The Emergence of Technology-Based Service Systems
The Emergence of Technology-Based Service Systems
www.emeraldinsight.com/1757-5818.htm
JOSM
20,1 The emergence of
technology-based service systems
A case study of a telehealth project in Sweden
98
Anna Essén
Stockholm University School of Business, Stockholm, Sweden
Received 22 June 2007
Revised 4 January 2008
Accepted 3 April 2008
Abstract
Purpose – The purpose of this paper is to propose a framework for studying the process of
technology-based service system innovation from a broad perspective using an approach that
elucidates the non-linear facets of this process. The framework draws on Lévy-Strauss’s concept
of bricolage, which implies that individuals’ “making do with resources at hand,” as opposed to
managerial visions, can trigger innovation. This concept is combined with the notion of technological
drift and with a model of emergentism.
Design/methodology/approach – The paper uses case study data from the Swedish elderly
homecare setting.
Findings – The findings illustrate how the emergence of technology-based care services can be
triggered by an injection of energy in terms of a new technological resource being made available in an
organization, proceeding as a continuous interaction between personnel repurposing and recombining
resources at hand, positive and negative feedback dynamics, institutional regulations and
culture-related stabilizing mechanisms.
Research limitations/implications – New services can arise as a result of a number of efforts and
events that, in isolation, might appear insignificant. Taken together, and interacting with enabling and
constraining forces that promote the emergence of certain new services and prevent others, such acts
and events generate unpredictable outcomes. The result may be incremental but by no means trivial
innovations.
Originality/value – The paper suggests an approach to innovation that complements conventional
thinking in the new service development literature. The proposed framework can help to explain how
and why certain new services emerge and why others do not in unexpected and unpredictable ways.
Keywords Elder care, Sweden, Customer service management, Technology led strategy,
Service systems
Paper type Research paper
1. Introduction
Knowledge about the service innovation process is important for our understanding of
the transformation of offerings, organizations and sectors over time. However, it is still
an underexposed area in the literature (de Jong and Vermeulen, 2003; Sandén, 2007;
Syson and Perks, 2004), particularly the process of innovating technology-based
service systems (Menor et al., 2002; van Riel, 2005). Authors have recently pointed at
the complexity related to this kind of service innovation, arguing that it involves not
only technological, but also organizational development (Magli et al., 2006; Piccoli et al.,
Journal of Service Management 2004). It has further been suggested that the technology-based service innovation
Vol. 20 No. 1, 2009
pp. 98-121 process encompasses many informal and iterative elements, and that it is influenced by
q Emerald Group Publishing Limited extra-organizational factors, such as prevailing policies and cultural values (Barlow
1757-5818
DOI 10.1108/09564230910936878 et al., 2006). These insights indicate that students of technology-based service
innovation should take on a broad perspective. Regrettably, the emerging Technology-
technology-based service innovation literature does not quite respond to this call. based service
Existing studies largely attempt to:
. model the systematic sides of technology-based service innovation; or
systems
.
investigate to what extent certain technology-based services respond to certain
consumers’ needs (Chircu et al., 2001; Dabholkar et al., 2003; Lanseng and
Andreassen, 2007; Massey et al., 2007; Mørch et al., 2004; Slater and Mohr, 2006;
99
Sung-Eui, 2005; Walker et al., 2002).
As noted above, however, such aspects have not seen much light in the new service
development literature. In their review, Johnson et al. (2000) conclude that the NSD
literature provides three types of innovation process models: models that depict a part
of the process (Schostack, 1984); models based on blueprints for new product
development (Bowers, 1989); and comprehensive models (Scheuing and Johnson (1989)
that propose a model including 15 stages). Common for these models is their normative
character and their focus on intra-organizational issues and phases that the NSD
process “should” encompass. Sandén (2007, p. 41) writes that more recent research has
concentrated on various aspects of NSD but that few studies have examined the NSD
“process”. Interestingly, Sandén (2007, p. 18) argues that NSD is often “ad hoc and
based on trial-and-error type of approach”. It is further important to note that research
on innovation systems more generally is increasingly underlining that innovation can
occur through other pathways than well-managed and systematic processes.
Observations suggest that innovation trajectories are often informal, ad hoc and
unpredictable and that they should be understood as cyclical, including various
feedback loops and evolving through complex – often unexpected and even accidental
– events (Consoli, 2005; Gadrey et al., 1995; Jensen et al., 2007; Metcalfe et al., 2005;
Rothschild and Darr, 2005).
However, few models elucidating how trial-and-error mechanisms and other factors
interact have been suggested. Hence, there appears to be a need for a more
comprehensive framework in the innovation process that allows for a multi-level
analysis of the dynamics between emergent micro-processes at the individual and
organizational level, on the one hand, and structures at societal level, on the other. In
the next section such a framework is outlined. I will start by introducing the notion of
bricolage (Lévy-Strauss, 1966) and technological drift.
Hence, the dissipative structures model overlaps with bricolage but it also extends this
concept by specifying the forces that enable and constrain what individuals can make
of the available technological resources. Although organizational students have used
the dissipative structures model to explain how the evolution of organizational systems
proceed from a “punctuated emergency” to the next, i.e. from one order to another over
time (Chiles et al., 2004; Leifer, 1989), this paper uses it to explain the first phase in a
service development process, i.e. the emergence of a new service, which can be
understood as the evolution of one new order.
The framework (Figure 1) suggests that the development of new services can
be triggered by the injection of energy in terms of a new technology resource
being made available in an organization. The organizational members will engage
in bricolage (Lévy-Strauss, 1966) by making do with the new resource, i.e. they
will repurpose it and recombine it with old resources, and as a result, they will
learn what the technology affords in context. The individual members’ acts of
making do should, however, not be confused with boundless freedom and endless
creativity. Positive and negative feedback mechanisms shape their acts of making
do. That is, the immediate responses the personnel encounter when using the new
resource will amplify certain uses and prevent others from being repeated. The
(unexpected) performance of the new technology, when implemented, will also
actuate responses and developments in certain directions rather than others. These
responses contribute to the definition of the boundaries of the emerging service.
JOSM Institutional constraints &
stabilization mechanisms:
20,1 Personnel adjusting to institutional
constraints, to culture and to values.
104
Feedback
mechanisms:
The injection of energy : A The positive/negative
New
new technological Services responses personnel
resource. This resource is emerging encounter when
redefined over time along introducing novelties
with personnel using it and and personnel
the contextual affordances reacting to
that emerge. unexpected
technological
Drifting outcomes performance.
Figure 1.
A framework for Making do
unpacking the concept of with resources at hand:
bricolage in the context of The recombination, reuse and
the innovation of repurposing of available
technology-based services resources, including the new
technology.
The emergence of new ways of using the new resource, i.e. the birth of new
technology-based services, is further influenced by more permanent institutional
constraints and stabilizing mechanisms, such as organizational structure,
regulations and cultural values (Chiles et al., 2004; Prigogine and Stengers,
1984). The innovation process will unfold as a continuous interaction between
these enabling and constraining mechanisms, producing results that may drift
from the original intention of the technology designers and the user organization
(Ciborra et al., 2000). In general, it is difficult for any single actor to control the
outcome of this process because it is shaped by participants and forces at various
levels and at different points of time.
This view of the innovation process has emerged during the process of writing this
paper (see method section) and it has guided the analysis and presentation of the
present findings.
3. Method
The present paper explores how the mechanisms shown in Figure 1 operate in a
particular context such as technology-based care service innovation, i.e. the purpose is
to develop rather than to test theory. The study is based on a single case. This case was
chosen for theoretical reasons in the sense that it could reveal an unusual phenomenon
(technology-based care service innovation) and support the elaboration of the emergent
theory (theoretical rather than representational sampling (Yin, 1984)). Studying the Technology-
single case over a three-year period (2004-2007)[4] allowed me to follow the informal, based service
gradual processes of service development over time in its real-world context and to use
various information sources (Yin, 1984). In general, the case study approach is suitable systems
for longitudinal research seeking to unravel the underlying dynamics of phenomena
that play out over time (Siggelkow, 2007).
105
3.1 Data generation
A telehealth project conducted by the community care organization in Heby, Sweden
constitutes the case studied. Heby is one of few elderly care providers engaged in
the development of IT-based services in Sweden. The author has participated in a large
number of formal and informal meetings in Heby from 2004 to 2007. Field notes have
been taken from these observations and home-helpers’ service documentation has
further been scrutinized and summarized in field notes. In 2006, 12 unstructured
interviews were performed with home-help and managerial personnel within the Heby
community care organization. The interviews revolved around visions about the
telehealth technology and the actual use and development of services based on this
technology (see Appendix). The longitudinal study allowed the researcher to ask
follow-up questions (see interview guide in the Appendix) and thereby understand how
one thing led to another (interactions).
Interviews were performed at the nursing home where personnel gather before they
deliver home-help services. The interviews, which lasted about 90 minutes each,
included open-ended questions in order to allow for unexpected issues to emerge.
The interviews were recorded, transcribed and translated (Swedish to English) by the
author.
4. Findings
The development process studied was characterized by a continuous interaction
between the mechanisms in the proposed theoretical framework. The mechanisms are
illustrated with examples from situations where they were salient.
4.1 An injection of energy: introducing a new technological resource without a clear end
in sight
A group of managers in the Heby community care organization initiated the
development process studied. They envisioned that new technology-based services
could contribute to a more cost-effective care service production and thus decided to
invest in a telemonitoring system. There were numerous new care technologies
available on the market, but few targeted the elderly homecare sector. Therefore, the
managers pragmatically “settled” with a technology that seemed to hold some promise.
An important reason for the managers paying attention to this particular technology
was an informal relationship between key actors (as opposed to a systematic scanning
of all technologies available). Serendipitous events, such as people being seated next to
each other at a grand dinner, played a role here. The vendor marketed the monitoring Technology-
system as a tool for ensuring the safety of seniors living in single households: based service
[. . .] The message was that the monitoring system would enhance our capacity to detect systems
emergencies [. . .] And the extended information about the senior patient’s “general status”
would enable us to “know” our seniors better [. . .] (Birgitta, Manager).
Although the managers were animated by such claims, they were uncertain about 107
what benefits the use of the technology could produce at a more concrete level:
We found it difficult to predict [. . .] At this stage, our belief was that the advantages of the
monitoring technology in practice would emerge along with the staff members starting to use
it (Anna, Manager).
It was difficult for the managers to formulate a new service concept at this stage because
they were unsure of what the new technology, in the hands of the home-helpers, could do.
4.5 Interactions
There were numerous interactions between the mechanisms. For example, stabilization
mechanisms influenced the “energy-injection mechanism” as financial constraints
encouraged the managers to choose a relatively low-cost technology and the prevailing
healthcare culture made them inclined not to choose a too radical technology
(e.g. robotics). Stabilization mechanisms in terms of prevailing values further
influenced the “feedback mechanism” in terms of the positive reaction among seniors
(via their high belief in the reliability of modern technology). Prevailing values also
influenced how the care workers interpreted the feedback signals from the seniors and
how the care workers, as a result, redefined the purpose of the technology. There were
also interactions between the stabilization mechanisms and the “making-do
mechanisms” (operational employees’ acts of bricolage). Care workers were forced to
make do with available resources because of institutional constraints, such as a limited
budget and the rigid financial structure. Cultural values further constrained their use of
the technology. Hence, stabilization mechanisms influenced how care workers made
do with the technology, which greatly influenced how seniors reacted to the
new technology, which influenced how care workers continued to make do with the
technology. These examples illustrate the cyclical nature of the emergence of new
technology-based services in the case studied.
4.6 Drift: redefining the new technological resource – unexpected services emerging
In summary, as a result of the implementation of the monitoring technology, new
technology-generated patient data entered the work-life of personnel. The new data
unexpectedly made it known that seniors often forget to wear their alarms and it
occurred to the personnel that they could use the technology to detect and respond to this
problem. The personnel also understood that the technology could notify them when
seniors were “weak” and thus provided them with an opportunity to address these subtle
JOSM health changes. Overall, the personnel gradually learned that the new technology
20,1 enabled various preventive services. This view differed from the technology vendor’s
claims and the managers’ initial expectations of the new technology, which revolved
more around its role as an emergency-detector. The personnel redefined the new
technological resource, increasingly referring to it as a complementary decision support
and an “early warning” tool. Based on this contextualized understanding of the
112 technological resource, the personnel started to provide seniors with new “extra support
visits” and “alarm-usage control services,” carefully adjusted to the individual senior
and the situation. Neither the vendor nor the managers had anticipated the emergence of
these new services. The services are still in a beginning stage. The personnel and
managers, however, assert that they will continue to use the technology to learn what it
enables them to do for their senior consumers.
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Appendix
Interview guide (many of these questions were asked (in one way or another) at several times, at
informal/formal meetings and during interviews).
To managers:
How did you choose to invest in this particular technology?
(Often, follow-up questions were asked, such as: was there any other aspect that
influenced your decision, you think?)
Who did you engage in the decision phase?
Why?
What was problematic in this first stage?
What was your intention at this stage? Vision? (What benefits did you foresee at this
stage?)
How did the project proceed?
Has your vision been realized?
What have you learned?
If it would be up to you to decide, would you recommend a continued use of the
technology?
Why?
To home-helpers:
What do you think of the new technology?
How many times per week have you used it, and for how long?
How have you used it? Technology-
Why have you used it in this way? based service
Has it been difficult?
systems
Did you use all functions/features possible in the application?
Why did you not/use certain features?
If it would be up to you to decide, would you recommend a continued use of the 121
technology?
Why?
What benefits can the technology produce from your viewpoint?
Corresponding author
Anna Essén can be contacted at: [email protected]