatically. Students need to think about the trade-off between quality improvements and higher costs of medical treatment by looking at the impact on several stakeholders: patients, hospitals and insurers.

Teaching Note: 8B05M53 (10 pages)
Industry: Health Care Services
Issues: Technological Change; Ethical Issues; Economic Analysis
Difficulty: 5 - MBA/Postgraduate


Chapter 4:
Internal Environmental Analysis and Competitive Advantage

GOJO INDUSTRIES: AIMING FOR GLOBAL SUSTAINABILITY LEADERSHIP
Chris Laszlo, Anya Briggs, Jayesh Potdar

Product Number: 9B13M108
Publication Date: 10/21/2013
Revision Date: 10/18/2013
Length: 11 pages

GOJO Industries, a U.S.-based hand hygiene company, plans to use sustainability as a business strategy in its big hairy audacious goal of reaching one billion people every day by 2020. It has developed a six level framework to embed sustainability throughout every aspect of the company internally and to assess its successes in the following areas: mitigating risk; reducing energy, waste and materials; differentiation; entering new markets; protecting and enhancing brand; and influencing industry standards. The company has a long history of using sustainability to drive innovation and facilitate expansion into new markets and sees sustainability as a key differentiator from its competitors to achieve its goal. In order to so, the company must also consider the importance of employee engagement in order to further embed sustainability and increase the number of people it reaches with its products.

Teaching Note: 8B13M108 (6 pages)
Industry: Health Care Services
Issues: Growth strategy; competitive advantage; flourishing; social sustainability; United States
Difficulty: 4 - Undergraduate/MBA



BUSINESS PROCESS OUTSOURCING AT APOLLO HEALTH STREET
Christopher Williams, Ramasastry Chandrasekhar

Product Number: 9B11M041
Publication Date: 5/10/2011
Length: 16 pages

The managing director of Apollo Health Street (AHS), a health care business process outsourcing (BPO) company headquartered in Pennsylvania, United States, was pondering two dilemmas: achieving short-term growth for his company, and finding new ways to compete in a changing industry. AHS was itself a subsidiary of Apollo Health Enterprises Ltd., an integrated health care company located in Hyderabad, India. AHS had been growing at an 80 per cent compound annual growth rate since 2005 and aimed to reach $100 million in sales by March 2010. Its target was to increase annual sales to $500 million within three years in a highly competitive space, which if successful would move AHS into the top three BPO companies in the health care sector. How should it secure short-term growth? The second dilemma was how to plan for the future. Industry analysts had predicted that over the next five to ten years, health care BPO would become unrecognizable from its current form. The managing director believed that although scaling up would strengthen the company’s position for the short term, the company should also be looking for solutions to stay relevant to the customer. How should AHS influence the shape of health care BPO in the future? What new ways of competing could the company pursue?

Teaching Note: 8B11M041 (10 pages)
Issues: Securing Scale; Competitive Strategy; Health Care; Business Process Outsourcing; United States; India
Difficulty: 4 - Undergraduate/MBA



NATIONWIDE PRIMARY HEALTHCARE SERVICES: EVOLVING BUSINESS MODEL
Kajari Mukherjee

Product Number: 9B15M012
Publication Date: 2/19/2015
Revision Date: 2/17/2015
Length: 16 pages

NationWide Primary Healthcare Services has launched a chain of primary healthcare clinics in India with the aim of bridging the gap between fragmented general practitioner services and highly expensive, specialist hospital care. The potential need for primary care is immense, though its delivery through organized retail is a new concept in India. The case describes the organization’s initial four years’ of operation. The clinics are not doing as well as expected. The initial business model and its subsequent refinements are discussed as the company tries to balance its core logic with its strategic choices for creating, delivering and capturing value.

Teaching Note: 8B15M012 (11 pages)
Industry: Health Care Services
Issues: Business model; value network; entrepreneurship; healthcare management; India
Difficulty: 5 - MBA/Postgraduate


Chapter 5:
Directional Strategies

NEPHROPLUS
S Ramakrishna Velamuri, Geetika Shah

Product Number: 9B15M040
Publication Date: 5/1/2015
Revision Date: 5/1/2015
Length: 14 pages

Starting with a small pilot centre in Hyderabad in 2010, a chain of quality dialysis centres had grown to 25 centres by mid-2014, with plans to expand to 100 by 2017. As they planned for this growth, the three co-founders had several questions with respect to NephroPlus's business model, partners, staff, systems, processes and culture playing on their minds. With the threat of competition looming large, they knew that they had to work hard to achieve both high quality and affordability as they continued with their fast-paced growth.

Teaching Note: 8B15M040 (12 pages)
Industry: Health Care Services
Issues: Health care; business model; growth strategy; India
Difficulty: 5 - MBA/Postgraduate



VISIONSPRING IN INDIA: ENABLING AFFORDABLE EYEGLASSES FOR THE POOR
Sandeep Goyal, Amit Kapoor

Product Number: 9B14M144
Publication Date: 4/21/2015
Revision Date: 5/1/2015
Length: 11 pages

VisionSpring enabled access to affordable eye care for low-income individuals suffering from vision impairment in developing economies. Established in the United States as a not-for-profit social enterprise, it sold more than two million pairs of eyeglasses globally, which included over one million pairs of eyeglasses sold in India. Despite achieving this scale, VisionSpring believed there was a long way to go considering the estimated 300 million people in India requiring eyeglasses for vision correction. Realizing this as a huge unmet opportunity, the company set a goal of achieving 10 times its annual sales volume in India. This was not an easy task considering the socio-economic dynamics of the base of the pyramid segment, as well as market challenges in peri-urban and rural India. The plan would require a total paradigm shift in the overall business model of VisionSpring in India.

Teaching Note: 8B14M144 (13 pages)
Industry: Health Care Services
Issues: Social enterprise; base of the pyramid; healthcare; business model; India
Difficulty: 5 - MBA/Postgraduate



ALBERTA HIP AND KNEE REPLACEMENT PILOT PROJECT: CHANGING THE PROVINCIAL MODEL OF HIP AND KNEE CARE
Michael J. Rouse, Aish Sundaram

Product Number: 9B12M057
Publication Date: 5/17/2012
Revision Date: 5/17/2012
Length: 16 pages

This case examines methods to incorporate the best evidence into clinical practice. More particularly, it considers the issue of knowledge translation from the perspective of implementing an evidence-based hip and knee care pathway in Alberta, Canada. A secondary problem would be bringing together multiple stakeholders with different incentives to implement a large-scale health care change.

Teaching Note: 8B12M057 (6 pages)
Industry: Health Care Services
Issues: Health Care; Evidence-based Practice; Knowledge Translation; Organizational Change; Canada
Difficulty: 4 - Undergraduate/MBA


Chapter 6:
Developing Strategic Alternatives

LIFESPRING HOSPITALS: DELIVERING AFFORDABLE, HIGH-QUALITY MATERNAL HEALTH CARE IN INDIA
S Ramakrishna Velamuri, Wei Zhang, Priya Anant, Monidipa Mukherjee

Product Number: 9B12M105
Publication Date: 2/19/2013
Revision Date: 4/9/2013
Length: 17 pages

This case highlights the journey of an organization that was set up in Hyderabad, in southern India, to provide affordable maternal care services to women from low-income urban families. LifeSpring Hospitals grew from a single hospital into a chain of nine hospitals, all in Hyderabad, in only five years. The chief executive officer has spent this initial period trying out new methods, continuously fine-tuning the model and learning from this process of experimentation. As the company seeks to scale the business to 200 hospitals, the chief executive officer must decide whether or not the business model is defined clearly enough to warrant the start of a rapid scaling process.



The case is unique because it juxtaposes a commitment to high-quality health care service delivery through processes and protocols with a commitment to making maternal care affordable to low-income urban women. LifeSpring Hospitals tries to achieve these seemingly disparate objectives by attempting to create a financially sustainable business model.


Teaching Note: 8B12M105 (10 pages)
Industry: Health Care Services
Issues: Maternity; social enterprise; affordable health care; urban poor; hospital chain; India
Difficulty: 5 - MBA/Postgraduate



NATIONAL PHARMACEUTICAL PRICING AUTHORITY (NPPA): INFLUENCING CUSTOMER BEHAVIOUR
K.R. Jayasimha, Srabanti Mukherjee

Product Number: 9B12A016
Publication Date: 5/25/2012
Revision Date: 5/17/2012
Length: 14 pages

Since its inception in 1997, the National Pharmaceutical Pricing Authority (NPPA) had been trying to control drug prices through various supply-side initiatives, which had yielded limited success. This time around, NPPA had announced a new initiative, which was aimed at educating consumers about the inexpensive alternatives for medicines prescribed by doctors. By giving consumers information about various brands and their prices, NPPA hoped to offer customer self-selection of drugs through short message service (SMS, or “texting”). NPPA appeared to be operating on the premise that customer self-selection could result in self-regulation of consumption, thereby giving greater control of health care expenses to customers. Given the huge penetration of mobile phones in India and the gradual reduction of various mobile service charges, text-based service looked feasible. However, the proposed system had met with strong opposition from other stakeholders, such as doctors and chemists. Besides, the large-scale adoption of the proposed service was being questioned as the decision-making process for medicines was very complex.

Teaching Note: 8B12A016 (10 pages)
Industry: Health Care Services
Issues: Decision-making Process; Decision-making Unit; Moral Hazard; Consumption; Health Care; India
Difficulty: 5 - MBA/Postgraduate


Chapter 7:
Evaluation of Alternatives and Strategic Choice

AYURVAID: GRANDMA'S REMEDIES OR BLUE OCEAN STRATEGY
Samta Jain, Sunanda Easwaran, Murray J. Bryant

Product Number: 9B15M058
Publication Date: 7/31/2015
Revision Date: 8/5/2015
Length: 13 pages

AyurVAID is a chain of Ayurveda (traditional Hindu medicine) hospitals founded by Rajiv Vasudevan, who moved to entrepreneurship after 16 years in the corporate sector and identified Ayurveda’s potential for root-cause diagnosis. AyurVAID provides Ayurveda-based healthcare to treat non-communicable diseases and chronic diseases, which together comprise two-thirds of the Indian healthcare market. Ayurveda’s system of root-cause diagnosis and subsequent disease management results in no side effects, but most Ayurveda companies are content to operate in the wellness sector and to provide Ayurvedic formulations in the over-the-counter consumer market. AyurVAID hospitals are positioned differently, catering to people with lifestyle diseases and offering long-term solutions to many chronic diseases. Over a period of 10 years, AyurvVAID’s approach has led to rapid growth for the hospitals; however, the founder and chief executive officer wants to identify the most appropriate strategy for AyurVAID. Should it focus on strengthening its position as a multi-specialty hospital, or should it explore specializing in India’s large and growing market for the treatment of diabetes?

Teaching Note: 8B15M058 (8 pages)
Industry: Health Care Services
Issues: Opportunities; chronic diseases
Difficulty: 5 - MBA/Postgraduate



STRONGEST FAMILIES
Anne Snowdon, Alexander Smith, Heidi Cramm

Product Number: 9B13M133
Publication Date: 4/7/2014
Revision Date: 4/4/2014
Length: 16 pages

Strongest Families is a 12-week distance treatment program for children with various mental health disorders and their families. The program was started in Nova Scotia in 2001 to address issues of stigma, lack of access to primary care specialists and difficulty of obtaining care, especially in rural areas. To meet these needs, the program utilizes long-distance communication methods such as weekly telephone meetings with trained personnel who are available days, nights and weekends, so access to care is easy and convenient for families. The founder of the program has already proven its efficacy in a major outcome paper that disseminated the supporting evidence to the research community. As chief executive officer of the Strong Families Institute, a federally registered not-for-profit organization, he and his founding partner, now chief operating officer, want to scale up the program to other provinces and eventually other countries, but they must get government ministries and other stakeholders on side in the interests of making mental health care widely available to the children and families who need it.

Teaching Note: 8B13M133 (7 pages)
Industry: Health Care Services
Issues: Health; innovation adoption; commercialization; change management; Canada
Difficulty: 4 - Undergraduate/MBA



L’OSERAIE — TURNAROUND CHALLENGE
Justin Paul, Marc Chaix, Shruti Gupta

Product Number: 9B11C018
Publication Date: 7/11/2011
Length: 15 pages

This case deals with the challenges faced at L’Oseraie, a nursing home located in the northeast of France. The director of L’Oseraie had to meet her new boss and brief him on the organization’s challenges while offering suggestions. A key obstacle involved employee motivation and engagement, particularly after a recent absenteeism episode. Furthermore, the lack of health care staff in France meant that employees might need to be sourced from abroad, perhaps from Eastern Europe or the French-speaking countries of North Africa. How could the director implement a strategy that would alleviate the day-to-day problems of the nursing home?

Teaching Note: 8B11C018 (8 pages)
Industry: Health Care Services
Issues: Health Care Administration; Organizational Structure; Employee Retention; Human Resource Management; France
Difficulty: 5 - MBA/Postgraduate


Chapter 8:
Value-Adding Service Delivery Strategies

TIME FOR A CHANGE AT THE CHANGE FOUNDATION
Anne Snowdon, Alexander Smith

Product Number: 9B14M087
Publication Date: 10/9/2014
Revision Date: 10/10/2014
Length: 14 pages

The Change Foundation is an independent charitable foundation founded in 1996 by the Ontario Hospital Association with the mandate to promote, support and improve health and the delivery of health care in Ontario. In 2006, its board of directors undertook a renewal process to evaluate its strategic directions and measure the value-add of progress to date. A planning session with a variety of key stakeholders had resulted in the development of a draft plan for going forward, which included hiring a new chief executive officer. When she began assessing the plan in January 2007, she faced several major issues and concerns about how the foundation should refocus its activities and transform itself. Before she could start to rebuild, however, she had to decide what its future direction should be.

Teaching Note: 8B14M087 (9 pages)
Industry: Health Care Services
Issues: Not-for-profit; strategic planning; change management; Canada
Difficulty: 4 - Undergraduate/MBA



CANCER CARE ONTARIO: AN INNOVATION STRATEGY FOR MANAGING WAIT TIMES
Anne Snowdon, Alexander Smith, Kevin Bernard, Hannah Standing Rasmussen

Product Number: 9B14M053
Publication Date: 7/10/2014
Revision Date: 7/10/2014
Length: 14 pages

Cancer Care Ontario, the organization that oversees cancer treatment in Ontario, is challenged with establishing an innovative approach to reducing wait times for breast cancer and prostate cancer therapy across Ontario after wait times increased to more than two months. The special advisor on cancer issues to the Ontario Minister of Health and Long-Term Care needs to report his recommendation to Cancer Care Ontario’s board of directors, who manage all regional cancer centres in the province. The major challenge is to balance the needs and values of all the various stakeholders, while developing short-, medium- and long-term solutions to the wait list dilemma.

Teaching Note: 8B14M053 (9 pages)
Industry: Health Care Services
Issues: Health care; stakeholder; performance management; privatization; Canada
Difficulty: 4 - Undergraduate/MBA



PROJECT HUGO AT LHSC: LEADING URGENT CHANGE IN HEALTHCARE
Cara C. Maurer

Product Number: 9B11C038
Publication Date: 12/13/2012
Revision Date: 9/21/2015
Length: 15 pages

This case describes in rich detail the change challenge the director of pharmacy services at London Health Sciences Centre (LHSC) faces in September 2011. She is responsible for implementing project HUGO, an acronym for Health Care UnderGoing Optimization. HUGO is a computerized system that requires a switch from paper and pencil to fully electronic patient records. This project is the most complex and comprehensive one that London area hospitals have ever undergone: the project includes a total of 11 healthcare organizations in London and surrounding region, with expected project costs in excess of $25 million. Implementing HUGO has the potential to save lives in the hospital, where critical errors are often linked to manual processes that involve multiple steps and people. Despite the strong reasons for implementing this project, the director expects significant resistance from nurses, doctors and staff who are used to their way of operating. It is clear that this change challenge involves not just the adoption of new technology but a significant cultural change.

Teaching Note: 8B11C038 (7 pages)
Industry: Health Care Services
Issues: Change Management, Resistance, Cultural Change, New Technology Implementation; Canada
Difficulty: 4 - Undergraduate/MBA


Chapter 9:
Value-Adding Support Strategies

INNOVATIVE PUBLIC HEALTH IN ALBERTA: SCALABILITY CHALLENGE
Anne Snowdon, Krista Pettit

Product Number: 9B13M067
Publication Date: 2/13/2014
Revision Date: 1/8/2014
Length: 9 pages

In 2011, the Alberta government launched an aggressive campaign to raise awareness about the growing rate of syphilis in the province. It launched an incredibly successful campaign that incorporated elements of social media that went viral. Though awareness was raised, the health system struggled to keep up with demand. The case deals with the challenges faced by the different areas of the health care system in receiving approval for the campaign and managing the subsequent demand.

Teaching Note: 8B13M067 (13 pages)
Industry: Health Care Services
Issues: Innovation; leadership; public relations; government; Canada
Difficulty: 4 - Undergraduate/MBA



PATIENT ORDER SETS
Anne Snowdon, Alexander Smith, Pardeep Sidhu

Product Number: 9B13M093
Publication Date: 9/13/2013
Revision Date: 9/13/2002
Length: 7 pages

In February 2004, a physician working in the intensive care unit of a Toronto hospital wondered how to implement a strategy whereby an entire health care team could work towards better and consistent patient care based on best evidence. Doctors’ orders varied from one physician to another, and oftentimes the health care team had little insight into what worked best, what the best evidence was and how they could be sure their patients were receiving the best care possible. He wondered if it would be possible to adopt the airline industry’s “order sets” — step-by-step, evidence-based checklists that could be used by clinicians to order treatments for patients. He recognized that there were problems in implementing such a program, especially the lack of a standardized information technology strategy across the provincial health care system and physicians’ fear of losing their autonomy in making care decisions. Physicians already had access to clinical practice guidelines, which were designed to assist them to make informed, evidence-based decisions by removing the burden of tailored research and intervention design, but many found these to be too long, sometimes outdated and not integrated with the clinical process. How could these guidelines be integrated with physician orders to create a standardized process to ensure that every patient had access to the best care possible?

Teaching Note: 8B13M093 (8 pages)
Industry: Health Care Services
Issues: health care; process improvement; stakeholder management; innovation; Canada
Difficulty: 4 - Undergraduate/MBA



APOLLO HOSPITALS ENTERPRISE LTD. CLINICAL SCORECARD
Murray J. Bryant, Ramasastry Chandrasekhar

Product Number: 9B11M066
Publication Date: 8/9/2011
Length: 13 pages

In January 2011, the group medical director of Apollo Hospitals Enterprise Ltd (AHEL), India’s largest integrated health care provider in the private sector, is weighing his options in promoting clinical excellence among group hospitals. AHEL has been using a clinical scorecard, called ACE@25, as a tool to measure and monitor clinical excellence, which is becoming a source of differentiation in the Indian health care industry. ACE@25 measures 25 clinical parameters, benchmarked against the best hospitals globally, every month. The group medical director is wondering whether his role should be limited to monitoring clinical outcomes or whether, in order to drive clinical excellence, he should also prescribe the steps that the medical superintendents of individual hospitals should take in improving outcomes on their watch.

Teaching Note: 8B11M066 (5 pages)
Industry: Health Care Services
Issues: Managerial Accounting and Control; Clinical Governance; Health Care; Performance Management; India
Difficulty: 4 - Undergraduate/MBA


Chapter 10:
Communicating the Strategy and Developing Action Plans

NIAGARA HEALTH SYSTEM: AN INNOVATIVE COMMUNICATIONS STRATEGY (A)
Anne Snowdon, Alexander Smith, Andrew Scarffe

Product Number: 9B15M022
Publication Date: 3/31/2015
Revision Date: 3/31/2015
Length: 11 pages

This case chronicles three major challenges faced by the Niagara Health System, a seven-hospital network in the Niagara region in the province of Ontario, Canada. An interim chief communications officer has joined the Niagara Health System team on secondment to help with communications issues during a C. difficile outbreak. He soon realizes that the public communication issues were not isolated to this outbreak, but rather continued a trend of poor relationships with local media and the public. The case examines the field of hospital communications in Ontario, including trends and best practices, a history of communications struggles at the Niagara Health System, strategy options and considerations to manage the C. difficile outbreak and strategies to improve trust and reputation. See supplement 9B15M023.

Teaching Note: 8B15M022 (11 pages)
Industry: Health Care Services
Issues: Crisis communication; reputation; stakeholder; health care; Canada
Difficulty: 4 - Undergraduate/MBA



SARS OUTBREAK IN TORONTO
Anne Snowdon, Alexander Smith, Mohammad Auais

Product Number: 9B13M101
Publication Date: 8/20/2014
Revision Date: 8/20/2014
Length: 11 pages

In the spring of 2003, the World Health Organization identified a worldwide epidemic of severe acute respiratory syndrome (SARS) that had started in China and spread to the rest of the world, with early cases reported in Toronto and Vancouver. Little was known about the disease, which meant that symptoms were often misdiagnosed as simple flu, and the infection spread rapidly. After the third SARS-related death occurred in Ontario in mid-March, the provincial premier declared a state of emergency, which was finally lifted on May 17 when it appeared the outbreak had ended. A week later, on May 23, four new cases were reported at Toronto’s North York General Hospital. The lack of public health infrastructure in Ontario combined with its hospitals’ noncompliance with following existing policies concerning infection control and especially the lack of communication between hospitals, health organizations and levels of governments, with numerous spokespersons making uncoordinated and sometimes contradictory announcements, all led to the public perception that the government and health care authorities did not know what they were doing or were lying about the severity of the outbreak. Before the next provincial election, the premier must examine and address what could have been prevented, how public health interventions were managed and the differences between public health responses in Toronto and Vancouver.

Teaching Note: 8B13M101 (7 pages)
Industry: Health Care Services
Issues: Health; crisis; communication; SARS; Canada
Difficulty: 4 - Undergraduate/MBA



U.S. PREVENTIVE SERVICES TASK FORCE: RELEASING NEW GUIDELINES FOR BREAST CANCER SCREENING (A)
Gregory S. Zaric, Michael Sider, Ken Mark

Product Number: 9B14M020
Publication Date: 3/13/2014
Revision Date: 3/13/2014
Length: 13 pages

In late October 2009, the U.S. Preventive Services Task Force (USPSTF), an independent panel of primary care experts, was preparing to release their updated guidelines for the use of screening mammograms, which were given to women in an attempt to detect evidence of breast cancer at a treatable stage. The new guidelines, based on rigorous scientific research and tests, now recommended routine screening starting at age 50 rather than at age 40. The challenge the USPSTF faced was that this shift in the recommended starting age was likely to spark significant debate among medical professionals and in the press. Also available is the supplement 9B14M021.

Teaching Note: 8B14M020 (7 pages)
Industry: Health Care Services
Issues: Bayes Theorem; communications; management science; change management; public sector; United States
Difficulty: 4 - Undergraduate/MBA



GERM WARFARE: COMBATING HEALTH CARE-ASSOCIATED INFECTIONS THROUGH COMMUNICATION
Mary Weil, Paul Bigus

Product Number: 9B12M117
Publication Date: 12/18/2012
Revision Date: 12/18/2012
Length: 14 pages

The director of the Infection Prevention and Control Unit at the University Health Network (UHN), in Toronto, Canada, is working to reduce healthcare acquired infections (HAIs) by using a different way to communicate with hospital staff. Through positive deviance (PD), participants are gaining new perspectives to help identify the changes that are needed to reduce HAIs. The initiative has been successful at UHN. Now the director needs to figure out how to spread the success of positive deviance to more health care regions and facilities in Canada and the United States to improve patient lives and the quality of health care.

Teaching Note: 8B12M117 (8 pages)
Industry: Health Care Services
Issues: Communications; Employee Engagement; Organizational Culture; Sustainability; Canada
Difficulty: 4 - Undergraduate/MBA