BUS 6543 Module 5 Evidence-Based Social Venture Proposal Example

Hearing Help Where the Clinics Are Not: An Evidence-Based Proposal for a Mississippi Delta Hearing Care Venture

Student Name

American College of Education

BUS6543: Entrepreneurial Thinking for Social Innovation

Module 5 Assignment

Instructor Name

November 26, 2029

Introduction

Hearing loss is common among older adults, often untreated and linked to isolation and other harms. Untreated loss is more likely where hearing specialists are scarce and incomes are low, conditions found across the rural Mississippi Delta. This paper proposes Delta HearWell, a composite hybrid social venture that would bring hearing screening, over-the-counter hearing aids and ongoing support to older adults in the Delta through trained community hearing workers. The proposal grounds each element in evidence, applies the entrepreneurial logics studied in this course and sets out the venture's revenue model, mission safeguards, impact measures, risks and path to scale.

The Need

Goman and Lin (2016) estimated from national survey data that hearing loss affects a large share of older Americans, with prevalence rising steeply with age so that most adults in their eighties are affected. Many who would benefit from hearing aids do not use them, and cost, access and stigma are frequently cited reasons. In the Delta, these barriers are compounded by distance: audiologists are concentrated in larger towns, public transportation is limited and many older residents live on fixed incomes. The need is therefore not only clinical but logistical and financial.

The Opportunity

A regulatory change created the opening. A 2022 federal rule opened a retail channel: adults whose own sense is that they hear somewhat poorly, but not severely, may now purchase hearing aids off the shelf, with no exam and no professional fitting required (Food and Drug Administration, 2022). The rule lowered prices and opened new channels, but it also shifted to consumers the work of choosing and adjusting devices, a task that many older adults find difficult. That gap, between devices now available and the support needed to use them well, is the opportunity Delta HearWell would address.

Why Benefits Should Be Claimed Carefully

Evidence on the broader benefits of treating hearing loss calls for care. Lin et al. (2023) conducted a randomized trial of a hearing intervention, including hearing aids and counseling, among older adults with untreated hearing loss. Across the full sample, the intervention did not significantly slow cognitive decline over three years, but among participants from a cohort at higher risk of decline it was associated with substantially slower decline. The venture will therefore claim improved hearing, communication and social participation as its primary outcomes and treat possible cognitive benefits as a hypothesis for higher-risk groups, not a promise.

The Delivery Model

The core of the model is the community hearing worker: a local resident, often recruited through churches and senior centers, trained to screen hearing with validated tools, help clients choose and set up an over-the-counter device, teach use and care and visit or call during the first three months. Workers would refer clients with signs of more serious loss or medical problems to audiologists and physicians. In a randomized trial among low-income primary care patients, Kangovi et al. (2018) evaluated a structured program of support from community health workers and found reduced hospital use and improved patient-reported quality of care, supporting the use of trained, locally rooted workers to help people navigate care.

An Effectual Launch

The venture would launch in the effectual manner described in the first module. Its founders, a nurse practitioner and a retired audiologist living in the region, would begin with their own skills, a network of church and senior center leaders and an affordable loss of personal savings and a small foundation grant. Rather than projecting a full market first, they would run a six-month pilot in two counties, learn what clients need and invite partners such as a regional health center and a credit union to shape the next stage. Sarasvathy (2001) described this approach as controlling an uncertain future by building it with committed partners.

Revenue Model

Delta HearWell would be organized as a nonprofit with an earned income line, a hybrid of the kind examined in earlier modules. Revenue would come from three sources: sliding-scale fees for devices and support, with the lowest tier free for clients below a set income; contracts with health plans that include hearing benefits for their members, paying per client supported; and grants and donations for outreach and free services. The target is for earned income to cover 60 percent of costs by the third year, with philanthropy covering the remainder and the free tier.

Mission Safeguards

Hybrid ventures face pressure to drift toward paying clients. Delta HearWell would protect its mission in three ways. Its bylaws would require that at least half of clients each year come from the lowest income tiers. Its workers would be hired from the communities served and trained in a culture that combines service and practical skill, an approach research on sustainable hybrids supports (Battilana & Dorado, 2010). And its board would include older adults who are clients, giving the people served a voice in decisions.

Start-Up Budget

The six-month pilot would cost about $310,000: $150,000 for four community hearing workers and a coordinator, $70,000 for devices for clients in the free and lowest-paying tiers, $35,000 for screening equipment, tablets and software, $30,000 for training and supervision by the audiologist and $25,000 for outreach, transport and evaluation. Sliding-scale fees are expected to recover about $45,000 during the pilot. The remainder would come from the founders' contribution and a regional health foundation grant. A full first-year budget would be prepared once pilot costs per client are known.

Impact Measures

Impact would be measured along a results chain. Outputs include people screened, devices fitted and follow-up contacts completed. Short-term outcomes include device use at three and twelve months, measured by self-report and device logs where available, and changes on a validated self-reported hearing handicap scale. Longer-term outcomes include social participation and loneliness measured by short validated scales. Results would be reported by income tier and county to show whether the venture reaches those it intends to serve.

Risks and Responses

Four risks are most significant. Clients may abandon devices, a common problem with hearing aids; the three-month support period and follow-up calls address this. Health plan contracts may be slow to secure; the pilot will use grant funding while outcome data are gathered. Over-the-counter devices may not suit clients with more severe loss; the referral pathway addresses this. And worker turnover could weaken trust; competitive pay, career steps toward health worker certification and local hiring are designed to retain staff.

Path to Scale

If the pilot meets its targets, the venture would scale in stages using the capabilities identified by Bloom and Chatterji (2009). It would expand staffing to additional Delta counties through a training program that other organizations could also use, build alliances with health centers and senior service agencies and generate earnings through additional health plan contracts. Eventually, it could scale out by licensing its worker training and support protocols to organizations in other rural regions, multiplying impact without building a large organization.

Conclusion

Delta HearWell would address untreated hearing loss among older adults in the Mississippi Delta by combining over-the-counter hearing aids, made possible by a 2022 federal rule, with trained community hearing workers, a model supported by trial evidence on community health workers. Benefits would be claimed carefully in light of the ACHIEVE trial. An effectual launch, a tiered hybrid revenue model, mission safeguards, measures along a results chain, identified risks and a staged scaling path make the proposal grounded and testable.

References

Battilana, J., & Dorado, S. (2010). Building sustainable hybrid organizations: The case of commercial microfinance organizations. Academy of Management Journal, 53(6), 1419-1440. https://doi.org/10.5465/amj.2010.57318391

Bloom, P. N., & Chatterji, A. K. (2009). Scaling social entrepreneurial impact. California Management Review, 51(3), 114-133. https://doi.org/10.2307/41166496

Food and Drug Administration. (2022). Medical devices; ear, nose, and throat devices; establishing over-the-counter hearing aids. Federal Register, 87(158), 50698-50762.

Goman, A. M., & Lin, F. R. (2016). Prevalence of hearing loss by severity in the United States. American Journal of Public Health, 106(10), 1820-1822. https://doi.org/10.2105/AJPH.2016.303299

Kangovi, S., Mitra, N., Norton, L., Harte, R., Zhao, X., Carter, T., Grande, D., & Long, J. A. (2018). Effect of community health worker support on clinical outcomes of low-income patients across primary care facilities: A randomized clinical trial. JAMA Internal Medicine, 178(12), 1635-1643. https://doi.org/10.1001/jamainternmed.2018.4630

Lin, F. R., Pike, J. R., Albert, M. S., Arnold, M., Burgard, S., Chisolm, T., Couper, D., Deal, J. A., Goman, A. M., Glynn, N. W., Gmelin, T., Gravens-Mueller, L., Hayden, K. M., Huang, A. R., Knopman, D., Mitchell, C. M., Mosley, T., Pankow, J. S., Reed, N. S., . . . Coresh, J. (2023). Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): A multicentre, randomised controlled trial. The Lancet, 402(10404), 786-797. https://doi.org/10.1016/S0140-6736(23)01406-X

Sarasvathy, S. D. (2001). Causation and effectuation: Toward a theoretical shift from economic inevitability to entrepreneurial contingency. Academy of Management Review, 26(2), 243-263. https://doi.org/10.2307/259121