Case Library

This case describes the development and growth of the Cincinnati Child Health-Law Partnership (Child HeLP), a medical-legal partnership founded in 2008 by Cincinnati Children's Hospital and the Legal Aid Society of Greater Cincinnati. Medical-legal partnerships (MLPs) involve collaboration between healthcare organizations and legal advocates to address the social and structural conditions that shape health, such as eviction, substandard housing, and barriers to public benefits. Child HeLP began by providing individual referrals from pediatric primary care clinics but soon uncovered systemic housing issues that affected dozens of children across entire neighborhoods. Over the next fifteen years, the partnership grew into one of the most established MLPs in the country, serving roughly 800 families annually, achieving high-profile legal victories, reducing hospitalizations for referred children, and expanding into specialty care.

By late 2022, demand had surged to more than 1,000 referrals each year, while funding and staffing remained largely unchanged. Co-founders Dr. Robert Kahn and Elaine Fink faced a strategic crossroads: they had to facilitate Child HeLP's continued growth, protect staff already stretched thin, and build the infrastructure required to sustain the program long after their direct involvement. The case highlights questions of organizational resilience, growth, and leadership succession in the face of rising demand and constrained resources. The case can be used to help students explore the challenges of building cross-sector partnerships, understand novel interventions addressing social and structural determinants of health, and learn how leaders balance short-term constraints with long-term strategy.

The Lee Kum Kee Group (LKK) case joins Dr. K. “Vish” Viswanath—Director of the Lee Kum Sheung Center for Health and Happiness at the Harvard T.H. Chan School of Public Health—as he explores the unique management philosophy of a Hong Kong-based company centered on the concept of Si Li Ji Ren—considering collective benefits before acting. Given his decades of research at the nexus of health and well-being, Dr. Viswanath developed a particular interest in the workplace as an important setting for promoting positive health. Since its founding in 1888, the family-owned global enterprise has attributed much of the company’s success to its commitment to the Si Li Ji Ren concept—a corollary to happiness—and associated values such as pragmatism, integrity, and constant entrepreneurship.

The case opens with background on the company and the evolution of its management philosophy as leadership explains how they apply the concepts in steering the company through business growth and economic downturns. The case delves into senior leadership’s interest in fostering and implementing health and happiness as a guiding force for business strategy, company culture, and competitive advantage; and it highlights specific examples of implementation across mission-driven initiatives, internal policies and programs, and external initiatives with vendors and clients. The case concludes with key questions Dr. Viswanath ultimately grapples with as he considers potential implications of applying the lessons learned from a family-owned enterprise, such as the Lee Kum Kee company, in a particular cultural context to other cultural contexts, organizational structures, and countries.

This case covers the controversy over the origin of the COVID-19 virus, a highly toxic debate that lasted over half a decade. In early 2020, there was substantial scientific uncertainty about whether the virus originated in the wild or had been manmade in a lab. Reasonable debate among scientists rapidly morphed into a single dominant narrative favoring the natural origin position. Proponents of the lab origin position were heavily criticized. It later became widely acknowledged that a lab origin was in fact quite possible; although by the time of the writing of this case, the true origin remained unknown. This case tracks the evolution of this issue for the purpose of understanding why it took on such toxic force and the consequences for civil discourse, trust in institutions, and public health. Students are invited to learn from this experience to inform decision making, leadership and communication in a turbulent and polarized world.

The UMass Memorial Health Care (UMMHC or UMass) case is an examination of the impact of crisis or high uncertainty events on organizations. As a global pandemic unfolds, the case examines the ways in which UMMHC manages crisis and poses questions around organizational change and opportunity for growth after such major events. The case begins with a background of UMMHC, including problems the organization was up against before the pandemic, then transitions to the impact of crisis on UMMHC operations and its subsequent response, and concludes with challenges that the organization must grapple with in the months and years ahead. A crisis event can occur at any time for any organization. Organizational leaders must learn to manage stakeholders both inside and outside the organization throughout the duration of crisis and beyond. Additionally, organizational decision-makers must learn how to deal with existing weaknesses and problems the organization had before crisis took center stage, balancing those challenges with the need to respond to an emergency all the while not neglecting major existing problem points. This case is well-suited for courses on strategy determination and implementation, organizational behavior, and leadership.

This case describes efforts to promote racial equity in healthcare financing from the perspective of one public health organization, Community Care Cooperative (C3). C3 is a Medicaid Accountable Care Organization–i.e., an organization set up to manage payment from Medicaid, a public health insurance option for low-income people. The case describes C3’s approach to addressing racial equity from two vantage points: first, its programmatic efforts to channel financing into community health centers that serve large proportions of Black, Indigenous, People of Color (BIPOC), and second, its efforts to address racial equity within its own internal operations (e.g., through altering hiring and promotion processes). The case can be used to help students understand structural issues pertaining to race in healthcare delivery and financing, to introduce students to the basics of payment systems in healthcare, and/or to highlight how organizations can work internally to address racial equity.

In August of 2020, after a day treating patients, John McAdams, MD, gets ready to meet with a young couple from the community. He is excited to share the latest progress on his institution’s Cancer Treatment and Control Center, which is set to open in 3 years. The $230+ million project is something that Dr. McAdams has been building in his mind for years. Its brick and mortar location will strive to be a truly different cancer center that emphasizes population health alongside acute treatment. Cutting edge technologies and innovative public health initiatives working in tandem will close the gap between rural and urban cancer patient outcomes.

After decades of diligence, vision, and advocacy from John, Midwest Regional Health (MRH) has purchased the physical location of what will be a state-of-the-art cancer treatment and control center—a rarity for rural America. The site is on the main campus and will be connected to the inpatient and pediatric hospitals by tunnels to have the cancer center be better integrated into the continuum of cancer care than an outpatient center at a separate location. According to John, “The architects have worked very hard to make the center what we wanted…very welcoming and reassuring but intertwining all the workings of the various departments.”

However, with just three years before the grand opening, questions remain about how to structure the management of the cancer center relative to the medical center and the oncology service line, how to expand the research base in oncology, and how to drum up excitement and support in the community.

The case recounts the events of the 2014-2016 West Africa Ebola Outbreak, starting with the death of patient zero, a young Guinean boy named Emile Ouamouno in December 2013 and ending in August 2014 when the World Health Organization declared the outbreak a Public Health Emergency of International Concern (PHEIC), an international legal tool aimed to draw additional attention and resources to particular health events which present a global risk. In doing so, the case particularly examines the role of the World Health Organization, a key actor in the epidemic, and provides further context into the strategy, finances, and organizational design of the organization. Additional information related to the Ebola Virus Disease (EVD), infectious disease epidemics, and the socioeconomic and political context of the three countries most affected by the outbreak (Sierra Leone, Liberia, and Guinea) is also provided. The case study draws upon interviews with key experts involved in both the management of the epidemic and its aftermath, including Dr. Suerie Moon, Study Director of the Independent Panel on the Global Response to Ebola, Amb. Jimmy Kolker, then Assistant Secretary for Global Affairs in the United States Department of Health and Human Services, and Dr. Bruce Aylward, Special Representative of the Director-General for the Ebola Response from September 2014 to July 2016.

The case is accompanied by an epilogue which retraces events after the PHEIC was declared in August 2014, and provides several quotes from key stakeholders involved in the outbreak, providing further context into how the epidemic was eventually contained, and which lessons could be learned from it.

This case is located within the multinational pharmaceutical company Novartis, as key managers decide what kind of monitoring and evaluation to implement for one of its social business programs, Novartis Access. This new program will expand the company’s reach into traditionally underserved markets in low- and middle-income countries using a basket of 15 medicines for non-communicable diseases offering them at public and faith-based facilities at a lower price than sold in the private market. Novartis Access is being launched in late 2015 in Kenya, with a long-term goal of operating in 30 countries. The case focuses on Michael Fürst, Senior Manager for Corporate Responsibility Strategy and Innovation, who must prepare a plan for monitoring and evaluation for Novartis Access to present to Harald Nusser, Head of Novartis Social Business. In order to prepare for his first meeting with Harald Nusser, Michael Fürst needs to identify the value and risks of monitoring and evaluating (and their differences) and make a proposal about what kind of monitoring and evaluation to adopt (if any), and how to overcome internal and external challenges.

Elizabeth, a middle-aged African American woman living in Minnesota, develops chest pain and eventually presents to a local emergency room, where she is diagnosed with stress-related pain and given Vicodin. Members of a non-profit wellness center where she is also seen reflect on the connection between her acute chest pain and underlying stress related to her socioeconomic status. On a larger level, how much of her health is created or controlled by the healthcare system? What non-medical policy decisions impacted Elizabeth such that she is being treated with Vicodin for stress?

In 2011 in response to two high profile cases of maternal death during labor and delivery, Ugandan citizens mobilized to prevent maternal mortality by improving the delivery of healthcare services in public hospitals. The Coalition to Stop Maternal Mortality ignited a social movement by utilizing strategic advocacy to hold the Government of Uganda accountable to its constitutional provisions on health service delivery. This case examines the Coalition to Stop Maternal Mortality and its landmark legal initiative, Constitutional Petition No. 16 of 2011, that focused the nation’s attention on the state of health services in Uganda and initiated a nationwide conversation about the role of government in delivering the right to health for all Ugandans.  What tactics and strategies can effectively mobilize power to bring about legal and policy change?  Would these be enough to achieve the change that the Coalition sought?

This case describes the development and growth of the Cincinnati Child Health-Law Partnership (Child HeLP), a medical-legal partnership founded in 2008 by Cincinnati Children's Hospital and the Legal Aid Society of Greater Cincinnati. Medical-legal partnerships (MLPs) involve collaboration between healthcare organizations and legal advocates to address the social and structural conditions that shape health, such as eviction, substandard housing, and barriers to public benefits. Child HeLP began by providing individual referrals from pediatric primary care clinics but soon uncovered systemic housing issues that affected dozens of children across entire neighborhoods. Over the next fifteen years, the partnership grew into one of the most established MLPs in the country, serving roughly 800 families annually, achieving high-profile legal victories, reducing hospitalizations for referred children, and expanding into specialty care.

By late 2022, demand had surged to more than 1,000 referrals each year, while funding and staffing remained largely unchanged. Co-founders Dr. Robert Kahn and Elaine Fink faced a strategic crossroads: they had to facilitate Child HeLP's continued growth, protect staff already stretched thin, and build the infrastructure required to sustain the program long after their direct involvement. The case highlights questions of organizational resilience, growth, and leadership succession in the face of rising demand and constrained resources. The case can be used to help students explore the challenges of building cross-sector partnerships, understand novel interventions addressing social and structural determinants of health, and learn how leaders balance short-term constraints with long-term strategy.

This case describes efforts to promote racial equity in healthcare financing from the perspective of one public health organization, Community Care Cooperative (C3). C3 is a Medicaid Accountable Care Organization–i.e., an organization set up to manage payment from Medicaid, a public health insurance option for low-income people. The case describes C3’s approach to addressing racial equity from two vantage points: first, its programmatic efforts to channel financing into community health centers that serve large proportions of Black, Indigenous, People of Color (BIPOC), and second, its efforts to address racial equity within its own internal operations (e.g., through altering hiring and promotion processes). The case can be used to help students understand structural issues pertaining to race in healthcare delivery and financing, to introduce students to the basics of payment systems in healthcare, and/or to highlight how organizations can work internally to address racial equity.

The case describes the challenges facing Shlomit Schaal, MD, PhD, the newly appointed Chair of UMass Memorial Health Care’s Department of Ophthalmology. Dr. Schaal had come to UMass in Worcester, Massachusetts, in the summer of 2016 from the University of Louisville (KY) where she had a thriving clinical practice and active research lab, and was Director of the Retina Service. Before applying for the Chair position at UMass she had some initial concerns about the position but became fascinated by the opportunities it offered to grow a service that had historically been among the smallest and weakest programs in the UMass system and had experienced a rapid turnover in Chairs over the past few years. She also was excited to become one of a very small number of female Chairs of ophthalmology programs in the country. 

Dr. Schaal began her new position with ambitious plans and her usual high level of energy, but immediately ran into resistance from the faculty and staff of the department.  The case explores the steps she took, including implementing a LEAN approach in the department, and the leadership approaches she used to overcome that resistance and build support for the changes needed to grow and improve ophthalmology services at the medical center. 

For more than 30 years, Dr. Joan Reede worked to increase the diversity of voices and viewpoints heard at Harvard Medical School (HMS) and at its affiliate teaching hospitals and institutes. Reede, HMS’s inaugural dean for Diversity and Community Partnership, as well as a professor and physician, conceived and launched more than 20 programs to improve the recruitment, retention, and promotion of individuals from racial and ethnic groups historically underrepresented in medicine (UiMs). These efforts have substantially diversified physician faculty at HMS and built pipelines for UiM talent into academic medicine and biosciences. Reede helped embed the promotion of diversity, equity, and inclusion (DEI) not only into Harvard Medical School’s mission and community values, but also into the DEI agenda in academic medicine nationally. To do so, she found allies and formed enduring coalitions based on shared ownership. She bootstrapped and hustled for resources when few readily existed. And she persuaded skeptics by building programs using data-driven approaches. She also overcame discriminatory behaviors and other obstacles synonymous with being Black and female in American society. Strong core values and sense of purpose were keys to her resilience, as well as to her leadership in the ongoing effort to give historically marginalized groups greater voice in medicine and science.

This case explores the challenges facing a new Chief Human Resources Officer as she evaluates health insurance benefits at a financial services company with 100,000 employees. Bank4 faces increasing costs while its employees see rising out-of-pocket expenses. Students will participate in workgroups focusing on pharmacy, provider prices, benefit and plan design, or prevention and wellness to evaluate the different options to address rising health care costs.