Course Objectives:

1. To provide students with a review of basic decision making theory.

2. To aid students in developing and understanding the structure of the decision making process in applied situations.

4. To give the students an opportunity to organize and draw upon the theories and principles learned in other health administration and business courses and to apply these concepts to actual executive decisions made in the health services delivery system.

5. To give students an opportunity to demonstrate their writing and presentation skills, as well as practice in the development of visual aids.

Required Texts:

Shortell, Stephen M.; Gillies, Robin R.; Anderson, David A.; Erickson, Karen Morgan; and Mitchell, John B. Remaking Health Care in America: Building Organized Delivery Systems, Jossey-Bass, San Francisco, 1996. [Please note, you should already have this text.]

Evans, Robert G., Barer, Morris L., and Marmor, Theodore R. Why Are Some People Healthy and Others are Not? The Determinants of Health of Populations, Aldine de Gruyter, Hawthorne, New York, 1994.

Reading Packet of cases provided by the Department.

Group case study assignments: This assignment focuses on major areas of concern in the management of health services organizations. Four case scenarios will be presented by health care professionals. The preceptors will present the case one week and the students assigned to that particular case will present the case solution(s) in class on a following date (at least two weeks later), submit a written response in the form of an executive summary (including slides), and lead the discussion. The student group will present the alternatives, clearly define the decision criteria, giving full explanation for their choices and discuss any formal or informal decision making methods used. After the group's presentation of the case study, the health care professional will share with the class the actual solution and insights into the problem, the different aspects that were considered during the decision making process, and comment on the solutions presented by the students. Students will be expected to research the case study area, providing 20 references as part of the written response. Students are expected to present the case in class as if they were presenting to a board of directors. All presentations should include visual aids, handouts, and presenters should be appropriately dressed. The group assignment is worth 100 points. [100 points]

Decision Examples paper. After reading the assigned paper, "A Pyramid of Decision Approaches" by Schoemaker and Russo from California Management Review, 36(1), Fall, 1993, students will provide eight examples of different types of decisions that would be appropriate to different approaches to decision making. [40 points]

Kepner-Tergoe Exercise: A short decision making exercise will be assigned after the presentation of the Kepner-Tergoe Decision Making Model. [20 points]

Ethical Incidents Role Playing: Students will be broken into small groups and each will be assigned an ethical incident case. The group will present the ethical case in class in a role playing format. In the process of role playing, the students should provide the audience with their decision and give the arguments for and against their ethical decision.Please feel free to be creative (costumes, props, etc.) [50 points]

Short case discussions/papers: Four short cases will be discussed in class. Students should be prepared to discuss the cases in class and prepare a short written response to the case based on questions provided. Preparation will result in quality class participation. [40 points or 10 points each paper]

Robert Wood Johnson case studies: Each student will be assigned one case (site) from the Robert Wood Johnson "Community Snapshots Project" to present in class. These case studies "...seek to capture the process of change in local health systems and the impact of that change on community residents." This study was accomplished through intensive interviews of key players in each market, a review of publicly available data, and consumer surveys of 15 communities. Each student will be assigned a market region (a case study) and will compare that site to the markets in Minneapolis, MN and Columbia, SC. The sites will be compared on eight dimensions: consumers, safety-net providers, hospitals , purchasers, the role of public policy, the level of health system integration, competition in the market place, and review the role of catalysts that brought about change. Stephen Shortell's book, Remaking of Health Care in America discusses the stages of system integration that each geographical area in the country goes through. Assess your market area in terms of its level of integration and compare your site with Minneapolis and Columbia. Students will also assume that they are the CEO of the largest hospital in that market area and will decide how to position their organization to meet the challenges of the next five years. What threats do you see? What opportunities? What steps do you need to take next to meet your strategic objective? One half of the grade will be based on the class room presentation and one half on the written summary. The classroom presentation cannot exceed 15 minutes. Each student will submit their presentation materials after their classroom presentation. The summary should be no more that six pages.

Cases: Paul B. Ginsburg and Nancy J. Fasciano, editors. "The Community Snapshots Project." The Center for Studying Health System Change, sponsored by the Robert Wood Johnson Foundation. 1996. The materials are available on the internet: www.rwjf.org/health/jhealth.htm. Go to national programs + Quick Jump (health tracking) + health tracking + community snapshots project. The following articles may be helpful to preparing your cases:

Health Affairs" Summer 1996, pages 7-129. These pages contain nine articles addressing the various dimensions that are to be covered in your RWJ paper.

Kemper P, et al. "The Design of the Community Tracking Study: A Longitudinal Study of Health System Change and Its Effects on People." Inquiry 33:195-206, Summer, 1996.

Kohn LT. "Methods in Case Study Analysis," Technical Publication No.2, June, 1997 from the Center for Studying Health System Change.

[100 points]

Final paper: There exists a whole social science literature on determinants of health in populations. As graduates of schools of public health, students should have the perspective of improving the health of populations, not just curing sick individuals, and understand the role, if any, that health service organizations play in making this happen. As private health care organizations (systems) become responsible for entire populations in a given geographical area, emphasis should shift from acute care to preventive care. Unfortunately, it has been found that risk factors for disease in individuals do not equate to causes of disease, nor do they necessarily determine the health status of a population. Robert Evans, Morris Barer, and Theodore Marmor have edited a book that reviews the entire medical sociology literature on the determinants of health in populations, Why Are Some People Healthy and Others Are Not? The Determinants of Health in Populations (Aldine de Gruyter Publishers, Hawthorne, NY, 1994). This book looks at the role of social class, culture, genetics, and biological pathways in determining the health of populations, as well as addressing the impact of health care services on health. You will read the first six chapters of the book and write a paper that a) discusses at least three new concepts or ideas that you learned from reading the book; and b) tell me how you might manage a health services organization differently or make different decisions about health care resources, now that you have been exposed to this type of information. The conclusion of the paper will be an overall critique of the book (Did it change the way you viewed health care? Every health care manager should read it! I will be a different health care manager because of it. It belongs in the trash bin! It puts health care services in their place! It provides a more balanced perspective on health status?). The entire paper should not exceed ten pages. This is a thinking paper. [100 points]

Grading summary:
 
 

Group case studies	100
Decision Examples paper	40
Kepner-Tergoe exercise	20
Ethical Incident role playing	50
Short case papers (4)	40
Robert Wood Johnson case	100
Final paper	100
Total points	450

Jan 12 Introduction & Review of Decision Making Theory

In-Basket exercise: This exercise will be completed in class. Students will be given a 21-item in-basket for an assistant hospital manager. Students will review the contents and decide what to be done with each item, or areas of concern. Students should be prepared to discuss what the contents of the in-basket tell us about the organization, the role of the CEO and the board, and the management style of the assistant manager. This exercise is for class discussion and is not graded.

Readings:

"Speed and Strategic Choice: How Managers Accelerate Decision Making" by Kathleen M. Eisenhardt California Management Review, 32(3), Spring, 1990.

"A Pyramid of Decision Approaches" by Schoemaker and Russo from California Management Review, 36(1), Fall, 1993.

Assignment: Based on the reading "A Pyramid od Decision Approaches," provide two examples, other than those in the article, of decisions that would be made by health care managers that would be appropriate to each type of approach (intuition, rules, weighting, and value analysis), i.e., 8 examples total. You need only one or two sentences per example. Due February 2, 1998. [40 points]

19 "Certificate of Need" group case study, presented by Mr. Leon Frishman, Director of the Bureau of Health Facilities and Services Development, DHEC. This case will present a CON request from physicians requesting to open a non-hospital-based ambulatory surgical center (one-day hospital) that will be privately owned.

Case discussion: Suburban Health Center. Students should come to class prepared to discuss this case. Written response due.

26 "Carolina Health Choice Network" group case study, presented by Ms. Susan Catelano of Med Corp. This case will address the process and decisions surrounding the strategic use of profits generated by a partnership.

Case discussion: Impaired Physician. Students should come to class prepared to discuss this case. Written response due.

Feb 2 Student presentation of the "Certificate of Need" case study.

Assignment due: "A Pyramid of Decision Approaches" paper is due.

Assignment: Students will be assigned the different scenarios from the case, "Ethical Incidents" to present in class on Saturday, February 20, 1999. The cases will be presented in role playing form.

9 No class

16 Student presentation of the " Carolina Health Choice Network" case study.

20 9:00 AM to Noon

Presentation: Kepner-Tergoe Decision Making Model. This decision making model is used at DHEC to aid in decision making by providing a systematic process. The method uses weighted decision criteria and a hazards analysis. This method will be demonstrated by Mr. Dennis Shepard.

1:00 - 3:00 PM

Role Playing: The "Ethical Incidents" case studies will be presented by students using role playing.

Assignment: You purchase vehicles for DHEC to use for inspections (food, nursing home, environment). You will be allowed to purchase five new vehicles this fiscal year. Each vehicle cannot cost more than $17,500. They must have automatic transmission and seat four adults comfortably. You have asked each department head to give you a list of features that would be nice to have. Their responses include: enough leg room for men in the back seat; air conditioning that works well; a good sized trunk to put sampling equipment; a color that is visible on the road; and a car where the front seat can be pulled up far enough for a short person to reach the pedals comfortably. Using the Kepner-Tergoe method of decision making, what car are you going to buy? Due March 2, 1999.

[40 points]

23 No class

Mar 2 "Integration of Alternative Medicine" group case study presented by Dr. David Adcock. This case will look at the issues surrounding the integration of alternative medicine into mainstream medicine in health services organizations.

Class discussion: Watergate Nursing Home. Students should come to class prepared to discuss this case. Written response is due.

Assignment due: Kepner-Tergoe exercise is due.

9 Spring Break

16 Student presentation of the "Integration of Alternative Medicine" case study.

23 No class

30 "Civilian Health Care System Preparation and Response to Biological Warfare Attack" group case study presented by Brig. Gen. Donna Barbish, U.S. Army. This case will explore the readiness and capacity of civilian health care systems to respond to a weapons of mass destruction incident. This class will be video-taped.

Apr 6 No class

10 9:00 AM - Noon

Student presentations of the Robert Wood Johnson case studies.

1:00 AM - 3:00 PM

Class discussion: Impaired Physician. Written responses are due.

13 Student presentation of the "Civilian Health Care System Preparation and Response to Biological Warfare Attack case study.

20 Final Papers are due in Dr. Stoskopf's office by 5:00 PM.