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Top 40 Most Popular Case Studies of 2017

We generated a list of the 40 most popular Yale School of Management case studies in 2017 by combining data from our publishers, Google analytics, and other measures of interest and adoption. In compiling the list, we gave additional weight to usage outside Yale

We generated a list of the 40 most popular Yale School of Management case studies in 2017 by combining data from our publishers, Google analytics, and other measures of interest and adoption. In compiling the list, we gave additional weight to usage outside Yale.

Case topics represented on the list vary widely, but a number are drawn from the case team’s focus on healthcare, asset management, and sustainability. The cases also draw on Yale’s continued emphasis on corporate governance, ethics, and the role of business in state and society. Of note, nearly half of the most popular cases feature a woman as either the main protagonist or, in the case of raw cases where multiple characters take the place of a single protagonist, a major leader within the focal organization. While nearly a fourth of the cases were written in the past year, some of the most popular, including Cadbury and Design at Mayo, date from the early years of our program over a decade ago. Nearly two-thirds of the most popular cases were “raw” cases - Yale’s novel, web-based template which allows for a combination of text, documents, spreadsheets, and videos in a single case website.

Read on to learn more about the top 10 most popular cases followed by a complete list of the top 40 cases of 2017.  A selection of the top 40 cases are available for purchase through our online store . 

#1 - Coffee 2016

Faculty Supervision: Todd Cort

Coffee 2016 asks students to consider the coffee supply chain and generate ideas for what can be done to equalize returns across various stakeholders. The case draws a parallel between coffee and wine. Both beverages encourage connoisseurship, but only wine growers reap a premium for their efforts to ensure quality.  The case describes the history of coffee production across the world, the rise of the “third wave” of coffee consumption in the developed world, the efforts of the Illy Company to help coffee growers, and the differences between “fair” trade and direct trade. Faculty have found the case provides a wide canvas to discuss supply chain issues, examine marketing practices, and encourage creative solutions to business problems. 

#2 - AXA: Creating New Corporate Responsibility Metrics

Faculty Supervision: Todd Cort and David Bach

The case describes AXA’s corporate responsibility (CR) function. The company, a global leader in insurance and asset management, had distinguished itself in CR since formally establishing a CR unit in 2008. As the case opens, AXA’s CR unit is being moved from the marketing function to the strategy group occasioning a thorough review as to how CR should fit into AXA’s operations and strategy. Students are asked to identify CR issues of particular concern to the company, examine how addressing these issues would add value to the company, and then create metrics that would capture a business unit’s success or failure in addressing the concerns.

#3 - IBM Corporate Service Corps

Faculty Supervision: David Bach in cooperation with University of Ghana Business School and EGADE

The case considers IBM’s Corporate Service Corps (CSC), a program that had become the largest pro bono consulting program in the world. The case describes the program’s triple-benefit: leadership training to the brightest young IBMers, brand recognition for IBM in emerging markets, and community improvement in the areas served by IBM’s host organizations. As the program entered its second decade in 2016, students are asked to consider how the program can be improved. The case allows faculty to lead a discussion about training, marketing in emerging economies, and various ways of providing social benefit. The case highlights the synergies as well as trade-offs between pursuing these triple benefits.

#4 - Cadbury: An Ethical Company Struggles to Insure the Integrity of Its Supply Chain

Faculty Supervision: Ira Millstein

The case describes revelations that the production of cocoa in the Côte d’Ivoire involved child slave labor. These stories hit Cadbury especially hard. Cadbury's culture had been deeply rooted in the religious traditions of the company's founders, and the organization had paid close attention to the welfare of its workers and its sourcing practices. The US Congress was considering legislation that would allow chocolate grown on certified plantations to be labeled “slave labor free,” painting the rest of the industry in a bad light. Chocolate producers had asked for time to rectify the situation, but the extension they negotiated was running out. Students are asked whether Cadbury should join with the industry to lobby for more time?  What else could Cadbury do to ensure its supply chain was ethically managed?

#5 - 360 State Real Options

Faculty Supervision: Matthew Spiegel

In 2010 developer Bruce Becker (SOM ‘85) completed 360 State Street, a major new construction project in downtown New Haven. Just west of the apartment building, a 6,000-square-foot pocket of land from the original parcel remained undeveloped. Becker had a number of alternatives to consider in regards to the site. He also had no obligation to build. He could bide his time. But Becker worried about losing out on rents should he wait too long. Students are asked under what set of circumstances and at what time would it be most advantageous to proceed?

#6 - Design at Mayo

Faculty Supervision: Rodrigo Canales and William Drentell

The case describes how the Mayo Clinic, one of the most prominent hospitals in the world, engaged designers and built a research institute, the Center for Innovation (CFI), to study the processes of healthcare provision. The case documents the many incremental innovations the designers were able to implement and the way designers learned to interact with physicians and vice-versa.

In 2010 there were questions about how the CFI would achieve its stated aspiration of “transformational change” in the healthcare field. Students are asked what would a major change in health care delivery look like? How should the CFI's impact be measured? Were the center's structure and processes appropriate for transformational change? Faculty have found this a great case to discuss institutional obstacles to innovation, the importance of culture in organizational change efforts, and the differences in types of innovation.

This case is freely available to the public.

#7 - Ant Financial

Faculty Supervision: K. Sudhir in cooperation with Renmin University of China School of Business

In 2015, Ant Financial’s MYbank (an offshoot of Jack Ma’s Alibaba company) was looking to extend services to rural areas in China by providing small loans to farmers. Microloans have always been costly for financial institutions to offer to the unbanked (though important in development) but MYbank believed that fintech innovations such as using the internet to communicate with loan applicants and judge their credit worthiness would make the program sustainable. Students are asked whether MYbank could operate the program at scale? Would its big data and technical analysis provide an accurate measure of credit risk for loans to small customers? Could MYbank rely on its new credit-scoring system to reduce operating costs to make the program sustainable?

#8 - Business Leadership in South Africa’s 1994 Reforms

Faculty Supervision: Ian Shapiro

This case examines the role of business in South Africa's historic transition away from apartheid to popular sovereignty. The case provides a previously untold oral history of this key moment in world history, presenting extensive video interviews with business leaders who spearheaded behind-the-scenes negotiations between the African National Congress and the government. Faculty teaching the case have used the material to push students to consider business’s role in a divided society and ask: What factors led business leaders to act to push the country's future away from isolation toward a "high road" of participating in an increasingly globalized economy? What techniques and narratives did they use to keep the two sides talking and resolve the political impasse? And, if business leadership played an important role in the events in South Africa, could they take a similar role elsewhere?

#9 - Shake Shack IPO

Faculty Supervision: Jake Thomas and Geert Rouwenhorst

From an art project in a New York City park, Shake Shack developed a devoted fan base that greeted new Shake Shack locations with cheers and long lines. When Shake Shack went public on January 30, 2015, investors displayed a similar enthusiasm. Opening day investors bid up the $21 per share offering price by 118% to reach $45.90 at closing bell. By the end of May, investors were paying $92.86 per share. Students are asked if this price represented a realistic valuation of the enterprise and if not, what was Shake Shack truly worth? The case provides extensive information on Shake Shack’s marketing, competitors, operations and financials, allowing instructors to weave a wide variety of factors into a valuation of the company.

#10 - Searching for a Search Fund Structure

Faculty Supervision: AJ Wasserstein

This case considers how young entrepreneurs structure search funds to find businesses to take over. The case describes an MBA student who meets with a number of successful search fund entrepreneurs who have taken alternative routes to raising funds. The case considers the issues of partnering, soliciting funds vs. self-funding a search, and joining an incubator. The case provides a platform from which to discuss the pros and cons of various search fund structures.

40 Most Popular Case Studies of 2017

Click on the case title to learn more about the dilemma. A selection of our most popular cases are available for purchase via our online store .

Case Studies in Business, Management, and Organizations

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Data and Analytics Case Study Roll-up Report

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Lessons from Becoming a Data-Driven Organization

October 18, 2016, introduction.

The case studies gathered and presented here tell, in a sense, a single story. It’s the story of a “management revolution,” brought about by the widespread adoption of big data and analytics in both the public and private sectors. 1 In these dispatches from the front lines of that revolution, we see four strikingly dissimilar organizations — a health care system, a bank, a major industrial company, and a municipal government — in the process of becoming data-driven. (The organizations are Intermountain Healthcare , Nedbank , GE , and the city of Amsterdam . Other MIT SMR published case studies cited in this report can be found at sloanreview.mit.edu/case-study/ .) We see them struggle and, to a greater or lesser extent, succeed at using analytics to improve the quality and variety of their products and services, engage in new and deeper ways with patients, customers, and citizens, and transform the way they operate. And crucially, we see them use data and analytics not just to improve productivity and make their operations more efficient, but also to change their fundamental business models.

A leading character in this story is technology. Quite simply, there would be no data and analytics revolution without easily accessible, increasingly inexpensive computing power: the cloud, the Internet, and powerful, versatile software and algorithms. Yet technology is only part of the story. People are equally important. The leaders who mobilize their organizations to embrace and fulfill the promise of analytics, the frontline people who experience how analytics are changing their roles and responsibilities, the data scientists and IT engineers who do the hard work of collecting, classifying, organizing, and deploying staggering amounts of information — they all help us gain a better understanding of the scope and meaning of this revolution.

The technology and the people who deploy it also need a process or system of rules to guide how people create and use information. Rules help transform the noise of disordered information into legible signals with the power to sharpen and deepen the focus on the customer (broadly defined), and in the process improve health outcomes, the customer experience, the realization of business value, and civic life and engagement.

MIT Sloan Management Review has prepared and presented these case studies to show how the analytics revolution is currently transforming organizations as well as the economies and societies in which they operate. This transformation is occurring at every level, from the microeconomic to the macroeconomic, from the way individual stores stock their shelves, to the way manufacturers and their customers connect to realize new forms of value, to the way economies and societies function.

At the same time, these case studies reveal that many organizations struggle mightily just to get a handle on the data they have. And once they’ve located, collected, classified, and organized the data, they must then manage the processes needed to ensure its timeliness, accuracy, completeness, and reliability. Integrating data into decision making can be another fraught step, especially among managers accustomed to acting on gut instinct, intuition, and experience. Organizations and their leaders need considerable fortitude and persistence — not to mention a judicious blend of patience and impatience — to do the grinding, unglamorous work that is the foundation of successful analytics initiatives. That’s a big ask, and it helps explain why so many such initiatives fall short of expectations.

These reports from the front offer a distinctive view of the organizations that are realizing, or aiming to realize, the promise of analytics. As disparate as they are, they share a few key success factors, and they have also faced common hurdles and reaped the benefits that flow from perseverance and dogged adherence to their digital vision. That vision, shaped by each organization’s senior leaders and elevated by those working most closely with the data, focuses not merely on using digital technology to make the existing organization better but using it to transform the organization along three crucial dimensions: improving the customer experience; overhauling operational processes; and designing and executing new, digitally powered business models.

How the Data-Driven Organization Takes Shape

The data-driven organization can be pictured as a pyramid that rests on a base of well-governed data, partnerships, and sustained commitment from leadership and employees alike. With that foundation in place, the organization can move to the next level, where it treats data as a core asset that is an essential element of strategy, fashions its data into commercial offerings, and uses it to deepen the engagement of employees and customers. Then finally, as the organization’s data and analytics capabilities mature, they can underpin innovative new business models — models that alter, sometimes radically, power arrangements within the organization.

Mastering the Basics of Information Management

Many organizations have been slow in compiling, classifying, and organizing the data sitting in siloes and dark corners. It’s “a boring, boring job,” says Ger Baron, Amsterdam’s first-ever chief technology officer. “But very useful!” He ought to know. The Netherlands’ capital has 12,000 different datasets, and even they can’t tell him everything about the city. For example, no one knows exactly how many bridges span Amsterdam’s famous canals, because the city’s individual districts have not centralized their infrastructure data.

That story underscores the challenges organizations face in the realm of data governance, or the methods and rules that organizations use to assure the quality of data, manage it, integrate it into business processes (see the sidebar, “Process Innovation Comes in Different Shapes and Sizes”), and manage its risks.

Mobilizing and motivating an organization to conduct a data inventory can, as Baron implies, be a significant challenge for senior leaders. It’s tough to persuade people to undertake a tedious, laborious job, especially when the payoff seems distant or insubstantial. So leadership needs to recognize and celebrate small wins along the way.

Organizational leaders must decide who will be responsible for data governance. They must determine who will define and disseminate a common vocabulary around data, specify who has access to what data and how and with whom they can share it, and establish how the entire organization can use that data to create value. Some cutting-edge organizations have created data councils, composed of leaders from across the organization, to address such questions. The work of data councils involves mapping workflows, assigning ownership and accountability for key deliverables, defining and enforcing the cultural norms for the use of data in decision making, and measuring what data and analytics contribute to organizational performance. Without such councils to make these and similar high-level decisions, organizations may find it difficult to sustain their analytics initiatives, much less take them to the next level.

The council’s first job is to create a common language for data. The language of data is, like any other language, a social construct, and it’s the job of the data council to define and enforce the social norms around that language, to ensure not just clear communication but organizational cohesion. But even defining data can be a stiff challenge. Although it may seem obvious that data simply means raw information, people involved in analytics can attest that many of their colleagues don’t really understand the term. Does data mean numbers? Social media postings? Location information? Customer activity? Readouts on machine performance? It is all these things and more, but many people have trouble grasping that a single concept can span so many different categories. Without that understanding, it’s all but impossible to sell, price, or even describe data and analytics product offerings.

When that understanding is achieved, though, language can expand listeners’ view of the world. Jeff Liberman, COO of Spanish-language media company Entravision Communications Corp., based in Santa Monica, California, was baffled when he first heard Franklin Rios, the driving force behind the company’s Luminar analytics unit, deliver a board presentation about big data. He simply didn’t see its relevance to the broadcast business where he had spent his professional life. “I was thinking as a broadcaster, saying, ‘How am I going to use this?’” Liberman recalls. “Then I said, ‘Wait a second, I have to take off my broadcaster’s hat and start looking at this as just a flow of information.’ It just really clicked at that point.” The point is that leaders should not underestimate the power of language to make the subject of data “click” in the minds of users.

In addition to finding a common language, those responsible for data governance must also create definitions of success that are consistent with the organization’s data strategy. Consider Intermountain Healthcare Inc. (IMH), a system of 22 hospitals and 185 clinics in Utah and Idaho, headquartered in Salt Lake City. Whether or not he knew it, IMH chief of surgery Mark Ott was socializing a new definition of success when he met with surgeons at IMH’s flagship hospital and showed them data that proved that their postoperative infection rates were in line with national averages. “You think you’re great,” he told them, “but compared to other hospitals in the country, you’re average.” Such blunt language, especially directed at people with as much professional pride as surgeons, can help promote thinking about data as a source of truth, however painful the truth may be. And it can be a powerful force for improving the experience of customers — or in this case, patients.

Data governance also entails determining what data matters in a given context. That’s what Caesars Entertainment Corp. , the Las Vegas-based international gaming company, discovered when it tried to develop a scorecard to promote and advance its initiative to make its hotels, casinos, and other properties more energy efficient and environmentally friendly. Contention quickly arose over the specific information to include in the scorecard.

Some stakeholders thought the scorecard should highlight progress toward cost-reduction and financial goals — which led to debates over whether to track energy consumption or cost savings. Some stakeholders then asked if it was fair to compare older buildings with newer ones built to greener specifications. What about buildings located in hot climates? Was it fair to compare them with buildings in more moderate zones without adjusting for temperature differences?

Other organizations will be sure to confront similar questions as they deliberate what to measure and what purpose the measurements should serve. The answers will vary according to the organization’s strategy and goals, but in any case, it’s up to senior leadership to arrive at a common data language and manage the debate over what to measure — that is, over what data matters most.

In addition to establishing a common language for data, nearly every organization has to close gaps in data quality, as IMH learned when it started to present surgeons with data about their patients’ health outcomes. IMH discovered that data listing a patient as under the care of a particular doctor was sometimes incorrect because the doctor’s partner was seeing that patient. This inconsistency risked undermining physicians’ trust in the data, which in turn posed a risk to the company’s efforts to promote data-driven decision making. In response, IMH encouraged physicians to trust the data by allowing them to see patient data and challenge it.

Categorizing data is another challenge. Amsterdam’s Baron has to pin down the definition of a bridge, which varies from one district of the city to the next. WellPoint (now called Anthem), a leading U.S. provider of health care benefits and insurance, has had to reconcile definitions of emergency-room visits that varied across the 14 regions it serves. And a leading central bank has had to harmonize the widely varying terminology that various bank departments used to refer to the different categories of private-sector institutions under their purview.

Unstructured data can also be a headache. Vince Golla, social media director at Kaiser Foundation Health Plan, one of the largest health care providers in the United States, tells of running an experiment to measure its members’ satisfaction with the parking facilities at the organization’s many locations. For 30 days, he and his team searched Twitter for mentions of Kaiser Permanente . Problem was, most people usually refer to Kaiser Permanente just as Kaiser, and as a result, the Twitter search threw up confounding references to Kaiser rolls, Kaiser beer, and the English rock band Kaiser Chiefs. “It required a little work to sift the wheat from that chaff,” Golla says, with some understatement.

Heavily siloed organizations have their own set of data problems. Wayde Fleener, a data scientist and senior manager in General Mills’ Consumer Insights group , encountered resistance when he set out to discover what his organization knew about its customers since no one had a data diagram that mapped out where data was or how it was being used. “People felt threatened because I was coming into their role and questioning them,” says Fleener. “So there was a lot of resistance, and ‘Are you trying to take over what I’m doing?’ I had to keep saying, ‘No, I’m just trying to help you do things better.’” While sifting through thousands of datasets that referenced the company’s Cheerios cereal, Fleener discovered that some data sources spelled “Cheerios” all the way out, and others spelled it “chrs.” 2 Resolving such discrepancies is a job for a team of “data stewards,” who spend much of their time reviewing reports of such terminological inconsistencies every time they run a data refresh.

Jeanne Ross, research director of the MIT Sloan Center for Information Systems Research, believes that many organizations need a “ data dictator ” to resolve issues such as definitional inconsistencies. As she said in an interview with MIT Sloan Management Review , they need “somebody who says, ‘This is how we will define sales, this is how we will define returns, this is when we will register revenue, and we are all living by this rule. Until we do that, we don’t have data that’s useful for most kinds of analytics. We can still go out and buy demographic data and probably learn something quite useful. But if we want to know how to avoid stock-outs in our stores or what products are of greatest interest to a particular customer segment, we’re going to need the data cleaned up.’” 3 Not every company has the will and resources to make that kind of commitment.

Ultimately, effective information management requires the intervention of people guided by rules, norms, and culture, none of which are static. It’s often tedious, painstaking work and requires a significant investment in human and financial resources.

The New World of Data Partnerships

Anyone involved in a data and analytics initiative soon learns that they can’t go it alone — data and analytics applications inevitably drift across departmental and organizational boundaries, requiring collaboration within and between organizations to reach their full potential. At IMH, for instance, endocrinologists partnered with data scientists and one another to learn how best to manage patients with diabetes.

The most consistently successful physicians shared with their colleagues the methods they used to help patients maintain low blood-sugar levels, ranging from motivational tools to regular calls from the physician’s team. This information-sharing partnership enabled IMH’s physicians to care so well for their diabetic patients that those patients now face no higher risk of heart disease than the general population.

Data partnerships also extend beyond the walls of the organization. Amsterdam relies heavily on the Amsterdam Smart City initiative, a public-private platform, to address many issues of urban life. The initiative encompasses projects across eight categories: smart mobility, smart living, smart society, smart areas, smart economy, big and open data, infrastructure, and living labs. Early wins include replacing most of the city’s parking meters with a pay-by-phone app; an initiative to improve crowd control and traffic flow at large gatherings like the SAIL Amsterdam Festival, which brings more than a million visitors to Amsterdam to view traditional wooden sailing ships; and Rain Sense, which examines where rain falls in the city to help reduce the effect of flooding on traffic flow. (See the sidebar, “How Data Drives Productivity Improvement.”)

At Nedbank Group Ltd., the fourth-largest bank by revenues in South Africa, the company’s card-acquiring business developed a commercial offering, Market Edge, for its merchant business customers that included a suite of analytical tools integrating the customers’ own client data with historical, demographic, weather, and other data to which the bank had access. Each Market Edge offering is tailored to and co-developed with each Nedbank customer to address their particular business needs. (See the sidebar, “Building Better Relationships With Data.”)

Meanwhile, GE’s Industrial Internet offerings are transforming sales agreements into partnerships as the company migrates away from a licensing-based pricing model for its Predix platform to a subscription model. Rather than charging a fixed price for, say, a turbine, GE sells a hardware, software, and service solution whose value is determined in part by whether a customer reaches a certain level of savings in operational costs. If that level is achieved, GE gets a cut. “If we improve, say, [a customer’s] power consumption by X, we get $1; by Y, we get $1.50,” says Ron Holsey, a senior executive at GE Oil & Gas. A crucial aspect of these agreements is that GE and its customer must work together to realize those savings — they become co-creators of value. And that itself changes GE’s relationship with its customer.

Engaged customers can be a company’s most effective sales force. To win new business, GE runs scores of pilot programs with customers in the oil and gas industry to demonstrate how Predix can improve asset performance, increase efficiency, and cut downtime — a crucial issue in an industry where a single idle well can cost millions of dollars a day. Successful programs generate positive word of mouth and convince oil and gas engineers (a conservative group, reluctant to try anything new that isn’t empirically supported and low-risk) to find out what Predix can do for them. “To get anywhere in the oil and gas industry, we need help selling,” says one GE executive. “We need customer voices out in the industry with success stories, or we’re just not going to come to the table with the credibility that we need. So we need to inspire our customers to want to do that.”

Data can also turn businesses and their vendors into partners. When IMH decided to overhaul its electronic health records (EHR) system, it chose to work with Cerner Corp., a leading EHR vendor. IMH’s leadership team liked Cerner’s careful attention to the secondary use of data for back-end analytics as well as its clinical transaction system, which helped clinicians make better patient-care decisions. But IMH wanted to retain its own data management and analytic systems, a condition that called for increased coordination between the organizations. Cerner set up shop in offices next to IMH’s main medical facility and relocated some of its top development talent to Utah.

As a result of their close work together, IMH and Cerner partnered to win a huge contract to provide health care services to the Department of Defense and are brainstorming new products based on IMH’s data management services and data warehouse framework.

In each of these cases, data and analytics fundamentally altered the scope, depth, and quality of the engagements between and among organizations and individuals. Rather than one party buying what the other is selling, they are working together, supported by data, to create value for both sides.

Yet even the closest partnerships have their points of contention and conflict. A handful of forward-looking companies are starting to explore the possibility of gathering, developing, and exploiting IoT data from not only their own physical assets but also those of their customers and vendors. In some cases, customers and vendors do not hesitate to share their data, viewing data sharing as a low-cost, low-risk way to acquire analytics capabilities. But as companies as different as GE and Luminar have learned, customers and vendors can be difficult to sell on the concept, because it suggests a loss of autonomy, a compromise of trade secrets, or the giveaway of a valuable asset. In the public sector, data sharing can raise troubling issues, even when the data concerns something people want to get rid of: garbage. When AEB Amsterdam tried to improve its waste stream by having citizens separate recyclables into different colored bags, it had to confront public concern that the city might be spying on its residents through their trash.

Data partnerships, and data sharing more broadly, are creating important new sources of business value but at the same time generating new and as yet unanswered questions regarding data ownership, data accessibility, and data rights. To the extent that companies rely on data sharing for business value, who will manage the risks that accompany such dependence?

Treating Data as a Core Asset

Organizations can use data to improve virtually anything they do, but a relative handful of standout organizations are using data in highly intentional, systematic ways to address strategic challenges and react to — and in many cases anticipate — sweeping changes in the markets they serve.

What these organizations have in common is that they view data as a core asset. Their leaders are convinced that analytics can improve their ability to innovate and give them a competitive advantage. They support the systematic use of data in decision making and strategy throughout the organizations they lead. These organizations don’t just use analytics to address tactical and operational issues or to support basic reporting and marketing — with a strong push from their leaders, they’ve taken the next step up and are using analytics to allocate resources and create new products and business models. (See the sidebar, “How Data Enhances Sales, Pricing, and Procurement.”)

Today, GE views its competencies around data and analytics, as well as its various Internet of Things offerings, as central elements of its new digital business identity. Data is changing what GE sells, who sells what they sell, and how they sell, in addition to expanding the range of buyers to whom they sell. IMH, a pioneer in the use of data and analytics to improve health outcomes and lower costs, has long believed that data is core to operational decision making and strategic planning. The City of Amsterdam is now using data, its own as well as that of myriad partners, to improve municipal management, and in the process has been named Europe’s most innovative city. Like many large financial institutions, Nedbank is striving to use data to improve its operations and customer focus and achieve strategic goals. All these organizations are, to varying degrees, organizing their activities around the use of data.

For instance, IMH made a data-driven, strategic decision to perform cardiovascular operations (surgeries and catheterizations) at only four of its hospitals. By concentrating expertise at those facilities, IMH has sharply cut response times to treat ST-elevated myocardial infarctions (STEMI) — heart attacks that follow the sudden, complete blockage of coronary arteries. Research has shown that up to 15% of people who suffer STEMI die within 30 days of the event, but survival rates improve if patients receive treatment to unblock the artery within 90 minutes of arriving at the hospital. IMH tracks each STEMI event at its hospitals and shares its measurements with its surgical teams, who use the information to boost their response times. As of 2014, the median response time had been cut to 57 minutes — dramatically lower than the national average of 90 minutes — leading to a marked improvement in health outcomes, with 96% of STEMI patients surviving longer than 30 days after hospitalization.

Commercializing Data and Business Model Innovation

Virtually every power user of data and analytics is discovering the commercial potential of the information they’re collecting, generating, and analyzing (see the sidebar, “Data-Driven Product Innovation”). All the companies covered in this series — GE, IMH, and Nedbank — are beginning to commercialize data, related analytics, or a software platform. GE’s cloud-based Predix software platform is a standout example. Originally developed to provide GE’s own machine operators and maintenance engineers with real-time information to schedule maintenance checks, improve efficiency, and reduce downtime, Predix is now available to GE’s channel and technology partners as well as other customers who can use the platform to build their own set of bespoke analytics.

Like Predix, virtually all efforts to commercialize data and analytics are built from the foundation of a prior internal application. Nedbank’s Market Edge began life as an innovative way for the bank to develop value-added services to differentiate its credit- and debit-card offerings. The products that IMH is brainstorming with Cerner spring from the analytics developed to improve clinical care at IMH’s own facilities.

Bringing those commercial ventures to scale is a pressing question for senior leaders. Do they do it from the inside? That choice inevitably entails deep and difficult changes to functions such as sales and finance, as GE discovered while commercializing the Predix platform. Or do they scale up from the outside? Entravision chose that course when it set up its Luminar analytics unit as a freestanding division, with a separate P&L and its own sales teams. In either case, the scaling effort will blur inter- and intra-organizational boundaries — Luminar’s sales teams, for example, now join Entravision’s teams on sales calls to some advertisers.

Partnerships can serve as a powerful tool for scaling commercial offerings. By joining forces with its small-business clients to improve their performance and fine-tune their strategy, Nedbank builds a following for its consumer analytics offering while enhancing customer satisfaction and engagement. GE, as we have seen, partners with its industrial customers to boost their efficiency, with revenues determined by the savings generated by its analytics.

Organizational constraints, however, can impede efforts to scale commercial analytics offerings. Sometimes other organizational priorities take precedence, while in other cases the organization simply lacks the capabilities needed to bring a product or service to scale.

Nedbank encountered several of these challenges when trying to scale Market Edge, the analytics product for its merchant customers. The internal product team recruited 12 salespeople from its card division to sell Market Edge to merchants but soon learned that despite receiving specialized training, the salespeople were simply not comfortable discussing the product with their clients. Leaders of the scaling campaign have realized that they’ll need to recruit a whole new sales team for Market Edge — the current sales force just isn’t fit for purpose. At the same time, the Market Edge team has run up against resource constraints, because a concurrent program to retool the bank’s IT infrastructure has slowed the drive to move commercialization effort beyond the pilot stage.

GE is using data and analytics to refashion several elements of its business model, including service delivery, its sales force, and the way it prices equipment. It has created a huge software division to support Predix (its new cloud-based platform to host and analyze asset productivity data), develop new machine data applications, and bring together a community of customers and developers (see the sidebar, “Toward Data-Driven Strategic Planning”). The industrial giant is committing $1 billion to install sensors on jet engines, gas turbines, and other machines, connect them to the cloud, and analyze the resulting flow of data to find ways to boost machine reliability and productivity.

The case studies discussed in this report reveal the emerging opportunities with data, along with related challenges: The contours of the “management revolution” are taking shape. Those companies that are winning with data are mastering the data they have access to, co-creating business value from that data, and in some instances, elaborating their business models to take advantage of these new possibilities.

A 2015 MIT Sloan Management Review survey of 2,719 managers in organizations around the world found that the chief barrier to creating business value from analytics was not data management or complex modeling skills. Rather, the main obstacle was translating analytics into business actions — or, as one survey respondent put it, “developing middle management skills at interpretation.”

There are ways to close that gap, notably formal training and experiential learning. But mindsets also have to change. To become effective analytics consumers, managers must learn to distinguish between facts and data. Facts are immutable; data can be spun and massaged to support the preconceptions of the interpreter — a deeply ingrained cognitive tendency known as confirmation bias. A line from Paul Simon’s song “The Boxer” neatly sums up confirmation bias: “A man hears what he wants to hear and disregards the rest.”

In the Nedbank case study, local merchants thought they knew who their best customers were, but data offered a different view. Surgeons at IMH thought they were above average until data showed them otherwise. GE’s Oil & Gas customers believed they knew best how to manage their wells and rigs, until data showed them more productive ways. For managers accustomed to making decisions based entirely on their own experience and intuition, there is a tendency to believe that they are the right people with the right information at the right time. It is noteworthy that managers changed their minds and behavior in each of these cases when counterintuitive data was introduced into a business environment in which they trusted the people presenting the data and were prepared to trust the data itself.

In order to create business value from data, it may not be sufficient for the right information to be received and trusted by the right person at the right time; the right information must also have the right salience to the right person. In an era of information overload, the ability to identify the right information from other information remains a critically important management skill. Blending data and experience in decision making is not a balancing act; neither is a substitute for the other.

Organizational leaders can take a page from the legendary Alfred P. Sloan, who, when faced with unanimous support from his General Motors executive team for one of his decisions, responded: “I propose we postpone further discussion of this matter until our next meeting, to give ourselves time to develop disagreement and perhaps gain understanding of what the decision is all about.”

Data will often underdetermine a course of action, if only because data is subjective in nature; how data is created, weighted, and analyzed is the product of many individual decisions that can introduce personal or political biases. Data-based evidence is often weighed with experience, bolstered with faith, and buffeted by politics. As analytics becomes a more common path to business value, experience, belief, and politics as well as luck will continue to play crucial roles in determining what kind of business value can be derived from data.

1. The term “management revolution” was applied to this data phenomenon by Andrew MacAfee and Erik Brynjolfsson in 2012. See A. MacAfee and E. Brynjolfsson, “Big Data: The Management Revolution,” Harvard Business Review 90, no. 10 (October 2012): 60-68.

2. W. Fleener, M. Fitzgerald, “General Mills Builds Up Big Data to Answer Big Questions,” MIT Sloan Management Review, May 29, 2015. www.sloanreview.mit.edu.

3. J. Ross, D. Kiron, and R.B. Ferguson, “Do You Need a Data Dictator?” MIT Sloan Management Review, August 28, 2012, www.sloanreview.mit.edu.

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Evaluation of online job portals for HR recruitment selection using AHP in two wheeler automotive industry: a case study

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• S. M. Vadivel   ORCID: orcid.org/0000-0002-5287-3693 1 &
• Rohan Sunny   ORCID: orcid.org/0009-0002-2347-3081 2  

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Automotive companies are booming worldwide in the economy. In order to sustain in the highly competitive world, every organization tries to create itself a trademark in the market. In our research, we looked at how two wheelers automotive company's selection enhances an organizational performance, which ensures the company's future growth. In today's fast-paced, globally integrated world, human resources are one of the most important production variables. It is critical to preserve and improve economic competitiveness by properly selecting and developing these resources. The main aim of this study is to identify the best online job portal website for recruitment at Two Wheeler Company and to suggest an HR strategy which resonates company’s values and culture. In this study, we have selected 6 criteria and 6 online popular job portals for recruitment with a sample of 15 candidates have been selected. Findings reveal that, AHP method has significant results on the selection of best employer, which helps HR Manager to finalize the decision making process/strategies. Towards the managerial implications section, the researcher aims to design an functional and effective HR strategy that can grasp, engage and retain the top talent in the organization.

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Analytic hierarchy process

Artificial intelligence

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Chief Human Resources Officer

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Curriculum vitae

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Decision making

Faculty Development Programme

Hierarchical linear modelling

Human resources

Research and Development

Randomized index

Structural equation modelling

Search engine optimization

Triple bottom line

Technique for order preference by similarity

Maximum Eigen value

The normalized value of ith criterion for the jth alternative

The normalized value of jth criterion for the ith alternative

The number of alternatives for a certain MCDM problem

The number of criteria for a certain MCDM problem

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Acknowledgements

The authors would like to express their gratitude to two wheeler Automotive Industries in Chennai, Tamil Nadu, India, for their invaluable assistance and cooperation. We greatly acknowledge Ms. Ruchi Mishra, Research scholar from NIT Karnataka, for editing this manuscript in better form.

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Vadivel, S.M., Sunny, R. Evaluation of online job portals for HR recruitment selection using AHP in two wheeler automotive industry: a case study. Int J Syst Assur Eng Manag (2024). https://doi.org/10.1007/s13198-024-02358-z

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• Open access
• Published: 09 May 2024

Evaluation of integrated community case management of the common childhood illness program in Gondar city, northwest Ethiopia: a case study evaluation design

• Mekides Geta 1 ,
• Geta Asrade Alemayehu 2 ,
• Wubshet Debebe Negash 2 ,
• Tadele Biresaw Belachew 2 ,
• Chalie Tadie Tsehay 2 &
• Getachew Teshale 2  

BMC Pediatrics volume  24 , Article number:  310 ( 2024 ) Cite this article

103 Accesses

Metrics details

Integrated Community Case Management (ICCM) of common childhood illness is one of the global initiatives to reduce mortality among under-five children by two-thirds. It is also implemented in Ethiopia to improve community access and coverage of health services. However, as per our best knowledge the implementation status of integrated community case management in the study area is not well evaluated. Therefore, this study aimed to evaluate the implementation status of the integrated community case management program in Gondar City, Northwest Ethiopia.

A single case study design with mixed methods was employed to evaluate the process of integrated community case management for common childhood illness in Gondar town from March 17 to April 17, 2022. The availability, compliance, and acceptability dimensions of the program implementation were evaluated using 49 indicators. In this evaluation, 484 mothers or caregivers participated in exit interviews; 230 records were reviewed, 21 key informants were interviewed; and 42 observations were included. To identify the predictor variables associated with acceptability, we used a multivariable logistic regression analysis. Statistically significant variables were identified based on the adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value. The qualitative data was recorded, transcribed, and translated into English, and thematic analysis was carried out.

The overall implementation of integrated community case management was 81.5%, of which availability (84.2%), compliance (83.1%), and acceptability (75.3%) contributed. Some drugs and medical equipment, like Cotrimoxazole, vitamin K, a timer, and a resuscitation bag, were stocked out. Health care providers complained that lack of refreshment training and continuous supportive supervision was the common challenges that led to a skill gap for effective program delivery. Educational status (primary AOR = 0.27, 95% CI:0.11–0.52), secondary AOR = 0.16, 95% CI:0.07–0.39), and college and above AOR = 0.08, 95% CI:0.07–0.39), prescribed drug availability (AOR = 2.17, 95% CI:1.14–4.10), travel time to the to the ICCM site (AOR = 3.8, 95% CI:1.99–7.35), and waiting time (AOR = 2.80, 95% CI:1.16–6.79) were factors associated with the acceptability of the program by caregivers.

Conclusion and recommendation

The overall implementation status of the integrated community case management program was judged as good. However, there were gaps observed in the assessment, classification, and treatment of diseases. Educational status, availability of the prescribed drugs, waiting time and travel time to integrated community case management sites were factors associated with the program acceptability. Continuous supportive supervision for health facilities, refreshment training for HEW’s to maximize compliance, construction clean water sources for HPs, and conducting longitudinal studies for the future are the forwarded recommendation.

Peer Review reports

Integrated Community Case Management (ICCM) is a critical public health strategy for expanding the coverage of quality child care services [ 1 , 2 ]. It mainly concentrated on curative care and also on the diagnosis, treatment, and referral of children who are ill with infectious diseases [ 3 , 4 ].

Based on the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) recommendations, Ethiopia adopted and implemented a national policy supporting community-based treatment of common childhood illnesses like pneumonia, Diarrhea, uncomplicated malnutrition, malaria and other febrile illness and Amhara region was one the piloted regions in late 2010 [ 5 ]. The Ethiopian primary healthcare units, established at district levels include primary hospitals, health centers (HCs), and health posts (HPs). The HPs are run by Health Extension Workers (HEWs), and they have function of monitoring health programs and disease occurrence, providing health education, essential primary care services, and timely referrals to HCs [ 6 , 7 ]. The Health Extension Program (HEP) uses task shifting and community ownership to provide essential health services at the first level using the health development army and a network of woman volunteers. These groups are organized to promote health and prevent diseases through community participation and empowerment by identifying the salient local bottlenecks which hinder vital maternal, neonatal, and child health service utilization [ 8 , 9 ].

One of the key steps to enhance the clinical case of health extension staff is to encourage better growth and development among under-five children by health extension. Healthy family and neighborhood practices are also encouraged [ 10 , 11 ]. The program also combines immunization, community-based feeding, vitamin A and de-worming with multiple preventive measures [ 12 , 13 ]. Now a days rapidly scaling up of ICCM approach to efficiently manage the most common causes of morbidity and mortality of children under the age of five in an integrated manner at the community level is required [ 14 , 15 ].

Over 5.3 million children are died at a global level in 2018 and most causes (75%) are preventable or treatable diseases such as pneumonia, malaria and diarrhea [ 16 ]. About 99% of the global burden of mortality and morbidity of under-five children which exists in developing countries are due to common childhood diseases such as pneumonia, diarrhea, malaria and malnutrition [ 17 ].

In 2013, the mortality rate of under-five children in Sub-Saharan Africa decreased to 86 deaths per 1000 live birth and estimated to be 25 per 1000live births by 2030. However, it is a huge figure and the trends are not sufficient to reach the target [ 18 ]. About half of global under-five deaths occurred in sub-Saharan Africa. And from the top 26 nations burdened with 80% of the world’s under-five deaths, 19 are in sub-Saharan Africa [ 19 ].

To alleviate the burden, the Ethiopian government tries to deliver basic child care services at the community level by trained health extension workers. The program improves the health of the children not only in Ethiopia but also in some African nations. Despite its proven benefits, the program implementation had several challenges, in particular, non-adherence to the national guidelines among health care workers [ 20 ]. Addressing those challenges could further improve the program performance. Present treatment levels in sub-Saharan Africa are unacceptably poor; only 39% of children receive proper diarrhea treatment, 13% of children with suspected pneumonia receive antibiotics, 13% of children with fever receive a finger/heel stick to screen for malaria [ 21 ].

To improve the program performance, program gaps should be identified through scientific evaluations and stakeholder involvement. This evaluation not only identify gaps but also forward recommendations for the observed gaps. Furthermore, the implementation status of ICCM of common childhood illnesses has not been evaluated in the study area yet. Therefore, this work aimed to evaluate the implementation status of integrated community case management program implementation in Gondar town, northwest Ethiopia. The findings may be used by policy makers, healthcare providers, funders and researchers.

Method and material

Evaluation design and settings.

A single-case study design with concurrent mixed-methods evaluation was conducted in Gondar city, northwest Ethiopia, from March 17 to April 17, 2022. The evaluability assessment was done from December 15–30, 2021. Both qualitative and quantitative data were collected concurrently, analyzed separately, and integrated at the result interpretation phase.

The evaluation area, Gondar City, is located in northwest Ethiopia, 740 km from Addis Ababa, the capital city of the country. It has six sub-cities and thirty-six kebeles (25 urban and 11 rural). In 2019, the estimated total population of the town was 338,646, and 58,519 (17.3%) were under-five children. In the town there are eight public health centers and 14 health posts serving the population. All health posts provide ICCM service for more than 70,852 populations.

Evaluation approach and dimensions

Program stakeholders.

The evaluation followed a formative participatory approach by engaging the potential stakeholders in the program. Prior to the development of the proposal, an extensive discussion was held with the Gondar City Health Department to identify other key stakeholders in the program. Service providers at each health facility (HCs and HPs), caretakers of sick children, the Gondar City Health Office (GCHO), the Amhara Regional Health Bureau (ARHB), the Minister of Health (MoH), and NGOs (IFHP and Save the Children) were considered key stakeholders. During the Evaluability Assessment (EA), the stakeholders were involved in the development of evaluation questions, objectives, indicators, and judgment criteria of the evaluation.

Evaluation dimensions

The availability and acceptability dimensions from the access framework [ 22 ] and compliance dimension from the fidelity framework [ 23 ] were used to evaluate the implementation of ICCM.

Population and samplings

All under-five children and their caregivers attended at the HPs; program implementers (health extension workers, healthcare providers, healthcare managers, PHCU focal persons, MCH coordinators, and other stakeholders); and ICCM records and registries in the health posts of Gondar city administration were included in the evaluation. For quantitative data, the required sample size was proportionally allocated for each health post based on the number of cases served in the recent one month. But the qualitative sample size was determined by data saturation, and the samples were selected purposefully.

The data sources and sample size for the compliance dimension were all administrative records/reports and ICCM registration books (230 documents) in all health posts registered from December 1, 2021, to February 30, 2022 (three months retrospectively) included in the evaluation. The registries were assessed starting from the most recent registration number until the required sample size was obtained for each health post.

The sample size to measure the mothers’/caregivers’ acceptability towards ICCM was calculated by taking prevalence of caregivers’ satisfaction on ICCM program p  = 74% from previously similar study [ 24 ] and considering standard error 4% at 95% CI and 10% non- responses, which gave 508. Except those who were seriously ill, all caregivers attending the ICCM sites during data collection were selected and interviewed consecutively.

The availability of required supplies, materials and human resources for the program were assessed in all 14HPs. The data collectors observed the health posts and collected required data by using a resources inventory checklist.

A total of 70 non-participatory patient-provider interactions were also observed. The observations were conducted per each health post and for health posts which have more than one health extension workers one of them were selected randomly. The observation findings were used to triangulate the findings obtained through other data collection techniques. Since people may act accordingly to the standards when they know they are observed for their activities, we discarded the first two observations from analysis. It is one of the strategies to minimize the Hawthorne effect of the study. Finally a total of 42 (3 in each HPs) observations were included in the analysis.

Twenty one key informants (14 HEWs, 3 PHCU focal person, 3 health center heads and one MCH coordinator) were interviewed. These key informants were selected since they are assumed to be best teachers in the program. Besides originally developed key informant interview questions, the data collectors probed them to get more detail and clear information.

Variables and measurement

The availability of resources, including trained healthcare workers, was examined using 17 indicators, with weighted score of 35%. Compliance was used to assess HEWs’ adherence to the ICCM treatment guidelines by observing patient-provider interactions and conducting document reviews. We used 18 indicators and a weighted value of 40%.

Mothers’ /caregivers’/ acceptance of ICCM service was examined using 14 indicators and had a weighted score of 25%. The indicators were developed with a five-point Likert scale (1: strongly disagree, 2: disagree, 3: neutral, 4: agree and 5: strongly agree). The cut off point for this categorization was calculated using the demarcation threshold formula: ( \(\frac{\text{t}\text{o}\text{t}\text{a}\text{l}\, \text{h}\text{i}\text{g}\text{h}\text{e}\text{s}\text{t}\, \text{s}\text{c}\text{o}\text{r}\text{e}-\,\text{t}\text{o}\text{t}\text{a}\text{l}\, \text{l}\text{o}\text{w}\text{e}\text{s}\text{t} \,\text{s}\text{c}\text{o}\text{r}\text{e}}{2}) +total lowest score\) ( 25 – 27 ). Those mothers/caregivers/ who scored above cut point (42) were considered as “satisfied”, otherwise “dissatisfied”. The indicators were adapted from the national ICCM and IMNCI implementation guideline and other related evaluations with the participation of stakeholders. Indicator weight was given by the stakeholders during EA. Indicators score was calculated using the formula \(\left(achieved \,in \%=\frac{indicator \,score \,x \,100}{indicator\, weight} \right)\) [ 26 , 28 ].

The independent variables for the acceptability dimension were socio-demographic and economic variables (age, educational status, marital status, occupation of caregiver, family size, income level, and mode of transport), availability of prescribed drugs, waiting time, travel time to ICCM site, home to home visit, consultation time, appointment, and source of information.

The overall implementation of ICCM was measured by using 49 indicators over the three dimensions: availability (17 indicators), compliance (18 indicators) and acceptability (14 indicators).

Program logic model

Based on the constructed program logic model and trained health care providers, mothers/caregivers received health information and counseling on child feeding; children were assessed, classified, and treated for disease, received follow-up; they were checked for vitamin A; and deworming and immunization status were the expected outputs of the program activities. Improved knowledge of HEWs on ICCM, increased health-seeking behavior, improved quality of health services, increased utilization of services, improved data quality and information use, and improved child health conditions are considered outcomes of the program. Reduction of under-five morbidity and mortality and improving quality of life in the society are the distant outcomes or impacts of the program (Fig.  1 ).

Integrated community case management of childhood illness program logic model in Gondar City in 2022

Data collection tools and procedure

Resource inventory and data extraction checklists were adapted from standard ICCM tool and check lists [ 29 ]. A structured interviewer administered questionnaire was adapted by referring different literatures [ 30 , 31 ] to measure the acceptability of ICCM. The key informant interview (KII) guide was also developed to explore the views of KIs. The interview questionnaire and guide were initially developed in English and translated into the local language (Amharic) and finally back to English to ensure consistency. All the interviews were done in the local language, Amharic.

Five trained clinical nurses and one BSC nurse were recruited from Gondar zuria and Wegera district as data collectors and supervisors, respectively. Two days training on the overall purpose of the evaluation and basic data collection procedures were provided prior to data collection. Then, both quantitative and qualitative data were gathered at the same time. The quantitative data were gathered from program documentation, charts of ICCM program visitors and, exit interview. Interviews with 21 KIIs and non-participatory observations of patient-provider interactions were used to acquire qualitative data. Key informant interviews were conducted to investigate the gaps and best practices in the implementation of the ICCM program.

A pretest was conducted to 26 mothers/caregivers/ at Maksegnit health post and appropriate modifications were made based on the pretest results. The data collectors were supervised and principal evaluator examined the completeness and consistency of the data on a daily basis.

Data management and analysis

For analysis, quantitative data were entered into epi-data version 4.6 and exported to Stata 14 software for analysis. Narration and tabular statistics were used to present descriptive statistics. Based on established judgment criteria, the total program implementation was examined and interpreted as a mix of the availability, compliance, and acceptability dimensions. To investigate the factors associated with ICCM acceptance, a binary logistic regression analysis was performed. During bivariable analysis, variables with p-values less than 0.25 were included in multivariable analysis. Finally, variables having a p-value less than 0.05 and an adjusted odds ratio (AOR) with a 95% confidence interval (CI) were judged statistically significant. Qualitative data were collected recorded, transcribed into Amharic, then translated into English and finally coded and thematically analyzed.

Judgment matrix analysis

The weighted values of availability, compliance, and acceptability dimensions were 35, 40, and 25 based on the stakeholder and investigator agreement on each indicator, respectively. The judgment parameters for each dimension and the overall implementation of the program were categorized as poor (< 60%), fair (60–74.9%), good (75-84.9%), and very good (85–100%).

Availability of resources

A total of 26 HEWs were assigned within the fourteen health posts, and 72.7% of them were trained on ICCM to manage common childhood illnesses in under-five children. However, the training was given before four years, and they didn’t get even refreshment training about ICCM. The KII responses also supported that the shortage of HEWs at the HPs was the problem in implementing the program properly.

I am the only HEW in this health post and I have not been trained on ICCM program. So, this may compromise the quality of service and client satisfaction.(25 years old HEW with two years’ experience)

All observed health posts had ICCM registration books, monthly report and referral formats, functional thermometer, weighting scale and MUAC tape meter. However, timer and resuscitation bag was not available in all HPs. Most of the key informant finding showed that, in all HPs there was no shortage of guideline, registration book and recording tool; however, there was no OTP card in some health posts.

“Guideline, ICCM registration book for 2–59 months of age, and other different recording and reporting formats and booklet charts are available since September/2016. However, OTP card is not available in most HPs.”. (A 30 years male health center director)

Only one-fifth (21%) of HPs had a clean water source for drinking and washing of equipment. Most of Key-informant interview findings showed that the availability of infrastructures like water was not available in most HPs. Poor linkage between HPs, HCs, town health department, and local Kebele administer were the reason for unavailability.

Since there is no water for hand washing, or drinking, we obligated to bring water from our home for daily consumptions. This increases the burden for us in our daily activity. (35 years old HEW)

Most medicines, such as anti-malaria drugs with RDT, Quartem, Albendazole, Amoxicillin, vitamin A capsules, ORS, and gloves, were available in all the health posts. Drugs like zinc, paracetamol, TTC eye ointment, and folic acid were available in some HPs. However, cotrimoxazole and vitamin K capsules were stocked-out in all health posts for the last six months. The key informant also revealed that: “Vitamin K was not available starting from the beginning of this program and Cotrimoxazole was not available for the past one year and they told us they would avail it soon but still not availed. Some essential ICCM drugs like anti malaria drugs, De-worming, Amoxicillin, vitamin A capsules, ORS and medical supplies were also not available in HCs regularly.”(28 years’ Female PHCU focal)

The overall availability of resources for ICCM implementation was 84.2% which was good based on our presetting judgment parameter (Table  1 ).

Health extension worker’s compliance

From the 42 patient-provider interactions, we found that 85.7%, 71.4%, 76.2%, and 95.2% of the children were checked for body temperature, weight, general danger signs, and immunization status respectively. Out of total (42) observation, 33(78.6%) of sick children were classified for their nutritional status. During observation time 29 (69.1%) of caregivers were counseled by HEWs on food, fluid and when to return back and 35 (83.3%) of children were appointed for next follow-up visit. Key informant interviews also affirmed that;

“Most of our health extension workers were trained on ICCM program guidelines but still there are problems on assessment classification and treatment of disease based on guidelines and standards this is mainly due to lack refreshment training on the program and lack of continuous supportive supervision from the respective body.” (27years’ Male health center head)

From 10 clients classified as having severe pneumonia cases, all of them were referred to a health center (with pre-referral treatment), and from those 57 pneumonia cases, 50 (87.7%) were treated at the HP with amoxicillin or cotrimoxazole. All children with severe diarrhea, very severe disease, and severe complicated malnutrition cases were referred to health centers with a pre-referral treatment for severe dehydration, very severe febrile disease, and severe complicated malnutrition, respectively. From those with some dehydration and no dehydration cases, (82.4%) and (86.8%) were treated at the HPs for some dehydration (ORS; plan B) and for no dehydration (ORS; plan A), respectively. Moreover, zinc sulfate was prescribed for 63 (90%) of under-five children with some dehydration or no dehydration. From 26 malaria cases and 32 severe uncomplicated malnutrition and moderate acute malnutrition cases, 20 (76.9%) and 25 (78.1%) were treated at the HPs, respectively. Of the total reviewed documents, 56 (93.3%), 66 (94.3%), 38 (84.4%), and 25 (78.1%) of them were given a follow-up date for pneumonia, diarrhea, malaria, and malnutrition, respectively.

Supportive supervision and performance review meetings were conducted only in 10 (71.4%) HPs, but all (100%) HPs sent timely reports to the next supervisory body.

Most of the key informants’ interview findings showed that supportive supervision was not conducted regularly and for all HPs.

I had mentored and supervised by supportive supervision teams who came to our health post at different times from health center, town health office and zonal health department. I received this integrated supervision from town health office irregularly, but every month from catchment health center and last integrated supportive supervision from HC was on January. The problem is the supervision was conducted for all programs.(32 years’ old and nine years experienced female HEW)

Moreover, the result showed that there was poor compliance of HEWs for the program mainly due to weak supportive supervision system of managerial and technical health workers. It was also supported by key informants as:

We conducted supportive supervision and performance review meeting at different time, but still there was not regular and not addressed all HPs. In addition to this the supervision and review meeting was conducted as integration of ICCM program with other services. The other problem is that most of the time we didn’t used checklist during supportive supervision. (Mid 30 years old male HC director)

Based on our observation and ICCM document review, 83.1% of the HEWs were complied with the ICCM guidelines and judged as fair (Table  2 ).

Acceptability of ICCM program

Sociodemographic and obstetric characteristics of participants.

A total of 484 study participants responded to the interviewer-administered questionnaire with a response rate of 95.3%. The mean age of study participants was 30.7 (SD ± 5.5) years. Of the total caregivers, the majority (38.6%) were categorized under the age group of 26–30 years. Among the total respondents, 89.3% were married, and regarding religion, the majorities (84.5%) were Orthodox Christian followers. Regarding educational status, over half of caregivers (52.1%) were illiterate (unable to read or write). Nearly two-thirds of the caregivers (62.6%) were housewives (Table  3 ).

All the caregivers came to the health post on foot, and most of them 418 (86.4%) arrived within one hour. The majority of 452 (93.4%) caregivers responded that the waiting time to get the service was less than 30 min. Caregivers who got the prescribed drugs at the health post were 409 (84.5%). Most of the respondents, 429 (88.6%) and 438 (90.5%), received counseling services on providing extra fluid and feeding for their sick child and were given a follow-up date.

Most 298 (61.6%) of the caregivers were satisfied with the convenience of the working hours of HPs, and more than three-fourths (80.8%) were satisfied with the counseling services they received. Most of the respondents, 366 (75.6%), were satisfied with the appropriateness of waiting time and 431 (89%) with the appropriateness of consultation time. The majority (448 (92.6%) of caregivers were satisfied with the way of communicating with HEWs, and 269 (55.6%) were satisfied with the knowledge and competence of HEWs. Nearly half of the caregivers (240, or 49.6%) were satisfied with the availability of drugs at health posts.

The overall acceptability of the ICCM program was 75.3%, which was judged as good. A low proportion of acceptability was measured on the cleanliness of the health posts, the appropriateness of the waiting area, and the competence and knowledge of the HEWs. On the other hand, high proportion of acceptability was measured on appropriateness of waiting time, way of communication with HEWs, and the availability of drugs (Table  4 ).

Factors associated with acceptability of ICCM program

In the final multivariable logistic regression analysis, educational status of caregivers, availability of prescribed drugs, time to arrive, and waiting time were factors significantly associated with the satisfaction of caregivers with the ICCM program.

Accordingly, the odds of caregivers with primary education, secondary education, and college and above were 73% (AOR = 0.27, 95% CI: 0.11–0.52), 84% (AOR = 0.16, 95% CI: 0.07–0.39), and 92% (AOR = 0.08, 95% CI: 0.07–0.40) less likely to accept the program as compared to mothers or caregivers who were not able to read and write, respectively. The odds of caregivers or mothers who received prescribed drugs were 2.17 times more likely to accept the program as compared to their counters (AOR = 2.17, 95% CI: 1.14–4.10). The odds of caregivers or mothers who waited for services for less than 30 min were 2.8 times more likely to accept the program as compared to those who waited for more than 30 min (AOR = 2.80, 95% CI: 1.16–6.79). Moreover, the odds of caregivers/mothers who traveled an hour or less for service were 3.8 times more likely to accept the ICCM program as compared to their counters (AOR = 3.82, 95% CI:1.99–7.35) (Table  5 ).

Overall ICCM program implementation and judgment

The implementation of the ICCM program in Gondar city administration was measured in terms of availability (84.2%), compliance (83.1%), and acceptability (75.3%) dimensions. In the availability dimension, amoxicillin, antimalarial drugs, albendazole, Vit. A, and ORS were available in all health posts, but only six HPs had Ready-to-Use Therapeutic Feedings, three HPs had ORT Corners, and none of the HPs had functional timers. In all health posts, the health extension workers asked the chief to complain, correctly assessed for pneumonia, diarrhea, malaria, and malnutrition, and sent reports based on the national schedule. However, only 70% of caretakers counseled about food, fluids, and when to return, 66% and 76% of the sick children were checked for anemia and other danger signs, respectively. The acceptability level of the program by caretakers and caretakers’/mothers’ educational status, waiting time to get the service and travel time ICCM sites were the factors affecting its acceptability. The overall ICCM program in Gondar city administration was 81.5% and judged as good (Fig.  2 ).

Overall ICCM program implementation and the evaluation dimensions in Gondar city administration, 2022

The implementation status of ICCM was judged by using three dimensions including availability, compliance and acceptability of the program. The judgment cut of points was determined during evaluability assessment (EA) along with the stakeholders. As a result, we found that the overall implementation status of ICCM program was good as per the presetting judgment parameter. Availability of resources for the program implementation, compliance of HEWs to the treatment guideline and acceptability of the program services by users were also judged as good as per the judgment parameter.

This evaluation showed that most medications, equipment and recording and reporting materials available. This finding was comparable with the standard ICCM treatment guide line [ 10 ]. On the other hand trained health care providers, some medications like Zink, Paracetamol and TTC eye ointment, folic acid and syringes were not found in some HPs. However the finding was higher than the study conducted in SNNPR on selected health posts [ 33 ] and a study conducted in Soro district, southern Ethiopia [ 24 ]. The possible reason might be due to low interruption of drugs at town health office or regional health department stores, regular supplies of essential drugs and good supply management and distribution of drug from health centers to health post.

The result of this evaluation showed that only one fourth of health posts had functional ORT Corner which was lower compared to the study conducted in SNNPR [ 34 ]. This might be due poor coverage of functional pipe water in the kebeles and the installation was not set at the beginning of health post construction as reported from one of ICCM program coordinator.

Compliance of HEWs to the treatment guidelines in this evaluation was higher than the study done in southern Ethiopia (65.6%) [ 24 ]. This might be due to availability of essential drugs educational level of HEWs and good utilization of ICCM guideline and chart booklet by HEWs. The observations showed most of the sick children were assessed for danger sign, weight, and temperature respectively. This finding is lower than the study conducted in Rwanda [ 35 ]. This difference might be due to lack of refreshment training and regular supportive supervision for HEWs. This also higher compared to the study done in three regions of Ethiopia indicates that 88%, 92% and 93% of children classified as per standard for Pneumonia, diarrhea and malaria respectively [ 36 ]. The reason for this difference may be due to the presence of medical equipment and supplies including RDT kit for malaria, and good educational level of HEWs.

Moreover most HPs received supportive supervision and performance review meeting was conducted and all of them send reports timely to next level. The finding of this evaluation was lower than the study conducted on implementation evaluation of ICCM program southern Ethiopia [ 24 ] and study done in three regions of Ethiopia (Amhara, Tigray and SNNPR) [ 37 ]. This difference might be due sample size variation.

The overall acceptability of the ICCM program was less than the presetting judgment parameter but slightly higher compared to the study in southern Ethiopia [ 24 ]. This might be due to presence of essential drugs for treating children, reasonable waiting and counseling time provided by HEWs, and smooth communication between HEWs and caregivers. In contrast, this was lower than similar studies conducted in Wakiso district, Uganda [ 38 ]. The reason for this might be due to contextual difference between the two countries, inappropriate waiting area to receive the service and poor cleanness of the HPs in our study area. Low acceptability of caregivers to ICCM service was observed in the appropriateness of waiting area, availability of drugs, cleanness of health post, and competence of HEWs while high level of caregiver’s acceptability was consultation time, counseling service they received, communication with HEWs, treatment given for their sick children and interest to return back for ICCM service.

Caregivers who achieved primary, secondary, and college and above were more likely accept the program services than those who were illiterate. This may more educated mothers know about their child health condition and expect quality service from healthcare providers which is more likely reduce the acceptability of the service. The finding is congruent with a study done on implementation evaluation of ICCM program in southern Ethiopia [ 24 ]. However, inconsistent with a study conducted in wakiso district in Uganda [ 38 ]. The possible reason for this might be due to contextual differences between the two countries. The ICCM program acceptability was high in caregivers who received all prescribed drugs than those did not. Caregivers those waited less than 30 min for service were more accepted ICCM services compared to those more than 30 minutes’ waiting time. This finding is similar compared with the study conducted on implementation evaluation of ICCM program in southern Ethiopia [ 24 ]. In contrary, the result was incongruent with a survey result conducted by Ethiopian public health institute in all regions and two administrative cities of Ethiopia [ 39 ]. This variation might be due to smaller sample size in our study the previous one. Moreover, caregivers who traveled to HPs less than 60 min were more likely accepted the program than who traveled more and the finding was similar with the study finding in Jimma zone [ 40 ].

Strengths and limitations

This evaluation used three evaluation dimensions, mixed method and different data sources that would enhance the reliability and credibility of the findings. However, the study might have limitations like social desirability bias, recall bias and Hawthorne effect.

The implementation of the ICCM program in Gondar city administration was measured in terms of availability (84.2%), compliance (83.1%), and acceptability (75.3%) dimensions. In the availability dimension, amoxicillin, antimalarial drugs, albendazole, Vit. A, and ORS were available in all health posts, but only six HPs had Ready-to-Use Therapeutic Feedings, three HPs had ORT Corners, and none of the HPs had functional timers.

This evaluation assessed the implementation status of the ICCM program, focusing mainly on availability, compliance, and acceptability dimensions. The overall implementation status of the program was judged as good. The availability dimension is compromised due to stock-outs of chloroquine syrup, cotrimoxazole, and vitamin K and the inaccessibility of clean water supply in some health posts. Educational statuses of caregivers, availability of prescribed drugs at the HPs, time to arrive to HPs, and waiting time to receive the service were the factors associated with the acceptability of the ICCM program.

Therefore, continuous supportive supervision for health facilities, and refreshment training for HEW’s to maximize compliance are recommended. Materials and supplies shall be delivered directly to the health centers or health posts to solve the transportation problem. HEWs shall document the assessment findings and the services provided using the registration format to identify their gaps, limitations, and better performances. The health facilities and local administrations should construct clean water sources for health facilities. Furthermore, we recommend for future researchers and program evaluators to conduct longitudinal studies to know the causal relationship of the program interventions and the outcomes.

Data availability

Data will be available upon reasonable request from the corresponding author.

Abbreviations

Ethiopian Demographic and Health Survey

Health Center/Health Facility

Health Extension Program

Health Extension Workers

Health Post

Health Sector Development Plan

Integrated Community Case Management of Common Childhood Illnesses

Information Communication and Education

Integrated Family Health Program

Integrated Management of Neonatal and Childhood Illness

Integrated Supportive Supervision

Maternal and Child Health

Mid Upper Arm Circumference

Non-Government Organization

Oral Rehydration Salts

Outpatient Therapeutic program

Primary health care unit

Rapid Diagnostics Test

Ready to Use Therapeutic Foods

Sever Acute Malnutrition

South Nation Nationalities People Region

United Nations International Child Emergency Fund

World Health Organization

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Acknowledgements

We are very grateful to University of Gondar and Gondar town health office for its welcoming approaches. We would also like to thank all of the study participants of this evaluation for their information and commitment. Our appreciation also goes to the data collectors and supervisors for their unreserved contribution.

No funding is secured for this evaluation study.

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Geta Asrade Alemayehu, Wubshet Debebe Negash, Tadele Biresaw Belachew, Chalie Tadie Tsehay & Getachew Teshale

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All authors contributed to the preparation of the manuscript. M.G. conceived and designed the evaluation and performed the analysis then T.B.B., W.D.N., G.A.A., C.T.T. and G.T. revised the analysis. G.T. prepared the manuscript and all the authors revised and approved the final manuscript.

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Geta, M., Alemayehu, G.A., Negash, W.D. et al. Evaluation of integrated community case management of the common childhood illness program in Gondar city, northwest Ethiopia: a case study evaluation design. BMC Pediatr 24 , 310 (2024). https://doi.org/10.1186/s12887-024-04785-0

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Patients' creative ideas can inform a health care organization's learning and innovation, finds study

R outinely collected patient experience surveys provide an opportunity for patients to share their creative ideas for improvement, according to a new study at Columbia University Mailman School of Public Health. Researchers in Health Policy and Management developed and assessed a methodological strategy that validates questions designed to elicit creative ideas from patients.

Until now the pace of translating patient insights into innovation has been slow and its effectiveness inadequate. The findings are published in the journal, The Milbank Quarterly.

"Our study contributes to the generation of ideas in the following ways: First, it enriches understanding of an overlooked form of patient knowledge—patients' creative ideas. Second, it contributes to health services research by offering a rigorously tested methodology for eliciting their creative ideas and how their experiences could be improved within the context of their own health systems," said Yuna Lee, Ph.D., Health Policy and Management professor and first author.

For the past decade, the National Academy of Medicine has envisioned learning health systems in this way for American health care—using knowledge obtained directly from their patients to achieve high-quality, patient-centered care while containing costs at the same time.

It is critical for health care organizations to consider how to report and use these data in health care delivery and quality improvement, according to Lee. "Our research is the first to fully assess the potential of creative ideas of patients across diverse populations. My colleagues and I believe that a valid and reliable method for eliciting creative ideas from patients can be deployed as part of routine quality improvement in health care organizations."

Lee and colleagues conducted multistage mixed-method studies of patients' creative ideas in two field study stages. The first stage included survey development and testing with a representative sample of 600 adult patients from New York State and their creative ideas.

The survey evaluated narrative elicitation methods that integrate open-ended questions into routine survey operations, Of four options tested, the final open-ended question generated roughly double the number of actionable items and highly creative ideas. This question was distinct in its approach to induce creativity explicitly.

They also found that certain subgroups of patients possessed a unique vantage point for especially actionable and/or especially creative ideas. "We contend that patients generate more actionable and creative ideas when explicitly invited to share such ideas, especially patients with negative health care experiences, those from minority racial/ethnic backgrounds, and those with chronic illness," observed Lee.

"Inviting patients to generate and share their creative idea may support their agency and autonomy in health care systems that need more of both and that seek to create more opportunities for patient feedback and empowerment."

The second-stage field study was a real-world health systems test with a sample of 2,948 creative ideas from 1,892 patient surveys from a large health system in New York City. Lee and team collected ideas from patients who completed patient care experience surveys over 18 months from July 1, 2020, to December 31, 2021).

They found four possibilities for patients' creative ideas to enable learning for innovation: they could solve extant challenges and identify patient experience "pain points," specify new interventions when generating solutions is important, amplify exceptional practices or people which may enhance morale of clinicians and staff, or forecast hopes for the future, providing important input for strategic planning.

While patients are routinely recognized as an important source of knowledge, and their insights have been routinely extracted, the pace of translating these insights into innovations has been slow and effectiveness inadequate. Learning from patients' creative ideas through effective methods, the research team hypothesized that these shortfalls could be at least partly rectified.

While not all patient recommendations may be immediately put into practice, they can infuse fresh perspectives into existing practices and proposed innovations, helping to identify those meriting resource or time investment, according to Lee.

"In a journey from idea generation to implementation, patients' creative ideas as a source of knowledge are a valuable starting point, providing important input for organizational strategic planning and forecasting, and providing a sense of what patients value and hope for the future," said Lee.

Co-authors are Rachel Grob, University of Wisconsin; Ingrid Nembhard, The Wharton School, University of Pennsylvania; Dale Shaller, Shaller Consulting Group: and Mark Schlesinger, School of Public Health, Yale University.

More information: Yuna S. H. Lee et al, Leveraging Patients' Creative Ideas for Innovation in Health Care, The Milbank Quarterly (2023). DOI: 10.1111/1468-0009.12682

Provided by Columbia University's Mailman School of Public Health