Categoría: Casos de estudio

Marzo 02, 2008

El caso USP Hospitales

USP Hospitales es una de las empresas más interesantes que conozco. Tanto a nivel de sector de la salud como de otros sectores de la economía.

Su fundador, Gabriel Masfurroll, a quien he escuchado hablar en alguna ocasión, es una persona muy interante. A raíz de una conferencia exclusiva que tuvimos en la empresa con él, me interesó el personaje y me compré su libro "Aprendiendo de los mejores".

El IESE ha preparado un caso que ya han presentado y que imagino que en breve sacarán a la venta. Mientras tanto, lo más interesante es el artículo que han escrito en Harvard Deusto Marketing & Ventas, que merece la pena. Son 5 páginas donde se recorren los principales hitos de la empresa.

Mientras el profesor Joan Roure y su equipo de investigación sacan el caso en el IESE Publishing, nos tendremos que conformar con esto.

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Noviembre 05, 2006

Caso de estudio: Balanced Scorecard en el Duke's Children Hospital

El caso del Duke's Children Hospital es uno de los primeros que se recogieron en la literatura de gestión sanitaria sobre la aplicación del Balanced Scorecard o Cuadro de Mando Integral en las organizaciones hospitalarias.

Jon Meliones
era director médico del hospital pediátrico. Un hospital que se encontraba con graves problemas financieros (las cuentas no cuadraban) y operativos (las cosas no salían y la gente estaba descontenta). El caso recoge las motivaciones que llevaron al Dr. Meliones a utilizar el BSC para impulsar el cambio en su organización, y conseguir darle una vuelta a los hechos. Sus resultados hablan por sí mismos.

Una de las cosas que más me ha interesado del caso ha sido la utilización del BSC como elemento de unión entre los médicos y los gestores, los dos grupos que estaban enfrentados ("Los médicos son de Venus y los gestores de Marte").

Robert Kaplan y David Norton lo incluyeron como uno de los casos, junto con el del Montefiore Hospital, en sus primeros libros, ahora no recuerdo si en el primero ("The Strategy-Focused Organization: How Balanced Scorecard Companies Thrive in the New Business Environment") o en el segundo ("The Balanced Scorecard: Translating Strategy Into Action").

El Duke's Children Hospital es uno de los miembros del Balanced Scorecard Collaborative Hall of Fame, desde el año 2001.

In 1996, Duke Children's Hospital was in serious trouble. Its $11 million annual operating loss had forced administrators to make cutbacks. As a result, some caregivers felt that the quality of care had deteriorated. Parents' complaints were on the rise. Frustrated staff members were quitting. In this article, Jon Meliones, DCH's chief medical director, candidly describes how his debt-ridden hospital transformed itself into a vibrant and profitable one. The problem, he realized, was that each group in DCH was focusing only on its individual mission. Doctors and nurses wanted to restore their patients to health; they didn't want to have to think about costs. Hospital administrators, for their part, were focused only on controlling wildly escalating health care costs. To keep DCH afloat, clinicians and administrators needed to work together. By listening to staff concerns, turning reams of confusing data into useful information, taking a fresh approach to teamwork, and using the balanced scorecard method, Meliones and his colleagues brought DCH back to life. This first-person account is required reading for any executive seeking to revitalize a sagging organization. Meliones shares the operating principles DCH followed to become a thriving business.

El artículo fue publicado en la Harvard Business Review de noviembre-diciembre de 2000. Acceso directo al caso: Saving Lives, Saving Money (7 páginas).

Más información: "Balancing act: Scorecards help businesses stay healthy" (

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Abril 12, 2006

Caso de estudio: Change Through Persuasion, Beth Israel Deaconess Medical Center

El caso de este mes tiene que ver con el proceso de cambio gestionado a través de la comunicación de uno de los hospitales más importantes de EE.UU., el Beth Israel Deaconess Medical Center

Beth Israel Deaconess.gif


Faced with the need for a massive change, most managers respond predictably. They revamp the organization's strategy, shift around staff, and root out inefficiencies. They then wait patiently for performance to improve--only to be bitterly disappointed because they've failed to prepare employees adequately for the change.

In this article, the authors contend that to make change stick, leaders must conduct an effective persuasion campaign--one that begins weeks or months before the turnaround plan is set in concrete. Like a political campaign, a persuasion campaign is largely one of differentiation from the past. Turnaround leaders must convince people that the organization is truly on its deathbed--or, at the very least, that radical changes are required if the organization is to survive and thrive. (This is a particularly difficult challenge when years of persistent problems have been accompanied by few changes in the status quo.) And they must demonstrate through word and deed that they are the right leaders with the right plan.

Accomplishing all this calls for a four-part communications strategy. Prior to announcing a turnaround plan, leaders need to set the stage for employees' acceptance of it. At the time of delivery, they must present a framework through which employees can interpret information and messages about the plan. As time passes, they must manage the mood so that employees' emotional states support implementation and follow-through. And at critical intervals, they must provide reinforcement to ensure that the desired changes take hold and that there's no backsliding. Using the example of the dramatic turnaround at Boston's Beth Israel Deaconess Medical Center, the authors elucidate the inner workings of a successful change effort.

Aquí os dejo el caso.

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Octubre 01, 2005

Caso de estudio: Shouldice Hospital Limited

Shouldice Hospital, a Canadian facility that performs hernia operations only, has developed procedures to maximize surgical success rates, save patients money, and speed their recovery in a friendly, noninstitutional environment.

Shouldice Hospital.gif

The hospital specializing in hernia operations is considering whether and how to expand the reach of its services. Various proposals are set forth for expanding the capacity of the hospital. In assessing them, serious consideration has to be given to the culture of the organization and the importance of preserving it in a service delivery system. In addition to issues of capacity and organizational analysis, describes a well-focused, well-managed medical service facility that may well point the way to future economies in the field.

The hospital's advertising consists of word of mouth, and Shouldice's popularity is such that former patients ("alumni") return by the hundreds for reunions.

The hospital has a backlog of prospective patients awaiting surgery, and the case sets forth various proposals for increasing its capacity. In considering change, the importance of the organization's close-knit culture—built around quality service, attention to patients, and an attractive work environment for doctors and staff—must be taken into account.

"I read a short magazine article about Shouldice in 1982, and it nicely illustrated excellence in the delivery of a service," explains the case's author, HBS professor James Heskett. "I knew we had a good story, and when I learned that Shouldice management had discussed the capacity question, it was clear we had a core issue that could be teachable in the classroom". (Indeed, aspects of the case were sometimes a bit too gripping for a few students: Heskett recalls that after a television report on Shouldice became a regular part of the case's classroom presentation, students would occasionally faint during some of the surgery scenes.)

Heskett says studying Shouldice helped him conceptualize the strategic-service vision that he and HBS colleagues would develop into a framework for success for service firms. "The case endures," he declares, "because the mission of Shouldice has remained constant and because Shouldice has inspired other focused medical ventures. More broadly, it is a dynamic illustration of concepts still critical to service-management success".

Like Heskett, HBS professor Regina Herzlinger cites Shouldice as an important intellectual stimulus, helping her develop innovative ideas about consumer-driven health care. "By showing the positive impact of making health care more consumer-oriented, Shouldice has helped recraft thinking about the field," Herzlinger says. In her course Innovating in Health Care, she uses the case to illustrate a medical "focus factory," emphasizing that focus without Shouldice-like consistency and execution is not enough.

One of her favorite aspects of the case is what happens after surgery. "Shouldice believes that walking early and often is a key to postoperative recovery," Herzlinger observes. "So there are no bathrooms, nor meals served, in the rooms. You have to walk to satisfy your basic needs. Your recovery—indeed, the entire Shouldice experience—is advanced by such fundamental inducements, as well as by attractive ones, such as the beautifully landscaped grounds that encourage patients to be ambulatory".

Shouldice Hospital facility.jpg

Study Questions:

1. How do you account for the performance of this organization?

2. Specifically, what decisions would you make concerning a) the possible addition to the hospital of rooms for 45; b) the addition of a Saturday operating schedule to the clinic; c) the development of a new self-contained "branch" of Shouldice; and d) the development of a new specialty medical service? Why?

Fuente: HBS Working Knowledge, "Classic Cases Live on at HBS"

Más información en la página del Shouldice Hospital.

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Mayo 02, 2005

Caso de estudio: Beijing Toronto International Hospital

El caso de este mes trata sobre el primer hospital privado en China, con capital extranjero. El caso tiene su utilidad a la hora de trabajar con los principales conceptos de marketing.

Beijing Toronto International Hospital.jpg

Aquí os dejo el resumen del mismo...

Beijing Toronto International Hospital was a new private facility being built in Beijing that would offer a full range of general and specialized Western-quality medical services to a very specific market segment: expatriates and wealthy Chinese families.

Membership cards were sold that entitled each member to a distinct level of hospital service. The chief executive officer found that as the building neared completion, only a few memberships had been sold which resulted in a cash shortage. He did not know why sales failed to materialize as expected, but felt that he must redirect and revitalize the marketing campaign. He considered several options and had to determine what would work best in the Chinese market.

In this case, we will discuss the remarkable story of an entrepreneur building the first Western style hospital in Beijing. The case covers several marketing decision concepts with a variety of interesting choices. We like this case because it is a pioneering idea and allows for some creative thinking.

This case dealt with a new hospital facility in Beijing that offers a full range of Western-quality medical services at a membership rate to a specific market niche: expatriates and wealthy Chinese families. As the construction of the hospital neared completion, membership sales were much less than projected and it was necessary that a marketing campaign be conducted to find out why sales failed to meet the target.

Topics covered:

1) 5Cs – Company, Competitors, Customers, Collaborators, Context
2) 4Ps – Product, Place, Price, & Promotion
3) Segmentation, Targeting, Positioning strategies
4) Consumer needs hierarchy
5) Buying behavior and process analysis
6) Marketing math: sunk costs, break even, variable cost, etc
7) Price elasticity
8) Product development process

El caso puede ser adquirido en esta página.

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Marzo 04, 2005

Caso de estudio: Process Improvement in Stanford Hospital's Operating Room

El caso de este mes ha sido creado por Stefanos Zenios, Kate Surman y Elena Pernas-Giz, profesores de Stanford. Trata sobre cómo se mejoró el funcionamiento del bloque quirúrgico dentro de Stanford Hospital and Clinics.


Aquí os incluyo el resumen del caso. Es un buen complemento del que vimos sobre el Karolinska, especialmente, por las metodologías utilizadas para el análisis diagnóstico.

It was June 2004 and members of the Material Flow Committee (MFC) at Stanford Hospital and Clinics were faced with the challenge of implementing important process improvements in the operating room.

stanford hospital and clinics.gif

Though notable progress had been made in the recent past, complaints from surgeons, nurses and technicians regarding the availability of surgical instrumentation had reached an all-time high. Finding a solution was urgent, but opinions varied widely regarding the best course of action.

Some individuals believed that instrumentation sterilization and processing should be adopted as a core competency (and made central to employee training and compensation).

Others felt the hospital should invest in additional instruments and information technology to improve efficiencies.

A third faction believed that instrumentation issues resulted, in large part, from low morale and a lack of cross-functional camaraderie and teamwork within the operating room.

While each of these issues was important, a decision had to be made to devote Stanford’s limited time and resources to the solution that would have the greatest, most immediate impact on its operating room effectiveness.

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Enero 05, 2005

Caso de estudio: Karolinska Sjuhhuset (Karolinska Institute)

El caso de este mes hace referencia a uno de los hospitales de mayor renombre a nivel europeo, el Karolinska. Ha sido creado por el equipo de profesores del INSEAD.


Aquí os incluyo el resumen del caso, para aquellos que esteis interesados en utilizarlos en vuestros cursos. Como casi todo el material en este mundillo, está en inglés...

The case describes the major transformation that took place in one of the largest university hospitals in Sweden.

karolinska institute.gif

Changes involved refocusing on the patient as final customer, improving quality and reducing costs. They were achieved through a total quality improvement scheme combined with process reengineering. Organisational changes helped implement these changes.

The case illustrates how efficiency can be improved by simple process changes, highlights the importance of leadership and of involving professionals (doctors, nurses). It also provides an example of how industrial concepts could be brought to hospitals and to the services industry in general.

Two key issues raised by the case are: (1) prioritization in a complex multi-client environment and (2) the relative value of quality when perception of quality differs from one group of 'clients' to another.

1. What are the changes in the market structure (Stockholm model) that have influenced Karolinska’s strategy?

2. Who are Karolinska’s “customers”? How is Karolinska addressing their needs?

3. What do you think about Karolinska’s change strategy? What are the advantages and limits of TQM (total quality management) versus TBM (time-based management, or re-engineering)?

4. How do you see the future of Karolinska after Jan Lindsten’s departure?

Case Study:
Karolinska Sjukhuset (A&B)
Leadership, Process Re-engineering, Organisational Change and
Quality Improvement in a large university hospital.
INSEAD Case-Study (1995-1997).

Si quieres solicitar el caso como material pedagógico, envía un email a

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