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Case Teaching Resources F R O M T H E E V A N S S C H O
O L O F P U B L I C A F F A I R S
T h e
E l e c t r o n i c H a l l w a y ®
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Barzelay for teaching use at the John F. Kennedy School of
Government, Harvard University. (0787)
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Denise Fleury and the Minnesota Office of State Claims
Introduction
When Denise Fleury left the private sector to become head of
the Minnesota Office of
State Claims in June 1984, she knew the job would be
challenging. Recent changes in
Minnesota’s worker’s compensation law had broadened the
mission of State Claims,
which administered worker’s compensation benefits for allstate
employees. As the
incoming manager of the office, Fleury was expected to re-
orient State Claims to meet
these new responsibilities and to make sure that supervisors
throughout state government
complied with the new law, as well.
When she took the job, however, Fleury did not realize how
badly State Claims was
handling its old responsibilities. She soon found scrambling to
cope with day-to-day
crises while trying to assume a host of new tasks. By the end of
her first year, Fleury had
made real headway, but office operations continued to suffer
from misunderstandings,
mistakes, and missed deadlines, which exasperated her staff as
well as the employees and
agencies they served. Fleury was anxious to resolve these
problems, but felt that she did
not understand the details of the office paper flow well enough

to sort them out herself—
nor did she have the time to tackle such a job.
Background
In Minnesota, both public and private sector employers are
required by law to pay for the
medical treatment of any employee who suffers a work-related
injury and to pay lump-
sum awards for permanent injuries, such as the loss of a limb.
In addition, employers
must provide “lost time” compensation (two-thirds the worker’s
salary) to any employee
who misses more than three days of work due to a work-related
injury.
Most private sector employers buy insurance to cover their
workers’ compensation costs
(1). The insurance companies evaluate claims and pay benefits,
working to keep their rates
competitive by containing costs—for instance, by conducting
investigations to make sure
Denise Fleury and the Minnesota Office of State Claims C15-
87-744.0
2
the claims are legitimate. Private employers and their insurance
companies are monitored
and regulated by the Workers’ Compensation Division of the
state Department of Labor
and Industry, which keeps files on the 50,000 workers’
compensation claims filed

annually in the state. If an employee feels s/he has wrongly
been denied benefits, s/he
can file a complaint with the Records and Compliance office of
the division.
The state of Minnesota covers its own workers’ compensation
costs directly, or is “self-
insured.” An office within the Workers’ Compensation
Division—State Claims—
administers the program (although the actual benefits are
ultimately paid out of each
agency’s overhead budget). State Claims is also regulated by
the Workers’
Compensation Division. In fact, long before Fleury’s arrival,
tension had developed
between the six-person State Claims office, designed to protect
the interests of state
agencies, and the rest of the 180-person division, designed to
protect employees.
“There’s a conflict of interest in being in the agency that
regulates you,” says Fleury.
Specialists [in State Claims] used to sit right across the
divider from the regulatory specialists. So if [a state]
employee called the regulatory people with a complaint,
they’d come marching around the divider and scream at
whoever was in this unit and tell them what bad people they
were (2).
Political Milieu
Workers’ compensation was a hot political topic in Minnesota
in the late seventies and

early eighties. Over the years, benefits had increased and more
and more employees were
applying for them. As a result, both public and private sector
employers found their
workers’ compensation costs escalating rapidly (3) and
businesses, threatening to leave the
state, lobbied the legislature to reduce the benefit level.
Unions—politically powerful in
Minnesota—strongly resisted the proposed benefit cuts.
After years of study and debate, the state legislature fashioned a
compromise in 1983,
enacting a set of reforms designed to lower costs without
reducing benefits. Despite a
climate of fiscal retrenchment, the legislature appropriated an
additional $7 million to
implement its new policy.
The lawmakers had concluded that the biggest source of
escalating workers’
compensation costs came not from increased benefits but from
increased worker
utilization of the program. Studies showed that once they began
receiving benefits, many
workers never returned to their old jobs—or to any job. The
new “mandatory
rehabilitation” law required employers to see that workers
received adequate medical care
and returned to their old jobs whenever possible. If workers
were unable to perform their
87-744.0

3
old job duties, employers were encouraged to adjust their old
jobs or to find them new
ones. Employers were asked to phase employees gradually back
to work when
appropriate and to work with a rehabilitation counselor when
any employee was absent
more than 30 days with a back injury or more than 60 days with
any other kind of injury.
The law also addressed employees’ complaints of delays in
receiving their benefits. It
effectively reduced the amount of time allowed for processing
initial report-of-injury
claims from 60 to 14 days, and imposed a 21-day limit on
payment of medical bills. If an
employer paid benefits late, s/he was required to pay a fine. In
the state of Minnesota,
agencies were required to pay 210 percent of the initial benefit
if payments were made
late: 110 percent to the employee; 100 percent to a Special
Compensation Fund in the
state.
Keefe's Agenda for State Claims
One of the chief architects of this law was a former state
legislator named Steve Keefe,
whom Democratic Gov. Rudy Perpich appointed commissioner
of Labor and Industry in
January 1983. The Department of Labor and Industry was the
regulatory agency that
enforced all labor and safety standards in the state, and nearly
half of the department’s
staff worked in the Workers’ Compensation Division. Keefe

hoped to tone down the
division’s identity as pro-employee, adversarial, and litigious
and move to a more neutral
role as arbiter and facilitator. “The system was a lawyer’s
system,” says Keefe. “What
we tried to do was redesign compensation the way a health care
person would design it.’
What you’ve got to do is not let the [injured employee] feel
sort of lost out there. You’ve got to keep him thinking [of
himself] as an employee who’s temporarily not working,
not as someone who’s stopped being an employee and
become a workers’ compensation recipient.
It’s a fairly elaborate system, but it means things like
checking up on him to see if he’s okay. If you had a friend
who came down with cancer, you wouldn’t just forget
about him. You’d call him up and see how he’s doing.
You’d wonder, “Is he going to be able to come back? Can
he do his old job? Should we keep it open for him?” You
wouldn’t want to just throw him on the scrap heap.
In implementing the state’s new workers’ compensation policy,
Keefe wanted State
Claims to model itself after some of the more progressive
private insurance companies.
“Something like 95 percent of [people with] work-related
injuries should be back at work
in less than six weeks, and that was not the case,” says Keefe.
“[About] half of our cases
went longer than three months.”

87-744.0
4
Perhaps most importantly, Keefe wanted State Claims to train
and support each line
agency to manage its own workers’ compensation cases.
“Somebody whose title is
‘claims investigator’ is not going to be very effective at
developing a sympathetic rapport
with the employee,” says Keefe. What you want is somebody
he knows from his office.
His immediate supervisor is best. … [But] the people [in the
agencies] who are doing this
are amateurs at it. They may have only had one workers’
compensation injury before and
they don’t know anything about the system. It’s the job of the
people in State Claims to
kind of bring them along.” Ultimately, Keefe says, “What we
wanted to do was set an
example for good, sympathetic, humane treatment of workers
compensation claims as a
way of saving money, demonstrating to the business community
that this could work.”
The Job of State Claims
When Keefe arrived, the State Claims staff was made up of
three lawyers, three workers’
compensation analysts (known as claims analysts), one account
clerk, and two general
clerical workers. No one oversaw the work of the office as a
whole. The claims analysts,
account clerk, and general clerical workers reported to a clerical

supervisor while the
lawyers, for all practical purposes, worked without supervision,
reporting to a deputy
commissioner in another office.
When a state worker was injured, s/he filed a “first report of
injury” (see Exhibit 1) with
his/her supervisor. The supervisor added his/her own
assessment of the injury to the
report, then sent it to State Claims. State Claims received about
5,000 first reports of
injury a year. Only a handful of cases involved serious
permanent injuries. In about
4,000 cases, employees continued to work but sought payment
of injury-related medical
bills. In the other 1,000 cases, employees stayed home from
work and applied for ‘‘lost
time” salary benefits. Thus, State Claims had traditionally been
responsible for accepting
or rejecting the worker’s initial claim of injury, authorizing or
denying payment of “lost
time” compensation or medical bills, and—when necessary—
defending its decisions in
court. For 90 percent of all first reports of injury and medical
bills, the cases were clear-
cut, according to Stephanie Hayes, a claims specialist. “But
those other 10 percent can be
a real problem.”
Processing First Reports of Injury
When a first report of injury arrived at State Claims (see
Exhibit 2), it was immediately
sent out of the office to the Labor and Industry computer
division and returned to State
Claims after it was entered into the computer. The office’s

clerical supervisor, who
opened all the mail, then put the report into either the “lost
time” or “medical only”
category and gave it to any one of three claims analysts. The
analyst made sure the form
was completed correctly, then took the claim to any one of three
lawyers for a decision.
87-744.0
5
The standard for making these decisions—to determine whether
the employee had
suffered a work-related injury that either caused or worsened a
medical condition—
allowed for a fair amount of discretion, and sometimes the
situations were murky. Hayes
explains:
If you’ve got a real specific incident—somebody is at work
and they trip over an electric cord and fall and there are 35
witnesses—it’s pretty evident. [But there are other cases]
where someone will come in a week after the date of the
injury and say, “Oh yeah, I tripped at work a week ago and
my leg is real sore now.” [Or cases] that are basically wear
and tear on the body over a long period of time, [where it
is] real hard to determine whether or not the employer is
liable.

About 95 percent of lost time claims were accepted. Once
accepted, lawyers handed
them over to the account clerks who calculated the benefits to
be paid. Every two weeks,
the account clerks brought the payment authorizations back to
the lawyers for final
approval before they were sent to another state agency—the
Department of Finance—
which issued the actual checks. When medical-only claims
were accepted, lawyers
returned them to claims analysts, who sent out forms to the
employees’ doctors seeking
information on the treatment prescribed.
Processing Medical Bills
Doctors, pharmacies, or other vendors sent their bills directly to
State Claims (or to the
employee’s agency, which forwarded them to State Claims).
(See Exhibit 3.) The office
received about 20,000 medical bills each year. The clerical
supervisor gave the bills to the
file clerk, who put them in the worker’s file sticking out
sideways to show that the file
needed action. Any one of the three claims analysts could pick
up these files, make sure
the forms were complete and the treatment costs fell within
state guidelines, and then take
the files to any one of the three lawyers who approved or denied
payment of the bill.
About 99 percent of the time, payment was approved. Once
approved, lawyers gave their
files to account clerks who sent payment authorization to the
Department of Finance.
Like the first reports of injury, these bills were sometimes

questionable. For instance, was
treatment for an ulcer related to a back injury? Maybe so, if the
employee had taken
analgesics to relieve the back pain. If a doctor prescribed a
waterbed for a patient, was
that compensable treatment or not? Was it reasonable for a
patient to see a chiropractor
four times a week several months after an injury?
87-744.0
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When either lost time or medical claims were denied, the
employees had the option of
challenging the decisions—first through the Workers’
Compensation Division, then in
court. The State Claims lawyers would then defend their
decisions.
Keefe's Initial Changes in State Claims
To cope with State Claims’ added responsibilities and to mirror
more closely staffing
arrangements in the rest of the Workers’ Compensation
Division, Keefe upgraded the
three claims analysts from clerical to professional status and
renamed them “specialists.”
During the year before Fleury’s arrival, Keefe increased the
specialist staff to six and
added two new clerical workers to the office. In addition, when

the clerical supervisor—a
30-year veteran of the office—retired in 1983, he upgraded the
post to that of a manager
to oversee the entire office. Until Keefe hired Fleury, the new
manager’s position was
filled by an “acting manager”—one of the claims analysts-
turned-specialist.
Wayne Jahr, one of the newly-hired claims specialists, recalls
that when he first arrived in
November 1983, the office was “a mess—physically: Files
everywhere, piles of them,
with pieces of paper sticking up out of them. There was a table
against the wall and it was
piled as high as you could see with files.” The paper sticking
out of the files, he soon
discovered, was incoming mail that had not yet been processed.
Some files with mail
sticking out were also stuffed into drawers. When the drawers
were opened, all the pieces
of paper were pulled out and had to be re-filed. “It was a
chaotic system,” says Jahr, and
there was little rhyme or reason to the order in which work was
being processed:
Truthfully, [the specialists] would go and they would
thumb through the files that were there, and if it was
something quick that they could get out right away, they
would put it in their pile to take back to their desk. If there
was too much mail to cope with [in a given file], they just
left it and passed on to the next one. If there were
rehabilitation reports, something from an attorney, they just
passed over it. They didn’t have time to read that stuff.

The backlog mounted as 270 pieces of new mail—injury reports,
bills, and related
paperwork—relentlessly poured in each day. What’s worse, the
farther behind the office
became in processing all the paperwork, the more paperwork
there was to process, as
employees, vendors, doctors, and other agencies sent in
duplicates of their original
material. Jahr remembers at one point finding files with as
many as “25 pieces of
[unprocessed] mail in them—an original bill and 24
outstanding-balance-due statements.
… There were so many delays, we were having to continually
go back to hunt down bills
somewhere in the process.”
87-744.0
7
During the next few months, several improvements were made.
The claims specialists
convinced the acting director to assign them each a caseload—a
set of agencies for which
each specialist would take responsibility. Each specialist was
also given a table on which
to stack his or her case files. But for the most part, office
operations did not improve
during this period. Although the size of the staff had increased
markedly, the newcomers
received only catch-as-catch-can training, usually learning the
ropes from their

predecessors or from co-workers who passed along idiosyncratic
systems they had
developed on their own. And—aware that a new manager would
be hired within a few
months—the acting manager was reluctant to make any changes.
Fleury Takes the Reins
Keefe had initially been looking for someone with experience in
a self-insuring company
to manage State Claims, but hired Fleury from a private
insurance firm. “Denise’s
credentials were unusually good,” he says.
She was a claims supervisor for the company with probably
the best [reputation for] claims management, Wausau.
Wausau has a similar sort of philosophy to our philosophy
about management of claims. They’re activist, they get
involved, they use rehabilitation extensively. She was also
known to some of our [regulatory] people as being tough
but very good. (See Exhibit 4.)
When she arrived in June 1984, Fleury had several things
working in her favor. For one,
she had $100,000 available to her for hiring new staff, and
another one-time allocation of
$100,000 for problem-solving. In addition, she had the
enthusiastic backing of Keefe,
who supported her ideas and ran interference for her with the
department’s accounting
and personnel offices, allowing her to make certain kinds of
changes more quickly than
usual. And, from her experience at Wausau, Fleury had in mind
a clear model for how to

run the office.
But soon after her arrival, the new manager realized that she
had vastly under-estimated
what she was up against. When she had visited the office
during her job interview, she
recalls, “it looked neat and tidy” and under control. “Later on,
I found out that they had
just bought some new lektrievers [lateral file cabinets] and kind
of thrown everything into
them and closed the doors.”
In fact, office operations were “totally crazy,” Fleury says. She
estimates that when she
arrived, only 20 percent of claims were being paid on time and
the staff was inundated
with piles of backlogged work. Fleury soon discovered some of
the reasons for the
backlog. For one, although agencies were supposed to send
first reports of injury to her
office immediately, most of them delayed two to four weeks
before doing so. The biggest
87-744.0
8
internal problem, Fleury believed, was the fact that the three
staff lawyers were still the
only people in the office who made any decisions. Despite
Keefe’s “upgrading” of the
claims analysts to claims specialists, in reality they were
“nothing but glorified file clerks,”

Jahr says. “The attorneys were God”:
Everything that was done had to have [the lawyers’] stamp
of approval on it. Even on cases of continuing
compensation where a doctor has said, “This employee will
not be able to work for six months because of this surgery,”
and payments go out every two weeks—the account clerks
would have to gather up all the pay sheets, write in [the]
amount from this period to that period, take them into the
appropriate attorney’s office and the attorney would have
to go through all those and put his initials next to that
payment. Without the attorney’s initials, the payment
didn’t get made.
This arrangement meant that lawyers were all-powerful in the
office and also
tremendously over-extended, so that they often “found
themselves preparing their trials
in the odd minutes that they could get away from claims
handling duties,” according to
staff lawyer Jacob Forsman. Because of their legal obligations
and independent
schedules, the lawyers were periodically out of the office for
days at a time, effectively
halting claims from being processed. Oftentimes when claims
specialists left a
questionable claim with a lawyer (for instance, whether or not
to allow the purchase of a
waterbed as medical treatment), the lawyer would not pick it up
for weeks or even
months, according to Jahr. “By that time, the issue had come
and gone and was long
since dead. We would always lose because whatever [the
employee] wanted [permission]

to do had happened. I mean, it may have been three months
since they bought their
waterbed, so it’s kind of a moot question at that point.”
The decisions about whether to accept or deny claims were also
very “haphazard,”
according to Fleury. Sometimes lawyers relied heavily on the
opinion of the employee’s
supervisor included on the first report of injury. One attorney
admits that he and the
other lawyers were so overburdened that “when I was looking at
a medical report or
something [I would ask myself], ‘Should I question this? Do I
really want to increase my
workload by questioning this? Or should I just let it slide?”’ On
the other hand,
“attorneys like to litigate and they like to go to court,” says
Fleury:
They would end up trying some cases even though the best
business decision might be to settle it or to pay it and
manage it from a rehabilitation standpoint. But they could
only see the legal issues and not the whole scope of it.
87-744.0
9
As a result of the delays and inconsistent decisions, the office
was constantly flooded

with phone calls from irate employees or supervisors. The
claims specialists spent
between a third and a half of their time fielding these phone
calls. “The specialists would
get a lot of the pressure but not the control, and the attorneys
were often not available,”
says Fleury. “They would come out and say, ‘Send out a denial
on this case,’ and then
the specialist would get the phone call from the employee about
their starving children or
‘how come this surgery’s not being paid for’ and those kinds of
things.” The specialists’
patience had long since worn thin and they were often rude on
the telephone, says Fleury,
screaming at employees or administrators that they did not care
what anyone thought of a
particular decision and slamming down the receiver: “When I
started here, it was kind of
like that Lily Tomlin routine where she says, ‘We don’t have to
care. We’re the Phone
Company.”’
Staff morale was also at low ebb. Fleury recalls:
[Many of the] people who had been here a long time had
been forced to come over at some point in their careers,
because it was a place no one wanted to work. [Some were
transferred from] Records and Compliance [the regulation
wing of the Workers’ Compensation Division] where you
can be the “good guys” because you tell people that they
should get all these benefits. But over here you have to be
the “bad guy” because you have to cut off people’s
benefits. The other reason it was a bad place to work was
because it was so understaffed that they couldn’t even get
to the phones or manage the papers. It’s real hard to spend

your day [in conditions like] that.
“There was an extremely defeatist attitude among the
employees,” adds Jahr. “They
really felt they were the bottom of the barrel in Labor and
Industry, that they were the
dumping grounds, that they were ignored, were not given any
training, any guidance, any
assistance.”
In addition to the general disarray in State Claims, Fleury was
personally bombarded as
soon as she arrived because the office operated by the maxim
that decisions should be
made at the highest level possible. “When I started this job,”
Fleury says, “every single
first report of injury came across the [manager’s] desk.” In
addition, she found her staff—
especially the claims specialists, frustrated by the limited
availability of the lawyers—lined
up at her door asking, “‘What should I do with this? What
should I do with that?’ I
thought, ‘There’s no way I can make decisions for all those
people,”’ she recalls. Even
worse, employees and administrators throughout the state now
directed all their questions
and complaints to her. “For the first year I was here, I couldn’t
even hold a five-minute
87-744.0
10

meeting,” she says. “[The phone] was ringing all the time. All
the problems came to
me.”
From the start, therefore, Fleury found herself waging battles on
several fronts, trying to
win the cooperation of agencies across the state, re-orient her
own office to cope with the
return-to-work policy, bring the basic operation of State Claims
under control, and, in the
meantime, keep the office running, which meant coping with
crises day in and day out.
It was hard for me personally. I mean, it was really hard. I
worked six or seven days a week for twelve hours a day and
people thought I was crazy—and I suppose I was kind of
intense—but I knew I couldn’t handle it the way it was,
because it was so wild, and I knew there was a better way to
do it, and I knew it would be easier once I had gotten it
straightened out.
Dealing with the Agencies
To put workers’ compensation recipients back to work as soon
as possible, Fleury’s
office needed active support from supervisors throughout state
government, which, she
notes, “is a lot of people if you’re talking about a 65,000-
employee base” spread across
125 agencies. With the assistance of a newly-hired
rehabilitation counselor and
occasional help from the claims specialists, the new manager
spent between 30 and 40

percent of her time traveling to other state agencies to explain
the new law and its
requirements. “The audiences really varied,” she says.
“Sometimes it would just be a
few top people. Sometimes it would be first line supervisors.
Anyone who would listen
to us, basically.
“In the beginning, Steve Keefe went with me, and of course
everyone gets totally
impressed if commissioners come to speak to you, so everybody
shows up and then they
see that my commissioner is there, pushing what I’m doing,”
she adds. But as time wore
on, Fleury encountered increasing resistance from the agencies.
For one thing, the
supervisors were not directly affected by the state’s financial
losses under the existing
workers’ compensation system. The benefits were paid out of
agency overhead, not out
of operating budgets within the agencies. In addition, they were
accustomed to operating
by a simple rule of thumb: “No one in the state system could
come back to work until
they were 100 percent recovered from whatever it was that had
happened to them,” says
Fleury. The advantage to this system was that it was easy to
administer. To many
supervisors, says Fleury, it was disruptive enough to have to
cope with an absent
worker—juggling other workers’ schedules or calling around for
a replacement. The last
thing they wanted was a host of new obligations. What’s more,
the supervisors often
believed the employees out on workers’ compensation were
“malingerers” or “problem

employees,” Fleury says:
87-744.0
11
There’s one guy [in the Department of Transportation who
says things like], “Ha-ha—I’ve got a ‘light duty’ job and
you guys don’t. You have to work hard.” The fellow
workers get all upset [that he’s] making a mockery of the
whole thing—getting paid the same amount of money and
just sitting around.
Employees who had been-out of work for several years
represented an especially difficult
problem. “A lot of old cases had been terribly, terribly
mismanaged for years and were
costing lots of money.”
If people sit home for six or seven years and just get their
checks and no one bothers them, and all of a sudden you
knock on their door and say, ‘Oh, we have a job for you, by
the way,’ they probably say, ‘Well, I can’t do that job and
my back really hurts,’ and they probably get an attorney,
and you get into a lot of back and forth.
Many supervisors, resentful that these employees had been
granted benefits in the first
place, did not want to deal with them further. They also

objected to paying a
rehabilitation counselor $60 to $70 an hour to work with injured
employees and
complained that oftentimes cases dragged on without results.
(The problem in many
cases, Fleury says, was that no one within the agencies would
exercise the necessary
authority: “We had a guy with a broken toe. Our [rehabilitation
counselor] called six
different people and not one of them would take responsibility
to say, ‘Yeah, it’s okay to
come back to work with a broken toe.”’)
In talking to other state administrators, Fleury also suffered a
credibility problem because
of her own agency’s reputation for erratic decisions, missed
deadlines, and mistakes.
After all, the managers asked, who was she to give management
advice? If the state
wanted to save money, some managers told Fleury, it should use
the $100,000-worth of
new staff at State Claims to do more thorough investigations,
deny more claims, and
defend the cases all the way “to the Supreme Court,” if
necessary.
By the end of the year, however, Fleury succeeded in launching
a rehabilitation pilot
project in a state hospital with unusually high workers’
compensation costs, and had laid
the groundwork for another five pilot sites.
Dealing with the Office
In her own office, faced with overwhelming problems, Fleury’s
first impulse was to turn

to the claims specialists for help:
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12
I realized I wasn’t going to be able to do it by myself, so I
started to have meetings with them and I said, “Well, this is
kind of your chance. I don’t know anything about how
you do things here, and I have had enough jobs to know
that no matter who you are, you have pet peeves or things
you’d like to change about your job, so here it is—here’s
your chance.” We sat through quite a few long silences
because no one had ever asked them questions like that
before.
The reason for the silence, according to Jahr, had partly to do
with the split between the
long-time claims specialists and the new hires: “The old crew
didn’t trust her because
they didn’t know her. The new crew—we had our opinions but
we had nothing to base it
on and we didn’t want to come in and be the young upstarts to
the old crew.” But Fleury
found that one on one, the specialists were much more willing
to talk:
I had a lot of in and out of my office, a little bit like a
confessional—some days it felt like that. Everyone would
come in and close the door and tell me what they really

thought of the whole situation. [There were] a lot of power
struggles between attorneys and specialists.
Fleury tried to convince the attorneys that they would be better
off if they allowed the
specialists to manage the cases, thus freeing their own time for
legal work. She also
monitored the attorneys’ work, letting them know when she
disagreed with their
decisions, and requiring them to keep more thorough files.
What’s more, in order to
develop a professional claims staff, Fleury needed the attorneys
to spend “as much
nonhostile time with the claims specialists as possible,” helping
her train them. The
ground rule that Fleury established was that at first, the
attorneys could continue to make
the decisions, “but they had to explain to the specialists either
verbally or in writing what
their reasoning was and why they chose to do what they did.”
There was a period when there was a heavy demand on my
time because [the specialists] could either go to the attorney
or they could come to me if they had a question about how
to deal with certain problems. People tended to come to
me. Some people tended to come to me after they asked
the attorney for an opinion. And so I spent some time
refereeing and sometimes explaining there could be
different approaches.

87-744.0
13
Some lawyers resisted the changes, Fleury says, and two of the
three left within six
months of her arrival.
Training the Claims Specialists
Fleury’s central task was to train the claims specialists, which
meant, for one thing,
teaching them how to evaluate messy claims:
For instance—this happens pretty typically in a claim
operation—you get a first report of injury in from an
agency, and on the bottom you see [the supervisor has
written], “Do not pay this claim under any circumstances,”
or “This guy is a faker. We know he went bowling last
week.” So my job was to teach them how to evaluate that.
What kinds of questions to ask, and of whom. [You might
find out,] “Oh, gee, there were three witnesses. The guy
picked up something that weighs 200 pounds and he hurt
himself.” Doesn’t matter whether he went bowling last
week.
Fleury also trained the specialists how to follow up on cases in
order to speed the
employees’ return to work. For instance, the question to ask
doctors was not whether the
employee should or should not be doing his old job, but rather,
what the actual
restrictions on the employee were. If s/he should not pick up

more than 50 pounds or
repeatedly stoop to the ground, the agency might be able to
adjust the job to
accommodate those limitations.
Although rehabilitation counselors were usually not brought
into a case for 30 or 60 days,
Fleury encouraged specialists to assign them right away to cases
that showed signs of
being difficult or complicated—for instance, when an employee
had suffered catastrophic
injury, or when a supervisor announced that s/he was pleased to
be rid of a particular
worker. For difficult cases, Fleury also instituted group
discussions among claims and
rehabilitation specialists as a way both to cope with the
immediate problem and to help
train the specialists to think through such cases. She also tried
to get the specialists “to
see themselves as servicing a customer.” Therefore, for
example, “they had to call the
person who wrote, ‘Don’t pay this claim under any
circumstances’ [on the first report of
injury] and explain to them why it was being paid so they would
understand it.” A few
months after her arrival, Fleury changed the name of the office
to “State Claims
Management” to reflect the shift in image from a paper-
processing operation to a system
of case management.
Gradually, Fleury gave the claims specialists more decision-
making authority, which was
nerve-wracking for her and also for them:

87-744.0
14
They’d be terrified that they’d have to make a decision on
[something]. They’d come in and they’d say, “What’s
going to be the ‘policy’ on this?” They had this view that
somehow I could make rules about every situation that
would come up. You just can’t make policies and rules
about all the different things we have to deal with. I’d say,
“Do whatever you want. Use your judgment and we’ll deal
with whatever happens.”
To show confidence in the specialists, Fleury began to insist
that employees and
administrators, calling in with questions or complaints, speak to
the claims specialists
before turning to her. If they were still unsatisfied, she told
them, they could call her
back.
Fleury also used performance reviews as a way both to
recognize the staff and to hold
them to standards.
Historically in this agency, they checked a bunch of boxes
[on the evaluation forms] and they said, “Well, you’re
pretty good at that and not so good at that and OK at that.
We’ll give you ‘satisfactory’ because you can’t check too
many of these [boxes] too high. Personnel doesn’t like
that.”

During the first performance reviews that I did with
people—especially the claims specialists—I talked to them
for two hours. I figured, I can’t give people money, I can’t
give them raises. The only thing I can do is give them time
and a lot of positive feedback.
And the people that weren’t performing, I rated “below
satisfactory” and there was a lot of stink about that because
they had always been rated satisfactory for mediocre
performance. So it was pretty wild there for awhile.
Still Plagued by Operational Problems
By the end of her first year, Fleury had increased her staff to 19
(4) and felt she had made
some progress on all fronts. Several agencies were already
saving money by bringing
workers’ compensation recipients back to work, and the annual
increase in workers’
compensation benefits had dropped from 20 percent to 9
percent. The claims specialists
were making 50 to 60 percent of all major decisions on claims.
The number of injury
87-744.0
15
reports received late from agencies had dropped from 90 to 20
percent, and the overall
number of claims and bills processed late had dropped from 80

to 20 percent.
But problems in office operations persisted. Mistakes were
frequent—duplicated
payments, for instance, or check authorizations made in the
wrong amount, or addressed
to the wrong vendor. Phone inquiries often fell through the
cracks. The office was
perpetually out of routine supplies. Workers were so unfamiliar
with one another’s jobs,
no one could fill in when an employee was out sick or on
vacation. “Everybody was
under stress and the clericals hated the specialist staff and the
specialist staff was getting
upset with the clerical staff,” recalls Jahr. “The clerical staff
perceived us as dumping on
them. We perceived them as sloughing off.”
To try to get a handle on the problems, Fleury sat down and did
some of the tasks in the
office herself after hours “to see what the jobs were really like.”
She also tried to make
small improvements here and there. In one case, says Fleury,
“They’d thrown a
computer system in here in ‘83 and [someone] said ‘OK, before
you do anything on the
file, we want it on the computer.’ By the time it got back to us
from Data Processing, we
lost a week, maybe 10 days, and hadn’t even started to take any
action on the claim.” In
that instance, after conferring with her clerical staff, Fleury
arranged to have the claims
entered into the computer after her office had acted on them.
From a Labor and Industry
employee survey conducted in October 1984, Fleury learned, to
her surprise, that even

though she had spent relatively little time working with the
support staff, they appreciated
the fact that she had asked their opinions.
I thought that they would have really blasted me because I
felt like I wasn’t really spending that much time on them.
In some ways I was just kind of taking them for granted.
Taking for granted that they would answer the phone and
cover this and cover that. [But on the survey, the people
that were] most positive about having input and employee
participation and feeling like they had a sense of what was
going on and had some control were the clericals.
At the same time, Fleury was frustrated and felt that her
attempts to improve the process
sometimes created new problems:
What’s constant for us is the piece of paper that flows from
person to person. You change something about one
person’s job in dealing with that piece of paper and chances
are you’re having a ripple effect on the timing of how it’s
done.
87-744.0
16
So it was hard to make quick, simple improvements and Fleury
didn’t have time for

anything more elaborate. “There wasn’t enough of me to go
around,” she says.
And I didn’t know enough about the operation. I could talk
about technical things and legal things, but as far as getting
down and figuring out when a piece of paper should move
or how often it should move or who had to sign it, I could
care less. That was the hardest part of this job for me,
knowing I had to care about that.
By spring of 1985, Fleury decided she needed help in tackling
the problem. She accepted
the offer of a private consultant to do a free assessment of her
operation, but this did not
prove too helpful: “They came in and said, ‘Yep, these are the
problems that need to be
solved.’ They sat here and didn’t tell me anything I didn’t
already know.” For $20,000,
the consultants would come in and “re-do the structure and
streamline it,” she says, but
she could not afford the expense and was dubious about the
consultants anyway.
Finally, Fleury turned to John Mirocha, director of the
Department of Labor and
Industry’s Organization Management office, whose job was to
improve the internal
management of the department:
I said, “Help! I’m in over my head. I need someone to
come in and help me solve these systems problems.
Otherwise we’re going to go down. I’m going to go down
and everybody else is going to go down, even though we

really have good ideas and we’re making good headway. “
Organization Management's Agenda
In the spring of 1985, Keefe, his deputy David Renz, and
Mirocha were called together to
hear a presentation from a representative of the Department of
Administration about a
new program called Strive Toward Excellence in Performance
(STEP), designed to
encourage innovative management at all levels of the state
bureaucracy. Under the STEP
program, they were told, mid-level managers throughout state
government could submit
ideas for improving their divisions to their commissioners who,
in turn, could decide
whether to submit them to an independent steering committee
that would select a group
of “winners” (5).
State managers should be encouraged to think of the projects as
experiments and to find a
way to measure the results, the DOA representative explained.
They should design their
goals with close attention to the “customer” of their service and
with input from
87-744.0
17

employees. If possible, they should use modern management
techniques and create
partnerships with private businesses. While the Department of
Administration wanted all
state agencies to participate in the program, it was up to each
commissioner to decide how
to solicit proposals in his or her own department. Keefe
delegated to Mirocha the task of
coming up with at least one STEP project for Labor and
Industry.
Meanwhile, Mirocha had hired Mike Cuffe, a graduate student
of organizational
communication, as a part-time intern in November of 1984 and
had assigned him to
assess the training needs of managers at Labor and Industry.
The department was
suffering in many offices from “huge backlogs,” Cuffe
discovered. Through a colleague,
he learned of a new software product that he thought might
address this problem.
“Process Flow Analysis” (PFA), developed by the Minnesota-
based Control Data
Corporation, was a method of analyzing administrative
procedures and highlighting their
inefficiencies.
Cuffe visited Control Data to learn more about the product, and
while listening to
Principal Consultant Dick Booth describe its features, Cuffe
recalls, “I just had a creative
thought.” Cuffe asked Booth whether any other state offices
used PFA. No, Booth
replied.

Control Data had not yet been able to convince any state offices
to try it. Cuffe recalls: “I
said, ‘Well, my challenge to you is to join forces with us on a
joint venture to explore the
application of your technology to state government,’ and I
basically marketed the STEP
concept to them.” The managers of Control Data—a firm with a
reputation for public
spiritedness—quickly agreed to donate their software product
and training services,
hoping that a successful, high visibility pilot project might
encourage other state managers
to purchase PFA.
The next step for Cuffe was to find “an environment where we
could pilot it, it would
have support, and [where we] could get some management on
board at the middle
management levels.” State Claims Management seemed like a
good bet: “Denise was one
of the more progressive, newer people with that outside
perspective. We saw a real
opportunity.” When Cuffe proposed to Fleury that she agree to
try the PFA pilot
experiment in her office, however, Fleury was reluctant:
It was hard to sell it to me. I was under pressure [thinking],
“Are we going to have enough time to do this? We have
real work to do.” I said, “Mike, I’ve got a lot of things going
on, and I’ve got a lot of work to do, and I’m working long
hours and there’s no way I can do this and manage [the
office] too.”

87-744.0
18
But she agreed to attend a meeting for state managers at which
representatives of Control
Data explained PFA. There Fleury learned that PFA provided a
system for documenting
any work process in an office—that is, breaking it down into a
detailed series of steps.
The idea was that once a process was laid out in this kind of
detail, managers or
employees would have a clearer understanding of how work in
the office was actually
accomplished. This might be useful in a number of ways,
Control Data suggested: to
identify unnecessary steps in a process, to identify tasks
performed by an inappropriate
category of employee, to see how the work of one employee
affected the work of another,
or to speed the training of new employees. While much of the
actual work was done
before the information was entered in the computer, PFA
provided a structure and
common language for analyzing work flow, and the PFA
software translated the
information into a graphic display that highlighted potential
problem-spots in work
processes. “Several managers who were there walked out.
They thought it was real
boring,” Fleury recalls. “But it clicked for me and I was really
excited about it.”

1. A few large private sector companies are self-insured.
2. In fact, there was a lot of joking within the division about the
“cold and heartless” State Claims staff. One senior
clerical worker, Denita Johnson, says the staff began to relish
the Scrooge image: “I’d get on the elevator with
somebody and if they tripped, I’d just turn around and tell them
they were ‘denied.’”
3. Between FY 1975 and FY 1984, workers’ compensation costs
for Minnesota state employees rose from $1.7
million to $11 million.
4. The staff was made up of three lawyers, seven claims
specialists, two rehabilitation counselors, two account
clerks, and five general clerical workers.
5. The steering committee was made up of leaders in business,
government, and organized labor and was co-
chaired by the governor and the former chief executive officer
of Dayton Hudson, a major Minnesota-based

corporation. In addition to drawing a certain amount of fanfare,
the winning projects would be eligible for
training and administrative support from the staff of STEP.
87-744.0
19
Exhibit 1
87-744.0
20
Exhibit 1 (cont.)
87-744.0
21
Exhibit 2

Flow Chart: First Report of Injury
87-744.0
22
Exhibit 3
Flow Chart: Medical Bills
87-744.0
23
Exhibit 4
Denise H. Fleury
6409 Nicollet Avenue South
Minneapolis, Minnesota 55409
Home: 824-0362
Work: 830-1795

PROFESSIONAL A career in business utilizing my technical
and managerial skills.
OBJECTIVE
EDUCATION Currently, University of Minnesota Evening MBA
Program
University of Minnesota Paralegal Program
Macalester College, BA English
SKILLS/ASSETS Self-starter, work well under pressure, willing
to take
responsibility and make decisions, excellent analytical
skills, enjoy problem solving, excellent communication
skills, good developer of people, good sense of humor.
INSURANCE Seven years, Wausau Insurance Companies. Two
years as
EXPERIENCE an adjuster of casualty, property and product
liability
claims for all types of businesses, including construction,
trucking,
manufacturing, restaurants and hotels. One year as a Claim
Examiner.
Four years as Claim Supervisor, Workers' Compensation. As
Supervisor, I am responsible for high exposure claims,
supervising
investigations, coordinating and directing all rehabilitation and
litigation. I work directly with corporate policyholders,
keeping them
informed of losses, reserves and on-going claim activity.
RELATED Prepared extensive legal brief, product liability
case.
EXPERIENCE Wrote legal study of pregnancy as a temporary
disability.
Prepared position paper on HMO regulations for presentation to

the
Minnesota Legislature.
RELATED Risk Management and Insurance, Business Law,
Financial Accounting,
COURSEWORK, Business Statistics, Management and
Organization Theory,
U OF M Decision Science and Information Systems, Managerial
Economics,
Marketing Management, Financial Management, Income Tax
Law,
Real Estate Law, Litigation.
OTHER EXPERIENCE Waitress, to pay my way through
college
Mail carrier, U.S. Postal Service
Paralegal
Member, Twin Cities Moneymakers, an investment partnership.
C a s e T e a c h i n g R e s o u r c e s F R O M T H E E V A
N S S C H O O L O F P U B L I C A F F A I R S
T h e
E l e c t r o n i c
H a l l w a y ®
Box 353060 · U n i v e r s i t y o f W a s h i n g t o n · Seattle
WA 98195- 3060 ww w . h a l l w a y . o r g
This case was written by Mary K. Feeney, School of Public

Policy, at the Georgia Institute of Technology. The case is
intended solely as a vehicle for classroom discussion, and is not
intended to illustrate either effective or ineffective
handling of the situation described. Support was provided by
the Kellogg Foundation.
educational purposes per Member’s Agreement
(www.hallway.org).
FLU VACCINE CASE STUDY
General Overview
The 2004-2005 U.S. Influenza Vaccine Shortage
Influenza, or the flu, causes approximately 36,000 deaths and
200,000 hospitalizations
annually in the United States and costs the American economy
between $11 and $18
billion each year (General Accounting Office 2001b, page 1).
The primary method for
preventing influenza is the flu vaccine, which is generally

available in a variety of
settings including clinics, hospitals, schools, workplaces, and
other convenient locations.
The vaccine is typically distributed in October and November in
anticipation of the
winter flu season, which usually begins in late November and
peaks in February. For the
2004-05 flu season, the Centers for Disease Control and
Prevention (CDC) recommended
that as many as 185 million Americans receive flu shots. Among
those 185 million,
almost half (90 million) are considered high-risk (CDC 2004, 2;
GAO 2004). The high-
risk population includes adults 65 and older, infants six to 23
months old, pregnant
women, health care workers, those who care for children under
six months old, and
people with compromised immune systems or chronic illnesses
such as asthma, lung
cancer, and cystic fibrosis (CDC 2004; GAO 2004).
In recent years Americans have faced flu vaccine shortages on
multiple occasions. For
example, at the beginning of the 2000-01 flu season, demand for
the vaccine outstripped
supply, when problems developing a new viral strain and safety
and quality control issues
temporarily delayed vaccine delivery by 6-8 weeks (Cohen
2002, 1999; GAO 2001b).
The reduced supply resulted in an uneven distribution of
available vaccines and sharp
price increases as the cost of flu shots more than doubled from
the previous season (GAO
2001b, 2). In 2001-02, three manufacturers produced 87 million
doses of which almost
one-third were not available when demand for the vaccine

peaked. The following year
supply exceeded demand when only 87% of the 95 million doses
produced were
purchased. In 2003-04, demand exceeded supply when 4 million
doses were discarded
and 87 million doses were inappropriate for that year’s flu
strain (Brown 2004; GAO,
2001b, 2004)
The Institute of Medicine (IOM) notes that these recent
shortages have “highlighted the
fragility of vaccine supply” which is further complicated by
declining financial incentives
Flu Vaccine Case Study
2
to develop and produce vaccines (IOM 2003, 1). The high-risk
market, long-term
exorbitant production costs, and low profit margins have
reduced the number of vaccine
manufacturers in the US, from more than 25 companies 30 years
ago to only five in 2003
(IOM 2003, 1).
The production of the flu vaccination is a risky and long-term
venture for numerous
reasons.
1. Opening new facilities can take five or more years due to
high Federal
Drug Administration (FDA) quality standards.

2. Producing the flu vaccine takes six to eight months and the
formula
cannot be altered once production has begun.
3. Manufacturers must reformulate the vaccine annually to
address new
influenza strains, preventing manufacturers from reusing excess
supplies from the previous season.
4. There is extensive risk associated with predicting supply and
demand
for the flu vaccine because there is no mechanism for predicting
the
market.
5. Demand and supply in the flu vaccine market tend to be
fickle, shifting
from year to year or month to month based on the severity of
the flu
season, public health efforts to promote vaccination, and the
timing of
vaccine availability.
6. The profit margin for producing the flu vaccine is low
because
vaccines are sold at a low price relative to the high time, risk,
and cost
of producing safe and efficient vaccines.

7. Producing vaccines is particularly unprofitable in comparison
to
developing pharmaceutical drugs which patients purchase on a
daily
basis.
Pre cipitating Factors in the 2004-05 Flu Crisis
By 2004, two companies, Aventis and Chiron, produced all the
flu vaccine for the US and
hoped to provide 100 million dosages for the 2004-05 flu
season. In August 2004,
Chiron, a California-based company, announced to the FDA and
the Medicines and
Healthcare Products Regulatory Agency (MHRA) in Britain that
the 48 million doses
produced at Chiron’s plant in Liverpool, England, had been
contaminated. Concerns
about quality and safety at the Liverpool plant emerged as early
as 2003 following an
FDA inspection. At that time, however, the FDA allowed Chiron
to voluntarily fix the
problems and, based on reassurances from Chiron, the US
government believed the
bacterial contamination issue would be resolved. The FDA
proceeded to communicate
3

with Chiron via letters, emails, and phone calls, while the
MHRA took a more proactive
approach including inspections of the plant (Brown 2004).
In October 2004, to the surprise of the US government, the
MHRA suspended Chiron’s
license and closed the Liverpool plant. Dr. Shaffner of the
National Vaccine Advisory
Committee stated, “we have been reassured on a regular basis”
that the contamination at
Chiron was not going to be a major problem (Pollack 2004, 3).
Tommy Thompson,
Secretary of Human and Health Services reported, “we had no
idea” this suspension
would occur (Pollack 2004b, 1). By mid-October the FDA
confirmed that none of the
Chiron vaccine could be salvaged.
Media frenzy and public outrage followed the announcement
that Americans would not
receive almost half of the expected 100 million dosages of the
flu vaccine. Across the
nation long lines formed outside health clinics while others
rushed to Canada for the flu
shot. As with the 2000-01 vaccine shortage, when demand
surpassed supply, reports of
price gauging immediately appeared. For example, a pharmacist
was reportedly offered
10 doses that usually cost $67 for $700 (Altman 2004).
Meanwhile Shore Memorial
Hospital in New Jersey was offered 8,000 doses, which had
been illegally smuggled into
the US, at the price of $60 each (Associated Press 2004a).
Besides price gauging, in a
more extreme case, 620 vaccine dosages were stolen from a

Colorado pediatrician’s
office (Belluck 2004).
In addition to the rising cost of flu sho ts, distributing available
vaccines quickly became a
problem. The distribution issues came as no surprise to federal
officials or health care
workers who have long known about the fragility of the US
vaccine market. Following
the 2000-01 vaccine shortage the GAO published a report
outlining the issues related to
vaccine shortages and recommending policies to prevent future
problems. The report’s
primary concern was that there is “no system to ensure that
high-risk people have priority
when the supply of vaccine is short” (General Accounting
Office 2001b, 3).
Because the production, sale, and distribution of the flu vaccine
are private enterprises,
the available 2004 vaccine supply was unevenly distributed
throughout the nation. Those
health facilities that ordered the vaccine from Chiron were left
with no dosages, while
others, supplied by Aventis, had their entire order filled
immediately. Distribution is
based on type of health care provider, not the level of risk
among patients. Public
officials know very little about how flu vaccine supplies are
shipped and to whom,
making it difficult to impossible for the government to
intervene in the distribution of the
available vaccine produced by Aventis.
The CDC responded to distribution concerns by recommending
that health care providers

ration the vaccine to high-risk patients. However, because the
CDC lacks the authority to
intervene in the distribution process or enforce guidelines, the
recommendation left
states, health care centers, county health departments, and
doctors to determine how to
distribute the vaccine. Many flu shot providers asked healthy
adults to voluntarily pass up
the vaccine, leaving available supplies for high-risk individuals.
In Maryland, the state
immunization center operated as a vaccine broker to ensure that
public health agencies
4
received 100% of their orders. Meanwhile, in Virginia, the state
divided available
vaccines proportionately to census data (Levine 2004b). In rare
cases, such as the District
of Columbia, flu shots were strictly reserved for high-risk
patients (Levine 2004a).
However, in general, city and state officials did not deny the
vaccine to healthy people
who wanted it.
In response to price gouging and distribution issues the CDC
created a panel to
investigate the ethics of distributing the flu vaccine. In
addition, a Federal task force, the
Flu Action Task Force, was convened to manage the federal
vaccine supply, coordinate
efforts, and prevent price gouging (Harris 2004b). By mid-

October, federal agencies
began distributing their store of flu dosages to high-risk areas
and within one week a total
of 3.2 million doses had been sent to high priority groups. That
same week many
hospitals began sharing flu vaccine supplies. The federal
government also diverted an
additional 300,000 doses from federal employees and the
military to the high-risk civilian
population.
Once it was confirmed that the entire Chiron supply was
unsalvageable, the federal
government began to look overseas for additional doses. Tommy
Thompson announced
that Aventis would have 2.6 million more doses of the flu
vaccine by January 2005. The
US also began negotiating with an ID Biomedical plant in
Canada and GlaxoSmithKline
in Germany to purchase additional doses. Unfortunately, those
purchases were delayed as
they awaited FDA approval. By early December President Bush
confirmed that the US
would purchase 1.2 million doses from Germany (Connolly
2004b) (1). The FDA
requires patients to sign a consent form for the more costly
doses from Germany since
they are not licensed in the US.
Many state officials also began looking for alternative methods
to obtain the vaccine for
their high-risk populations. Illinois Governor Rod Blagojevich
(D) located 750,000 doses
overseas and requested permission from the FDA to purchase
them. In New York City,
Mayor Michael Bloomberg (R) requested 500,000 dosages of the

flu vaccine from federal
health agencies for high-risk residents. When that request was
denied, Bloomberg
decided to spend $2 million to buy vaccines from manufacturers
in Germany and Canada
however that purchase too would require FDA approval
(Connolly 2004a).
Unfortunately, previous experience indicates that people will
not rush to purchase these
delayed supplies. For example, during the 2000-01 flu season,
the late shipments went
unused or sold at very low prices. According to Rod Watson,
president of Prevention
MD, an immunization and medical screening company in
Seattle, he cancelled numerous
flu-shot clinics in October, and by December 2004 had excess
shots he could barely give
away let alone sell (Associated Press 2004b). The same lack of
demand occurred in states
such as California, Colorado, and Texas despite the fact that
December vaccinations
would still protect many people during the peak flu mont h,
February.
1Ceci Connolly. 2004. “U.S. to Buy German Flu Vaccine”,
Washington Post, December 8, A02, reports 1.2 million.
Pollack,
Andrew. 2004. “More Questions for Producer of Flu Vaccine.”
The New York Times , December 11, reports up to 4 million.

5
Attachment 1 - Influenza Facts and Figures
• Influenza causes approximately 36,000 deaths and 200,000
hospitalizations
annually in the US.
• Nearly 90 million Americans are at high risk for getting the
flu.
• Estimated annual costs of the flu to the US economy are $11 -
$18 billion.
• As of 2004-05, two companies, Aventis and Chiron, produce
all flu vaccines for
the US and deliver that vaccine in October and November.
• In 2003-04 the US had 80 million doses of flu vaccine
(ironically, they were not
appropriate for that year’s flu strain).
• In 2000-01 delivery of the flu vaccine was delayed until
December because of a
vaccine production problem.
• Health officials have warned about the fragile vaccine

situation in the US for
decades (Cowley, 2005).
• The “Flu vaccine marketplace has been withering for years”
(Thompson, 2005).
6
Attachment 2 - Flu Time Line 2004
Aug 26, 2004 Bush administration announces first national plan
for how US can prepare for
and respond to an influenza pandemic. Tommy Thompson,
secretary of health
and human services said, “A pandemic virus will likely be
unaffected by
currently available flu vaccines”
Aug 27, 2004 Chiron announces contamination of 50 million
doses (nearly half the US
supply) of flu vaccine. Chiron is based in California, but
manufactures the
vaccine in Liverpool, England. About 90% of the vaccines
produced at
Chiron go to the US. US government and Chiron both contend
that the flu
vaccine problem would be resolved by Oct/Nov when
Americans receive flu

vaccinations.
Oct 5, 2004 UK suspends Chiron’s license. The Chiron license
suspension came as a
surprise to the US government. “We had no idea,” said Tommy
Thompson.
Dr. Schaffner of the National Vaccine Advisory Committee
stated that “we
have been reassured on a regular basis” that the contamination
at Chiron was
not going to be a major problem.
Oct 7, 2004 CDC recommends rationing vaccine to high risk
patients only
Oct 8, 2004
CDC says that someone will investigate reports of price
gauging, but does not
specify what agency. AP reports charges against a Kansas
distributor who
tried to sell vaccine with 1,000% markup.
Oct 12, 2004 House Government Reform Committee opens
investigation of FDA response
to August reports of contamination problems at Chiron. CDC
and FDA may
have known about Chiron’s license suspension and shortage as
early as Sept
13th.
Oct 13, 2004 620 vaccine doses stolen in Colorado
Oct 13, 2004 Feds begin to distribute flu dosages and divert
vaccines to high risk areas
Oct 15, 2004 DC denies flu shots to non high-risk people
Oct 17, 2004 FDA confirms no vaccines from Chiron can be

salvaged
Oct 18, 2004 Tommy Thompson announces Aventis will have
2.6 million more doses of flu
vaccine in January 2005.
Oct 18, 2004 US negotiating with Canada to get 1.5 more
vaccine dosages
Oct 19, 2004 Hospitals start sharing flu vaccine supplies.
Federal task force, Flu Action
Task Force, will manage vaccine supply, coordinate effort, and
prevent price
gouging.
Oct 20, 2004 Canadian doctors asking for Canadian ID before
giving vaccine. Canadians
argue Bush administration is hypocritical by not allowing
Canadian drugs into
US, but then asking for flu vaccines.
7
Attachment 2 - Flu Time Line 2004 (cont.)
Oct 22, 2004 Tommy Thompson says, “we are prepared” and
claims Bush administration
increased spending on flu from $39 million in 2001 to a
proposed $283

million next year. Thompson argues that the US has a “healthy”
supply of flu
vaccine and 61 million doses will be available to the 90 million
high risk
Americans (you do the math).
Oct 22, 2004 3.2 million doses sent to high priority groups
Oct 22, 2004 Many Americans go to Canada for vaccination
Oct 22, 2004 US looking to Europe for vaccines (France!)
Oct 28, 2004 CDC creates panel on ethics of vaccine
distribution
Oct 28, 2004 Feds divert 300,000 doses from federal employees
and military to high risk
civilian population.
Oct 28, 2004 United States identifies 5 million flu vaccine
doses at Canadian and German
plants, but awaits FDA approval, which should come in
December.
Oct 30, 2004 Vancouver offers special flu vaccination clinic
for Americans, $40 per dose.
Nov 1, 2004 WHO plans a Nov 11th summit of flu makers and
nations
8
Attachment 3- Flu Time Line 2005
Aug 12, 2005 ID Biomedical Corporation’s influenza virus
vaccine (Fluviral) receives the FDA

approval for a fast track designation. Fast track designation, a
result of the FDA
Modernization Act of 1997, facilitates and expedites the review
of new drugs to treat
serious or life-threatening diseases and address unmet medical
needs.
Oct 6, 2005 Senators Clinton (D-NY) and Roberts (R-KS)
introduce legislation to ensure an
adequate flu vaccine supply. "Despite three shortages of
seasonal flu vaccine since
2000, we still don't have the flu vaccine production and
distribution infrastructure we
need to ensure a stable supply and demand for seasonal flu
vaccine, raising serious
concerns about our ability to respond to a flu pandemic or an
outbreak of avian flu,"
said Senator Clinton.
Oct 11, 2005 Indiana State Medical Association used their
private stock to vaccinate high risk
children. The Indiana State Department of Health uses funds
from the federal
program, Vaccines for Children, to stockpile doses for
uninsured and underinsured
children.
9

Attachment 4 - References
1. Altman, Lawrence K. 2004a. A Big Maker of Flu Shots Finds
Some
Contaminated. The New York Times, August 27, A14.
2. Altman, Lawrence K. 2004b. U.S. Inquiry in Price Rises for
Flu Shots. The New
York Times, October 8, A23.
3. Associated Press. 2004a. Flu Shot Supply Grows, but
Demand Withers.
December 13.
4. Associated Press. 2004b. Flu Vaccine Smugglers Thwarted.
November 24.
5. Belluck, Pam. 2004. A Headache and a Fever: Long Lines for
Flu Shots. The New
6. Bozeman, Barry. 2002. Public-Value Failure: When Efficient
Markets May Not
Do. Public Administration Review 62, 2: 134-151.
7. Brown, David. 2004a. Canada's Vaccine Plan May Be Model
for U.S.
Washington Post, October 25, A03.
8. Brown, David. 2004b. How U.S. Got Down to Two Makers of
Flu Vaccine.
Washington Post, October 17, A01.
9. Brown, David. 2004c. U.S. Knew Last Year of Flu Vaccine

Plant's Woes.
Washington Post, November 18, A01.
10. Cohen, Jon. 2002. U.S. Vaccine Supply Falls Seriously
Short. Science, March 15,
1998-2001.
11. Connolly, Ceci. 2004a. N.Y. Mayor Has Plans to Import Flu
Shots. Washington
Post, November 10, A03.
12. Connolly, Ceci. 2004b. U.S. to Buy German Flu Vaccine.
Washington Post,
December 8, A02.
13. Cowley, Geoffrey. The Flu Shot Fiasco. Newsweek.
MSNBC. Retrieved on Nov
18, 2005 from
http://www.msnbc.msn.com/id/6315714/site/newsweek/
14. Department of Health and Human Services. 2004. Interim
Influenza Vaccination
Recommendation - 2004-05 Influenza Season. Atlanta, GA:
Centers for Disease
Control.
15. Edwards, John. 2004. Senator Edwards asks GAO to Probe
Flu Vaccine Shortage
2003 [cited November 22 2004]. Available from
http://edwards.senate.gov/press/2003/1210-pr.html.
10

Attachment 4 – References (cont.)
16. Enserink, Martin. 2004. Crisis Underscores Fragility of
Vaccine Production
System. Science, October 15, 385.
17. General Accounting Office. 2001a. Flu Vaccine: Steps are
Needed to Better
Prepare for Possible Future Shortages. Statement of Janet
Heinrich, Director,
Health Care-Public Health Issues. In Special Committee on
Aging. Washington
DC: United States General Accounting Office.
18. General Accounting Office. 2001b. Flu Vaccine: Supply
Problems Heighten
Need to Ensure Access for High-Risk People. Washington DC:
United States
General Accounting Office.
19. General Accounting Office. 2004. Infectious Disease
Preparedness: Federal
Challenges in Responding to Influenza Outbreaks. Washington
DC: United States
General Accounting Office.
20. Harris, Gardiner. 2004a. Advice on Vaccine Shortage is
Lacking, Local Officials
Say. The New York Times, October 22, A12.
21. Harris, Gardiner. 2004b. U.S. Creates Ethics Panel on
Priority for Flu Shots. The
New York Times, October 28, A18.

22. Institute of Medicine. 2003. Financing Vaccines in the 21st
Century: Assuring
Access and Availability. Washington DC: Institute of Medicine,
The National
Academies.
23. Kettl, Don. 2004. More than the Flu. Governing Magazine-
On -line, December,
2004, downloaded May 25, 2005,
http://www.governing.com/archive/2004/dec/potomac.txt
24. Levine, Susan. 2004a. A Painstaking Parceling:
Communities Agonize Over Flu
Vaccine Distribution. Washington Post, November 21, 01.
25. Levine, Susan. 2004b. D.C. Plans Flu Shot Crackdown:
Only High Risk People
get Doses under Emergency Order. Washington Post, October
15, 2004, 02.
26. Ozols, Jennifer Barrett. 2004. We Are Clearly Not Prepared.
Newsweek, October
25, Society Page 00.
27. Pollack, Andrew. 2004a. More Questions for Producer of
Flu Vaccine. The New
York Times, December 11, C3.
28. Pollack, Andrew. 2004b. U.S. Will Miss Half Its Supply of
Flu Vaccine. The New

11
Attachment 4 – References (cont.)
29. Pollack, Andrew. 2004c. Vaccines Are Good Business for
Drug Makers. The New
York Times, October 29, C1.
30. Ruethling, Gretchen. 2004. In Minnesota, Flu Vaccines Go
Waiting. The New
York Times, November 12, A16.
31. Simon, Herbert A., Victor A. Thompson, and Donald W.
Smithburg. 1950. Public
Administration. New Brunswick, NJ: Transaction Publishers.
32. Thompson, Tommy G. 2004. Flu Vaccines and Antivirals.
Remarks by Secretary
of Health and Human Services. United States Department of
Health and Human
Services. October, 19. Hubert H. Humphrey Building,
Washington, DC. Retrieved
from http://www.hhs.gov/news/speech/2004/191004.html on
October 29, 2005.
33. Vedantam, Shankar. 2004. U.S. to Direct Flu Shot
Shipments. Washington Post,
October 13, 01.
34. Waxman, Henry A. 2004. Flu Vaccine Crisis: The Role of

Liability Concerns.
Washington, DC: US House of Representatives, Committee on
Government
Reform.
T h e
E l e c t r o n i c
H a l l w a y ®
Box 353060 · U n i v e r s i t y o f W a s h i n g t o n · S e a t
t l e W A 98195- 3060
www.hallway.org
This case study was made possible through the generous
contributions of the Institute for Local Government and
Public Service in Budapest, Hungary. Its distribution through
the Electronic Hallway system is made possible through
the Pew Charitable Trusts’ generous support of the Public
Service Curriculum Exchange. The case was prepared by
Vassily Selishchev, Professor at the Belarus Educational Center
for Leadership Development in Minsk, Belarus.
Professor Selishchev was a participant in the Cascade Center for
Public Service’s 1994-95 Case Project for Central
and Eastern Europe.

(www.hallway.org).
A CHANGE OF LEADERSHIP AT THE
LOCAL EDUCATION AUTHORITY
After hanging up the phone receiver, Ales Rakovich, the new
Local Education Authority (LEA)
head in the town of Rubensk, sat back to collect his thoughts.
The call from Zenon Gvozd, the
head of the Regional Education Authority, was very disturbing.
The conversation revealed
Gvozd’s extreme dissatisfaction with the work of the Rubensk
LEA staff. Rakovich knew that
he had to act immediately to address the situation.
Among the issues brought to Rakovich’s attention were
problems laid at the feet of Olga
Vasyuk, the LEA secretary, which were interfering with the
effectiveness of the LEA operation.
Even though Rakovich had spoken with Olga about her
performance several times, nothing had

ever changed for the better. Besides the phone call from the
REA, he had also received recent
complaints about Olga from the heads of the LEA departments.
Background
Lyubenski was a small, remote rural district in southern
Belarus. There were about 35,000
people living in the area, working mostly in agriculture. Most
residents had lived in this place for
a long time and knew each other relatively well. The school
district was not big--about eight
schools (including one vocational school for agriculture and one
music school)--with between
sixty to two-hundred children attending each school.
Very few newcomers came to settle in the area, which had been
severely polluted during the
Chernobyl nuclear plant explosion. There were thus many
vacancies in the local schools. In
addition, there were problems with hiring virtually every kind
of teacher or school administrator.
It was also quite difficult to find employees for office work, as
salaries were very modest.
A Change of Leadership at the Local Education Authority (A)
2
The Belarus Educational Administration System
The system of educational administration in the Republic of
Belarus was highly centralized. All
decisions were made at the top and imposed on mid-level

administrators, who did not
participate in the decision-making process. This system bred
administrators who were not
willing to make decisions on their own, as independent
decision-making was accompanied by
stress and greater responsibility which the administrators tried
to avoid. They considered it to
be much safer to monitor the accomplishment of tasks and
execution of decisions made by top
administrators. Thus they considered the control function, or
maintaining the status quo, to be
the most important aspect of their work.
The heads of the local Authorities were thus subject to long-
term pressure of varying degrees.
Very often they were valued not for their professional skills,
but for their ability to conform to
the policies and procedures dictated by top administrators.
Even experienced administrators
had no idea what educational leadership was or how the
organization should be managed.
Many them managed their educational or administrative support
organizations intuitively, basing
their decisions only on their own previous experience. Most
had received no formal training in
management, leadership or administration.
The Local Educational Authority (LEA) in Rubensk
The Local Education Authority office was situated in Rubensk,
which was located in the
Lyubenski district. There were fourteen people working in the
office. Before Ales Rakovich’s
arrival, the head of the LEA office had been Adam Lozinsky.
He was an experienced
administrator and had served for five years in this position.

The role of the Lyubenski LEA was very important, as it served
the rural population in a
disadvantaged area of the country. The LEA was involved in
such activities as: allocating and
distributing educational resources, hiring teaching staff,
organizing staff development programs,
designing and implementing assessment and evaluation
procedures, and overseeing curriculum
development.
As part of the centralized system of educational administration,
the LEA monitored and
controlled the implementation of the policies and decisions of
the Regional Education Authorities
(REA), which in turn received decisions and policy directives
ready-made from the national
Ministry of Education and Science.
This period of education development in Belarus was
characterized by the transition to
liberalism, which proceeded rather slowly given the
unpredictable political environment. This
transition was accompanied by uncertainties in the division of
rights and responsibilities between
the national authorities (Ministry of Education and Science) and
the Educational Authorities in
the regions and localities. For LEA administrators, the
situation meant constant change,
3

adapting to new conditions, varied student needs, new economic
demands and development
imperatives.
The Rubensk LEA consisted of three departments: primary
education, secondary education,
and vocational education (Attachment 1). Each department was
comprised of the head of the
department and three administrative employees. The heads of
the individual departments
reported to the head of the LEA. The LEA head was
responsible for hiring and supervising all
departmental employees, although to undertake disciplinary
actions and/or to fire the
employees, the LEA head had to consult with the head of the
Regional Educational Authority.
The Rubensk LEA had one secretary, Olga Vasyuk, who had
been hired by Adam Lozinsky
about three years before Ales Rakovich’s arrival. Olga was the
sole clerical employee in the
office. (See Attachments 2 and 3 for LEA employee job
descriptions.)
Organizational Culture
Under the stewardship of former LEA head Adam Lozinsky,
there had been a tradition in the
organization of following the working habits of the head
administrator. Thus, there were no
formal policies defining when staff had to arrive at the office
and when they could leave work
each day. The national Ministry of Education regulations
defined the length of the working day
(eight hours), but did not decree specific work schedules.
Because Lozinsky had typically arrived in the office at nine in
the morning and left at five in the

afternoon, everybody in the office followed this pattern. This
tradition became a part of LEA
office culture--an informal, but common working norm which
was followed by most LEA
employees. It lent predictability to the operation and to the
work of LEA employees.
The Secretary
Olga was the only secretary in the LEA office. Her
responsibilities included working for the
LEA head and for the three department heads. Olga did a lot of
computer work, since she was
responsible for sending letters and reports to the district and
regional Education Authorities.
She enjoyed her work; she liked to type and to meet people.
Olga didn't mind when employees
from the departments asked her to do some small tasks (e.g.
looking for documents, answering
phone calls) for them.
From the time she was hired, Olga considered Adam Lozinsky
(and later Ales Rakovich) to be
her real supervisor, though there were no official regulations
defining to whom she formally
reported. Olga was a very good worker in many ways. She
knew the answers to practically
everything and she had good communication skills. Local
principals, kindergarten directors,
teachers, and parents had often commented to Lozinsky about
how much they appreciated
Olga's helpfulness and friendliness.
But Olga had some negative qualities. She was not particularly
orderly. First and foremost, this
became apparent through her work with LEA documents and

files. Over the course of a typical
4
day, Olga had to prepare documents, answer telephone calls,
and take messages for the head
of the LEA and for the heads of the departments. Her desk
would inevitably become a mess.
It was usually piled high with letters, messages, and pages from
files she had pulled while
answering calls or preparing documents or messages. Olga
sometimes forgot to put documents
back in their proper files and she never threw away papers she
didn't need anymore.
Once or twice a month, when her desk became a complete mess,
Olga would spend the whole
day cleaning it. After such episodes, her desk was a model of
organization. But this was a
temporary state and her desk soon became covered with papers
again, as Olga continued to do
things in her own disorderly fashion.
Olga’s second major shortcoming was that her arrival at the
office each morning was very
unpredictable. When she worked for Adam Lozinsky, she would
arrive at work from five
minutes to a half- hour after her boss every day. However, she
usually stayed at work later than
most other LEA employees. Olga was typically in the office
until 6:30 or 7:00 p.m. waiting for
her husband to pick her up. During that time, she answered

phone calls and assisted visitors
who dropped in after-hours. Many of these people worked in
small schools or farms far from
the central office, and could only visit the LEA office after their
working day was over. Since
Lozinsky and LEA department heads often scheduled meetings
after official working hours, they
found having Olga in the office to be very convenient.
From time to time, Adam Lozinsky would speak to Olga about
her tardiness in the mornings,
and about how critical it was to return LEA documents to the
files so that others could access
them when they needed to. The files were organized into
several key groups: the first contained
information about teaching evaluations; the second group
included educational institutions’ work
plans and data on student test scores and achievements. The
third file-group contained financial
information, including the detailed budgets of local schools,
special program funds (e.g.
additional funding for the Chernobyl zone), salary data, etc.
Many of these documents were
classified “confidential” and were not intended for general use.
Within each file-group, folders were arranged according to their
importance and frequency of
use. Often, after Olga had used the files, certain documents
were missing one or more pages,
or were missing altogether.
During her periodic conversations with Lozinsky, Olga would
always promise to improve, but
within several days she would have resumed her usual practice.
A New Regime at the LEA

After Adam Lozinsky retired, Ales Rakovich was appointed to
direct the LEA office. Rakovich
had previously worked in a neighboring region. His work habits
were different from those of
Lozinsky. Rakovich spent a lot of time in the field, getting
acquainted with the facilities and
5
employees across the school district. He usually began his day
by visiting the principals of area
schools.
He usually started work at eight each morning, but was out of
the office until close to noon. The
period from 9:00 to noon or 1:00 p.m. was, as a rule, the most
busy period in the LEA office,
as many people called and important messages were taken. It
was during this time that
Rakovich was out in the field, visiting schools, riding from one
school to another, and it was very
difficult to locate him. However, he usually informed Olga of
his whereabouts.
Because Rakovich was out of the office most mornings, LEA
employees soon began arriving to
work at different hours. As a result, there was often no one in
the office at nine or half past nine
to answer calls or greet visitors.
Conflict

Regional Educational Authority (REA) officers called
practically every day to ask for statistical
information that LEA was responsible for preparing on a regular
basis. Such information
included data on teacher assessment, school reports, student
grades, student absenteeism,
financial reports or additions to them, and other standard
documents. REA officers typically
called Rakovich’s office for this information, but, due to Olga’s
absences, these calls frequently
went unanswered. If other staff members happened to be
standing by her desk, they would
answer the calls. However, they had such a difficult time
locating the necessary documents that
they were unable to answer inquiries effectively. Very soon
they gave up trying.
After trying to reach Olga several times without success, a
frustrated REA officer mentioned in a
phone conversation with LEA’s primary-education department
head that he was going to report
this problem to the head of the REA. Consequently, Ales
Rakovich and the LEA department
heads were forced once again to discuss with Olga the impact of
her working habits. As she
had done in the past, Olga promised to change but then did little
about it.
Finally, when Olga failed to give the primary-department head a
very important message from
the REA and sent the documents intended for one principal to
that of another school, the LEA
department heads complained again to Rakovich. The situation
began to escalate very quickly;
it was clearly influencing the effectiveness of LEA’s work and
its standing in the community.

Even Rakovich’s reputation as a capable manager was
endangered.
REA Chief Applies Pressure
The situation finally culminated in a phone call between
Rakovich and Zenon Gvozd, the
Regional Education Authority (REA) head, who expressed his
dissatisfaction with the working
habits of LEA staff. The REA head said that he had recorded
several cases when his messages
clearly hadn’t reached Rakovich. He also informed Rakovich
that, due to the inadequate work
of the LEA staff and their inability to provide information to
their chief, Rakovich had missed a
very important meeting with the head of the State Commission
on Radiology about the
6
consequences of the Chernobyl catastrophe. During that
meeting, the problem of allocation of
additional resources to educational districts in the polluted
areas was discussed. With the
exception of Rakovich, all district heads were present and were
able to present and justify their
districts’ needs.
This reflected poorly on Rakovich and seriously damaged the
reputation of the LEA. Word
about the LEA office had filtered down to district constituents,
who were talking, as Rakovich

learned, about his inability to improve educational services and
the financial condition of
kindergartens and schools. Some even said that Rakovich was
neglecting the interests of local
people.
Rakovich knew that if he didn’t take immediate action to rectify
the situation, such events would
be increasingly damaging to his department. He sat down to
decide what to do.
7
Attachment 1
LEA Organizational Chart
8
Attachment 2
Job Descriptions: LEA head and LEA secretary
Local Educational Authority Head Organizes and monitors the
work of the LEA. Reports to the

REA head. Responsible for organizing those educational
activities in the district aimed at achieving educational goals
developed by the Ministry of Education and Science.
Monitors the work of local schools and evaluates their
progress on their annual plans. Responsible for providing the
necessary financial and programmatic conditions under which
the schools can operate successfully.
LEA Secretary Responsible for maintaining and responding to
requests about
documents. Should perform in accordance with the
regulations and protocols approved by and used in the LEA.
Collects information requested by the LEA head from LEA
departments, schools and top authorities. Organizes meetings
between visitors and LEA head. Makes and answers phone
calls, takes phone messages for the LEA head and relays
them to him. Types necessary materials. Monitors incoming
information from the regional and national offices. Must
understand the structure of the organization, the protocols for
completing and organizing documents, how to operate office
machines, the rules of orthography, and LEA internal job
regulations and operations guidelines. Secondary school
education is required.
9
Attachment 3
Job Descriptions: Primary education department
Head of the department Reports to the LEA head. Is the LEA

head
deputy. Organizes and supervises the work of
the department.
Advisory officer Deals with educational technologies, teaching
methodology, teaching resources. Responsible
for conducting annual and biannual evaluation
of primary education organizations. Monitors
and assists the evaluation of the teachers in the
schools.
Training officer - analyst Deals with retraining of teachers and
principals (organizes teachers’ and principals’
participation in the retraining courses and
programs). Conducts analysis of primary
education organizations’ accomplishments.
Defines services gaps, makes prognosis, etc.
Book keeper Organizes and monitors distribution of state
finances to the primary education
organizations (PEO). Assists in developing
budgets of PEO’s. Responsible for effective
allocation of taxpayer money in the district,
etc.
NOTE: The structure of the secondary education and vocational
education departments are the
same.
PADM 520 - Public Administration and Society
Case Study Format
Dr. Kristen Obst

CASE STUDY FORMAT
Pick one of the case studies available in the “Case Studies”
folder and analyze it roughly following this format. Your paper
should be 8-10 pages in length and should follow APA format.
For help with APA please consult the library website.
A case study is intended to look at one public management issue
in close detail. Most often, these cases will be embedded in a
political system in which actors exercise power and influence
over processes and decisions. We are interested in cases for
both their uniqueness and commonality. Cases are organic and
built into a socio-political environment; hence, we observe
working parts that connect people with programs in some sort of
purposive fashion. Some cases are so important in themselves
that we focus on studying their intrinsic qualities. Other cases
are applicable to important public administration and public
policy questions. Hence, they are considered instrumental to
understanding larger issues. Following is a good format to
follow when organizing your case study analysis:
1. Introduction
The introduction provides the reader with summary background
information for the event analyzed in the paper. Its purpose is to
establish an analytical framework for the study, so that the
reader can understand how it is related to other research. The
Introduction has multiple purposes, namely to create reader
interest in the topic, establish the problem that leads to the
study, place the study within the larger context of the scholarly
literature, and reach out to a specific audience. Identify the
public management issues you believe are relevant and need to
be addressed or resolved via this study.
2. Literature Review
While this event may seem unique, chances are pretty good it is
not. What has previous research shown about this issue? How
has this problem been addressed at other organizations? The
review of previous research accomplishes several purposes. It

shares with the reader the results of other studies that are
closely related to the study being reported, it relates the study
to the larger, ongoing dialogue in the literature about the topic,
and it provides a framework for establishing the importance of
the study. It can serve as a benchmark for comparing the results
of the study with other findings.
3. Analysis
The analysis compares the findings of the study with
benchmarks established in the review of literature. It may point
out similarities and differences, agreements and contradictions,
and posit explanations for these relationships. Normally, it will
not assume a burden of proof or disproof, nor claim superiority
or insights not justified by the small sample size or singularity
of the subject or methodology. Cautious conjecture, with
appropriate language and solid reasoning, however is
encouraged. Since we are not collecting data in our case studies,
they are merely anecdotal, we do not have data to analyze here
as you might in a more formal study.
4. Conclusions and Recommendations
Although this section does not need to be long, the writer has an
opportunity to tie up loose ends, summarize findings, and draw
inferences. Specific recommendations are a good way of
concluding the paper. The writer should recommend possible
changes in current administrative practices, suggest new
methods of management or analysis, or propose changes in
ordinances and statutes, for example. The recommendations
should flow from the present study and be related directly to the
analysis. Don’t ever leave a paper without summarizing your
main points otherwise you leave the reader (in whose hands is
your GPA!) feeling abandoned.
5. References
You should be citing your sources parenthetically throughout
the paper, but you must list your sources at the end of the paper.
Please follow APA format for your references section. A list of
websites does NOT constitute works cited.

PADM 520 - Public Administration and Society
Case Study Grading Rubric
Dr. Kristen Obst
TASK
POSSIBLE
EARNED
Summarize public administration issue
25
Summarize related research
15
Draw connections to text
15
Compare and contrast studies, support with examples
10
Summarize your findings
10
Recommend changes in current administrative practices
15
References
10
TOTAL
100
� Based on the Case Study Format used at SHRI SHIVAJI
VIDYA PRASARAK SANSTHA'S BAPUSAHEB SHIVAJIRAO
DEORE COLLEGE OF ENGINEERING. Retrieved February 9,

2009 from
ssvps.com/~comp.download/CASE%20STUDY%20FORMAT.do
c
T h e
E l e c t r o n i c
H a l l w a y ®
Box 353060 · U n i v e r s i t y o f W a s h i n g t o n · Seattle
WA 98195- 3060
www.hallway.org
This case was prepared by Richard F. Elmore while on the
faculty of the University of Washington’s Graduate School
of Public Affairs. The dialogue is based on the transcripts of a
legislative hearing but has been disguised in the
interests of confidentiality.

(www.hallway.org).
THE COMMITTEE CHAIR, THE ASSISTANT SECRETARY,
AND
BUREAU CHIEF
The following dialogue occurred in the course of a legislative
hearing. The Assistant Secretary is
a political appointee in charge of the budget in a large agency.
The Bureau Chief is a career
official who runs a bureau within the agency; the Bureau Chief's
responsibilities include, among
other things, the management of the Indian Health Program.
The Committee Chair is of the
opposite political party from the Assistant Secretary and has
chaired the committee with
jurisdiction over the Commissioner's Bureau for about ten years.
The Ranking Minority
Member is of the same political party as the Assistant Secretary.
Committee Chair: I've been concerned for some time that the
administration is growing
increasingly out of touch with the needs of certain of our less-
privileged citizens. I've
communicated that to you, Mr. Assistant Secretary, on several
occasions. Now, I'm frankly
quite distressed about what the administration is apparently

proposing to do to the Indian Health
Program. You are responsible, are you not, Mr. Assistant
Secretary, for preparing your
agency's budget submissions for the next fiscal year?
Assistant Secretary: This is more or less correct. The various
operating programs submit
their budget requests to my office, we evaluate them according
to the Secretary's and the
administration's policies, and then the Secretary submits them
to the Office of Management and
Budget for final approval before the administration's budget is
presented.
Committee Chair: Last year, you requested large reductions in
funding for the Indian Health
Program, did you not? They were on the order of 40%, as I
recall. I was successful in
reversing that request, over strenuous opposition from you and
other representatives of the
administration. I would like to know whether you will be
renewing that request in this year's
budget.
The Committee Chair, the Assistant Secretary, and Bureau Chief
2
Assistant Secretary: I'm afraid I can't say, since the
administration's budget is still being
prepared.
Committee Chair: Mr. [Bureau Chief], will you tell the

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