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India's diagnostics business valued at USD 10 billion was growing at 20% annually. Several players with different business models competed. Dr. Lal PathLabs, the world's largest histopathology centre led with a menu of 3,500 tests, 1,600 collection centres and 7,000 pick-up points. Its Initial Public Offer had been oversubscribed 33.41 times and the team at Dr. Lal PathLabs was excited about expanding its international footprint. Two overseas companies were incorporated in Netherlands and Nepal. Yet, there were enormous unmet needs in India alongside potential for public-private partnerships. Trade-offs over portfolio choice and regional versus international footprint needed thinking through.

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.

Diagnostics services in India were growing at 20% annually with billing of USD 3.4 billion. With WTO's GATS, foreign competition was arising. Dr. Lal PathLabs had formidable brand recognition and Dr. Arvind Lal was wondering whether to accept private equity and induct management professionals to keep pace with competitors through acquisitions or greenfield or sell out. He worried over loss of proprietary control. The industry practice of incentivizing doctors for referrals meant that acquisitions brought perverse incentive systems. The choice of compromising ethics or inventing another business model had to be made alongside whether to expand in India or abroad.

The subject areas are strategy, general management, health-care management, change management and inclusive growth model and application of technology to manage health care.

The case can be used to teach challenges in managing change in a health-care facility.

Tata Memorial Centre (TMC) is dedicated to provide best health-care services in the field of cancer cure. TMC established its credentials for service, education and research, which contributed to it being rated among the ten best hospitals year on year. Starting from humble moorings, TMC has grown to an institution of high repute from an 80-bed hospital to a 700-bed hospital. TMC held a number of pioneering efforts, which included bone marrow transplantation, external beam radiotherapy (linear accelerator), tumor tissue bank and bio-imaging to name a few. The management team of TMC had ensured that the growth had been orderly and appropriate to the changing needs of the community. Managing a hospital with disparate skill sets in the face of ever-increasing demand for services had always been a challenge in itself. As a government-run facility and well funded by the trust, TMC offered excellent services and post-operative care to the patients. So, it became imperative for the hospital to adopt technology to improve its hospital services and maintain transparency. Patients came to the hospital from different states in India and across the globe. TMC registered international and national patients online. Online medical reports were checked before the patients visited the hospital. TMC has developed an e-system that will allow patients around the world to send their tissue samples that are suspected to be cancerous for medical advice to the hospital. This case study is developed to provide insights into the transformation of TMC into an e-health-care service and explains the process of change management.

They are to provide insights into the challenges in health-care management, to illustrate the challenges faced by organization in implementing information and communication technology- managing change and to bring about best practices in the case organization and find solutions to the following questions: What are challenges faced by health-care officials in providing health care using new technological innovations? How can hospitals equip themselves with new technology? With the advent of improved and modern communication methods, medical practices and cases are more easily shared. Cases are discussed, recorded and, in many cases, put up for general public viewing through the electronic media. How can hospitals manage change? How can hospital administrators manage speed of delivery, quality healthcare, innovation and brand image?

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

CSS:11 Strategy.

Prudential Equity Group had downgraded Danaher to underweight status, citing concerns over its inadequate organic growth. By March 2009, its CEO wondered how to keep growing a company that faced changing worldwide economic circumstances, pressure from low-cost competitors, new competitors, flat or declining demand for company products, price increases for certain raw materials, and criticism from market analysts.

This case uses the concept of social entrepreneurship to analyze the entrepreneurial journey of Mr Suraj Prakash and his social enterprise, the Swasth Foundation. It further deepens our understanding of strategic decision-making by exploring the successful use of pivots.

The case was primarily developed through a series of interviews with the leadership team over a year. Secondary sources included literature about Swasth Foundation available on the internet and those shared by the founder.

In 2008, Suraj Prakash left McKinsey & Company after six and half years in the health and development sector as an engagement manager. Along with his friends, Aman Paul and Ankur Sharma, he established Swasth with the goal of building an ecosystem that delivered high-quality, affordable and accountable health services to low-income communities in India. Right from its inception, Swasth went through many fundamental shifts in terms of its business model, team composition and even the nature of its existence; however, this did not deter Suraj from pursuing his goal.

The case brings into focus the health-care system of India, especially in the context of the urban poor and the challenges they are facing, followed by the initiatives taken by Swasth Foundation and the impact it is trying to create. The remainder of the case delves into Suraj’s entrepreneurial journey and the three pivotal decisions that changed the course of his organization over 11 years. It will also provide a transpicuous view of the entrepreneurial decision-making process through the lens of pivoting. As Suraj and his team are trying to bring about the required changes through the third pivot, there remain some challenges that need to be addressed for a successful implementation.

The case is written for business management students and can be used in general management, entrepreneurship and strategy classes. The case can be used for discussions on leadership, social entrepreneurship and strategic decision-making. It is suited for both undergraduate and postgraduate levels.

The case documents the evolution of an eye care hospital promoted by a not-for profit organization located in Mandvi, Surat, close to the tribal community of Gujarat state, India. In a short span of five years (as of 2016), the trust has evolved as a community hospital. The value proposition of the trust is a portfolio of activities, which includes awareness by education, prevention of eye care diseases through eye screening camps, treatment, and rehabilitation on need basis and addressing direct and indirect healthcare needs of the community. The managerial challenge before the board of trustees is to carefully balance (a) The purpose for which the trust was created, (b) the gap between the ground realities and the need in the relevant tribal community (c) the accomplishments of the eye hospital so far.

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.

Regency Hospital Limited, a multi-specialty hospital in Kanpur, India was founded by Dr. Atul Kapoor in 1995. The hospital had grown over the years. However, there were a number of issues that were yet to be dealt with. The case describes the struggles that the founder went through in setting up this hospital. It presents the challenges from the perspective of the founder as well as the staff and doctors of the hospital. In the process, the case highlights issues on leadership, entrepreneurship, organizational culture, and management of change.

The subject area is operations management.

The case is to be used at master’s level, for example, MBA courses on operations management, operations research, logistics management and supply chain management.

It was the morning of 20 September 2012 and the three directors of Distromed Bioclean Pvt. Ltd. were in the office discussing the developments from past night’s meeting with the Rajkot Chapter of the Indian Medical Association. They are a bio-medical waste treatment facility involved in collection, treatment and disposal services and charge yearly subscription fees. On 13 September 2012, fuel prices had gone up consecutively for the second year. Last year, the doctors resisted the fee hike and seemed reluctant this year again. In response, management of the company was looking for ways to minimize the total distance travelled by its fleet to reduce the operating cost.

The paper enables illustration of concepts of routing/scheduling and generation of optimal solutions in a realistic setting; and developing the understanding regarding the travelling salesman problem, Chinese postman problem and the entire family of vehicle routing problems and vehicle scheduling problems.

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

CSS 9: Operations and Logistics.