Case studies in health administration最新文献

The case hospital was required to strategically respond to significant environmental challenges brought into play by the legislative enactment of a new Medically Indigent Assistance Act (MIAA). Publicity surrounding the debate leading up to the passage of the new law by the state legislature placed the hospital under unprecedented scrutiny by local taxpayers, healthcare recipients, elected officials, advocates for the poor and other local providers of healthcare services. This case reports the implementation of a highly desired strategy on the part of the hospital and the necessary roles of multiple stakeholders in the realization of hospital strategy. The case also illustrates the spill-over effects of stakeholder relationships developed in pursuit of particular strategy on the organization's ability to pursue future strategy.

St. Luke's Hospital was the only hospital in town until 26 years before the time of the case. In the late 1950s St. Luke's Hospital was overcrowded and in dire need of renovation and expansion. Plans were devised and the hospital applied for Hill-Burton money to expand. At the same time, a group of local citizens decided to also apply for Hill-Burton money to build another hospital, County Memorial, in the community. The Hill-Burton money was divided and both received money. Both facilities opened within months of each other. For about 10 to 12 years, both hospitals prospered. At the time of the case, competition has heated up between the two facilities. Attempts at collaboration fail; the story is one of wasted resources and community pain because of the lack of ability of two competitors to put aside differences for mutual benefit. The case ends with there being only one hospital in town. Read alone, the case is instructive in terms of the difficulties created when organizations value survival in a known form above all else. Read and considered in concert with Case Eight, it encourages contemplation of the pros and cons of head-on competition versus collaboration.

The practice of strategic planning, both in business and healthcare, greatly expanded during the 1970's. Many process models were proposed and applied to determine environmental threats and opportunities, to identify achievable goals and to predetermine achievable courses of action. Developing and maintaining a strategic planning process is described as a requirement for healthcare organizations. This case report is a study of the successful evolution of a planning process which the author presents as a model for other institutions. The case describes the development of a formal process for strategy formulation, based on economic definitions of strategy, under what Ansoff would consider ideal conditions. It is unique in that it ties the process to product line management implementation.

This case reports a major shift in growth orientation pursued by a multi-institutional system--systemwide product line management. Competitive response to one environmental disruption led to the initiation of a year-long study to re-evaluate the corporation's mission, goals, strategies, growth and action orientations and organizational structure in light of the dramatic changes occurring in healthcare delivery. Of particular interest in this case is the connectedness between growth and action orientations, organizational culture, management style and organizational structure.

Although Carolina Community found itself continuing to grow and expand at a time when most facilities in the area were suffering from census declines, it was obvious that continuation of such growth would require more sophisticated strategic planning. At the time of the study, Carolina Community was growing in all areas. Inpatient census as well as outpatient utilization were taxing the resources of the organization. The strategic location of the facility and the support of a committed medical staff provided the institution with a competitive advantage over the other area facilities in the past. In the span of three months, two major competing institutions made strategically significant organizational changes. Both institutions hired new administrators known for their aggressiveness and organizational abilities. It became obvious very quickly that the playing field would soon be changing. No longer would Carolina Community's administration be able to move aggressively to protect and expand its markets without fear of competition. Carolina Community is a hospital with a long-standing tradition of formal strategic planning forced by a rapid "heating up" of the environment to respond much more quickly than it has had to in the past and much more quickly than it is currently able. The case report describes a change in strategy formulation process which was designed to speed up response time and to modify the organization along Ansoff's eight characteristics to a more environmentally appropriate configuration.

In 1983, the medical center had no strategic planning process and no individual or department with an identified responsibility for planning to meet the needs of the organization and its service community. There were limited resources to apply to this endeavor and a prevailing attitude among current leadership that any planning done should be focused solely on facilities development. While the process pursued in this case is similar to that in Case One, unlike Case One, conditions within the organization are less than ideal for the implementation of any process, formal or informal, for the formulation of strategy. Read alone, the case is instructive. Considered in combination with Case One, it provides grist for a good discussion of the differences between organizations which have the capacity to be strategically managed and those which have learning to do.

In this case, a medical center learns how to evaluate each of its services along a Product Life Cycle curve. Each stage of the cycle has characteristics that suggest appropriate strategic growth and action orientations. When services were plotted along the Product Life Cycle curve, many of the services were found to be mature or making the transition from growth to maturity. At the time of the case, Memorial Medical Center's competitors were entering many of its traditional markets creating a strong competition for market share. Greater competitive emphasis on performance and price reduced profits in the medical center's mature services. The case reports the medical center's approach to modifying its action orientation in light of a better understanding of organizational competence.