In late November, Ms. Elaine Taylor, the director of supply for Winston, was reviewing proposals for a study of Carson Manor, a city-owned nursing home, which aims to improve its operational efficiency and address high per-bed costs. The report highlighted increasing care needs and recommended an independent operational review to identify problem areas and strategies for change, though costs and implementation challenges were noted. Eight consulting firms were invited to submit proposals for the study, and a scorecard with criteria like cost and savings was required for analysis.