Edgewood lake hospital case study

Health Professions Press, Inc. Post Office Box 10624 Baltimore, Maryland 21285-0624

www.healthpropress.com

Copyright © 2017 by Health Professions Press, Inc. All rights reserved.

Manufactured in the United States of America by Versa Press, East Peoria, Illinois. Cover and interior designs by Erin Geoghegan. Typeset by Absolute Service, Inc., Towson, MD.

This casebook can be used alone or in conjunction with other texts. To help instructors use the cases most effectively in the classroom, the editors have prepared an instructor’s guide, Instructor’s Manual for Cases in Health Services Management, available to faculty as a downloadable PDF file from Health Professions Press (see website and address above or call 1-888-337-8808 or 1-410- 337-9585). Cases in Health Services Management can also be used in conjunction with the textbook, Managing Health Services Organizations and Systems, also published by Health Professions Press.

The cases presented in this volume are based on the case authors’ field research in a specific organization or are composite cases based on experiences with several organizations. In most instances, the names of organizations and individuals and identifying details have been changed. Cases are intended to stimulate discussion and analysis and are not meant to reflect positively or negatively on actual persons or organizations.

Library of Congress Cataloging-in-Publication Data Names: Darr, Kurt, editor. | Farnsworth, Tracy J., editor. | Myrtle, Robert C.,

editor. Title: Cases in health services management / edited by Kurt Darr, Tracy J.

Farnsworth, Robert C. Myrtle. Description: Sixth edition. | Baltimore : Health Professions Press, Inc., [2017] |

Preceded by: Cases in health services management / edited by Jonathon S. Rakich, Beaufort B. Longest, Kurt Darr. 5th ed. c2010. | Includes bibliographical

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http://www.healthpropress.com
references. | Description based on print version record and CIP data provided by publisher; resource not viewed.

Identifiers: LCCN 2017008811 (print) | LCCN 2017010156 (ebook) | ISBN 9781938870736 (epub) | ISBN 9781938870620 (pbk.)

Subjects: | MESH: Hospital Administration | Health Services Administration | Total Quality Management | Organizational Case Studies | United States

Classification: LCC RA971 (ebook) | LCC RA971 (print) | NLM WX 150 | DDC 362.10973—dc23

LC record available at https://lccn.loc.gov/2017008811

British Library Cataloguing-in-Publication data are available from the British Library.

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https://www.lccn.loc.gov/2017008811
To the Alumni of the GWU MHA Program (Dedication of Dr. Darr)

To my wife, Michelle; parents Karl and Jackie;

and children, Lindsey (Dan), Taylor (Jill), Rachel (Steven), and Dallin

(Dedication of Dr. Farnsworth)

To my students, who made this work possible (Dedication of Dr. Myrtle)

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Additional titles on healthcare management and administration

Managing Health Services Organizations and Systems (Sixth Edition)

Ethics in Health Services Management (Sixth Edition)

Climbing the Healthcare Management Ladder: Career Advice from the Top on How to Succeed

Superior Productivity in Healthcare Organizations: How to Get It, How to Keep It (Second Edition)

Becoming an Effective Leader in Healthcare Management: The 12 Essential Skills (Second Edition)

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Contents

About the Editors Contributors Preface Acknowledgments Introduction

PART I POLICY ENVIRONMENT OF HEALTH SERVICES DELIVERY

1 Carilion Clinic Alexandra Piriz Mookerjee and Kurt Darr Led by a new CEO, the efforts of a mid-Atlantic acute care hospital to develop a vertically integrated, clinic-driven health services system result in allegations of antitrust, excessive healthcare costs, disruption of physician referral patterns, and use of harsh collection practices, all of which cause a negative reaction in its service area.

2 Flu Vaccine Mary K. Feeney and Abigail Peterman Flu vaccine shortages in 2004–2005 caused by a major manufacturer’s problems with quality control result in federal and state efforts to secure supplies of the vaccine and raise public policy and resource-allocation issues that users can role-play in three scenarios.

3 Merck’s Crixivan Kimberly A. Rucker, Nora G. Albert, and Kurt Darr A pharmaceutical manufacturer encounters significant negative stakeholder reaction to its introduction of a new medication for the human immunodeficiency virus despite having met expectations for clinical rigor and carefully assessing stakeholders and the external environment.

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4 Pineridge Quality Alliance: A Case Study in Clinical Integration and Population Health Tracy J. Farnsworth A new CEO urges his board to move toward becoming an accountable care organization and promoting regional population health, which demands choosing among three common approaches to navigating the challenges and opportunities of developing a clinically integrated network.

5 Hawaii Health Systems Corporation: The Politics of Public Health Systems Governance Earl G. Greenia A healthcare executive facing continual public policy restructuring of Hawaii’s Health Systems Corporation must develop strategic options for his board to consider in response to this environmental uncertainty.

PART II STRATEGIC MANAGEMENT

6 Riviera Medical Center Michael J. King and Robert C. Myrtle The CEO of a 350-bed hospital explores strategic alternatives to enhance its financial situation and reputation by asking the hospital board to approve a worksite wellness program to be marketed to area companies to improve workers’ health and decrease employers’ healthcare costs.

7 Edgewood Lake Hospital: Leadership in a Rural Healthcare Facility During Challenging Economic Times Brent C. Pottenger, Douglas Archer, Stephen Cheung, and Robert C. Myrtle The new CEO of a 30-bed, not-for-profit rural hospital faces a turnaround situation to make the hospital profitable after 3 years of losses. Problems include challenging payer mix, employee overstaffing, and difficulty recruiting physicians.

8 Klamath Care: Targeting and Managing Growth and Company- Wide Development Tracy J. Farnsworth, Leigh W. Cellucci, and Carla Wiggins

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The CEO of a growing system of urgent care centers recounts the organization’s development over a decade while considering strategies and options for future growth in an increasingly crowded marketplace with an analysis that uses financial, market share, and demographic data.

9 Hospital Consolidation Tracy J. Farnsworth This case focuses on the relationship healthcare providers have with their local and regional markets and the need to balance organization and community interests when making decisions that affect the healthcare marketplace.

10 Service Area Management Tracy J. Farnsworth Users are challenged to analyze, prioritize, and use disparate information common to a dynamic and competitive healthcare marketplace as part of an organization’s strategic planning and marketing processes.

11 Western Healthcare Systems: A Healthcare Delivery Continuum Robert C. Myrtle Western Healthcare Systems was creating an integrated delivery system when an opportunity to acquire a large multispecialty group arose, but it may be imprudent to proceed because of hospital and multispecialty group physician resistance.

PART III ORGANIZATIONAL MANAGEMENT

12 Hartland Memorial Hospital: Part 1, In-Box and Prioritization Exercise Kent V. Rondeau, John E. Paul, and Jonathon S. Rakich The VP for nursing services of a 285-bed for-profit hospital must decide what actions to take regarding her in-box, which includes e- mail, correspondence, and phone messages that communicate various challenges, such as two angry nurses, a wandering patient, staff shortages, and increasing numbers of OR infections. Emphasizes priority setting, decision making, and delegation.

13 Bad Image Radiology Department

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Kurt Darr Management of a community hospital is unwilling to recognize and address major problems in its radiology department, which is directed by a radiologist whose disruptive behavior and preoccupation with income and stock market speculation have diminished the quality of radiograph readings with tragic results.

14 Westmount Nursing Homes: Implementing a Continuous Quality Improvement Initiative Kent V. Rondeau The future of a total quality management initiative is threatened when the CEO has to overcome more than the expected barriers and pitfalls in a chain of seven nursing homes and the initiative becomes entangled in negotiations with the union representing nurses.

15 District Hospital: A Lesson in Governance Cynthia Mahood Levin and Kurt Darr A tax district community hospital has major problems with its governance structure because of historical animosities among internal stakeholders, medical staff politics, weak and ambivalent senior management, and a disruptive member of the medical staff who has ambitions to attain major power in the hospital.

16 Restructuring Decision Making at Holy Family Hospital: Overcoming Resistance to a Shared Governance Program Kent V. Rondeau A change initiative introduced to democratize decision making and improve clinical care in a healthcare organization is met with staff suspicion, derision, and resistance.

PART IV ORGANIZATIONAL EFFECTIVENESS

17 Attica Memorial Hospital: The Ingelson Burn Center Bonnie Eng-Suess and Robert C. Myrtle After the merger of two hospitals, planning must include how to consolidate duplicated services and realign units, including a burn center, while considering the center’s financing and community and organizational impact.

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18 Pediatric Dental Care Center Eleanor Lin A not-for-profit pediatric dental care center that has struggled financially for years as it serves a Medicaid population is offered the opportunity to become part of a federally qualified health center, but to do so requires expanding services and significantly changing its governance structure.

19 Radical Innovation on the Idaho Frontier: Bengal Telepharmacy Julie Frischmann, Neil Tocher, and Alexander R. Bolinger Efforts to provide pharmacy services in a rural community are successful because of creative thinking, perseverance, political deal making, and using telepharmacy in a unique and effective way.

20 Structure and Funding of Hospitalist Programs John E. Paul and Gillian Gilson Watson An academic medical center must decide how to structure and fund hospitalist services in the context of its relationship with an affiliated school of medicine; the history and content of hospitalist functions; and other revenue that might be derived from hospitalist services, even while considering several alternate strategies.

21 Appian Health Systems Robert C. Myrtle A negotiation simulation allows participants to assume union and hospital roles to work toward an acceptable collective bargaining agreement.

22 Evolution of the Healthy Communities Initiatives Barry Ross Several years after initiating healthcare services for diverse, underserved communities, hospital leadership is planning how to take its activities to a level with greater impact and sustainability.

PART V LEADERSHIP CHALLENGES

23 Hospital Software Solutions (A) Elizabeth M. A. Grasby and Jason Stornelli A software company supplying information technology services to

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Ontario (CN) hospitals has an ill-defined structure and controls that frustrate a new employee with conflicting demands from the firm’s managers, including expectations inconsistent with her job description.

24 The Case of Tim’s Last Years Kurt Darr and Carla Jackie Sampson Declining physical health forces an accomplished retired professor to enter a life care community in which his diminished independence leads to conflicts with management and staff even as further health problems result in an apparently willed death.

25 Autumn Park Cara Thomason Embry and Robert C. Myrtle The executive director and the director of assisted living in a community for independent and assisted living must resolve a disagreement as to the appropriate level of care for a difficult resident.

26 Appalachian Home Health Services Kathryn H. Dansky A not-for-profit home health agency faces a controversial choice after learning its best applicant for a nursing position is a convicted felon, and a review by management shows more widespread problems with recruitment and staffing.

27 Suburban Health Center Bruce D. Evans and George S. Cooley The supervisor of the suburban branch of a city health department faces problems with an insubordinate and possibly incompetent nurse, even as the lack of authority and inadequate support from superiors are complicated by the absence of employee performance evaluations.

28 Team Building: From Success to Failure in 24 Hours Cherie A. Hudson Whittlesey What starts as a highly successful team-building exercise becomes problematic when one physician challenges the process and forces the facilitator to consider underlying issues and then devise responses

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that will preserve team cooperation.

PART VI ETHICS INCIDENTS

29 Ethics Incidents Kurt Darr Twelve mini-case studies cover the spectrum of administrative and clinical ethical issues, from conflicts of interest to dishonest contractors and from infection control to advance medical directives.

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Administrative Ethics Incident 1: Borrowed Time Incident 2: ED Repeat Admissions: A Question of Resource Use Incident 3: The Administrative Institutional Ethics Committee Incident 4: Bits and Pieces Incident 5: A Potentially Shocking Revelation Incident 6: Intensive Care Unit Dysfunction

Clinical Ethics Incident 7: Protecting the Community Incident 8: Decisions Incident 9: The Missing Needle Protector Incident 10: To Vaccinate, or Not Incident 11: Demarketing to Avoid Bankruptcy Incident 12: Something Must Be Done, But What?

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About the Editors

Kurt Darr, JD, ScD, LFACHE, is Professor Emeritus of Hospital Administration, and of Health Services Management and Leadership, Department of Health Services Policy and Management, School of Public Health, The George Washington University. Dr. Darr holds the Doctor of Science from The Johns Hopkins University and the Master of Hospital Administration and Juris Doctor from the University of Minnesota. His baccalaureate degree was awarded by Concordia College, Moorhead, MN.

Dr. Darr completed an administrative residency at the Rochester (MN) Methodist Hospital and subsequently worked as an administrative associate at the Mayo Clinic. After being commissioned in the U.S. Navy during the Vietnam War, he served in administrative and educational assignments at St. Albans Naval Hospital (NY) and Bethesda Naval Hospital (MD). He completed postdoctoral fellowships with the U.S. Department of Health and Human Services, the World Health Organization, and the Accrediting Commission on Education for Health Services Administration.

Dr. Darr is admitted to practice before the Supreme Court of the state of Minnesota and the Court of Appeals of the District of Columbia. He was a mediator for the Civil Division of the Superior Court of the District of Columbia and has served as a hearing officer for the American Arbitration Association. Dr. Darr is a member of hospital committees on quality improvement and on ethics in the District of Columbia metropolitan area. He is a Life Fellow of the American College of Healthcare Executives.

Dr. Darr’s teaching and research interests include health services management, administrative and clinical ethics, hospital organization and management, quality improvement, and applying the Deming method in health services. Dr. Darr is the editor and author of numerous books, articles, and cases used for graduate education and professional development in health services.

Tracy J. Farnsworth, EdD, MHSA, MBA, FACHE, is President and

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Chief Executive Officer of the Proposed Idaho College of Osteopathic Medicine Dr. Farnsworth has served as Director and Associate Dean of the School of Health Professions, Division of Health Sciences, Idaho State University (ISU [Pocatello]) since 2010. He is Associate Professor in the Health Care Administration Program at ISU and has served as Program Director.

Dr. Farnsworth is a graduate of Brigham Young University. He received master’s degrees in Business and Health Services Administration from Arizona State University and the Doctor of Education in Educational Leadership from ISU. In 2014, Dr. Farnsworth was awarded the Kole- McGuffey Prize for excellence in education research, and in 2016 he received the J. Warren Perry Distinguished Author Award from the Association of Schools of Allied Health Professions.

Prior to becoming an educator, Dr. Farnsworth had executive-level appointments with Intermountain Healthcare, Catholic Healthcare West, the City of Hope National Medical Center, and other public and private healthcare systems.

A Fellow of the American College of Healthcare Executives, Dr. Farnsworth has written and spoken widely on subjects related to hospital and health systems performance improvement, healthcare reform, medical education, healthcare leadership and governance, and interprofessional education/collaboration.

Robert C. Myrtle, DPA, is Professor Emeritus of Health Services Administration, Sol Price School of Public Policy, University of Southern California. Dr. Myrtle received a bachelor’s degree in business administration from the California State University, Long Beach, and a master’s and doctoral degree in public administration from the University of Southern California. During 41 years at the University of Southern California (USC), Dr. Myrtle co-authored two books on management; 18 book chapters; 51 articles in journals, including Health Care Management Review, Health Policy and Planning, Public Administration Review, Social Science and Medicine, and The Gerontologist; and 70 conference papers and professional reports. He has academic appointments in the Leonard Davis School of Gerontology and the Marshall School of Business and is a Visiting Professor in the Institute of Health Policy and Management at the National Taiwan University.

Dr. Myrtle’s key research interests are leadership, executive development, and organizational and management effectiveness. Current research includes the influence of managers’ behavior on perceptions of

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overall leadership effectiveness; examining factors influencing the performance of surgical teams; and assessing factors influencing organizational legitimacy during and following major natural disasters.

Dr. Myrtle is the recipient of the Academy of Management’s Health Care Division’s Teaching Excellence Award and the American Society for Public Administration’s Los Angeles Chapter Harry Scoville Award for Academic Excellence. He was named Professor of the Year at USC and has three times been named Most Inspirational Business Professor. He is the recipient of the American College of Healthcare Executives Regents Award, and the Hubert H. Humphrey Award for best article of the year appearing in the Journal of Health and Human Services Administration.

Dr. Myrtle was chair of the Los Angeles County Hospitals and Health Services Commission. He was board chair for SCAN Health Plan and was a member of the board of directors for the Huntington Medical Foundation. He has served as board chair of Health and Human Services for the City of Long Beach (CA).

Professor Emeritus Darr coauthored the textbook, Managing Health Services Organizations and Systems, Sixth Edition (2014), with Beaufort B. Longest, Jr., published by Health Professions Press. This health services management textbook should be used as a complement to Cases in Health Services Management.

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Contributors

Nora G Albert, MHA Project Manager Children’s National Health System 111 Michigan Ave, NW Washington, DC 20010

Douglas Archer, MHA Hospital Administrator Sutter Health-Memorial Hospital–Los Banos 520 West I St. Los Banos, CA 93635

Alexander R Bolinger, PhD, MBA Associate Professor of Management Idaho State University 921 S. 8th Ave. Pocatello, ID 83209–8020

Leigh W Cellucci, PhD, MBA Professor and Program Director Department of Health Services and Information Management East Carolina University Greenville, NC 27858–668

Stephen Cheung, MHA, DDS School of Dentistry State Capital Center School of Policy, Planning, and Development University of Southern California Sacramento, CA 95811

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George S Cooley Long Green Associates, Inc. Long Green, MD 21092

Kathryn H Dansky, PhD Associate Professor Emerita Department of Health Policy and Administration College of Health and Human Development Pennsylvania State University 201 Main University Park, PA 16802

Kurt Darr, JD, ScD, LFACHE Professor Emeritus, Hospital Administration Dept. of Health Services Management & Leadership The George Washington University 2175 K Street, NW Suite 320 Washington, DC 20037

Cara Thomason Embry, MSG, MHA, RN Sol Price School of Public Health University of Southern California Los Angeles, CA 90089–0626

Bonnie Eng-Suess, MHA Director of Hospital Risk Contracting and Operations Dignity Health 251 S. Lake Ave., Ste 700 Pasadena, CA 91101

Bruce D Evans, MBA Professor of Management University of Dallas Satish & Yasmin Gupta College of Business 1845 E. Northgate Dr. Irving, TX 75062

Tracy J Farnsworth, EdD, MHSA, MBA, FACHE

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Associate Dean and Director Kasiska School of Health Professions Division of Health Sciences Idaho State University 921 South 8th Ave. Pocatello, ID 83209–8090

Mary K Feeney, PhD Associate Professor and Lincoln Professor of Ethics in Public Affairs School of Public Affairs Arizona State University 411 N. Central Ave., Suite 450 Phoenix, AZ 85004

Julie Frischmann Instructor/Academic Coach Student Success Center Idaho State University 921 S. 8th Ave. Pocatello, ID 83209–8010

Elizabeth M A Grasby, PhD c/o Richard Ivey School of Business The University of Western Ontario 1151 Richmond Street North London, Ontario N6A 3K7 CANADA

Earl G Greenia, PhD, FACHE Professor, Healthcare Administration & Management Colorado State University–Global Campus 7800 E. Orchard Road Greenwood Village, CO 80111

Michael J King, MHA Chief Financial Officer, Shared Services Division Tenet Healthcare Corporation 1445 Ross Ave., Suite 1400

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Dallas, TX 75202

Eleanor Lin, MHA, DDS Children’s Dental Health Clinic 455 E. Columbia St. Long Beach, CA 90806

Cynthia Mahood Levin, MHSA Healthcare Consultant Palo Alto, CA

Nova Ashanti Monteiro, MD Children’s National Medical Center 111 Michigan Avenue NW Washington, DC 20010

Robert C Myrtle, DPA Professor Emeritus, Health Services Administration Sol Price School of Public Policy University of Southern California 105 Siena Drive Long Beach, CA 90803

John E Paul, PhD, MSPH Clinical Professor and Associate Chair for Academics Department of Health Policy and Management Gillings School of Global Public Health University of North Carolina at Chapel Hill 135 Dauer Drive. Chapel Hill, NC 27599

Abigail Peterman Center for Science, Technology and Environmental Policy Studies Arizona State University University Center 411 N. Central Ave. Phoenix, AZ 85004

Alexandra Piriz Mookerjee, MHSA

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Administrator Westminster Communities of Florida Magnolia Towers 100 E. Anderson St. Orlando, FL 32801

Brent C Pottenger, MD, MHA Dept. of Physical Medicine & Rehabilitation Johns Hopkins Medicine 707 North Broadway Baltimore, MD 21205

Jonathon S Rakich Professor Emeritus Indiana University Southeast 4201 Grant Line Road New Albany, IN 47150

Kent Rondeau, PhD Associate Professor School of Public Health University of Alberta Faculty of Extension, Enterprise Square 10230 Jasper Ave., Room 2–216 Edmonton, Alberta T5J 4P6 CANADA

Barry Ross, MPH, MBA Vice President, Healthy Communities St. Jude Medical Center 101 E. Valencia Mesa Dr. Fullerton, CA 92835

Kimberly A Rucker Healthcare Consultant Washington, DC

Carla Jackie Sampson, MBA, FACHE Graduate Research Associate

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Florida Center for Nursing 12424 Research Pkwy, #220 Orlando, FL 32826

Jessica Silcox, RN, MSN Staff Development Educator & Stroke Coordinator Sentara Northern Virginia Medical Center 2300 Opitz Blvd. Woodbridge, VA 22191

Jason Stornelli c/o Richard Ivey School of Business The University of Western Ontario 1151 Richmond Street North London, Ontario N6A 3K7 CANADA

Neil Tocher, PhD Professor of Management Idaho State University 921 S. 8th Ave. Pocatello, ID 83209–8020

Gillian Gilson Watson, MHA Department of Hospital Medicine University of North Carolina Hospitals 101 Manning Dr. Chapel Hill, NC 27599–7085

Cherie A Hudson Whittlesey, ML Director, Organizational Learning and Effectiveness St. Jude Medical Center 101 E. Valencia Mesa Dr. Fullerton, CA 92835

Carla Wiggins, PhD Professor and MHA Program Director Weber State University

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3875 Stadium Way, Dept. 3911 Ogden, UT 84408

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Preface

Like its predecessors, the sixth edition of Cases in Health Services Management describes management problems and issues in various healthcare settings. The primary criterion to select a case was that it had to be rich in applied lessons. Case selection was tempered by the editors’ 90 years of combined experience in teaching and using the case method. The result is a comprehensive set of health services management cases in one volume.

Cases vary in length and complexity and are grouped into six parts. Of the 28 cases in this edition, 14 are new. There are two new ethics incidents. Cases and ethics incidents that have stood the test of time and use were retained in this edition. All have been updated and edited to make them as streamlined as possible. Consistent with the evolving healthcare delivery system, half the cases are set outside of acute care hospitals. Those include a long-term care facility, a health network, a continuing care retirement community, an emergency department, a hospital burn unit, a dental clinic, a pharmaceutical company, a city health department, a home health agency, and a software company.

Acute care hospital cases include a range of sizes, types, ownerships, and geographic locations, including rural and inner-city settings. One hospital case is set in a multi-institutional system; another applies the principles of continuous quality improvement. An in-box exercise set in a hospital simulates the time pressures that confront managers and the importance of prioritizing the issues, and a labor relations role-play case creates a powerful learning experience that emphasizes the challenges and dynamics of any negotiated relationship.

Depending on depth of analysis and time available for out-of-class preparation, most cases can be analyzed in two hours, or less. A few cases are short and have one issue. Most, however, are integrative and complex and involve multiple problems and issues. As a result, analyses will often require applying concepts from different disciplinary fields and knowledge areas. This may require users to synthesize and apply knowledge, skills, and experience from the social and health sciences in their analyses and

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discussions. The primary use of this book of cases is the education of health

services managers. Case analysis bridges theory and practice. In this regard, students studying health services management, as well as experienced managers, will find the cases informative as they hone analytical and problem-solving skills. These cases can also be used in continuing professional development for practicing managers.

By their nature, cases present events, situations, problems, and issues. The dynamics of the analysis, including the group discussion, make the case method a powerful and rich tool for learning. Users are urged to review the Introduction, which describes the case method and case analysis.

The cases included in this volume are intended to stimulate discussion and analysis. In most instances, the names of organizations and individuals are disguised. In all instances, authors of the cases have prepared well- written, factual situations that are based on field research in a specific organization, or a composite case based on experience with several organizations. No case is meant to reflect positively or negatively on actual persons or organizations, or to depict either effective or ineffective handling of administrative situations.

The 28 cases and 12 ethics incidents are organized into six parts:

Part I: Policy Environment of Health Services Delivery (five cases)

Part II: Strategic Management (six cases)

Part III: Organizational Management (five cases)

Part IV: Organizational Effectiveness (six cases)

Part V: Leadership Challenges (six cases)

Part VI: Ethics Incidents (12 statements of fact that show ethics issues)

The case synopses in the table of contents …