Case studies in health administration最新文献

St. Martin's for many years enjoyed a friendly and supportive relationship with a small community hospital nearby even though it was the leading provider of healthcare in the other's market place. In the highly competitive environment reported in the case, it was clear that the smaller hospital would have to move aggressively to increase its market share, consider closure or merge with one of the larger competing hospitals. St. Martin's administration knew that it needed to decide whether to attempt to align itself with Community in some fashion or to compete aggressively enough with Community to so dilute Community's market that it could no longer function. One of these actions was required to avoid serious erosion of St. Martin's own patient base. The decision was made to pursue acquisition. This case presents the successful implementation of a carefully crafted and realized strategy. It provides the opportunity to consider multiple "what ifs" in terms of the alternative strategies not chosen.

Two hospitals sit together on a medical campus located in a large metropolitan area. The larger (746 beds) of the hospitals, St. Catherine's, was established in 1887 by a Catholic congregation of religious women. The other hospital (527 beds), Martindale, was established by a group of Lutheran pastors in 1916. The missions of the two hospitals are very similar. The hospitals are strategically located in the center of a metropolitan area. The marketplace is one which has been characterized as fiercely competitive, with 40 percent of the market enrolled in prepaid plans. The demand for hospital services continues to decline each year. There is significant over capacity in the metropolitan area, with an average occupancy around 50 percent. The hospitals have had a varied history of both cooperation and competition. In 1975, a joint venture organization was established to jointly share expensive technology and develop new shared programs. After a brief study of the declining volumes and profitability in both hospital emergency rooms and identifying that both were perceived as substandard by the public and by the physicians, the question became--"should two competing, neighboring hospitals consolidate their emergency services?" The case reports a problem commonly experienced by hospitals today--when to compete, when to collaborate and how to balance the two in pursuit of organizational competence and advantage.

Mercy Medical Center is a 467 bed, not-for-profit teaching hospital affiliated with a multispecialty group practice and health maintenance organization through contractual arrangements. Historically, strategy development was not helping the hospital remain viable while accomplishing its mission. Strategic planning was fragmented, not focused toward concern for balance of the overall product line, total growth of the organization or the best use of resources. The hospital did not involve the affiliated group practice or HMO in its planning. This last case in Chapter One describes the pursuit of synergy through strategy formulation. The case provides a good example of what Kanter describes as a post-entrepreneurial organization, striving for advantage through collaboration and linkage with "PALs."

The problem explored in this case is the pursuit of horizontal and vertical growth by a multi-institutional system through hospital acquisition. Emphasis is on the selection of appropriate means to identify candidates for acquisition. Since the system did not have extensive experience in formal evaluation of acquisition candidates, it was necessary for system management to develop criteria for acquisition and a process by which to evaluate the criteria. The case is a good example of a thoroughly considered growth orientation.

Over the past several years, national coalitions and multi-hospital systems have been expanding and increasing in popularity. These organizations have offered the member hospitals services and resources to enhance the competitive position of the member hospitals. As these coalitions have grown, they have approached children's hospitals but, in most cases, to be an affiliate of one of the general acute care hospitals. The services of these coalitions are designed to enhance the general acute care centers and have not been refined to address the needs of children's specialty centers. As children's hospitals around the country assessed how they should work with these national coalitions, they were faced with several challenges. These coalitions did pose a potential competitive threat to the children's hospitals. But, at the same time, the coalitions did not offer services to the children's hospitals that would justify membership and the large outlay in dues. Faced with this dilemma, a group of children's hospitals came together to develop a formal national coalition for children's hospitals. This case provides an excellent example of and the opportunity to explore the implementation of a collaborative strategy designed to create competitive advantage for each of the collaborators.