A Case Study forBecky Skinner, RRT, BSSpecialized Care Coo.docx

A Case Study for
Becky Skinner, RRT, BS
Specialized Care Coordinator
University of Iowa Hospitals and Clinics
May 30, 2013
UIHC Human Capital Strategies to Comply and Thrive Under
The Patient Protection Affordable Care Act Regulations
Table of Contents
Mission & Vision 3
History of the University of Iowa Hospitals & Clinics 4
Fiscal Year 2012 Facts 4
Statement of Problem or Challenge 5
Research and Background Data 7
Implications PPACA Has on UIHC Human Capital Management
11
Resolution Proposal 14
Summary and Conclusion 17
Appendix A: SWOT Analysis 19
Appendix B: Corporate Parenting Strategy 27
Appendix C: Portfolio Analysis 35
References 45
History of the University of Iowa Hospitals & ClinicsVision:
World Class People.
· Building on our greatest strength.
World Class Medicine.
· Creating a new standard of excellence in integrated patient
care, research and education.

For Iowa and the World.
· Making a difference in quality of life and health for
generations.Mission:
Simply stated, our mission is: Changing Medicine. Changing
Lives.®
University of Iowa Health Care is changing medicine through
Pioneering discovery
· Innovative inter-professional education
· Delivery of superb clinical care
· An extraordinary patient experience in a multi-disciplinary,
collaborative, team-based environment
University of Iowa Health Care is changing lives by
· Preventing and curing disease
· Improving health and well-being
· Assuring access to care for people in Iowa and throughout the
world
In 1873 The University of Iowa began providing medical
services when it reached an agreement with Sisters of Mercy to
operate a small hospital in the area. It began with two wards,
one for women and the other for men containing four private
rooms and a surgical amphitheater. In 1865 this agreement was
terminated when the Sisters of Mercy moved across town and
opened up Mercy Hospital. Today, the University of Iowa
Hospitals and Clinics is a public -teaching hospital affiliated
with the University of Iowa and a Level 1 trauma center. It has
711 beds including a 190-bed UI Children’s Hospital (About Us,
n.d.). On an average day, there are close to 9,000 individuals
providing care to patients, including employees, students and
volunteers (About Us, n.d.). Fiscal Year 2012 Facts
There were 32,000 patients admitted to the hospital for in-

patient care with 59,000 emergency room visits. In the 200
outpatient clinics of the UIHC, 977,337 clinic visits were
counted. In addition to the 1,300 volunteers of UIHC, it
employed during FY2012:
· 1,548 physicians, residents, and fellows
· 8,221 non-physician employees of whom 1,845 are
professional nurses (About Us, n.d.)
Since U.S. News & World Report began to rank hospitals in
1990, UIHC has made the list as one of the best and has over
271 physicians ranked as “Best Doctors in America”.
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JanuaryStatement of Problem or Challenge
The passage of the Patient Protection and Affordable Care
Act (PPACA) as well as the poor economic conditions
worldwide, have dealt the healthcare industry in particular,
many challenges as depicted in a SWOT analysis found in
Appendix A. There is an increased push to curb healthcare costs
at the same time people are demanding high level, innovative
medical care. The two do not always correlate. The University
of Iowa Hospitals and Clinics is in a unique position to meet
these challenges as a business unit of the University of Iowa,
explained in Appendix B: Corporate Parenting Strategy. As a
tax-exempt ‘charitable hospital’ subject to state funding by the
State of Iowa, it has further requirements to meet that make
maximizing reimbursement scales imperative for growth.
Such requirements and the increased pressure to meet
benchmarks have become vital to maximize Medicare/Medicaid
reimbursements and remain tax exempt. There are several
problems that are being addressed or need to be addressed in the
future to meet these challenges. Problems addressed in this
specific proposal relate to how a new strategy in human capital
management needs to be addressed which will assist in

containing costs and complying with increased needs based on
the PPACA.
1. Better strategic planning in human capital management.
Strategic planning has, in the past, focused on expansion of
services, land, equipment, and other traditional assets. In the
past the University of Iowa Hospitals & Clinics was viewed as
the premier employer in the state of Iowa. This is not the case
anymore. Cuts in benefits and increased demands on staff have
caused many employees to leave or abuse paid sick time leave.
Staff had felt the benefits offered were worth a commute of an
hour and a half or more. This however, has changed since
benefits were cut in the past two years. While UIHC continues
to attract a large employee pool that will only know the current
benefits offered, it has a significant challenge with its current
employees that felt the cuts firsthand and are resentful. This has
created poor employee morale, attendance and thus poor
customer service as a result. Each year over $2 million is spent
in sick time usage in the nursing department of the hospital
alone (Stafley, 2013)! The need is to nurture not only incoming
employees, but to improve relations with the existing
employees. If this is not addressed, the negative employees will
continue to spread a poisonous attitude which will reach the
incoming ones.
2. While educational opportunities are abundant as part of the
University of Iowa, it is not always taken advantage of amongst
the varying departments within the hospital. Some units take
continuing education quite seriously and foster the importance
of it among staff; however there are other departments that have
remained stagnant in this. Improving education for all
departments is needed to close the gap and provide better
communication and teamwork. Improved communication and
teamwork will assist in reducing costs and provide better
outcomes.
3. Staff attitude is vital to patient satisfaction. Improving the
attitudes of staff needs to be a priority in improving the image
of the hospital. A large problem the hospital has in attracting a

local market is from poor reports in satisfaction and a
reputation as being a machine. The hospital serves as a choice
only when specialized services are necessary that are not
available in other facilities or in case of a complex emergency
among local residents. Not all of this can be attributed to
attitude of staff, but other issues as well such as location, the
vast size of the hospital and the well-known long waiting times
for appointments.
4. Streamlining processes is a must and a high priority need
within the hospital. The first two problems are in need of
improvement in communication among units and improving
human capital management strategies because without
improvements in those areas, streamlining is virtually
impossible. Communication among units is needed to curb
redundant costs, errors, satisfaction, and wastefulness.
These challenges are not impossible to tackle if there is a
commitment among the varying units within the system. An
increased emphasis on human capital management as further
discussed in Appendix C: Business Unit Analysis is needed to
show employees that they are just as valued as the facilities,
technology, and patients. Research and Background Data
The PPACA is the result of a broken health care system that has
cost lives as well as tremendous amounts of money to
individuals, local, state and federal governments. One such
cause for the breakdown of the system is the fact that 45 million
Americans lack health insurance which has ballooned from 23
million in 1976 and the fact that taxes have not risen as fast as
the uninsured or health care costs (Sager, 2001) (Message from
the Secretary, 2011). This in effect means, while there has been
more uninsured patients seeking care, the amount of bad debt
the health care industry and government has had to write off
increases (Garrett & Roberson, 2009). It also means more
Medicare/Medicaid patients that hospitals will have to care for.
This not only is damaging to the health care industry because of
the poor reimbursement scale from Medicare/Medicaid, it also
is one of the causes the United States deficit keep skyrocketing.

The government has to pay out for Medicare/Medicaid, but
taxes have not risen proportionately to afford to continue to do
so (Garrett & Roberson, 2009).
This cycle has also affected businesses and individuals
negatively. As Edward Sanchez, former Texas State Health
Commissioner stated, “those that have insurance through their
workplace will pay for the uninsured more than once through
taxes and through decreased benefits and increased premiums”
(Garrett & Roberson, 2009). Premiums are increasing because
of standard healthcare industry practices of charging the insured
150 percent of the actual costs of care. Health care facilities do
this in order to pay for charity care, uninsured, and Medicare
under payments (Garrett & Roberson, 2009). To recoup this
over charge, insurance companies raise premium prices.
The HHS will oversee that the new requirements for health
care institutions mandated by the PPACA to include:
· Community health needs assessments are held one time per
three years. These results are to be published on the HHS
website, “Hospital Compare” along with an implementation
strategy and collected quality measurements (Smith, 2010)
(Mangan K., Sick Economy, 2009).
· Implement and publicize a financial assistance policy
outlining eligibility requirements and if assistance includes free
or discounted care. It also must inform how people will be
charged and how collection actions will be employed for non-
payment (Jones Day Commentary, 2010).
· Set limits for emergency or medical necessary care given to
the uninsured who qualify for charity care which enables the
patient to be billed no more than what is generally charged to
the insured (Jones Day Commentary, 2010).
· Submit annual reports as well as a five year trend study to the
HHS and Treasury to Congress in regards to charity care, bad
debt or cost shortfalls from public programs such as Medicaid
(Jones Day Commentary, 2010).
· Pay a $50,000 excise tax for failure to comply with the new
standards and complete the community health needs assessments

(Message from the Secretary, 2011).
The reporting requirements will cause non-profit hospitals to
provide more information, submit to increased occurrences of
IRS reviews on all schedule H filings every three years and
develop standards for patient friendly billing and collection
methods (Health Care Reform, 2010). What HHS will require of
non-profit hospitals, as well as those that are considered safety
nets, and for-profit hospitals will be affected by the PPACA.
Most of these impacts will be discussed in the next section.
The HHS will also require participating Medicare & Medicaid
providers to report quality measurement standards that the
Centers for Medicare/Medicare Services (CMS) develops. Each
participant will receive a performance score based on its
progress toward the standards set by CMS and the Secretary of
the HHS (Smith, 2010). The highest total performance scores
will be eligible for a value-based incentive payment for the year
the score is tallied (Smith, 2010). In addition, certain standards
and figures by HHS will result in a 1 percent Medicare payment
penalty if the hospital is in the 25th percentile of certain types
of hospital acquired conditions which will go into effect by
2015 (Smith, 2010). This penalty not only encourages better
care, but helps keep unnecessary costs down. This penalty will
also work as a deterrent for noncompliance because the
percentage of penalty increases over time. The impact of this
will be felt by 2013 and seen in reduced revenues generated by
acute care (Smith, 2010). These types of penalties will cause the
health care industry to reanalyze its business strategies and
practices if they wish to survive.
The one certain conclusion that can be made is that it is too
early to really predict what will transpire as more and more of
the plans are set into motion. The first and already apparent
struggle the health care industry will face is a workforce
shortage. The United States has already been expecting a
physician, in particular in primary care, shortages of
approximately 35,000 to 44,000 by 2025 (Doherty, 2010). In
addition the current nursing shortage is expected to climb as

well. One of the primary reasons for the primary care physician
shortage can be attributed to an increasing number of physicians
unwilling to see Medicare/Medicaid patients or those with no
insurance at all (Lewis, 2010). The reasoning behind these
refusals is numerous. Medicare/Medicaid have low
reimbursement scales, meaning physicians do not get paid at the
level they desire (Reid, 2010) (Mirvis, 2010). When these types
of patients are unable to get preventative treatments or seen for
minor ailments, they tend to visit the emergency room (ER) or
wait so long to get help that a simple cold has bloomed into a
full-fledged acute respiratory distress syndrome requiring
expensive intensive care. The Emergency Medicine Treatment
and Labor Act (EMTLA) restrict providers from turning away
an emergency or a medical necessity type of patient which is
why emergency rooms are frequently abused (EMTLA.com,
n.d.).
Medicaid patients cause a significant headache for hospitals.
Not only are they 32% more likely to visit an ER once a year,
they are three times more likely as the insured to visit the ER
twice in the same year (Reid, 2010). Emergency care is not
cheap. Hospital executives fear that although it is suggested that
the PPACA will be a money saver in the health care industry
because of more insured citizens, it may not turn out to be that
way (Reid, 2010) (Mirvis, 2010). A technology based business
solutions provider, the CSC, interviewed health care executives
and revealed that approximately 25% of them predicted a
“heavy burden” on their hospital’s finances as well as 43%
saying it would hinder outpatient clinics and emergency room
staff (Reid, 2010). It is important to note however that these
figures come from health care executives more interested in
turning the largest profits possible.
The PPACA is a double edged sword to emergency care centers
and hospitals dedicated to charity care such as UIHC. Even with
insurance becoming available to 32 million citizens, the
Congressional Budget Office estimates that 16 million of those
will end up covered by Medicaid (Doherty, 2010). There will

also be 12 million ineligible illegal immigrants without any type
of coverage to contend with (Mangan K., Health-Reform Bill
Holds, 2010). Illegals will require a great deal of the charity
care that will be proided mainly by non-profit teaching hospitals
(Field, 2008). Large teaching hospitals in particular, account for
6 percent of the nation’s hospitals; however, these teaching
hospitals are generally safety-nets that provide 41 percent of
charity work (Mangan K., Sick Economy, 2009). This poses an
additional culprit to the physician shortage. Medicare has a cap
on the number of residency positions it will pay for. This will in
effect limit the number of graduating medical students from
even entering the workforce, exacerbating the shortage further
(Mangan K. S., 2001) (Mangan K., Health-Reform Bill, 2010).
The passage of the PPACA will not eliminate charity care and
with a physician shortage, this spells stress on an already
stressed workforce and system. To assist in funding the act, $36
billion in cuts to Medicare and Medicaid have been instituted
even though enrolled individuals is expected to increase by
approximately 16-20 million citizens.(Mangan K., 2009)(
Health-Reform Bill Holds, 2010) (Reid, 2010).
Operating margins have already nearly evaporated due to taking
on more charity cases but receiving less money per patient from
the government (Mangan K., Sick Economy, 2009). This is only
expected to balloon as hospitals are unable to afford hiring
more staff to treat the influx of patients. Yet another factor for
diminishing operating margins lies with the problems associated
with Medicaid. The federal government may pay for Medicaid
for the poor, but the individual states set the rules as to who
qualifies (Garrett & Roberson, 2009). Eventually, the states will
be responsible for funding Medicaid as well (Doherty, 2010).
Because some states, like Texas, have strict qualifiers, it will
still leave many underinsured until states change their
legislation (Garrett & Roberson, 2009).Implications PPACA
Has on UIHC Human Capital Management
PPACA is moving reimbursement scales from a fee-for-service
system to a Physician Quality Reporting System (PQRS) or

rather pay-for-performance. This means quality will be
measures addressing such areas as preventive care, chronic and
acute care management, procedure-related care, and care
coordination, as well as a very important measure of patient
satisfaction (Zimlich, 2013). Below are Patient Survey Results
in Table 1 reported on the Medicare.Gov website and are factors
that are being considered in reimbursement scales for Medicare
(Hospital Compare, n.d.).
Table 1: Patient Survey Results: UIHC compared to National
Average
UIHC
National Average
Patients who reported their nurses always communicated well
77
78
Patients who reported their doctor always communicated well
75
81
Patients who reported that they always received help as soon as
they wanted
60
67
Patients who reported their pain was always well controlled
67
71
Patients who reported that staff always explained about
medicines before giving it to them
61
63
Patients who reported their room and bathroom were always
clean
67
73
Patients who reported the area around their room was always
quiet at night
44

60
UIHC has work in several patient satisfaction measures.
According to a survey published by Medical Economics,
employee attitude is crucial to patient retention (Staff attitude,
2012). An important take-away from this survey was in the
result that personal experience was the top reason patients
choose a doctor or hospital. Personal experience is 2 ½ times
more important in healthcare than other industries (Staff
attitude, 2012). Staff attitude is a result of poor employee
relations and stress from a variety of triggers. Hospitals and
other healthcare providers must be extra dilligent in assuring a
strong, positive relationship with its employees because of the
stressful nature of the work. Burn-out is a common occurance in
the healthcare industry and results in poor attitudes and high
usage of sick time leave. An analsyis done by Amos and
Weathington illustrates that when employees had a high value
congruence with its employer, they were more satisfied with
their job (2008). When employees perceived their organization
valued employees as ‘individuals’, there was higher job
satisfaction (Amos & Weathington, 2008).
With poor attitude comes poor communication and a lack
of teamwork and poor communication will lead to poor attitude.
Poor communication is tied to patient safety. This is a concern
to any hospital because it results in medical liability and poor
patient satisfaction. The American International Group, reported
more than half of risk managers and exectuives of hospitals
sited the top safety threat was related to teamwork,
communications or culture (Tracer, 2013). Patient satisfaction
and safety is of utmost importance to UIHC for a number of
reasons: it is in the business of caring for people, it desires
quality outcomes and service, and there is also the
demographics of the patient population to consider.
Demographics is becoming an increasingly important factor
with the new health care laws for a number of reasons. H-CUP
which is the Healthcare Cost and Utilization Project estimated

that in 2008, 25% of patients in public hospitals were covered
by Medicaid compared with 17.3% in the private NFP (non-for-
profit) hospitals. Public hospitals treated over 75% more
uninsured patients than did the private NFP hospitals (Fraze,
Elixhauser, Holmquist, & Johann, 2010). This weighs heavily
for a public hospital such as UIHC because of recent healthcare
law initiatives linking patient satisfaction results to
reimbursements by Medicare/Medicaid. In 2009, Medicare was
the single largest payer for hospitalizations and accounted for
46% of the cumulative inpatient costs demonstrated in Charts 1
and 2 (HCUP Facts and Figures: Statistics on Hospital-Based
Care in the United States, 2009). Compliance with the rules
proposed by the largest payer for hospitalizations is obviously
very important to UIHC. Resolution Proposal
1) Implement a new benefit structure. Currently UIHC has
separate accounts for sick time and vacation time. The accrual
rate of sick and vacation time is dependent on the number of
years employed with the University and the percentage of time
worked. Abuse of sick time is prevalent and costly. UIHC needs
to change its benefit structure to a single Paid Time Off
account, one in which both sick time and vacation time are
grouped together. While 80% of healthcare institutions surveyed
in a World at Work Analysis responded that PTO is preferred,
UIHC does not have such a system (Paid Time Office Programs
and Practices, 2010). Implementation of PTO as opposed to the
traditional method currently in use could save UIHC’s sick time
usage. Consider Chart 3 results from the World at Work survey
results on implentation of a PTO system (Paid Time Office
Programs and Practices, 2010). If UIHC implemented such a
system it could improve absenteeism by 55%, possibly saving
over $1 million.
Chart 3: Effect PTO system had on absenteeism when first
implemented
2) Increase efforts in employee satisfaction is needed to
improve patient satisfaction numbers. The more employees feel

they are valued, the better the chances are they will provide the
exceptional care that is part of the UIHC mission. It is proposed
Human Resources improves its efforts in hiring practices and
counseling of problem employees. In the area of hiring, HR
should implement pre-employment screening that will
demonstrate how closely a prospective employees value are in
congruence with UIHC’s values and mission. It is necessary to
create new culture in UIHC. One important step in this goal is
to hire those that are a close fit with UIHC’s mission.
3) Steps to improve employee relations with existing staff are
multi-faceted.
a. Individual departments should be required to ramp up their
continuing education and training available. The more staff feel
prepared and confident, the happier they will be with their job.
A worker feels better about their job when they have the
necessary training to feel competent and supported by
management. To implement this step, departments will be
assigned a number of training, inservices, or other program
offerings they are required to offer each year.
b. Re-design the performance appraisal system. Currently the
appraisal format is designed to focus on rating the skills
necessary to complete a job. This is rated on a scale of 1 to 5.
Some managers routinely score employees with a 3 which
represents ‘meets standard’. Meeting the standard after years of
being more than competent in routine skills, does not motivate
employees when they feel they are more than competent in a
routine skill set. Rather than focus on rating skills that are more
than routine, performance appraisals should spend more
emphasis on Individual Development Planning (IDP). This
assists in creating a culture that encourages, supports and
invests in the development of employees. An IDP assists in
identifying an employee’s career development goals and helps
in strategies to achieve those goals (Individual Development
Planning, n.d).
c. Improve communication to staff. Many patient care staff are
unaware of the financial struggles UIHC faces. When staff

members come to work, they see a new Children’s Hospital
being constructed, large-screen television sets at every entrance
displaying directions for staff, greeters, and constant
renovations. They also see posters displayed by the union
stating that UIHC proposes a 0% raise increase and is asked to
do more and more. Many employees are unaware that capital
and operating budgets are different and all they see is that they
have to fight for raises while the hospital is growing and
building constantly. It does not add up for morale improvement.
What it equals is that staff feel undervalued and unappreciated.
Communication needs to be delivered frankly as to the
differences in budgets and the reasoning behind particular
initiatives. The Service Excellence program provides as a
perfect example. Rather than explain to staff that service
improvements are necessary to maximize Medicare
reimbursements, staff were just told that this program was being
implemented to improve satisfaction thus the overall message
staff received was that they were doing a poor job. Had they
understood that the satisfaction is not just because of their
behavior, but a number of elements, and is required to get paid,
it may have been more well received. Improved Communication
is VITAL.
4) Introduce Employee-Centered Action Committees. Employee
input in the planning process is often ignored or reserved to the
management level. More employees need to feel empowered.
Those working with patients and visitors on a day-to-day basis
are more equipped to improve the processes. Management can
look at charts, surveys, and numbers and go through walk-
throughs, but until they are in the ‘weeds’, they are too
divorced from the realities of how things work or how it can be
improved. These types of committees will not only assist in
improving employee morale, they will serve in cost containment
strategies. Only those using the supplies and materials know
how the costs of those items can be decreased.Summary and
Conclusion
PPACA will have significant impact to hospitals and other

healthcare facilities nationwide. As more of the new elements of
the law are introduced, it will inevitably change the practices
UIHC has been utilizing for a number of years. New strategies
will be required. Patient satisfaction is a growing concern for
UIHC. It must meet the demands patients have in their care
while doing so on a tighter budget and with more stressed-out
workers. With poor employee satisfaction already a concern,
this increased stress forced on employees will likely become
substantially worse.
The actions outlined are needed to address these problems
caused by current practices and further stress on the system by
PPACA:
1) Re-design employee benefit structure to a Paid Time Off
system to combat absenteeism.
2) Institute changes in pre-employment screening and mentoring
staff to align with the internal culture desired.
3) Improve employee relations by increasing training efforts
and opportunities for career development, re-designed
performance appraisal system, improving communication
efforts.
4) For Employee-Centered-Action Committees to empower staff
and get more accurate information on ways to contain costs and
improve processes.
Implementing these strategies in the business units within UIHC
will allow it to have the tools in place to improve patient and
employee satisfaction, thus improving reimbursements and
containing costs. Value will be created by developing human
capital that is the definitive assets for future innovation and
growth for the University of Iowa.
This proposal suggests ideas to better manage our human capital
assets that will serve as a means in overcoming the challenges
UIHC faces now and in the future. UIHC has such a diverse
staff that utilizing those assets to their fullest will provide the
solutions needed to continue reach its mission and vision.

Appendix A: SWOT Analysis
Strengths:
The University of Iowa Hospitals & Clinics (UIHC) has
consistently been nationally ranked as a leader in many areas by
U.S. News & World Report. Such services include: Cancer,
Gynecology, Neurology & Neurosurgery, Orthopedics, Urology,
ENT, Ophthalmology, Nephrology, and Pulmonology. It is also
considered high performing in the areas of Geriatrics,
Cardiology & Cardiothoracic Surgery, Psychiatry,
Gastroenterology, and Diabetes & Endocrinology. Such a large
number of service areas attract a large number of referrals as
well as staff. UIHC is the ‘go-to’ hospital in the state of Iowa
for neurosurgery and is also the only burn center in the state.
Recently, the UIHC recognized its deficiency in customer
satisfaction and has since embarked in improvement. It has
taken on the ‘Disney’ approach and has rolled out training to
staff in how best to provide excellent customer service. Such
training is part of a marketing initiative to not only provide
better service but also to attract increased local usage.
UIHC has a Children’s Hospital; however it has always been
incorporated in the main body of the hospital. Such an
arrangement has not allowed UIHC to thoroughly capture the

market share of the pediatric population. The new design of the
Children’s Hospital will increase the bed capacity by 20% to
about 200 beds. The site will be technologically advanced with
a focus on key patient satisfaction areas of natural light, noise
reduction, and spaces for children and their families that are
useful in design (Heldt, 2012). It is slated to open October 2016
at a price tag of $285 million (Heldt, 2012).
In addition to the construction of the Children’s Hospital, it has
added the Iowa River Landing facility. This facility will
encompass a number of services the UIHC offers, but at a more
convenient location than the main facility. In an effort to move
a number of the clinics that have traditionally been located
within the hospital, it will improve satisfaction by eliminating a
great deal of congestion and crowding. This will free up the
needed space needed when the Children’s Hospital opens.
UIHC is a leader in medical research and technology. This has
enabled it to recruit outstanding staff and physicians. As a
teaching hospital with national recognition it has the ability to
be very selective in the resident students it accepts within its
program. It offers a stand-out benefit package, further adding to
its appeal. It has abundant resources for providing education to
staff which subsequently aids in employee retention.
Weaknesses:
With as many resources UIHC has available to it, it still
has been plagued with very poor patient satisfaction ratings.
This has become increasingly problematic with attracting
insured customers, in particular local residents. As a state
hospital considered a ‘charitable’ hospital, it is required to
accept all patients despite their ability to pay. All hospitals
must treat a person in the case of a life threatening emergency,
however, once the emergency is stabilized, most facilities can
then transfer the patients on to another facility such as UIHC.
It is subject to funding cuts as a part of a state university
system. This makes it more difficult, especially in today’s
economic environment when states nationwide are making
significant budget cuts.

In 1999, UIHC became unionized by SEIU Local 199.
While this has been widely popular with staff, it has created
problems for UIHC. In the past, raises were determined by
performance appraisals and under the discretion of management.
Now however, raises are negotiated and employees receive
raises regardless of performance. It also makes disciplining
problematic employees quite difficult. As a state institution and
under union representation, regulations are strict in what
management can do in recognizing strong performers as well.
As a result, poor performance and behavior is widespread. For
those employees that are doing an outstanding job, it creates a
no-win situation because even if management wanted to reward
good performance, it cannot in a way that makes much of a
difference to staff. Those that are problem employees do not
feel a need to change because they know they will get raises
regardless. All of this has led to poor attitudes which affect
patient satisfaction.
In such a large bureaucratic system, communication is a
challenge. Many services must work together, however
important information gets lost in the process. The outcome is a
large waste in costs and poor patient satisfaction.
Opportunities:
The launch of the new Children’s Hospital in 2016,
promises to be a new beginning for UIHC’s image. Not only is
it designed to increase patient satisfaction, but it should open
the market for more local usage of UIHC for children’s
services.
Efforts to improve communication, processes, and employee
morale issues are underway. The guidelines in the Affordable
Care Act have increased the motivation to address shortfalls in
these areas because if improvement in a variety of areas is not
proven, Medicare reimbursements could be less by way of
penalties.
UIHC and Mercy Hospital of Iowa City have entered into
an Accountable Care Organization (ACO). ACOs are groups of
doctors, hospitals, and other health care providers, that

voluntarily give coordinated high quality care to the Medicare
patients they serve. This ensures that patients, in particular the
chronically ill, get proper care while avoiding costly duplication
of services and preventing medical errors. When the partners
will share in the savings it achieves for the Medicare program
(Accountable Care Organizations (ACOs): General Information,
n.d.).
UIHC had higher than expected revenue for fiscal year
2012. This was very fortunate with the poor economy. In a poor
economy, more and more patients are relying on
Medicare/Medicaid or go without any type of coverage. This
typically would mean UIHC would have an increase in charity
cases and non-payment for services. UIHC is doing a better job
at cutting expenditures which provides for numerous
opportunities.
Threats:
While the Affordable Care Act has motivated UIHC to
change its way of doing business in the positive, it also poses a
significant threat. Currently UIHC falls under the scope of a
penalty (.06%) for too many readmissions in the categories of
heart failure, acute myocardial infarction and pneumonia (Fact
Sheet, n.d.). While UIHC has nationally rated services for these
areas, the problem is the patient population and a lack of
follow-up. As a charitable hospital, it has a large number of
patients that are extremely sick, without resources, and non-
compliant in their care. When you have these factors at play, it
is more difficult even with the best of services to decrease the
readmission percentages.
Recently, Governor Terry Branstad has proposed
revamping Iowa Care rather than expansion of Medicaid (Press,
2013). It is uncertain at this time if this will be good for UIHC
or bad, however in 2010 and 2011; UIHC appropriations from
Iowa Care were $74.3 million and $76.3 million respectively
(Audited Financial Statement, 2012). Depending on what
legislation is passed, this could mean fewer appropriations
UIHC could count on in the future.

As a teaching hospital, there are a large number of
physicians that are completing their residency at UIHC.
Residents have less of a motivation and commitment in reducing
costs because they know that their stay there is most likely
temporary. A lack of commitment to an institution means that
there is less of a motivation to reduce costs. Residents are also
under an enormous amount of pressure from their staff
physicians in charge of them. What happens is a lack of
confidence, meaning more tests are ordered ‘just to make sure’
they are not missing anything. On the other side of things is the
long-term staff. Long standing employees used to a certain
process are resistant to change. This is problematic in a
technology driven and ever changing industry. Improving
processes often means eliminating extra steps and employees
that were determined unnecessary as a result of the
improvements. For employees that had it good with the old
system, they are unhappy when the new system means they have
to take on more work. Those that cannot adapt create a negative
environment and it is often contagious in nature.
Recommendations
UIHC has much strength to capitalize on and needs to
utilize these strengths in tackling the challenges it currently
faces. It has recognized how crucial patient satisfaction is, now
in particular with part of patient reports affecting Medicare
reimbursement. While it has instituted the Disney approach, it
has failed to recognize a core problem, employee satisfaction.
Regardless of the number of classes and in-services you require
staff to attend; it will not change the culture until the root of the
problem is addressed. Patient satisfaction is not just related to
employees. UIHC continues have poor execution in clinic areas
in regards to appointment schedules. One of the number one
complaints is waiting time in the clinics. If a patient is to be
seen by multiple clinics, staff must be diligent on assuring these
patients are able to make their other appointments on time
otherwise other patients get pushed back and are angry.
Employees can improve and diffuse this anger from

patients to some extent; however they will not be motivated to
do so if they feel they are not fully recognized and appreciated.
It needs to step up its efforts to empower its employees. When
the SEICU union came to UIHC, it got very lazy in staff
recognition. There are a great deal of restrictions on UIHC in
the manner in which they can provide employee recognition
because of the Union and state regulations, however for a
facility that boasts about its innovation, it has failed to be very
innovative in simple “Good Job!” measures. It may not be able
to reward union contracted employees with raises based on
performance, but that should not stop management for finding
more creative ways to communicate to its staff that they are
appreciated.
The threat of Medicare reimbursement rates dropping is
significant. UIHC needs to improve its readmission ratios and
its proactive measures. This is an extremely difficult task
because such a large portion of the patient population at UIHC
is uninsured, non-compliant patients with multiple co-
morbidities. This is why improving its outreach and follow-up
with patients is even more important to focus on.
Improving processes and communication needs to involve
the staff more, not just management dictates. Staff working in
the ‘trenches’ will have much more insight on what can be
improved, eliminated, or streamlined than management who do
not see what is going on routinely. My empowering employees
in this challenge, it will not only provide better results, it will
also assist in making employees feel more valued.
Diagram A.1 Pictorial diagram of SWOT Analysis
Strengths

Opportunities
Weaknesses
w
Threats
T
S
O
· Recognized leader in many service areas.
· Service Excellence program development.
· State of the art Children’s Hospital being constructed.
· Expansion of clinics.
· Leader in research.
· Strong recruitment of staff.
· Abundant resources for educational opportunities.
· Poor patient satisfaction.
· State facility subject to funding cuts.
· Charitable hospital.
· Not first choice among local residents for basic care services.
· Employee union.
· Communication challenges.
· Poor employee morale.
· 2016 opening of Children’s Hospital.
· Improving processes & increased awareness of communication
shortfalls is recognized.
· Service Excellence program.
· Accountable Care Organization with Mercy Hospital.
· Streamlining services to improve satisfaction.
· FY 2012 had higher than projected revenues.
· Initiatives to improve employee morale.

· Affordable Care Act legislation.
· Competitors face fewer restrictions as private industry.
· Large number of non-compliant patient population.
· Iowa Governor, Terry Branstad’s proposal to eliminate Iowa
Care program.
· Employee resistance to change.
· Lack of commitment by physician residents to consider costs.
Appendix B: Corporate Parenting Strategy
UIHC is affiliated with the University of Iowa and falls under
the direction of the State of Iowa Board of Regents. The Board
of Regents oversees Iowa’s public universities. Leaders of the
University meet regularly to assess factors that affect decision
making and develop action plans. The various colleges and units
then develop its own strategic plans and align them to the
University-wide strategic plan. The University of Iowa acting as
the ‘corporate parent’ maintains financial control and strategic
planning over the various units of the University and UIHC. It
sets the basic strategic plan of the overall University and
expects subunits to develop align their plans to keep in line
with the strategy. It maintains financial control by issuing
specific budget guidelines for the various departments. The
University has identified the following goals as part of its
control in strategic planning:
· Undergraduate education
· Graduate and professional education and research
· Diversity
· Vitality

· Engagement
The ability to accomplish these goals is a function of critical
resources (strategic factors) such as: budget, size of the student
body and their demographics, clinical enterprise, administrative
efficiencies, space, and technology (President, 2005).
Analysis of Critical Resources (strategic factors) and areas of
improvement needed
1. Budget: The top priority of the budget is to raise faculty
salaries to be consistent with peers and restoring previous lost
lines from budget reductions in recent years. Faculty salary
competitiveness has slipped in the past decade which has
decreased recruitment and retention efforts. The poor economy
has caused delays in making tenure track faculty appointments
because it involves long-term investments to do facilitate.
Simultaneously it seeks to improve the competitiveness of staff
salaries (President, 2005).
2. Clinical enterprise: This encompasses UIHC, practicing
physicians of the UI Carver College of medicine and their
mutual activities. The clinical enterprise faces substantial
challenges in a turbulent reimbursement environment. It must
improve methods for cost containment and patient education to
limit the number of readmissions due to poor compliance to
health regimes prescribed.
3. Administrative Efficiencies: Cost containment methods
through ‘enterprise-wide’ collaboration have been adopted by
the Board of Regents, State of Iowa as a resolution of
“Administrative Services Transformation”. There has been a
reorganization of internal audit, risk management, and fleet
operations. This involves restructuring and cost-saving
measures (President, 2005).
4. Student Body: With a student population of approximately
30,000 students which includes more than 20,000
undergraduates, it taxes the University’s ability to provide high-
quality education by limiting space, faculty-student ratios, and
other resources.

5. Space: Charitable donations play an important role in the
construction of facilities for the University of Iowa. Current
focus of capital expenditures is focused primarily at basic
infrastructure needs and renovation of existing infrastructure.
6. Technology: Coordinating and aligning IT resources and
service providers with one another are a key component in
strategic planning efforts of the University of Iowa.
There are 44 indicators and benchmark measures used to
measure the progress of achieving the goals of the strategic
plan. The following table (B.1) includes a sample of the various
areas of performance improvement outlined and various
indicators used to assess progress towards these improvements.
The (I) denotes an internal target and (P) is a peer benchmark.
In addition to these indicators, other measures that are
contained in annual governance reports are used to measure
progress (President, 2005).
Organizational alignment of units
The role of the Board for UIHC is reviewing reports on
planning, programs, operation and finance and for governing the
UIHC. The CEO of UIHC submits reports to the President of the
University which then go to the Board of Regents for quarterly
review (Operations Manual, n.d.).
Alignment of such a vast structure between the University of
Iowa’s educational side and the hospital side is a difficult task.
Aligning the two sides of the University is crucial in
maintaining a successful University and complying with a
substantial amount of regulations dictated by the State and
various hospital related regulatory commissions. Although both
the University of Iowa and UIHC each have its own business
units, these units must have their strategies fall in line with
each other to meet the University’s strategic goals. Diagram B.1
illustrates the UIHC administrative structure. The main business
functional units within the UIHC are responsible for submitting
these reports to the CEO.

Table B.1
Business Functions
Finance and Operations: At UIHC the functions of finance and
operations fall into the same departmental control. It provides
services in human resources, business services, finance, and
facilities management. As outlined previously, the University
has identified 5 strategic goals. Finance and operations has set
priority levels to meet the strategic goals of the University of
Iowa in its own strategic plan: Priority I: Organizational

vitality, Priority II: Financial stewardship, Priority III: Quality
Service, Priority IV: Process Improvement (Finance and
Operations Strategic Plan, 2007). Each priority has a strong set
of goals, strategies to achieve these goals, and measures to
assess the ongoing progress in order to complement the
University of Iowa’s business strategy. The finance and
operation department then ensure that the varying working
departments (nursing, physical therapy, phlebotomy, surgery,
respiratory therapy, radiology, etc.) in the hospital are working
to meet the same goals. It sets budget requirements for each unit
and goals to achieve and improve. The budgets and strategy of
each department must fall in line with the strategies and budget
considerations set by Finance and Operations.
Diagram B.1
Diagram B.1
These budgets are in part based on different benchmark factors.
For example, the respiratory care department’s budget is in part
related to mechanical ventilation hours. At times when
ventilator hours are decreased, it suggests that there is not a
need for more staff. This snapshot however is a gray area.
While ventilator hours may decrease during a particular time
frame, this does not mean it will remain low, nor does it reflect
the other responsibilities this particular department’s staff may
have. In regards to financial control, ensuring that each unit has
particular budget guidelines is important. It is difficult to judge
some departments based on particular measures that may not
reflect all elements relevant to a particular job and or
department.
Marketing: This business unit serves as the ‘voice’ of the
University. It develops and communicates strategies and
outreach reflecting the goals of the strategic plan. It does this
by: 1) creating and implementing public relations messaging,
marketing and branding, and strategic communications. 2)
Provide council and anticipates responses for the University to
public issues. 3) Develops materials and public relations for

media purposes. 4) Serves as a center for general information of
the University both externally and internally.
Human Resources: The primary focus of this business unit is to
implement programs and policies that retain and recruit
qualified staff and provides programming to augment
effectiveness of the University as a whole (Administrative
Services, n.d.).
Recommendations
1) In using specific measures to determine budget dollars, such
as the example of the respiratory care department, it is
somewhat demotivating. Although it is encouraged to decrease
ventilator hours for improvement of patient outcomes, it in turn
impacts the department’s budget in maintaining staff levels and
services. Nobody wants to eliminate positions and resources
based on some measure that fails to encompass all the
responsibilities a particular department has. When ventilator
hours decreased because of advances in patient care methods,
the budget dollars allotted to the department also may decrease.
This means that there is less money for the department to work
with even though it is improving patient outcomes. When
budget dollars are stretched based on this measure, it causes
tough decisions for management. Cut staff, services, equipment,
or other costs? It is a difficult balance. Although the goal is to
improve patient care, in doing so, it also could cost jobs and
resources that staff and management would not want to lose.
Allotment of budget dollars should be standardized in such a
way that does not create a conflict of interest. Management does
not want to lose money for their budget; however it also wants
to improve patient care. In some ways improving patient care,
costs a department staff and budget dollars. It should consider
changing its division of budget dollars based on measures that
do not create an agency theory situation. Financial budgets
should be developed based on the overall value a particular
department provides in terms of revenue rather than the methods
currently utilized.
2) The patient satisfaction survey target is especially important

to UIHC as a result of the PACA. A part of the PACA revolves
around an incentive pool. This incentive pool acts to reward
hospitals scoring well on a value-based purchasing program.
The score is determined by 12 clinical measures and a patient’s
reported experience (Medicare Fee for Service Payment, n.d.).
UIHC has had poor patient satisfaction survey results. This is an
area of increased focus for improvement, especially with the
passage of PACA.
3) Employee satisfaction needs improvement, in particular for
certain departments. The department of nursing has strong
resources and recognition available which creates a positive
atmosphere for those within the department. Resources and
recognition however for many other departments is lacking.
UIHC must remember that there are more than just nurses and
physicians providing important services to its patients. The
ancillary services and departments should receive equal
opportunities in education, recognition and the ability in
advancing beyond patient care in administrative capacities.
Many positions in administration will accept applicants with
nursing degrees but there are few opportunities for non-nursing
patient care providers in administration even when nursing
experience is irrelevant to the position.
4) Facing significant challenges in medical reimbursements,
UIHC must create a stronger culture of cost containment and
deliver this message to staff, not just administration.
Administrative personnel know the hurdles, limitations of
budget dollars, and how the budget is decided, etc. Staff is not
aware of many of the ongoing challenges behind the scene. If
there was a larger effort for employee empowerment and in
knowledge transfer of these challenges, it may provide incentive
for employees to be better advocates in cost containment. It will
also increase understanding behind certain policies the hospital
introduces because without the knowledge behind why the
policies are instituted, staff feel it is just more rules and work
imposed on them that have no merit.
5) There is a disconnect with the strategies geared towards

improving salary competitiveness and what is communicated to
staff. On one hand, the strategy is to improve salaries and on
the other what staff sees happening is during collective
bargaining, UIHC is reported to not want to give staff raises.
Posters and flyers distributed by the UIHC union, SEICU show
that the union pushes for raise increases of a certain percentage
while UIHC proposes no raises for the collective bargaining
periods. This sends a negative message to staff regardless if
staff is supportive of the union or not. UIHC needs to show
some effort to reward employees even when it is negotiated in
the long run through union contracts.
6) There has been a recent push to implement the ‘Disney
strategy’ of service excellence to improve patient satisfaction.
UIHC has failed to get to the heart of the problem. While it has
staff education in ‘Service Excellence’ and attempted to
implement a number of improvements, these improvements are
cosmetic at best. For example, one such ‘solution’ has been
spending $419,000 in a project to put greeters in the UIHC.
Now instead of detailed maps for visits, large screen television
sets showing location points, there are now people in red suit
coats standing at key entrance points to direct patients and
visitors to their intended destinations. As Andrea Rauer
reported in an editorial to the Iowa City Press Citizen,
When my family made a report of poor service to UIHC a
couple of years ago, it was our concern of lack of staff attention
for a patient rather than poor signage and directions. Too much
time was spent on getting information into the supposedly
centralized computer system rather than time with the patient.
Please use money for additional nursing staff so there are more
hands on the patient and fewer on the computer (Rauer, 2011).
Another example of wasted funds has been in the new scrub
policy. Some patient satisfaction results have revealed
confusion in who is entering their room and in keeping track of
staff taking care of them. Rather than educating staff on the
importance of identifying yourself and explaining what you are

doing, it decided to implement a pilot study in scrub (uniform)
color coding among services. Its plan was to have each major
service in a standardized color. Nursing would wear royal blue,
respiratory would wear pale blue, and nursing assistants would
wear purple, and so forth. The problem with this plan is that it
would have to issue charts to patients and visitors for this to
mean anything to them. How are a sick patient and distraught
family member going to remember such a large color coding
system and why would they care? They are still going to want
introductions and explanations. This was a large waste of
money, especially considering the contract with the scrub
supplier has now fallen through and the project is on hold.
Cosmetic solutions such as greeters and scrub colors are not
why patients are dissatisfied. The heart of the problem is that
UIHC has failed to empower employees and create a positive
working relationship and as a result, staff is not very courteous.
It has also failed to realize that patients and visitors care more
about the time wasted waiting for appointments and the hassle
of parking difficulties. Those two issues are of greater
importance than the cosmetic effects UIHC has chosen to focus
on and have yet to be addressed in a productive manner.
Appendix C: Portfolio Analysis
Although the focus of this case study is on UIHC in particular,
it is necessary to understand that UIHC is a business unit of The
University of Iowa as a whole and not a separate legal entity.
Considering these special circumstances, the following portfolio
analysis covers The University of Iowa while acknowledging
UIHC as one of its business units. The University of Iowa has
the following core business units:
· Educational Departments
· Auxiliary Enterprises
· Grants and Contracts
· Patient Services (UIHC)
· Academics
Educational Departments: This business unit not only provides

education to students, faculty and the community but also has
additional sales and services it generates for the University. It
accounted for $103.7 million in operating revenue in FY2012
(Financial Report 2012, 2012).
Auxiliary Enterprises: It provides infrastructure and services to
enrich technology transfer and commercialization of UI
technologies, new company formation, and support of Iowa
companies and in workforce development. This particular
business unit has a significant impact on Iowa’s economy (The
University of Iowa, 2011).
Grants and Contracts: Obtaining grants and contracts to
maintain operations of the University and fund its vast research
and development opportunities is critical in maintaining a
competitive edge. Research drives innovation and that is a large
part of the University mission.
Patient Services: UIHC generates 56% of the University of
Iowa’s operating revenue (Financial Report 2012, 2012). It
provides a large number of services through inpatient and
outpatient means. It also serves as an educational source for
thousands of students throughout the nation. It is one of the
largest public university hospitals in the nation.
Academics: This, along with patient services unit are the soul of
the University. Academics generate $357.1 million in operating
revenue from tuition and fees collected by students (Financial
Report 2012, 2012). Although it does not generate the volume
of operating revenue that patient services does, it is the soul of
the University.
Analysis
Each of these business units are critical in the University’s
ability to achieve its mission of :
In pursuing its missions of teaching, research, and service, the
University seeks to advance scholarly and creative endeavor
through leading-edge research and artistic production: to use
this research and creativity to enhance undergraduate, graduate
and professional education, health care, and other services
provided to the people of Iowa, the nation, and the world; and

to educate students for success and personal fulfillment in a
diverse world.
Chart C.1 breaks down the percentage of revenue these units
generate for the University. This is one important aspect in
analyzing the units. Patient Services provided by UIHC
accounts for more than all other major business units combined.
Specific financial reports for UIHC are found at the end of this
appendix. Although UIHC provides the largest portion of
operating revenue, academics are the driving force. Without
academics, UIHC would not be what it is today. A large portion
of UIHC is comprised of student resident/fellow physicians and
research scientists. Staff physicians provide a dual role;
providing patient services and educating students. A large
portion of grants, contracts and donations the University obtains
is based in part on its ability to teach and conduct research.
UIHC contributes to the largest portion of operating expenses at
47% on the other side of financial analysis (Audited Financial
Statement, 2012). It poses the biggest financial challenges for
the University because of uncertain effects of the new health
care law and its ability to provide state of the art medicine and
outcomes on a tight budget.
Based on basic financial numbers presented in this appendix,
one may conclude that UIHC should receive more focus from
the primary business functions of finance and operations,
marketing, and human resources, however that is simplifying
things. In examining a GE Business Screen/McKinley Matrix
Analysis (Figure C.2), both Academics and Patient Services
provide for approximately equal importance.
Figure C.1 GE Business Screen/McKinley Matrix Analysis
UIHC is a large driver of business, but the academic
grants/contracts and auxiliary enterprise units contribute to the
ability for UIHC to recruit students, staff, research scientists
and patients needing specialized care. From a human resource
perspective however, UIHC should receive additional resources.
Of the 22,278 University of Iowa employees over 35% are a

direct part of UIHC’s staff. These employees have the greatest
impact in retaining and growing patient services.
Recommendations
Targeting human capital assets in the business unit of UIHC can
lead to better services provided to customers, the community
and provide for better management of expenses through
employee engagement and education. Presented in previous
sections of this case study, human capital management must
focus in the areas of: employee satisfaction, employee education
on lean strategies, and fostering a culture of positive attitude.
The Department of Operations and Finance has a sub-
department in Operational Excellence. This department focuses
on lean methods. It offers consultation to any area of the
University that seeks its assistance and is instrumental in all
new planning for the University. Lean Strategies is a course
offered four times a year to staff, however, a large number of
staff are unfamiliar with what this is or know it is offered.
Rather than do this training on a voluntary basis, this course
should be scaled down to a point that it could be incorporated
into the new employee orientation program. This will have a
greater impact in creating a culture of ‘lean’. A large segment
of UIHC employees are educated in medical fields and are
unfamiliar with business concepts (until they go into
management, that is), so when broadcasts announcing the class
come out, it is often overlooked. If a culture of lean is desired,
it needs to be introduced to each employee and the best time to
do so is before they get too far into their employment tenure.
The contents of this particular course have far reaching
consequences in human capital management, Figure C.2. It
stresses the importance of involving all staff in developing more
efficient, less costly processes. Involving staff will empower
them and create more efficient working conditions, thus
reducing stress.
Figure C.2 Mixing it all together

Positive employee attitude as discussed previously has a
strong correlation to patient satisfaction results. Patient
satisfaction is the crux of the UIHC mission. Without employee
involvement, the mission is unattainable. Marketing needs to
work in conjunction with Operations and Finance to better
educate employees on the programs Operations and Finance has
available to make their jobs better and easier. Although ‘Lean’
techniques have been a part of UIHC since 2005, it has been
slow to integrate into the culture of UIHC. This is a failure of
marketing. Marketing needs to direct more attention and
commitment into marketing to employees, not just customers.
Failure to educate staff on the direction UIHC is striving for
will not allow it to fulfill its goals. Employee engagement is
necessary and crucial to make everything happen. It has spent
the majority of its focus on patient satisfaction, but it has
forgotten that it cannot make employees ‘be friendly and
happy’. It has to create a culture that employees FEEL happy
and WANT to be friendly. Employees are not going to do this
when they are not viewed as stakeholders.
While UIHC implemented ‘Service Excellence’ by training
with the Disney Institute to improve patient satisfaction and
reduce employee turnover, it received complaints because at the
time of a tight budget, UIHC was proposing to spend $130,000
to send a group of executives to Orlando, Florida for the Disney
Institute training. When this received criticism, it changed its
plan to have two Disney Institute representatives to come to the
hospital for a two-day training session at a cost of $13,000
(Heldt, 2009) (Heldt, 2010). The plan, before it even started,
received bad press and had staff upset. It has not been received
well because UIHC has failed to encompass a large theme
behind the Disney Experience, and that is, EMPLOYEE
engagement. Instead of focusing on how best to engage
employees in solutions, it has told employees how to behave
towards patients and not proposed solutions in preventing
problems from erupting in the first place.
Failing to present Service Excellence properly to the

public and employees has been a failure in marketing as well as
human resources. Human Resources has failed to recognize that
Service Excellence has not met the unrealistic expectations
executives had. Human Resources needs to better match
prospective employees to the UIHC values. It needs to better
communicate with all the units within the hospital how
important employee relations are to improving attitude and
satisfaction. The over-arching theme is that these functional
units need to communicate the common goals UIHC has and
work together to implement a plan in improving employee
commitment and engagement.
References
Finance and Operations Strategic Plan. (2007). Retrieved from
Uiowa.edu:
http://fo.uiowa.edu/files/fo.uiowa.edu/files/strategic_plan.pdf
HCUP Facts and Figures: Statistics on Hospital-Based Care in
the United States. (2009). Retrieved from HCUP:
http://www.hcup-us.ahrq.gov/
(2010). Health Care Reform Raises the Stakes for Tax Exempt
Hospitals. Retireved from Business Source Complete. Accession

number 52093622: Jones Day Commentary.
Paid Time Office Programs and Practices. (2010). Retrieved
from World At Work:
http://www.worldatwork.org/waw/adimLink?id=38913
Message from the Secretary. (2011). Retrieved December 27,
2011, from U.S. Department of Health and Human Services:
http://www.hhs.gov/secretary/about/message.html
The University of Iowa 2011 Annual Economic Development
Report. (2011). Retrieved from Regants.Iowa.Gov:
http://www.regents.iowa.gov/Meetings/DocketMemos/11Memos
/October2011/EcoReport2011.pdf
Audited Financial Statement. (2012, January 12). Retrieved
from Board of Regents, State of IOwa:
https://www.legis.iowa.gov/DOCS/LSA/Docs_Filed/2012/DFJY
D121.PDF
Financial Report 2012. (2012). Retrieved from uiowa.edu:
http://afr.fo.uiowa.edu/files/afr.fo.uiowa.edu/files/2012financial
_report.pdf
Staff attitude vital to patient retention, according to survey.
(2012, August 3). Retrieved from Medical Economics:
http://medicaleconomics.modernmedicine.com/print/115190
Amos, E., & Weathington, B. (2008). An Analysis of the
Relation Between Employee-Organization Value Congruence
and Employee Attitudes. Journal of Psychology, 615-631.
Bruington, B., Hamlyn, K., Magnus, B., Otero, L., & Walker, D.
(2010, December 10). Integrated Company Analysis. Retrieved
from Business Library:
http://business.library.wisc.edu/resources/kavajecz/09%20Fall/g
eneralmills_rep.pdf
Doherty, R. B. (2010). The certitudes and uncertainities of
health care reform. Annals of Internal Medicine,
http://web.ebscohost.com.ezproxy.bellevue.edu/ehost/pdfviewer
/pdfviewer?hid=8&sid=c6cdfd22-262b-4d1c-ad62-
bf9b7a331ef2%40sessionmgr12&vid=4.
Field, K. (2008). Teach Hospitals Warily Await Details of
Obama's Health Care Plan. Chronicle for Higher Education.

Fraze, T., Elixhauser, A., Holmquist, L., & Johann, J. (2010,
September). Public Hospitals in the United States, 2008.
Retrieved from H-CUP: http://www.hcup-us.ahrq.gov/
Garrett, R., & Roberson, J. (2009, September 19). Cost of Care:
'Viscious Circle' of uninsured results in higher bills for health
coverage, taxes in Dallas-Fort Worth. Retrieved January 24,
2011, from Tribune Business News: Retrieved from ProQuest
database
Heldt, D. (2009, November 5). Republican lawmakers question
UIHC Disney training. Retrieved from The Gazette:
http://thegazette.com/2009/11/05/republican-lawmakers-
question-uihc-disney-training/
Heldt, D. (2012, Febuary 12). UIHC Officials: More Accessible,
Welcoming Hospital Is The Goal. Retrieved March 23, 2013,
from KCRG News: http://www.kcrg.com/news/local/UIHC-
Officials-More-Accessible-Welcoming-Hospital-Is-The-Goal-
138829479.html
Horovitz, B. (2012, January 9). Trend alert: 10 new products to
watch for in 2012. Retrieved from USA Today:
http://usatoday30.usatoday.com/money/industries/retail/story/20
12-01-09/product-trends/52472380/1
Jones Day Commentary. (2010, June). Health Care Reform
Raises the Stakes for Tax Exempt Hospitals. Retrieved January
20, 2011, from Jones Day Commentary: Retrieved from
Business Source Complete Accession number 52093622
Ken. (2013, May 5). Administrator. (B. Skinner, Interviewer)
Mangan, K. (2009). Sick Economy Puts Strain on Teaching
Hospitals. The Chronicle of Higher Education, Retrieved from
EBSCOHost.
Mangan, K. (2010, March 22). Health-Reform Bill Holds
Changes for Medical Training. Retrieved 27 January, 2011,
from The Chronicle for Higher Education:
http://chronicle.com/article/Health-Reform-Bill-Holds/64795
Mangan, K. S. (2001). Cost of Caring for the Poor is
Devastating Academic Hospitals Report Says. The Chronicle for
Higher Education.

Mirvis, D. (2010). The uncompensated care problelm: The
Robin Hood model of health care financing. Tennessee
Medicine: Journal of the Tennessee Medical Association,
Retrieved from MEDLINE with Full Text.
Individual Development Planning. (n.d). Retrieved from
opm.gov: http://www.opm.gov/policy-data-oversight/human-
capital-management/reference-materials/leadership-knowledge-
management/developmentplanning.pdf
About Us. (n.d.). Retrieved from uihealthcare.org:
http://www.uihealthcare.org/BasicFacts/
Accountable Care Organizations (ACOs): General Information.
(n.d.). Retrieved from Centers for Medicare and Medicaid
Services: http://innovation.cms.gov/initiatives/ACO/
Administrative Services. (n.d.). Retrieved from Uiowa.edu:
http://www.uiowa.edu/hr/administration/
Corporate. (n.d.). Retrieved from General Mills:
http://www.generalmills.com/Company/Mission.aspx
EMTLA.com. (n.d.). Retrieved January 29, 2011, from
EMTLA.com: www.emtla.com
Fact Sheet. (n.d.). Retrieved from Centers for Medicare and
Medicaid Services: http://www.cms.gov/Outreach-and-
Education/Medicare-Learning-Network-
MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_S
heet_ICN907664.pdf
Hospital Compare. (n.d.). Retrieved from Medicare.Gov:
http://www.medicare.gov/HospitalCompare/compare.aspx#vwgr
ph=1&cmprTab=1&cmprID=160058&stsltd=IA&loc=52240&lat
=41.6113703&lng=-
91.5015009&AspxAutoDetectCookieSupport=1
Medicare Fee for Service Payment. (n.d.). Retrieved from
CMS.gov: http://www.cms.gov/Medicare/Medicare-Fee-for-
Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-
Program.html
Operations Manual. (n.d.). Retrieved from Uiowa.edu:
http://www.uiowa.edu/~our/opmanual/i/01.htm
Resonsibility Marketing. (n.d.). Retrieved from General Mills:

http://www.generalmills.com/Responsibility/MarketingandAdve
rtising/Responsible%20marketing.aspx
Okrent, D. (2010). Last Call: The Rise and Fall of Prohibition.
New York: Scribner.
President, O. o. (2005). The Iowa Promise. Retrieved from
uiowa.edu: http://www.uiowa.edu/homepage/news/strategic-
plans/strat-plan-05-10/goals/index.html
Press, A. (2013, March 4). Terry Branstad holds firm on plan to
overhaul IowaCare. Retrieved from Omaha.com:
http://www.omaha.com/article/20130304/NEWS/703049939
Rauer, A. (2011, June 13). Mercy Hospital, UIHC not spending
in right places. Retrieved from Press Citizen: http://www.press-
citizen.com/article/20110613/OPINION05/106130323/Mercy-
Hospital-UIHC-not-spending-right-places
Reid, K. (2010, October 5). Medicaid expansion will not ease
strain on hospital emergency departments. Retrieved January
26, 2011, from Health Care Finance News:
http://www.healthcarefinancenews.com/blog/medicaid-
expansion-will-not-ease-strain-hospital-emergency-departments
Sager, A. (2001, March 30). Threats to urban public hospitals
and how to respond to them. Retrieved January 16, 2011, from
Boston University School of Public Health:
http://dcc2.bumc.bu.edu/hs/sager/Threats%20to%20Urban%20P
ublic%20Hospitals%20DC%20General%20Medical%20Staff%20
30%20Mar%2001.pdf
Smith, A. (2010, May 14). Moving From a Medicare Fee-For-
Service System to a Pay-For-Performance. Retrieved January
24, 2011, from American Health Lawyers Association:
http://www.hallrender.com/library/articles/632/Smith_HLW_arti
cle.pdf
Tracer, Z. (2013, April 19). Hospital Safety Hurt by Teamwork
Lapses, AIG Study Shows. Retrieved from Bloomberg:
www.bloomberg.com/news/print/2013-04-19/hospital-safety-
hurt-by-teamwork-lapses
York, E. B. (2010, Feburary 12). General Mills Targets Three
Groups to Fuel Growth. Retrieved from Ad Age:

http://adage.com/article/news/advertising-general-mills-targets-
3-groups-fuel-growth/142138/
Zimlich, R. (2013, April 10). The PQRS Challenge. Retrieved
from Medical Economics:
http://medicaleconomics.modernmedicine.com/medical-
economics/news/tags/cms/pqrs-challenge
Empower
Efficient working conditions
Reduce Stress
Positive Attitude!
Chart 1: 2009 Distribution of Cummulative Costs by Payer
Series 1 Medicare Medicaid Private Insurance Uninsured
Other 0.46 0.15 0.3 0.05 0.03
Chart 2: Average Cost per Stay by Payer, 2009
Series 1 Other UninsuredPrivate Insurance Medicaid
Medicare 9700 7500 8500 6900 11300 Improved
absenteeism Had no impact Worsened absenteeism
0.55000000000000004 0.43 0.03
Revenues By Core Business Units
Revenues By Business Unit (In millions)

Educational Departments Auxiliary Enterprises Grants and
Contracts Patient Services Other Academics 103.7
175.3 388.8 1319.6 46.5 357.1
Skinner, Case Study, 2013 Page 1
TargetIndicator
Complete a comprehensive study
of the undergraduate experience
at Iowa
Committee report to recommend
programmatic improvements (I)
Review collegiate general
education requirements to ensure
that all students receive a strong
background in the arts and
sciences
Committee report to recommend
programmatic improvements (I)
Women in executive positionsIncrease from 32.1% to 37.0% (I)
P&S salaries
Monitor salaries of P&S employees
at CIC institutions on an annual
basis; make determinations annually
related to the competitiveness of UI
Racial/ethic minority P&S staff as a percentage of total P&S
staffIncrease from 6.5% to 7.5%
Faculty salaries as compared to
peer institutions
Increase nonclinical tenured/tenure
track faculty salaries to top third of
peer group (P); increase clinical
medicine faculty salaries to 50th
percentile in AAMC (P)
Percent of employees receiving
annual performance reviews
Increase from 85.0% to 100.0% (I)

Patient satisfaction rating
Improve outpatient mean score from
4.35 to 4.50 (scale=5.00) (I); improve
inpatient mean score from 86.8 to
90.0 (scale=100.0) (I)
Business Strength AnalysisAcademics Patient Services
Auxilairy Enterprise Grants & Contracts Educational
Departments
1 Poor, 5 Excellent 1 Poor, 5 Excellent 1 Poor, 5 Excellent 1
Poor, 5 Excellent 1 Poor, 5 Excellent
Rating Rating Rating Rating Rating
Characteristics Weight(1-5)ValueWeight(1-5)ValueWeight(1-
5)ValueWeight(1-5)ValueWeight(1-5)Value
Carry out mission, goals & Objectives
20%51.0010%50.5020%51.005%50.2510%50.50
Sharp focus on concerns vital to large market
20%51.0020%51.002%50.105%50.2520%51.00
High appeal to those whose financial support is essential
5%50.2510%50.5010%50.5020%51.0010%50.50
Stable financial support
10%30.3010%20.2010%50.5020%20.4010%20.20
Volunteer leadership
2%50.102%50.102%50.101%20.022%50.10
Market demand 2%50.1052%40.085%30.152%30.06
Program results are reportable
2%40.082%50.102%50.105%40.2010%50.50
Alternative coverage 2%20.044 45%10.0510%30.30
Dominant market share 10%40.402%50.1052%20.0420%51.00
Better quality/value/service than competitors
10%50.5020%51.0020%52%40.082%50.10
Superior ability to produce and market
10%50.502%50.1020%510%40.402%50.10
Cost effective program delivery
5%50.2520%51.0010%50.5010%40.402%50.10
Strong match between program and future needs
2%50.102%50.102%510%50.505

Total (Weight must total 100%)
100%4.62100%4.70100%2.88100%3.74100%4.46
Academics, 4.62Patient Services, 4.70Auxilairy Enterprise,
2.88Educational Departments, 4.46Grants & Contracts, 3.74
0.001.002.003.004.005.006.00
Business Unit Strength Analysis
AcademicsPatient ServicesAuxilairy EnterpriseEducational
DepartmentsGrants & Contracts
MediumHighLowMediumHigh
Market Attractiveness
Low
20122011
Net patient service revenue, net provision for bad debts
of$1,041,179988,234
$25,990 in 2012 and $22,589 in 2011
Other revenue57,11445,214
Total operating revenues1,098,2931,033,448
Salaries & benefits546,771488,546
Medical supplies and drugs222,447202,779
Other supplies and general expenses212,655211,714
Depreciation and amoritization69,72470,062
1,051,597973,101
Total operating expenses46,69660,347
Operating income
Gain (loss) on disposal of capital assets851(8,420)
Noncapital gifts3544,507
Investment income24,24337,472
Interest expense(4,051)(5,008)
Total nonoperating revenues, net21,39728,551
Excess of revenues over expenses before
transfers68,09388,898
Capital gifts and grants2,323 ---------------
Net transfers out(15,467)(2,955)
Increase in net assets54,94985,943
Net assets, beginning of year1,107,0391,021,096
Net assets, end of year$1,161,9881,107,039

Nonoperating revenues (expenses)
(In thousands)
Statement of Revenues, Expenses, and Changes in Net Assets
Operating revenues
Operating expenses
University of Iowa Hospitals & Clinics
Years ended June 30, 2012 and 2011
Statement of Cash Flows
University of Iowa Hospitals & Clinics
For Years Ended 2012 and 2011
Cash flows from operating activities20122011
Receipts from and on behalf of patients$1,030,093988,973
Other receipts55,83042,244
Payments to employees(534,360)(478,690)
Payments to suppliers and contractors(431,055)(410,227)
Net cash provided (used) by operating activities120,508142,300
Cash flows from noncapital financing activities
Net transfers(15,467)(2,955)
Noncapital gifts3544,507
Net cash provided (used) by noncapital financing
activities(15,113)1,552
Cash flows from capital and related financing activities
Purchase of capital assets(131,184)(76,572)
Proceeds from the sale of capital assets2,7716,081
Capital gifts and grants received2,323 ----
Proceeds from the issuance of long-term debt47,15537,571
Premium received on issuance of long-term debt819531
Principal paid on long-term debt(24,357)(4,538)
Interest paid on long-term debt(4,334)(4,588)
Net cash used in capital and related financing
activities(106,807)(41,515)
Cash flows from investing activities
51,780159,186
Proceeds from sale of investments(63,810)(279,588)
Purchase of investments13,83318,519
Interest and dividends received on investments

Net cash provided by (used in) investing
activities1,803(101,883)
Net increase in cash and cash equivalents391454
Cash and cash equivalents at beginning of year1,428974
Cash and cash equivalents at end of year$1,8191,428
Reconciliation of operating income to net cash provided by
operating activities
Operating income$46,69660,347
Adjustments to reconcile operating income to net cash provided
by operating activities
Depreciation and amoritization69,72470,062
Provision for bad debts25,99022,589
Changes in assets and liabilities
Accounts receivable(43,375)(28,303)
Inventories835(1,445)
Other assets(2,075)(2,057)
Accounts payable and accrued expenses25,61211,934
Other liabilities(7,916)5,690
Due to related parties(1,282)(2,970)
Estimated third-party payor settlements6,2996,453
Net cash provided by operating
activities$120,508142,300
UIHC held cash and investments at June 30, 2012 and 2011 with
a fair value
of $755,246 and $731,341, respectively.
During 2012 and 2011, the net increase in fair value of these
investments was
$10,456 and 19,492, respectively.
(In thousands)
Noncash investing activities
Number of Pages: 2
Writing Style: APA
Number of sources: 1
the book to use for quote and references. (Diana Kendall.

Sociology in Our Times, 9th Edition)
and this is the assignment instructions.
For this assignment you will have the opportunity to conduct an
experiment, or quasi-experiment, in order to explore deviance in
our society. As we learned this week, deviance is simply, “the
recognized violation of cultural norms” (Macionis, 2009, p.
176). Cultural norms are behaviors and expectations for a group
and fall into three categories: folkways, mores, and laws. For
this assignment you will explore society’s reaction to a folkway
violation. You will then utilize the textbook, online materials,
and the South Online Library in order to write a two-page essay
on the deviant (not criminal) experience.
Below you will find a step-by-step guide for completing this
paper:
First, review the sections on Research Ethics and the subsection
on Testing a Hypothesis under the section Research Methods in
chapter one of your text in order to familiarize yourself with
sociological experiments. Then, begin this assignment by
choosing a folkway to violate. Examples include (and there are
many folkways to choose from): wearing the other gender’s
clothing, speaking a foreign language to an English speaker,
sitting with a stranger at a restaurant, and eating dinner with
your hands. Be sure to ask your facilitator if you are unsure if
the norm you choose to violate is appropriate for this
assignment. Here are some examples of norm violations for you
to watch: http://www.youtube.com/watch?v=JlVsj5vLu_U and
http://www.youtube.com/watch?v=3lDwIlY9gX8.
Violate your chosen folkway (not a law) in at least one situation
and document it with pictures, video, and/or notes. Be sure to
note how you feel when you violate the norm, as well as other
people’s reactions to the violation. If you do not receive
adequate data (reactions) in one situation, try it again in

another.
Write an organized essay that explores the norm you violated,
how you felt while being deviant, and the reactions you
received while you were violating the norm. You should then
analyze the experience, including the theories of deviance
presented in the text. Your paper should also include an
introduction with a thesis and a conclusion that reviews all main
points you present.
Remember to use APA format for the essay style as well as in-
text citations and when listing the references. Submit your essay
(maximum 12 pt. font) describing your application project and
your findings
Developing a Case Study
Overview:
The final project for this course is the completion of a
comprehensive case study. Components of the case study will
be completed at designated intervals throughout the course.
Students will be provided with a focus area from which to
construct their case study. The case study will represent an
empirical inquiry investigating a significant contemporary issue
in the business sector. As a summative project in your MBA
program, it is expected that you will draw from the skills and
competencies developed throughout your MBA program.
Prepare your case study as if you were a senior executive of the
corporation preparing a document for review by the
organization’s Board of Directors. Therefore, the quality of
your presentation should be of a caliber appropriate for this
audience.
Case Study Theme:

You must select from one of two topical areas in the
development of your case study. The two areas are: 1) Human
Capital Management or 2) Healthcare Cost Containment. For
the topic selected, a problem scenario is provided in which to
address.
You will also be given a choice to select the type of the
organization in which you will be developing your case study.
You may also have a choice of identifying an existing
corporation/organization or creating a hypothetical corporation
from which to base your case study.
Topical Areas for Student-Written Case Studies
1. Human Capital Management
The average age of your workforce has increased sharply over
the last 10 years. Within the next 10 years, a significant
number of your workforce will be within the normal age range
for retirement. As a senior staff member leading a team on
success planning, you are concerned that valuable knowledge,
skills, and abilities will not transfer to existing and new
employees and will be lost with the employees that will retire.
How would the increased talent shortfall affect the development
and approach of your organization’s succession planning
strategy and what might such a strategy look like? Please
present your case to the Board of Directors.
2. Healthcare Cost Containment
The political environment specific to healthcare continues to be
unstable. However, recent legislation has specified some
employer-based requirements for the provision of healthcare to
employees. In addition, as the demographics workforce
changes so does the use pattern for employer-sponsored
healthcare coverage. This increased utilization effects rate

structure for a company. How would recent governmental
legislation affect your organization’s strategy of providing
continued healthcare benefits to its employees?
Selecting your Organization:
For your case study, you may select an actual organization or
you may create a hypothetical organization. The organization
selected or hypothetically constructed one must be a publicly
traded company, government sponsored organization or
nonprofit. The type of the organization must be selected from
one of the following sectors:
· Options for Types of Organizations:
· Financial Services Organization
· Transportation Organization
· Public Utility Organization
· Service Sector Organization
It will be important to dive into your case study development
immediately. For example, your selection of an organization
must be made in Week 1, as your SWOT Analysis Appendix
(due Week 3) will reflect this choice.
Time Frame:
1. Case Research (Weeks 1-4): During the first four weeks of
class, each student will complete the Case Research Section of
their Case Study focus. Please read the applicable resource
identified in your “Assigned Reading and Research” section of
your weekly assignments to ensure you understand the
respective areas of the case study prior to beginning your case
study. As with all problems to solve, properly identifying the
problem, and designing a good strategy for solving the problem
at the onset is crucial. If you do not address these areas

properly, the case study will not turn out successful. Also, each
student should include the theoretical framework(s) they are
basing their premise on. Therefore, your approach in the case
study must be informed by known frameworks and supported by
data and relevant information.
Each student will submit a draft of their Case Research Section
of their Case Study in Week 4.
Components of the Case Research Section:
a. Identify the Problem, Purpose, and Research Question
b. Using Literature/Literature Review
c. Selecting and Bounding the Case/Selecting a Design
d. Designing the Case
e. Considering Issues of Validity and Reliability in Designing
Case Study Research
2. Data Gathering (Weeks 5-8): During Weeks 5-8, each student
will complete the Data Gathering Section of their Case Study.
There are six data selection sources that you should consider for
this part of your Case Study: documentation, archival records,
interviews, direct observation, participant observation, and
physical artifacts. Each student will submit a draft of their Data
Gathering Section of their Case Study in Week 8.
Components of the Data Gathering Section:
a. Collecting Data
b. Analyzing Data
c. Integrating the Study Findings
3. Presenting the Case (Weeks 9-12): During Weeks 9-12, each
student will conclude their Case Study, and present their
findings. An essential component of this section is a
conclusion. In Week 11 (or Week 12 at the latest), each student

will submit their Case Study to the Discussion Board, along
with a narrated PowerPoint presentation representing the Case
Study. Please remember that your audience for both the report
and narrated PowerPoint is a Board of Directors. Include both
the PowerPoint and written case study in your e-portfolio.
Presenting the Case Component:
a. Interpreting Findings and Drawing Conclusions
b. Writing and Reporting the Findings
c. Presentation with Conclusions
Assignment 3.2: SWOT Appendix
Due Fifth Day of Week 3 (Midnight CST) (50 Points)
Over the next three weeks, you will perform a SWOT Analysis
specific to your topical area for your case study. This SWOT
Analysis will become “Appendix A” for your case study.
Additional guidance for this SWOT Analysis is as follows:
1. The over-arching theme of the analysis should be focused on
developing a particular business strategy that integrates sound
business policy and sustainable competitive advantages.
1. The analysis should address how the various forms of
business capital are integrated with business strategy, policy,
and governance to effectuate the desired business strategy
identified.
1. The analysis should address main business functions, to
include: finance, marketing, operations, and human resources.
1. The analysis should be suitable for review by a senior
business executive demonstrating evidence of logical analysis,
reasoned judgment, attention to organizational ethics, and value
creation.

1. Please be sure to include your recommendations for action in
your narrative.
The SWOT Analysis should be at least 1,000 words in length.
This assignment will be due in Week 3.
SWOT Analysis on
Assignment 10.2: Case Study
Due no later than Week 10 (Midnight CST) (200 Points)
Begin writing your case study. Specific guidance to complete
this case study is available within the “Course Documents” Tab.
Detailed format guidelines to follow for your case study are
found within your “Research in Organizations” e-book (refer to
your Assigned Reading and Research). The general timeline to
follow for this case study is:
1. Case Research (Weeks 1-4)
0. Identify the Problem, Purpose, and Research Question
0. Using Literature/Literature Review
0. Selecting and Bounding the Case/Selecting a Design
0. Designing the Case
0. Considering Issues of Validity and Reliability in Designing
Case Study Research
1. Data Gathering (Weeks 5-8)
1. Collecting Data
1. Analyzing Data
1. Integrating the Study Findings
1. Presenting the Case (Weeks 9-12)
2. Interpreting Findings and Drawing Conclusions
2. Writing and Reporting the Findings
2. Presentation with Conclusions

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