| Course | D156 Business Case Analysis for Healthcare Improvement |
|---|---|
| Task | Task 2 |
| Paper type | Healthcare business case |
| Length | About 1,000 words, 4 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | MSN Leadership and Management |
| Updated | September 2026 |
Free sample paper for D156 Task 2
Business Case: A Patient Blood Management Program With Real-Time Decision Support to Reduce Avoidable Red Cell Transfusions
Student Name
Leavitt School of Health, Western Governors University
D156: Business Case Analysis for Healthcare Improvement, Task 2
Course Instructor
Month Day, Year
Business Case: A Patient Blood Management Program With Real-Time Decision Support to Reduce Avoidable Red Cell Transfusions
Executive Summary
Request: approval of $92,000 in the first year and about $73,500 a year thereafter to establish a patient blood management program on the medical and general surgical services. Why: two units in every five transfused on these services go to stable patients whose hemoglobin already sits at or above 8 g/dL, double the committee's 20% ceiling, despite international guidelines recommending restrictive thresholds, at an estimated avoidable cost of $462,000 a year. What: a revised transfusion order set with single-unit default and required indication, a real-time alert at the moment of ordering, targeted education, monthly clinician-level feedback and a half-time blood management nurse coordinator. Expected return: net savings of about $97,000 in year one and about $163,000 a year from year two, with fewer patients exposed to transfusion risks. Decision needed: approval to begin the electronic record build next quarter.
Recommended Intervention
The program has five parts. First, the transfusion order set will default to one unit, require the most recent hemoglobin value and an indication chosen from a short list, and prompt reassessment before a second unit. Second, a real-time best practice alert will appear when a red cell transfusion is ordered for a patient whose most recent hemoglobin is 7 g/dL or higher (8 g/dL for patients flagged with cardiovascular disease or orthopedic surgery), consistent with international guidelines (Carson et al., 2023); the clinician may proceed by selecting a reason. Third, education: a 20-minute session for hospitalists, surgeons and advanced practice providers at department meetings, and a one-hour module for nurses, who administer and monitor transfusions and often prompt orders. Fourth, monthly feedback reports showing each clinician and service their share of transfusions above threshold. Fifth, a half-time patient blood management nurse coordinator to run education, review alerts and reports, and support the transfusion committee.
The combination is deliberate. At an academic center, education alone produced only a small reduction in out-of-guideline transfusions, while adding real-time decision support at ordering reduced the rate from about 60% to below 30% and cut annual red cell use by 24% (Goodnough et al., 2014).
Costs
Each figure is shown with its basis. Electronic record build and testing: 120 analyst hours at $85 an hour, from the information technology department's internal rate, $10,200 in year one. Blood management nurse coordinator: 0.5 full-time equivalent at a salary and benefits cost of $124,000 a year, $62,000 a year. Nurse education: 220 nurses on the two services for one hour at an average loaded rate of $48 an hour, $10,560 in year one, and $2,500 a year after for new staff. Clinician education: delivered in existing meetings, no added cost. Data analyst time for monthly reports: 0.1 full-time equivalent, $9,000 a year. Total: about $92,000 in year one and about $73,500 a year after.
Benefits and Their Conversion Into Money
The problem analysis counted roughly 880 units a year transfused at or above the 8 g/dL line across the medical and surgical services at a total cost of $525 per unit ($215 acquisition plus $310 administration). The administration figure is conservative: an activity-based study at four hospitals put the full cost of providing a red cell unit to surgical patients at $522 to $1,183, three to nearly five times the acquisition cost (Shander et al., 2010). If the program brings the share above threshold down to the internal target of 20%, about 430 units a year would fall at or above that line instead of 880, avoiding about 450 units. At $525 per unit, that is about $236,000 a year once fully in effect. Because the alert and order set take effect gradually, year one is assumed to achieve 80% of this, about $189,000. Net benefit: about $97,000 in year one ($189,000 minus $92,000) and about $163,000 a year after ($236,000 minus $73,500). Return on investment in year two: $163,000 divided by $73,500, or about 2.2 dollars returned for each dollar spent.
The estimate is conservative. It does not count the single-unit default, which reduces units even among appropriate transfusions, nor savings from fewer transfusion reactions, fewer cases of fluid overload or shorter stays. Clinical benefits that are not priced include fewer patients exposed to transfusion risk and better stewardship of donated blood.
Sensitivity Analysis
Because the savings depend on how far practice changes, three scenarios were tested. Pessimistic: the share above threshold falls only to 30%, avoiding about 235 units a year, a benefit of about $124,000 and a net gain of about $50,000 a year after year one. Expected: the share falls to 20%, as above, net gain about $163,000. Optimistic: the share falls to 15%, similar to the academic center's experience, avoiding about 560 units, a benefit of about $293,000 and a net gain of about $219,000. The program pays for itself in every scenario after the first year, and in the pessimistic case it still covers its costs in year one only if the ramp-up reaches at least 75%.
Risks and Mitigation
Alert fatigue could lead clinicians to override the alert without reading it; the alert will fire only at the point of ordering, allow a one-click reason and be reviewed monthly for override rates. Some surgeons may resist; the surgical chief has agreed to review the evidence with the department, and the order set allows higher thresholds where guidelines support them. Patient safety must not be compromised; a balancing measure, rapid response calls for symptomatic anemia, will be tracked. Blood bank workload may change briefly as practices shift; the blood bank supervisor sits on the project team.
Recommendation
Approve the patient blood management program with first-year funding of $92,000, beginning with the electronic record build next quarter and the education series in the following month. The program addresses a documented problem with a proven intervention, returns more than it costs in all modeled scenarios after year one, and reduces patient exposure to unnecessary transfusion. The implementation plan and evaluation measures will follow in the next stages of this work.
References
Carson, J. L., Stanworth, S. J., Guyatt, G., Valentine, S., Dennis, J., Bakhtary, S., Cohn, C. S., Dubon, A., Grossman, B. J., Gupta, G. K., Hess, A. S., Jacobson, J. L., Kaplan, L. J., Lin, Y., Metcalf, R. A., Murphy, C. H., Pavenski, K., Prochaska, M. T., Raval, J. S., . . . Pagano, M. B. (2023). Red blood cell transfusion: 2023 AABB international guidelines. JAMA, 330(19), 1892-1902. https://doi.org/10.1001/jama.2023.12914
Goodnough, L. T., Shieh, L., Hadhazy, E., Cheng, N., Khari, P., & Maggio, P. (2014). Improved blood utilization using real-time clinical decision support. Transfusion, 54(5), 1358-1365. https://doi.org/10.1111/trf.12445
Shander, A., Hofmann, A., Ozawa, S., Theusinger, O. M., Gombotz, H., & Spahn, D. R. (2010). Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion, 50(4), 753-765. https://doi.org/10.1111/j.1537-2995.2009.02518.x
What the D156 Task 2 instructions ask
The second D156 task asks you to build the business case for solving the problem you analyzed. Most versions ask for an executive summary, a recommended intervention with its evidence, costs, benefits converted into financial terms where possible, a sensitivity or scenario analysis, risks with mitigation and a recommendation. Figures may be estimates, but each should have a stated basis. The audience is a leader deciding whether to fund the work, so the case should be concise, specific and honest about uncertainty. Evaluators look for costs and benefits that can be traced, scenarios that show what happens if the program works less well than hoped, and a recommendation that includes timing and a request.
How this D156 Task 2 example is built
The case begins with the ask and the bottom line, so a leader could decide from the first page. The intervention is described in five parts, each linked to a contributing factor from Task 1. Costs are itemized with hours, rates and sources. Benefits are converted into money by multiplying units avoided by cost per unit, and the non-financial benefits are named separately. The sensitivity section tests three scenarios and shows that the program still pays in the pessimistic case. Risks are paired with responses, including limiting the alert to the point of ordering. The recommendation restates the request, the start and the first review date.
Where the D156 Task 2 rubric puts the marks
D156 Task 2 is marked aspect by aspect as competent, approaching competence or not evident. An executive summary aspect checks for a clear request and rationale. An intervention aspect looks for an evidence-based solution tied to the problem. Cost and benefit aspects want figures with stated assumptions, and benefits converted to money where reasonable. A sensitivity aspect rewards scenarios that test the case. A risk aspect asks for specific risks and mitigations. The recommendation must follow from the numbers. Evaluators check arithmetic, and borrowed figures, such as outcome data from published programs, need citations beside them. Cases that show the payback period, or the point at which savings cover the first year's cost, tend to persuade evaluators and executives alike.
D156 Task 2 help: what sends it back
Business cases are returned most often because the savings are asserted rather than calculated. Show units avoided, cost per unit and the result. Second, costs omit people's time. Include analyst, coordinator and training hours. Third, sensitivity analysis is missing or only optimistic. Show what happens if practice changes less than expected. Fourth, avoid generic risks. Name those that belong to this intervention, such as clinicians overriding alerts, and how you will respond. Finally, lead with the request. Executives read the first paragraph most closely, so state the amount, the purpose and the expected return there. Keep the whole case to a length a busy leader would actually read.
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Send the D156 Task 2 instructions and the rubric aspects from your course of study, plus the problem and cost picture you built in the first stage. We write a custom example to those aspects, with the intervention priced, the return shown and the alternatives weighed, and return it in 24-48h. The first custom sample is free.
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D156 Task 2 questions, answered
How exact do the financial figures have to be?
Defensible rather than precise. Show the components, the assumptions and the arithmetic, and give ranges where one number would be false confidence. Published cost-per-event figures from federal agencies or peer-reviewed work are fair to use when cited. What leaves an aspect unmet is a saving that appears with no working behind it, however reasonable it sounds.
Can the recommended intervention be something my organization already does?
Usually yes, if the case argues for extending, resourcing or standardizing it, and your instructions allow it. An existing practice can be easier to cost because local figures exist. The case still has to show what additional investment buys and what changes because of it, otherwise the request gives a budget holder nothing to approve.
Does the business case include the implementation timeline?
Only at the level a funding decision needs: when money would be spent and when return would begin. Detailed execution, with stakeholders, owners, sequencing and decision gates, is what D158 is for. Overbuilding the timeline here tends to crowd out the financial argument this stage is actually judged on.
How exact do D156 Task 2 figures need to be?
Realistic and traceable rather than exact. State the basis for each figure, such as a contract price or hourly rate, as the sample does throughout its cost and benefit tables.
Where can I find a free D156 Task 2 sample paper?
The whole business case, with costs, scenarios and risks, appears above with notes. Share your D156 task and Task 1 problem, and a first tailored business case will be prepared free.