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The case is based on data collected from in-depth interviews, and from company, third-party and regulatory–agency documents. In addition to prior conversations over several years between the company founders and the lead case writer, there were several rounds of interviews in 2023 with the surviving founder and in-depth interviews with eight of the company’s key managers. Company documents reviewed included bylaws, organization charts, profit and loss statements and staffing statistics, all from founding to sale. Also reviewed were documents and evaluations of company operations and performance produced by the merger & acquisition firm that handled the company’s eventual sale. The company owner insisted on complete disguise of the company and all its members and prohibited disclosure of detailed proprietary financial data.

At the strategic level, this case is about how the unique, complex and changing healthcare environment created opportunities and threats to which a women-owned and run start-up company, Aloe Health (AH), had to respond to become and remain successful. At the personal level, the case illustrates what it takes for an entrepreneur and leader having clinical but no real business acumen to start, expand and turn around a company and ultimately position it for a successful acquisition, continually learning and adapting along the way.

The case describes how two women who were friends for many years started up a home healthcare company later in their lives and grew it into the largest women-owned business of its kind in the USA. Based in the Southwest USA, an area with many factors conducive to success, they navigated the many complexities of US Medicare regulations to create a fully-integrated home healthcare company providing unskilled personal care, medically skilled homecare and end-of-life hospice services to thousands of clients. The case provides background on the founders and the home healthcare industry context, and details the steps taken to start up and build the company into a fairly successful enterprise; one of the largest of its kind in the region. The (A) case ends with one of the founders facing a crisis brought on by the death of her co-founder and the revelation of some significant organization dysfunctions, leaving her unable to profitably exit the company and unsure of whether she would be able to turn things around. The students are tasked with making recommendations for what she should do next.

The (B) case brings events up to fall 2023, describing the steps the surviving founder took to transform her leadership style and the company’s systems and culture, and to navigate the due diligence process associated with preparing for an (ultimately very successful) acquisition. It also shares the owner’s “lessons learned,” and briefly notes the current state of the acquired company and the many AH employees that it continues to employ.

The case provides ample information for students to appreciate the company’s strategy and the challenges of operating in the highly regulated health care industry. However, it is probably even better suited to illustrating the “soft” issues of new-venture management, such as the tendencies of founders to overload themselves by micro-managing their growing venture and not adapting to expansion, and for those with clinical backgrounds to focus on caring for patients and employees while overlooking business essentials and organization systems. It also illustrates how business partnerships among strong-willed individuals can produce dynamics in the founding team similar to a “marriage,” with affection and complementary talents, yet also tensions. It further illustrates the process of a successful turnaround strategy, and the “due-diligence” challenges of preparing for an acquisition.

This case has a range of course applications at multiple education levels. Although it is probably best suited for graduate and executive-level programs, it can also be selectively used in undergraduate classes, particularly if populated by upperclassman. It is ideally suited to courses on entrepreneurship and on healthcare management. For an entrepreneurship course, it could be positioned mid-way through the semester, after covering topics relating to the entrepreneurial mindset, founding teams and business models. It can be used to get the class focusing on competitive issues and the challenges of starting up a company in a highly regulated environment, on entrepreneurial founding-team characteristics and management tendencies (e.g. micro-management control tendencies), on transition issues from start up to growth stages and on exit strategies.

We believe this case is also well suited as a teaching exercise for students pursuing healthcare management studies in baccalaureate and graduate programs (MBA, MHA, MHS) in which instructors wish to broaden student exposure to a real-world scenario that focuses on entrepreneurial behavior in a healthcare setting (a topic of increasing interest to healthcare practitioners and managers given the current trend toward provider formation and ownership of health facilities). Here, the case may be used to focus on the complexities of the healthcare industry, the key differences between various healthcare service business models and on the challenges that technically (clinically) trained professionals often face when trying to manage a healthcare business. Ideal placement of the case would be in a capstone course, after students have been introduced to their functional coursework in topics such as introduction to management, organizational behavior and leadership, financial management and strategic thinking. The case also challenges students to apply knowledge obtained in specialized coursework in healthcare systems and policy, industry regulation, as well as healthcare reimbursement methods.

The case also may be used in organization behavior courses to focus on team, cultural and leadership issues and in strategic management courses to focus on strategy implementation. In addition, there are enough family business themes in the case (even though Aloe is not actually a family business) to use it in a course on managing family businesses.

This paper aims to understand the strategic management of innovation by examining the effect that management control systems (MCS) have on innovation activities during the strategic change process.

A case study was carried out at an innovative company as they undertook a strategic change from closed innovation to open innovation. Simons’ levers of control was used to frame the ways in which MCS were designed and used by managers and the effect MCS have on the innovation activities of organization members.

The findings indicate that while managers designed and used MCS to support a drive toward open innovation, organization members did not change their innovation activities. Instead, the findings show that new MCS enabled improvements to their closed innovation strategy. This led to a decrease in the time taken to develop new products, which resulted in increased customer satisfaction, which contributed to the achievement of organizational goals.

By focusing on the relationship between MCS and innovation activities in the strategic change process, the paper sheds new light on the ability of MCS to change the innovation activities of organization members. Even though the innovation activities at our case company did not change the interactions between the MCS enabled organizational goals to be achieved as they provided the necessary information infrastructure and motivated goal congruence.

The purpose of this paper is to analyze the market for audit services for publicly traded companies operating in the US for-profit (FP) healthcare sector. Complex national and local healthcare laws and regulations suggest the importance of assessing fee effects of joint nationallevel and city-specific expertise among auditors. Using cross-sectional OLS regression analysis, we find that joint expertise significantly affects audit pricing in the healthcare sector. We find a fee premium of 33.6 percent on engagements where auditors are both national and city-specific specialists. We also find that Big-4 auditor reputation is significantly priced over and above the effects of joint auditor expertise, and a significant positive association exists between audit and non-audit service fees-indicating the presence of knowledge spillover effects among healthcare company auditors.

Corporate social responsibility (CSR) in India includes education, environment, healthcare and rural development. In post-liberalized India, the healthcare sector (services and facilities) has grown in leaps and bounds over last two decades. The purpose of this paper is to reveal and explain the CSR profile of select healthcare companies of India and reveal gaps and scope of healthcare activities with a special consideration towards maternal health.

Primary data are collected from seven listed companies of Goa state which were willing to participate in the study. In total, 67 companies constituting the Healthcare Sector Index of Standard & Poor of the Bombay Stock Exchange are considered as secondary source. Data of 59 companies that come within the threshold of Companies Act, 2013, are studied. CSR guidelines (with a turnover of Rs 10bn or a market capitalization of Rs 5bn or a net profit of Rs 50m) are taken as an initial frame of reference.

In total, 89.83 per cent of these companies have initiatives related to health care. Structured companies (contribute to the company’s overall mission and goals) with CSR policy have committee size varying from three to five directors with an independent director. During 2016–2017, they were mandated to spend Rs 4.2613bn out of which only 74.59 per cent was spent. Geographical spread of CSR initiatives is skewed, with majority of companies focussing on the states of Maharashtra and Gujarat, whereas the states of Odisha and North-Eastern being neglected. The focus areas of CSR are education, healthcare and rural development. The variation of MMR in different states of India is an indicator for corporate as to which state needs more attention. The corporate sector in India needs to focus on SDG3 target of MMR and move towards a newer dimension and direction.

The originality of this paper lies in the recognition of the initiative of Government of India of weaning out CSR activities outside the purview of business sense and towards instilling a social sense in company behaviour. This is a dimensional and directional change in the evolution of CSR practices in companies and countries. To this end, 59 healthcare sector companies under the threshold of Companies Act 2013 were studied and results were outlined.

The case is particularly well suited to entrepreneurship, marketing, technology, innovation, or strategy courses.

This teaching case is aimed at postgraduate students in management or business programmes.

This case follows the Kenyan healthcare tech company Savannah Informatics as they contemplate how the company will continue to grow in a post-pandemic world. Savannah is the market leader in electronic claims validation solutions for the Kenyan healthcare system. Their flagship product, the digital platform Slade 360, allows health insurers, healthcare providers, and patients to share claims information for health services in real time, drastically reducing payment transfer times, incidents of fraud, and account errors. The Covid-19 pandemic and the subsequent lockdown mandates from the Kenyan government have reduced short-term revenues by driving down hospital visits for citizens overall, but they have also created a demand for telemedicine and more online healthcare solutions. CEO John Muthee and his co-founders are left to consider their options for growing Savannah Informatics: expanding into new markets, creating more solutions for their insurance and provider customers in Kenya, or diversifying.

Identify the key challenges facing Savannah

Analyse the organisation using the 5Cs model (company, customers, competitors, collaborators and context) and VRIO (value, rarity, imitability, and organisation) analysis

Assess the growth opportunities available to Savannah and make recommendations

This study evaluated the influence of the coronavirus pandemic on the healthcare and non-cold pharmaceutical care distribution supply chain.

The model involves four objective functions to minimize the total costs, environmental impacts, lead time and the probability of a healthcare provider being infected by a sick person was developed. An improved version of the augmented e-constraint method was applied to solve the proposed model for a case study of a distribution company to show the effectiveness of the proposed model. A sensitivity analysis was conducted to identify the sensitive parameters. Finally, two robust models were developed to overcome the innate uncertainty of sensitive parameters.

The result demonstrated a significant reduction in total costs, environmental impacts, lead time and probability of a healthcare worker being infected from a sick person by 40%, 30%, 75% and 54%, respectively, under the coronavirus pandemic compared to the normal condition. It should be noted that decreasing lead time and disease infection rate could reduce mortality and promote the model's effectiveness.

Implementing this model could assist the healthcare and pharmaceutical distributors to make more informed decisions to minimize the cost, lead time, environmental impacts and enhance their supply chain resiliency.

This study introduced an objective function to consider the coronavirus infection rates among the healthcare workers impacted by the pharmaceutical/healthcare products supply chain. This study considered both economic and environmental consequences caused by the coronavirus pandemic condition, which occurred on a significantly larger scale than past pandemic and epidemic crises.

Information systems play a significant role in the improving of health and healthcare, as well as in the planning and financing of health services. Fund’s Information System is an essential component of the information infrastructure that allows assessment of the impact of changes in health insurance and healthcare for the population. The purpose of this paper is to give a brief overview of the affection of e-services and electronic data exchange (between Fund’s information systems and other IT systems) at the quality of service for insured people and savings funds.

The authors opted for an exploratory study using the e-services implemented in Health Insurance Fund (HIF) of Macedonia and data which were complemented by documentary analysis, including brand documents and descriptions of internal processes. In this paper is presented an analysis of the financial aspects of some e-services in HIF of Macedonia by using computer-based information systems and calculating the financial implications on insured people, companies and healthcare providers.

The analysis conducted in this paper shows that the HIF’s e-services would have a positive impact for the insured people, healthcare providers and companies when fulfilling their administrative obligations and exercising their rights.

The analysis presented in this paper can serve as a valuable input for the healthcare authorities in making decisions related to introducing e-services in healthcare. These enhanced e-services will improve the quality service of the HIF.

Climate change is one of our time’s most pressing global environmental challenges, and environmental innovation is critical to addressing it. This study aims to investigate the relationship between environmental innovation and carbon emission in the healthcare industry in Europe while also examining the moderating role of environmental governance.

Data for this study were collected from publicly listed healthcare companies in ten European countries spanning the years 2012–2021. The selected countries encompassed Belgium, Denmark, France, Germany, Italy, Netherlands, Spain, Sweden, Switzerland and the United Kingdom. The research encompassed all healthcare companies for which data were accessible, resulting in a comprehensive dataset comprising 1,210 companies. The authors collected data from multiple sources, including annual reports, the World Bank and Eikon databases, to ensure a robust and extensive dataset.

The results of this study indicate that environmental governance plays a significant moderating role in the relationship between environmental innovation and carbon emission within the healthcare sector in Europe, but when combined with high levels of environmental innovation, strong environmental governance leads to enhanced efforts to reduce carbon emissions. This combination also contributes to meeting the expectations of a broader range of stakeholders and maintaining legitimacy.

The study’s findings have practical implications for healthcare regulators, policymakers and various stakeholders. It underscores the importance of integrating solid environmental governance and innovation to address climate change challenges in the healthcare sector effectively. This integrated approach not only helps reduce carbon emissions but also contributes to achieving sustainable outcomes while satisfying a wider range of stakeholders.

This study adds to the existing body of knowledge by highlighting the significant role of environmental governance as a moderator in the relationship between environmental innovation and carbon emission in the healthcare industry. The research findings provide valuable insights for academics, practitioners and decision-makers, emphasizing the need to combine governance and innovation for sustainable outcomes in healthcare sectors.

The process of performance measurement provides support to company management to achieve the objectives established in strategic planning. Through the definition of critical success factors and related key performance indicators, performance measurement verifies the gap between planned objectives and the results achieved, informing the responsible bodies to enable them to evaluate performance and, if necessary, implement improvement actions. Although many types of companies adopt performance measurement, this process is challenging when applied to national health services. This paper aims to identify the evolution of performance measurement and the critical success factors of national health services.

The authors conducted an explorative case study of a leading national health service to delineate the evolutionary path of performance measurement and the main critical success factors.

The results indicate a significant increase in the maturity of performance measurement of a national health service that has been motivated by international reforms and national regulations. This research highlights performance measurement features such as a balanced set of metrics, targets, and incentives linked to strategic objectives and regular and frequent performance reviews. Furthermore, it identifies the performance measurement model of a leading national health service.

The evolution of performance measurement and numerous critical success factors of national health services are described; the critical success factors cover a wide range of financial to operational aspects such as patient safety, organizational appropriateness, and clinical appropriateness.

This paper aims to compare the mission statements of Indian and Singaporean firms in the healthcare sector, and define the main components of Indian and Singaporean mission statements.

The study was based on a network analytic approach and content analysis. The research was performed on 200 companies (100 Indian companies and 100 Singaporean companies). For each company, we searched for a mission statement published in the company website. Nonnegative Matrix Factorization (NMF) in Python programming language was utilized to obtain the differences in the components of mission statements between Indian and Singaporean firms.

The study results indicate a similarity and variation between Indian and Singaporean mission statements. Both countries are more concerned about patients, service, community, quality, and healthcare in their mission statements, but Indian mission statements emphasize quality, affordable price, and technology more than Singaporean firms. In contrast, Singaporean mission statements tend to highlight innovation and company value. This research will assist strategic managers in identifying the mission statement components and choosing the right strategy for the organization.

This study contributes to the literature and ethos theory by identifying and distinguishing the paramount differences between the Indian and Singaporean mission statement components in the healthcare sector.