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The case is based on data collected from in-depth interviews, and from company, third-party and regulatory–agency documents. In addition to prior conversations over several years between the company founders and the lead case writer, there were several rounds of interviews in 2023 with the surviving founder and in-depth interviews with eight of the company’s key managers. Company documents reviewed included bylaws, organization charts, profit and loss statements and staffing statistics, all from founding to sale. Also reviewed were documents and evaluations of company operations and performance produced by the merger & acquisition firm that handled the company’s eventual sale. The company owner insisted on complete disguise of the company and all its members and prohibited disclosure of detailed proprietary financial data.

At the strategic level, this case is about how the unique, complex and changing healthcare environment created opportunities and threats to which a women-owned and run start-up company, Aloe Health (AH), had to respond to become and remain successful. At the personal level, the case illustrates what it takes for an entrepreneur and leader having clinical but no real business acumen to start, expand and turn around a company and ultimately position it for a successful acquisition, continually learning and adapting along the way.

The case describes how two women who were friends for many years started up a home healthcare company later in their lives and grew it into the largest women-owned business of its kind in the USA. Based in the Southwest USA, an area with many factors conducive to success, they navigated the many complexities of US Medicare regulations to create a fully-integrated home healthcare company providing unskilled personal care, medically skilled homecare and end-of-life hospice services to thousands of clients. The case provides background on the founders and the home healthcare industry context, and details the steps taken to start up and build the company into a fairly successful enterprise; one of the largest of its kind in the region. The (A) case ends with one of the founders facing a crisis brought on by the death of her co-founder and the revelation of some significant organization dysfunctions, leaving her unable to profitably exit the company and unsure of whether she would be able to turn things around. The students are tasked with making recommendations for what she should do next.

The (B) case brings events up to fall 2023, describing the steps the surviving founder took to transform her leadership style and the company’s systems and culture, and to navigate the due diligence process associated with preparing for an (ultimately very successful) acquisition. It also shares the owner’s “lessons learned,” and briefly notes the current state of the acquired company and the many AH employees that it continues to employ.

The case provides ample information for students to appreciate the company’s strategy and the challenges of operating in the highly regulated health care industry. However, it is probably even better suited to illustrating the “soft” issues of new-venture management, such as the tendencies of founders to overload themselves by micro-managing their growing venture and not adapting to expansion, and for those with clinical backgrounds to focus on caring for patients and employees while overlooking business essentials and organization systems. It also illustrates how business partnerships among strong-willed individuals can produce dynamics in the founding team similar to a “marriage,” with affection and complementary talents, yet also tensions. It further illustrates the process of a successful turnaround strategy, and the “due-diligence” challenges of preparing for an acquisition.

This case has a range of course applications at multiple education levels. Although it is probably best suited for graduate and executive-level programs, it can also be selectively used in undergraduate classes, particularly if populated by upperclassman. It is ideally suited to courses on entrepreneurship and on healthcare management. For an entrepreneurship course, it could be positioned mid-way through the semester, after covering topics relating to the entrepreneurial mindset, founding teams and business models. It can be used to get the class focusing on competitive issues and the challenges of starting up a company in a highly regulated environment, on entrepreneurial founding-team characteristics and management tendencies (e.g. micro-management control tendencies), on transition issues from start up to growth stages and on exit strategies.

We believe this case is also well suited as a teaching exercise for students pursuing healthcare management studies in baccalaureate and graduate programs (MBA, MHA, MHS) in which instructors wish to broaden student exposure to a real-world scenario that focuses on entrepreneurial behavior in a healthcare setting (a topic of increasing interest to healthcare practitioners and managers given the current trend toward provider formation and ownership of health facilities). Here, the case may be used to focus on the complexities of the healthcare industry, the key differences between various healthcare service business models and on the challenges that technically (clinically) trained professionals often face when trying to manage a healthcare business. Ideal placement of the case would be in a capstone course, after students have been introduced to their functional coursework in topics such as introduction to management, organizational behavior and leadership, financial management and strategic thinking. The case also challenges students to apply knowledge obtained in specialized coursework in healthcare systems and policy, industry regulation, as well as healthcare reimbursement methods.

The case also may be used in organization behavior courses to focus on team, cultural and leadership issues and in strategic management courses to focus on strategy implementation. In addition, there are enough family business themes in the case (even though Aloe is not actually a family business) to use it in a course on managing family businesses.

This case is based on primary and secondary data collection. ABCo’s Founder, Jocelyn Sheppard, sat down with the author for a 75-min recorded interview in July 2022, and she provided follow-up information via email. Interview data was supplemented with secondary data from publicly available sources to fill in portions on the founder, the company’s history and its location; and triangulate the collected interview data (Creswell and Poth, 2018). There are no conflicts of interest that the author needs to disclose related to the founder or company.

The case was piloted at one institution in the Fall 2022, Spring 2023 and Fall 2023 semesters, with 59 undergraduates in an in-person social entrepreneurship course and 165 undergraduates and 33 graduate students in an online asynchronous social entrepreneurship course. All students worked through the case in groups, and as a requirement of their corresponding assignment submission, they provided feedback that was de-identified. In total, 60 groups reported their feedback, which was considered during the subsequent drafts of the case and instructors’ manual IM.

According to the anonymized feedback, the protagonist, product line, desired social impact and experienced challenges of ABCo were all said to be interesting, approachable and relatable for students, and the case piqued the interest of students coming from different majors (e.g. business, environmental issues, human services and criminal justice). Students from rural areas, or those who have family in rural areas, felt the case was particularly interesting; a handful of the students in the asynchronous online class who were unfamiliar with such settings suggested providing students with some additional contextualization of rural environments, either through class discussion with other students who had experience in those environments or additional media or text-based supports. Further adjustments also included removing a reading and a corresponding question and revising elements within the Teaching Approaches section of the IM to support the additions they suggested within the feedback (i.e. spending time to define and walk through the provided model and highlight the differences of rural entrepreneurship and entrepreneurship in the rural as a class before engaging in the related write-ups for that question).

Jocelyn Sheppard, Founder of Appalachian Botanical Company (“ABCo”), had built her company not just on a vision of revitalizing reclaimed coal mine land through planting and producing products with lavender, but also to have a social impact on the rural town of Ashford and its greater region of Boone County in West Virginia, USA. While she understood that hiring workers in need of a second chance would present its challenges, she was shocked by the depth of social need her new employees presented, which contributed to many employees’ disruptive behaviors and turnover. To approach the problem at hand, Sheppard needed to reflect on the resources around her, namely, other entities and organizations who might be able to support her efforts to improve how ABCo delivers on its social mission and, thus, helps to improve the local community and its economy. The case draws upon literature and models within rural entrepreneurship and community development to have students advise Sheppard on what she should do next to improve the social outcomes for ABCo and its employees.

This case is geared for both upper-level undergraduate and graduate courses in entrepreneurship, including in social, environmental and rural entrepreneurship courses and course modules. The case introduces students to a social enterprise struggling to get its footing in a rural context. The case would be suitable for both introductory and advanced courses, especially when placemaking/place-based entrepreneurship or ecosystem building are discussed.