This case provides an overview of the nonprofit organization PATH and its Safe Water Project-a five-year effort launched in late 2006 with $17 million in funding from the global development unit of the Bill and Melinda Gates Foundation. The purpose of the grant was to evaluate to what extent market-based approaches could help accelerate the widespread adoption and sustained use of household water treatment and safe storage products by low-income populations. One of the key objectives of this effort was to explore how the private sector could help make HWTS products more affordable. By conducting a portfolio of field-based pilots in collaboration with commercial partners, the PATH team sought to better understand the effect of different pricing, consumer financing, and subsidy models on demand within low-income population in developing countries. Over several years, the Safe Water Project team experimented with different affordability models, including microfinance loans for water filters and a layaway program. Although specific results varied across the pilots, which spanned India, Cambodia, and Kenya, they collectively gave rise to series of important insights about the affordability of HWTS products.

This case provides an overview of the nonprofit organization PATH and its Safe Water Project-a five-year effort launched in late 2006 with $17 million in funding from the global development unit of the Bill and Melinda Gates Foundation. The purpose of the grant was to evaluate to what extent market-based approaches could help accelerate the widespread adoption and sustained use of household water treatment and safe storage products by low-income populations. One of the team's primary objectives was to investigate sales and distribution challenges in this space. By conducting a portfolio of field-based pilots, the team hoped to test different models for improving customer access to these safe water products in an effort to identify scalable, sustainable, and replicable solutions. Although specific results varied across the pilots, which spanned India, Vietnam, Cambodia, and Kenya, they collectively gave rise to series of important sales and distribution insights.

This case provides an overview of the nonprofit organization PATH and its Safe Water Project-a five-year effort launched in late 2006 with $17 million in funding from the global development unit of the Bill and Melinda Gates Foundation. The purpose of the grant was to evaluate to what extent market-based approaches could help accelerate the widespread adoption and sustained use of household water treatment and safe storage products by low-income populations. Through a portfolio of field-based pilots, PATH intended to experiment with different sales and distribution strategies to improve consumer access to safe water solutions, such as water filters and chlorine-based water purification tablets. It also planned to test different pricing and consumer financing models to address the affordability of these products. However, extensive market research revealed another problem-few products in the space were both effective and designed specifically to meet the unique needs and preferences of these consumers. Accordingly, PATH applied for and was awarded $7 million in additional grant funding from the Gates Foundation to design a water filter product that would meet high standards of efficacy, be desirable-or aspirational-to low income consumers, and work effectively within the rural conditions where the majority of the poor resided. The PATH team would accomplish this through a process that the organization called user-centered design.

As of 2012, the Physician Payments Sunshine Act of 2009 requires medical device manufacturers to track any payments or gifts they make to physicians that are worth more than $10 and then starting in 2013 to report those that exceed a total of $100 per year to any given doctor. While a majority of doctors, academic medical centers, and pharmaceutical and device companies generally support the principle of greater transparency when it comes to physician-industry collaborations, many have raised concerns that over regulating potential conflicts of interest could be detrimental to the development and commercialization of new treatments. Particularly in the medical device industry, physicians play a host of essential roles that span commercialization and, more importantly, product development. Any requirements that negatively affect the willingness or ability of physicians to partner with industry have the potential to hinder medical device innovation because, by its very nature, it is incremental and doctor-dependent This note provides a taxonomy of the different roles physicians play in device innovation and identifies which ones are most susceptible to conflicts of interest that may not be well managed by today's institutions. It also makes recommendations on how to better manage conflicts without jeopardizing the ability of physicians and companies to collaborate for the betterment of patient care.

Jane Chen (GSB '08) and Brian Trelstad (GSB '99) had known one another for years. Trelstad, the chief investment officer of the nonprofit global venture fund Acumen Fund, had been a mentor to Chen and her colleagues as they worked to develop a low-cost infant warmer to meet the needs of low-birth-weight babies, their mothers, and healthcare providers in developing countries. Chen, who became the chief executive officer of Embrace Global, the nonprofit founded to achieve this objective, had come to value Trelstad's guidance and trust his advice. In late 2010, as she and her team were on the cusp getting their innovative new product to market, Chen and Trelstad's relationship took on a new dimension. Embrace was seeking an infusion of funds to support its product launch and help the company rapidly achieve scale. In parallel, Acumen Fund was continuing to look for organizations with game-changing products and services in need of patient capital on their way to becoming self-sustaining businesses that effectively serve the poor. Suddenly, Trelstad was a potential investor and Chen was a prospective investee. As they explored the possibilities of a financial partnership, one of the key questions facing Embrace was whether or not it should consider adopting a for-profit or hybrid organizational structure so it could raise more substantial funding by taking on equity investors. Acumen Fund had to think about whether or not it was interested in investing in Embrace, how to value the company, and how large a stake it might be willing to take if a deal moved forward. This case explores the situation from the perspective of both organizations and can be used to support a high-level negotiation between the two parties.

In 2005, Stanford Hospital and Clinics (SHC) was internationally recognized as a leading medical institution in terms of its clinical capabilities and specialty expertise. However, the organization was lagging many of its competitors in terms of its operations and information technology (IT). While other major health care providers of a similar caliber had begun to transition to integrated electronic medical records (EMR) systems, SHC was using a patchwork of disjointed and outdated software programs to manage inpatient and outpatient care, as well as its back office functions. Dr. Kevin Tabb, who was the chief quality and medical information officer at the time, along with other executives within the organization, recognized the importance of adopting an EMR system. Yet the implementation of such a system would require a sizable investment over multiple years and would necessitate a major organizational disruption. In parallel with building a business case to justify the cost of the new system (see OIT-101A), Tabb and his colleagues had to think carefully about the implementation strategy that would lead to the successful adoption of the EMR system. This case explains EMR systems, describes SHC's vendor selection process, introduces Epic System Corporation's EMR offering, and explores the key issues that SHC considered in developing its implementation strategy, including the appropriate rollout approach and timing, how to manage system configuration and customization, and how to most effectively staff the project.

In 2007, Walmart was sourcing approximately $750 million in seafood annually. Although output from the world's fisheries had declined to 3 percent of production levels in the year 1900, the company's volume of seafood business was growing at roughly 25 percent per year. Against this backdrop, Peter Redmond, vice president for seafood and deli, believed that continuity of supply was the single greatest long-term issue facing the seafood network. To help address this challenge as part of the company's recently-announced sustainability strategy, Walmart set a goal to transition to selling 100 percent MSC certified wild-caught seafood by the end of 2011. To accomplish its goal of selling only certified wild-caught fish, Walmart would have to work through its suppliers to increase the number of fisheries and processing plants in the MSC certification program. This case describes MSC certification and the salmon supply chain from the point of view of one of Walmart's tier-one seafood suppliers. It provides enough detail that students should be able to make recommendations regarding how should Walmart rationalize its seafood supply chain to reduce costs and promote sustainability.

In 2007, Walmart launched a new business strategy designed to meet three sweeping and aggressive environmental goals set by CEO Lee Scott: (1) to be supplied 100 percent by renewable energy; (2) to create zero waste; and (3) to sell products that sustain people and the environment. The initiation of this new approach to managing the company's extended supply chain is the subject of OIT-71A. In OIT-71B, the authors provide an update on Walmart's sustainability strategy, three years after the original case was written. In addition to outlining the progress made in the three sustainable value networks profiled in the A case (textiles, seafood, and electronics), the B case also describes how the company is strengthening, modifying, or abandoning the new supply chain management practices it adopted in 2007. It also touches on some of the company's new sustainability initiatives, including Walmart's 2010 GHG goal, the globalization of the network approach, and new measurement programs (e.g., GreenWERCS and the sustainability consortium).

The Federal Republic of Nigeria was the most populous country in Africa. According to a July 2009 estimate, it was also the world's 8th largest nation. With land area roughly twice the size of California, Nigeria was rich in natural resources, especially oil. However, the country seemed to have mineral wealth in equal measure to its economic, social, and political troubles. For decades, the country had grappled with tumultuous military rule, religious and ethnic unrest, as well as a highly unequal allocation of resources. Nevertheless, recent reforms and developments in key sectors had boosted economic growth and spurred a sense of optimism for the country's future. The question was whether or not Nigeria could sustain this momentum, overcome its key challenges, and create a business environment that would allow it to compete on an international level. This paper provides a brief history of Nigeria and explores its current position in the global economy.

"Safety net" providers play an essential role in delivering health care to underserved populations in states such as California. As the prominence of the safety net increases, medtech innovators seeking to make a difference have begun to design and develop new technologies to help these providers improve the quality and cost effectiveness of their care. This note introduces practical considerations that should be taken into account when developing technologies targeted at the safety net. Specifically, by looking downstream in the biodesign innovation process to anticipate issues related to safety net economics, reimbursement, technology assessment, and purchasing behavior, innovators can begin to understand how to adapt their approach and create new technologies that are not just meaningful, but feasible for adoption in the complex safety net system.

As director of the California HealthCare Foundation's (CHCF) Innovations for the Underserved program, Margaret Laws' goal was "to reduce barriers to efficient, affordable healthcare services for the underserved." The path to achieving this goal took multiple forms, including improving the availability of specialty care for low-income, uninsured, non-English speaking and rural Californians. Specialty care was an incredibly constrained resource within the healthcare system, even for insured patients. In order to improve access, increasing specialist throughput became paramount; and this could often be achieved through process improvements. But in conversations with faculty from Stanford University's Program in Biodesign (henceforth referred to as Biodesign), Laws became intrigued by the potential of new device technologies to improve throughput and increase capacity. The question was whether the biodesign innovation process taught at Stanford to develop devices for commercially attractive markets could be adapted to focus on the needs of the underserved, and particularly needs related to limited access to specialists. In order to answer that, the faculty from the Biodesign program and CHCF launched a pilot program that would undertake a condensed version of the identification phase of the biodesign innovation process, which included needs finding and needs filtering. This paper explores that project and what was learned.

In 2009, the Federative Republic of Brazil was the 5th largest country in the world in terms of its geographic area and population. At 3,290,000 square miles, its territory comprised nearly half of South America. It was also the most populous nation on the continent, with more than 190 million people. In economic terms, Brazil had grown to be the tenth largest global economy, with a 2008 GDP estimated at $1.99 trillion. When the global financial crisis erupted, Brazil's president vocally and repeatedly asserted that Brazil would be able to "decouple" itself from the slowdown. However, in early 2009, it became clear that Brazil could not isolate itself entirely from events in the rest of the world. The country's 2008 fourth quarter economic results were the worst in a decade. As analysts downgraded their 2009 growth forecasts into negative territory, it remained to be seen when (and if) Brazil would ever be able to realize its full potential. This paper provides a brief history of Brazil and explores its current position in the global economy.

The Russian Federation (Russia) was the largest of the 15 geopolitical entities that emerged in 1991 from the Soviet Union. Despite a series of reforms initiated in 1992 to help the country transition from its centrally planned economy, Russia plunged into a deep recession that was exacerbated by a financial crisis in 1998. It was not until 1999, following eight years of turmoil, macroeconomic stabilization and economic restructuring, that the economy slowly began to grow again. When Vladimir Vladimirovich Putin became president on December 31, 1999, Russia was the world's tenth-largest economy and its foreign reserves stood at $8.5 billion. By 2007, the country's economy had become the world's eighth-biggest, with reserves of $407.5 billion. In May 2008, when Russia's new president, Dmitry Medvedev, was inaugurated and Putin assumed the role of prime minister, western companies with interests in Russia faced great uncertainty. Would Putin's hand-picked successor, under Putin's powerful and watchful eye, continue to enact policies and take actions that would make the business environment increasingly unfavorable to foreign investment? Or, would the new regime chart a more liberal and democratic course for Russia that would enable the country to improve its global competitiveness and allow outside investors to participate in its prosperity? Russia had made great strides to improve its position in the world since the dissolution of the Soviet Union. Yet, it remained to be seen whether the country, particularly under its current circumstances, could create and sustain lasting international competitive advantage, which many western critics believed would require a more democratic political regime. This paper provides a brief overview of the country and explores the status of China's competitive advantage through the framework of Michael Porter's Competitive Advantage of Nations.

Throughout its history, Corning Incorporated had maintained a strong dedication to technology and innovation, committing approximately four to six percent of its annual sales to research, development, and engineering (RD&E) until the late 1990s when this figure climbed to 10 percent. Even when the company was faced with severe financial challenges in the early 2000s by a crash in the telecommunications industry, its largest business segment, Corning saw investment in innovationand particularly in new business developmentas its road to recovery. While other companies might have slashed their RD&E budgets in a desperate effort to regain profitability, Corning increased and formalized the amount of time, money, and resources it dedicated to the identification of potentially large new businesses. As the company emerged from its financial crisis, management set a goal to double Corning's rate of innovation with the objective of launching two to four significant new businesses each decade. To accomplish its ambitious goals, Corning created an organization called Strategic Growth. The purpose of this new team was to collaborate with corporate research to identify and develop new, large (approximately $0.5 billion), and profitable business opportunities. Under the leadership of Dr. Mark Newhouse, a Corning senior vice president, Strategic Growth was more than three years into its charter by late 2007. Although the group had realized many accomplishments since its inception, the question facing Newhouse, his team, and Corning's executives was how well the company's innovative approach to organic growth was working. This case describes the Strategic Growth organization, its process, and its challenges.

In November 2005, members of Corning Incorporated's early-stage opportunity identification and development team were preparing to make a recommendation regarding whether or not the company should move forward with a project to develop mercury abatement technology to help power plants meet impending U.S. legislation for the cleaner use of coal. This opportunity, which had been surfaced through Corning's relatively new process for early-stage opportunity identification, was believed by some to have the potential to become a sizable new business. As the company evaluated whether or not to invest in the development of this new venture, it was equally important for Corning to consider the effectiveness of its early-stage opportunity identification process. With limited resources and a pressing need to increase the company's rate of innovation, this process was designed to take as much guesswork as possible out of the ambiguous "art" of identifying new business prospects. This case describes the Corning process for identifying and evaluating early-stage opportunities and allows readers to construct a recommendation as to what Corning should do regarding its mercury abatement project.

In 2007, popular acceptance of the problem of global warming, and new recognition of its potential consequences, had brought carbon dioxide emissions to the front of Americans' minds. The continued turmoil in Iraq, as well as the United States' worsening relations with other oil rich nations such as Russia and Venezuela, highlighted a lack of energy security for Western countries importing vast quantities of petroleum. Moreover, rising gas prices were beginning to frustrate drivers at the pump while U.S. vehicles consumed 3.3 billion barrels of gasoline and 1.2 billion barrels of diesel fuel a year (as of 2006). These factors combined to create what some observers were calling a "perfect storm," drawing attention to the developed world's widespread addiction to oil. However, as concern about these issues was reaching an all-time high, transportation technology was undergoing a revolution. Advancements in alternative fuels, electric drive vehicles, and hybrid technologies were showing promise for reducing oil consumption. This paper examines some of these emerging innovations.

In mid-2006, Overstock.com faced a daunting set of business challenges. Founded in 1999 as an online "closeout" retailer, the $800 million company had more than 15 million unique visitors a month, 10 million life-to-date customers, and greater than 500,000 active SKUs in roughly 20 product categories. However, while it had come within one half of a percent, the firm had yet to realize an annual profit. Moreover, the tremendous growth that had enabled the company to become on online shopping giant appeared to be slowing at an alarming rate. At least partly as a result of the challenges facing the core business, Worldstockthe company's socially responsible initiativewas also in jeopardy. Started by CEO Patrick Byrne in 2001, the division leveraged the firm's infrastructure to market handicrafts produced by third world artisans to the mainstream U.S. retail market via a designated portal on the Overstock.com website. However, working with third world artisans turned out to be significantly more expensive than originally anticipated. By mid-2006, Worldstock's "self-sustaining" model for economic development was projected to contribute nearly $1 million to the company's losses that year. Although most managers were cautious about criticizing the CEO's "pet project," a few felt the company had to address (what they saw as) the negative the impact that Worldstock was having on Overstock's financial performance. As a result, all those committed to the Worldstock model, from CEO Byrne to Division Manager Angela Ramirez, faced the thorny questions about how to balance these new fiscal imperatives with the group's philanthropic and social objectives. While no one wanted to openly acknowledge it, some stakeholders wondered if Worldstock might eventually be shut down or spun off if the situation did not improve.

This case has been developed to facilitate a negotiation exercise related to the formation of partnership deals in the healthcare industry. It is based on actual information, but reflects a hypothetical situation involving two companies and a product that have all been disguised. The scenario described within the case involves Pharmac, a large pharmaceutical company, and Respire, a small medical start-up. Pharmac and Respire began negotiating a partnership to develop and eventually market an inhaled form of parathyroid hormone (PTH) to treat osteoporosis. If successful, this product would improve the available options for the treatment of osteoporosis. It was also expected to produce "blockbuster" sales since it would make PTH, an already extremely effective treatment option, more convenient and appealing to a large segment of untreated patients who were injection-averse (injection was the standard delivery mechanism for this drug). Development of the product was highly speculative and was expected to take six to seven years due to early stage development of the inhalable delivery system and the multi-year Phase III fracture trials required for approval. Pharmac had released the first man-made, injectable form of parathyroid hormone, called Strocal, in 2002. However, no one had yet developed a non-injectable version of PTH, despite efforts by Pharmac and other companies that spanned more than a decade. Respire's goal was to be the first company to solve this problem by developing an inhaled formulation and a device to deliver Strocal through the lungs in a safe, effective, and reproducible manner. Enough information is provided within the case to enable students to negotiate terms for royalties, milestones, exclusivity provisions, and an equity investment. At the end of OIT-81A, information known to Pharmac (but not to Respire) is provided. In OIT-81B, information known to Respire (but not to Pharmac) is given.

This case has been developed to facilitate a negotiation exercise related to the formation of partnership deals in the healthcare industry. It is based on actual information, but reflects a hypothetical situation involving two companies and a product that have all been disguised. The scenario described within the case involves Pharmac, a large pharmaceutical company, and Respire, a small medical start-up. Pharmac and Respire began negotiating a partnership to develop and eventually market an inhaled form of parathyroid hormone (PTH) to treat osteoporosis. If successful, this product would improve the available options for the treatment of osteoporosis. It was also expected to produce "blockbuster" sales since it would make PTH, an already extremely effective treatment option, more convenient and appealing to a large segment of untreated patients who were injection-averse (injection was the standard delivery mechanism for this drug). Development of the product was highly speculative and was expected to take six to seven years due to early stage development of the inhalable delivery system and the multi-year Phase III fracture trials required for approval. Pharmac had released the first man-made, injectable form of parathyroid hormone, called Strocal, in 2002. However, no one had yet developed a non-injectable version of PTH, despite efforts by Pharmac and other companies that spanned more than a decade. Respire's goal was to be the first company to solve this problem by developing an inhaled formulation and a device to deliver Strocal through the lungs in a safe, effective, and reproducible manner. Enough information is provided within the case to enable students to negotiate terms for royalties, milestones, exclusivity provisions, and an equity investment. At the end of OIT-81A, information known to Pharmac (but not to Respire) is provided. In OIT-81B, information known to Respire (but not to Pharmac) is given.

Historically, the biggest obstacle that healthcare innovators, such as pharmaceutical and medical device manufacturers, needed to overcome on their way to market was securing approval by the U.S. Food & Drug Administration (FDA) or other international regulatory authorities. However, in the last decade, a new (sometimes even more challenging) hurdle had to be cleared: insurance coverage and reimbursement. Payers--either public payers, such as Medicare in the U.S. and the National Health Services (NHS) in the U.K., or private commercial payers, such as Blue Cross/Blue Shield and UnitedHealth Grou--could deny coverage for a technology that had received regulatory approval if they determined that the supporting evidence did not adequately demonstrate that the technology was superior to existing treatment alternatives that were already being reimbursed. This had the potential to create a potentially adversarial relationship between payers and innovators in cases where they had conflicting interpretations of the evidence regarding the cost, benefits, and risks of new technologies. The challenges to innovators in managing this conflict are illustrated in this case study by an example: the 2006 decision by the U.K.'s NHS to deny coverage for Exubera, a new form of inhaled insulin.