Part I: Strategic Management

7. District Hospital: A Lesson in Governance
   Cynthia Levin & Kurt Darr
   
   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 with ambitions to attain major power in the hospital.
   
   
8. The Day After
   Richard L. Johnson
   
   Fired CEO reflects the board’s lack of understanding of medical staff and individual physician relationships with the hospital. Confident that the board would support him in a contract dispute with hospital-based radiologists seeking to build a competing off-site imaging center, he is surprised to have been fired. He underestimated the power of the medical staff and the four physician board members.
   
   
9. Hartland Memorial Hospital: An In-Basket Exercise
   Kent V. Rondeau & Jonathon S. Rakich
   
   Vice president of nursing services at a 285-bed for-profit hospital determines what action to take regarding items in her in-basket, including correspondence, phone messages, and interruptions ranging from an angry physician, to a wandering patient, staff shortages, and increasing OR infections.
   
   
10. The Bad Image Radiology Department
    Kurt Darr
    
    Management of a community hospital is unwilling to recognize and address the major problems in its radiology department, which is being directed by a radiologist whose preoccupation with income, stock market speculation, and disruptive behavior have greatly diminished the quality of radiograph interpretations, with tragic results.
    
    
11. Westmount Nursing Homes, Incorporated: A Continuous Quality Improvement Initiative
    Kent V. Rondeau
    
    CEO of Westmount has difficulty overcoming barriers and pitfalls in implementing TQM in a chain of seven nursing facilities. The embroilment of the TQM initiative in negotiations with the union representing nurses threatens the initiative’s future.
    
    
12. Dr. Johnson, Network Medical Director
    William Q. Judge & Chris P. McLaughlin
    
    Responsible for building and maintaining a network of providers and overseeing quality in the southeast region of a national insurance and HMO company, the medical director is “constantly putting out unexpected fires” that detract from addressing strategic issues.
    
    
13. Sibley Memorial Hospital
    Kurt Darr
    
    A lawsuit alleging conspiracy and breach of fiduciary duty forces changes on a community hospital board whose members have been content to allow the board chair and treasurer to handle all financial dealings for many years even though key board members and their employees have benefited directly and indirectly.
    
    
14. Ethics Incidents
    Kurt Darr
    
    A collection of mini-case studies raise various types of administrative and clinical ethical issues, including patient privacy, billing irregularities, infection control, do-not-resuscitate orders, and more.
    
    

15. Endoscopes at Victoria Hospital
    Elizabeth M.A. Brasby & Mark D. Applebaum
    
    Biomedical department at Victoria Hospital evaluates the cost/benefit of setting up a regional repair facility for multiple hospitals to repair endoscopes. Students make assumptions and do cost-benefit analysis.
    
    
16. Regional Health System: The Satellite Health Park Strategy
    Jonathon S. Rakich & Michael F. Rolph
    
    CFO assesses the financial feasibility of establishing a satellite health park consisting of three services: an ophthalmic surgery center, a diagnostic facility, and a rehabilitation facility. Data on investment, costs, and projected revenues based on patient mix are provided for each proposed health park service. CFO determines the present value of cash flows and conducts payback analysis.
    
    
17. The ER that Became the Emergency: The Double Bind
    Earl Simendinger, Mary Anne Watson, Mike Jasperson & Bryan Boliard
    
    Community hospital experiences the negative financial impact of a city hospital’s decision to divert indigent ER patients. Unchecked, the practice will create a large deficit for the community hospital. Turning these patients away will create a double bind of serious public relations problem for the hospital.
    
    
18. Attica Memorial Hospital: The Ingelson Burn Center
    Bonnie Eng-Suess & Robert C. Myrtle
    
    After the merger of two hospitals, planning included how to consolidate duplicate services and how to realign other units. The burn center received close attention, with the decision taking into account not only financial considerations but community and  organizational impact as well.
    
    
19. Brunswick Community Hospital Cash Flow Crisis
    Michael Wiltfong, Gary R. Wells, & William E. Stratton
    
    New CFO of a county-owned 54-bed acute care hospital with an attached 58-bed skilled nursing facility considers options to resolve a cash flow crisis. Among them are securing long-term financing, borrowing from deferred compensation funds, and reducing working capital needs such as outstanding accounts receivables. Financial statements are provided.
    
    
20. Cardinal Health Care Systems: Some Behavioral Issues in Corporate Cost Allocation
    Joseph F. Castellano & Harper A. Roehm
    
    Health care system with several subsidiaries under pressure to cut corporate overhead costs proposes a change from allocation of costs by revenue to a chargeback system based on use that pleases administrators but increases resistance from service departments and subsidiaries.
    
    
21. West Florida Regional Medical Center (A)
    Curtis P. McLaughlin
    
    CEO of a large for-profit medical center in a service area with intense competition evaluates the hospital's CQI program to address issues of improvement in outcomes.

Part IV: Human Resources Management and Organizational Dynamics

22. A New “Brand” for Senior Health Plus
    Rosalie Wachsmuth & Robert C. Myrtle
    
    Interdepartmental conflict between marketing and human resources emerges in a Medicare HMO. Conflict is caused when marketing develops a branding campaign that requires HR to manage the culture change needed to support the brand’s implementation.
    
    
23. Autumn Park
    Cara Thomason & Robert C. Myrtle
    
    Executive director and the director of assisted living of a community for independent and assisted living residents face significant problems in resolving a disagreement over the proper level of care for a difficult resident.
    
    
24. Hammond General Hospital: The New Contract Food Service
    Raymond L. Hilgert, Cyril C. Ling, & Edwin C. Leonard, Jr.
    
    A food service manager assigned to oversee a contract food service finds employees have negative attitudes, perform poorly and have a culture of entrenched mediocrity.
    
    
25. Appalachian Home Health Services
    Kathryn H. Dansky
    
    Not-for-profit home health agency faces a controversial choice because their best nurse applicant is a convicted felon. Review shows underlying problems in its recruitment process and staffing generally.
    
    
26. Mercy Hospital
    
    Sudden resignation of the vice president of nursing services at a 300-bed general acute care hospital prompts the president to examine the hospital's organization; consultant uncovers planning problems, confusion regarding relations and responsibilities, and lack of leadership.
    
    
27. Watergate Nursing Home
    Donna Lind Infeld & Dorothy J. Moon
    
    Administrator of a private, not-for-profit nursing facility is concerned about the visit of the new corporate regional supervisor; he is unsure how her “modern” management ideas will mesh with the facility's tradition of open, friendly service and his personal involvement at all levels.
    
    
28. Suburban Medical Center
    Bruce D. Evans & George S. Cooley
    
    Supervisor of a suburban branch of the city health department faces problems of  an insubordinate and possibly incompetent nurse; lack of authority and apparent lack of support from superiors are complicated by the lack of employee performance evaluations.
    
    

See Table of Contents for:
Cases in Health Services Management Instructor's Manual