Established in 2010, the endurance event start-up Tough Mudder experienced rapid international expansion in the years following the company's inception. By 2013, the company had developed a cult-like following and an extremely powerful brand. However, near the end of 2013, Tough Mudder's growth began to slow. Eager to turn the tide, founder Will Dean wondered what steps he could take to reinvigorate the company. "Tough Mudder: Scaling Dynamics after Early Traction" explores the challenges that a start-up inevitably faces once its initial momentum begins to slow.

"Stanford Medicine: Health IT Purchasing Decisions in a Complex Medical Organization" examines how a complex medical organization evaluates new health information technology products to pilot, purchase, and utilize. Every year, hundreds of companies pitched their health IT solutions to Stanford Medicine and its associated entities: the Stanford University School of Medicine, Lucile Packard Children's Hospital Stanford, and Stanford Health Care. However, Stanford Medicine would only select a few of these IT products to purchase and implement. Highlighting a few specific health information technology companies and products, this case explores the organizational decision-making process at Stanford Medicine and the criteria used to evaluate new technologies.

For 20 years, TTTech had honed its innovative suite of technology solutions, developing cutting-edge products for customers such as Audi, General Electric, Cisco, Boeing, Airbus, and HYDAC International. Yet the two cofounders were perhaps even more excited by a confluence of market and technology trends in TTTech's favor-trends that aligned perfectly with TTTech's products and capabilities. One of the most pronounced tailwinds was the race towards fully autonomous vehicles. Within the industry, there was growing consensus that cars would become fully autonomous in the next decade or two. Given the complexity associated with developing the networks and electronic systems that would enable autonomous vehicles, manufacturers looked to companies like TTTech to provide the underlying technology needed to turn this vision into a reality. Yet the trend towards increasingly complex electronic systems was not restricted to the automotive industry. Across every industry, physical devices, machines, vehicles, and buildings were becoming embedded with electronics that allowed for the collection and exchange of data, all of which enhanced automation. Against this backdrop, Kopetz and Poledna believed that TTTech could reach more than $200 million in revenue by 2020. Yet achieving this success would not be without its challenges. TTTech would have to align itself with the right strategic and financial partners, continue to hire top managerial talent, and compete in multiple industries, each of which had its own set of unique regulations and standards. TTTech was in a strong position to achieve explosive growth, yet Kopetz and Poledna would have to navigate several hurdles in order to realize that growth.

In 2007, Jody Greenstone Miller founded Business Talent Group (BTG), a company that connected top independent professionals, including consultants and executives, with global companies for project-based work at a lower cost and with more precision than traditional consulting. From BTG's inception, Miller and cofounder Amelia Warren Tyagi believed that the way people work - and the way companies use talent - was changing for several reasons. High-end business professionals were growing weary of the commonly accepted notion that in order to succeed in one's career, it was necessary to work 60 to 80 hours per week. In addition, the increasing scope and complexity of business around the globe meant that firms were competing across multiple industries and geographies, with products and services launching at a faster pace than ever before. As such, companies demanded human capital with targeted skills and knowledge, as well as workers who could take on specific, time-sensitive projects. Moreover, improvements in technology, including the widespread use of e-mail, smartphones, cloud computing, and video conferencing, allowed individuals to work effectively from almost anywhere in the world. Given these trends, BTG's mission was "to bring together the world's top companies and independent professionals to enhance business performance and improve people's lives." Although BTG encountered some early resistance from companies that were skeptical about the idea - and quality - of independent talent, it did not take long for the BTG model to gain traction. Companies were increasingly convinced of the value proposition associated with utilizing high-end, independent business talent, and the market for independent professionals grew rapidly. Not surprisingly, this growth attracted an influx of new competition. "Business Talent Group: Growing the Market for Independent Business Talent" explores the challenges BTG faced as it pioneered the market for high-end business talent in

In 2014, Mar Hershenson and Pejman Nozad teamed up to form Pear VC, a venture capital firm that invested in start-ups spanning three stages of company development: 1) pre-seed, which Pear termed "soil"; 2) seed; and 3) Series A. The duo had known each other for well over a decade before creating Pear VC. And while they have very different backgrounds-Hershenson had founded several companies after receiving her PhD in electrical engineering, while Nozad had invested in dozens of successful start-ups as an angel investor after immigrating to the United States from Iran-they shared the same deep-rooted mission of helping early-stage start-ups succeed. Along with financial capital, Pear provided its portfolio companies with the tools, network, support, and mentorship needed to grow their businesses. Hershenson and Nozad took great pride in Pear's high-touch, values-driven approach, which they deemed "partnering" rather than "investing." The two spent significant time helping start-ups develop into sustainable, category-defining companies, whether that meant assisting with an operating plan, introducing founders to potential employees, or connecting teams with experts in a given industry. The "Pear VC" case explores the myriad challenges associated with forming and growing a seed-stage venture capital firm, from raising a fund, to aligning on investment criteria, to scaling the business.

Entrepreneurs looking to launch start-ups in developing economies must confront numerous challenges that their peers in more developed countries may be less likely to encounter. Depending on the country in which they are operating, entrepreneurs in developing economies oftentimes lack access to human capital and professional services, sufficient sources of funding, large markets for their products, adequate infrastructure, and predictable legal and regulatory processes, among myriad other challenges. This note aims to explore these challenges in more depth-while simultaneously examining some representative countries and regions in which entrepreneurship is thriving. The note also serves as a complement (and informal update) to the 2013 World Economic Forum Report: "Entrepreneurial Ecosystems around the Globe and Company Growth Dynamics." This note is intended primarily for current or budding entrepreneurs interested in starting a new venture in a developing economy, as well as investors seeking to fund start-ups in these countries. The note is also relevant for policy makers looking to encourage entrepreneurship in their cities or countries, universities wanting to support entrepreneurship, and corporations seeking a better understanding of their role in the entrepreneurial ecosystem of a developing economy.

In 2009, brothers Patrick and John Collison began working on a start-up called Stripe that made it simple for companies to send and receive money around the world. By the end of 2016, Stripe had expanded far beyond an online payment mechanism. Fueled by a belief that the Internet and developers would drive rapid economic growth across the world, Stripe created tools for social commerce and online marketplaces, as well as products to facilitate the creation and management of new businesses. Having raised nearly $450 million, Stripe was sufficiently funded to take advantage of a variety of industry tailwinds, including growth in global e-commerce, the proliferation of smartphones and mobile applications, and a rise in social media usage, among others. "Stripe: Increasing the GDP of the Internet" explores the challenges and opportunities faced by Stripe as it expanded from a small start-up to a company valued at $9 billion. Specific obstacles addressed in the case include: evaluating business opportunities, prioritizing new customers and markets, and assessing competition in a rapidly changing market. In a world with seemingly endless opportunities, the Collison brothers would have to be ruthless in prioritizing Stripe's product pipeline, geographical expansion, and partnerships, while continuing to provide value for Stripe's existing customers.

Near the end of 2008, Tyler Gage and Dan MacCombie enrolled in an entrepreneurship course at Brown University. During the class, they refined the business plan for Runa, a beverage company that would make drinks from guayusa, a little-known leaf that grew in the Amazon. Beyond the potential of the business to make money, the two believed in Runa's social mission―respecting the cultural traditions of Ecuadorian Kichwa communities, providing sustainable income streams to small farmers, and helping the Amazon rainforest thrive. Just months after delivering their final classroom presentation for Runa, Gage and MacCombie found themselves in Ecuador, pursuing the idea full time. "Runa: Driving Social Change through Passion and Profit" explores Gage and MacCombie's journey from class project to a fast-growing start-up. More specifically, the case explores the myriad challenges Gage and MacCombie faced in building Runa: raising money to launch the venture; establishing successful partnerships and overcoming deep-seated skepticism among Ecuadorian communities; building a supply chain from scratch; developing a successful go-to-market strategy; and maintaining their focus on social impact while simultaneously generating financial returns.

As of 2016, Mathias Döpfner, chief executive officer (CEO) of Axel Springer SE, had successfully transitioned the German publishing house through a major digital transformation in the world of journalism. Given the massive disruption that had occurred over the previous two decades with how people consumed news, this was no small feat. During this time, many newspapers, magazines, and journals failed to keep up with the rapidly changing industry. Historically, print advertising constituted the majority of revenue for large publishers. But the digital revolution in journalism meant that print advertising revenues dropped precipitously. This downward trend in print advertising revenues happened around the globe, with traditional publishers cutting thousands of jobs. Many publishers were forced to declare bankruptcy during this period. In spite of these industry headwinds, Axel Springer was thriving. Döpfner had transformed Axel Springer through a two-stage digital transformation strategy process. Starting in 2006, Axel Springer first focused on organic growth and late-stage digital acquisitions, which infused digitization into Axel Springer's corporate culture. In 2013, the second stage centered around Döpfner's mission to become "The Leading Digital Publisher"; Axel Springer would be defined not by its distribution channels, but by its (content) brands and services. Having successfully transformed Axel Springer from a print-only company to a thriving print and digital media conglomerate, Döpfner wanted to accelerate Axel Springer's growth even further. He believed that Axel Springer was well positioned to succeed not only in their core German market, but also more broadly on the world stage. Yet he knew this path to becoming a global media powerhouse would not be straightforward, especially given the rapid changes occurring within the media and publishing realm. In a world in which people were consuming content from a variety of sources-traditional print

"Mesosphere: Creating Lasting Value on Top of Open Source Software" explores the challenges associated with building a company on top of open source software. In 2013, Florian Leibert, Ben Hindman, and Tobias Knaup founded Mesosphere. By combining proprietary software products with an open source software called Apache Mesos, Mesosphere developed a single platform called the datacenter operating system (DC/OS). With the DC/OS, companies could easily deploy, operate, and scale workloads and applications across multiple servers in a datacenter. In an era of big data analysis and software containers, companies were thrilled to find a solution that simplified the management of these complex services. For Mesosphere's co-founders, there was little doubt that Apache Mesos and the DC/OS could provide tremendous value to thousands of enterprises around the globe. However, the trio faced several challenges associated with building a successful organization on top of a free, open source product. Specific obstacles addressed in the case include: building and managing open source software communities; understanding distinct customers and customer needs; creating products (and a product release schedule) aligned with customer needs; determining how to monetize Mesosphere's products and services; aligning on what product features to open source (versus what features to make proprietary); and responding to major competitive threats.

"Keyssa: Unraveling the Laws of Physics" explores the challenges associated with growing a start-up around a brand new technology. In October 2012, Eric Almgren became CEO of Keyssa. Founded in 2009, Keyssa reinvented the physical connector, an essential component in every computing and mobile device around the globe. Using a novel technology called Kiss Connectivity, Keyssa enabled contactless, wireless, secure, instant data flows within and between devices, while freeing product designers from the constraints of bulky but fragile metal connectors. Almgren was confident that this technology would have a huge impact on the next generation of mobile and computing devices. However, he faced several challenges in his efforts to grow Keyssa. Specific obstacles addressed include: replacing an existing CEO; raising money in a challenging fundraising environment; aligning on the company's go-to-market strategy; determining the right approach with regard to industry standards; and assessing opportunities outside of Keyssa's core computing and mobile markets. To Almgren and the Keyssa team, there was little doubt about the endless opportunities for Keyssa's revolutionary technology. Yet they also knew that it was only a matter of time before competitors would develop market ready products across multiple industries. Against that backdrop, Keyssa would need to continue innovating for the customers and industries that mattered most.

The ConvenientMD case highlights the role of emotion and ambiguity in business interactions. ConvenientMD, led by co-CEOs Gareth Dickens and Max Puyanic, operated urgent care centers (UCCs) in the northeastern United States. UCCs are medical facilities that provide treatment for a variety of injuries and illnesses at a fraction of the cost of hospitals. The case, which examines ConvenientMD in its nascent and high-growth years, is divided into two vignettes. In the first vignette, Dickens and Puyanic had opened a UCC in Hampton, New Hampshire. Although they believed that ConvenientMD could coexist peacefully with the city's largest healthcare provider, Hampton Hospital, it was clear that the CEO of Hampton Hospital felt differently. Wanting to establish a positive affiliation with Hampton Hospital, Dickens and Puyanic scheduled a meeting with the CEO. Hopeful about paving the way for a better relationship, Dickens and Puyanic were stunned when the CEO greeted them with open hostility. In the second vignette, Dickens and Puyanic were trying to find a location for a UCC in Pelham, New Hampshire. After some bad luck, Dickens and Puyanic had a great opportunity. According to a member of the local zoning board, a site that had previously been described as unavailable was now offered to Dickens and Puyanic. According to the board member, the site would be theirs if they "take the right steps." But should they take these steps?

Despite the existence of large social networks, such as Facebook and LinkedIn, co-founders Jeff Tangney and Dr. Nate Gross believed there was a unique opportunity to create a social network specifically targeted at physicians. The two envisioned a social network that would enable doctors to find any doctor in the United States, regardless of whether they had signed up for Doximity. By combining hundreds of medical databases and journals onto a single platform, Doximity would immediately contain information on nearly every U.S. physician, including their medical school, specialty, location, phone number, fax number, and associated journal articles. In addition to locating doctors, Doximity would allow for HIPAA secure messaging between any doctors in the United States. Finally, Doximity would provide custom-curated news and research, personalized to the clinical interests on their Doximity profiles. Doctors within any geography or specialty would receive the most up-to-date and relevant information without having to read through dozens of journal articles. Tangney and Gross's vision proved wildly successful; in just two years, Doximity became one of the largest networks for U.S. healthcare professionals, with approximately 10 percent of U.S. doctors as members. By the beginning of 2014, 40 percent of U.S. physicians had signed onto Doximity's platform. "Doximity: Financing a Social Network for Physicians" examines how Tangney and Gross raised capital for their rapidly growing healthcare start-up.

Near the end of 2014, Derek Belch decided to turn his master's thesis into a virtual reality athletic training company called STRIVR Labs [Sports Training in Virtual Reality]. Born out of Stanford University's famed Virtual Human Interaction Lab, STRIVR garnered immediate interest from a wide array of organizations. Having played and coached football at Stanford University, Belch had connections within several professional and collegiate football programs. Furthermore, he had tested STRIVR's revolutionary product extensively with the Stanford University Football team throughout the 2014 football season. During this testing phase, Belch made drastic improvements to the virtual reality training solution, and several national media outlets began to take notice of the innovative technology. Against this backdrop, Belch was able to secure several meetings in the beginning of 2015 with coaches, scouts, and NFL executives, with the hope of acquiring a few customers. By the end of June, STRIVR had signed contracts with two NFL teams and six colleges. By the end of August, STRIVR had added an additional four NFL teams, three college football teams, the NBA's Washington Wizards, and the NHL's Washington Capitals. As STRIVR grew its customer base, it generated significant press, which led to even more inbound interest in STRIVR's solutions. Much of the interest came from sports teams, eager to utilize STRIVR's sports training solution. However, several companies approached Belch to discuss partnership opportunities outside of sports training-some related to sports entertainment, and others in industries completely unrelated to sports. In less than a year, Belch and the STRIVR team had seemingly endless opportunities for growth. And while Belch was thrilled about the many potential avenues for STRIVR's continued expansion, he knew that the excitement needed to be tempered with caution.

Centered on Practice Fusion, a free web-based electronic health record (EHR) company based in San Francisco, the Practice Fusion case examines the rapid growth of EHR systems in the United States from 2009 to 2014. The case discusses the challenges associated with adopting an EHR system (also referred to as an electronic medical record [EMR] system) from the standpoint of health care providers, both large and small. It also examines the benefits of EHR systems for health care providers, patients, insurance companies, pharmaceutical companies, and society as a whole. In addition, the case explores how Practice Fusion can best grow its revenue in light of slowing EHR adoption among physicians.

"Carlypso: Overcoming Bumps in the Road in the Used Car Industry" explores various challenges associated with scaling a start-up. In 2013, Christopher Coleman and Nicholas Hinrichsen cofounded Carlypso, a company that simplified the process of buying and selling used cars. Over the course of two years, Coleman and Hinrichsen ran into a series of challenges that prevented Carlypso from selling cars more efficiently. The case highlights several of these challenges, as well as the innovative steps Coleman and Hinrichsen took to overcome these challenges. Specific obstacles addressed in the case include: attracting used car sellers to Carlypso; reducing the amount of time required to meet with potential buyers; overcoming operational inefficiencies through the use of technology; learning the types of cars that sell quickest; dealing with copycat competitors; and figuring out how to grow monthly sales in a scalable fashion.

In 2010, Rob Dyrdek launched a new skateboarding league called Street League Skateboarding (SLS) with the goal of raising the profile of street skateboarding around the world. Dyrdek had excelled within the world of professional skateboarding for more than 20 years, during which time he amassed he amassed a large following of international fans. In 2006, Dyrdek gained further fame through his starring role in the MTV reality series Rob & Big, which reached more than 70 million viewers in its first season. On the show, Dyrdek often discussed his many entrepreneurial pursuits and creative passions. Among these pursuits, Dyrdek imagined recreating the world of professional skateboarding through the creation of a new, innovative skateboarding league.

This case focuses on major strategic challenges faced by Tenet Healthcare (Tenet), a U.S.-based health care provider, in 2014. It discusses major changes to the health care provider industry over the previous decade―customer, demographic, reimbursement, structural, technological, financing, and regulatory―and raises questions related to the strategic direction Tenet should pursue in response to these changes. The case emphasizes two primary decisions to be taken by Tenet: 1) the acquisition of Vanguard Health Systems (Vanguard), another U.S.-based health care provider, in 2012; 2) portfolio management for Tenet's primary business units (acute-care hospitals, outpatient facilities, health plans, and Conifer Health Solutions) in 2014.