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The learning objectives have been prepared following Bloom’s taxonomy (Bloom et al., 1956). After completing the case study, the students will be able to identify and recall the prerequisites necessary for establishing a pathology laboratory. (knowledge); analyze the micro- and macroenvironmental factors considered by Mr Sabihul Haque in the development of the strategic plan for Healthcare Laboratories (HCL) (knowledge and application); explain the key components of the Porter’s value chain and their significance in the operation of HCL (comprehension and evaluation); use the TOWS analysis to map the internal strengths, weaknesses, opportunities and threats of HCL (application and synthesis); and analyze the challenges faced by protagonist in managing HCL and generate suggestions for addressing the challenges (analysis and synthesis).

HCL, an enterprise established in 2018 in Sahdeo Khap, Gaya, Bihar, India, aims to provide high-quality pathological diagnostic services in semi-urban and rural areas. This health-care initiative is pioneering, offering pathology services to make high-quality, low-cost diagnostic services accessible in rural India. In rural settings, numerous health-care hurdles make it challenging for individuals to access the care they need. Since its inception, HCL has expanded its reach to connect more areas, facilitating diagnostic services for people in remote regions. The establishment of laboratories in semi-urban areas aims to reduce patient travel time, costs and health risks by bringing services directly to their doorstep. Haque, the chief executive officer of the lab, grappled with multiple challenges, including selecting an appropriate location for the lab, recruiting and retaining skilled workforce, managing logistics supply, collaborating with local health-care providers, dispelling the stigma among the population that superior services are only available in cities and enhancing health literacy in rural communities. Following numerous meetings with Ms Ummati Naiyyer, head of operations, they worked collaboratively to address these challenges, developing a blueprint and future plan to operate services in rural areas. This case study provides insights into the obstacles faced by HCL striving for success in rural areas. It elucidates the beneficial application of the Porter’s value chain, along with an analysis of macro- and microenvironmental factors. Unique challenges such as societal stigma and mistrust are specifically emphasized. Students engaging with this case study will enhance their problem-solving skills through brainstorming and providing recommendations, contributing to potential solutions for HCL’s difficulties.

The teaching notes for the HCL case is designed to enhance the learning experience of undergraduate and graduate students within the context of the course. This case study serves as a valuable teaching tool, allowing students to apply theoretical knowledge to real-world scenarios in the health-care industry. The notes provide a framework for instructors to facilitate discussions, encourage critical thinking and promote a deeper understanding of key concepts related to establishing diagnostic laboratories in rural areas.

Teaching notes are available for educators only.

CSS3: Entrepreneurship.

This case was based on both primary and secondary data. In-depth semidirected interviews were conducted in 2021–2022 after receiving the institutional research board approval. The interviews took an approximate time ranging from 90 to 120 min. They were recorded and transcribed. A thematic analysis was undertaken to identify the most relevant themes for the case. The secondary sources used included various websites, scholarly and trade journals, as well as specific databases, such as Statista.

The case exposes students in multiple disciplines to the challenges created by the COVID-19 crisis at Yale School of Medicine (YSM). It describes its remarkable effects on organizational and community members as they struggled to reimagine more inclusive and supportive spaces. As one of the most severe crises humanity has ever witnessed, COVID-19 exacerbated the existing struggles of the underrepresented communities, creating a double pandemic. It has also amplified inequities among marginalized groups including black, indigenous and people of color; women; immigrants; lesbian, gay, bisexual, transgender, queer/questioning; people with different abilities; working parents; single parents; religious minorities; and people with low income. When COVID-19 hit in 2020, Yale University School of Medicine (YSM), like other pioneering schools in the field of health care, doubled their efforts to face both the public health crisis and the substantial social turmoil (racial tensions after the death of George Floyd, food insecurity, vaccine resistance, social inequalities, etc.). Professor Marietta Vazquez, MD, who was the first Latina to be named Associate Dean for Medical Students Diversity at YSM, launched with Dr Latimore (Chief Diversity Officer) and her other colleagues many strategic initiatives aiming at improving the diversity, equity and inclusion of organizational and community members.

The case is an invitation to graduate students and students in executive education programs to reflect on the grand challenges leaders faced at YSM as well as in other institutions across the nation and the globe. It is also a call to reimagine ways leaders can accelerate the pace of change in their organizational ecosystems.

This case was written for use in graduate-level courses, including executive education dealing with Diversity, Equity, Inclusion and Belonging, Leadership and Change, Health-Care Equity/Policy, Health Sciences, Human Resource Management, Organizational Behavior, Crisis Management, Sustainability, Business and Society, Social Issues in Management, Strategy, etc. Faculty members can easily adapt the case to fit the content of the course they teach, the students’ context as well as the specific learning outcomes to be achieved.

The case is designed to be used with the digital business model framework developed by Peter Weill and Stephanie Woerner of Massachusetts Institute of Technology (MIT) (Weill and Woerner, 2015) and is referred to as the W & W framework. This approach provides a useful structure for thinking through the strategic options facing environments ripe for digital transformation.

Research for this case was conducted through face-to-face interviews with the protagonist, as well as through a review of their business planning documents and other data and documentation provided by the founder. Some of the market and industry data were obtained using secondary research and industry reports. Interviews were digitally recorded and transcribed to ensure accuracy.

The case follows the story of Kurt Waltenbaugh, a Minnesota entrepreneur who shared the dream of using data analytics to reduce costs within the US health-care system. In early 2014, Waltenbaugh and a physician colleague founded Carrot Health to bring together their personal experience and expertise in both consumer data analytics and health care. From the beginning, they focused on how to use data analytics to help identify high-risk/high-cost patients who had not yet sought medical treatment. They believed that they could use these insights to encourage early medical interventions and, as a result, lower the long-term cost of care.

Carrot’s initial success found them in a consultative role, working on behalf of insurance companies. Through this work, they honed their capabilities by helping their clients combine existing claims data with external consumer behavioral data to identify new potential customers. These initial consulting contracts gave Carrot the opportunity to develop its analytic tools, business model and, importantly, to earn some much-needed cash flow during the start-up phase. However, they also learned that, while insurance companies were willing to purchase data insights for one-off market expansion projects, it was much more difficult to motivate them to use data proactively to eliminate costs on an ongoing basis. Waltenbaugh believed that Carrot’s greatest potential lay in their ability to develop predictive models of health outcomes, and this case explores Carrot’s journey through strategic decisions and company transformation.

This case is intended for either an undergraduate or graduate course on entrepreneurial strategy. It provides an effective introduction to the unique structure and constraints which apply to an innovative start-up within the health-care industry. The case also serves as a platform to explore the critical criteria to be considered when developing a digital transformation strategy and exposing students to the digital business model developed by Weill and Woerner (2015) at MIT (referred to in this instructor’s manual as the W&W framework). The case was written to be used in an advanced strategy Master of Business Administration (MBA) class, an undergraduate specialty health-care course or as part of a health-care concentration in a regular MBA, Master of Health Care Administration (MHA) or Master of Public Health (MPH). It may be taught toward the end of a course on business strategy when students are building on generic strategy frameworks and adapting their strategic thinking to the characteristics of specific industries or sectors. However, the case can also be taught as part of a course on health-care innovation in which case it also serves well as an introduction to the health-care payments and insurance system in the USA. Finally, the case can be used in a specialized course on digital transformation strategy in which case it serves as an introduction to the MIT W&W framework.

The case is particularly well-suited to students who are familiar with traditional frameworks for business strategy and business models. The analysis builds on this knowledge and introduces students interested in learning about the opportunities and challenges of digital strategy. Equally, the case works well for students with clinical backgrounds, who are interested in how business strategy can influence changes within the health-care sphere. Finally, an important aspect of the case design was to develop students’ analytical confidence by encouraging them to “get their hands dirty” and to carry out some basic exploratory data analytics themselves. As such, the case requires students to combine and correlate data and to experience the potentially powerful combination of clinical and consumer data. Instructors should find that the insights from these activities give students unique insights into the potential for of data analytics to move health care from a reactive/treatment ethos to a proactive/intervention ethos. This experience can be particularly revealing for students with clinical backgrounds who may initially be resistant to the use of clinical data by commercial organizations.

This case requires students to evaluate alternative dual-share-class corporate structures that allow companies and entrepreneurs to pursue profit with purpose. The case explores Impact Makers, an IT consulting company based in Richmond, Virginia. While original founders of the firm hold all voting rights, the cash flow rights belong to two nonprofits setting the stage for a Newman's Own model of management consulting. The case discusses whether and how the alternative corporate structure aids the firm's overall strategy to attract top-quality employees, pay them competitive salaries, and provide superior service to its clients while donating 100% of its lifetime value to charitable causes, largely through partnerships with various nonprofit organizations. More importantly, the case asks students to evaluate how such a dual-share-class and dual-purpose company can raise capital to fund continued growth.

The case opens with CEO Michael Pirron reminding himself of all the questions he had run through to execute a strategy to further grow Impact Makers' consulting business both through expanding a menu of services and through conquering new geographical markets. To do either, or both, the company needed a cash infusion. Internal cash was limited, as up to 40% of it flowed to charitable partners, demonstrating Impact Makers' commitment to its mission. Raising debt for a company without fixed assets was challenging and time consuming. Complicating it all was that being structured as a nonstock corporation rendered equity raising difficult. Could Impact Makers raise money to grow and stay true to community values at the same time?

This case was developed via primary data collected from personal (one to one) interview with the CEO and founder of Dialogue in the Dark Malaysia (Dialogue Malaysia), Stevens Chan. With Stevens’ contact, the authors also conducted personal interviews with Kaye Chan (co-founder and wife of Stevens Chan), Lynn Foo (project manager since inception until early 2022) and Dr Foo Yin Fah (academic researcher in social entrepreneurship and advisor for Dialogue Malaysia). Secondary data included reports on visually impaired context in Malaysia, Dialogue Malaysia’s annual reports and online articles. Prior to the primary data collection, the authors obtained ethics approval from the University Human Ethics Committee (Project ID: 35461).

This case narrative focuses on Stevens Chan, a blind social entrepreneur who champions the empowerment of the disabled and marginalised community. Through a social franchising model, Stevens founded Dialogue in the Dark Malaysia in 2012. As a social start-up, Stevens showcases the strengths of blind and visually impaired individuals through transformative experiential encounters and reimagining future possibilities. Although there are constant challenges in securing financial and human capital, Stevens never lacks psychological capital, characterised by hope, self-efficacy, optimism and resilience. His vision is to educate society on the power of empathy (and not sympathy) and to create a holistic experience of celebrating diversity and inclusion through an innovative discovery centre, where the elderly and the disabled community (including the deaf, mute and those with mobility issues) share their lives with the public through fun activities. However, the future of this social enterprise is uncertain, and this case invites participants to embark on this journey with Stevens to uncover future pathways for growth and social impact.

The case is tailored for higher level undergraduates and entry-level and mid-level managers of executive education programs.

The case study is based on a social entrepreneurial journey where the authors have used an interview method to get the insights from the protagonists and the employees. Rigorous interviews were conducted online and in person for deep analysis of the protagonist’s strategies and decisive dilemma.

Secondary data was collected from company’s website for facts and figures.

This case study is a story of indigenous tribes of Odisha from the eyes of a woman who, with her co-founder, empathized with their vulnerable life and took on the challenge of creating sustainable livelihoods by establishing Millet Magic Foundation. The Millet Magic Foundation was established in 2021 by Shyama and her cofounder to uplift the indigenous tribe of Mayurbhanj by providing them livelihood through millet-based products. The foundation launched their millet-based snack products with the brand name WOWMOM. Millet Magic Foundation created social impact for the tribals by providing them with employment, fair wages, health care and social well-being. The specialty of the Millet Magic was reverse positioning and focusing on the bottom of the pyramid. The success of the Millet Magic Foundation relied on its mission to uplift the life of these indigenous tribal, especially the women, by overcoming the challenges with the strategies to establish Millet Magic as a social enterprise.

The case study is primarily suitable for postgraduate programme to teach the concept of social entrepreneurship in the entrepreneurship module. The case study can also be used for highlighting the role of social enterprise in sustainable economic development of emerging economies.

After completion of this case study, students should be able to reflect on the concept of creating shared value and then determine whether Shesha Geza can be referred to as a shared value company and, if so, what level of shared value it demonstrates. They will be able to subjectively and objectively understand the possible meaning of when a social enterprise embarks on a strategy to scale the organisation; clarity of construct will enable managers to better plan and successfully implement scalability goals. They will also be able to recognise, once scalability goals are better understood and planned, that there are a multitude of intra-organisational levers and drivers that may contribute to the organisation’s ability to scale its operations, which are related to specific internal organisational capabilities of social enterprise companies. In addition, there are situational factors that may affect the business either positively or negatively in relation to the scalability success of which a social entrepreneur should be aware.

In April 2021, Dean Boniface and his brother, Roger, had just signed off a new informational video for their Shesha Geza innovation, a low-cost hand-washing station designed for use at commuter hubs and high-traffic areas across the African continent. The unit used diluted chlorine instead of alcohol-based sanitisers to ensure a more expedient and sustainable solution, one better suited to Africa’s logistical challenges. Boniface, the co-founder of Vue Architects, had conceptualised the idea of the hand-washing hub during South African Government’s enforced COVID-19 lockdown from 27 March 2020 to 1 May 2020. Shesha Geza’s speed to market was a key contributor to its successful response in solving a critical social need. Throughout 2020, Boniface and his team built successful partnerships and secured an impressive order pipeline within a short span. Export opportunities across Africa, installations and maintenance of a sizable number of units across South Africa and the development of a behavioural change programme aimed at hygiene in schools kept the momentum going in the business. However, a year into the business and the future sustainability of a crisis–response enterprise and the ability of a shared value enterprise to scale were playing on Boniface’s mind. He was worried about the future of the small resource-constrained business. Holding onto the mental map of everything the team had learned over the past year, Boniface was confident about one thing: “All the programmes we build around Shesha Geza are value-adds to our current business. Hand hygiene will not diminish after COVID-19; it will continue to be an important social issue across the African continent.”

This case is intended for discussion in post-graduate-level courses such as an MBA and in postgraduate courses focused on business model innovation or on creating shared value. This case is suitable for use in the environment of business courses in relation to environmental situational factors that may affect the ability to scale social enterprises or strategic implementation courses, considering the still pervasive challenge of scaling increasingly important social impact enterprises.

Teaching notes are available for educators only.

CSS 11: Strategy.

After completion of this case study, students will be able to describe the funding path for start-ups, including the amounts and profiles of the usual investors or sources of funds, according to the moment in their life cycle and the characteristics of the initiative; highlight the challenges faced by start-up founders in weak entrepreneurial ecosystems and risky institutional environments; and argue in favor of or against different modes and typical instruments of venture capital (VC) investments in the early stages of new businesses, each of them different regarding dilutions, valuation potential, depth of negotiations and term sheets.

Asistensi, a technology and telemedicine start-up founded in 2020 in Venezuela by three entrepreneurs (Andrés Simón González-Silén, Luis Enrique Velásquez and Armando Baquero), raised US$3m in less than a year in a seed round in which it attracted the attention of professional VC funds such as Mountain Nazca, Alma Mundi Ventures and 468 Capital. Everything was set for launching operations in Mexico and the Dominican Republic in April 2021. However, a series of difficulties led to higher expenditure than planned, prompting the entrepreneurs to seek additional capital. The decision on the financial instrument to be associated with the potential valuation and shareholder dilution figures has been posed as a dilemma.

The case study focuses on understanding the start-up financing process. It can be used effectively in management- and finance-related subjects for graduate students taking introductory topics in entrepreneurship and entrepreneurial finance, as well as introductory executive education courses in entrepreneurship, entrepreneurial finance and VC.

Teaching notes are available for educators only.

CSS3: Entrepreneurship

This case study was developed using data from secondary sources. The data was collected from the organization’s website, annual reports, press releases, published reports and documents available on the internet.

According to the International Energy Agency’s (IEA) World Energy Outlook (WEO), 775 million people worldwide would not have access to electricity even by 2022, with the majority of them living in sub-Saharan Africa (SSA) (Cozzi et al., 2022). In SSA, energy poverty had been a serious issue over the years. According to the IEA, 600 million people lacked access to electricity in 2019, while 900 million people cooked with traditional fuels (Cozzi et al., 2022). A World Bank report from 2018 said many SSA countries had energy access levels of less than 25% (Cozzi et al., 2022). Energy poverty in SSA hampered sustainable development and economic growth.

Despite significant efforts to address this poverty, Africa remained the continent with the lowest energy density in the world. Although solar and other energy-saving products were appealing, their adoption rates were modest, and their distribution strategies were not particularly effective. The lack of electricity exacerbated a number of socioeconomic problems, as it increased the demand for and use of wood fuel, which caused serious health problems and environmental harm.

While working in Uganda, Katherine Lucey (Lucey) saw that having no electricity had negatively affected women’s health in particular because it was women who were responsible for taking care of the home. These effects were both direct and indirect. The women’s reliance on potentially harmful fuels for cooking, such as firewood and charcoal, resulted in their suffering from respiratory and eye problems, in addition to other health issues. Furthermore, the distribution of energy-saving and renewable energy items was seen as the domain of men, and there was an inherent gender bias in energy decisions. Women were not encouraged to participate in energy decisions, despite the fact that they were the ones managing the home and would gain from doing so. In addition, because there was no light after dusk, people worked less efficiently. Lucey saw the economic and social difficulties that electricity poverty caused for women in rural Africa. She also witnessed how the lives of a few families and organizations changed after they started using solar products. This motivated her to start Solar Sister with the mission of achieving a sustainable, scalable impact model for expanding access to clean energy and creating economic opportunities for women.

Solar Sister collaborated with local women and women-centric organizations to leverage the existing network. Women were trained, provided all the necessary support and encouraged to become Solar Sister Entrepreneurs and sell solar products in their communities and earn a commission on each sale. To provide clean energy at their customers’ doorstep, the Solar Sister Entrepreneurs received a “business in a bag” – a start-up kit containing inventory, training and marketing assistance.

Solar Sister’s business model empowered the women in SSA by providing them with an entrepreneurship opportunity and financial independence. Also, the use of solar products helped them shift from using hazardous conventional cooking fuels and lead a healthy life. The children in their households were able to study after sunset, and people in the community became more productive with access to clean energy.

The COVID-19 pandemic outbreak, however, had a serious impact on Solar Sister. It found it challenging to mentor and encourage new business owners due to restrictions on travel and on group gatherings. The Solar Sisters were unable to do business outside the house either. Their source of income, which they relied on to support their families, was therefore impacted. The COVID-19 outbreak also slowed down the progress achieved by the community over the years and made household energy purchasing power worse. Furthermore, the organization was also grappling with other issues like limited access to capital, lack of awareness and infrastructural challenges. Another challenge lay in monitoring and evaluating the organization’s impact on the last mile.

In the absence of standardized measurement tools and issues in determining the social impact of Solar Sister, it would be interesting to see what approach Lucey will take to measure the impact of Solar Sister on the society. What measurement tool/s will Lucey implement to gauge the social impact of Solar Sister?

This case is intended for use in PG/Executive-level programs as part of a course on Social Entrepreneurship and Sustainability.

After completion of this case study, students will be able to help participants appreciate how the personal experiences of the founder(s) shape the inception of a social venture and impact its ongoing evolution; elucidate the intricacies and challenges inherent in managing a mission-driven organization dedicated to serving the underserved segments of society; emphasize the difficulties associated with exploring opportunities for scaling up a social venture; and facilitate comprehension of the various options and strategies available for achieving scalability.

The Kalinga Institute of Social Sciences (KISS), founded in 1992–1993 by Prof. Achyuta Samanta in Bhubaneswar, was a pioneering institution with a distinctive focus on providing high-quality education at all levels, exclusively to tribal students. From its inception, KISS remained unwavering in its commitment to the holistic development of marginalized tribal communities. It offered not just free education but also comprehensive support, including accommodation, food and health care, to thousands of students spanning from kindergarten to post-graduation levels. Remarkably, KISS held the unique distinction of being the world’s only university dedicated to tribal education. Over the years, KISS witnessed remarkable growth, evolving from a modest 125 students in 1992–1993 to a thriving community of 30,000 students. Its success garnered attention from federal and state governments, public institutions, philanthropists and corporations, all intrigued by the prospect of replicating its transformative model in diverse regions of the country. KISS even received invitations to establish similar campuses in neighbouring countries such as Sri Lanka, Bangladesh and Nepal. What set KISS apart was its self-sustaining approach. While it did receive support from like-minded organizations and government schemes, it operated without charging any fees to its students. This ethos posed a unique challenge for Samanta: determining the nature and extent of support and resources required should KISS choose to expand its impact beyond its current boundaries.

This case study is suited for inclusion in courses pertaining to social innovation and non-profit management, particularly in modules around the theme of scaling social innovation. It provides an illustration of the growth trajectory of social innovation-oriented ventures and the key factors underlining their success and sustainability. Furthermore, this case study delves into the inherent tensions that often emerge during the process of scaling up such initiatives.

In addition to the MBA-level courses, this case study can also be used as a resource for executive education programs with a specific focus on social purpose organizations and those dedicated to fostering partnerships in pursuit of social goals. It offers insights into the dynamics of these organizations and their collaborative efforts towards achieving social impact.

To effectively explore and analyse the case material, instructors should allocate approximately 70–90 min of class discussion time.

Teaching notes are available for educators only.

CSS11: Strategy.