Downsizing at the Dodge Clinic

This is a finely woven case about a hospital's decision to overcome its operating loss by downsizing. The case, which is presented in three parts, forces students to grapple with complex decision-making processes as they follow the divided debate of the hospital's governing board.

The Case A deals with the board's divided debate, in which members argue the need for massive layoffs, enhanced training and development with no layoffs or a shift in focus to incentive and the addition of financial risk. Many of the members do acknowledge the need for Continued Quality Investment (CQI).

In Case B, we see the clinic's administrator make a final decision, which is essentially a compromise between many of the opinions presented in the debate. Case C looks at the effects of the decision on the hospital's staff from which 32 people have been discharged leaving the remaining staff in an alternating mix of depression and renewed seriousness/energy.

Students are forced to consider the advantages and disadvantages of the decisions made in the downsizing and steps that the leadership can take to rebuild the staff's morale. This case provides students with critical lessons in physician group practice, cost management, downsizing and continuous quality improvement. Dealing with three points in time, this highly complex case also offers a valuable perspective on cumulative decision making.