Dissertation Proposal - Health Care Management

Dissertation Proposal (Healthcare Management)

By Priyanka Singhal Delhi

Table of Content Aim......................................................................................................................................3 Objectives............................................................................................................................4 Introduction..........................................................................................................................5 Introduction..........................................................................................................................5 Organizational Background.................................................................................................6 Literature review..................................................................................................................7 Literature review..................................................................................................................7 Rationale............................................................................................................................10 Hypothesis..........................................................................................................................11 Research methodology.......................................................................................................11 Research methodology.......................................................................................................11 Primary research and secondary research..........................................................................13 Quantitative and Qualitative Methods in Health Care Management.................................16 Research ethics...................................................................................................................18 Conclusion:........................................................................................................................20 Conclusion:........................................................................................................................20 Time Scale.........................................................................................................................21 Reference...........................................................................................................................23

Aim The healthcare industry has now become the most vibrant industries across the world. With growing size of this industry, demand for potential and skilled mangers and healthcare professionals is also increasing. The demand and requirement for the managers have mounted because there is urgent need for meeting the challenges of this potential market. With the globalization of the healthcare industry, healthcare mangers and professionals must possess practice-oriented, international and intellectual skills. Healthcare management aims to furnish managers with the potentials that are needed for the future global healthcare facilities. With the application of the healthcare management, managers are able to collate the incompatible managerial skills to enhance the quality while decreasing the cost at a same time.

Objectives The need and demands for quality healthcare services has been increased so fast that it has become an issue for the Apollo Hospital as well. With new trends, pressure is there to deliver new and better delivery services. Earlier people were coming to the healthcare centers but now healthcare centers have located themselves near to the patients’ house. Other issues affecting healthcare management is the managed care contracting, which has become a serious issue for every healthcare organizations. Increasing the growth of healthcare contracting is foreseeable but some of the organization in healthcare field lacks proper data for the managed care contracting.

Introduction

Healthcare management is a kind of process that seeks to manage and overlook properly one or two elements of the healthcare system. Today, great chances are there to become a manager within the healthcare field. If we find Apollo Hospital groups, it tends clear that they have applied healthcare management properly in their vast business. (Mclaughin, 2008) The current surrounding and environment for the healthcare organizations consists of many forces that demands extraordinary changes in the organizations. These forces consist of increased customer look, changing demographics, strengthen governmental pressure and rise in competition. Meeting such challenges requires efforts from the side of healthcare organizations such that they can be thorough with the fundamental changes and consistently inquire the new actions so as to produce new values. Healthcare is an information-intensive process. Pressures for the professional and healthcare managers is rising as healthcare organizations are looking for the ways that lessen the costs, enhance quality and able to access the managed care. Also, healthcare has been developed as a complex system. There should be proper coordination of the information technology with the twofold effects of the complicacies in organizations still assuring consistent growth in the field of medical technology. Healthcare organization is a field which is in relation to the set of activities including administering, managing and leading of hospitals, healthcare systems and network of healthcare clinics. Healthcare management program was basically launched at the University in Chicago in United States of America in the year 1934. The program is for two years; first year is for providing formal graduation to the students and the second year is for the purpose of internship. Healthcare management developed as an independent profession in the year 1978. After which it is considered to be the hidden profession in the field of healthcare with the emergence of the involvement of low profile managers rather than directly involving professions like medicine and nursing. In the recent years, there is great need for the healthcare management in the organizations because the developed countries are facing problems in balancing quality, access to healthcare providers and systems and cost.

Organizational Background Apollo Hospital In today’s world, Apollo Hospital Group has not only gained name but has also become a leader in the field of health care centers by delivering quality health care in Asia. Besides, it is being considered to be the biggest incorporated firm in healthcare aspect as well as it is complete in every aspect. Apollo is a powerhouse which you can trust blindly as its business is vast expanded with over 50 hospitals inclusive of 8500 beds, diagnostic clinics, a chain of hospital management colleges and nursing schools across Asia. Aim of Apollo Hospital is to make use of advanced technology with old traditions which are running down from centuries. Apollo Hospital Enterprise Limited was actually incorporated as a Public company in1979. With the contributions of Dr. C Reddy, it became the first group that opened up the notion of corporate delivery in healthcare in India. It was then, the first company to be listed on the Bombay stock Exchange.

Literature review Healthcare professionals or the manager’s plans, coordinates, directs and supervises the healthcare delivery. Rapid changes in the healthcare management lead to refurbishing of authorized standards and curricula. Healthcare management is multidisciplinary in nature which not only covers the healthcare aspects but also borrows the prospects of the public administration and business administration. A survey conducted informally by some trade magazine, Modern Healthcare, suggests that 70% of the business executives and educators believe in employing healthcare management in the healthcare organizations. Whereas 50% of the people believe that other areas or fields like trade finance, IT, etc should be given more importance. Several articles or journals for healthcare management have been published. Many of the research journals have reported the research that has been done on the healthcare and their conduits.

Books New Frontiers in Healthcare Management by Deborah Shlian – this book states the opportunities and threats that have been faced by the healthcare management. Leadership challenges have been a greater threat in the healthcare organizations. It also states that still there is a rise in managed control enrollment, many mergers and acquisitions are going to take place, also the cost of prescription is on rise and an intense pressure is on employers to provide its employees with healthcare benefits. (Shlian, 2001) Healthcare Administration by Lawrence Wolper - this book says that healthcare administration has become a major issue since the beginning of 21st century. It also states the ethical issues related to healthcare services as poor are paying more for healthcare services than rich. Healthcare management by John R. Schermerhorn – with the tremendous change in the healthcare workplace, everyone needs to react to these changes. Managers are accountable for delivering high quality and creating diverse work environment. This book also says that at every level, managers have different roles to play and has to perform varied duties. (Schermerhorn, 2007) Haimann’s Healthcare management by Rose T Dunn – this book is well written and able to deliver the role, duty and functions of supervisors in healthcare system. (Dunn, 2007) Advances in healthcare management by John Blair- this book contains research project or research proposal which includes state of the art reviews and research on some specific topics in the area of healthcare management. The Next Generation of Healthcare delivery by Michael A Murer – this book states as healthcare services keeps on changing, it is vital for all the healthcare organizations to insistently check the patterns of development such that cost effective and high quality healthcare services can be delivered.

Healthcare Management: Organization Behavior and Design by Stephen. M Shortell – this book states the purpose of taking decisions by healthcare managers in their respective field. The objective of the book is to state the motivational factors for the employees in the improvement of the healthcare services. Some suggestions are being provided to healthcare mangers for providing motivation to their employees and coworkers. . Risk Management Handbook for Health Care Organizations, by Hardcover, Jossey-Bass & Roberta Carroll – this is the 4th edition of the book which suggests the implementation of the risk management in healthcare organizations. All the associated risks have been carefully amended to show the prevailing and present changes in healthcare organizations and administrations. This book provides the information regarding legal, regulatory updates to the new professional and healthcare managers. This book makes use f userfriendly technique and represents information regarding new up coming risks in healthcare industry. It also consists of timely approaches or measures for patient safety, risk financing, error reduction and bioterrorism response and preparedness. Show the Management Principles for Health Care Professionals, by Joan Liebler, Paperback, Fourth Edition, Jones and Bartlett Publishers – The book is perfect for those healthcare professionals without any need for knowing their field for specialty. The realistic commands and instances in the book show the multidisciplinary backgrounds.

Articles – Jim Ayers & Larry Benson Administrative Radiology Journal, August 1995 This article states that there are 10 ways in which managers can coordinate with the difficulties of healthcare environment. These 10 ways are divided into three categories which are operations control, operation effectiveness and operation control. This is basically for healthcare professionals to be able to deal with managed care. Administrative Radiology Journal, December 1994 Many healthcare professionals have to face unnatural management challenges. This article suggests how these professional can deal with the current realities related to healthcare market various kinds of tools and methods have been mentioned in this article for rewarding and measuring the performance of doctors and professionals.

James B. Ayers & Robert C. Bonhag, DMD Administrative Radiology Journal, Date: November 1998

The key to success of healthcare organizations are the people. As there is intense competition among the healthcare organizations, new innovative ideas and rewards for measuring future success is necessary. The article suggests that there is need for evaluating current performance as well as there is need for the development of new reward techniques so as to have satisfaction from the employee side and enhancement of competitiveness Jim Ayers, Lawrence Benson, & Robert Bonhag DMD Journal of Healthcare Resource Management, October 1996 The healthcare providers are confused so as to which healthcare industry is in difficulty with physicians, hospitals and group of physician to deal with managed care and patient customer providers. It is vital for the providers to respond to the requirements of the managed care organizations and HMO’s. Jim Ayers & Mark Marcussen Administrative Radiology Journal, March 1989 There is an urgent need for the cost-effective delivery of healthcare services. Most of the service industries are reluctant to adapt the industrial tools in designing their performance process and evaluating their performance. This article suggests such tools for the healthcare setting. The conventional, lucid administration model recommends that development will advance organizational conclusions. Healthcare organizations face extensive ambiguity in their surroundings. To reduce uncertainty, healthcare organization seeks to “be familiar with” their surroundings through scrutinizing behaviors; to lessen prospect uncertainty, they plan predictable environmental changes and intend desired outcomes. Strategic planning augments the probability that the healthcare administration’s structure, strategy, culture, and any other key preferences will fit mutually and fit within the up-and-coming environment.

Rationale The article shows the research findings that have been conducted to see the impact of development of new HMO for the healthcare organizations. The study shows the association between the initial rationales which leads to the creation of the mission statement for the Apollo hospital and its performance. The findings present importance of the mission statement in the hospital and its likely success if the missions have been created for the organization.

Hypothesis If the development of new HMO is in accordance to the cultural, ethical and religion beliefs, then financers as well as the patients is attracted to it.

Research methodology Aim of research – to see the development of new HMO would affect the management activities of Apollo hospital Objective of the Research – to provide people the facilities and service of a new HMO by optimally using the resources and efforts of the healthcare professionals To see how research purpose and research objectives are developed, let us consider the case of Apollo hospital keening healthcare management in their organization. They have decided to use their resources to work a health management organization (HMO). The resources are wide, as would be predictable in a large teaching and research healthcare centers with a well-built confined reputation. Leading HMOs are testing with the demi-science called substitute medicine hoping to heal harms when normal medicines are unsuccessful. This is an astonishing drift. Many doctors still sight some substitute methods with great cynicism- the health maintenance organizations have a status for spurning all except the most unswerving treatments. whilst most of the HMOs by now offer chiropatic coverage, a number are adding acupunturists and massage therapists, in conjunction with the practitioners called naturopaths who use herbal therapies, relaxation remedies, yoga and many more. Managers of Apollo Hospital enterprise gathered for a meeting and represent their thoughts and research to construct support for the notion within the hospital. The meeting came to an end with some sort of worries and problems. The problem was how to decide the market demand in the region to hold another HMO although each member of the planning committee was persuaded of the potential benefits of the proposal, bed consumption rate and teaching programs, the confirmation is required to demonstrate the financers before they begin investing resources into the proposal. (Yin, 2009) After the second meeting with the hospital planning committee, quick agreement was achieved that the chief principle of the study was to deal with the decision as to whether the offer for an HMO should be followed to the viewpoint of marketing major investments in its execution. Following is the purpose of the study consists of research questions and a statement of the study scope.

Research Question: what is the demand for the new HMO? Scope: limited to staff, students and faculty of the university. The study was restricted to the university students, staff and the faculty for several reasons. First the university management was favorably liable toward the plan, giving it the best possibility of achievement in those surroundings. If support from that group was not in confirmation, then the prediction would not be bright in other organizations .Second, the budget restraint made it improbable that any valuable research should be carried out for more than one organization. No geographic limits were there, as it was consider that distance from the home to HMO should have only a weak pressure on individual choice in the proposed HMO. Finally, the following set of purposes and objectives are set; Purpose: what target market segments should the HMO emphasize? Objective: recognize the market sections which are most paying attention in the proposed HMO. Assess their feasible rate of consumption of medical services from their past medical records. Purpose: what services should be offered at what price level? Objectives: recognize the features or characteristics of health plans that would have the greatest control on an individual’s option among options. Number of hypothesis were developed as to who was most probable to be paying attention in the plan. Of course, they would have to express strong interest in the plan as described to them. Besides, good prediction would be those who were disgruntled with the treatment or quality of their current plan, did not have a long standing connection with a family doctor, had positive attitudes toward the Apollo Hospital, and were not registered in other healthcare plans through their spouses. Research design – a research design is a blueprint used to guide research study towards its objectives. The procedure of scheming research study involves many consistent decisions. The most important decision is the alternative of research because it decides how the information will be accessed. (Marczyk, 2009) Types of approach Exploratory approach – it is done when one is looking for imminent into the common nature of a problem, pertinent variables that require to be measured and alternative decisions. The research methods are highly elastic, qualitative and amorphous. (Hartwig, 1979)

Descriptive research – descriptive research clinches a large populace of marketing research. Causal research – when it is vital to present that one variable causes or develops the value for the other variables, a causal research approach must be used. The first step is to use exploratory research approach to generate all possible reasons for the problem. Thereafter, a combination of descriptive and a causal approaches is used to narrow the possible causes.

Primary research and secondary research Primary research – primary research is done to collate specific research purpose for the further research. A variety of techniques, ranging from qualitative research to survey methods may be employed To make choice for the best research approach for the HMO, a victorious decision has to be made which having large number of strengths and least weakness in relation to the options. Once this is obtained by uniting quite a few methods to take gains of their best characteristic and curtail their limitations (Axinn, 2006) Our research for HMO would engage preliminary qualitative research followed by a survey to depict the notion of the healthcare organization to a wide representative sample and test of the hypothesis. The principle survey options were mail questionnaires and personal or telephone interviews. (Fowler, 2009 dissertation proposal.doc) Personal interviews – the interviewer interviews the respondent in person. There is direct contact between the interviewer and the respondent. Personal interviews using trained interviewers are too costly and would be feasible only with a sample that was too small to identify adequately the differences. Telephone interviews – the respondent is interviewed by the interviewer on telephone. There is no direct contact between the interviewer and the respondent. Telephone interviews would have been difficult to conduct both because of the length of the questionnaire and the evident need for multiple category questions, which are awkward to communicate orally. Mail questionnaires – the questionnaire is administered through fax. The interview may or may not have contact with the respondent. The response rate would be low unless substantial incentives and follow ups are not provided.

The solution was a self administered questionnaire, with door to door delivery and pickup by untrained survey assistants. .

Secondary research – secondary data are by now available, because they were composed for some other functions other than solving the basic problem. Included here are: Syndicated data sources, such as consumer purchase panels. Databanks and other sources like government sources such as Census Bureau Existing company information system

Research Tactics and Implementation Measurement – The first step is to understand the research purpose into information requirements and then into questions that can be answered by expected respondents. One of the purposes of HMO study is to assess viable demand for the proposed HMO in relation to their current health plan. This means the information will be required on the respondent’s overall assessment of the projected HMO, their liking for the proposed HMO relative to their current health plan and their possibility of accepting the new plan if it becomes obtainable. Once the individual questions have been decided, the measuring instrument has to be developed. The researcher designing an effective questionnaire must be concerned with how questions on sensitive topics such as income can be asked, what the order of the question should be and how misinterpretations can be avoided. Sampling Plan Most of the marketing research studies are restricted to the sublet of the total population or sample which is applicable to the research questions. One approach is to select a sample for the proposed HMO is probability sampling, in which all population members have a chance of being in the sample. Anticipating the Analysis Before actual data collection commences, the researcher must be attentive to the likelihood that the data will be not enough for testing the theory or will be interesting but unable of supporting act recommendations. With these anxieties in mind, the researcher should map how each of the data items is to be examined. One useful device is to generate imaginary dummy data from the questions in the measurement

tool. The dummy data can be examined to make sure that the consequences deal with the objectives. Analysis of value versus cost and time involved Cost-benefit analysis should be likely to conclude if the research should be taken as designed or if it should not be conducted at all. One of the mechanisms of cost is time. A research study for the proposed HMO can take six months or more. It may be place such that a time phase will not delay a decision, thus generating the jeopardy that set of attractive circumstances will be missed. The examination can bring to a close that either the research design is cost efficient and should be preceded further or that it is not and should be ended. Errors in research design The value of research project is based on the overall excellence of the research design and on the data collected and examined based on the design. More than a few possible sources of error can have an effect on the quality of a research procedure. The errors can persuade the variety of stages of the research procedure and result in imprecise or ineffective research conclusion.

Quantitative and Qualitative Methods in Health Care Management Quantitative research approach These are research methods that are based on the scientific approaches in providing numeric value for the study. Researcher establishes various relationships among these numeric values. Statistical analysis is also being implemented to find the scope and strength of the causal relationship. (Creswell, 2009) Advantages: The findings of quantitative research are in the form of numeric values or statistics that are easy to explain and bring effective working. Comparing can be done easily as well as the hypothesis can be formulated and development of objectives. The researchers can be tested on the basis of its effectiveness in observations by using effective quantitative methods.

Disadvantages: Any false numeric value can mislead the research study and purpose. With the simplification of research study, the quantitative research becomes less meaningful. Artificial environment can be set up if there is unnatural settling of numeric values. Qualitative approach Healthcare management includes the planning, monitoring and coordinating the financing and delivery of medical services. Healthcare professionals and managed care doctors or managers work in such an environment where there is constant increase in costs, demand for innovations in medical and care technology and regulations by government. Also, healthcare managers work with multiple people like third party insurers and health care providers. Healthcare management is therefore a complex and composite process. Luckily, various qualitative methods are there to assist research in healthcare management. Various qualitative methods In our research, healthcare managers are concerned with the issues of developing new HMO, in which qualitative methods can be used for the effective working. Qualitative methods helps in reaching to a specific decision related to the research purpose. Qualitative research tools and methods can be applied to Apollo hospital for

healthcare management which includes Nominal group technique, focus groups, brainstorming sessions and Delphi. (Merrium, 2009) Nominal group techniques – these are kind of group discussion which are held to deal with a particular issue. At the time of nominal group techniques, each member group independent of others are asked to pen down a list of notions regarding the issue under discussion. Then, group members are asked to present their ideas one at a time which is then followed by a huge discussion. After all the individual group members have accessed their thoughts and each group has discussed them, each member then ranks the notions which are being presented. NGT is a kind of interactive process that emerges after several ideas and their respective discussions. Focus groups- it is the most popular technique in marketing and is a group interview. The sizes for the group can vary accordingly from eight to twelve people. In healthcare management, focus groups are best for providing discussion on important issues or in evaluating patient satisfaction. Many healthcare organizations make use of focus groups to know their strengths and weaknesses from the view points of the patients. Focus groups of practitioners and patients helps in exploring important issues like service delivery. Brainstorming – in brainstorming sittings or sessions, healthcare managers call together or assemble a group of applicable people like medical professionals and medical providers so as to know the problems or emerging issues evaluate impacts or think for other strategic alternatives. At the time of brainstorming sessions, each individual from the group present their concepts and notions following with a short explanations such that the problems could be addressed. During these sessions, healthcare managers are needed to provide new ideas so as to meet new challenge. These sessions are helpful for the hospitals as the changes in public policy and medical technology poses new threats and challenges to the healthcare management. Expert insight – According to W.J Duncan and Peter Ginter, brainstorming and nominal group techniques are the effective decision making tools for the healthcare management. With these techniques healthcare managers are able to know the demand and applicability of the new proposed HMO. Delphi – it is an effective and popular technique to evaluate qualitative data for the issues which are in relation to the environment in which healthcare organizations works or operates. Under the method of Delphi, healthcare mangers end to seek opinions of professionals on a specific issue. After assessing and collecting the opinions of the professionals, mangers evaluate them and the send further to the experts for their expertise judgments and opinions. By this way, synthesis of opinions generates.

Research ethics Ethics in research can be considered to be the vital matter. These can be evaluated by the difference between its acceptability and unacceptability. The key or the most significant ethical issue is the safeguard of data or information obtained from the patient, which is both personal and private. Initially, medical records of patients were available to everybody and anybody but now it is no more obtainable. Nowadays, majority of the healthcare organizations keep the records of patients confidential and safe. An ethical worry of many healthcare professionals, nurses and doctors is to shield themselves from the hazard of obtaining communicable sickness from the patients, particularly if the patient past record is not available for some or any other reason. Even though, healthcare experts have all the rights to secure themselves from the a range of viruses which might be conveyed to them by the patients, yet, simultaneously they are responsible for not showing these protective measure to the patients which might cause them uncomfortably for the patients. Besides, marketing of the healthcare organizations is important to create awareness about its existence and services which it is offering. Precision should be followed such that hospitals and healthcare organizations follow certain rules and ethics. To take care of ethical issues by Apollo Hospital, the staff and authorities of the hospital should be certain about the information which they are going to provide while advertising their organization. The information and data so provided should not be false and have accuracy in it. Whilst marketing their healthcare management in the organization, Apollo should take care that they are not forcing people for adopting their services or they are not making use of any harmful tools of marketing. The main purpose of the marketing should be the health of the patient; this objective should be the main tool for marketing. Profit is vital but should not be the basic principle for the organization. The present issue in healthcare research is concerned with the fact that medical research is now only related to developing countries and low income groups. Earlier it was carried in the developed countries. The main purpose of this shift is the rapidness and ease with which healthcare organizations have to spend less money that are needed for running trials in such countries. Even the application of ethical regulations and rules are much less in these countries. It is easy to have participation from the members for trials in low income countries as poor people are in favor of accepting such proposals by the rich medical and healthcare organizations such as Apollo. The underlying problem in such case is providing information to the participants regarding the research study, effects of the drugs and the

kind of medicines they are using which is important to know for carrying out the trials. Another ethical issue is the low quality care is shown to low income countries.

Conclusion: Modernism in medical services and application of the best obtainable medical knowledge tends to solve the problems and concerns of individual patients. as well as provide huge potential in assisting the patients and the overall healthcare system.The development of policies and procedures in Apollo Hospital had been able to decrease the premature death rate and enhanced the quality life of the patients. Also, healthcare management is cost effective and seeks greater profit for the very hospital. Healthcare management also consist the financial growth and feasibility of the Apollo Hospital. The importance of healthcare organization can be realized only when the hospital is fully staffed with professionals and healthcare managers and is financially sound to invest in the advanced equipment. A basic concept behind the role of healthcare management is to provide affordable healthcare services to an average person. If in a community many people are unable to pay the fees for the laboratory or for prescribed drugs, then there is inadequate access to the healthcare services. Therefore, if people are unable to have adequate access for the medical services then there is not proper application of healthcare management. (Kelley, 2007) Apollo hospital has adequately practiced preventive medicine has realized in lessening of premature death, accidental death, preventable death and infections that are being acquired within the hospital. Healthcare management implements policies and procedures which are specifically designed for the improvement in the quality health of patients which it serves. Apollo hospital is being very effective in financial aspect due to which it is able to adopt quality healthcare management in their organization. No organization is able to spend or adapt healthcare management in their system until it is not earning well enough. The outcomes of better healthcare standards cannot be enhanced until it has not effectively implement the healthcare management. Due to this, there are better outcomes from the expected patients and favorable healthcare standards. (Gapenski, 2007)

Time Scale

Key

activities Time

(Milestones)

scale

(Plan

of Resources required

action)

proposal 29th April 2010

Project submission Project proposal Approval

Introduction, aims and 30th June 2010

University

objectives,

Online library sources.

reading,

reviewing

books

Library,

and

journals.

Reviewing the statistical 30th June 2010

University

research

Online library sources,

methods

for

questionnaire preparation

Library,

Tutor’s help

Formulating

the 15th July 2010

Approval from the tutor

qualitative

and

and

quantitative questionnaires

university

board. and

ethics

University

students list and email Id.

sending to students

Completion of Literature 15th August 2010

University

Library,

review,

analysis

and

Online library sources.

discussion

Data collection, review, 15th August 2010 analysis

and

interpretation 15th September 2010

Conclusions, recommendations submission

and

Statistical tools

Reference Axinn, W& Pearce, L (2006), Mixed Method Data Collection Strategies, New York: Cambridge University Press Creswell, J (2009), Research Design, Qualitative, Quantitative and Mixed Approaches, USA: Sage Publications Inc Dunn, R (2007), Haimmen’s Healthcare Management, America: Library of Congress Cataloging-in-Publications Data Gapenski,L (2007), Understanding Healthcare Financial Management, America: Library of Congress Cataloging-in-Publications Data Fowler, F (2009), Survey Research Methods, USA; Sage Publications Inc Hartwig, F (1979), Exploratory Data Analysis, Sage Publications Inc Kelley, D (2007), Applying Quality Management in Healthcare, America; Library of Congress Cataloging-in-Publications Data Mclaughin, D & Hays, J (2008), Healthcare Operation Management, America: Library of Congress Cataloging- in- publication Data Marczyk, g & DeMatteo, D (2003), Essentials of Research Design and Methodology, New Jersey: John Wiley & Sons, Inc Merriam, S (2009), Qualitative Management, San Francisco: John Wiley & Sons Inc Shlian, D (2001), New Frontiers in Healthcare Management, USA: Writers Club Press Schermerhorn, J (2007), Healthcare Management, United States: John Wiley & Sons, Inc Yin, K (2009), Case Study Research, United States of America: Sage Publications Inc