Case Study of Safety Net Hospital 1
Jessica Collins
BUSI691: Healthcare Administration Capstone
Assurance of Learning Exercise
July 27, 2025
Respectfully submitted to: Dr. Geraldine Rosol
Case Study of Safety Net Hospital 2
Wishard’s Competitive Situation
The Wishard Health Services organization was put into a challenging situation. From all
accounts, the organization was not competitive in the sense of obtaining profit for their
services; rather, they did something no other hospital in the area was willing to do. They
made it their mission to provide care to needy, and it did not matter if they were insured
or not. The surrounding hospitals have made it difficult to attract new patients given the
current state of the facility and the area it is in. At the time of this case study, revisions
to Medicaid had yet been introduced; however, many benefits are given to institutions
that help the indigent population. “Federally Qualified Health Centers (FQHCs) provide
high quality primary care to over 30 million patients across the U.S. regardless of
income, employment status, residency status, health insurance coverage, or ability to
pay for care” (Bifulco et al., 2023, para. 2). Since Wishard Hospital was the main provider
for the underserved and uninsured, the financial woes continued to stack up.
The one area that Wishard could compete with other healthcare organizations in
was that it operated a burn unit. Having established wound care specialists and
resources to treat patients in this area of expertise set them up to bring in profits from
referrals from surrounding organizations. Outside of that, other organizations feared the
potential closing of Wishard because someone had to take in its indigent population.
This would cost them money and potentially ruin their reputation.
Evalution of the Environmental Factors
The current situation for the Wishard organization is that it lacks advanced technological
abilities, financial inabilities prevent occupation of specialty physicians, its run-down
facilities prevent new paying patients, and societal values are placing emphasis on
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expensive higher quality of care. According to Walston, (2023), “Leaders should identify
key factors contributing to both successes and failures and use these to inform the
planning process” (p. 286). Management is aware of their options to keep the doors
open, but unfortunately there are downsides to every idea. The economic factors that
plagued Wishard Hospital were reimbursement cuts. “For every $1 in hospital bills
submitted to the two federal programs, Medicare paid just 82 cents, compared to 89
cents four years earlier. Medicaid paid 70 cents for every dollar of service, down from 90
cents” (Walston, 2023, p. 432). Another economic factor impacting the hospital is
government funding. Since this hospital is doing the city a service by providing care to its
poorest residents, financial support should be provided to ensure the hospital stays
open and these residents do not hurt the profits of the larger more profitable hospitals
in the city. “Federal spending on programs (beyond health care) that are known to
improve health for people with low or moderate incomes has been projected to
decrease through 2029.
Federal budgets continue to propose shifting massive costs to states” (Fleming et al.,
2021, p. 10). This kind of decision-making is going to be costly to the state of Indiana.
Social factors that influence the state of Wishard Hosptial are health disparities and
patient preferences. “Within the United States, there are significant healthcare
disparities based on race, ethnicity, socioeconomic status, education level, sexual
orientation, gender identity, and geographic location” (Salmond & Dorsen, 2022, p. 64).
Wishard Hospital is opening its doors to everyone who needs help regardless of any of
the information stated previously. They guarantee that anyone who needs care will
receive care. This extends into their patient preferences.
Case Study of Safety Net Hospital 4
Technological factors are slim for Wishard Hospital. Without money, it cannot offer
advancement. “The current use of information and communication technologies (ICT)
has introduced efficient patient portals, electronic health records, telemedicine, and
more” (Thacharodi et al., 2024, p. 329). Offering telehealth services would be beneficial
to Wishard Hospital, but that would include technology they could use to perform these
services, as well as the patients. These kinds of things require an adamant amount of
training to prevent any misconduct.
Wishard’s Strategic Leverage
Wishard Hospital’s strategic leverage was its unwavering support for the public
and servicing the indigent population. Their commitment to community service is a pro
and con, but they stayed true to their mission and values. The reason it is a con is
because their services do not bring in revenue due to the decrease in payout from
Medicaid and Medicare. Utilizing its strengths, Wishard has continued to do what it set
out to do and did not try to copy what other hospitals in the area were doing. Even
when they thought about merging, they still thought about the community they serve
first and how they would fit into the new look of the operation. Why? Because they are
the primary institution in the community that handled care for the poor. Other hospitals
treated a smaller population of indigent people, but Wishard was the face of the
initiative in the community, and people knew that. If that hospital shut down, the impact
would be felt all over the city.
Case Study of Safety Net Hospital 5
Issues with Having a Stand-Alone Hospital
From a societal perspective, having a stand-alone hospital whose sole mission is
to provide care for the indigent population will have problems with operating costs, high
demands, which will extend their financial burden due to the increased number of
patients without insurance. The added pressure to serve the population and the rising
costs of services such as prescriptions and equipment will ultimately lead to its closure.
The hospital must have adequate resources to keep their doors open and provide care to
people, but if the budget is being threatened and the negative profit margin keeps
increasing, that is a recipe for disaster. The pressure on this institution to perform under
these circumstances is harsh. They have become overburdened, causing struggles
making them less competitive with other hospitals. But they are a beacon of hope to
people in the community.
Recommended Strategic Steps for Wishard
There are several steps that can be taken for Wishard to stay open. The first step is to
solidify its status as a charity hospital. This would require them to rely on donations and
charitable contributions. If the surrounding hospitals are building larger facilities and for
profit and better patient demographics, then they can make contributions to Wishard to
continue the work they are doing for the people in the community, with hopes of not
accepting any patients themselves who would make them lose profit. If every local
hospital donated $1 million to Wishard and other local clinics provided help to the
neighboring patients, Wishard would not be so overburdened.
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The second step is getting active in the communities and assessing social determinants
of health. These actions are good for getting access to the truth of what people need
and how they can be treated. Smaller clinics and other healthcare initiatives would
benefit from this kind of exposure, but it would also show who’s willing to help and
people in the community can utilize their facilities as well. A third step would be cutting
excessive overhead and operating costs, but they are already experiencing reduced
resources and financial strain.
Strategic Planning Initiatives
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If Wishard is going to succeed, they need a financial plan that is going to be
effective. There has been a challenge to obtain funds from the city, and they must find a
way to collect $20- $80 million. Long term, the hospital has a plan for new construction,
but that would cost $750 million. ”In many hospitals, specifically older hospitals, a lot of
capital is needed to upgrade the existing physical space, including facilities and
equipment, reduced liquidity and increased the debt ratio with financial problems, and
the bankruptcy of these hospitals” (Homauni et al., 2023, p. 1889). They could use cloud
technology to introduce an electronic health record to improve documentation for
patients and go paperless. Freeing up funds in their operating budget to introduce new
integrative technology while also lowering expenses.
Human capital management is a way for an organization to achieve its strategic
objectives by ensuring proper training and professional competency. People play a
dynamic role in the success of organizations, but it really is how they are used that
makes the organization effective. “The key function of human resources management
(HRM) is to “put the right people in the right jobs at the right time” (Qin et al., 2023,
para. 1). Adopting a schedule where time blocks are created on different days for
training to increase employees’ competency in specific quality service areas is beneficial
to the entire organization. It helps create a positive work environment that fosters
teamwork and positive work relationships. This helps create a learning culture that could
boost work performance and attract more patients.
To achieve effectiveness in marketing, a target audience must be chosen.
Consumers want a user friendly, but trustworthy experience with an organization.
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Wishard could advance itself into the contemporary setting if it added messaging
applications and used social media to interact with people. “For organizations like
hospitals, digital media and new technology platforms provide opportunities to expand
into new markets, offer new services, apply new online communication techniques, and
compete on a more equal footing with larger businesses” (Pasaribu et al., 2022, para 2).
Wishard would expand its audience if it was able to use telehealth for patients and have
an app to set up virtual appointments. Thus, making it easier and more attractive for
stakeholders and patients.
References
Bifulco, L., Grzejszczak, L., Velez, I., Angelocci, T., & Anderson, D. (2023). A qualitative
investigation of uninsured patient and primary care provider perspectives on
specialty care eConsults. BMC Health Services Research, 23(1),
1133. https://doi.org/10.1186/s12913-023-10086-6
Fleming, P. J., Spolum, M. M., Lopez, W. D., & Galea, S. (2021). The public health funding
paradox: How funding the problem and solution impedes public health
Progress. Public Health Reports (Washington, D.C.: 1974), 136(1), 10–13.
https://doi.org/10.1177/0033354920969172
Homauni, A., Markazi-Moghaddam, N., Mosadeghkhah, A., Noori, M., Abbasiyan, K., &
Jame, S. Z. B. (2023). Budgeting in healthcare systems and organizations: A
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systematic review. Iranian Journal of Public Health, 52(9), 1889–1901.
https://doi.org/10.18502/ijph.v52i9.13571
Pasaribu, S. B., Novitasari, D., Goestjahjanti, F. S., & Hendratono, T. (2022). The impact
and challenges of digital marketing in the health care industry during the digital
era and the COVID-19 pandemic. Frontiers in Public Health, 10, 969523.
https://doi.org/10.3389/fpubh.2022.969523
Qin, X., Huang, Y. N., Hu, Z., Chen, K., Li, L., Wang, R. S., & Wang, B. L. (2023). Human
resource management research in healthcare: A big data bibliometric study.
Human Resources for Health, 21(1), 94. https://doi.org/10.1186/s12960-
023-00865-x
Salmond, S., & Dorsen, C. (2022). Time to Reflect and Take Action on Health
Disparities and Health Inequities. Orthopedic nursing, 41(2), 64–85.
https://doi.org/10.1097/NOR.0000000000000828
Thacharodi, A., Singh, P., Meenatchi, R., Tawfeeq Ahmed, Z. H., Kumar, R. R. S., V, N.,
Kavish, S., Maqbool, M., & Hassan, S. (2024). Revolutionizing healthcare and
medicine: The impact of modern technologies for a healthier future-A
comprehensive review. Health Care Science, 3(5), 329–349.
https://doi.org/10.1002/hcs2.115
Walston, S. L. (2023). Strategic healthcare management: Planning and execution (3rd ed.).
Health Administration Press.
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