This case demonstrates the difference between tropospheric and stratospheric ozone and shows the sources and long-term affects of ozone on human health and ecosystem health. Students develop an appreciation of the complexity of the problem and gain an understanding of the economic impact and costs of not achieving compliance with National Ambient Air Quality Standards for ozone. Students must discuss the effectiveness of alternative abatement programs and the balancing of competing health priorities and their associated costs.

This case may be used effectively in a graduate or undergraduate environmental management, social marketing, or public health class dealing with environmental issues and public policy. It has been successfully used in a public health class to discuss the health and environmental effects of tropospheric ozone as well as related health behavior, epidemiological, and health policy issues.
 

For the past couple of months, Sam Bell had been putting together a solution to try to get the city of Birmingham, Alabama into attainment of the Environmental Protection Agency’s (EPA) ozone standards. It was a frustrating problem. Sam had been placed in charge of the ozone project and had begun to implement some short-term solutions – mainly social marketing to the residents of Birmingham. The EPA wanted a plan for the city to reach attainment with National Ambient Air Quality Standard for ozone. At stake was millions of dollars for the state.

Sam didn’t want to leave anything to chance, so he began to go through every file he had collected about the problem of ozone. He thought about everything from how ozone affects humans to other city’s efforts to address their ozone problems. He wanted to make sure Birmingham had a "clear" future. There were many considerations that Sam had to take into account. His plan in the short term had to bring Birmingham back into compliance relatively quickly. His long-term plan had to take into account such things as growth and the increase in travel that will be experienced throughout the next decade.
 

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Contact Person: Peter M. Ginter, University of Alabama at Birmingham, Birmingham Alabama
Mail: Health Care Organization and Policy, RPHB 330, 1530 3^rd Avenue South, Birmingham, AL 35294-0022 USA
Voice: (205) 975-8970; FAX: (205) 934-3347; e-mail: pginter@uab.edu

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This case illustrates the impact of the changing health care environment on a public hospital and the complexity of creating a primary care network. The objectives are to provide students with an opportunity to assess the impact of a rapidly changing external environment on a public agency, understand the importance of organizational issues in implementing strategic plans, and realize that a public agency, through visionary leadership, can innovate and change.

This case is appropriate for graduate courses in health care strategic management, health administration, or public health policy. For strategic management students, the instructor may focus on creating a fit with the environment. For health administration courses, the analysis may focus on organizational issues such as structure, culture, and implementation difficulties. For public health policy courses, the analysis may focus on the development of public health programs, the unique problems and solutions of health care delivery to poor populations, and partnering with other community agencies.
 

Dr. Max Michael, CEO of the Jefferson Health System, was having a tough day. He had the difficult responsibility of balancing cost with care, of rationing procedures with policy, and of juggling personnel with budgets, performance, and demand. Dr. Michael had spent the better part of his day fighting a losing battle in an understaffed, understocked, overflowing outpatient clinic. As he left the clinic that evening, he mulled over a looming decision.

Four years earlier, Dr. Michael had led the development the of Community Care Plan (CCP), an innovative approach to delivering health care to the county’s indigent population. He had gotten it off the ground only through his perseverance, the dedication of small cadre of believers, and a sizeable grant award. Now the grant was ending, and he was faced with deciding the future of the CCP. The CCP had been "pet project," his vision for improving health care for the county’s population, but even he had to admit it had met with only limited success. Should he forge ahead with expansion plans to try to achieve a critical mass, hold steady until they work out their "growing pains," or give up on the plan altogether? He must make this decision in the context of a rapidly changing health care environment and numerous organizational constraints.

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Contact Person: Alice M. Adams, University of Alabama at Birmingham, Birmingham Alabama Mail: Lister Hill Center for Health Policy, RPHB 330, 1530 3^rd Avenue South, Birmingham, AL 35294-0022 USA
Voice: (205) 975-9007; FAX: (205) 934-3347; e-mail: aadams@uab.edu
 

The DeKalb County Board of Health has been t he leader in providing public health services within the State of Georgia. It has been viewed as highly professional and has initiated many of the programs adopted by other public health boards. Its past director recruited highly qualified professionals and had an excellent record in obtaining grants. Unfortunately, the director died in October of 1988 as the result of an automobile accident. Her unexpected death provided the impetus for this sequential case.

Case A presents the student with two opportunities. First, the student is asked to assume the role of a member of the selection committee, which will determine the next director. Information is provided about DeKalb County, Human Services activities within the county, a fact sheet, and perceptions of senior managers, who served under the previous director. After reviewing this information, the student is asked to describe the characteristics for a suitable director. Next, the student is presented with a narrative from Paul Wiesner, MD, who is considering and actually applies for the position.

Case B is also presented in two parts. In the first part, the student reviews a series of Dr. Wiesner’s ideas/perceptions and asked to discuss the consequences these ideas would have on the organization. In the second part, the student is presented with a series of analysis Paul had made of the organization and the community as well as the actions he took on the basis of these analyses. The analyses and actions provide a framework for discussing the role and actions of a transformational leader.
 

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Contact Person: Jane C. Nelson, Center for Public Health Practice, Rollins School of Public Health of Emory University,
1518 Clifton Rd., NE (Rm. 668), Atlanta, Ga. 30322, ph: 404-727-7890.
FAX 404-727-9198, e-mail jnels01@sph.emory.edu

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This case depicts strategic challenges faced by a modest, religious, community-based healthcare organization in an environment of dramatic change. The student is encouraged to utilize strategic management concepts to evaluate the options for and consequences of various transitions, to evaluate stakeholders, and to generate strategic direction and implementation plans. The case also demonstrates human resources issues involving congruence among the board members, the executive officers, and the staff, and it introduces the role of quality assessment in a non-accredited organization.

The case is appropriate for graduate students in healthcare strategic management courses, and could be used at almost any point in the term. However, it has been used in a human resources course and would be appropriate for a public administration or community management course. It might also be considered for a "capstone" course integrating strategic management, human resource, and quality management concepts in a small not-for-profit community organization.
 

The San Jose Clinic Board Retreat was coming up. The Clinic had been in existence for 75 years providing primary healthcare for the "working poor" in downtown Houston. Both the Clinic’s mission and crowded building had gone unchanged for many years. The small staff was dedicated and consumed by their daily work. The board members were interested and willing to listen and provide advice as needed, but no one really wanted to rock the boat. There had been no significant management problems or complaints from anyone about anything for years. However, a recent consultant’s report revealed motivation and communication issues among the staff, and possible lack of consensus about program priorities between the staff and board.

Coincidentally, the time and place were ripe for the Houston Sports Authority to pursue a new baseball park to replace the Astrodome in the area adjacent to the clinic. The state was shifting to a Medicaid managed care system, state funding was expanding for children’s healthcare services, and most other non-profit clinics in the city were seeking accreditation from the Joint Commission for Healthcare Organizations. The Board was confronted with strategic decisions about the Clinic’s services, facility, and staff that it had not been faced with previously. Careful review of the internal and external environment were needed, and the Board had to decide upon a plan for the Clinic’s future.

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Contact Person: Terrie C. Reeves, Ph.D., Texas Woman’s University, Houston, TX 77030
Mail: 1130 M.D. Anderson Blvd., Houston, TX 77030 USA
Voice: 713-794-2185; Fax: 713-794-2350; email: tcreeves@mindspring.com
 

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This case shows that not all efforts in the rapidly growing health care industry are necessarily lucrative. The issue in this case is to evaluate the business plan to determine if Cathy’s idea will work. The objectives of the case are to bring out issues regarding decisions about target markets, positioning, competitive analysis, product strategy, pricing, financial analysis, SWOT analysis, and development of a competitive strategy for the long-term. Students are encourage to critically analyze the projected cash flow statement and the forecasted supply and demand -- what assumptions underlie Cathy’s projections? The case provides enough information about the external factors, including competition, the industry, and Cathy’s plans to consider the broad situation as well as more detailed factors. The case situation is ideal for having students develop and present their arguments to a "bank" loan committee -- something that makes this case ideal for oral team presentations.

This case can be used in either a small business management/ entrepreneurship course or a strategic management course. In a small business management course, this case can supplement material about writing a strategic planning, developing a business plan or a making a decision to enter a new venture. Questions like "What are the risks?" and "What are the benefits?" or "What is the market like?" can be considered in fairly good detail. In a strategic management course, this case works well either after material on industry analysis is presented or later when business strategies have been covered.
 

The students are introduced to Cathy S. Heriot (RN, Ph.D.), an Assistant Professor of Nursing at the Medical University of South Carolina (MUSC) in Charleston, SC. Ms. Heriot has become dissatisfied with the current climate at MUSC, following a change in the work expectations of the administration. As a result, Ms. Heriot contacts a counselor at the local Small Business Development Center in order to start the process of starting an Intermediate and Basic Foot Care and Reflexology Service.

The students are charged with reading the resulting business plan Cathy submitted to Wachovia, a regional bank in Charleston, in order to finance the proposed business. Is this particular new venture in the health care industry a good idea? What are its prospects? External factors are particularly important considerations to analyze this business plan.

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Contact Person: Kirk C. Heriot, North Georgia College & St. University, Dahlonega, GA 30597
Mail: 124 Newton Oakes Center, North Georgia College & St. Univ., Dahlonega, GA 30597
Voice: (706) 867-2723; FAX (706) 864-1668; e-mail: kcheriot@ngcsu.edu
 

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This case describes how Fletcher-Allen Health Care – a large teaching hospital in Vermont – addressed the so-called "millennium bug," or "Y2K problem" in their administrative and clinical software, and in a variety of clinical and other devices containing embedded microprocessors. At the time of the case (June 1998), many organizations were coping with the Y2K problem, a challenge which arose due to the use of two-digit year fields in software and microprocessors. An application which is not "Y2K compliant" processes "00" as either "1900" or zero, instead of as the year "2000." In turn, this creates computational havoc in a great variety of date-sensitive applications and devices.

The case can be used as a vehicle for examining the challenges of organizing and managing enterprise-wide IT projects when faced with conflicting priorities. It is targeted for use in a senior-level undergraduate MIS course or a graduate MIS course. From the case, students should easily grasp the potential risks of non-compliant software and medical devices, and this can generate a lively classroom discussion. In addition, the case provides ample material for discussion of challenges in managing change in a highly complex IT architecture.
 

Bob Sadlemire, an outside consultant hired temporarily as Fletcher-Allen’s Year 2000 Project Manager, is coping with the tension of conflicting priorities as he attempts to complete a complex set of interrelated Y2K compliance tasks, faced with the immovable deadline of 12/31/1999. Managers and clinicians at Fletcher-Allen seem to view this project as, at best, an expensive but "necessary evil." If not fixed, the Y2K problem could have disastrous consequences, yet eradicating the "millennium bug" does not offer the hospital any strategic advantage. In contrast, a $30 million telemedicine project, also underway at the hospital, is viewed as offering strategic value, and this project has attracted a great deal of attention from senior management.

Fletcher-Allen, like many hospitals, is coping somewhat belatedly with the complexity, broad scope, and high uncertainty of their enterprise-wide Y2K compliance projects. Although Bob Sadlemire was hired in July 1997, he experienced great difficulty in gathering basic information necessary to launch the projects, with very little real progress before winter, 1998. At the time of the case (June 1998) Sadlemire is preparing his first presentation to the hospital’s Board of Trustees on the project. He has carved the project into eight separate initiatives, assigned responsibility for each, and established a project organization structure comprised of a high-level Y2K Steering Committee and a central Y2K Task Force. Sadlemire’s boss, Alan Wyman, has said to him: "The Board has heard plenty of year 2000 horror stories, so you need to assure them that we have a solid process in place to deal with it..." Yet, the case reveals aspects of the Y2K project which are less than "solid," and Sadlemire believes that it "sometimes plays second fiddle" to less critical organizational priorities.

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Contact Person: Janis L. Gogan, Bentley College, 175 Forest Street, Waltham, MA 02452-4705
voice: 781 891 2098 email: jgogan@bentley.edu
 

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