Globalization has provided opportunities for Small and Medium-Sized Enterprises (SMEs) operating in high-cost regions. However, globalization also presents a risk to SME sustainability due to increased, worldwide competition. In an effort to reduce cost and grow their businesses, Multi-National Companies (MNCs) may decide to move their supply base to low-cost regions. SMEs in high-cost regions are therefore presented with a competitiveness challenge and how they address this challenge may

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... their sustainability. The aims of this study are to learn how SMEs select business sustainability approaches that successfully make it difficult for MNCs to transfer work from them and, also, identify why SMEs select specific approaches over other approaches, and how these approaches impact their ability to be financially sustainable. During the preparation of the thesis proposal, a preliminary literature review revealed that knowledge, resources, and innovation are relevant factors to SMEs' business sustainability. A conceptual model was created at the outset of the thesis work, presenting the relationships these factors and manufacturing business practices have on driving business sustainability. These factors then inspired the formulation of the research questions. This model was modified to include the seven factors (strategy, flexibility, cost reduction, knowledge, innovation, communication, and Supply Chain integration) identified through the systematic literature review, and then modified again to include the three essential practices (continuous improvement, lock-in, diversification) identified and influenced by the case studies field work. The methodology used during the study was the generation of a literature review, followed by a case study research approach. The literature review helped identify key factors that affect SMEs' business sustainability, and was used to craft the questionnaire used as a guideline during the case study interviews. The study was conducted in California, a high-cost region in the USA, and included visiting four companies, gaining consent for their participation in the research, interviewing four employees from the management team, including the highest-ranking person, and participating in a plant tour.