Solved by verified expert:Nestled in the Commonwealth of Virginia between Salem and Vinton is the city of Roanoke, whose
population was approximately 98,000 in 2010.
1 The metropolitan area population was about 309,000.
Bisected by the Roanoke River and circled by the Blue Ridge Mountain Parkway, Roanoke is the commercial
and cultural hub of western Virginia and southern West Virginia
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Health Professions Press, Inc.
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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
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.,  | Preceded by: Cases in health services management / edited by
Jonathon S. Rakich, Beaufort B. Longest, Kurt Darr. 5th ed. c2010. | Includes bibliographical 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 |
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.
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)
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)
About the Editors
POLICY ENVIRONMENT OF HEALTH SERVICES DELIVERY
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.
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 resourceallocation issues that users can role-play in three scenarios.
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.
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.
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
PART II STRATEGIC MANAGEMENT
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.
Edgewood Lake Hospital: Leadership in a Rural Healthcare Facility During Challenging Economic
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.
Klamath Care: Targeting and Managing Growth and Company-Wide Development
Tracy J. Farnsworth, Leigh W. Cellucci, and Carla Wiggins
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.
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
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
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
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.
Bad Image Radiology Department
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
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.
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.
Restructuring Decision Making at Holy Family Hospital: Overcoming Resistance to a Shared
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
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
Pediatric Dental Care Center
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.
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.
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
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.
Evolution of the Healthy Communities Initiatives
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
Hospital Software Solutions (A)
Elizabeth M. A. Grasby and Jason Stornelli
A software company supplying information technology services to Ontario (CN) hospitals has an illdefined structure and controls that frustrate a new employee with conflicting demands from the firm’s
managers, including expectations inconsistent with her job description.
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.
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.
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.
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.
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
that will preserve team cooperation.
PART VI ETHICS INCIDENTS
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.
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
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?
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 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
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
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.
Nora G Albert, MHA
Children’s National Health System
111 Michigan Ave, NW
Washington, DC 20010
Douglas Archer, MHA
Sutter Health-Memorial Hospital–Los Banos
520 West I St.
Los Banos, CA 93635
Alexander R Bolinger, PhD, MBA
Associate Professor of Management
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