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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.

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 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.

After the completion of this case study, students will be able to understand the importance of being close to local people when embarking on social business; understand that clear purpose and good decision-making can lead to great outcomes; and learn that innovation is crucial to ensure sustainability of both business and impact.

The case highlights the journey of Laiterie du Berger (LDB), a social enterprise in the agribusiness industry and the challenges faced as it expands and innovates. LDB’s roots lie in its commitment to social impact, aiming to uplift the Fulani livestock farmers and address socioeconomic issues. The company’s business model prioritizes people over profits, focusing on sustainable development and poverty alleviation. The LDB case showcases the challenges and opportunities in the agribusiness industry. LDB’s commitment to social impact, demonstrated through its support for farmers and sustainable farming practices, has been integral to its success. As the company expands and innovates, it faces critical decisions that require balancing financial growth with social responsibility. By embracing development, innovation and collaboration, LDB can continue to be a catalyst for positive change in the agribusiness industry while staying true to its roots and the principles that have defined its journey.

This case study is designed for bachelor’s and master’s degree students in the field of entrepreneurship and innovation, as well as MBA students. The case focuses on social entrepreneurship with the example of an agribusiness company located in Senegal, prioritizing social impact and quality of life. The case study explores the dynamics of the sector, including expansion strategy, innovation initiatives and the dilemma of balancing social mission and profit that social entrepreneurs may be facing. By analyzing this real-world situation of LDB, students will have the opportunity to enhance their decision-making skills.

Teaching notes are available for educators only.

CSS 3: Entrepreneurship

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 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.

The learning outcomes of this case study are to understand the business-to-business (B2B) consumer outlook on mental health care in emerging markets; analyse the challenges faced in creating a need for mental health care in Indian workplaces; explore the business attractiveness of the B2B model and understand the business potential of the B2B segment at heyy,; and contemplate different innovative strategies that could change consumer mindset on mental health care in emerging markets.

Ankit, the founder and CEO of heyy, was facing a conundrum. “heyy,” was built on normalizing mental well-being at workplaces. His mental health-care app heyy, had crossed 50,000 subscribers within a few months of launch. The mobile app was designed to spread mental health awareness and provide various levels of mental well-being interventions. Business-to-consumer and B2B customer segmentation had been targeted by this start-up. The B2B space consisted of employees working with partner organizations. The adoption rates of employees using the features of heyy, declined after the initial app download. The employees had yet to fully become acclimatized to the features of heyy,. Exploring the business potential and investigating the business attractiveness of the B2B segment were the focus of the present study. Ankit contemplated various strategies he could adopt to increase user adoption of “heyy,” services by employees in his partner organizations. The case study strives to address the question – “What are the risks faced by organizations when entering the mental health-care industry in emerging markets like India, where mental health care is still not openly discussed?”

This case study is designed to be taught as part of the “entrepreneurship development” and “strategic management” courses for undergraduates, postgraduates and students of executive programmes in management. Students need to be aware of basic strategic management concepts such as BCG matrix, SWOT analysis and business canvas before working on this case study, so they could dissect the case from multiple perspectives to get a comprehensive outlook on the case.

Teaching notes are available for educators only.

CSS 11: Strategy.

This case is the second of a three-part series that follows the managerial, strategic, and communications decisions of the Swachh Bharat Mission (SBM) or Clean India Mission, the flagship programme of the Government of India to eliminate the practice of open defecation (i.e., not using a toilet) from 2014 to 2019. As of 2014, 550 million people in India practiced open defecation. This problem posed a massive public health hazard and economic drag for the country as well as a threat to global health. Written from an insider's perspective, the cases centre on the decisions made by a new Secretary of India's Ministry of Drinking Water and Sanitation, who was hired to manage SBM, and the team he assembled. Case B discusses the start-up challenges for SBM, including implementation in India's complex federal system, workplace culture, and the deep-rooted behaviour of open defecation in rural India and the managerial and communication strategies formulated to address them. The case concludes by framing the difficulties with slow-moving states and monitoring rigour that the leadership SBM, with a new team, strategic focus, and early momentum, faced as the mission entered its final two years.

This case is the second of a three-part series that follows the managerial, strategic, and communications decisions of the Swachh Bharat Mission (SBM) or Clean India Mission, the flagship programme of the Government of India to eliminate the practice of open defecation (i.e., not using a toilet) from 2014 to 2019. As of 2014, 550 million people in India practiced open defecation. This problem posed a massive public health hazard and economic drag for the country as well as a threat to global health. Written from an insider's perspective, the cases centre on the decisions made by a new Secretary of India's Ministry of Drinking Water and Sanitation, who was hired to manage SBM, and the team he assembled. Case B discusses the start-up challenges for SBM, including implementation in India's complex federal system, workplace culture, and the deep-rooted behaviour of open defecation in rural India and the managerial and communication strategies formulated to address them. The case concludes by framing the difficulties with slow-moving states and monitoring rigour that the leadership SBM, with a new team, strategic focus, and early momentum, faced as the mission entered its final two years.

South Africa had formally introduced a policy of inflation targeting (IT) in February 2000. By December 2001, the governor of the South African Reserve Bank, after reading the latest statistics, was concerned with the disappointing economic data. Economic activity had slowed drastically, to the point that the country appeared to be heading for a recession. The gloomy statistics forced the governor to consider whether the country had pursued the right policy. Persistently high unemployment, one legacy of the apartheid era, meant that South Africa did not have the luxury of waiting for new policies to bear fruit. With the inflation forecast to exceed the mandated target, the governor would have to tighten monetary policy, which would further restrict investment. Was it is time for South Africa to change course?