Part 2: Home Health Care Adventures in San Francisco

7/21/16 – This post is part 2 in a series written by Shorouk, Nick, and Labeat as they search for opportunities to innovate in the antiquated, elderly home health care industry. Read their first post here.

Innovation in San Francisco
After our initial contact went radio silent the day we landed in San Francisco, and after several phone interviews with company executives that resulted in a lot of the same information we had discovered in our secondary research, we found Sue Kwon. Sue Kwon is elderly1the director of communications at Honor, a home health care company founded in 2015 that has raised more than $20M in venture capital funding. She is also an Emmy-award winning journalist, and you may recognize her from her time at NBC, ABC and CNN during her 15 years in the industry. Sue was generous enough to meet with us, even after repeated e-mails and phone calls that bordered on harassment, for a coffee just outside Honor’s headquarters in downtown San Francisco.

Sue told us Honor’s story and, although short in timeline, provided us everything we needed to know for our venture’s direction moving forward. Honor’s emergence as one of the top providers of home health care in the Bay Area is simple and profound, yet bold and unorthodox, to say the least. Sue told us the story of how Honor is executing something so obvious it has almost become a cliché in business textbooks, yet something no agency in this industry has been able to accomplish. This idea is almost so obvious that is has become largely forgotten, and industry leaders have developed ingrained responses that have become such a part of our human nature that we might actually believe it. The story Sue told us was how Honor has eradicated the single most destructive force in home health care: employee turnover. She told us that there are several issues relating to senior health, but none are more important to home health care than having the ability to retain service providers to provide consistent results to people in need. All the other issues are a direct result of employee turnover.

Honor has “put its money where its mouth is” and taken this issue of turnover into its own hands. Instead of providing the industry average $9/hour to its nurses with no benefits or guaranteed hours, Honor has empowered its employees by offering better wages and comprehensive benefits to all workers, regardless of title. Wow. There is such a huge gap between what Honor offers its employees compared to the competition that it doesn’t seem to make sense. How can this add up to a positive bottom line or, how is it even close? Her answer was simple (of course): It is a long-term strategy. Honor is tech-enabled, which means it is one of few agencies that have been able to scale its operations, and we’re not talking about opening franchises. By nearly eliminating employee turnover, Honor can achieve efficiencies that no other company of its kind can manage. The employees care about the company because they truly have a stake in the game, and Honor offers training to its employees, even if the training allows an employee to be over-qualified for the services Honor offers. After talking with Sue, it is difficult to imagine starting a company that did not provide a similar offering to its employees, even if you don’t have Silicon Valley technology and major VC funding. It just makes sense. Treating your employees better is no longer taboo at Honor.elderly2

Sue also went into great detail about the company we had previously studied so rigorously, and why its referral model had failed despite its vast resources. Regulation in the state of California, and most other states (including Colorado), place restrictions on these types of companies by not allowing the third party to perform background checks on hired contractors, as well as restricting the training employees can receive if employed under another employer. In other words, this company could connect a senior to another agency’s nurse, but it also had no control over these nurses and, therefore, no control over its reputation. The result was these nurse contractors failed to do a good job, or even care about the work they were performing on behalf of the company and the connection it facilitated. So, this company pivoted to a traditional model in just under two years of existence.

Next Steps for our Team

We are looking into the future. Now that we have officially chosen a direction after pivoting, we will continue with expert interviews and focus groups. True to the nature of entrepreneurship, we look forward to continue building momentum, innovating, and eventually, generating lasting impact.

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Saving the Best for Last: Improving the Quality of Life for the Elderly

7/20/16 – This guest post is written by three students in the Global Social and Sustainable Enterprise MBA program who are working on finding ways to improve the quality of life for the elderly. Please join Nick, Shorouk, and Labeat on their journey into the home health care industry.

The Home Healthcare Industry

We have been researching the home health care industry, its effect on senior citizens’ overall health, and the impact it has on the healthcare industry. Home health care is not a new idea, and this industry has been growing for several decades to meet the demands of a growing population of senior citizens. Despite this growth, our team has found this industry is in major need of a facelift. A few of our observations include:

  • Very few agencies have the ability to scale and effectively care for the demand of seniors.
  • Major nurse (caregiver) turnover results in inconsistent practices in caring for seniors.
  • The majority of seniors and their families find the process of finding, hiring and managing home health care to be difficult and a major headache throughout the entire process.
  • Home health care has long been antiquated, and has been in desperate need of innovative entrepreneurs to help bring this industry into the 21st century.

We knew there was an opportunity somewhere, but we just didn’t know where it would be.

For months, our team has been brainstorming ideas for how these gaps could be closed and how a better type of company could be formed in this industry. We intended to implement a lean business model that could scale and reach thousands of clients more affordably than anyone else. While researching several innovative new home health care models conceived from the minds in Silicon Valley, we found one company in particular that had a similar vision to ours, which had raised $23M in venture capitalist funding two years prior, and was becoming a major player in the Californian market. Combined with our secondary research led us to believe this model could help us achieve a lean and scalable business by being a third party facilitator of home health care services; in other words, a home health care broker. Due to the early successes of this type of company, this seemed like a viable direction for our venture, so we were armed with motivation to begin our primary research in Fort Collins, Denver, San Francisco, Tucson and Phoenix.

The Pivot: All is not as it first seemed

Our team began conducting depth and expert interviews by partnering with one of the leading home health care companies in the industry to distribute letters to its elderly clientele requesting volunteers for our venture practicum research. Out of 150 letters, we received only 10 responses. After sitting down with these 10 respondents, we learned valuable information, albeit completely unrelated to the questions we asked. Even though 10 interviews is a very small sample size, none of the respondents were interested in hiring a third party to find, hire, and manage home health care. In fact, none of the seniors or their families saw any value in the idea, and most of the expert interviews from executives at nursing home or home health care agencies similarly dismissed the idea. This got us thinking: Could this really be a case of being too early to the market, and not understood as being genius until several years later? Our guess: probably not.  But the research continued anyway.

Then the news that would rock our little venture world came crashing down like an avalanche of confusion and doubt. The company we had been researching in Silicon Valley – the one that had raised millions of dollars – had pivoted away from its brokerage model to a traditional home health care company that employed its own nurses.  Shorouk read about the pivot on a Yelp review that had been complaining about the company. The CEO of this company had responded to multiple negative remarks about the agency’s nurses, and had informed the reviewer that his company would be pivoting to a more traditional model. There was no press release, article, or announcement, but only a 28-year old CEO doing Yelp damage control.

Unfortunately, the news of our inspiration’s pivot came just days after we had booked our tickets to San Francisco, so there was no going back. We would need to at least alter our direction as well. We decided we would begin researching traditional best practices in home care, as well as the regulation that sent our previous model spiraling downward in just under two years of operation. First up: San Francisco.


The Global Social and Sustainable Enterprise elderly health care venture team, on the CSU Oval. From left to right: Nick Schroeder, Shorouk Elmahdy, and Labeat Fejza.

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Market Research Tips: The Art of the Interview

7/18/16 – This post is a continuation of the update from the team of GSSE MBA students working on energy access in Uganda. You can read their first post here.

During this summer of research, we have found that the process of interviewing, and especially interviewing through a translator, requires skill and nuance. This expertise is not possible to learn in the classroom because it takes experience and practice to create the right atmosphere to put people at ease. Here are some of the tactics we used:

  • IMG_4751

    Alana interviewing while Ali takes notes.

    From the beginning, our team chose to break into two groups so that there were never more than two foreigners talking to someone. It worked out well and we rotated the combination of people so that we worked together in different pairs.

  • When we were conducting depth interviews, one person was the interviewer working with our translator and the other was the note taker. The interviewer concentrated on the interview questions but didn’t write anything down. The note taker hardly spoke and was responsible for transcribing everything that was said. We chose to rotate interviewer and note taker roles as well, although we found some people gravitate towards one role over the other.
  • It was very interesting using a translator, and we found at the beginning we were talking directly to him and then listening to his answer when he translated. After a few interviews, we felt very disconnected from the villager we were talking to. It was as if we were having a conversation with just our translator. So, we changed our strategy and instead of directing questions and looking at our translator, we instead looked at the person we were interviewing and directed questions in the first person. The question would then be translated, but this allowed us to make eye contact with the interviewee and, even though he/she didn’t understand our language, it worked out really well because it felt more like a conversation with that person.
  • We consciously practiced different interview techniques because some people wouldn’t look us in the eye, so we experimented with what actions put people at ease and when to make eye contact, when to smile, how to sit, when/if we should lean forward or back, etc.

Brett and Alyse getting to know their customers.

These skills evolved out of practice, and despite months of prep in the classroom, we couldn’t have learned and adapted and improved without being in the field. In addition to the information gathered during this summer practicum experience, the chance to implement these skills has been invaluable.

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Harnessing the Grit of Cambodian Youth – Continued…

7/11/16 – This post is the second installment by the team of GSSE students conducting field work in Cambodia this summer for their educational startup company. Read their first post here.

One of the wonderful aspects of the GSSE MBA program is how well the curriculum prepared our team to enter the field. Our coursework taught us that an important technique for entrepreneurs is to learn from best practices and study the gaps. This technique helped guide us in our fieldwork and has allowed us to organize our findings from our multiple interviews, observations, and casual conversations.

IMG_0468We found bright spots following best practices such as Chumkriel Language School, which offers quality education and community growth programs in the salt-producing community of Kampot. Similarly, we found that the Don Bosco Technical School is well-known for offering technical skills and training for youth in Cambodia. Although they have created positive change and impressive outcomes, we recognized some gaps, including a lack of opportunities for students entering into secondary education and a lack of awareness of the vocational school models that exist in Cambodia.

As we move forward, we will work on testing if there are potential business models that are appropriate to fill these gaps. Two potential models include:

  1. IMG_0298Starting a vocational high school with a curriculum that is designed to enable students to acquire employable skills while receiving a quality general education. The “earn while learn” component is a crucial selling points for both parents and students since at the high school level, students are of working age, and the families cannot afford to lose one source of income when a child goes to school.
  2. A student recruitment agency for vocational schools would be an excellent opportunity to bridge the information gap between existing potential students, vocational schools and employers. Not many students or parents are aware of the vocational school model, and vocational schools find it challenging to enroll and retain students. Moreover, the supply of vocational skills graduates, particularly in tourism and hospitality, does not meet the employer’s demand.

The success of these models will be based on relationship building with the key stakeholders: parents and students, vocational schools, and employers. Clearly we have lots of work to do! So, off we go!

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Recycling Carbon Fiber: From Waste to Additive

7/7/16 – This post is written by four students in the Global Social and Sustainable Enterprise MBA who are exploring business opportunities associated with waste streams and overconsumption. To start, they have been partnering with Vartega Carbon Fiber Recyling LLC, focusing on industrial options.

Our team is conducting market research in partnership with Vartega Carbon Fiber Recycling LLC, with the goal of understanding the applications of recycled carbon fiber in the 3D printing industry. A quick description of our partner: Vartega is a technology development company specializing in the carbon fiber-reinforced plastic recycling process.  Vartega has developed alternative technology, processes, and equipment to provide low-cost carbon fiber for use in mass market applications. So far, Vartega is in the patent pending process and is evaluating different markets for the application of their recycled carbon fiber.

Because the Aerospace industry requires 5 years of testing and certification for usage of new applications, Vartega will look into that market in future phases. So far they aim to strongly focus on entering the 3D printing industry. Due to fast prototyping and the new applications of carbon fiber in the printing process, this market represents the most convenient entrance and product placement for Vartega. In order to evaluate the opportunities of entering the 3D printing market, we have conducted secondary and primary market research.

Our secondary research included information about:

  • new applications of composites in the additive industry
  • innovations implemented in the composites industry
  • innovations in recycling composites
  • the entire recycling process.

GSSE MBA student Venera Fusha and Todd May, the NASA Mashall Space Center Director

Our primary research began on May 23rd at the Society of Advanced Materials and Processes Engineering (SAMPE) conference, where we networked with the big players in the aerospace and automotive industries, including BOEING, Hexcel, Lockheed Martin, and Impossible Objects. One of the highlights of the conference was our meeting with the NASA Marshall Space Center Director, Mr. Todd May. Surprisingly, he was familiar with some of the professors at Colorado State University working on composites, which made us proud being CSU grad students!

We have conducted several interviews with companies in the 3D printing and carbon fiber composites industries, and we visited Vartega’s laboratory – all helping fill in the gaps in our knowledge about processes, operations and goals.

Leveraging our student status has helped us in getting replies from big companies, and the network we established at the SAMPE conference has been a tremendous resource for our research.  Each of our interviewees offered to help us if we might need any additional information or had follow-up questions.  We are working on a thorough report to our partner including information about the outcome of our research, challenges, results and recommendations, and are looking forward to continuing overconsumption and waste market research in a new industry in the coming weeks.

vartega visit

GSSE MBA team with their partners at Vartega.

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Reduce, Reuse, and Recycle the Tanzanian Way

7/5/16 – This post is written by a team of students in the Global Social and Sustainable Enterprise MBA program spending their summer conducting market research in Tanzania. Their goal: understand the waste problems and housing issues, the related supply chains, and consumer behavior.

Dar es Salaam is Tanzania’s largest city, Africa’s third fastest developing urban area, and the world’s eighth fastest growing city by population. However, it is also one of the dirtiest cities in the world. Rapid population growth and rural to urban migration, coupled with a waste management system that is well below average, has led not only to serious waste issues, but has also created a housing crisis resulting in a housing deficit of 3 million units.

Organizations throughout the country have tasked themselves with addressing the housing crisis by researching alternative building materials. Others attempt to tackle waste management problems through financial incentives, and education and training programs. A few even work in the space in between these two challenges exploring non-traditional alternatives and affordable building materials and technologies, specifically working with recyclables, and it is somewhere within this space that our team is operating.


Prior to leaving to Fort Collins, our research highlighted the need to have an in-depth understanding of the supply chain and to be able to define its specific components. This includes everything from the waste pickers at the very beginning to the plastic processors, and, ultimately, the consumer. Though our research in the field has not followed a linear path, it is the beginning stages of the process that have exposed the most profound insights, and those which we couldn’t have ever really learned in class.  We needed to understand how behaviors informed decision-making processes and how that might influence players downstream in the supply chain. We also needed to be able to articulate how current organizations navigate the waste management space while exposing the barriers to implementing a large-scale waste management system. More specifically, we wanted to know why Tanzanians don’t recycle.

Through expert and in-depth interviews we learned that Tanzanians do recycle. In fact, they reduce, reuse, and recycle perhaps better than most by reinventing products and redefining lifecycles to meet their needs. We did not anticipate the degree to which this occurred, and have since transitioned away from the conventional definition of recycling as the systematically managed end-of-life disposal of a good, to one where the consumer is the agent of change.  Another factor we did not anticipate is the degree of complexity inherent within the Tanzanian social system and how that influences consumer behavior at the bottom of the pyramid. Who you are and who you know plays a significant role in how, why, and where you consume. Here, we can see the base of the pyramid as more than a concept in an article. We see it every day in action and unbound, and we can observe how it moves in relation to a vast system of informal and dynamic networks.

Though our time in the field has led us down many new and unanticipated paths, it has brought our research to life. We look forward to the remaining weeks as we work to bring it full circle and to identify whether there is space in the housing market for innovative alternative solutions using recyclable materials.


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Concerning Coffee: Supporting Guatemalan Smallholder Farmers

7/1/16 – The Growing for the Future team has been conducting on the ground research in the coffee farms of Guatemala, in partnership with the non-profit coffee organization, De La Gente. Bishal Kafle, Javier Echeverria, and Austin Bell are focused on identifying methods that would improve smallholder farmer’s livelihoods as part of the Global Social and Sustainable Enterprise MBA program.


Javier hauling coffee.

We landed in Antigua, Guatemala to work alongside De La Gente in their quest to help smallholder farmers. Thus far, we have learned the entire process of coffee production and have been working directly with farmers planting seedlings, fertilizing the plants organically, cleaning/drying/sorting the coffee beans, roasting the coffee, and finally packaging it.  Experiencing the entire process first hand exposed us to the challenges that smallholder farmers are facing, and has prepared us for finding opportunities that will bring more value to farmers and their families.


Bishal testing out the coffee mill and demonstrating the final product.

In collaboration with De La Gente, we have been focusing on finding market opportunities in the US for selling roasted packaged coffee, because this brings much more value to smallholder farmers than selling green coffee alone.  In order to achieve this goal we have been working on developing a report that focuses on market opportunities for De La Gente and the cooperatives with whom they work. We have applied our learnings from our marketing class in order to identify potential target markets, segment those markets according to our customer’s needs, and find the best channels available for reaching these market segments.  We created an in depth analysis of the potential market opportunities by identifying advantages, disadvantages, and providing detailed recommendations for entering new markets and increasing the sales of roasted packaged coffee.

In addition to performing market research we have been analyzing De La Gente’s financials, reports, and sales history in order to find opportunities that are within the scope of the organization.  The knowledge gained from our financial and managerial accounting class has proved to be extremely beneficial in understanding how the organization is financially structured, and identifying what they can do to improve their bottom line. Through the knowledge gained from our GSSE classes, and the knowledge gained from working with farmers in the field, we hope to be able to provide legitimate strategies that can be used to increase the sales of coffee, and therefore add value to smallholder farmers and their families.

During our remaining time in Guatemala, we will identify other high value agro products that are considered superfoods and have the potential to be exported to the US as a value-added product. Growing for the Future has gained a tremendous amount of agricultural knowledge during our venture development experience in Guatemala, and we will continue to focus on research that will create opportunities for smallholder farmers.


Bishal, Austin, and Javier with the De La Gente team in Guatemala.

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Energy Needs, Customer Insights and Industry Illuminations in East Africa

6/20/16 – This blog post is written by four students in the Global Social and Sustainable Enterprise MBA program who are conducting field research in East Africa. Brett, Alyse, Alana, and Ali share some of their insights into understanding their customers thus far.

The first couple of weeks have been illuminating in a way that class has prepared us for pretty well. While in Fort Collins, we learned the concepts surrounding human-centered design and relationship-based marketing.  We are currently in and around Jinja, Uganda, and we’ve had opportunities to employ or experience these concepts firsthand.


Human-centered design is at the core of all we do, ask, and perceive. We talk with people every day who are hoping that their next big investment yields the fruits they’ve planned in their heads, but oftentimes the products they buy are ill suited to the environment in which they’ll be used. For example, nobody has adapted a solar system perfectly to the needs of a rural east African woman running her own bar. Instead, she makes do and succeeds with what is available, but knows things could be better.


In firm agreement with precepts of sustainability marketing, we see a real desire in people to have a closer, longer term relationship with the companies from whom they buy. They know they have valid ideas and feedback, and in most cases they simply have no outlet in which to express them. Especially in the cases of companies peddling cheaper (low cost, low quality) solutions, we see the nature of the relationships as strictly transactional, leaving the man who runs a movie hall holding the bag when his very expensive battery suddenly goes very dead.

Both of these insights remind us how important it is to keep the people we meet centered firmly in our minds, and to focus most intently on understanding how they truly desire to live and work. Check back here in a couple weeks for an update on our progress.

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Harnessing the Grit and Perseverance of Cambodian Youth

6/17/16 – This guest post is written by three students in the Global Social and Sustainable Enterprise MBA program who are conducting field work in Cambodia this summer for their educational startup company.


Farishta, Sovan, and Melissa, with a project partner in Cambodia.

Suor Sdey! Hello from Education Team in Cambodia! We are taking a respite from the oppressive summer heat, in a thankfully air conditioned coffee shop, to share some of our insights from the last few days of fieldwork. In short, our research focuses on understanding the challenges of gaining secondary education among students from low income families in Cambodia. From our secondary research, of all school-aged children, only 59% enroll in lower secondary school, and 39% in upper secondary school. Simply put, for every 100 kids who enter primary school, only 10 of them will continue on to graduate from high school. The main reasons, also from our secondary research, are financial constraints (the necessity to focus on earning income for their family), the need to do household chores and take care of other family members, and the poor quality and low return on investment of the education they receive.

We arrived in this beautiful and resilient country with these facts and other statistics pertaining to the education sector, and we have heard these same reasons from our partners and community conversations.  By connecting with the issue at a human level in the field, through in-depth interviews (so far 6 with parents and 2 with teenagers), casual conversations (with our tuk tuk drivers and street sellers), and focus groups (so far 2) in the urban and semi-urban areas, we have discovered another element to the drop-out rate epidemic during the transition to secondary education: psychological factors.


Getting to know families in Cambodia to work towards a solution to their education challenges.

For example, we have found a pattern among our parents’ responses that internal characteristics such as grit, perseverance, hard-working attitude and a thirst for learning have played a vital role in the education of their children. For some, the reason one of their children decided to drop out is because they could not retain “focus” and they had little motivation to learn. On the other hand, another child living under the same circumstances and environment succeeded because they were very internally driven. This observation and dialog may seem intuitive and obvious, but this is not a factor that we have found in the prominent journals and research articles we studied. We believe this guides us in our pursuit of truly understanding the problem, and will give us more depth as we eventually move toward formulating solutions. Education is an extremely complex issue with so many layers; therefore, we are pleased to be actively peeling back the layers and discovering new dynamics with real people and conversations!

Until next time!



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Summer Sun and Excitement in the Caribbean: Cultivating Youth Employment Opportunities

6/14/16 – This guest post is written by team CaribSource, who are working in the Caribbean to find solutions to the high rates of youth unemployment in the region. They are conducting primary research in St. Lucia, Jamaica, and Trinidad & Tobago this summer as part of their venture practicum for the Global Social and Sustainable Enterprise MBA program.

“Find out where the excitement is. What keeps people up at night?”

-Dr. Christopher Blocker, Assistant Professor of Marketing at CSU

investment summit

Team CaribSource at the Caribbean Investment Summit in Miami, May 2016.

The Caribbean Investment Summit in Miami on May 13, 2016 marked the launch of our summer practicum. Investment promotion agencies representing the 25 Caribbean island countries and Belize pitched sandy beaches, sunshine, favorable tax environments and an educated, multilingual workforce to deep pocketed investors. We gathered stacks of business cards, refined our pitch and shook a lot of hands; but just as important to growing our venture’s network, we also confirmed that our proposed venture industry – business process outsourcing (BPO) in the Caribbean – is set to grow.  This is good news as we launch our summer goals:

  • identify potential customer segments in three different US cities,
  • prototype potential work tasks with our intended beneficiaries, (unemployed youth), in Saint Lucia, and
  • conduct primary research of successful BPO models in Jamaica and Trinidad & Tobago.

Our progress thus far: We arrived in Jamaica on May 15, 2016, where we were welcomed by the blistering Caribbean summer heat. While there, we were greatly assisted by the Jamaican investment promotion agency, JamPro, whose assistant director we had met at the summit. They were instrumental in helping us set meetings with various organizations and stakeholders that were meaningful to our research, such as the most well-known Jamaican youth NGO, YUTE, and a local BPO provider, HGS. We also met with Dr. Knlfe, the Caribbean intellectual leader in social enterprise, as well as with career specialists at the two major universities in Jamaica. Last, but certainly not least, we were able to speak with a number of youth to find out how they felt about the issues they were faced with.

What we found in Jamaica was truly fascinating. Jamaica has been able to successfully position itself as the regional leader in all things BPO. By combining their very well-educated and English speaking labor force with the government’s significant focus in the development of the BPO sector, Jamaica has attracted a wide array of organizations looking to take advantage of what the island has to offer. Most notably, we met with VistaPrint Jamaica, a company of about 1000 employees that provides all of VistaPrint’s English voice services in a Google-esque setting complete with an on-site videogame room and gym. They have been operating in Jamaica for over 12 years and lauded the high caliber of work they receive from the Jamaican workforce.

jumping for joyWe left Jamaica filled with excitement, got to St. Lucia on May 22nd, and were surprised to find the country in the midst of unplanned political elections, which disrupted meetings we had planned with government officials. We were, however, able to meet with the Springboard Training Academy, the Minister of Commerce, and a few youth leadership groups who have given us a bit of a pulse on the youth environment on the island. We were pleased to learn that St. Lucia as a whole seems to have many of the same characteristics that make Jamaica so competitive, and that the few that are missing are currently being developed.

Over the coming weeks, we will be conducting youth workshops during which we will combine quantitative and qualitative data collection methods in order to get a clear and concrete understanding of the youth perspective and create a “youth profile.” Watch for an update here regarding these outcomes, and the other exciting discoveries made under the Caribbean sun in this promising region.

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