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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.

Executives at biotechnology firm Genzyme are debating funding a clinical trial for a new version of a medical device called Synvisc. The trial is expensive and the odds of success are not high, but the upside is substantial. The case presents a common business question: invest or not? The case forces students to think about customer insights, wrestle with a number of complex issues, and evaluate the financials of the decision.

The case is ideal for teaching financial analysis and decision making. It can also be used to teach marketing, new product strategy, and healthcare industry management.

To ensure that students are well prepared to successfully analyze this case, they should be familiar with the following concepts, theories and principles:

▪ Stakeholder theory

▪ Concept of duty to consult and accommodate

▪ Concept of social license to operate (SLO)

▪ Concept of indigenous economic self-determination

▪ Indigenous world view

▪ Seventh generation principle

▪ Cree principles

▪ Dene principles

The information provided in this case was gathered by the authors through face-to-face interviews, phone interviews, e-mail exchanges and secondary research. Meadow Lake Tribal Council (MLTC) separates business operations from council operations through use of corporate entities (as shown in Exhibit 1 of the case). Meadow Lake Tribal Council II (MLTCII) is the corporate entity that oversees two companies referenced in the case: Mistik Management and NorSask Forest Products LP. Interviews were conducted with the General Manager at Mistik Management, Certification Coordinator at Mistik Management, Chief of Buffalo River Dene Nation, Chief of Waterhen Lake First Nation, MLTC Vice-Chief, Board Member and Advisor to MLTCII, President and CEO of MLTCII, MLTCII Business Development Consultant and a former consultant with MLTC, NorSask Forest Products and Mistik Management.

Mistik Management Ltd., a forestry management company co-owned by the nine First Nations of MLTC, was a leader in economic reconciliation in 2022. However, the company had dealt with significant challenges not long after it was established in 1989. Richard Gladue, former Chief of the one of MLTCs Member First Nations and a leader in economic development at MLTC, had been actively involved in establishing the organization. Gladue loved the life and vitality of the boreal forest in the Meadow Lake region and felt a sense of responsibility to take care of the forest and the land for generations to come. This responsibility was balanced with the acknowledgement that the forest also provided vast economic development, employment and wealth generation opportunities for MLTC and its Member First Nations.

In the early 1990s, MLTC and Mistik Management dealt with a year-long blockade by a group of protesters that included members of Canoe Lake Cree First Nation, one of the Member First Nations of MLTC. They had not been consulted on Mistik’s processes and policies, and the company’s clear-cut logging had affected their ability to continue their traditional way of life and practices on the land. After the incident, Mistik Management moved more quickly to invest in a co-management process that they were still refining and using in 2022 when consulting with Indigenous groups and communities.

A natural resource economy brings together Indigenous peoples, industry and government. In this case, students will learn about the important role that relationships play and how decisions are made when balancing complex legal, environmental and economic interests. Students will learn about the history of duty to consult and accommodate in Canada; conduct a stakeholder analysis and reflect on how decisions affect stakeholder interests; and make recommendations for meaningful Indigenous engagement strategies using the concept of social license and indigenous principles.

This case is suitable for use in undergraduate courses on indigenous business, ethical decision-making, public policy and/or natural resource development. There may also be applications in other fields of study, including anthropology, economics and political science.

If the case is used in an indigenous business course, it would be best positioned in the last third of the class, after topics such as duty to consult and accommodate, social license and meaningful engagement with indigenous communities have been covered. If used in an ethical decision-making course, it would be best used when discussing stakeholder theory and engaging in stakeholder analysis. If used in a public policy course, the case could be used to start a discussion around the duty to consult and accommodate indigenous communities in Canada. If used in a natural resource development course, the case would be best used as an example of indigenous economic development.

This case was designed not only for MBA and executive education but also undergraduate courses in human resources (HR), leadership development, HR metrics and change management. It is ideal for introducing the concepts of diversity, equity and inclusion (DE&I), the balanced scorecard and talent retention.

The case deals with initiating and integrating DE&I programs into a company. It highlights how and when to start, change management issues during roll-out and convincing senior leadership why a program such as the one the protagonist started adds value to an organization.

In early 2018, Kate McKinnon, AVP of HR for CareerStaff Unlimited (CSU), a temporary staffing company and division of Genesis HealthCare, reflected on the late 2016 decision to develop women for leadership roles at the company. With a rather unconventional implementation of the Women’s Leadership Group (WLG), Kate successfully developed fifteen female individual contributors, many of whom were promoted to leadership roles by early 2018. Kate was concerned about maintaining the momentum necessary to continue (and expand) the program of identifying, developing, promoting, and retaining women and other diverse employees across the company. She also wanted to measure a clear correlation between the WLG and CSU’s financial and customer outcomes. It was time to plan phase two of the program, including further improvement of the DE&I efforts at CSU.

The learning outcome of this paper are as follows: focused programs, led by courageous and committed leaders, improve gender equity. DE&I is a business imperative, as much as a legal/risk challenge. To be understood, approved and communicated, HR Initiatives must add value and be aligned with the company strategy along with financial and customer outcomes. People development and growth contribute to top talent retention.

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

Given the issues the USA is encountering after the George Floyd death and protests, this is a good way to demonstrate how courageous leadership can start to facilitate change in organizations.

CSS 6: Human Resources.

The primary learning objectives/outcome of case discussion is to apply design thinking principles to design innovative and socially responsible strategies that promote financial sustainability for organizations serving unique societal needs. The secondary learning objectives/outcome of case discussion is to gain a deeper appreciation for the potential social impact of their innovative ideas and understand the complexities and ethical considerations in social entrepreneurship, especially when working with individuals with special needs.

The case study describes the challenge facing Anil Kumar Kundra, the founder and trustee of Autism Ashram and Autism Guardian Village in Hyderabad and Gujarat, an organization that provides shelter and care for individuals with autism and residential facilities for their parents. Autistic individuals often lack social skills and may face challenges in reading, writing and communicating. In addition, they may experience behavioral issues, making it difficult for them to obtain employment or run their own ventures, resulting in a lifetime financial dependency on their guardians. In August 2023, Kundra, in pursuit of sustainability, aims to empower autistic individuals in the ashram to attain financial independence. He envisions Autism Ashrama as a self-sustaining entity, no longer dependent on contributions from parents. The dilemma facing Kundra is the need to identify innovative ideas that will enable these autistic individuals to contribute to revenue generation. The challenges faced by autistic individuals in their day-to-day lives make Kundra’s decision-making complex. While he acknowledges the challenge, he firmly believes that a handful of transformative ideas can bring about a revolutionary shift in the ecosystem for autistic individuals, rendering this business model truly sustainable. The case study invites students to help Kundra identify innovative ideas using design idea techniques, such as the Stanford d.school model.

This take-home assignment is suitable for both undergraduate and postgraduate students and is designed to explore the integration of sustainable business practices and design thinking in a real-world context.

Teaching notes are available for educators only.

CSS 7: Management science.

Judy was a high-performing professional manager who was with her company for 15 years and was a manager for six. She was a confident, positive, and happy person but recently lost her confidence in herself and her abilities. She dreaded going to work because she never knew what she would face from her boss, Dennis. Dennis was a brilliant man who was recently promoted to Senior V.P. He was condescending, and he humiliated people in public. Complaints to the CEO and a harassment claim produced no results. Dennis did the CEO's dirty work and served a role needed in a fast-paced and profit-driven corporate culture. Judy enrolled in an MBA program to build her resume and her self-confidence. She faced a critical juncture in her career. Should she quit, transfer, complain to HR, or confront Dennis?