Dr. Max Michael, CEO of the Jefferson Health System, a county public hospital, had the difficult responsibility of balancing cost with care, of rationing procedures with policy, and of juggling personnel with budgets, performance, and demand.Dr. Michael implemented the Community Care Plan (CCP) to serve the county's indigent population through a sizeable grant award.The program has been met with limited success and the grant period will be ending soon.Should he forge ahead with expansion plans to try to achieve a critical mass, hold steady until they worked out their "growing pains," or give up on the plan altogether?

This case illustrates the complexity of leadership decision making in a public hospital within the context of rising healthcare costs and declining funding sources.You must consider each of the choices for Dr. Michael and propose a recommendation.Should he move ahead with expansion plans to achieve critical mass, try to maintain the status quo with the program while culture and structure issues are resolved, or close down the Community Care Plan?

1. Why have patients such as Martha Jones not been signing up for CCP? Discuss some of the unique problems associated with delivering health care to an indigent population.
2. What is the purpose and structure of the Community Care Plan? Briefly describe the program's intent and how it has been operating.
3. What are the factors that point to the need for change at Cooper Green Hospital? (Challenges, constraints, competitive forces, changing demographics, etc.)
4. What are Cooper Green's strengths and weaknesses that need to be considered in reaching a decision?
5. What are your recommendations for Cooper Green Hospital and the CCP program? Should they maintain a network model and stabilize or expand? Or, should they use a hospital model and contract and eventually close the program.