Read “The Cali Clinic Case Study” Below
An important part of your answer is to identify the issues/actions in the case which may be problematic. The following questions may help you to do this:
What actions were taken in the case?
Were these actions the most appropriate and why?
Were there any consequences of the action taken?
Was anything omitted or not considered?
Were actions/procedures in line with existing codes of practice, policy or theories?
Do you see any challenges?
Discuss the element of external validation of quality and how important this issue is among the international market (Chapter 3).
Include the role of transparency and ultimately quality metrics.
Discuss why you think the other senior partners are against this more “sophisticated management approach”.

The Cali Clinic
Javier Perez Ornalez has called a meeting of his five partners. As one of the largest gastroenterology groups in Cali, Colombia, Javier and his partners have always been viewed as leaders in the medical community. For the past 2 years, Javier took a leave of absence and studied in the United States at a well-respected business school where he received an MBA with a concentration in health care management. Now, returning to Cali, he wants to move his group to a more sophisticated management approach. “We need to be more sophisticated in our management strategy,” he says, we have always just gotten patients to our clinic as a function of the fact that we exist and we are good doctors. I am not sure that strategy will continue to work. We need to change our approach.
Senior Marquez, one of the founding partners interrupts, “Javier,” it is great that you have been to the United States, but to come back now and want to change what we have built seems loco. Why? What are we doing wrong? In fact, more Americans are finding their way to Cali for care. Just last week, I did bariatric surgery on five Americans right here in the clinic. Ten years ago, I am not sure I saw any American patients. Yes, you are right, the world is changing, but in my 30 years of being a doctor, the world has always spun, the world has always changed. You too will learn this.
“I think we cannot assume patients will just come to us, they can also go to Medellin and Bogota if they even come to Colombia.” Javier continues, “Yes, we are growing, but so too is everyone else. We need to recognize that in the past 3 years in Cali as in all of Colombia. The environment has changed. Look at our neighbors in Brazil and elsewhere in South America. Medical tourism is on the rise. Can we assume that we will get business just because we are good?”
“It has worked in the past,” says Don Marquez a specialist in reflux diseases, “why should we assume that now, because you have seen the light, it should not continue. The endoscopy business has steadily grown. I think we will continue to ride this curve of growth into the future by being good.”
“Please Javier,” says Maria, the most recent partner who trained at a U.S. medical facility and also practiced with a large multi-specialty group in the United States for several years before returning home for family reasons. “What do you think we should do if we were to be more sophisticated, as you say, can you lay out some of those tactics? Maybe that could help us all and then we could respond more specifically.”
“That is a good suggestion, thank you Maria, I have thought about it,” Javier said. “Let me tell you what I think we need to consider. Foremost, of course we need to develop a far more sophisticated website, where patients can see our surgi-center and take a virtual tour. We should get the Surgical Review Corporation (www.surgicalreview.org) to give us their stamp of approval. This will help our quality positioning. As doctors, we should all become members of the American Society of Bariatric Surgery and we can then display that on our website as another indicator of our excellence. I wonder if we should mount a promotional campaign on YouTube. And, should we hire a salesperson to give talks in Miami and the southeastern part of the United States for us with a targeted strategy.”
“This is absurd!” says Dr. Echiverra, the most senior partner in the group. “You will bankrupt us and there is no need to change what we have always done. See patients, do our procedures and provide good care. The patients will come. I have heard enough. I have patients to see.”