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GEB 4894 - Assignment 2

Assignment 2 contains ten questions. Six questions relate to the case below, and the other four questions relate to your lectures and readings. Please make sure you answer all ten questions. Let’s begin with a review of the case, shown below:

Chronic Effects of Untreated High Blood Pressure

You work for an HMO as a strategic manager and business analyst, and you have been asked to begin investigating the activities of a company insured by your HMO. The HMO has seen an increase in the number of older men who have been hospitalized and have undergone surgery for aortic dissection, aortic expansion, and other cardiovascular illnesses typically related to the long-term effects of untreated high blood pressure.

For example, untreated high blood pressure results in inordinate growth of the aorta which will continue expanding as long as the patient’s blood pressure remains excessively high. Often, the patient will experience symptoms and pain which will eventually require emergency care, hospitalization, and invasive surgery. This is unfortunate because early diagnosis and successful treatment of high blood pressure may have circumvented the need for emergency and surgical intervention.

Taking blood pressure medicine daily as opposed to undergoing invasive surgery is much more agreeable to the patient and much less expensive for your HMO. It is much cheaper for the HMO to cover primary care visits and high blood pressure medication as opposed to later covering costs of the patient’s emergency care, hospitalization, surgery, and long-term rehabilitation.

Decrease of Medical Examinations

So why was high blood pressure in these older men not diagnosed in a timely fashion? It is suspected that high blood pressure went undiagnosed because these older men were avoiding their annual medical checkups with their primary care physicians. An annual medical examination would have likely included readings of blood pressure using a conventional cuff which would have alerted the physician to the patient’s high blood pressure. The medical exam would have also likely included an electrocardiogram which would have made the physician aware of concerns and abnormalities with the patient’s heart which may have been due to untreated high blood pressure.

You then notice that the decrease in medical examinations all occur among employees of one very large organization that contracts with your HMO for health insurance coverage.

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Short-Sighted HR Director

You identify the older men who were hospitalized between February 2014 and September 2019. You begin contacting and informally interviewing them regarding the circumstances of their health and hospitalizations. Most of these older men wound up in the emergency room in severe pain and were then admitted to the hospital where they subsequently underwent surgery.

In the course of your interviews you discover that beginning in January 2011 through September 2019, the company employed a Human Resources (HR) director who frowned upon the annual medical checkup because he believed it drove up insurance costs and would result in short-term higher premiums for the company.

Further investigation reveals that the HR director had no background or experience in human resources, benefits management, healthcare management, managed care, or insurance. In fact, he was a used car salesman for his entire career before being hired as the HR director at this large company. As it turns out, he was hired as the HR director because he had been a fishing buddy of one of members of the company’s board of directors.

This HR director had mistakenly focused on saving money now by preventing older employees from going to their annual medical checkups. The HR director had not appeared to be cognizant of excessive long-term healthcare costs associated with foregoing the annual medical exam; these costs being emergency care, hospitalizations, and surgery due to expanding aortas and other long-term medical problems associated with untreated high blood pressure.

It has been rumored that the HR director instructed managers to casually ask their employees if they had received a medical checkup within the last year, and the employees answering “yes” were to receive an unfavorable employee performance evaluation. Giving these employees a bad performance evaluation would be a deterrent from them getting their annual medical checkups with their doctor. You tried questioning these managers regarding the HR director’s instructions, but none of them will speak to you. Of course, their silence only intensifies your suspicions.

Regardless of the managers’ reticence, many employees have relayed to you their experience of getting a bad performance evaluation in connection with their annual medical checkup. You have also talked to other employees who told you they didn’t go for their annual checkup with their doctor for fear of getting a bad performance evaluation.

Therefore, anecdotal evidence now indicates that employees are skipping their annual medical checkups because of the threat of a bad performance evaluation. You need to test this anecdotal evidence to determine if there is any validity to it.

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The Organization’s Performance Evaluation System

Hypothesis - is there an association between getting an annual medical checkup and receiving a bad performance evaluation?

The organization’s employee performance evaluation system is based upon a ten point scale shown in Table 1 below:

Table 1 Employee Performance Evaluation System: Ten Point Scale Performance Points: Outstanding 9-10, Above Average 6-8, Average 5, Marginal 3-4, Unsatisfactory 2 or Less

You define a Good Evaluation as any performance score average or above. A bad evaluation will be defined as a performance score reflecting marginal or unsatisfactory performance.

Good and bad evaluations are then defined as follows:

• Good Evaluation = Outstanding, Above Average, or Average

• Bad Evaluation = Marginal or Unsatisfactory

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Setting up the Crosstab

You then set up a 2x2 cross-tabulation (contingency) table to record the numbers of employees receiving good and bad performance evaluations and those who did or did not receive an annual medical examination.

The 2x2 cross-tabulation (contingency) table is shown in Table 2.

Table 2: 2x2 Cross-Tabulation Table

Bad Evaluation Good Evaluation Totals

Medical Checkup - Yes

Medical Checkup - No

Totals

It is suspected that the HR director began implementing this practice of penalizing employees for getting their annual medical checkups beginning in February 2011. So, you establish your sample to include male employees, 50 years and older who had received a performance evaluation since February 2011. Your time frame is between February 2011 and September 2019.

You then begin compiling data on 348 employees who received performance evaluations between February 2011 and September 2019.

Setting up the Table for Analysis

You must keep in mind that there are employees who may have received bad performance evaluations because they really are bad employees. Bad evaluations may not be attributed only to the employee getting his annual medical checkup.

Likewise, there may be employees who went to their annual medical checkups, yet they still received a good performance evaluation. The reasons for this could have been that their managers didn’t hold it against them because they had gone for their medical checkups, or perhaps these employees were not honest about going for their medical checkups when asked by their managers.

These are the reasons you need to perform an analysis to determine if there is a statistically significant association between getting a bad evaluation and undergoing an annual medical exam.

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Listed below is your data:

• 55 Employees Underwent an Annual Medical Examination and received a Bad Performance Evaluation (i.e., less than Satisfactory)

• 62 Employees Underwent an Annual Medical Examination and did Not receive a Bad Performance Evaluation (i.e., Satisfactory or Above)

• 51 Employees Did Not Undergo an Annual Medical Examination, but received a Bad Performance Evaluation (i.e., less than Satisfactory)

• 180 Employees Neither Underwent an Annual Medical Examination Nor received a Bad Performance Evaluation (i.e., Satisfactory or Above)

Shown below is the way the table should be started:

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Software for Your Analysis

You may use Open Epi to perform your analysis.

Use the following link to access Open Epi:

https://www.openepi.com/Menu/OE_Menu.htm

Assignment 2 – Ten Questions begin on the following page.

Initiate your analysis by clicking “Two by Two Table.”

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Assignment 2 Questions

Assignment 2 contains ten questions. The first six questions relate to this case, and the final four questions relate to your lectures and readings.

Make sure you review the tables at the bottom of the attachment before answering your questions. Please feel free to contact your professor if you run into any problems completing the assignment.

The first six questions are as follows:

1. What is the Odds Ratio: A. 0.592 B. 1.849 C. 4.026 D. 0.00000000000000009875 E. 3.131

2. What is the lower confidence limit of the Odds Ratio? A. 0.237 B. 1.941 C. 2.832 D. 8.99999999999999999999999990 E. 4.164 F. 3.000

3. What is the Relative Risk Ratio: A. 0.652 B. 10.888888888888888888888888889 C. 1.774 D. 0.0584247892582684128628 E. 3.587 F. 2.129

4. What is the Uncorrected Chi-Square Statistic? A. 18.65 B. 39.60 C. 22.79 D. 10.11 E. 0.96 F. 55,000.0589741211411589521

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5. Is the association between getting a medical checkup and getting a bad performance

evaluation statistically significant? A. Yes B. No C. Statistical significance is not relevant in this case D. It is statistically significant at the low end, but not at the high end. E. There is no such concept as statistical significance. F. The case does not provide sufficient information to determine statistical significance.

6. Please write three to five sentences discussing your findings. Include in this discussion how doing this analysis will help correct a competitive disadvantage (weakness) for your HMO. Hint, see the Lecture on Internal Environmental Analysis and Competitive Advantage (Chapter 4). Pay close attention to the Strategic Thinking Map of Competitive Disadvantages, Slides 60-64.

7. Which of the following are directional strategies? A. Mission, vision, values, and strategic goals. B. External environment, internal environment, strengths, and weaknesses.r C. Leadership, systems thinking, and strategic planning. D. Service and structure analysis, competitive analysis, service areas, and service

categories. E. Strategies lacking direction.

8. The three elements of service delivery are:

A. Pre-service, point of service, and after-service. B. Pricing, quality, and marketing. C. Lion roar, bear growl, cat meow D. Target market, clinical operations, and billing. E. Branding, process innovation, and clinical.ling.

9. Which of the following is the proper interpretation of competitive disadvantage for an

organizational weakness that exhibits high value, is not rare, is easy to correct, and such that competitors can sustain their advantage? A. Long-term competitive advantage. B. Long term advantage conditioned upon the CEO’s ability bench press over 200

pounds. C. Neither a competitive advantage or disadvantage D. Short-term disadvantage. E. No Competitive Disadvantage

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10. Which of the following are positioning strategies?

A. Mergers and Acquisitions B. Defender, protector, analyzer, and reactor C. Internal development, internal ventures, and configuring value chain D. Standing, sitting, lying down E. Cost leadership and differentiation

This concludes Assignment One. After working out your solutions and answers to these ten problems, please record your official responses in Canvas.