A UON case stidy research paper

Lake Forest Graduate School of Management – 2010

April 24, 2010

United Ostomy Network (UON): Meeting the Differentiation Challenge

“If there ever would be a time for us to differentiate ourselves by better using the internet, this is it,” thought April

Flowers, Executive Director of the United Ostomy Network (UON) — a not for profit North American organization that

provides health care information to those that have undergone, or will undergo surgery resulting in the formation of a

temporary or permanent stoma (ostomy).

The directors of the UON are concerned about the possible overlap of efforts with other organizations. They view most of

the available informational websites as being somewhat the same in their offerings. That is, they do not want their

website to be another „me too‟ website, offering the same information available elsewhere on the internet. To move ahead,

they feel that they must differentiate and are willing to make the necessary investments to do so but not without a proper

facts based analysis.

As her chief analyst, Flowers asked you to analyze the results of a just completed survey and to make specific

recommendations to her and the directors on the course of action UON should take.

Mission Statement: UON is a network for those that have undergone a bowel and urinary diversion, their caregivers, and

support groups. Its goal as a nonprofit association is to provide and disseminate health care information that will serve

and benefit those that have undergone a bowel or

urinary diversion.

 UON is committed to the improvement of the quality of life of people who have, or will have, an intestinal or

urinary diversion.

 UON is dedicated to the provision of information, advocacy and service to their members and the

intestinal/urinary diversion community at large.

 It is organized to grow and develop while remaining independent and financially viable.

Background: A stoma is a temporary or permanent surgically created opening of the bowel or urinary tract to the

abdominal surface of the body. Its function is to facilitate the removal of waste (feces or urine) from the body. Those that

undergo stoma surgery may do so to alleviate years of pain and suffering from debilitating intestinal diseases such as

Crohn‟s Disease or Diverticulitis, or to stop the spread of intestinal or bladder cancers. Stoma surgeries are generally

classified into three major types; surgeries of the colon, know as colostomies; surgeries of the ileum, known as

ileostomies, and surgeries of the urinary tract, known as urostomies.

Stoma surgery is a life altering surgery often requiring a lengthy period of coping and adapting to an altered body schema,

altered continence states, and social stigmas. Fortunately, most people who undergo this type of surgery do adapt well,

and go on to live productive quality lives.

Approximately 80,000 ostomy surgeries are performed in the US annually, and while there are no statistics as to the death

rate among ostomates, it is estimated that there may be as many as 800,000 ostomates currently living in the US.

This case was prepared by Professor of Business Management Thomas Nichols. It was written as a basis for class discussion rather than to illustrate effective or

ineffective handling of an administrative situation.

Temporary stomas are usually reversed (normal bowel function is returned) within 6 to 12 months after the date of the

original surgery. Not all temporary stomas are reversed. While reversal statistics are sketchy at best, it is estimated that

20 to 33 percent of all surgeries scheduled for reversal are not reversed due to complications.

The situation: United Ostomy Network has taken its website offline while it deliberates how to best differentiate itself

from other not for profit organizations such as the United Ostomy Association of America (UOAA: www.uoaa.org ), and
the International Ostomy Association (IOA: www.ostomyinternational.org/ ). UON would like to increase its use of the
internet to provide quality informational services to those that have undergone ostomy surgery. They would like to model

this extended service, in part, after the format of a popular ostomy website www.c3life.com. However, they believe that
those who would require their service most are those within three years post surgery, but given that population

demographics point to the fact that the ostomy population is an older population they are concerned that internet use may

not be common among an older population
A
. Hence, their first goal is to obtain a demographic profile of the general

ostomy population within the US and Canada. To this end, they have commissioned a survey of the ostomy population.

Secondary to a demographic profile of the general population is to profile where the ostomy population currently gets

health care information.

During a brainstorming session with key health care opinion leaders it was also determined that the UON should provide

stoma management and support services, support services for complications of stoma management such as hernias and

skin irritation or infection, support with ordering stoma management products, counseling in support of stoma

management, and support with health insurance related to the stoma.

Obstacles: No databases of the general population of people that have undergone ostomy surgery exist in the public

domain; therefore the UON has contracted with a North American distributor of ostomy supplies to distribute the survey

to ostomy customers. The survey was included in the customer‟s normal shipment of ostomy products. The 1500 surveys

were randomly distributed with 367 respondents. See Exhibit 1 for the questions listed in the survey. The results are

contained in the Excel file: lfgsm-UON Case 042410.

Regulatory considerations: Because the survey is intended for people with health considerations, it is subject to

regulatory restrictions. The survey is not a clinical investigation as outlined in the Code of Federal Regulations (CFR),

and falls within compliance for “survey procedures where no identifying information will be recorded that can link

subjects to the data, and disclosure of the data could not reasonably place the subjects at risk of civil or criminal liability

or be damaging to the subjects’ financial standing, employability, or reputation.”

The confidentiality of all respondents was assured, and no identifying information that could link the respondent to the

survey was collected.

As a matter of survey record, the survey will ask the respondents to provide the date of the original ostomy surgery. To

further protect the identity of its customers, the distributor requires that the date of original ostomy surgery be recoded in

the database as June 15, of the year of the surgery.

The survey has been constructed, implemented and completed. The data has been returned to the UON for analysis.

The key variables of interest in the survey are

1) type of surgery; colostomy, ileostomy, or urostomy (q3_1, q3_2, q3_3, q3_4, and Q3_5)

2) the reason for the surgery (q4)

3) permanent or temporary stoma (q5)

4) whether the stoma surgery was expected or unexpected (q6)

A
: While demographic information points to an older population, the need for ostomy surgery has no age limit; affecting a range from

infancy to senior citizens.

http://www.uoaa.org/

Home

http://www.c3life.com/

5) time in years since initial stoma surgery (q7)

6) current health assessment (q8)

7) the stoma‟s affect on their life (q9)

8) adaptation to living with a stoma (q10)

9) continuation of treatment (q11)

10) spouse/partner/family member involvement (q12)

11) gender (q13)

12) work habits (q14)

13) occupational status (q15)

14) employment status (q16)

15) current annual salary (q17)

16) help with the care and management (q18)

17) well informed (q19)

18) information resources (q22_1, q22_2, q22_3, q22_4, q22_5)

19) sources of information (q23_1 – q23_8)

20) information value_1: importance (q24)

21) information value_2: importance (q25)

22) information value_3: satisfaction (q26)

23) information value_4: importance (q27)

24) information value_5: importance (q28)

25) information value_6: importance (q29)

26) information value_7: importance (q30)

27) online support (q31)

28) year of birth (q32)

Analysis Expectations:

The directors of UON feel that the key to their decision making is the demographic profile of the sample, information as

to where the sample currently gets its health care information, information as to the provisions determined by the key

health care opinion leaders, and other recommendations based on the data.

They are expecting the analysis will provide answers to the following questions along with supporting analysis:

1) Does the survey satisfy the goal of obtaining a demographic profile of the general ostomy population within the US and

Canada?

Provide pivot tables and descriptive statistics are required to support the answer. All pivot tables must include n and

percent.

a) what is the gender distribution of the sample?

b) provide descriptive statistics of age of the survey respondent, age by stoma type, and age by gender.

c) provide descriptive statistics of the length of time since their surgery. How many of these are less than three

years post surgery.

d) provide a pivot table of type of stoma by originating diagnosis. Hint: use an Excel function to combine stoma

types (Q3_1 thought Q3_5 ) into a single variable.

e) provide a pivot table of the frequency of permanent and temporary stomas.

f) provide a pivot table of expected and unexpected surgeries.

g) provide a pivot table of the respondents current health status.

h) provide a pivot tables showing Q9 (How much do you think having a stoma affects your life) by Q10 (Have you
adapted to living with a stoma).

2) Where does this sample currently get its health care information?

a) Does the sample consider itself well informed about their stoma? Provide a pivot table of Q19.

b) Where do they currently get their information? Provide pivot tables of Q22_1 through Q22_4.

How many respondents do none of these?

c) What is their primary source of new ostomy information? Provide frequencies of Q23_1 through Q23_8.

3) Key health care opinion leaders in a focus group determined that the UON should provide stoma management and

support services, support services for complications of stoma management such as hernias and skin irritation or infection,

support with ordering stoma management products, counseling in support of stoma management, and support with health

insurance related to the stoma. What information do you have that this should be pursued?

a) Provide a pivot table of Q24 (The very last time you asked a health care professional about the management of

your stoma, did you receive useful information?).

b) Provide a pivot table that cross-tabulates Q25 and Q26 (Many health care organizations provide stoma

management and support services. If an organization provides health care information and support related to

stoma management, how important is this to you? by How satisfied are you with the stoma management and

support information you currently receive?)

c) Provide pivot tables to determine the importance of Q27 through Q30.

d) Provide a pivot table to determine the frequency of those that have sough help via the internet (Q31).

Recommendations to the directors of the UON:

Flower and the directors are anxiously awaiting your finding on the demographic profile of the general ostomy population

within the US and Canada, and whether or not you believe they should proceed with their plans to restructure the website,

and if yes, to provide recommendations as how to best do this.

Exhibit 1

UON

Survey questions

Q2. What is today’s date?

_____/_____/____

Mon day year

Q3. I have a
____(1) colostomy stoma
____(2) ileostomy stoma
____(3) urostomy stoma
____(4) I am not certain what it is
____(5) I have multiple stomas

Q4 My ostomy surgery is a result of

___(1) Cancer
___(2) Diverticulitis
___(3) Familial polyposis
___(4) Multiple Sclerosis
___(5) Congenital illness

___(6) Crohn’s Disease
___(7) Ulcerative colitis
___(8) Diabetes
___(9) Accident or injury
___(10) Inflammatory Bowel Disease
___(11) Other, please identify___________________

___(12) I don’t know

Note: for the case study, Q4 responses have been combined
Into three categories of originating diagnosis, cancer, chronic bowel
disease, and other.

Q5. My stoma is

___(1) permanent
___(2) temporary

Q6. My ostomy surgery was
___(1) planned
___(2) unexpected

Q7. When did you have your initial ostomy surgery?

______Year

______Month
______Date if known (ex: the 17

th
)

Note: Q7, in the data, presents the time since surgery based upon the response to the question.

Q8. How would you describe your health at present?

___(1) I am in very good health

___(2) overall, my health is good
___(3) I am in fair health
___(4) I am in poor health
___(5) I am in very poor health

Q9. How much do you think having a stoma affects your life?

___(1) has greatly affected my life for the better
___(2) has somewhat had a positive effect on my life
___(3) does not effect my life at all

___(4) has somewhat had a negative effect on my life
___(5) has greatly affected my life for the worse

Q10. Have you adapted to living with a stoma.
____(1) not at all
____(2) somewhat
____(3) quite well

Q11. Do you continue to undergo treatment of the disease or injury that caused your ostomy surgery.

____(1) yes
____(2) no

Q12. Did your spouse/partner, or a family member, learn about stoma care with you during your
hospitalization?
____(1) yes
____(2) no

Q13. What is your gender?
___Male

___Female

Q14. Because of your ostomy surgery did you need to change how you go about working (your work
habits)?
___(1) yes
___(2) no
___(3) does not apply

Q15. Because of your ostomy surgery did you need to change occupations?
___(1) yes
___(2) no
___(3) does not apply

Q16. Are you now

____(1) gainfully employed full time

____(2) gainfully employed but part time

____(3) student; full time
____(4) doing volunteer work
____(5) my illness does not permit any type of work
____(6) unemployed, but not due to my illness
____(7) retired, but not because of health
____(8) other, please explain ________

Q17. Is your annual salary, (money generated only from current employment)

___(1) less than $20,000
___(2) between $20,000 and $40,000
___(3) between $40,000 and $60,000
___(4) between $60,000 and $80,000
___(5) between $80,000 and $100,000
___(6) over $100,000

___(7) does not apply

Q18. Do you now require help with the care and management of your stoma?

____(1) yes
____(2) no

Q19. Do you consider yourself well informed about your stoma?
____(1) yes
____(2) no

Q22. Do you (check all that apply)

____(1) belong to an ostomy support group
____(2) subscribe to any magazines for ostomates

____(3) read any current ostomy literature
____(4) frequently discuss current ostomy topics
____(5) none of the above

Defined in the data as Q22_1 – Q22_5

Q23. Is your primary source of new ostomy information

____(1) from your ostomy retail supplier

____(2) from an enterostomal therapist
____(3) your doctor
____(4) your doctor’s nurse
____(5) magazines or other literature
____(6) an ostomy support group
____(7) the internet

____(8) I do not have a source of information
____(9) other; please explain________________

Q23_1 – Q23_8
Note: the category other has been removed from the case study
due to non-response in the category.

Q24: The very last time you asked a health care professional about the management of your stoma, did
you receive useful information?

___(1) Yes
___(2) Yes, but not to my satisfaction
___(3) No

___(4) does not apply

Q25. Many health care organizations provide stoma management and support services. If an organization
provides health care information and support related to stoma management, how important is this to
you?

___(1) Very important

___(2) Important
___(3) Neither important or unimportant

___(4) Unimportant
___(5) Very unimportant

Q26: How satisfied are you with the stoma management and support information you currently receive?

___(1) Very satisfied
___(2) Satisfied
___(3) Neither satisfied or dissatisfied
___(4) Dissatisfied
___(5) Very dissatisfied

Q27: If a health care organization offered support services for complications of stoma management such

as skin irritation or infection, hernias, etc., how important is this to you?

___(1) Very important

___(2) Important
___(3) Neither important or unimportant
___(4) Unimportant
___(5) Very unimportant

Q28: If a health care organization offered support with ordering stoma management products, that is
selection and ordering, how important is this to you?

___(1) Very important
___(2) Important
___(3) Neither important or unimportant
___(4) Unimportant
___(5) Very unimportant

Q29: If a health care organization offered counseling in support of your stoma management, how
important is this to you?

___(1) Very important
___(2) Important
___(3) Neither important or unimportant

___(4) Unimportant
___(5) Very unimportant

Q30: If a health care organization offered support with health insurance related to your stoma, how
important is this to you?

___(1) Very important

___(2) Important
___(3) Neither important or unimportant

___(4) Unimportant
___(5) Very unimportant

Q31: Have you ever sought online (internet) help or support for issues related to your stoma

management?

___(1) Yes, within the past six months
___(2) Yes, but more than six months ago
___(3) No

Q32: In what year were you born?

_____

Statistics:

Identifying the respondent

1: Gender frequency
2: Descriptive statistics of age of respondent
3: Age by gender
4: Surgery resulted in
5: Age by stoma type
6: Type of stoma and originating diagnosis
7: Descriptive statistics of time (years) since surgery
8: Frequency of surgeries performed within three years and beyond three years of date of surgery
9: Frequency of permanent and temporary stomas
10: Frequency of expected vs unexpected surgeries
11: Current health status
12: Frequency of those continuing to undergo treatment for the reason(s) that resulted in surgery
13: Cross-tabulated response.
9: How much do you think having a stoma affects your life x 10: Have you adapted to living with a
stoma.

Information status

14: Do you consider yourself well informed about your stoma? x Do you belong to an ostomy
support group or organization?
15: Do you consider yourself well informed about your stoma? x Do you subscribe to any
magazines for ostomates?
16: Do you consider yourself well informed about your stoma? x Do you read any current ostomy
literature?
17: Do you consider yourself well informed about your stoma? x Do you frequently discuss
current ostomy topics?
18: The very last time you asked a health care professional about the management of your stoma, did you receive
useful information?
19: Q25: Many health care organizations provide stoma management and support services. If an organization
provides health care information and support related to stoma management, how important is this to you? x
Q26:How satisfied are you with the stoma management and support information you currently receive?
20: If a health care organization offered support services for complications of stoma management such as skin
irritation or infection, hernias, etc., how important is this to you?
21: If a health care organization offered support with ordering stoma management products, that is selection and
ordering, how important is this to you?
22: If a health care organization offered counseling in support of your stoma management, how important is this
to you?
23: If a health care organization offered support with health insurance related to your stoma, how important is
this to you?
24: Have you ever sought online (internet) help or support for issues related to your stoma management?
25: Those seeking on-line help by age category
26: Do you now require help with the care and management of your stoma?
27: Did your spouse/partner, or a family member, learn about stoma care with you during your hospitalization?
28: Because of your ostomy surgery did you need to change how you go about working (your work habits)?
29: Because of your ostomy surgery, did you need to change occupations?
30: Employment. Are you now….
31: Is your current annual salary (money generated only from current employment)

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