Abstract
Multisided platforms are new organizing forms that can boost innovation in the healthcare sector by empowering patients as innovators and facilitating the commercialization of innovations by and for patients. However, applying the playbook script for the platform model from other sectors may prove challenging given the distinctive nature of the healthcare services. Drawing on the case of a leading healthcare innovation platform in Europe, this article examines the platform’s role in identifying and enabling the development and diffusion of patient innovations. This involves three main roles (community organizer, market matchmaker, and innovation manager) and corresponding orchestration activities.
Keywords
I knew there had to be a better way to manage my diabetes without the repeated needle sticks, and I knew that I was not the only person with diabetes who felt this way. So, I came up with something better.
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Motivated to find a better solution for her treatment, she developed a device that could solve her problem with a minimal impact on her life, the injection port (i-Port 2 ). I-port is a medical device for diabetes patients who need daily injections and eliminates the need to puncture the skin for each dose. “[I]t’s really a quality of life (improvement) and a convenience. It’s changed the way I look at this disease,” said Catherine. 3 In 2004, she founded Patton Medical Devices to manufacture and distribute her invention. In 2015, i-Port got approval to market from the Food and Drug Administration (FDA).
Catherine is like many other patients and informal caregivers becoming “patient innovators,” 4 the developers of solutions to their own medical problems. She is also one of the very few patients who brought her solution, developed for her own use, to the market, after finding an established industry partner, Medtronic, to commercialize the device. Patient Innovation (PI), a leading platform in Europe for innovative user-developed solutions in healthcare, was instrumental in sharing, receiving feedback, and promoting the i-Port solution. The PI platform facilitates the sharing of patient innovations, enabling ideation, experimentation, and validation of solutions. Through such activities, PI empowers the community of patients to innovate along with incumbents, connecting them to the resources and networks required to commercialize promising solutions.
There are many kinds of patient innovations. Their solutions range from very simple, like using helium balloons to stimulate children’s physical therapy and walking exercise, to complex solutions that require regulatory approval to be used, such as a sophisticated exoskeleton or an insect-eye-like camera for brain surgeries. 5 When designing their solutions, patient innovators are unlikely to deliberate on fitting some general market need or produce a careful cost-benefit analysis for profit-maximizing considerations. Patients solve their own pressing problems, which are likely relevant to many others with similar problems but largely unaddressed by incumbent products and services. The solutions patient innovators create might fall outside of the incumbents’ established market domain or innovation zone, which is also why incumbents may be unaware of such needs or perceive them as less important. 6
Patient innovation is an instance of the broader phenomenon of user innovation, which suggests that users with tacit knowledge about problems can be a valuable source of innovations that they come up with for their own benefit. 7 However, unlike the successful example of Catherine, many good ideas and innovations die in the community because of a lack of sharing and commercialization. As a result, they may be lost for good. 8 For simple solutions, the problem may be the patients’ unawareness of a suitable and trustworthy place to share such solutions. For more complex solutions, the problem is the lack of an interconnected innovation network, as the intersteps of the production process needed to transform user ideas or innovations into commercial products are missing. This might be because the innovation taking place among users (user innovation) follows a different modus operandi and value chain than the innovation taking place among producers (producer innovation). The difference between these two modes of innovation also includes distinct motivations for engaging in the innovation process (e.g., use benefits and profits, respectively), an aspect already recognized in the innovation management literature. 9
When considering these alternative innovation paradigms, 10 we refer to the distinctive innovation value networks, user- or producer-based, emphasizing the context within which innovation and problem-solving happen. 11 Each value network has a specific architecture, defined by stakeholders and assets, its modus operandi, and stakeholders’ roles in the value generation and appropriation process. 12 Once it emerges, the architecture of a value network is unlikely to change quickly due to issues such as “compatibility, interoperability, regulation, and existing preferences.” 13 The producer innovation value network optimizes for efficient market value estimation, production, and profit maximization. It has limited or no connections with the user innovation value network. 14 The value created and exchanged in both value networks is an innovative solution to a pressing problem. However, in the producer innovation value network, the properties of the value of interest are related to maximization of the economic benefits; thus, cost-benefit analysis plays a key role. In the user innovation value network, the value arises from the subjective perceptions of a problem’s burden and the benefits one rips from solving it, without explicit considerations of the economic effects the solution might generate. Hence, the architectures and internal dynamics in producer and user innovation value networks are distinctive and likely to be incompatible. 15
Multisided platforms (MSPs) can offer a solution to the problem of disconnected innovation value networks by connecting and coordinating the multiple actors who need to come together to develop and commercialize patient innovations. There have indeed been calls 16 for the sector to shift toward MSP business models 17 to overcome organizational inertia, leverage external innovators, and become more responsive and oriented toward patient needs. However, unlike the contexts in which we see MSPs thriving, healthcare solutions are not simple commodities that can be freely traded on the market. Many of these solutions are complex, involve different actors along the value chain, and also require regulatory approval. Many of these actors would be off-platform; they are not part of the different platform market sides (neither on the demand or supply side). Nonetheless, they need to be engaged to enable and facilitate the transforming of patient solutions into commercial innovations. Thus, the platform coordination role and activities, or platform orchestration, require much more than simply matching users on different sides.
In this article, we investigate how healthcare platform providers can address innovation bottlenecks for traditional, highly regulated sectors like healthcare and the orchestration required to drive patient innovation toward wider adoption. We study the case of an award-winning user innovation platform in healthcare, Patient Innovation, 18 and document the orchestration that the platform performs to unlock the innovation value creation capacity of its patient community. We find that PI modularizes the bridging between the user and producer innovation value networks, creating options and pathways to the market for ideas generated by the patient community. The PI platform case unveils three main orchestration roles: community organizer, market matchmaker, and innovation manager. These roles, performed concurrently, bridge the idea generation process (out of the patient community affiliated with the platform) with the innovation production and commercialization processes that occur off-platform, involving multiple actors in the established producer innovation value networks. We also find that the extent these platform’s orchestration roles are needed depends on the complexity of a solution and its risk class (e.g., in the United States, medical devices are categorized along three risk-based classes—classes I, II, and III). The PI case shows how connecting the on- and off-platform innovation value networks is necessary to govern the innovation process and unlock value for patients.
This case study helps illuminate the complexity of the strategic choices in determining the technological and organizational scope of the platform for successful orchestration. The related orchestration activities differ significantly in terms of the typical activities performed by MSPs to coordinate buyers and sellers (Amazon Marketplace), hosts and guests (Airbnb), or software developers and customers (Apple AppStore). The PI platform case is intriguing. It shows that modularity—the critical element for the successful orchestration and growth of MSPs—is implemented at the process level of innovation development. It enables distinct innovation value networks—user and producer innovation—to interact, jointly producing value for society. With such a design, the platform strikes a delicate balance between separation and connectedness. It maintains the two cultures of the distinct innovation value networks separated for the platform’s internal dynamics to unfold freely. Yet, it connects them sufficiently to unlock collaboration and innovation in the healthcare sector. Effectively, the PI platform performs the role of what we define as the innovation value shaper: establishing missing links between the innovation value networks that transform the dual user-producer paradigm of innovation into an innovation singularity.
Leveraging Patients as Innovators: Changing the Innovation Paradigm?
Patients are the end-users of a linear value chain delivering finished solutions. Such a perception constrains the breadth of the innovation search process, ignoring or discarding needs, or poorly addressing those needs. Consider, for example, the case of ostomy bags. Michael Seres, who was diagnosed with the incurable bowel condition known as Crohn’s disease, had over 25 surgeries and underwent a small bowel transplant. After an ileostomy, he was given a stoma, that is, part of the bowel was brought to the outside of the body, so that the waste can be collected in a bag. Managing an ostomy is a challenge, and Michael wanted to change his life and the lives of all patients connected to medical bags. He hacked together a sensor and a bag and managed to have the sensor communicate with his phone via Bluetooth to tell him when the bag was full. 19 It took the initiative of a patient directly affected by its use to develop a digitally enhanced ostomy bag to ease the suffering of millions of people with bowel injuries, chronic gut illnesses, and cancer. 20 In such cases, bottlenecks to innovation emerge due to disconnected and uncoordinated actors whose incentives are constrained by their current innovation value network structure and misaligned with final customers. 21
Measurements of user innovation at the national level in several countries have shown that up to 0.5% of adult citizens innovate in healthcare. 22 Patients constitute a significant source of innovation but live on the margins of the value creation and value appropriation system. Oliveira and colleagues 23 show that in underserved communities in which patients have few solutions to cope with their life-long health challenges, the share of innovators is substantially higher; over 30% of 500 interviewed patients developed new-to-the-world solutions. However, only 5% of the innovators shared their solutions with their doctors; personal connections and peer-to-peer (P2P) diffusion were the main diffusion pathways. While user innovation may represent a new paradigm for creating functional solutions, empirical evidence indicates that user innovation may live within silos. Innovation networks may emerge but engender only users 24 disconnected from the traditional research and development and producer innovation value network. This constrains the commercialization of many of the users’ innovations and creates innovation bottlenecks.
When innovating, producers focus on research, the viability of product commercialization, profitability, returns on investment, and activities to enhance a product’s adoption. Users focus on solving problems with little or no attention to such questions as returns on investment. They innovate even under the conditions of monopsony, 25 and invest little or no effort toward product diffusion and its adoption. These two innovation paradigms exist in parallel. 26 Complementarities and innovation spillovers may occur when punctuated by ad hoc steering activities by a firm around its own product innovations. 27 In practice, however, the user and the producer innovation value networks remain largely disconnected, except for a few unilateral initiatives of single firms leveraging the network of their own product users to boost their innovation trajectories. This implies that many potential innovations ideated by users will not be promoted or produced due to the incentives or capability constraints of the individual firm. Also, because the innovation search process (by users) is largely shaped around the firm’s offerings, much of the value in the user network remains untapped.
MSPs offer a possible organizational solution. MSPs are digital infrastructures that create value primarily by enabling direct value exchange interactions between two or more distinct types of users affiliated with the platform (e.g., consumers and service providers). 28 These platforms are “managed marketplaces” 29 governed by the controlling firm, which establishes rules for participation and interaction on the platform. Their capacity to coordinate transactions between multiple actors on the supply and demand side allows MSPs to organize economic activity in and across sectors. 30 Platform management theory highlights the importance of such a coordination role by referring to the concept of platform orchestration, generally defined as the facilitation of a set of processes that lead to and promote activities among platform participants 31 to grow the platform value to its users. Different platform types require different orchestration activities, and understanding which orchestration activities to focus on is instrumental to its long-lasting success. 32 In most MSPs, attracting both sides to the platform through pricing strategies (e.g., giving away the core product or service for free to end-users while charging the other side) can suffice for the market to emerge. This model is widely adopted across several sectors, from hospitality (e.g., Booking.com), online dating (e.g., Match.com), to media and entertainment services (e.g., Spotify, YouTube). In other cases, there are additional coordination challenges to address. When systemic innovation is involved, offerings from multiple actors must work in combination for an integrated solution to emerge and create value for the customer. In such cases, tighter control by the platform provider might be required to coordinate the integration process and guarantee high-quality solutions. We summarize the most critical orchestration activities by the platform’s archetype in Table 1.
Typical Orchestration Activities for Different Platform Types, Based on the Work of Cusumano et al.
The innovation platforms in Table 1 are examples of such cases. These platforms require orchestration activity to steer innovation development in productive directions. 33 On the other hand, this multisided market model appears to thrive in contexts in which the offer is: highly modular, so that the customer can easily combine different components through the platform; widely diffused—that is, can be provided in sufficient variety by multiple, specialized actors in the sector; and not reliant on a multiple-step integration process for its creation (i.e., actors can work in total autonomy to create self-contained solutions, albeit the value of such solutions might be enhanced when connected to other products).
Intensively regulated industries, like healthcare or banking, share characteristics that make it difficult for innovation-oriented, platform-based, multisided markets to emerge. For such a platform marketplace to emerge, actors must have incentives to produce in the first place and must be empowered. Effective coordination of the multiple actors involved in creating an offer is only possible if the platforms resolve important bottlenecks in the innovation and value creation process, 34 and internalize the externalities associated with the regulatory framework within which players must operate. A different kind of orchestration that moves beyond simply coordinating users within the platform is required to remove these bottlenecks.
The problem becomes even more complex when considering that patient innovators are individuals who may lack the complementary assets to develop their solutions, validate them, and increase the likelihood of their adoption. On top of that, patient innovators are, or were at some point in their lives, afflicted with additional disease/health-related constraints. Also, the context and nature of the problem that creates the need for solutions—a health disorder—are such that patients can face additional limitations in terms of access to resources and incentives to invest effort in bringing their innovations to the market. Tackling this innovation bottleneck may unlock the innovation potential in healthcare and resolve the loss in societal welfare reflected in the loss or underutilization of patient innovations. The question remains as to how.
A Model of Orchestration among Multiple Value Networks
One way to address the identified innovation bottlenecks is an orchestration approach that aims to coordinate on-platform user network dynamics with the off-platform relevant actors of the healthcare innovation value network. The orchestrator connects the two distinctive networks of healthcare innovation, the patient community network with the traditional network. The traditional innovation value network follows the classical linear value chain logic (Figure 1a). It has well-defined stages where actors tightly control complementary assets, operate under well-defined value appropriation mechanisms, and have specialized expertise in bringing innovations to the market. There are thus strong economic incentives in place to sustain and grow these linear dynamics.
Innovation value networks in healthcare: (a) traditional (producer) innovation value (creation) network and (b) patient community (user) innovation value (creation) network.
In contrast, the patient community innovation value network (Figure 1b) works through feedback loops across the community characterized by: informal and P2P information exchange; high needs-related knowledge; general scarceness in resources to develop and diffuse innovations; and use benefits as the principal motivation for developing innovations. The incentive system is such that intrinsic motivations dominate the effort investment, such as solving pressing problems or altruism.
For patients with innovative ideas or solutions to break into the traditional, producer-centered value network, they need to command significant resources and have expertise in dealing with the regulatory institutions. This does not happen on its own; it requires a hub organizational unit to internalize these externalities between the two innovation value networks and steer the process (Figure 2), so that, valuable innovations can reach the market. This level of coordination requires stimulating the collaboration and shaping the innovation ecosystem. 35 The orchestrator in this setup needs to gain trust as an organizer of the user innovation community. On the one hand, it needs to demonstrate the coherence of the enabling role and actions to promote the interest of the patients’ community for the patients to be engaged. On the other hand, the orchestrator needs to establish a reputation as an innovation discovery channel with traditional actors within the established producer innovation value network. Thus, it needs to demonstrate tangible output and measurable value to these players from interacting with the platform’s patient community. The case of PI exemplifies this orchestration role and shows the unique orchestration activities required to navigate the process.
Unlocking the innovation flows between the user community and traditional value networks via orchestration that enables free sharing and commercialization.
The Case of the PI Platform: Methodology and Research Context
Empirical Research Methodology
We made an empirical inquiry into the case of the PI platform and the orchestration roles it performs or has been performing within its real-life context. 36 We followed a qualitative research approach with a single case study of the PI platform. Although it offers limited generalizability of results, a single remarkable case is suitable as it may inform us in unprecedented ways about a phenomenon of interest. 37 We followed a five-step process. In the first step, we took an autoethnographic approach. 38 The platform’s founder, also a co-author of this article, built the PI platform’s history narrative, which served as the basis for this article. In the second step, all co-authors read the story and helped build it further by discussing the candidate platform’s roles and orchestration activities. This was done by iterating over important events, decisions, and emerging interpretations (Table 2).
Overview of Data Sources.
In the third step, once the chronologically ordered events database was ready, we applied temporal bracketing 39 to delineate different periods within the organization’s history. We took an interpretative epistemological stance in this process. We iterated in interpreting what a set of actions from the timeline in different periods mean, focusing on the orchestration roles and activities and ignoring purely administrative or technical activities. Note that the focus of the study is the understanding of the orchestration roles, not the process of their emergence. This step was necessary as, during the first two analytical steps, we became aware of the interlinked nature and polyvalence of the orchestration activities. In other words, as one activity opened a possibility for other activities to happen, their co-occurrence, interdependence, and interaction blurred the role boundaries. The processual perspective allowed us to comprehend the complexity of the activities and to reach an agreement in identifying the associated role.
In the fourth analytical step, we validated the narrative, aiming to extend our understanding of the platform orchestration as an innovation value shaper. In other words, we used external data to confront the founder’s recollections and find evidence of the innovation challenges and the necessity for organizational responses that the platform made.
We analyzed transcribed interviews using content analysis. 40 Two co-authors engaged first in an active reading of data, informed by the narrative and PI timeline. Then, in accordance with the analytical objective, we searched for statements that could inform us about the patient innovation and producer innovation value networks, the innovation bottlenecks, and the need for such an organizational response by the platform. Each statement was assigned a label. After a revision, the labels constituted a list of sub-dimensions. We grouped the sub-dimensions into a set of aggregated dimensions based on their shared characteristics related to the orchestration of the innovation flows between the two value networks. Note that the content analysis was informed by the analytical objective, as its purpose was triangulation and not the generation of roles. We have started with a list of orchestration roles and activities from the previous steps. We engaged in the analysis with an open mind to find confronting evidence and explore the orchestration process. In the last step, throughout the coding process, we iterated over the findings from all steps, revising the orchestration roles and activities in light of the context and the extant theoretical basis from the academic literature. In case of divergence, we engaged in discussions and revisions of evidence until converging on a clear conclusion.
Research Context: The PI Platform
PI is an open online platform that facilitates the sharing of innovative solutions developed by patients with any disease and their informal caregivers to help them cope with pressing health-related needs. PI was established as a non-profit organization in 2014 in Lisbon, Portugal. The organizational chart in Figure 3 illustrates the main PI activities. The chart shows how PI organizes its activities in three main sub-groups: free sharing of patient-developed solutions, which was prevalent until 2019; commercialization of innovative solutions via new firms (e.g., Bootcamp and other European Institute of Innovation and Technology [EIT] Health-related activities); and commercialization of innovative solutions via existing firms (e.g., pitch camp).
Chart of main PI activities.
Technology-wise, the platform’s main affordances are to collect, store, and make freely and permanently available the information about solutions developed by patients and informal caregivers (see Table 3). The information about a solution is provided as a textual description and enriched with multimedia files and links to other digital resources to improve the adoption of the solution. The platform also features advanced tagging functionality that allows connecting solutions based on the medical conditions and symptoms, parts of the body, functions afforded, and the type of solution. These features break the information silos between health disorders and the impact they introduce to those afflicted by them. Each post is open to the community to comment on and indicates whether they liked, copied, or purchased the solution. Support for multiple languages improves sourcing of and access to solutions at multiple geographies. As the interactions with the producer innovation value network increased, the platform introduced features, such as a “showroom,” a curated list of solutions of interest for specific companies.
PI Platform’s Core Features and User Types.
Note: PI = Patient Innovation; IP = intellectual property; EIT = European Institute of Innovation and Technology.
On top of the technology are a non-profit organization and a set of organizational procedures that maintain the platform’s trustworthiness. Each post goes through a standardized process. The platform’s administrative staff checks the post for elementary conformity with the terms of service and type of intellectual property protection. Those that pass are then reviewed by the platform’s medical team, led by the chief medical officer, for final validation and medical screening before making them publicly available online. On average, almost 50% of the solutions submitted to the platform comply with the terms and are therefore approved. Figure 4 shows a simplified process diagram of post validation.
Review process conducted by the PI medical team.
The platform features a series of community activities on- and off-platform. There are high-profile activities, such as the annual PI Award or the Patient Innovation Bootcamp, and regular activities, such as participation in educational programs, conferences, and trade fairs. PI facilitates the creation of innovations by organizing the patient community and coordinating user interactions within the platform. It also links these innovators and their innovations with other potential users, both on and off the platform. PI is currently the largest clearinghouse of health-related innovations in Europe, 41 with a community of over 1.2 million visitors annually, including 100,000 frequent users from over 100 countries. Among the innovators, 44% are patients, 41% are informal caregivers, and 15% are collaborators. Among the visitors, 58% are male, and the two most prominent age brackets are 25-34 and 35-44. As of February 2022, over 5,189 innovations have been submitted by the community. Of those, after screening by the PI medical team, 1,517 have been “approved” and published on the platform. An additional set of 953 are still classified as “work-in-progress” (WIP), that is, they are still being evaluated and/or waiting for information or clarifications. These numbers exemplify the importance of screening and labeling all the submissions and filtering information about the relevant projects for the community. A total of 628 innovations have been successfully commercialized (41% of the solutions approved).
The platform supports patients at various stages of their PI journey, as shown in Figure 5. The figure describes the steps followed by a patient when they need a solution to treat a disease or health condition. When patients find themselves afflicted with a condition, the first step is to search for a solution, namely, by looking for solutions on the market, seeing doctors, or seeking advice from acquaintances or other medical professionals. If the search is unsuccessful, some patients start thinking about potential solutions themselves. Of those, a smaller percentage will become innovators, specifying an idea, developing a prototype, and testing it until it is suitable for diffusion. At the diffusion stage, innovators can follow one of several paths (Figure 5): commercialization via existing firms; commercialization via a startup created by the innovators; or P2P free sharing.
The Patient Innovation journey: from a need imposed by a health problem to the commercialization/diffusion of an innovation.
Orchestrating PI: Findings from the PI Platform Case
The platform deploys different types of orchestration activities to address different kinds of innovation challenges.
The Multiplicity of Platform Roles and Innovation Bottlenecks
Based on the findings from the case, we summarize the innovation bottlenecks that the PI platform addresses and the related orchestration activities (see Table 4). Multiple platform roles and orchestration activities are needed to support innovation within the patient community value network.
Innovation Challenges Faced by Patient Innovators and Orchestration Activities Designed as Organizational Responses to the Challenges.
Note: PI = Patient Innovation; EIT = European Institute of Innovation and Technology.
Surfacing the PI value network—The community organizer role
Until recently, patient innovations were not recognized for their value, and there was no established innovation value network they were part of. Patient innovators existed at the margins of the healthcare industry in dispersed and fragmented local networks such as patient associations. They were exceptions that sparked moments of surprise rather than something worth a coordinated effort to surface and systematically bring into the healthcare innovation value network. While we often refer to a community of patients, in reality, this community is far from a homogenous entity; many groups exist that gather around a common problem, such as a specific disease, and exchange information locally. Neither the patients nor most of the external world see them(selves) as the source of innovation. The PI platform was a technological and organizational response to the challenge of coordinating a sparse community of patients facing information problems.
Patients suffer information search and overload problems in self-assessing the validity of a proposed solution. Our analysis shows that the PI platform is more than just a repository infrastructure of health-related information. Rather, it fulfills the role of a community organizer—it creates a safe venue for sharing innovations developed by patients and informal caregivers, boosts their innovation potential, and coordinates activities to enhance their impact. This distinctive orchestration activity is not present in the traditional platform archetypes (i.e., the transaction and innovation platforms of Table 1). In some transaction platforms, such as Airbnb, we observe activities aimed at managing the community, such as verifying user identity and facilitating the exchange of information between the parties. However, these remain supportive activities geared toward the main orchestration activity of enabling direct economic transactions among the platform users. In the case of the PI platform, one of the core orchestration activities as the community organizer is knowledge exchange facilitation—the orchestrator provides a venue, a sharing infrastructure to resolve the knowledge fragmentation innovation bottleneck; coordinates knowledge exchange among peers in the form of solutions and feedback; and supports the innovation and diffusion process (see Table 4). From the temporal perspective, the community organizer is the first role that the platform assumed.
Contrary to other community platforms that have self-organized moderation, 42 in healthcare, due to safety concerns and the need to establish trust, PI introduced a medical screening mechanism from the very beginning. The screening is enacted by the platform’s medical team under the supervision of the chief medical officer, following a simple internally devised protocol. The medical team comprises medical doctors affiliated with the platform, performs the screening of all the solutions submitted to the platform. When in doubt about a solution from outside their area of expertise, they reach out to and consult with specialized medical experts, including some Advisory Board members, and consult with them. The chief medical officer always makes the final decision, registering the approval/rejection of the posts’ publication on the platform or eventually requesting further information from the innovator. Therefore, the medical team acts as an information gatekeeper, certifying the proposed solution and guaranteeing its quality.
In this sense, the platform performs an orchestration activity of an information certifier, validating and promoting only relevant information (see Table 4). This filtered information mechanism contributes to building trust in the community in a similar fashion to how transaction platforms reduce information asymmetry problems in their user community (see Table 1). However, in this case, it also helps create value for the community by steering users’ attention and development efforts toward those solutions with the greatest potential. For example, instead of users filtering through posts searching for something useful, the validation process ensures that every post contains a solution that solves a specific problem and does not represent an obvious threat to an individual’s safety. This process also has potential innovation spillover effects. By browsing published solutions, a potential innovator better understands what constitutes patient innovation and can be inspired to share or develop something for their own problems. This activity is somewhat similar, in terms of effects, to the curation activity performed by hybrid platforms (see Table 1) to improve information flow and shape the innovation direction in the ecosystem. Over time, the awareness of what constitutes a patient innovation has resulted in fewer rejected submissions, as the innovators who submit solutions have learned what is and is not appropriate for submission. The platform triggers collective awareness, helping to empower patients via information and knowledge sharing and through collaborative social action.
The platform stimulates the innovation activity of the community by categorizing and facilitating the exchange of relevant information among peers. It also steers knowledge exchange and innovation activities in specific directions, such as pooling together and matching a sufficient number of users working on similar projects. This addresses the innovation challenges that patient innovators often face in producing and improving prototypes of devices. The critical orchestration activity of the community organizer in these cases is the engagement manager—the orchestrator directs users’ focal attention, creates an urgency of action around a solution requiring support from the community, and motivates and engages members to support and adopt the solution. One such activity was a focused ideation sprint held in partnership with the Portuguese League Against Rheumatic Diseases to bring together a community of patients and other collaborators to solve specific rheumatology challenges. The sprint resulted in a few innovative ideas jointly developed by the community. As a result, greater experimentation, along with convergence around initial innovation designs, can emerge.
Together, these orchestration activities improve access to innovative solutions to more potential beneficiaries, amplifying the solutions’ value to the community and individual end-users. Indirectly, additional value is unlocked from showing and connecting innovations addressing diverse diseases and illuminating hidden needs, incentivizing more and better innovations in both innovation value networks. As the activities on the platform unfolded and new actors got involved, a new set of interlinked activities emerged. The second role the platform assumed was the market matchmaker role.
Bridging the innovation value networks—The market matchmaker role
Using the FDA’s risk-based classification that accounts for the properties and intended use of a product, the solutions posted on the PI platform can be of any of the three regulatory classes (class I—lowest risk, and classes II and III—highest risk to user safety). Most posts describe simple and very low-risk products and services, easy to describe in writing or nearly self-explanatory in nature, and fit into class I products—devices, processes, and exercises. Products that are more complex usually belong to classes II and III, and may have significant market potential. Such products require the involvement of key players in the established producer innovation value network that possess the manufacturing and commercial resources to bring innovations to market. Considering the solutions that have passed the medical screening and been approved (1,517 as of February 2022), about 68% of the devices in the PI portfolio are of class I, 30% are of class II, and only about 2% are of class III.
Lacking credibility for their own innovations, patient innovators face resistance from medical professionals (for adoption) and regulators (for commercial approval). To orchestrate such innovations, the PI platform must go beyond simply organizing the platform’s patient community; it must support innovators in the process of innovation development and commercialization, which also involves engaging with off-platform actors. One way is to take on the role of a market matchmaker. Compared with traditional matchmaking orchestration of transaction platforms (as in Table 1) aimed at facilitating transactions between sellers and end-users, in this role, the platform acts as an intermediary, connecting innovators with producers with the relative resources and manufacturing capabilities that are interested in bringing the innovations to the market. A critical orchestration activity is that of an information amplifier—the orchestrator augments information signaling of potential market matches through standardized screening and selective endorsement. These activities help overcome information asymmetry problems between innovators (patients), manufacturing firms (which might be interested in developing and selling the innovation), and adopters (medical professionals) (see Table 4). In this way, the platform contributes to the emergence of an (off-platform) market around those innovations. One form of selective endorsement is the PI Award, given on average every two years. The aim is to identify the most innovative and impactful solutions and, by promoting them, help amplify the impact of the innovations submitted to and shared by the platform. The Advisory Board of PI, composed of two Nobel Laureates and several prestigious scientists, selects the awards’ winners. The awards allow innovators to “borrow” the reputation of the Advisory Board for their innovations, signaling their value to the market through such endorsement. The selection process follows several steps. In the first step, the PI team creates a shortlist of potential candidates by selecting up to ten most promising solutions in each of the three categories. Each one of the shortlisted solutions is presented in detail to the Advisory Board to decide who the winner(s) are. Typically, there is a consensus about the winning solution. The jury includes individuals with various backgrounds, from material sciences and biomedical engineering to medicine, management, and law. It also includes individuals who are experts in the innovation and commercialization process. The interdisciplinary nature of the jury, with its pluralistic views and structured selection process, has been designed particularly to avoid potential selection bias due to the view/beliefs/background of a single member or a homogenous group of the jury.
In cases where innovative solutions can be created but necessitate further testing and other complex processes (such as for drugs), hindering the easy emergence of a market, the market orchestrator role of the platform can also involve facilitating the search for potential innovative solutions. Next, the orchestration can match these solutions to corporations or other entities interested in developing them further (i.e., developing them into a sellable product/drug). The platform thus orchestrates by value networks bridging—bridging disconnected innovation value networks (Table 4) and facilitating market access by connecting innovators to key players from the local market and healthcare innovation value network. Such bridging orchestration can take different forms, including innovation contests, 43 bilateral contracting based upon certification procedures, 44 or standardized one-to-many rules based upon self-selection mechanisms. 45 An example of the platform’s innovation contests is the PI Bootcamp Pitch Competition, launched in partnership with EIT Health, leading universities (in Denmark, the United Kingdom, Portugal, and Spain), and MedTech companies. Following participation in the Bootcamp, startups can attend the EIT Health Tour and network with many of the over 150 members of the consortium, including medical technologies and pharmaceutical companies, universities, R&D labs, and healthcare regulators. The tour is an example of bilateral contracting based on certification procedures.
The PI Awards and the PI Bootcamp Pitch Competition are examples of mechanisms set by the orchestrator to screen innovation projects based on their potential and augment their market value by signaling to prospective buyers through selective endorsements. Lacking these signaling mechanisms, a market for these innovations will fail to emerge because of the limited ability of market players to properly evaluate and assign value to those innovations. Therefore, the information amplifier orchestration activity is critical, along with the bridging activity, which facilitates access to, and the emergence of, the market for those innovations.
Consider the innovation developed by Lisa Crites, a journalist from Florida who had undergone a double mastectomy for breast cancer. After the surgery, the doctors advised her not to shower so as to avoid potential infections. Lisa searched for a product that would allow her to shower and not dampen her surgical wounds, but she could find no such product. She thus created one herself—The Shower Shirt—which she is now commercializing after founding her own company. Lisa was one winner of the Patient Innovation Awards mentioned above, which played an important role in her advertising efforts worldwide. As an example of one orchestration activity, PI showcased The Shower Shirt alongside other innovations during the Edge of Government presentation at the World Government Summit 2016 in Dubai. At the Summit, Lisa established a contract with a client in the Middle East, boosting her commercialization efforts. In addition, PI played a role in connecting Lisa Crites with potential producers of her innovation and customers in Portugal.
As a market matchmaker, the platform shapes the value for the innovators by improving the solution’s availability (in more markets), affordability, quality, safety, efficiency, and delivery. The existing producer innovation value network benefits from new customers, in the case of providers of complementary assets, or a better portfolio of solutions for a problem when companies acquire the technology or collaborate with patient innovators. The end-users benefit from better, safer, and potentially more affordable solutions. Our analysis further revealed that, as the two orchestration roles examined above evolved, new activities started to bring together the actors in both networks even closer, surfacing the need for additional activities by the PI platform and a new platform role—the innovation manager.
Making internetwork transition possible—The innovation manager role
Platforms create value by cultivating an ecosystem of complementary products and services. The concept of an innovation ecosystem has increasingly gained ground in the literature on strategy, innovation, and entrepreneurship. 46 If anything, given the specific constraints of the healthcare industry, taking a holistic perspective of the ecosystem is even more important in healthcare and MedTech, particularly for the production and commercialization of highly regulated and high-risk devices. When developing a healthcare device or service involves substantial R&D and is subject to demanding regulatory approval, facilitating information exchange among patients within the community (and with outside actors) is not enough. Specialized actors from the different segments across the value network must get together. PI must act as an innovation manager. The platform’s role, in this case, is to bring together all the actors involved in the innovation process to internalize the innovation externalities (from regulatory approval to market commercialization) and to coordinate innovation activities such that complementarities from cooperation can emerge. The orchestrator must create micro innovation ecosystems around those complex healthcare innovations (typically those of classes II and III) by engaging specialized actors, structuring roles, and leveraging their skills across the different steps of the innovation process. Such orchestration is needed to address the information complexity about the innovation development and commercialization process that patient innovators face. It is also needed to address their lack of knowledge, resources, and skills, which are required to scale up the process and move from prototyping into a functional product that can receive regulatory approval and scale its production (see Table 4). This is quite a unique orchestration activity compared with that in “traditional” platforms (see Table 1).
The PI platform, as an innovation manager orchestrating micro innovation ecosystems, can serve as a new collaborative entity to organize the external innovation activities of multiple actors and achieve complementarity in terms of assets (for generating and commercializing innovation). By specializing in the infrastructure of common assets for organizing and coordinating the different innovation sub-tasks accompanying the innovation process, the platform allows for the emergence of a layered, modular structure of the division of innovation tasks and labor 47 alongside the innovation value network. In this sense, in contrast to other traditional hierarchical organizations, the orchestrator makes sure that a product system can come into place not by assembling and directly integrating the different parts of the system but by integrating knowledge between the different parties that need to contribute their components to the system. Also, it does so by engaging these parties and structuring their roles and activities. One orchestration activity as an innovation manager thus is knowledge integration—the orchestrator selects, aggregates, and directs knowledge to and from multiple parties and directs innovation development efforts. PI Bootcamp—an accelerator program for innovators to implement and scale up innovative solutions—is an example of the knowledge integration orchestration activity. To facilitate orchestration activities, PI created the Bootcamp in partnership with leading universities and MedTech firms in Europe (Copenhagen Business School, IESE Business School, Nova School of Business and Economics, and Technical University of Denmark) and the United States (MIT Bootcamps and Harvard Medical School). It offers invaluable mentorship to patient innovators, passing on to them the knowledge about market validation, building effective teams that make great commercial products, finding customers, and optimizing logistics. PI also established other specialized knowledge integration orchestration activities. By partnering with Lex Mundi, the world’s leading network of independent law firms, PI supports innovators with knowledge on legal issues of liability and intellectual property protection. The lawyers help reduce the complexity of regulatory information, provide practical advice on specific issues, and guide actions. Another specialized knowledge integration activity is the healthcare innovation project, designed to provide mentorship to entrepreneurs about scaling up their patient innovation–based ventures, often through the engagement of the external actors in the innovation ecosystem.
Consider the example of PneuMon, a MedTech startup based in Copenhagen, developing novel sensor technology to measure breathing patterns for chronic obstructive pulmonary disease (COPD) patients, which participated in the PI Bootcamp and the follow-up activities. As the company is in an early stage of development, it needs help with the validation and product-market fit. PneuMon’s primary target groups were patients and doctors—patients because they use and wear the product; doctors because they prescribe medicine to patients. Via the platform’s medical team, they were connected to doctors who had collaborated with PI and had agreed to test the product with their COPD patients.
The development, testing, validation, and commercialization of Biel Digital Glasses by Jaume Puig (Spain), originally for his son Biel, also fall under this category. Biel Digital Glasses, for instance, was one of the participants in the PI Bootcamp, which won the EIT Health pitch competition. Following the Bootcamp, they participated in follow-up activities, such as the healthcare innovation project in partnership with innovation programs at different European universities (CBS, NovaSBE, and DTU), aimed to help entrepreneurs overcome innovation challenges related to a lack of knowledge with the innovation development and entrepreneurial process. Additionally, they gained significant insights along the way about entering the Danish healthcare system, which they had established as a priority of their go-to-market strategy.
The examples mentioned above also show that the PI platform performs another orchestration activity, innovation system integrator. It engages and structures roles and activities among specialized actors along the inter-steps of the innovation production process. This activity goes beyond integrating knowledge, as it organizes and coordinates the different innovation sub-tasks, allocating them to suitable parties. The importance of innovation system integration is best observed when analyzing a case of failure, when the orchestration did not create a functional micro innovation ecosystem. Consider the case of Diogo Lopes, a young pianist who suffers from Charcot-Marie-Tooth (CMT) disease. CMT is an incurable neuromuscular disease that affects the muscles of the hands and feet, making them cold and rigid. Lopes envisioned a set of removable thermal pockets he could use to keep his hands warm as a possible solution. He made some draft plans but lacked the skills and resources needed to build such a product by himself. The PI team facilitated the engagement of and collaboration with several engineering students and faculty who helped Diogo develop his product as part of their studies. Unfortunately, they all entered this journey without discussing the ownership of the innovation and subsequent developments, as well as of the intellectual property of the final product. PI provided no infrastructure setup to guide such a process. At this stage, neither Lopes nor the students could agree on the developmental trajectory for the innovation, or whether to share it or register it as intellectual property. Even though PI provides free legal advice worldwide via Lex Mundi, in this case the advice was insufficient to negotiate ownership of intellectual property. This was an apparent coordination failure of the various efforts and can be related to the lack of a functional ecosystem that links the value networks, resources, and knowledge assets needed to undergo the required testing and clinical trials for approving the devices and their use. In short, the PI team has failed to perform its innovation manager role to properly integrate knowledge, align the incentives, allocate the innovation tasks, and shape the innovation trajectory of the project.
In summary, as innovation manager, the platform shapes the value by easing the development process of an innovative solution. The orchestration activities benefit the innovators by integrating their skillset with assets and skills from specialized actors, augmenting their ability to produce their innovations and commercialize them. The end-users benefit from having more specialized solutions to tackle their problems. In terms of social welfare, having new solutions emerging is improving healthcare and quality of life, and the commercial component means more economic activity.
All approved solutions (1,517 as of February 2022, about 48% of the total submitted) have benefited from the community organizer orchestration activities. About 21% of the approved solutions have also benefited from the platform’s market matchmaker role, and about 5% from the role of innovation manager. All in all, a total of 628 innovations published in the platform are now commercially available (i.e., 41% of the solutions that have been approved by the PI medical team) and have benefited from different roles of the platform (community organizer, market matchmaker, and innovation manager).
The Innovation Value Shaper Model—A Tripartite Role of the MSP
The three roles described above are not mutually exclusive. They must be performed in parallel by the PI platform, which effectively performs the tripartite role of the innovation value shaper. In Figure 6, we propose a general model of innovation value shaping based on the PI platform case. From the innovation management perspective, the patients’ community is a universe of needs, ideas, and solutions to problems related to living with different medical conditions, of which some reach the PI platform (label 1, Figure 6). The platform (label 2, Figure 6), as a technological artifact, affords the patients the technological functionalities to freely share and categorize ideas and solutions in a curated, regulated environment and to collaboratively improve them by giving feedback, suggestions, personalization, or other modifications.
The “Patient Innovation” innovation value shaping is operationalized by creating pathways and establishing missing links that afford to the patient community the capacity to frame, communicate and engage on (1) innovative ideas and solutions; the options to (2) certify and freely share information about them with other users of the Patient Innovation platform; and to commercialize promising ideas or solutions (3) via firms in the established producer innovation value network or (4) via newly formed, ad hoc innovation value networks.
The solutions that emerge in the community cannot achieve their potential impact on their own. The facilitation of easy sharing and the support provided to ensure trust, ease of search, and access to information is not a guarantee that novel solutions will materialize their potential. For that to happen, the solutions need to mature, improve, pass the necessary checks with the regulators, and get into the supply chain to reach the masses. As a value shaper, the platform needs to create those links to ensure a pathway between the two value networks. There are two options for the commercialization of the patient-developed solutions: via firms in the established producer innovation value networks (label 3, Figure 6), or newly formed ad hoc innovation value networks created around new firms in the form of user entrepreneurship (label 4, Figure 6). 48 The two options have some of the orchestration activities required in common. First, there is a need to ensure the objective function fit, which means that the solutions shared on a platform also have commercialization potential. In principle, that process is a funnel (funnel 2, Figure 6) and requires solution-related domain knowledge expertise and market assessment expertise. Once the solutions are selected, the founders require upskilling in terms of understanding the complex regulatory landscape, which is especially relevant for medical products or services requiring regulatory approval (FDA classes II and III), identifying how to reach the minimum viable product suitable for market, and how to access funds. For commercialization via producers in the established value networks, the critical orchestration activity is matchmaking. The orchestrator creates venues and interactions between MedTech firms or complementary assets providers and patient innovators, showing the value of collaboration to both parties and facilitating the collaboration to happen. In the case of the other path (label 4, Figure 6), the orchestration is focused on the production and commercialization of patient innovations via ad hoc innovation value networks, usually more complex class II and III medical devices. The orchestrator is doing more than enabling interactions; it establishes the processes of discovery, sharing, and exploring of ideas that could be solutions and of solutions that require improvement or accelerations. It also establishes processes to produce and enable the commercialization of patients’ ideas and solutions and their introduction to the market.
A peculiarity of the PI platform orchestration is that one set of processes happens on-platform within the patient community, involving the actors internal to the platform (Figure 1b), and the other set of processes happens off-platform, as they involve actors external to the platform (Figure 1a; e.g., doctors, regulators, and manufacturing firms).
The platform performs all three orchestration roles (described in Table 4) in parallel to execute these on- and off-platform processes, decoupling the activities according to the types of innovation challenges faced by patient innovators. This decoupling allows the patient community and traditional healthcare innovation value network to maintain their internal dynamics. At the same time, the platform enables and coordinates the collaboration and inter-steps innovation processes between internal platform users and external actors in the established innovation value network to drive user ideas into commercial innovations.
By organizing the patient innovation community and coordinating and integrating the two innovation value networks, whether through market matchmaking or innovation management, the orchestrator performs a tripartite role of the innovation value shaper, directing value creation by guiding users toward effective innovation pathways that involve established actors in standardized forms. This is done by providing: clear options to user innovators to freely share or commercialize their innovations (as presented in Figure 6); directions on how to navigate within and between the innovation value networks; and, most important, motivating and engaging all the actors toward the steps needed to introduce novel patient-developed solutions to the community or the market.
When considering the learning from the case of PI, it is important to take into account the platform’s origin and the associated path dependency. Namely, the platform had its origins in an academic research environment, and for a relatively long period, it grew almost solely based on the research funds. While these circumstances allowed freedom in determining how the platform evolves, the limited availability of resources may have played a significant role in how and when each of the roles materialized. For example, the innovation manager role activities have happened closely after the first market matchmaker role activities. But these two roles did not continue to develop concurrently, even though the need for both was clearly identified. In other words, although the innovation value shaping was fully observed as a tri-partite role, it materialized in stages due to resource limitations. Hence, the platform’s orchestration roles are not sequential, as the temporal analysis may be suggesting. The innovation value shaping may happen at any stage of a patient innovation, whenever an idea, prototype, or an already marketed product enters the platform’s ecosystems.
Conclusion
Building platform marketplaces in the healthcare sector presents unique opportunities but also substantial challenges. Given the nature of healthcare, its risk levels, and the essential need to ensure safety and effectiveness, as well as complex regulatory frameworks that vary from country to country, simply replicating the playbook of the platform model from other sectors in the healthcare industry will not work. In this context, we discussed the case of the PI platform to illustrate how the platform model can stimulate user-generated innovations and perform the different orchestration activities required to support various types of such innovations. How to govern this collective innovation effort via an MSP is a major information management problem—one that involves choosing the appropriate platform orchestration mode.
As a community organizer, the platform organizes a community of user innovators and beneficiaries and stimulates innovation by validating relevant information, enabling information sharing and user interactions on the platform. As a market matchmaker, the platform can facilitate access to the market for patient innovations by promoting innovation contests, providing supporting tools for innovation commercialization, and connecting innovators to key actors in the local target market and healthcare system. This means establishing links between the platform’s internal actors and the external off-platform actors. As an innovation manager, the platform can structure roles and activities among the actors in the (micro) ecosystem around the complex innovation solutions, organize them as a collective and distributed enterprise, coordinate innovation efforts from multiple actors, internalize the process of testing and trial, and facilitate the ultimate commercialization of innovations and their scale-up.
Our findings reveal that—given the properties of the patient community and traditional healthcare innovation value networks, the plurality of healthcare devices and services, and their distinct nature in terms of safety risk and the complexity and knowledge required—the platform must simultaneously operate in these multiple orchestration modes. As an innovation value shaper, it must organize and engage the community of patients, stimulate the influx of the critical platform asset—patient innovations, promote free sharing of solutions as the pillar of the patient community, and create options to transition from the community to traditional value network and commercialize solutions. In this way, the platform can surface the patient community innovation value network, connect it to the traditional healthcare innovation value network, and guide value creation and appropriation within and across the two networks, unlocking the innovation potential in healthcare. This presents resources and organizational challenges for the platform provider, who must also manage the potential tensions and conflicting mechanisms for attracting and coordinating different constituencies on- and off-platform.
A key strategic challenge for a like-minded wannabe platform organization is determining the platform’s key asset: who provides what and who uses it. That asset dictates the resources and processes that need to be in place to incentivize the engagement of patients and trigger reinforcing direct and indirect network effects. With the PI platform, since the key asset is patient innovation, the platform must simultaneously maintain a reputation among patient community members and the established healthcare value network, protect individual safety, and stay aligned with all positive regulatory practices. Therefore, besides a technical team to maintain the quality of use experience and administrative staff to monitor routinized work, the platform requires a medical team trained to filter—recognize user innovations in healthcare of different complexity, risk, and intended use—and certify that the solutions are safe. Finding suitable candidates for these tasks is not trivial; the medical team needs to handle solutions for a wide scope of health conditions. The composition of the Advisory Board—which, in the case of the PI platform, includes world-class scholars and Nobel Laureates—is another critical challenge. As the platform addresses problems that require medical, social science, technical, and other knowledge, having experts to help cut through the complexities and converge quickly to practical solutions is instrumental. In this sense, helping users overcome their lack of legitimacy and reputation as innovators is among the delicate tasks the platform must take on. The Advisory Board’s reputation is invaluable in bringing credibility to the project, which in turn helps in fundraising. Also, it helps establish partnerships with leading universities, which are not only valuable for transferring critical knowledge to the participants, but also for the shared reputation and legitimacy that participants can acquire and transfer. This instills positive reputational feedback loops, with platform members benefiting from legitimacy spillovers.
Arguably, part of the PI platform’s success can be attributed to the tertiary nature of the founding team members and their affiliated institutions. We interpret success as the capacity to shape the innovation value in the user innovation network and selectively funnel it to both the market (producer innovation value network) and the user community. Practically, the success is observed in the number of shared solutions that became more accessible to the community for free or through commercial channels, or in solutions that became better and reached more individuals. The platform emerged at an independent university and from a research project focused on understanding the dynamics within the informal and fragmented community of citizens innovating in healthcare for their own use. The traditional healthcare innovation value network keeps academic institutions in high regard. However, this might not be a granted outcome for a platform organized by a for-profit organization; it could face greater tensions and experience resistance from both the patient community and the external actors, an aspect that must be added to the challenges.
Footnotes
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by Fundação para a Ciência e a Tecnologia (UIDB/00124/2020, UIDP/00124/2020 and Social Sciences DataLab -PINFRA/22209/2016), POR Lisboa and POR Norte (Social Sciences DataLab, PINFRA/22209/2016).
Author Biographies
Carmelo Cennamo is Professor of Strategy and Entrepreneurship at Copenhagen Business School and the Director of the Digital Markets Competition Forum (email: 
;
Pedro Oliveira is Professor MSO at Copenhagen Business School and the Calouste Gulbenkian Foundation Chair Professor for the Impact Economy at Nova School of Business and Economics. He is also the Founder and President of Patient Innovation (email:
Leid Zejnilovic is an Assistant Professor at Nova School of Business and Economics. There he founded and co-directs the Data Science Knowledge Center. He is also a consultant at Patient Innovation, a platform for sharing solutions developed by patients, non-professional caregivers, and volunteer collaborators (email: