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At the macro level, the case study enables the students to appreciate the complexity emerging market economies face in achieving economic development and environmental sustainability without comprising each other. The students understand the importance of behavioural change and empowerment of communities in projects dealing with transformational social changes. Theoretically, the students learn about the change mechanisms and organisational practices market-based organisations install to drive their positive social change (PSC) projects. At the micro level, students learn about the process of setting up Mangalajodi Ecotourism Trust (MET) – that not only enthused the local community economically but also instilled it with awareness and motivation towards sustaining its ecosystem. Analytically, at macro level, it assists the students to have a lens of PSC framework to examine corporate social responsibility, social entrepreneurship and BoP strategies of market-based organisations to affect social change. Application/problem solving: The case study explains to the students how the PSC levers of motivation, capability and opportunity structures were applied by NatWest Bank during different phases of project execution. As management grapples with new problems, the students are encouraged to use the levers to recommend an action plan. It allows students to apply SWOT and think of competitive strategies for MET. It allows students to think of strategies that may apply for a better management of Ecotourism at Mangalajodi.

As part of its broader commitment to sustainable development and climate change action, the NatWest Group (formerly Royal Bank of Scotland Group) launched its Supporting Enterprise Programme in India in the year 2007. The project aimed at creating income-generating opportunities for indigenous and economically vulnerable sections of society living in critical natural ecosystems. The project was under the leadership of N. Sunil Kumar, a zealous nature lover, with over two decades of experience in business strategy and public affairs and a specialty in environmental sustainability. He headed Sustainable Banking at NatWest and was head of NatWest Foundation-India. The Mangalajodi project shared the problems many of NatWest’s other projects in India presented. Poor communities that relied solely on natural resources for their sustenance slid deeper into poverty as ecosystems degraded. Lacking alternative sources of livelihood and facing scantier resources, the communities helplessly caused additional damage to weak ecosystems when they drew on the resources even more vigorously. Poaching of migratory birds for supplemental income was a huge problem at Mangalajodi; it was not only rapidly altering the ecosystem to sustain the birds but also deteriorating and weakening its ecology as a whole. Measures to eliminate poaching were failing in the absence of alternate means of livelihoods and a strong incentive to protect the birds. MET was established under the project in 2009. A decade later, it had become a resounding success. A community-owned and run enterprise, MET was providing direct employment to over 100 poorest families at the tiny village and creating income-generating opportunities and entrepreneurial ventures for many others. Poaching was practically negligible at Mangalajodi, and the community was drawing huge admiration for its role in conserving the ecosystem. However, the progress of Mangalajodi Ecotourism was paradoxical, on the one hand; its popularity was rising but, on the other hand, it was becoming overcrowded and looked ill managed. Its rising commercial value was bringing in more land developers, builders and investors, but permanent concrete structures were also coming up quite unscrupulously. There were many challenges – how should growth of ecotourism at Mangalajodi be managed? What mechanisms and practices ensured that the community was empowered enough to participate in decisions of land use, infrastructure, energy and waste management at Mangalajodi? How should MET become more competitive and innovative to grow despite future challenges?

The case study is useful for students of Management at Under Graduate and Post Graduate Levels for understanding the following: the sustainability of fragile ecosystems; the community at the intersection of sustainable development and natural resources conservation and protection of biodiversity; knowing in detail about the planning, implementation and management of ecotourism projects; and decisions regarding community-based ecotourism projects.

Teaching Notes are available for educators only.

CSS 7: Management Science

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.

Health Management and Leadership, Marketing Social Causes, Strategy, International Business.

Post-graduates, Practitioners.

General Electric has been operating in the Middle East, North Africa (MENA) region for over a century. GE is committed to corporate citizenship having launched ecomagination in 2005 and healthymagination in 2009. For sustainability, GE believes that both innovation and localization are critical. This case deals with contextualization of breast cancer campaign for the Kingdom of Saudi Arabia through healthymagination. Rania Rostom, Communications Director, Middle East, North Africa and Turkey region, GE, reviews the campaign implemented and looks at roll-out across the MENA region. The situation is unique, as breast cancer strikes women in the region ten years earlier than the West, and the cultural context does not allow the discussion of the topic in public. One of the peculiarities of this region was the high penetration of social media and its large adoption rate by the young. GE used a unique Facebook campaign to drive awareness on the topic, encourage screening appointments, seek treatment and reduce the discomfort associated with the process.

On completion of utilizing the case study as an exercise, students should be able to gain case-specific skills – critically examine the importance of the consumer behavior, health marketing, marketing strategy and aspects of international business in the Middle East, KSA, in particular, and demonstrate this by analyzing real regional/world examples using complex theoretical frameworks; identify examples of best practice and explain the dynamics toward consumer behavior, health marketing, marketing strategy, international business with reference to a range of theoretical models and apply these in a meaningful way to the MENA region – discipline-specific skills – synthesize and critically evaluate a corpus of academic literature and government reports on consumer behavior, health marketing, marketing strategy, international business – and personal and key skills – reflect on the process of learning and undertake independent/self-directed learning (including time management) to achieve consistent, proficient and sustained attainment; work as a participant or leader of a group and contribute effectively to the achievement of objectives in the field of consumer behavior, health marketing, marketing strategy, international business.

Teaching Notes are available for educators only. Please contact your library to gain login details or email support@emeraldinsight.com to request teaching notes.

After reading the case study, the students will be able to analyze the impact of post-pandemic “new normal” customer behavioral change on a start-up aggregator operating virtually. Recognize the need for the service marketing strategy to prepare a service provider/aggregator to sustain a dynamic and volatile consumer environment. Understand the importance of competitors’ analysis as a primary step of service marketing strategy in influencing “new normal” consumer behavior. Examine the utility of customer engagement through website blogs, social media posts, videos and continuously updated information on the mobile application in influencing the “new normal” customer behavior, from skinner operant conditioning behavior and Rusbolt’s investment model perspectives.

Rafeeg is a mobile application-based home maintenance service providing company, conceived and founded in 2017 by Khamis Alsheryani – who, as an Emirati entrepreneur, has a prior record of accomplishing successful mobile applications and business ventures since 2004. The unique selling proposition of Rafeeg in the Abu Dhabi market is its functioning as the home maintenance services aggregator bringing its suppliers and consumers under-one-roof alongside maintaining ensuring high quality, punctuality and security at competitive prices. Rafeeg has collaborated with approximately 1,000 licensed suppliers using nearly 5,000 technicians and maintenance workers with a customer base of about 70,000 households. Although it is formally situated in Al Salam St, Abu Dhabi, United Arab Emirates (UAE), the company communicates with its consumers virtually. However, with the outbreak of the COVID-19 pandemic in the UAE in March 2020, Rafeeg witnessed a considerable decrease in service requests. Consumers’ psychological fear of the pandemics spread into their houses through the technicians and maintenance workers and the degree of hygienic practices the latter follows before their service provision acted as the major reason behind the fall in requests. Despite Alsheryani’s assurance on the provision of only those suppliers who are verified of their hygienic practices, negative COVID-19 test reports and their availability to the consumers as proof and regular temperature checks of the technicians, the consumer apprehensions remained stagnant and the loss of new service requests, as well as revenue, continued. The pandemic’s spread and consequent lockdown of services in the UAE affected Rafeeg’s business operations gravely, as projected by its sudden drop-in service requests – from 53,638 average monthly customer requests in January and February to approximately 10,000 in March and April. The sudden drop of 81% in new requests drove Alsheryani to develop a service marketing strategy in May to boost consumer behavior, encouraging them to resume their requests without further apprehensions. However, with the continuous rise in the pandemic and vaccines still under trial and research, Alsheryani contemplates the viability of the new marketing strategy. Alsheryani took measures in supplier training programs, excommunicating with suppliers who fail to comply with his strict safety regulations, developing the app with clearly stated, uniform, safety procedures and bearing the additional safety-related costs small suppliers provide quality work as part of the strategy. Despite so, will there be an increase in new requests? Will the bearing of additional costs on the suppliers’ behalf jeopardize its competitive advantage in UAE? Should he consider an alternate business model to adapt to the new normal environment?

This case is written for undergraduate students majoring in consumer behavior, consumer engagement approaches, digital marketing approaches using websites, mobile applications, social media communities and service marketing strategies. Students, through this case, can relate the importance of virtual space in engaging consumers and the importance of the latter in addressing the dynamicity of consumer behavior, especially affected by sudden environmental change, such as the COVID-19 pandemic. The case study also subtly highlights the importance of collaboration with suppliers in an aggregator business model to capture the essence of changing consumer behavior. This case study is appropriate for students having previous knowledge of Rusbolt’s investment model and skinner’s operant behavioral model of consumer behavior and their application in service marketing. Besides, students must be aware of the online business model and aggregator businesses in the service industry of the UAE. The case study purports to motivate critical analytical thinking among students and build their understanding of the importance of consumer behavior for business sustenance.

Teaching notes are available for educators only.

CCS 8: Marketing.

The central lesson to be learned from studying the case is to understand the challenges and constraints posed by contextual conditions in designing contracts in public–private partnerships (PPP) for financing and delivering health care in emerging economies such as India.

Perverse incentives, along with contextual conditions, led to extensive opportunistic behaviors among involved agencies, limiting the effectiveness of otherwise highly regarded innovative design of the program.

India’s “Rashtriya Swasthya Bima Yojana” or National Health Insurance Program, launched in 2007 provided free health insurance coverage to protect millions of low-income families from getting pushed into poverty due to catastrophic health-care expenditure. The program was implemented through a PPP using standardized contracts between multiple stakeholders from the public and private sector – insurance companies, hospitals, intermediaries, the provincial and federal government.

Teaching Notes are available for educators only.

CSS: 10 Public Sector Management.

Need for preventive health care: To comprehend the contribution of preventive health care in improving the health quotient. Sri Sathya Sai Sanjeevani Hospital (SSSSH) and its initiative is an apt example of the wonder which preventive care can bring in the context of rural health. Community participation: The case can be instrumental in showing the pathway to encourage community involvement in mainstream health by promoting the holistic model of SSSSH that understands mothers and children's health profile and needs, especially in the unreached rural segments of an emerging economy like India. Importance of healthy childhood: World Health Organization (WHO) promotes the school health programme to prevent health risks among children by inculcating healthy behaviours during childhood. The successful SSSSH model proves that it is implementable by integrating comprehensive health education modules in the existing institutions for medical care.

The challenge of a healthy childhood is inadequate availability and accessibility of quality care. Non-awareness of the parents is also a significant reason for the children who miss the benefit of a happy childhood. While much is planned by the Government and some part of it being executed, this case highlights the effectiveness of the maternal and child health programme executed by the Sri Sathya Sai Sanjeevani Hospital (SSSSH). This initiative fulfills the dire need of ensuring the preventive healthcare component leading to safe motherhood and safe birth of healthy children. Further, the case is also the culmination of pin-pointed innovative awareness activities such as school health screening and the Divine Mother and Child Health Program (DMCHP). It opens up the discussion on the current model of health care followed by SSSSH, Raipur, and its impact in the local areas to decide on its expansion across the country for nationwide implementation.

Bachelors in Business Administration, MBA, Executive MBA, Post Graduate Diploma in Healthcare Management

Teaching notes are available for educators only.

CSS 2: Built Environment.

The present case study would help readers to understand paternalistic leadership behavior with its underlying theory. Readers would be able to appreciate the nature of experiences employees may have while working with a paternalistic leader high on authoritarianism. This case study would motivate readers to work out appropriate strategies for working under paternalistic bosses. The teaching note sensitizes readers about the complicated relationship between paternalistic leadership and culture.

Pyramid Globe Management Institute (PGMI) is struggling to generate revenue. PGMI founder, Tugmanshu Lakhani, has to find out new sources of revenue to keep the institute functioning. He constitutes a team of three professors for starting a new academic program with a foreign university. The initial success of the team brings favor from the founder but jealousy from the colleagues reeling under job threat. High authoritarianism and interference of the founder create a problematic situation for the three professors. When the new program starts showing promising results, the founder gets apprehensive about whether the new course may hurt the enrolment in the flagship program of the institute. The authoritarian and erratic behavior of the founder had a demotivating effect on the team working for the new program. Some team members resign under pressure while three professors stay to ensure the launch of the program. The professors have to resolve the conflict between their commitment toward PGMI in a troubled time and a career uncertainty if they continue working for it. Anticipating no change in the behavior of the founder and an uncertain future with PGMI, three professors quit after the start of the new program. The founder may continue losing committed employees if he is unable to balance his authoritarianism with benevolence and moral behavior. It will create more problems for PGMI in the future.

This case can be used in organizational behavior, leadership and team-building courses in the regular Master of Business Administration (MBA) programs. The case can further be used in the executive development program, especially for analyzing the leadership problem in higher education organizations.

Teaching notes are available for educators only.

CSS 7: Management science.

Key State Blue Cross and Blue Shield Plan (a disguised case of an actual BCBS Plan) is the merged product of three state plans. Initially burdened with a reputation of poor customer service, Key State's executives decided to invest heavily in service improvement, eventually achieving superior levels. Key State's high-quality customer service emerged as a true competitive advantage for its customers, who were primarily businesses and health benefits consultants who influenced corporate purchasers of health insurance. The Key State brand came to be synonymous with personal service, security, choice, and dependability. But the health care insurance market was changing under Key State's feet. Spiraling costs meant that high-quality service became less of a competitive advantage as employers were lured by low-cost, low-service providers. Many employers cut or dropped health care benefits entirely, swelling the ranks of the under- and uninsured, who in turn were extremely price-sensitive when shopping for health insurance on their own. Finally, the health care insurance market was being revolutionized by financial institutions willing to hold health benefit accounts and pay providers directly, thereby eliminating the need for Key State as a mediator. Key State executives were aware of these changes but were challenged by the mindset, culture, and organizational design custom-fit to their business accounts. The case asks the reader to consider whether Key State has the right number of target markets, whether it should have one brand or several for its different target markets, what it should do for the uninsured, and how it should improve its brand experience in light of the industry's changing landscape. All of these decisions will have significant implications for the organizational design of Key State.

To better understand the challenges involved in a successful health insurance company to cope with a rapidly changing and unpredictable environment; to formulate a new strategy and a new organizational design to accomplish this adaptation.

Entrepreneurship.

The case has been used at Master's level but it has direct application to any MBA programme or entrepreneurship module.

Adrian Gore started Discovery in 1992 with seed-funding of R10 million from merchant banking group, Rand Merchant Bank (RMB), as a health insurance company within the RMB stable. By 2009, Discovery had become a large, listed, financial services institution employing more than 5,000 people and comprising not only Discovery Health (DH), but also Discovery Life (DL), Discovery Invest (DI) and Discovery Vitality (a wellness programme). In addition, it had operations in the USA, where it licensed Vitality for use by employers and other health insurers, and in the UK where it operated two joint ventures with The Prudential plc – Pruhealth and Prulife.

To understand the similarities and differences between corporate and start-up entrepreneurship; to understand the entrepreneurial process within an established organization; to explore the environment within an established company in terms of how much it supports or constrains entrepreneurship; and to look at creative ways to overcome obstacles to entrepreneurship in established companies.

Teaching notes.