Abstract
Organizations around the world are challenged with managing complex decisions; however, many students do not have practical experience with the way in which these organizations go about this process. In this article, we outline an experiential case, based on a contemporary, real-world health policy challenge, which illustrates the ethical and team-based difficulties inherent in making decisions in instances of limited budgets and multiple stakeholders with conflicting priorities. This highly adaptable exercise places students in the role of decision-maker where they must select the best course of action to address a virulent blood-borne disease afflicting their constituents. Throughout this process, students are exposed to a number of decision-making, stakeholder, ethical, and team dynamic issues. The exercise has been successfully implemented in undergraduate- and graduate-level classes and encourages high-quality class discussions in a wide range of organizational behavior and management courses.
Articulating the importance of ethics, decision-making, and team processes are cornerstones of any business school education. For many, however, these topics remain distant considerations, particularly, for those with limited organizational experience. A common concern while teaching these topics is that many consider these fundamental business processes as obvious and straightforward. This linear decision-making process is often not the case as individuals are prone to be biased in terms of their decision-making abilities (De Martino et al., 2006), have difficulty learning teamwork skills (Waddock & Lozano, 2013), and often perceive themselves to be more ethical than they actually are (Chung & Monroe, 2003; Yang et al., 2017). To help dispel these existing beliefs and to encourage students to increase their understanding of several core management topics, we present the Iecur Sanguinem Robiginem-1 (ISR-1) Drug Case—a fictional and highly adaptable experiential exercise centered on the intersection of ethics, decision-making, and team processes.
The ISR-1 Drug Case is an interactive classroom activity inspired by real events that engage students in acting out a realistic dilemma whereby they assume the role of decision-makers tasked with addressing the aversive impact of a virulent blood-borne disease. The inherent flexibility of the exercise provides instructors with multiple options to conduct the case based on desired learning outcomes. Nevertheless, in every situation, students must analyze a shared case and decide on a course of action that allocates budgetary funds that offers the greatest benefit to their constituents. As a result of this exercise, students are able to develop advocacy skills and gain a greater understanding of the difficulties inherent in making complex ethical decisions both individually and in a team.
In its current format, the exercise has been used over a dozen times in a variety of organizational behavior and management classes at the undergraduate, graduate, and executive education levels and has been well received. At the graduate level, this exercise has been used for students in traditional MBA programs, along with specialized programs (namely MBA in Social Enterprise and Masters of Employment Relations programs). When used in Executive Education, it has been taught in conjunction with courses focused on managing teams. Interestingly, we have used this simulation with students who have had little to no work experience and were as young as 20 years of age (primarily at the undergraduate level) to employees with over 30 years of work experience and who are in senior management positions. While the content of class discussions varies given students’ ages and experience levels, all students are equally able to comprehend the exercise and engage in comprehensive discussions. Given the flexibility of the ISR-1 Drug Case, we present a number of variations that have been used to adapt the contents of the exercise to fit different class time frames.
Theoretical Background
The objective of the ISR-1 Drug Case is to provide students with an opportunity for experiential learning that reflects many of the same issues that leaders and policy makers have to deal with on a daily basis when addressing complex organizational and societal issues. The exercise draws upon the three topics of ethics, decision-making, and team processes to illustrate these challenges. Next, we will present the theoretical background of each of the three main topics covered by the ISR-1 Drug Case.
Ethics
The importance of teaching ethics in management courses has been emphasized for many years (e.g., Lau, 2010); however, it is often challenging for educators to go beyond ethical awareness (Lowry, 2003) where students are able to realize the ethical consequences to business actions (Williams & Dewett, 2005). To place students in realistic scenarios where they are tasked with making ethical choices that expand their moral reasoning skills (Rossouw, 2002) is perhaps more difficult. In the ISR-1 Drug Case, students are not only made aware of ethical issues but must make decisions that require them to expand their moral reasoning skills and use ethical frameworks to justify their decisions. While various ethical frameworks can be used to provide a rationale for students’ decisions, the case is best suited for comparing and contrasting commonly used organizational ethical frameworks such as utilitarianism, where the emphasis is on the ratio of benefits to costs for the greatest number of people impacted by the action (Gandz & Hayes, 1988) and the ethics of care where the self is connected to others and primarily relationship-focused (Liedtka, 1996).
For example, students may decide that they would like to allocate resources that can help the most people by providing education to the broader population (utilitarianism), yet others will argue that it is better to provide a cure for a smaller number of people who need it the most (ethics of care). In addition, students are asked to make ethical decisions that hinge on short- versus long-term orientations (e.g., Nevins et al., 2007). Consistent with research on the theory of moral development (Kohlberg, 1981) and cultural values on long-term orientation (Hofstede, 2001), decisions can be made with a moral concern for the “here-and-now” or adopted with a long-term orientation where planning and hard work now will lead to greater future rewards (Nevins et al., 2007). For example, the ISR-1 Drug Exercise allows students to choose between either curing some patients immediately (short-term orientation) or allocating resources toward research which may cure more patients in the distant future (long-term orientation). As such, this exercise allows students to expand their moral reasoning skills, focus on the ethical frameworks that they would use to support their views, and examine how their value of time influences their choices.
Decision-Making
Beyond ethics, the desire to create practical experiences in which students can safely engage in decision-making where the choices have meaningful impacts on people’s lives inspired this exercise. While other examples of decision-making exercises do an excellent job of demonstrating students’ cognitive biases in decision-making (e.g., Carter Racing Brittain & Sitkin, 1990), we were motivated to develop an exercise where students’ decision-making biases challenge their ability to balance the interests and needs of organizational stakeholders for limited resources (Reynolds et al., 2006). In particular, we wanted students to not only recognize their decision-making biases but also be comfortable justifying and presenting their decisions to impacted stakeholders. As such, this exercise enables students to better understand why even carefully made decisions are often viewed as unfair (e.g., Barsky & Kaplan, 2007; Schminke et al., 1997).
Team Processes
Finally, this exercise simulates important team processes, as the exercise asks students to examine their own insights and assessments individually and then come to a group consensus. While it is likely clear to both educators and students that team discussion can be beneficial for coming to more accurate and informed decisions (Kugler et al., 2012; Zimbardo et al., 2003), the reality is that reaching team consensus is challenging, time-consuming, and often disappointing (Hackman, 1987; Ilgen et al., 1995). There are a number of reasons why, such as the failure of others to consider dissenting or minority voices (e.g., Park & DeShon, 2010); biased information processing in group discussions (e.g., Faulmüller et al., 2012; Mojzisch et al., 2010) or individual motivations to process information in a team setting (e.g., Nijstad & De Dreu, 2012). This may be heightened when people are tasked with having to justify and discuss an individual ethical choice in a team environment. Depending on the social and informational dynamics within a team, individuals may have to change their earlier choices and those changes may feel particularly uncomfortable when confronting ethical dilemmas. As such, the ISR-1 Drug Case provides an opportunity for students to reflect on how individual ethical choices may be compromised in team settings and what that means for team identity (Ashforth et al., 2011), group cohesion (Schminke & Wells, 1999), and psychological safety (Leung et al., 2015).
The ISR-1 Drug Case Exercise
The ISR-1 Drug Case is designed to cover a number of important organizational behavior topics, including ethics, decision-making, and team processes. The exercise is also designed to be highly adaptable to the needs of students, the learning content of the course, and the time limits of the instructor. The goal of the current exercise is to offer students an experience that will illustrate and reinforce the following learning objectives.
Learning Objectives
At the end of this exercise, students should be able to
Reflect on the ethics, complexity, and impact of the decision-making process when multiple stakeholders are affected by the outcome.
Identify various trade-offs that exist among stakeholders when making resource allocation decisions both individually and in a group setting.
Understand the team-related dynamics in group-based resource allocation decisions.
In doing so, we adopt Kolb’s (2015) learning cycle in the design of the exercise to ensure that students are provided with the most robust opportunity for experiential learning. Kolb’s (2015) experiential learning cycle is a learning theory made up of four stages that reflect how individuals both understand and process information. These skills include concrete experience, reflective observation, abstract conceptualization, and active experimentation. Experiential learning highlights the important role that experience plays in personal development and change (Ng et al., 2009). As such, we have developed a classroom exercise that integrates reflection and application—two critical aspects of classroom engagement and managerial skill development (Chen et al., 2004; Petriglieri et al., 2011; Smart & Csapo, 2007).
In the following sections, we present the real-world global health challenge that informed the case. This will be followed by a description of the various options that instructors have for implementing this exercise. Options vary based on available class time, such that we provide instructions for running this exercise in a 1-hour, 2-hour, and longer than 2-hour classes. We then provide a guide for how to debrief the exercise based on the major topics explored (see Table 1). Finally, we summarize the student feedback that we have received thus far, and conclude with our final thoughts on this exercise.
Iecur Sanguinem Robiginem-1 (ISR-1) Drug Case Teaching Options, Time Allocation, and Topics Covered.
The ISR-1 Drug Case
The ISR-1 Drug Case was inspired by a contemporary public health emergency regarding hepatitis C that has posed management challenges for policy makers and public health officials (Ireland, 2017). In the current case, however, we changed many names and details to offer students a realistic scenario that ensures that the issues in the case do not depend on future scientific breakthroughs or policy changes. Changing the details and specifics of this case based on real-life events also ensures that students with personal knowledge of the disease are not forced to disclose this information in class. In spite of these changes, the challenges identified in the case provide an ideal case to address ethical issues in organizations, decision-making biases, and team process difficulties. As well, the case provides students with a contemporary, high-stakes context around the health and public safety of citizens that is both easy to understand on its face and continues to perplex policy experts in terms of finding a comprehensive set of solutions to this issue.
Hepatitis C, the disease in which the exercise the ISR-1 Drug Case is based on and which we call Iecur Sanguinem Robiginem-1 or “ISR-1” in the case, is considered the most common chronic blood-borne infection in the world (Armstrong et al., 2006; Louie et al., 2012) that contributes to a number of comorbidities, including death (Ly et al., 2016). Hepatitis C has also been referred to as a “silent killer,” as it is highly pervasive with symptoms that often take years to appear (Brahm et al., 2017, p. 6).
Epclusa, a recent breakthrough drug that was recently developed by Gilead Sciences, has proven to be a highly effective medication for the treatment of hepatitis C (Afdhal et al., 2014). The medication has been deemed so successful as a cure for hepatitis C that it has been recently added to the World Health Organization’s (2017) list of essential medicines; this list contains medications deemed most effective and safe to meet the needs of health systems around the globe. We used the pseudonym “Diprolapril” and “Nostrum Pharmaceutical” to represent Epclusa and Gilead Sciences in the case, respectively.
While Epclusa is recognized as highly effective for treating hepatitis C, it is also extremely costly, preventing many from accessing this potentially life-saving treatment (Rosenthal & Graham, 2016; Trooskin et al., 2015). Epclusa’s prohibitive costs make it exceptionally problematic, given the recent increase in the number of people who have been diagnosed with hepatitis C as a result of the opioid epidemic (Zibbell et al., 2018). This rise in hepatitis C cases is possibly a result of the prevalence of needle-sharing among those who engage in injectable opioid drug use, which can increase the transmission of hepatitis C between users (Aitken et al., 2017). As a result, health departments and public health agencies must choose how to allocate government funds to hepatitis C, and this presents a rich case from which students can learn the fundamental challenges of making ethical decisions in a group environment.
Exercise Design
As described above, this case is inspired by real-life events associated with the hepatitis C virus. All students receive the same case material (see Appendix A for the full case) that provides information for students to make a budget in terms of how resources should be allocated to the various options (see Appendix B for the Recommended Budget Breakdown form). The ISR-1 Drug Case is flexible in that instructors can choose to deliver it over a 1-hour, 2-hour, or longer than 2-hour classes, and we provide outlines as well as suggested timing for each option (please see Appendix C). The case assumes that students will take on the role of a member of the Health Policy and Planning Board for a territorial government and can be delivered in person or online (discussed later in the Online Delivery of ISR-1 Drug Case section). Finally, we include a number of sample discussion questions (Appendix D), as well as a list of pros and cons and ethical talking points of allocating funding to each of the five identified initiatives (Appendix E) that will help instructors during the class debrief.
Instructions for Implementing the Exercise
We present three options in which the exercise can be conducted based on time availability. In Option A, students independently read the case (Appendix A) and make an individual budget recommendation (Appendix B), based on the case material. Option B builds on Option A by having students form groups and attempt to reach consensus on a single group-level budget allocation. Last, Option C builds on the work of the previous two options by having all groups reach consensus on a single class-level budget allocation. We present an outline for each option below that was developed and tested in a wide range of management courses. Then we provide a guide to debrief the exercise based on the topics the instructor wishes to discuss, specifically separate ethics, decision-making, and team processes debriefs.
Option A (1-Hour Class)
Each student is provided with a copy of the information sheet that outlines the vignette, core issues of the case, as well as five initiatives where they can allocate their budget (Appendix A). The instructor then specifies to all students that they are to read the entire case as well as the descriptions of the funding initiatives before they begin. Students are informed that they have 100 points, where each point represents $100,000, in which to fund five proposed health initiatives. The use of points rather than money was based on feedback from students to ensure a more streamlined budget allocation process. This method also has the additional benefit of placing more emphasis on the justification portion of the activity rather than the dollar value of each budgetary allocation. Once the instructions are provided, students complete this first portion of the exercise independently either at home or in-class depending on available class time. Specifically, students decide on how they wish to allocate their 100 points of departmental funding and provide a brief justification for each decision using the provided form (see Appendix B) regardless of whether points are allocated to a particular initiative or not.
In terms of selections, students are offered the chance to provide funding to five different initiatives. These include paying to offer a full treatment regimen that will effectively cure patients of the ISR-1 virus; negotiate and lobby the pharmaceutical company to lower medication prices; improve education, awareness, and testing campaigns to help combat the disease; offer a Clean Needle Exchange Program for citizens; and devote funding to a research prize that may offer a low-cost alternative treatment to the disease. Once students have reviewed their options and allocated their points, the instructor can ask students to anonymously submit their point allocations. For small classes, instructors can then quickly enter the individual point allocations; in larger classes, we recommend using an online survey method (e.g., TopHat; Qualtrics surveys), where the instructor can quickly download the data and show the different point allocations to students once the exercise is complete.
Option B (2-Hour Class)
Option B builds on Option A and simulates a Health Policy Board meeting as students who have each completed the individual budget allocation activity (Appendices A and B) are then assigned to larger teams (four to five students). In these teams, students must reach a consensus around how each initiative should be funded and provide a justification for their decisions without having discussed their results with the rest of the class. Groups must then submit their team-level budget to the instructor.
Option C (2+-Hour Class)
The final option builds on the prior options by involving students in reaching consensus across multiple groups. The ISR-1 Drug Case provides an engaging means of discussing stakeholders in a number of different ways. If conducting the activities sequentially, Option C can be integrated into the class by having students examine the final budget allocations made by each team. From there, all teams must work with one another to reach consensus and agree upon a final, class-level budget.
Debrief Guide
There are many ways in which instructors can lead the debrief, but we outline the approach we have used to guide a challenging yet important conversation with students. We first begin the debrief by telling the students that while the exact facts of the case are fiction, we have grounded the exercise on an existing virus: hepatitis C.
From our experience, many students will immediately ask what the “right” solution is to this problem. We draw from research on ill-structured problems defined as (a) ambiguous and difficult to define, (b) the solution is elusive as an optimal outcome is difficult to determine, and (c) experts will be unclear on what is the best solution (Kayes, 2002; King & Kitchener, 1994). Many students express disappointment or frustration when we inform them that there is no “right” solution. We acknowledge the students’ frustration but we also explain the prevalence of ill-structured problems in daily life and that the purpose of this exercise is to highlight the challenges of making difficult ethical decisions that need to address the needs and interests of multiple stakeholders.
Next, the instructor can select from the following debrief sections that map onto the major topic(s) that the instructor wishes to address. Below, we have broken down the debrief into the three major topics: ethics, decision-making, and team processes covered in the exercise (see Appendix D for accompanying discussion questions). While in this article we discuss the topics separately, instructors are encouraged to combine many of the points in their debrief if time permits (e.g., we frequently debrief decision-making, and team processes simultaneously).
Ethics Debrief
We first present the data from the individual budget allocations—for small classes (e.g., less than 20 students) we typically show all individual decisions. In larger classes, we present the averages for each option along with standard deviations. We go through each alternative one by one and ask students to explain their rationale for their budget allocation. We then connect their rationale to the ethical frameworks that can map onto their decision. We also ask students to consider whether their solutions impact stakeholders in the short term or in the long term and what the ethical implications are for that choice (see Appendix E).
An excellent resource that partners well with this discussion is the third chapter in Bazerman and Tenbrunsel’s (2012) book on ethical blind spots during the decision-making process. In the chapter titled “When we act against our own ethical values,” the authors outline how individuals who try to make moral and ethical decisions are hindered by their own biases, such as in-group favoritism, implicit biases, overly discounting the future, egocentrism, and overclaiming. For example, students often focus on allocating resources to priorities that can deliver short-term outcomes (i.e., education and awareness campaigns; curing a small percentage of currently afflicted patients), while discounting the long-term benefits associated with reducing the price for all patients (i.e., allocating more resources toward lobbying efforts or the research prize). For those looking for more resources on ethical blind spots, Sezer et al. (2015) provide an excellent review of the literature.
Decision-Making Debrief
To debrief the decision-making component of the case, we start by asking students how they made their decisions regarding their budget allocations. Most students state that they evaluated each option and went with the ones they felt would do the best. We highlight rational decision-making models that students could have used (e.g., PrOACT model; Hammond et al., 2015) and ask whether they believe that their budget allocations would differ had they used a more systematic approach as opposed to their own intuition. We then outline many of the decision-making biases that exist when rational decision-making models are not implemented, particularly, for ill-structured problems, highlighting a variety of cognitive biases such as anchoring bias, availability bias, and affect heuristics (e.g., Gilovich et al., 2002; Tversky & Kahneman, 1974). We also discuss how decision-making biases are often exacerbated when groups have to make decisions (which we elaborate on further in the section on team process). We highlight the importance of implementing an effective decision-making model prior to deciding on a single solution, as teams are very unlikely to change their minds once a decision has been made.
We also ask students how willing they are to explain the rationale behind their decisions to affected stakeholders. We have a discussion about the fairness of decision-making, referencing work by Brockner (2006) to discuss why decisions that might be fair to the decision-makers also need to seem fair to stakeholders. We elaborate on the three forms of justice (distributive, procedural, and interactional; Colquitt et al., 2005) and explain why all three need to be considered when making decisions with limited resources that impact a multitude of stakeholders.
Team Processes Debrief
To begin the team processes debrief, we discuss with students how they combined their individual budget allocations to develop a team-level budget. Typically students say that they compromised when there were differences in allocations, voted in their small groups, or picked the average of all individual allocations. Other students will discuss that one person in the group seemed to be more knowledgeable about the case and that their ideas held more weight in the final team-level decision. We encourage students to consider how that might have influenced their overall budgets.
We then highlight many of the group-level decision-making biases and problems that exist. For example, we find that students often will leave the decision to the person in the group who is seemingly the most knowledgeable, speaks first, or has the loudest voice. We then discuss how status differences and diversity in groups have a strong influence on team processes, highlighting that those differences need to be managed carefully in order to realize the benefits (e.g., Mannix & Neale, 2005). We explore the evidence that dissenting ideas tend to go unheard in group decision-making due to pressures of conformity (Janis, 1982; Nemeth & Staw, 1989). We explore the important roles that leaders must take in order to ensure that minority voices are heard (e.g., Kearney & Gebert, 2009; Mitchell et al., 2015).
We often finish the team-process debrief by asking students to do a show of hands of who would be in favor of the team (or class) budget versus something different. We discuss the implications of public versus private choices in groups (e.g., the Abilene paradox, Harvey, 1974; Rubin & Dierdorff, 2011) and what this implies for teams, particularly, as it relates to team-level identity, psychological safety, and group cohesion.
General Debrief Comments
This exercise has been successfully run in a number of different courses with students who vary significantly by age and work experience. This being said, there are important differences between the types of conversations and debriefs that will likely occur depending on student demographics. Consistent with previous research on stages of moral development (e.g., Rest, 1986; Rest et al., 1999), younger students at the undergraduate level who are often at lower stages of their moral development are more likely to emphasize a utilitarian ethical framework without having fully thought through the consequences of having to justify their decision to the broader public. They are also more likely to consider short-term options as opposed to allocating resources toward initiatives that will provide long-term benefits. However, we also found that senior-level students, particularly, those engaged in executive education, tended to be more cynical about whether their efforts would materialize into real change. Some, especially those who have had experience on boards, felt that some of the funding options would only provide a temporary solution. This provided an interesting discussion about the role of decision- making at a governance level.
While our own experiences with this exercise have been largely positive, it is important to point out some issues we have witnessed ourselves, which instructors may want to mitigate. First, instructors may find that running the case in groups with varying levels of diversity (e.g., age, background, work experience) will change the nature of the debrief and discussion. In certain classes, and particularly, at the undergraduate level when students were largely homogenous (i.e., approximately the same age and similar backgrounds), there is the potential to have low variance in group budget allocations. If instructors experience this, we encourage them to draw from Appendix E where they can challenge the dominant view of the class by pointing out to students the costs and benefits associated with the various options to encourage greater discussion and reflection. Alternatively, in highly diverse classes, instructors must ensure that the various perspectives put forward by students are given fair treatment and that students are heard.
Second, we found that among some of the students with more experience, they tended to be more cynical and were more likely to hide behind the diffusion of responsibility when questioned on their budget allocation. Alternatively, in some group decisions and debriefs, one or two students have tried to dominate the conversation. As such, some students did not take the decision-making process seriously as they admitted that their input would likely not matter in bureaucratic matters or that the group decision was really an individual decision that others agreed with. In these situations, we encourage instructors to use this as an opportunity to discuss team processes issues, such as why minority voices are critical but frequently ignored, and why team size and team member roles are important for decision-making.
Third, in our experience, some students did not agree with the solutions provided to them in the case and wanted to come up with their own options, and this was particularly, true for senior-level students who had a policy or health care background. While this may be challenging to manage, in these situations, we reminded students that the alternatives provided to them had been previously chosen as being the best evidence-based practices and to make decisions based on the information that was available to them. Finally, when we reveal that this case is based on a real-world health issue associated with hepatitis C, some students have expressed dismay with existing health care bureaucracies, which may lead to difficult and emotional conversations. We have found, from past experience that these conversations can be valuable but also triggering for some, so it is best for instructors to provide students with a warning that these discussions may be emotionally charged.
Online Delivery of ISR-1 Drug Case
This exercise could easily be modified for use in online or hybrid courses. In both cases the individual component of the budget allocation process would remain the same, however, the group-based exercise could take place using face-to-face online discussion tools (e.g., Zoom). Once teams have reached a consensus, these results could be posted and the class could discuss the outcome of the activity using online discussion board forums or a self-reflection assignment exercise. Regardless of the method used to disclose the final budget allocation, conducting the exercise in a virtual environment may create certain context-dependent situations (i.e., conversation delays) that may influence team member perceptions (Schoenenberg et al., 2014). It may also encourage further discussion about how virtual communication may impact important board decisions (e.g., Baines et al., 2019).
Student Feedback
As previously mentioned, this exercise has been used in a number of different business courses at the undergraduate, graduate, and executive management levels at two universities of different sizes (approximately 18,000 and 45,000 students) with class sizes that range from nine to 120 students. As part of the development of this exercise, we facilitated feedback from 394 (223 female) students with a mean age of 23.83 years (SD = 7.14), from 13 course sections (seven undergraduate, three graduate, and three executive education classes). To do so, we developed a measure of six items pertaining to the extent to which students felt that the exercise was consistent with our learning objectives (Lewis & Grosser, 2012). We also assessed perceived interest/enjoyment (e.g., “I enjoyed doing this exercise very much,” seven items, α = .94) and value/usefulness (e.g., “I believe doing this exercise could be beneficial to me,” seven items, α = .91) of the exercise using two subscales of the Intrinsic Motivation Inventory (Deci et al., 1994; McAuley et al., 1989). All measures were assessed using 5-point Likert-type scales (1 = strongly disagree, 5 = strongly agree). The results presented in Table 2 indicated that overall, students perceived the exercise to be consistent with our learning goals, valuable, and interesting. Overall, we found that in general, graduate students and professionals rated the ISR-1 Drug Case higher than undergraduate students on the aforementioned metrics. We attribute this primarily to work experience as the current exercise clearly demonstrates the difficulties of negotiating with others, particularly, when stakeholder groups have differing perspectives, and when the outcome of the negotiation is ambiguous.
Student Reactions to Iecur Sanguinem Robiginem-1 (ISR-1) Exercise Learning Objectives.
Note. N = 394. 5-Point Likert-type scales (1 = strongly disagree, 5 = strongly agree).
Table 3 presents the average negotiated results from a sample of 30 teams across the 13 classes. The results demonstrated a relatively even funding distribution across the five budget options with the awareness campaign (M = 30.00, SD = 11.66) and Clean Needle Exchange Program (M = 25.20, SD = 14.79) receiving the most funding in points and the research prize (M = 17.00,SD = 16.97), negotiating and lobbying with the pharmaceutical company (M = 16.20, SD = 12.43), and providing the cure to patients (M = 11.60, SD = 13.98) initiatives receiving lower levels of funding.
Team Budget Allocation (in Points).
Note. N = 30 teams. Scores are out of 100 points.
Limitations and Conclusion
The ISR-1 Drug Case was designed to offer students a way of immersing themselves in the position of public policy makers tasked with making difficult life-or-death decisions. As this exercise was based on real-world events, a potential limitation of this exercise is that it may elicit strong emotional reactions from students. Although we have not observed this occurring in any of the classes in which the activity was conducted, the fact that policy makers remain unsure about how to resolve issues around the transmission of hepatitis C as well as the process by which constituents may or may not be offered the cure may upset some students. In this case, instructors can focus on the larger picture of how we as citizens can ensure that all those who require the proper medication are able to gain access to it.
It is important to note that while we have not conducted this exercise since the World Health Organization declared the COVID-19 outbreak a global pandemic, we assume that both instructors and students will find this exercise timely and relevant. Students may automatically push the conversation in that direction and instructors will likely need to be prepared to discuss the relevant comparisons between the fictionalized ISR-1 Drug Case and the ill-structured problems associated with COVID-19.
Drawing on various ethical frameworks, research on decision-making, and team processes as well as current challenges in the medical field pertaining to the cost of health care, students are tasked with allocating a finite budget to address the concerns of multiple stakeholders as they pertain to a virulent blood-borne disease ravaging their territory. Through this process, students must develop a budget for a series of initiatives that attempt to address and manage the disease in the local population. From examining their own ethical views to building team consensus to justify their decisions in the face of likely criticism and backlash from multiple stakeholders, students are able to engage in a timely case that highlights real-world complexity through an ill-structured problem. Students are also able to work through an intricate situation where they ultimately do not have sufficient resources to be able to adequately solve an ethical decision. They must wrestle with balancing their own personal ethics and choices with those of others and discuss how those decisions impact broader stakeholders. As such, it enables students to use many concepts and theories from organizational behavior, specifically from ethics, decision-making, and team processes, and apply it to a real-world scenario. We have found this exercise to be beneficial in helping students to understand these challenges, and it contributes to meaningful discussions about the difficulties inherent in resolving an ill-structured problem fraught with moral complexities, challenging decision-making biases, and difficulties in acquiring group-level consensus.
Footnotes
Appendix A
Appendix B
Appendix C
Appendix D
Appendix E
Acknowledgements
The authors wish to thank Charlotte Genge, Maggie O’Dea, Adon Moss, Dawn Murphy, and Meaghan Larkin for their help at various stages of this project, as well as Dr Kara Arnold and Raghid Al Hajj for their invaluable feedback on the exercise. In addition, we would like to thank Dr Maria Hamdini, associate editor, as well as the anonymous reviewers whose constructive comments helped greatly improve the quality of this article.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
