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Regency Hospital Limited, a multi-specialty hospital in Kanpur, India was founded by Dr. Atul Kapoor in 1995. The hospital had grown over the years. However, there were a number of issues that were yet to be dealt with. The case describes the struggles that the founder went through in setting up this hospital. It presents the challenges from the perspective of the founder as well as the staff and doctors of the hospital. In the process, the case highlights issues on leadership, entrepreneurship, organizational culture, and management of change.

The learning outcomes are as follows: identify and evaluate the impact of risk factors for health-care organizations during crisis; evaluate the role of different organizational factors in building resilient health-care organizations; define organizational resilience in a health-care context; and apply the effect-strategy-impact resilience framework.

September 2022 found Ranjan Thakur, the Hospital Director at Manipal Hospital, Jaipur (MHJ) reflecting on MHJ’s resilience toward future health-care crises. MHJ was established in the capital city Jaipur of the Indian state of Rajasthan in 2014, as a 225-bed multispecialty unit of the nationally renowned Manipal Health Enterprises Ltd. As the Hospital Director, Thakur had been responsible for navigating his team and the hospital through the multiple health-care related challenges exacerbated by the multiple waves of the Covid-19 pandemic in a large Indian state with a sizable rural and semiurban population. Though Thakur and his team of doctors had worked through the vulnerabilities of their health-care ecosystem, mapping the risks and mitigating the same, Thakur asked himself if they had done enough. He wondered how a health-care institution such as theirs could sustain effective health-care delivery during future crises situations to deliver high-quality health care to the vulnerable communities. Had they effectively mapped MHJ’s vulnerabilities and built resilience into the hospital’s functioning? The backdrop of the case is public health in the state of Rajasthan (Jaipur), and the case is rich in detailing social factors such as behavior issues of patients, doctors and nurses; operational factors such as standardization of treatment and standard operating procedures, availability of resources, clinical concerns; leadership and management of the hospital through the pandemic. This case can be used by instructors to teach organizational resilience building in the health-care context.

Graduate- and executive-level courses in managing change during crisis in health-care context; health-care management/leadership.

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CSS 7: Management Science.

The learning outcomes of this paper are follows: students should be able to understand the complexity related to the provision of safe drinking water for disaster-hit areas and effective solutions to overcome this problem. Also, students should be able to evaluate the need for awareness about post traumas mental health especially in case of disasters and identify how technology can provide answers to such critical issues.

The case represents a unique scenario where the head of an organization has moved away from the financial prospect and invested time and efforts for the provision of safe drinking water to the inaccessible areas and devise strategies for the improvement of disaster relief operations.

Undergraduate and post graduate students.

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CSS 4: Environmental Management.

The case and discussion questions posed will allow the instructors the opportunity to introduce critical strategic concepts from strategic, nonprofit management and social enterprise literature. Specifically, (1) strategic transformation: countering drift and anticipating future trends and crises; (2) types of leadership: transactional versus transformational; (3) hybridity and mission drift; and (4) nonprofit funding models, the starvation cycle and the overhead myth.

Both primary and secondary sources have been used to prepare the case. The first two authors had the opportunity to interview Thomas Tighe, Direct Relief’s (DR) President and CEO in July of 2019. The interview lasted one hour and was transcribed by one of the authors and reviewed by the other two authors for accuracy. In addition, the authors conducted nonparticipant observations in DR’s headquarters in Santa Barbara (California). Given the longevity and media exposure of the organization, extensive internal and external archival data was also available for the analysis.

This real and undisguised case is based on DR, a +70-year-old humanitarian $1.2bn nonprofit organization headquartered in California (USA). From its headquarters in Santa Barbara, DR responds to emergencies and delivers medical support for vulnerable people affected by poverty, natural disasters and civil unrest in all 50 US states, six US territories including Puerto Rico and US Virgin Islands, and in more than 90 countries.

The case presents Thomas Tighe, DR’s President and CEO, reflecting in late 2018 on the transformation and growth that the organization had experienced since he started his tenure in 2000. Specifically, he is considering the most effective way to allocate an unrestricted recent cash donation. Should DR spend that money on traditional fundraising, reducing its efficiency rate, or should DR take a long-term approach and use the funds to build long-term capabilities? In addition, the case outlines the history and evolution of DR over its more than 70 years of existence, the CEO’s background and motivations, as well as a detailed description of the organization’s revenue portfolio. Students will have an opportunity to learn about a unique nonprofit named among “the world’s most non-for-profit organizations” by Fast Company; DR was also included in the Charity Navigator’s list of the “10 Best Charities Everyone’s Heard of.” In addition, in January 2009, DR was designated as a Verified-Accredited Distributor by The National Association of Boards of Pharmacy, which placed it as the first nonprofit to receive this designation to deliver prescription medicines to all 50 US states. Throughout Tighe’s tenure, DR had been lauded for its fundraising efficiency. The unique distinction to DR’s efficiency is its tradition of adopting new technologies and modern business practices for humanitarian purposes.

Students will learn how DR, under the leadership of Thomas Tighe, reinvented and reinforced the organization’s traditions to retain high levels of efficiency in the face of an ever-larger organizational scale, public scrutiny and demand for humanitarian support across the world. Students will witness many strategic and operational tenets that they may be more familiar with from the for-profit world. The case also will help students to understand the concept of hybrid organizations and different nonprofit funding models.

The case has been written to be used in graduate Nonprofit Leadership Management and Social Entrepreneurship courses. Given the scope and implications, the case could also be used on an upper-level strategy course. To maximize students’ learning, the case should be introduced halfway into the course after students have a solid understanding of what nonprofits are and how they operate. If students are not familiar with some of the concepts introduced in the analysis, the proposed readings will prepare them for a more fruitful discussion.

The blast at Beirut Port on the 4th of August was the cherry on the cake in a series of disastrous governmental failures manifested in the of lack of trust, an unprecedented economic crisis, hyperinflation, financial fallout, political bottle necks, toxic environmental situation and a vertical cleavage between the government and the people. The blast resulted in billions of dollars in losses both at the port and the surrounding Beirut area, destroyed more than 300,000 housing units, displaced their residents, ruined many artifacts of cultural heritage, injured thousands of people and killed hundreds. Definitely, it was a case of negligence in the storage of the Ammonium Nitrate, corruption, irresponsible leadership or all of these together. However, investigations are still underway to pinpoint the responsible individuals and to bring them to justice. This case looks at potential ways that could have prevented the blast, by questioning the reasons behind the non-voicing out of objections against the nature of the material stored unsafely for several years in Container 12 at the Port. Through the lens of Hadi Karim, a fictional character, the authors lead the readers to consider the disaster’s characterization, as well as applicable disaster management frameworks. The case also emphasizes the role of public leadership and leads the readers to consider measures and processes that could have been abided by to prevent the disaster.

Against the backdrop of the recent Beirut Port explosion, this case examines how events unfolded leading up to the tragedy, highlighting how it could have been avoided, as well as the managerial and ethical dimensions involved.

At the end of the case, students will be able to: 1. Characterize the disaster in terms of type and nature. 2. Analyze the blast by referring to the relevant disaster management frameworks. 3. Analyze the critical role of ethical and transformational leaders pre and post disaster. 4. Reflect on the role of employees in preventing disasters mainly through whistleblowing.

Shedding the light on an avoidable disaster, drawing lessons to avoid the occurrence of such events in the future, and raising awareness on disaster management and on whistleblowing as a tool in the ethical leader’s toolbox.

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CSS 10: Public Sector Management.

The case deals with comparison of two events namely Bhopal Gas Tragedy and BP Oil Spill Tragedy. Specifically, the case compares the negotiation process and its outcome. In other words, the case compares how negotiation was carried out on behalf of victims of these tragedies and resulted in optimal outcomes in one situation and sub-optimal outcomes in another situation. It case also provides insights into cross-cultural issues in negotiation process as one of the events took place in emerging economy (India) and other one in a developed economy (USA). The case gives insight for individuals on how handle communication process during the course of negotiation.

After completion of the case study, students will be able to evaluate the journey of launching a business in an emerging market context and judge how opportunities and challenges can be navigated to build sustainable enterprises; assess the relevance of individual attributes and process skills that are necessary for entrepreneurial agency to transform social structures through entrepreneurial action; formulate an argument highlighting the role of the entrepreneurial ecosystem in growing a competitive business in an emerging market context; make an informed decision and critique how accelerators and incubators affect the development of ideas and access to finance in South Africa; and propose various strategic options available for technology entrepreneurs, considering the challenges they face in emerging economies.

In April 2023, Queen Ndlovu, CEO and founder of QP Drone Tech, a provider of drone business solutions, was considering options to fulfil her original dream of manufacturing drones in South Africa. She had encountered obstacles to achieving the same in 2019, and had decided to focus on providing commercial drone consulting services. However, her dream had not extinguished, and in 2022, she decided to restart her efforts. She found practical support from The Innovation Hub, an incubator that was supporting her business, which enabled her to enhance the prototype of her drone. She then had to think about how she would manufacture drones locally by ensuring she had access to production infrastructure, funding, partners and customers. Would she be able to gain a competitive advantage that would differentiate her from competitors? Or should she reconsider whether she should be manufacturing in the first place, as there are risks and benefits for smaller businesses in this regard.

This case is intended for discussion in postgraduate diploma in business and Master of Business Administration courses.

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CSS 3: Entrepreneurship.

For discussion of social entrepreneurship in middle-income economies, emerging markets generally and Africa, specifically, Quali Health presents interesting questions about entrepreneurial funding, scaling and the interplay between social entrepreneurial activities and the informal sector.

South Africa’s primary health outcomes do not correspond to the country’s spending on public health, with South Africa ranking among the worst globally in the incidence of tuberculosis, HIV prevalence, infant mortality and life expectancy. In part, this poor outcome can be explained by high inequality in access to healthcare, which reflects South Africa’s grossly skewed income and wealth distributions, with the bulk of the country’s population reliant upon an underfunded, inefficient and poorly managed public health system. This substandard service for the working poor in South Africa’s townships with high population densities offered a profitable entrepreneurial opportunity to provide affordable and effective primary care with vast gains in quality and outcomes improved dignity for patients. After receiving her MBA, physician and entrepreneur Dr Nthabiseng Legoete self-funded the launch of Quali Health in 2017. The business model set out to disrupt healthcare delivery for South Africa’s poorest citizens. Drawing patients from the working poor in Diepsloot, Quali Health’s inaugural site was cash flow positive within five months when the facility hit only 30% of installed service capacity. With quick success, Dr Legoete faced the strategic question of how fast to scale and finance the expansion. She also considered a new micro-insurance product for her clientele.

For discussion of social entrepreneurship in middle-income economies, emerging markets generally and Africa, specifically, Quali Health presents interesting questions about entrepreneurial funding, scaling and the interplay between social entrepreneurial activities and the informal sector.

Teaching notes are available for educators only.

CSS: 3 Entrepreneurship.

Organizational diagnosis. The case addresses the issue of an outsider at a senior position in a family-run business.

MBA.

NCR-Delhi is a multi-specialty hospital in Delhi and is essentially a family-run business. Though it had done well in the early years since its inception, it had been plagued by many problems and had undergone many changes in management and processes. An outsider joined it as the Facility Director (FD) two years ago. In these two years, he introduced multi-directional changes. However, he has not been able to achieve a complete turnaround of the hospital. The major issues facing him are financial, operational and personnel-related issues. The hospital is currently in a major financial crisis, which has been causing delays in disbursement of salaries and creating resource crunches in daily operations. Most of the patients are government empanelled patients, and collection of payments from such patients usually takes at least three months. Employee attrition and customer satisfaction are also continuing challenges. Other issues include lack of proper support and interference from top management. The FD has been showing considerable prowess and capability in leading the organization, but has not been able to achieve the desired results owing to the above factors.

To understand the frameworks and process of organizational diagnosis; to understand the influence of change initiatives on organizational culture; and to understand the complexity of family business and what happens when an outsider leader joins family business.

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CSS 6: Human Resource Management.

Public Health; Leadership; Organisational Development; Organisational Behaviour; Public Administration Management.

Postgraduate level for honours or masters programmes in courses on public health; executive leadership and management programmes; MBA level.

The case unpacks decentralisation as a means to promote and improve local decision-making and accountability through community participation and engagements. Ayanda Nkele was a programme manager in a health district in South Africa. He was faced with many challenges when trying to implement his programme, most of which were related to local authority, responsibilities and decision-making abilities at his level. This case describes briefly the South African health system. and how it functions. It describes the proposed changes to the health system and its transformation towards Universal Health Coverage. The decision space analysis as discussed in the case illustrates the types of decentralisation in the country and how this also applies to Nkele’s level.

Understanding the concepts and principles of decentralisation within the context of strengthening district health services, the re-engineering of primary health care (PHC) and rolling out a National Health Insurance in South Africa. Applying the “decision space” approach to analyse the extent of decentralisation. Grasping the requirement of leaders to be “contextually intelligent” and identify the important contextual variables to take into account when analysing public health care.

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CSS 7: Management Science.