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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.

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.

Teaching notes are available for educators only.

CSS 7: Management Science.

This case presents some of the entrepreneurial challenges faced by a female leader in the technology sector who conceived a new product based on her passion to help others especially those most disadvantaged.

Upon completion of this case study, students should be able to prepare supply chain and distribution analysis that considers ethics and sustainability, integrate philanthropic efforts as part of an organizational strategy and recognize strategies to promote equity within and beyond an organization.

Connie Stacey (she/her) is an entrepreneur and president of Growing Greener Innovations, an award-winning battery energy storage company based in Alberta, Canada, with a mission to end energy poverty globally. With the emergence of COVID-19 as a global pandemic in 2020, Stacey turned her attention to an innovation called Project Rescue, a ventilator that uses non-identifying patient vitals to track data. It serves as a pandemic early warning system, addressing two key challenges: pandemic data are prone to error, and real-time information is non-existent after the pandemic has spread. This new product was conceived based on her passion to help others, especially those most disadvantaged. This multi-faceted case focuses on the many challenges that Stacey and her team needed to address. The dilemma in this case centres on establishing supply chains amid a pandemic, as well as prioritizing the corporate social responsibility elements of philanthropy and equity within her organization (and beyond).

This case is appropriate for third- or fourth-year undergraduate or graduate-level students.

In addition to “call out boxes” throughout the case and teaching note, additional readings/links/videos are outlined below. (These supplementary materials, “Teaching Tips”, are included in the teaching notes as well.)

CCS 11: Strategy.

This case study has been developed based on the primary data obtained through a series of interviews held with the senior management of Cargills, and the secondary data obtained from the company’s corporate website www.cargillsceylon.com/,annual reports and publicly available sources of information such as newspaper articles.

This case study focuses on the strategic responses employed by Cargills (Ceylon) PLC – a leading business conglomerate in Sri Lanka – in response to the challenges posed by the COVID-19 pandemic. The duration of this case study is from January 2020 to September 2021. The case study particularly examines the key business sectors of Cargills (Ceylon) PLC – retail, food manufacturing and quick service restaurants – which elaborate on the change management practices and strategies deployed by the company in each of these sectors during this challenging period. This study is based on the primary data gathered from the interviews held with the Cargills (Ceylon) PLC team, and the secondary data obtained from the corporate website of Cargills (Ceylon) PLC. This case study is most suitable to be taught in academic courses related to strategic change management.

The case is most suited to be discussed with undergraduates (3rd year and 4th year) following business and management studies related disciplines. While the pivotal area around which the case has been developed is strategic change management, covering environmental analysis, strategic analysis and process of change management, the case could also be used in strategic management classes, to discuss environmental analysis, strategic planning approaches and business and corporate level strategies.

CSS 11: Strategy.

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.

LifeBank is primarily focused on tackling the challenge of maternal mortality in Nigeria and other African countries by providing women access to blood, thereby tackling the challenge of gender inequality. The company employed both men and women at its workplace providing equal opportunities for men and women.

Discuss how women entrepreneurs are solving social problems in developing countries using technology and innovation.

Analyze the challenges faced by women entrepreneurs in getting the right human capital, raising funds and managing growth for their social business.

The case discusses how social entrepreneur Temie Giwa-Tubosun (Temie) founded LifeBank, a medical distribution company, to provide access to blood, medical oxygen and vaccines to hospitals in Nigeria. The company used technology to provide information to health providers about which blood bank stored the blood type they needed and delivered it quickly and safely to help save lives.

Teaching notes are available for educators only.

CSS 3: Entrepreneurship.

The case deals with a chain of hospitals, that has grown vary fast in last few years as a result of various acquisitions and new developments. The hospital chain is lagging behind in use of technology. The IT department is inward looking and the focus is more on provide support services rather than strategic orientation. A new CIO takes charge of the IT department and decides to transform IT from playing a support to strategic role. He identifies cloud computing as a tool to take the leap. The case provides an opportunity to discuss the type of service and deployment models of benefits of cloud technology. A rough data to do financial evaluation of cloud technology is presented. Evaluation parameters that may be used to decide on cloud versus in-house technology are also discussed.

The pandemic induced lockdown lead to supply and manufacturing disruptions that were swiftly dealt with by the Indian Pharma Industry through successful industry-government collaboration. By May 2020 production was back to normal and exports were higher than the same period in May 2019. The case deals with the processes that enabled this to happen, the policy responses and the changes that happened in the period from March 2020 to August 2020.

This case study is designed to enable students to analyze the competitive landscape of a business impacted by technological disruption; evaluate the viability of an organic growth strategy using stakeholder analysis; evaluate the revenue and cost structure of Apollo 24/7 and decide on the future investment strategy; and analyze funding strategies of traditional hospitals versus pure digital players.

To extend its reach, Apollo Hospitals Enterprise (Apollo Hospitals), a leading private sector brick-and-mortar hospital chain in India known for using state-of-the-art technology, launched a unified virtual mobile platform Apollo 24/7 in February 2020, 45 days into the COVID-19 pandemic. The management believed that the digital platform had a unique ecosystem that could not be replicated. The analysts were optimistic about the impact of the decision on the future performance of Apollo Hospitals, as it was expected to lead to higher penetration and increased revenue. They also anticipated the unlocking of value, as and when the venture capitalist (VC) would invest in Apollo Hospitals. However, with increasing operating expenses on account of burgeoning technological and marketing expenses, things did not seem to go going as planned. Three years later, in February 2022 after the Q3 of financial year 2023 results. Suneeta Reddy, the company’s managing director found herself pondering whether the digital platform could boost Apollo Hospitals’ profitability in addition to expanding its reach and increasing affordability when the company missed the analyst estimates. In India, which was then the second most populous country, “incremental access” and “affordability” were what mattered to the patients, However, for the investors and analysts, it was quarter-on-quarter performance. The change in the macroeconomic environment stalled the company’s plan of raising money from VCs.

Furthermore, the financing dilemma also plagued Reddy. She knew there was a difference between financing for conventional businesses that for digital businesses. She also had to take decide between short-term profitability with which investors were obsessed versus long-term sustainability, which involved taking care of stakeholders’ interests.

This case study is basically aimed at postgraduate courses and executive management courses.

Teaching notes are available for educators only.

CSS11: Strategy.

In early 2014, recent Stanford University graduate Tyler Shultz was in a quandary. He had been working at Theranos, a blood-diagnostic company founded by Elizabeth Holmes, a Stanford-dropout wunderkind, for almost a year. Shultz had learned enough about the company to realize that its practices and the efficacy of its much-touted finger-prick blood-testing technology were questionable and that the company was going to great lengths to hide this fact from the public and from regulators.

Theranos and Holmes were Silicon Valley darlings, enjoying positive press and lavish attention from potential investors and technology titans alike. Just as companies like PayPal had revolutionized the stagnant payments industry and Uber had upended the for-hire transportation sector, Theranos had been positioned as the latest technology firm to substantially disrupt yet another mature sector: the medical laboratory business. By the start of 2014, the company had raised more than $400 million in funding, and had an estimated market valuation of $9 billion.

Shultz's situation was exacerbated by the fact that his grandfather, the highly respected former US Secretary of State George Shultz, was on the Theranos board and was one of Elizabeth Holmes's biggest supporters.

But Tyler Shultz worried about the customers he was convinced were receiving highly unreliable and often inaccurate blood-test results. With so much at stake, Shultz wondered how he should proceed. Should he raise his concerns with the firm's investors? Blow the whistle externally? Report to industry regulators? Go away quietly?

This case and its subsequent four brief follow-up cases are based largely on interviews with Tyler Shultz, and outline the dilemma he faced and the various steps he would take both to extricate himself from his unsavory position and let the public know the full extent of the deception at Theranos.

Five optional handouts are available to instructors to further discussion after the case has been debriefed. The handouts serve as additional decision points for the students if your class time permits.