Publications

2021
Yatsko, P. & Koh, H., 2021. Dr. Joan Reede and the Embedding of Diversity, Equity, and Inclusion at Harvard Medical School, Harvard T.H. Chan School of Public Health case collection. Available from Harvard Business PublishingAbstract
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.
Levin-Scherz, J., 2021. Bank4’s New CHRO Confronts Health Care Costs, Harvard Business Publishing: Harvard T.H. Chan School of Public Health case collection. Available from Harvard Business PublishingAbstract
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. 
Yatsko, P., 2021. Boston Health Care for the Homeless (B): Disaster Medicine and the COVID-19 Pandemic, April-May 2020, Harvard Business Publishing: Harvard T.H. Chan School of Public Health case collection. Available from Harvard Business PublishingAbstract

Jessie Gaeta, the chief medical officer for Boston Health Care for the Homeless Program (BHCHP), learned on April 7, 2020 that the City of Boston needed BHCHP to design and staff in 48 hours one half of Boston Hope, a 1,000-bed field hospital for patients infected with COVID-19. The mysterious new coronavirus spreading around the world was now running rampant within BHCHP's highly vulnerable patient population: people experiencing homelessness in Boston. A nonprofit community health center, BHCHP for 35 years had been the primary care provider for Boston's homeless community. Over the preceding month, BHCHP's nine-person incident command team, spearheaded by Gaeta and CEO Barry Bock, had spent long hours reorganizing the program. (See Boston Health Care for the Homeless (A): Preparing for the COVID-19 Pandemic.) BHCHP leaders now confronted the most urgent challenge of their long medical careers. Without previous experience in large-scale disaster medicine, Gaeta and her colleagues had in short order to design and implement a disaster medicine model for COVID-19 that served the unique needs of people experiencing homelessness.

This case study recounts the decisive actions BHCHP leaders took to uncover unexpectedly widespread COVID-19 infection among Boston's homeless community in early April 2020. It details how they overcame their exhaustion to quickly design, staff, and operate the newly erected Boston Hope field hospital for the city's homeless COVID-19 patients. It then shows how they adjusted their disaster medicine model when faced with on-the-ground realities at Boston Hope regarding patients' psychological needs, limited English capabilities, substance use disorders, staff stress and burnout, and other issues.

Yatsko, P., 2021. Boston Health Care for the Homeless (A): Preparing for the COVID-19 Pandemic, January-March 2020, Harvard Business Publishing: Harvard T.H. Chan School of Public Health. Available from Harvard Business PublishingAbstract

On February 1, 2020, Jessie Gaeta, the chief medical officer for Boston Health Care for the Homeless Program (BHCHP), received news that a student in Boston had tested positive for the novel coronavirus virus that causes COVID-19 disease. Since mid-January, Gaeta had been following reports of the mysterious virus that had been sickening people in China. Gaeta was concerned. Having worked for BHCHP for 18 years, she understood how vulnerable people experiencing homelessness were to infectious diseases. She knew that the nonprofit program, as the primary medical provider for Boston’s homeless population, would have to lead the city’s response for that marginalized community. She also knew that BHCHP, as the homeless community’s key medical advocate, not only needed to alert local government, shelters, hospitals, and other partners in the city’s homeless support network, but do so in a way that spurred action in time to prevent illness and death. 

The case study details how BHCHP’s nine-person incident command team quickly reorganized the program and built a detailed response, including drastically reducing traditional primary care services, ramping up telehealth, and redeploying and managing staff. It describes how the team worked with partners and quickly designed, staffed, and made operational three small alternative sites for homeless patients, despite numerous challenges. The case then ends with an unwelcome discovery: BHCHP’s first universal testing event at a large city shelter revealed that one-third of nearly 400 people there had contracted COVID-19, that most of the infected individuals did not report symptoms, and that other large city shelters were likely experiencing similar outbreaks. To understand how BHCHP and its partners subsequently popped up within a few days a 500-bed field hospital, which BHCHP managed and staffed for the next two months, see Boston Health Care for the Homeless (B): Disaster Medicine and the COVID-19 Pandemic.
 

Arnold, B., Reis-Henrie, T. & Siegrist, R., 2021. Tackling Inequity in Cancer Care in Rural America, Harvard T.H. Chan School of Public Health. Download free of chargeAbstract

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.

Kane, N.M. & Atkinson, M.K., 2021. Envision Healthcare and Out-of-Network Billing, Harvard Business Publishing: Harvard T.H. Chan School of Public Health case collection. Available from Harvard Business PublishingAbstract

The Envision Healthcare (EVHC) case examines the operations of one of EVHC's divisions, EmCare, a national physician services outsourcing company. The case describes EmCare's controversial use of out-of-network billing for a significant share of its revenues. As the company faced increasingly negative scrutiny for these practices, the case highlights the different perspectives and vantage points- both good and bad- of this strategic decision, and delves into the question of ethical practices as it relates to out-of-network billing. Students will explore the legal, societal, and economic implications of EmCare's business model, grappling with questions of business ethics and responsibility to customers. As EVHC contemplates reducing the out-of-network billing practices of its divisions including EmCare, the company faces important questions around financial viability, which serve as an opportunity for students to develop recommendations and novel approaches to EVHC's strategic quandary.

Ethical challenges are common to healthcare organizations as they develop and implement strategy. Organizations must deal with questions of profitability and performance against the backdrop of making self-guided decisions around social responsibility and ethical practices. The case provides relevant context regarding emergency medicine, out-of-network billing, and payer-provider-hospital relationships. With this background, students are encouraged to consider the gamut of considerations, some of which are not so obvious, when weighing strategic decisions that bear in mind social and ethical implications.

2020
Chaumont, C. & Anyona, M., 2020. Caught in a Storm: The World Health Organization and the 2014 Ebola Outbreak, Harvard T.H. Chan School of Public Health, Harvard Kennedy School. Access onlineAbstract
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.
2019
Guyer, A.L., Wirtz, V.J. & Reich, M.R., 2019. Monitoring and Evaluation for the Novartis Access Initiative, Harvard T.H. Chan School of Public Health case collection. Available from Harvard Business PublishingAbstract
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.
Staus, R. & Hudspeth, J., 2019. Vicodin as a Treatment for Structural Violence, Harvard University: Social Medicine Consortium. Download free of chargeAbstract

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?

McCoy, M., Namwase, A. & Finnegan, A., 2019. The Coalition to Stop Maternal Mortality: Uganda , Harvard University: Social Medicine Consortium. Download free of chargeAbstract

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?

Louis, Y.E., et al., 2019. Resident Doctors on Strike in Haiti's Public Hospitals, Harvard University: Social Medicine Consortium. Download free of chargeAbstract
In 2016, resident physicians organized a strike at the State University Hospital of Haiti (HUEH) in the capital of Port-au-Prince that eventually spread to at least ten other public hospitals in the country, effectively paralyzing the health care system for several months. Through interviews with strike participants and other key stakeholders in the Haitian medical system, this case explores the ethical challenges of health care worker strikes and the far-reaching consequences of the Haitian strike on the nation’s provision of health care and training of health professionals.
Guerra, I., et al., 2019. SALUDos: Healthcare for Migrant Seasonal Farm Workers, Harvard University: Social Medicine Consortium. Download free of chargeAbstract
The SALUDos program began in 2008 as a response to an influx of migrant seasonal farm workers (MSFWs) at a mobile medical unit serving homeless persons in Santa Clara County in Northern California. The program offered patients free and low-cost primary care services, linkage to resources, and advocacy.  As the farm workers involved in this program became more involved in their primary care, they advocated for evening hours, transportation, linkage to coverage programs, and health education resources to better understand their medical and psychological conditions. During continual modifications of the SALUDos program, the team sought to understand and address large-scale social forces affecting migrant health through interventions to mitigate health inequities.
Yoder, K., et al., 2019. The Formerly Incarcerated Transitions (FIT) Clinic: Interfacing with the Social Determinants of Health, Harvard University: Social Medicine Consortium. Download free of chargeAbstract

This case describes and explores the development of the first medical transitions clinic in Louisiana by a group of community members, health professionals, and students at Tulane Medical School in 2015.  The context surrounding health in metro New Orleans, the social and structural determinants of health, and mass incarceration and correctional health care are described in detail. The case elucidates why and how the Formerly Incarcerated Transitions (FIT) clinic was established, including the operationalization of the clinic and the challenges to providing healthcare to this population. The case describes the central role of medical students as case managers at the FIT clinic, and how community organizations were engaged in care provision and the development of the model.  The case concludes with a discussion of the importance of advocacy amongst health care professionals.

Carrasco, H., et al., 2019. The Story of Esdras: Child Malnutrition as a Social Condition, Harvard University: Social Medicine Consortium. Download free of chargeAbstract
This case tells the story of Dr. Roblero, a newly-graduated Mexican physician working in the rural community of La Soledad, who cares for Esdras, a young boy suffering from chronic malnutrition and pneumonia. Dr. Roblero and a team of providers subsequently seek to address the structural determinants of malnutrition through numerous interventions including education campaigns, homestead gardens, and poultry husbandry. This case details the challenges they encounter as they explore novel ways to improve child nutrition in La Soledad.
Wispelwey, B., et al., 2019. Healthcare as Resistance and Right: Forced Displacement and the Quest for Health in Bedouin Villages in the Negev, Harvard University: Social Medicine Consortium. Download free of chargeAbstract

The Palestinian Bedouin of the Negev desert are a minority community within Israel, one that has experienced limits on its rights to land use and health access. The Bedouin claim of ownership of their ancestral lands is disputed by the state of Israel, which has attempted to condition access to state services, like health clinics, on the relinquishing of land claims. After the passage of universal healthcare in Israel in 1995, the Bedouin and their representatives developed a legal strategy to secure a right to health on their ancestral lands. This case explores this legal fight, the historical and health contexts of Bedouin citizens of Israel, the limitations of the law in pursuit of justice, and the role of community organizing in the struggle for fundamental rights to health. It highlights the concept of settler colonialism and the relevance of historical context when striving to secure health. Finally, it also emphasizes the distinction between public narratives about vulnerable populations from actors with power such as the State and the narratives of the vulnerable community populations themselves.

Mux Xocop, S., et al., 2019. Barriers to Care for Indigenous Women with Cervical Cancer in Guatemala, Harvard University: Social Medicine Consortium. Download free of chargeAbstract

In Guatemala, rural and indigenous women face disparities in access to prevention and treatment of cervical cancer. This case analyzes barriers faced by Mayra, an indigenous woman from a rural community in Guatemala who was diagnosed with cervical cancer.  Even though all Guatemalans are entitled to free health care provided by the public health system, economic, geographic, linguistic, and cultural barriers prevent women from obtaining specialized healthcare for complex conditions such as malignancy.  Accompaniment and care navigation are potential solutions to overcome these impediments, helping marginalized patients receive treatment and reducing health disparities for indigenous peoples.

Jung, H.R. (M.) & Bhabha, J., 2019. Friends-International: A Response to the Plight of Children in the Aftermath of Cambodia’s Atrocities, Harvard T.H. Chan School of Public Health. Download free of chargeAbstract

In the aftermath of the atrocities endured by the Cambodian people, Friends-International (FI) was established in 1994 to address some of the many protection needs faced by the country’s marginalized children and youth. In the intervening quarter century, FI has grown substantially, both in the scope and complexity of its operations. The organization’s core mission consists of providing comprehensive, innovative, and high quality services to children, youth, and their families, based on a child rights-based approach that informs all of the organization’s programs. FI has established a strong and highly respected presence in Cambodia, building social services for children, operating effective social businesses, and initiating the global ChildSafe Movement. Over time, they have expanded their community-based model to multiple countries. But amidst their expansion, FI has continued to face financial insecurity and a constantly shifting landscape of challenging child protection concerns. At what point might they have been trying to do too much, possibly unduly stretching themselves across too many sectors and borders? Innovation had been a core strength of FI, but was it always appropriate to innovate? The case addresses these common problems.

Kane, N., 2019. Low Course Ratings: What Can You Learn From Them?. Low Course Ratings
Slides from an active learning workshop session on low course ratings by Prof. Nancy Kane. Most instructors receive some negative comments from students on their course evaluations. One option is to dismiss them as outliers or in conflict with positive comments, and sometimes that is appropriate. Often, however, negative evaluations represent good opportunities for reconsidering how a course is positioned, what it is trying to achieve, and/or how it is taught. Dr. Kane describes common themes found in negative course evaluations at Harvard Chan and discusses ways of addressing them.
Al Kasir, A., Coles, E. & Siegrist, R., 2019. Anchoring Health beyond Clinical Care: UMass Memorial Health Care’s Anchor Mission Project, Harvard Business Publishing: Harvard T.H. Chan School of Public Health case collection. Available from Harvard Business PublishingAbstract
As the Chief Administrative Officer of UMass Memorial Health Care (UMMHC) and president of UMass Memorial (UMM) Community Hospitals, Douglas Brown had just received unanimous and enthusiastic approval to pursue his "Anchor Mission" project at UMMHC in Worcester, Massachusetts. He was extremely excited by the board's support, but also quite apprehensive about how to make the Anchor Mission a reality. Doug had spearheaded the Anchor Mission from its earliest exploratory efforts. The goal of the health system's Anchor Mission-an idea developed by the Democracy Collaborative, an economic think tank-was to address the social determinants of health in its community beyond the traditional approach of providing excellent clinical care. He had argued that UMMHC had an obligation as the largest employer and economic force in Central Massachusetts to consider the broader development of the community and to address non-clinical factors, like homelessness and social inequality that made people unhealthy. To achieve this goal, UMMHC's Anchor Mission would undertake three types of interventions: local hiring, local sourcing/purchasing, and place-based community investment projects. While the board's enthusiasm was palpable and inspiring, Doug knew that sustaining it would require concrete accomplishments and a positive return on any investments the health system made in the project. The approval was just the first step. Innovation and new ways of thinking would be necessary. The bureaucracy behind a multi-billion-dollar healthcare organization would need to change. Even the doctors and nurses would need to change! He knew that the project had enormous potential but would become even more daunting from here.
Ratleff, C. & Tucker-Seeley, R., 2019. The Rhode Island Commission of Health Advocacy and Equity: Developing a Report on Health Disparities (Parts A, B, & C), Harvard Business Publishing: Harvard T.H. Chan School of Public Health case collection. Available from Harvard Business PublishingAbstract
In 2011, the Rhode Island (RI) legislature established the Commission on Health Equity and charged this group with writing a report on health disparities every two years. The case protagonist, Dr. Harper Avery, Director of Minority Health at the RI Department of Health, has recently assumed the co-chair position on the Commission of Health Advocacy and Equity in RI. Through the experiences of Dr. Avery, the reader sees the issues involved when a multidisciplinary and multi-sectoral group must work together to create the health disparities/health equity report. Such issues include how to define "health disparities" and related terms, what health outcomes and behaviors to choose to report, where to get the data required for the report, and how to measure disparities with the data obtained. Additionally, the reader is encouraged to consider the multiple perspectives of the Commission members and the various constituencies they represent. This case study takes the students through the process of developing a state-level health disparities report.

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