Instructor’s Manual:
JESSICA CASSERRA’ S TASK FORCE:
HOSPITAL INTEGRATION IN THE REGION OF ERIE
Gene Deszca, Wilfrid Laurier University
Case Objectives and Use
The case addresses integration challenges a credible and capable senior hospital manager (Jessica
Casserra) faces when economic and political pressures from the Province make change
inevitable. The services of five small local hospitals and a larger regional hospital are to be
integrated in some manner, opening the door to a discussion of strategy, structure and design.
Integration planning is to be done by a task force chaired by Jessica, but approval rests with the
Case Synopsis
Jessica Casserra, CFO of the largest hospital in the region, has been asked to orchestrate the
integration of hospital care delivery for the region. Five of the area hospitals are small, serving
outlying towns, while the largest is located in the main metropolitan area. Jessica is credible and
competent, but the magnitude of the undertaking is new to her. Provincial funding authorities,
looking for greater financial efficiency in health care delivery, have mandated the rationalization
of services, but downloaded the ultimate responsibility to the local level. She has ten months in
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JESSICA CASSERRA’ S TASK FORCE:
HOSPITAL INTEGRATION IN THE REGION OF ERIE
INSTRUCTOR’S MANUAL
Case Synopsis
Jessica Casserra, CFO of the largest hospital in the region, has been asked to orchestrate the
integration of hospital care delivery for the region. Five of the area hospitals are small, serving
outlying towns, while the largest is located in the main metropolitan area. Jessica is credible and
competent, but the magnitude of the undertaking is new to her. Provincial funding authorities,
looking for greater financial efficiency in health care delivery, have mandated the rationalization
of services, but downloaded the ultimate responsibility to the local level. She has ten months in
which to reach agreement on a solution and there are severe financial implications related to
Teaching Objectives
This case is designed to be an integrating one, towards the end of a semester, but it can also be
used in a more targeted manner to address one of a number of specific purposes, which are
highlighted below. If a focused approach is the intent, it is recommended that the instructor
focus on no more than a couple of these in order to allow for a deeper discussion of the
underlying issues and increase the likelihood of meaningful learning. This teaching note is
written for the faculty member who wants to use it more as an integrating case in their course.
The teaching objectives to which the case can be put include:
o Assessing strategic and operational issues related to merger and service integration in a not-
for-profit, hospital context
o Exploring the management of issues related to power and politics in a situation involving
multiple stakeholders and agendas, and high levels of ambiguity and turbulence
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Courses and Levels for Which the Case is Intended
o An intermediate to senior level course in organizational behavior
o An elective in change management
o An elective in strategy development and implementation
o A course in the management of not-for-profit and/or health service organizations
Discussion Questions
1. What are the strategic and service delivery issues that Jessica faces?
The key strategic question facing Jessica is what should the hospital health care delivery system
look like in the Region of Erie and how should service delivery be structured. Imbedded in this
are the potentially conflicting visions of the different stakeholders and the question of what
decision criteria should be used when developing and evaluating strategic options (i.e., design
specifications). The Province is interested in seeing greater cost efficiency and increased value
from the health dollar spent, but how best to achieve such outcomes in the eyes of the various
stakeholders is far from clear. This is something the Province appears to have left to the local
communities and hospitals to sort out and as a result this question and the process used to resolve
it now reside on Jessica’s plate.
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will need to be undertaken with an assessment made of how best to respond to such pressures
from the perspective of the task force members, given their mandate and the design
specifications they’ve set out for themselves for the development and assessment of what they
should do in the Region of Erie. At some point, a similar assessment will need to be undertaken
of the various ancillary services and options in this area.
2. Who are the key stakeholders? Assess their likely agendas and roles and the role power and
politics may play in a situation such as this?
There are multiple stakeholders in the Region of Erie and they each have their own agenda and
beliefs about what needs to occur and how it should be done.
Stakeholder Interests Power/Influence
a. The urban hospital and its
board
Coordinating and integrating services,
improved financial health, greater
capacity to attract and retain highly
skilled specialists and medical
professionals
Moderate to high
expert, legitimate,
referent power
b. The rural hospital
administrators and their
Retain and enhance local services and
autonomy, enhanced access to quality
Moderate expert,
legitimate, referent
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obstetrics, internal
medicine, oncology,
gerontology)
supports medical specialists expect
and need, ability to manage their
professional lives
f. The G P’s, divided on
urban and rural grounds)
Enhanced quality of access to care for
their patients, ability to manage their
professional lives
High expert, referent
and legitimate power
g. Other health care
providers (e.g., mental
health counseling,
physiotherapy, pharmacy,
nutritionists)
Access to the services and supports of
interests to their members as they
supply services to the community
Low to moderate
expert power
Once students have identified the key stakeholders, ask them then to assess the likely interests
and perspectives that each of these would bring to the task force either directly, though another
member of the task force, or through some other vehicle of influence. Next ask them what
sources of power and influence different stakeholders would have and how important these
would be to helping or impairing Jessica’s ability to find a plan that was acceptable to most/all
3. What change management challenges does the situation present to Jessica? How would you
suggest she approach the leadership and management challenges inherent in the situation?
Her first challenge is to build a sense of team and reduce the mistrust that certain members of the
task force may have, given that Jessica is also the CFO of the larger hospital. She will need to
begin by having frank discussions with the Province, the members of her hospital and other task
force members concerning how she proposes to approach these matters, so that there is no
misunderstanding about her mandate or how she proposes to approach her role. Though a few
months have passed, it is not too late to initiate such a discussion, because clarity in these areas
will play an important role for setting the stage for her ultimate success or failure.
4. What are the personal career implications that Jessica may what to consider?
Entering into an undertaking such as this contains the potential for career growth and personal
fulfillment, but this comes with a significant investment of personal time and energy and
contains significant career risks, since the odds of success are often stacked against someone in a
role such as the one Jessica finds herself in – even when they are uniquely skilled. The potential
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Teaching Plan
50 Minute Class 75 Minute Class
5 minutes
15 min.
Introductory comments, learning
objectives and agenda for the
class
What are the strategic and
service delivery issues that
Jessica faces?
5 minutes
20 min
Introductory comments, learning
objectives and agenda for the
class
What are the strategic and service
delivery issues that Jessica faces?
150 Minute Class or Two 75 Minute Classes
5 min
20 min
30 min
30 min
Introductory comments, learning objectives and agenda for the class
What are the strategic and service delivery issues that Jessica faces?
What strategic and structural approaches would you find most appealing if you
were in Jessica’s role?
Who are the key stakeholders? Assess their likely agendas and roles and the role
power and politics may play in a situation such as this?
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In the 150 minute design, the class can be broken into small groups to address and report on
particular questions and themes. For example, the faculty member can assign different groups to