A stakeholder evaluation of a business model for a commercial online health platform.

1

Master’s Thesis

MSc BA Small Business and Entrepreneurship

A stakeholder evaluation of a business model for a commercial online health platform.

Stefanie van Logchem Faculty of Economics and Business

Augustus 2016

Student number: 2205785 Supervisor: dr. F. Wijbenga Second supervisor: prof. dr. P. Zwart

Word count: 12.393

Kanaalwestzijde 62a

7936TM Tiendeveen

s.van.logchem@student.rug.nl

Abstract

In light of the vast increase in the offering of self-reliance healthcare consumer products, it is hard for consumers to choose the product that is most suitable for them. For businesses, on the other hand, it is hard to stand out and signal the quality of innovative products. The purpose of this study is investigate the feasibility of an online platform that provides this transparent information to customers and, helps businesses signal quality of their innovative products. This study aims to answer the question “What elements are critical to the feasibility of an online platform that functions as comparison website for healthcare consumer products?” Several interviews with stakeholders from both the business as well as the healthcare side were conducted. In the healthcare sector, it is essential to into account the perspectives of multiple stakeholders. Caregivers are enthusiastic about the platform, but notice that their patients do not want to pay much for these products on grounds that they already have paid healthcare premiums. Therefore price of the product is important, as well as quality, reliability and safety. Instead of focusing solely on (expensive) innovative products, the platform could start with a number of established products and provision of information that creates traffic towards the platform, which makes it attractive for small businesses to display their innovative products.

Key words:

Feasibility study, business model, healthcare, multi-sided platform, stakeholder theory

List of figures

Figure 1: The Health Care Value Chain (Burns et al., 2002) ... 4

Figure 2: Preliminary business model Platform Q ... 7

Figure 3: Conceptual model ... 9

Figure 4: Reflective redesign. ( van Aken, Berends & van der Bij, 2012) ... 10

Figure 5: The research process ... 11

Figure 6: Stakeholder network Platform Q ... 15

Figure 7: Revised business model ... 32

List of tables Table 1: Search terms ... 12

Table 2: Cases ... 13

Table 3: Example structure interview guide (based on Emans, 2004) ... 14

Table 4: Stakeholder opinions about current concept platform Q ... 18

Table 5: Product criteria ... 22

Table 6: Important points of attention for Platform Q ... 28

Table of Contents

Introduction ... 1

The opportunity ... 1

The purpose ... 1

The research question ... 1

Significance of the study ... 2

Background ... 3

Stakeholder theory ... 3

Stakeholder theory in the healthcare sector. ... 3

Feasibility study ... 4

Business models ... 4

Multi-sided platforms ... 5

Conceptual model ... 6

A business model for Platform Q ... 6

Customer segments and their value propositions ... 6

Channel and customer relationship ... 6

Key partners, key activities and resources. ... 6

Costs and revenues ... 7

Design for a feasibility study ... 7

Industry feasibility ... 8

Product feasibility ... 8

Organizational feasibility ... 8

Methodology ... 10

The research design ... 10

The process of literature review ... 11

Data collection ... 12

Case selection ... 12

Interview guide ... 13

Quality criteria of the research ... 14

Analysis ... 15

Industry feasibility ... 15

The stakeholders and their interests or needs ... 15

Product feasibility ... 16

Organizational feasibility ... 21

What product evaluation criteria are important to the stakeholders? ... 21

What criteria relating to the platform are important for the feasibility of the platform? . 26

Discussion ... 29

Recommendation ... 31

A revised model for Platform Q ... 31

Customer segments and their value propositions ... 31

Channel and customer relationship ... 31

Key partners, key activities and resources. ... 31

Costs and revenues ... 32

Conclusion ... 33

Limitations and further research ... 33

Acknowledgements ... 34

References ... 35

Appendix 1: Flyer Platform Q ... 37

Appendix 2: Instructions for the interviewer ... 38

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1 Introduction

In recent years, there has been increasing interest in consumer empowerment in healthcare. With aging populations, governments face the challenge to curb the increasing costs of healthcare. This has resulted in more attention for self-reliance of patients and prevention of chronic diseases.

Concurrently, there has been a vast increase in the offering of self-reliance healthcare consumer products. In light of this development, it is hard for consumers to choose the product that is most suitable for them. For businesses, on the other hand, it is hard to stand out and signal the quality of their products. On top of that, there is an increasing pressure for universities to commercialize inventions. This process, however, is arduous, as proper distribution channels in many cases are non- existent.

The opportunity

The aforementioned recent developments have heightened the need for a transparent and independent source of information, that helps consumers choose and firms display the quality of their products.

Besides that, the platform should pave the way for small firms with innovative products that so far have not found a large distributor, in that the platform presents the consumer’s interest for the product.

The opportunity here is the development of an online platform that, on one hand, provides this transparency by means of assign products on a number of quality criteria and by giving customers the opportunity to share their product experiences; and, on the other, connects business partners with each other.

The purpose

The purpose of this study is to assess the feasibility of the platform. In order to do so, this paper will focus on innovative healthcare consumer products. The objective of the study is to examine the information facilitating role and which variables play an important role to come to a transparent and feasible platform. In addition to this, the role of the platform as business incubator will be examined.

The research question

The research question that will be answered is “What elements are critical to the feasibility of an

online platform that functions as comparison website for healthcare consumer products?” As the

market for healthcare consumer products is different from ordinary consumer products, since different

parties (e.g. general practitioners, physiotherapists, specialists and health insurers) can influence

consumers’ buying behavior, it is paramount to map the most influential stakeholders. Therefore, the

following sub-questions will be addressed: “What are stakeholders of the platform?” and “What are

the needs or interests of these stakeholders?” Furthermore, their opinion about the platform is valuable

as it will enrich our understanding of what the platform should look like. This leads to the following

sub-questions: “What do stakeholders think of the concept?” and “What product evaluation criteria are

important?” Lastly, it is essential to gain insights in what makes a platform feasible. This results in the

2 final sub-question: “What criteria relating to the platform are important for the feasibility of the platform?”

Significance of the study

Over the course of the years several guides have been written about how to conduct a feasibility study (e.g. Barringer & Ireland, 2014; Karis, 2014; Liraz, 2014). However, far too little attention has been paid to how to systematically conduct a feasibility study in healthcare settings. The market for healthcare consumer products is different from ordinary consumer products, as different parties (e.g.

general practitioners, physiotherapists, specialists and health insurers) influence consumers’ buying behavior. So far, only Starkey, Judd, Clark, and Smith (2011) evaluated the “development of an e- commerce website for innovations emerging from a public sector healthcare system”. However, this e- commerce website dealt with products that are commercially not feasible, but that could be helpful to the National Health Service of the United Kingdom. It did not focus on the feasibility of an online platform that for clear information healthcare consumer products. The theoretical contribution of this study is to develop a framework that provides insights in how business opportunities in the healthcare sector differ from other business opportunities, and how different perspectives of different

stakeholders have to be taken into account in this process. The aim here is to provide the reader with a framework that can be applied in the assessment of a business opportunity in a healthcare setting.

From a managerial perspective, this study attempts to test the feasibility of an opportunity in healthcare setting by means of this framework by applying it to the platform . Platform Q is a collaboration in the form of a consortium by Lavoisier BV, The Quantified Self Institute of Hanze University of Applied Sciences, and Business Generator Groningen of the University of Groningen and University Medical Center Groningen. Once the concept has proven to be feasible, Platform Q will be spun-off as a separate entity.

This paper has been organized in the following way. It first provides a theoretical background in which the topic of stakeholder theory, feasibility studies and business models are introduced. To connect the literature to the opportunity and to clarify the concept of Platform Q, a preliminary business model for Platform Q was prepared. Subsequently, the conceptual model is presented.

Afterwards the methodology will describe the research process, the literature review, the case

selection, method of analysis and quality criteria for research. Subsequently, it moves on to the

analysis, which is followed by a discussion of the results and a recommendation. The paper ends with

a conclusion, in which main findings will be summarized, limitations will be addressed and directions

for future research will be provided.

3 Background

In this section there will be a focus on relevant literature. This chapter will first introduce stakeholder theory. After that, it raises the topic of feasibility study. This paragraph will lay the foundation for the theoretical framework. Subsequently, the topic of business models will be introduced. Business models are relevant to this study, as it “describes the rationale of how an organization creates, delivers, and captures value.” (Osterwalder & Pigneur, 2010, p.14). By constructing a business model for

‘platform Q’ based on initial meetings, the framework can be tested and criteria can be applied to the platform.

Stakeholder theory

Stakeholder theory states that firms should not only be responsible to their shareholders, but also to their stakeholders (Freeman & Reed, 1983). A stakeholder is ‘any group or individual who can affect or is affected by the achievement of the firm’s objectives’ (Freeman, 1984). Consequently, considering the interests of these groups is crucial to a firm’s existence as thoughtful consideration of their needs will make stakeholders more amenable to support the firm, which is important for the firm to thrive (Freeman, 1984).

Because management is constrained in time, it is necessary to define which entities require management’s attention. Therefore it is worthwhile to make a distinction between primary and secondary stakeholders (e.g. Clarkson, 1995; Parmar et al., 2010). Primary stakeholders are stakeholders the firm depends upon for survival (Clarkson, 1995). Secondary stakeholders are stakeholders ‘who influence or affect, or are influenced or affected by, the corporation, but they are not engaged in transactions with the corporation and are not essential for its survival’(Clarkson, 1995).

Usually stakeholder theory researches the interactions between the focal firm and its

stakeholders on a dyadic level (Neville & Menguc, 2006). This leaves valuable information uncovered as stakeholders are not autonomous (Neville & Menguc, 2006). Rowley (1997) argues that firms are part of complex networks of interwoven relationships. Therefore, in order to understand how firms take on their stakeholders claims, it is necessary to analyze the complex interactions in the

stakeholders (Rowley, 1997). Stakeholder multiplicity, “the degree of multiple, conflicting, constituent expectations exerted on an organization’ (Oliver, 199, p. 162), can strengthen the claim of a

stakeholder. A stakeholder that on its own does not have the attributes to influence the firm may through support of others substantiate their claim (Neville & Menguc, 2006).

Stakeholder theory in the healthcare sector.

Previous studies (Burns et al., 2002; Schau, Smith & Schau, 2005) demonstrated the importance of

stakeholders in the healthcare sector. By placing different players in a healthcare value chain, Burns et

al. (2002), distinguish between paying, intermediating providing, purchasing and producing parties in

the healthcare sector. A classification of the different parties can be found in figure 1. However, this

value chain has its shortcomings as healthcare sector is fragmented and “professional norms of patient

4 care and provider autonomy, as well as public goals regarding patient access and quality of care” are highly valued (Burns et al. 2002). Although, the industry is fragmented, Schau, Smith and Schau (2005) indicate that the Internet facilitated communication amongst different parties in the healthcare sector. It follows that although communication has been facilitated, each player in the value chain has its own interests or needs, in which some players have more similar interests than others.

Figure 1: The Health Care Value Chain (Burns et al., 2002)

Feasibility study

After having identified an opportunity, and before developing a business model, it is imperative to conduct a feasibility analysis to determine whether the business idea is viable (Barringer & Ireland, 2016). Barringer and Ireland (2016) distinguishes between four types of feasibility, which are product or service, industry or target market, organization, and finance related. Product or service feasibility that analyses whether there is demand for the business idea, industry or target market feasibility that determines whether it is interesting to operate in a specific industry or market. Immature markets that are growing have the most potential to be successful. Organizational feasibility examines whether an organization has the potential to follow through on a business idea. Lastly, financial feasibility is necessary to assess whether the business idea could generate enough revenues, but also what amount of capital needs to be invested and also estimates how similar businesses perform.

Business models

In the business community the use of business models is common, but in the academic world little has been written about this topic (George & Bock, 2011).A Business model consists of several elements that ‘describe the rationale of how an organization creates, delivers and captures value” (Osterwalder

& Pigneur, 2010, p.14). It represents a static view on organizational activities and how it translates an opportunity into value (George & Bock, 2011). Therefore, business models can be useful in the process of starting up a business, as the building blocks of a business model can “justify the financial capital needed to realize the model and to define a path to sale up the business” (Chesbrough &

Rosenbloom, 2002, p. 534). Several researchers have identified elements of what constitutes a

business model (e.g. Al-Debei & Avison, 2010; Osterwalder & Pigneur, 2010; Teece, 2010) One of

5 the most convenient templates is the business model canvas by Osterwalder and Pigneur (2010). The model delineates the firm’s customers segments; the customer relationship; the value proposition, which describes how the mix of products and services delivered by the firm creates value for its customers (Osterwalder & Pigneur, 2010); and the channel it uses to communicate with its customers (Osterwalder & Pigneur, 2010) Furthermore, it describes the firm’s key partners, key activities and key resources. Besides that, it lets managers think about the firm’s cost structure and how revenues are generated.

A business model differs from strategy while “[S]trategy generally requires careful, analytic planning, calculation and choice, which assumes that there is a great deal of reliable information available”, whereas business models are based on confined amounts information available

(Chesbrough & Rosenbloom, 2002). A business model is more widely applicable, meaning the same business model can be applied to several firms and is therefore easily imitable. Teece (2010) states that in order to protect a competitive advantage it is paramount to focus on the business model and

strategy.

Doz and Kosonen (2010) point out that many firms fall short, because they stick to what used to be working for too long, without being strategically agile. Strategic agility is a combination of a management’s ability of being aware of strategic developments; being able to make swift decisions;

and being able to ‘reconfigure’ its firms abilities and quickly reassign the firm’s resources (Doz &

Kosonen, 2010). To put it in other words, a business model does not direct change over time, thus it should be adapted when the firm evolves. For example, a business models may be renewed when the firm uses a new channel to communicate with its customers.

Multi-sided platforms

Platform Q will be an example of a multi-sided platform. Multi-sided platforms have a distinctive business model. A multi-sided platform acts as an intermediary between at least two different groups that are interdependent of each other (Eisenmann, Parker & Van Alstyne, 2006; Evans, 2003;

Osterwalder & Pigneur, 2010). Characteristic of this business model is that the value of the platform increases when more consumers make use of the platform (Eisenmann, Parker & Van Alstyne, 2006;

Evans, 2003; Osterwalder & Pigneur, 2010). However, when one type of consumer is missing, the

platform will lose all its value. In the case of Platform Q, the consumers that search for healthcare

products can be seen as one side. The other side constitutes the firms that promote their products via

the platform.

6 Conceptual model

Having explained the key elements of this study, two models are applied in this study. For the

opportunity itself, it is important to develop a preliminary business model, which is exhibited in figure 2. For the academic perspective it is important to develop a framework that can be applied in the health-care sector. This chapter therefore contains two models that will be evaluated in the end. The chapter will first introduce a preliminary business model for Platform Q in form of the business model canvas (Osterwalder & Pigneur, 2010). This model was based on initial meeting with the parties in the consortium. Afterwards a conceptual model for the design of a feasibility study in the healthcare sector will be presented.

A business model for Platform Q

Customer segments and their value propositions

Many things at this point were still unclear. Starting with the customer segments, platform Q should attract three types of customers. On one hand the platform will function as a testing ground for firms with innovative products. The value proposition belonging to this group is to give innovative firms the opportunity to display the quality of their products, so that they may be able to find a distributor that will expand distribution. On the other hand there are the potential customers of these products, which is a heterogeneous group. Some customer segments within this group are the chronically ill, the healthcare professional, the preventive users with a healthy lifestyle, and the tech-savvy early adopters. The value proposition belonging to this group is to provide clear and unequivocal information that is suitable to the customer, so that they can make informed choices. Eventually, distributors can be identified as a third group of customers, as the platform may function as a matchmaker when distributors are convinced about the interest for the product. The platform can inform the distributors about products that are interesting for them to distribute.

Channel and customer relationship

Platform Q is in fact a channel. The platform communicates the quality of products and provides information for comparison to the end-users. The relationship with the end-consumer is automated;

Platform Q should be self-explanatory when it comes to finding information and posting reviews. The value of information should become more accurate when more customers leave a review. A customer relation that is also considered is the option of matchmaking so that firms find each other in the creation of products.

Key partners, key activities and resources.

From the side of the platform there are the key partners, key activities and resources. Starting with the key partners, the parties in the consortium will be seen as the key partners in platform Q. Key

activities of the platform are the provision of information and giving voice to end-consumers. The key

resources of platform Q will be the data it generates by means of obtaining reviews. Furthermore, the

7 network that will be created will be the most important key resource that will exist over time. Besides that, the plan is to develop a number of criteria a product can be evaluated upon.

It is still uncertain whether the platform will handle the sale of products or will link to the firms of the innovative products. In case sales are realized, warehousing would be another resource of the platform.

Costs and revenues

How cost structures and revenues stream will look like depend on the other elements in the platform.

Costs that have to be taken into account are for the design, maintenance and marketing of the platform.

Besides that, in case the platform will take on the sales, it will have distribution costs. Revenues could be in the form of a commission for a sold product via the website or for a match found via the website.

Figure 2: Preliminary business model Platform Q

Design for a feasibility study

For this research elements in the framework of Barringer and Ireland (2010) will be used as guidance.

Because of the complexity and the broad scope of the project, the feasibility study will limit itself to three of these areas. In this study attention will be paid to product, industry and organizational

feasibility. Financial feasibility is at this point in time difficult to estimate, because at the outset of the

8 project, there is no clear concept of what the platform should look like. The conceptual model

presented in figure 3 demonstrates the design for this study.

Industry feasibility

The purpose of the industry/ target market feasibility study is twofold. Firstly, in the healthcare landscape there are many stakeholders that play an important role. Because it is not feasible to address every stakeholder in the healthcare sector, it is paramount to determine which stakeholders will be most influential. Secondly, because the stakeholders have different needs or interests, it is essential to establish their activities in the healthcare sector and how this could affect the feasibility of Platform Q.

This part of the analysis deviates from Barringer and Ireland’s (2010), as stakeholders are inquired in order to assess whether their needs are interpreted correctly.

Product feasibility

For the product feasibility different stakeholders will be asked about their opinion about the concept.

“What do they like about the platform ?” and “What are points that should be augmented?” are the questions that are key to this type of feasibility. However, before respondents can answer these kinds of questions it is paramount to provide them with some background information. In order to do so, a flyer with a brief description will be provided. This flyer can be found in appendix 1.

Organizational feasibility

The aim of this part of the study is to reveal a number of factors that are key to the success of online

platforms. Here, a distinction is made between the quality criteria for the products on the platform, and

the quality criteria for the platform itself. These key success factors should then be taking into account

in the actual development of Platform Q. In order to do so, interview partners will be asked about what

is important to them concerning the development or purchase of a health-care product and what

aspects are important to them for the platform to be attractive.

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Organizational

What product evaluation criteria are important to the stakeholders?

What criteria relating to the platform are important for the feasibility of the platform?

Product

What do stakeholders think of current concept of platform?

Industry

Who are the stakeholders of the platform? What are the needs or interests of different

stakeholders?

10 Methodology

In this section account will be given of how the research was conducted. Firstly, the research design will be addressed. The ensuing section will give the reader a better understanding about how the literature review was carried out. Subsequently the data collection will be explained, which will be followed by an explanation about the method of analysis. This chapter will be concluded with a justification of the research by providing an explanation of how the quality criteria of research were taking in account.

The research design

This research was initiated based on a field problem, as there was an opportunity to be evaluated. For this purpose the reflective redesign method by van Aken, Berends, and van der Bij (2012) was used as basic principle. Figure 4 displays the steps as should be taken when dealing with a business problem.

However, van Aken et al. (2012) indicate that the process of the evaluation of an opportunity is different from a business problem (p.89), which means that the steps to be taken are a bit different.

Based on their suggestions, the following steps are taken.

The first step van Aken et al. (2012) dictate is to investigate the opportunity. In order to do so, initial meetings with the parties of the consortium were held to better understand the background of the firms and what was understood to be the opportunity.

After having clarified the opportunity, a design step was taken, which consisted of reviewing literature and developing designs. For the purpose of the opportunity, literature about business models was reviewed and a business model was designed. Besides that literature about feasibility studies and stakeholder theory were reviewed. Based on this, a conceptual model for the elements of the

Figure 4: Reflective redesign. ( van Aken, Berends & van der Bij, 2012)

11 feasibility study were created, which will form part of the academic reflection at the end of the

research. Having established a preliminary design for the opportunity, data were collected and

analyzed. The topic of data collection will be elaborated upon later in this chapter. For the analysis of the interviews, the process of open analysis was used (Blumberg, Cooper and Schindler, 2011). This means that analysis was start without prior coding, and codes were developed during the analysis. A code was developed when a topic recurred multiple times or emphasize was added. After the analysis of the interviews, the results were compared and contrasted with literature. The following step was to summarize the findings relating to the exploitation of the opportunity. Afterwards a new design was made, which is in the case an adjusted business model. Because the project is only in its infancy, it is not possible to implement the business model and evaluate its outcomes. Thus after having made a final design, the problem solving cycle was concluded. Ultimately, I will reflect on the project and provide some directions for further research. Figure 5 provides a schematic overview of this process.

The process of literature review

In this section it will be explained how the literature review was conducted. The literature review was started, based on suggested readings by the supervisor. Furthermore, the EBSCOhost database was used to find relevant peer-reviewed articles. Table 1 gives an overview of the key words and search terms used in the search for literature. Combinations of search terms were made to direct the search towards for instance self-reliance healthcare consumer products. References of relevant papers were examined in order to find other papers that could contribute valuable information.

Figure 5: The research process

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concept search terms

e-commerce e-commerce, e-business, e-marketing

online platform online platform, online interface, comparison website platform two-sided platform, multi-sided platform

business model business model value creation value creation healthcare healthcare, health

self-reliance self-care, self-reliance, self –aid consumer products product, appliance, device, equipment key success factors key success factor, success factor, criteria

stakeholder theory stakeholder theory

Data collection

Case selection

Considering the complexity of the research project, qualitative research was deemed most applicable.

Based on the literature of stakeholder theory and its application to the health landscape (Pesse, Erat, &

Erat, 2006; Schau, Smith, & Schau, 2005), a number of key stakeholders that play an important direct or indirect role were selected. Each participant was asked for their opinion about the concept of Platform Q. Table 2 provides an overview of the interviewed parties and contains a reference to the interview guides that were developed for the interviews. Firstly, the research started with the intent to develop a platform for the promotion of inventions that came forth from academic knowledge transfer.

Therefore, an interview was conducted with a representative from a university hospital. From the demand side, three entrepreneurs have been interviewed. In these interviews attention was paid to the difficulties in the development and commercialization of the inventions. An interview was conducted with three representatives from an organization that specializes in business development and financing of medical innovations. These interview partners can indicate what problems are common in business development and financing in the field of healthcare.

One of the interview partners develops a product that is destined to help people who are oblivious. In order to create an overlap between different aspects, a case was built around the topic of dementia. Therefore, a patient organization in the northern part of the Netherlands was approached.

The sectorial service of this organization indicated it was better to approach a case manager or a member of a psychogeriatric team of home care providers, as these people work with these patients on a daily bases. A home nurse who is team leader of a psychogeriatric team and who is also case

manager in dementia has been interviewed. The intention of this interview was to gain insight in the

13 activities of the care providers, their patients’ needs, what devices are useful to the care providers and the patients and what the care provider would expect from the platform.

The scope of this project is broader than a case study on dementia and thus, a general practitioner and a nurse practitioner were interviewed.

Lastly, another stakeholder that was considered to be influential was the health insurer.

Although the connection of health insurers to the platform may be obscure, the rationale is the following. Platform Q will be established for innovative products, which are solutions that can have a substantial price. Since everyone is obliged to have at least a basic form of health insurance, it is assumed that potential consumers will approach the health insurer to see which products are covered in their policy.

Interview Date Stakeholder Interview guide

1 26 April 2016 University hospital Appendix 3

2 26 April 2016 General practitioner Not available

3 29 April 2016 Start-up 1 Appendix 4

4 3 May 2016 Start-up 2 Appendix 4

5 12 May 2016 Organization for business development and financing

Appendix 5

6 17 May 2016 Start-up 3 Appendix 4

7 20 May 2016 Home nurse psychogeriatric care (team leader)

Case manager dementia

Appendix 6

8 25 May 2016 Research institute Not available

9 27 May 2016 Health insurer Appendix 7

10 9 June 2016 Practitioner nurse Appendix 8

Table 2: Cases

Interview guide

Because of stakeholders differ from each other, several interview guides were created. For most interviews an interview guide was available, except for the interview with the general practitioner.

The latter was a spontaneous interview; a visit for making an appointment turned out into an interview. The interview with the Quantified Self Institute, the knowledge institute in the study and partner in the consortium, revolved principally around the question “What comparison criteria could be used for the products on the platform? Therefore, it was decided not to create a separate interview guide for this interview.

In order to come to a sound interview guide, the method Emans (2004) described for

developing an interview guide was used. For each interview guide a table was created to connect

questions to a conceptual variable. Table 3 serves as an example. First, conceptual variables were

14 developed, which in turn were divided in (smaller) raw variables. In the sequential steps the set of values were indicated. Because this is an exploratory research most questions are open questions.

In accordance with Emans-method (2004), each interview guide includes instructions for the interviewer. These instructions can be found in Appendix 2. All interviews were recorded and transcribed afterwards. In the final column, the numbers of the questions corresponding to the conceptual variables are given.

Quality criteria of the research

Reliability and validity are important to guarantee the quality of a research (van Aken et al., 2012;

Blumburg et al.,2011; Yin,2008). Another criteria essential to a field problem like this is recognizability of the results(van Aken et al., 2012).

Validity means that the conclusions that are drawn from the research are justified by the way the research was conducted (Audi, 1998; .van Aken, et al. 2012). In order to increase validity the research focused on the two sides of the platform, in which multiple representatives from both sides were interviewed. Furthermore, interviews were coded and and emerging patterns were matched.

Eventually results were compared with literature (Yin, 2003).

The objective of reliability is that future reseach can replicate the research and come to simular conclusions, which requires that the process should be well-documented(Yin, 2008).

Moreover, a chain of evidence was maintained (Yin, 2008): The interviews were recorded, then transcribed in Dutch. Subsequently, the key points of each transcript were summarized in English and compared afterwards.

Recognizability means that the results of the research will be accepted by the parties in the consortium ( van Aken et al. 2012). There are several aspects that should contribute to

recognizability: During the project several meetings have been held with the clients. To give the clients an idea of the research, two initial interview guides have been shared to discuss the covered scope. Besides that, the preliminary business model was presented to and adjusted in accordance with the clients. Several meetings were held to discuss intermediary findings.

Conceptual variable

Raw variable

Set of values Format answer

Format of notes

Involves question(s) The respondent Background,

Position

Answers given by respondent

Open questions

Audio file 1-3

15 Analysis

Industry feasibility

The stakeholders and their interests or needs

Based on the interviews and literature (Pesse, Erat, & Erat, 2006; Porter, 1980;Porter, 2008;

Schau,Smith, & Schau, 2005) figure 6 was designed. Porter (1980, 2008) distinguishes the bargaining power of customers, suppliers, employees, competitors and new entrants. Because of two-sidedness of the platform the supply and customer side may be confusing, therefore it was chosen to put on the left side the product suppliers, which are the firms that introduce innovative products; on the other side the consumers who buy products. Both sides of the market are markedly complex. To decrease complexity the treat of new entrants and existence of competitors are treated in one cell called competitors.The force ‘employees’ has been replaced by ‘founding partners’ as the platform is a collaboration between different parties. These are the primary stakeholders of the consortium.

Product suppliers consist of established firms and start-ups. Some start-ups are university spinnoffs who face a particular hard time, as they lack a business background. Start-ups are often dependent on third parties, that provide them with financing and/ or help establishing the business.

The difficulty for the start-ups is to obtain financing, whereas for investors it is difficult to judge which start-ups introduce a winning product.

The consumer side of the platform is complex to. The aim of the platform is to provide a wide

range of innovative products that can be applicable for professional and home usage. This research is

bound to those products that can be used by private consumers. These products range from medical

diagnostic tools to devices that make it possible to live independently for a longer period of time and

healthy lifestyle products like activity trackers. Consumers find it hard to assess which products are

16 most suitable to them and are influenced by parties like healthcare providers and the healthinsurers.

These two parties also have their own network of stakeholders, but in order to keep it comprehensible the most influencial party in this context the platform has been identified. Government policies provide healthcare providers and insurers with boundaries that have to be abided. From this

perspective costs of proffessional care should be curbed, efficiency in healthcare should be increased and patients should be empowered.

The founding partners have an important role in the platform. Their interest is the foundation and survival of the platform. The founding partners will depend on a number of parties to get platform up and running. Firstly, there are the development partners that for instance will have to develop the website. Secondly, there are the investors. Thirdly, in order to be awareof most recent developments and verify quality , the platform will have to remain in contact with research institutions. Lastly, since the platform is will hold innovative products, it is wise to stay in touch people in the field who can inform about their findings of the product.

A final group of stakeholders that is important to mention is the competitor. As far as I am aware there is not yet a platform that makes a wide range of innovative healthcare products available to consumers. However, it should be noted, that if the assumption of innovativeness is relaxed, there are numerous competitors that provide healthcare consumer products. These take the form of click- and-brick home care shops and member associations that can decide to take up innovative products.

Websites like Kieskeurig do compare healthcare products, but these compare only one type of product at a time.

In conclusion it is essential to understand the perspectives of all stakeholders, as

responsiveness to the stakeholders’ perspective impacts the platform’s success. From the product supply side, it is implied that some inventions may not reach the platform as start-ups find it difficult to find the financial resources. From the product demand side, it is implied that potential customers are influenced by healthcare professionals and the health insurer that both are abiding government policy.

It follows that although Platform Q has a commercial intent, it should also bear in mind the value of patient care and public goals in the healthcare sector.

Product feasibility

The product feasibility addressed the question “What do stakeholders think about the concept?” Table 4 provides an overview of the opinions held by the stakeholders and the key message that was

deducted from the interviews.

The findings reveal that there are two camps. On one hand, some stakeholders are receptive to

the idea. The stakeholders in favor are the professionals (general practitioner, home nurse, practitioner

nurse), and a start-up. This start-up and the business developers point at the fact that the market is

fragmented, in which large distributors wait until products start to catch on. However, there is the

chicken-egg problem: which target audience do you address first? This is the reason why the other two

17 start-ups and the health-insurer are skeptical about the platform. They point out that the success of the platform will depend on the ability to attract users. Start-up 1 doesn’t feel the need to use the platform himself, start-up 2 would rather use an established network, and start-up 3 would need to do additional research to see whether it would suit with their plans. The health-insurer states that the customers don’t like to pay for healthcare, as they expect the insurer will pay because of the premiums paid by their clients. Therefore the health-insurer also believes it will be hard to attract a large audience.

A solution, as provided by the business developers would be trying to attract some products

that are strong already that will generate much reviews. However, you have to be able to find some

parties who are willing to do that.

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18

Stakeholder Opinion about the platform Deducted message

General practitioner  The platform should not be a big commercial ‘toko’ (= store). This has no added value.

 Current systems are too commercial; instead there should be a confidential setting under auspices of GP.

 There is room for a good distribution channel, since the market is fragmented

 You’ll have to work with software developers, and connect the right things for patients with products and care or services. Patients want good services.

 For platform q, it would be good if there is a link to the GP

 When it boils down to activity trackers, those are omnipresent. Don’t go there;

comparison sites like Kieskeurig already do that.

 When it comes to innovative product, expensive ones won’t be sold as customers don’t want to pay.

 There is room for a platform

 Focus on the health aspect

 Should not be to commercial

Health insurer  The first thing that comes to mind is “When do I go to the website?”, “what would be a trigger for me to go there?” You don’t get there by saying: “it’s there”

 Is there something comparable? It looks like a Kieskeurig.nl. But new products are not yet reviewed on Kieskeurig.

 If you go to the GP, then the GP should have a reason to send you to the platform, thus he should know about the platform and not everything can be solved with a product

 I can understand that companies may want to use the platform: they want to generate revenues and they search a launching customer that searches for sales channels.

 I am skeptical when it comes to the client side of the platform: clients do not want to pay.

Innovative products are expensive. People pay health insurance premiums and expect that we will pay the product for them.

 I don’t see a direct connection between the platform and us as health insurer.

 Difficulty of attracting customers

 Customers unwilling to pay

 Chicken –egg problem

Practitioner nurse  I think the platform could be useful, when there is a clear overview. If I was a patient, I would take a look to see what is on the market that could help me. As practitioner I would take a look to see if there is something that has added value for my patients, so that I can advise them.

 If you make segments, you have to be have an exhaustive offering

 I can imagine that some segments will be easier to attract then others and some products

 Is interested

 Difficulty of reaching

particular segments

19 will be more attractive. COPD patients will be more difficult to attract, as I experience

that they are not that interested. There are little to no devices available to them. In our practice diabetics and elderly show most interest in their health. For the elderly it will be mostly the family that wants their parent to be safe, elderly not only, but family members.

Organisation for business development and financing

 The issue in the market: high tech diagnostic tools aren’t affordable for domestic use. If it’s affordable, it’s often not reliable, and specialist don’t attach value to it

 The market is fragmented; there are missing links in the value chain. For small firms sales and marketing is difficult because they don’t have the money

 If there is a tool that is medically validated and acknowledged, that’s the value added to the platform

 It might help to find associates, products that are ‘powered by’ for instance, a GP association, because consumers find it hard to judge quality of healthcare products

 Chicken-egg problem: you need a fantastic idea to bring it to the customers. So how do you get customers? But good ideas won’t be put on the platform when there are no users.

Maybe, you need to figure out how to bind some strong things (products) to the platform that, so that the number of customers grow and the number of reviews increases. In that case, you can start doing new things

 The market is

fragmented, there is an opportunity

 Chicken- egg problem

 Difficulty of attracting customers

Start-up 1  The success of the platform will stand or fall with the usage of the customers

 The concept looks a bit like Health talk online from a university in Massachusetts, which also spilled over to the UMCG where it is called “Praten over Gezondheid”. Patients can share their experiences and there are links to other sites.

 Would you consider using the platform?

o That depends on the costs involved

o It depends on success platform, I am skeptical.

o With a New firm, new product, I rather use something that is established, so that I can easily reach my target audience

 I do not see why would people go to the platform and that Platform Q is well-known

 The value added is that people use the platform, targeting multiple audiences makes it more difficult.

 Take a look at comparison sites for, for instance hotel rooms or insurance, it takes lots and lots of advertising before these sites get well-known and used.

 Chicken-egg problem

 Difficulty attracting customers

 Problem of newness of

the platform; no

established network

20 Start-up 2  Success of the platform depends on how well you will be able to attract people and how

well you will be able to make them leave a message. The main problem is: how do you convince your audience?

 Distributors are only interested when the platform is up and running

 You will have to foist products, explain customers they can’t do without the products.

 I don’t need a platform: our product is well known. I don’t need someone who is going to sell it for me. I may use it as advertising to link to our website, but who hasn’t heard of our product already?

 A major proportion of the firms link to suppliers. You can do that with Platform Q to, but the question is how to make money when making use of this mechanism.

 Chicken-egg problem

 Difficulty attracting customers

Start-up 3  I believe in the initiative, mainly because I think large distributors wait till new products catch on. The platform offers the possibility to demonstrate the potential of the product

 The platform could play an interesting role in the first phase of sales; the platform can demonstrate the commercial potential of the product

 Whether I would use the platform?

 That is something we should research whether it fits with our plans

 Depends on how the platform profiles itself, what kind of products will be promoted?

 Our product will be medically validated; we want to be acknowledged as such.

 Possibility to demonstrate

commercial potential

 Profile of the platform

Home nurse

psychogeriatric team (team leader) / Case manager dementia

 A think it is a good idea that you can go somewhere when you have question. How I envision it, if I have a question, concerning for instance personal alarm systems, I go to the platform were I can find the answer, then I don’t have to use google, but someone else filters the information and makes a recommendation about what is useful for me.

 Product reviews are helpful, as they help determine whether the product is tried for some sort of patients in similar situations. We are asked to test a robot with some of our clients.

I haven’t done so far, (I am afraid what it may do with the patient, they may get scared) but if I can read reviews of care givers that have good experience with it, then I’ll go for it.

 Platform is interesting

 Reviews are useful

Table 4: Stakeholder opinions about current concept platform Q

21 Organizational feasibility

There are two important aspects that should be tested to assess the feasibility of the platform. Platform Q will help consumers in making informed choices, so that they can chose the products that are most suitable to them. In order for platform Q to be able to do this, it is helpful to understand what

stakeholders find important when comparing healthcare products. Therefore, the first part of the organizational feasibility analysis will address the question "What product criteria are important to the stakeholders?" The final section of the organizational feasibility analysis will focus on the platform itself: What thoughts do the stakeholders have about what the platform should fulfill?

What product evaluation criteria are important to the stakeholders?

Analysis of the interviews suggests a number of criteria for comparison of product criteria. Table 5 provides an overview of criteria that were deduced from the interviews. The following criteria

emerged: quality, reliability, usability, efficacy and price. One criterion that was only mentioned once though could be especially important to healthcare products is safety.

The interviewees indicated that quality is an important aspect of a product. The question here is what exactly encompasses quality. Based on the interviews quality consists of reliability, usability.

Although mentioned only explicitly mentioned by the home nurse, safety would be another element.

High quality products are reliable; they provide accurate and consistent data. Besides that quality products have high usability; they are easy to use. Several parties (the start-ups and the practitioner nurse) indicated the importance of medically validated products. Start-ups 3 indicated that their product will be medically validated and wants to be recognized as such. The practitioner nurse indicated that, although not necessarily innovative, products like blood pressure monitors should be foreseen from a quality label. Besides being reliable and convenient, quality products should be save to use.

Lastly, another crucial element is price. Several interview partners indicated that consumers

do not want to pay much for healthcare products, as they feel they have right to the product because of

the high health insurance premiums they pay. Therefore, they feel the health insurer should pay. The

health insurers have their own business models and have to allocate their resources in an efficient way

that decreases the total spending on healthcare and leads to quality improvement. When it comes to

product criteria, medical necessity and efficacy are especially important to the health insurer.

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Stakeholder What is mentioned during the interview deducted criteria

General practitioner Many innovative products don’t make it to the market because engineers pay attention to incorrect requirements.

The costs of health-care have to be curtailed, which means some activities (like self-tests) can be done by the patient himself.

Firms should focus on:

 quality improvement for clients

 time savings for care givers

 cheaper solutions

Expensive products won’t be sold, as customers don’t want to pay. This leads to unnecessary and/or expensive solutions.

 quality improvement

 efficiency

 inexpensive

 decrease in healthcare spending

Health insurer What criteria are important for the health insurer to remunerate the purchase of a healthcare product?

You need to know is that there is an obligatory insurance and a supplementary insurance.

The contents of the obligatory insurance are determined by law. We have to abide to that.

When it comes to supplementary insurance, we can put together our own packages

 Medical necessity; a practitioner should recommend the product to the client

 Not widely applicable, but for a specific purpose that is medical necessary; activity trackers are immensely popular, which doesn’t serve the purpose health insurance.

 The need for the product should be an uncertain event. Glasses, for instance, should not be covered in the policy, as it is not an uncertain event.

 It should be proven that the product works for the treatment or diagnosing of illnesses.

 It should lead to a decrease in total spending on professional healthcare

 It should lead to reduced health insurance premiums

 medical necessity

 efficacy

 uncertain event

 decrease in healthcare spending

Practitioner nurse  Easy to use:

 People should use the products the right way, in similar circumstances as we do

 usability

 reliability

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 Quality is important, some products such as blood pressure monitors and blood sugar monitors need quality certification

 It should not be too expensive; if people don’t believe they need it, they won’t buy it themselves. They expect that things are remunerated by the insurer, because they pay premiums.

I am interested in innovative products, Improvements get my interest if they are more efficient in use

 quality (certification)

 inexpensive

 efficient

Organisation for business development and financing

 The issue in the market: high tech diagnostic tools aren’t affordable for domestic use

 If it’s affordable, it’s often not reliable, and specialist don’t attach value to it

 quality

 reliability

 affordability

 acknowledged by specialists Research institute What criteria do you apply for testing wearables?

 We examine whether the use of wearables lead to effective change in behavior. We also look at the validity and reliability of the wearables.

 To validate products on these criteria there needs to be a ‘gold standard’

 In order to validate new products, you need to determine these standards. You will have to start from scratch; determine how to do the research, its costs and the time it takes to determine the standard.

 This is a time consuming process. Developing quality certifications does not make sense, as it is not feasible. The technologic developments move faster than

academic research.

For technological products we use the criteria accuracy, and applicability. Accuracy is about the validity and reliability of the wearable. Applicability consists of usability, quality, price, and for technologies user experience.

 accuracy

 reliability

 validity

 usability

 quality

 price

Start-up 1  It should do what it promises; if it doesn’t work the product is useless.

 It should be easy to use, should be comprehensive, not complicated.

 It should have an attractive design. Appearance does matter.

 reliability

 usability

 attractive product

Start-up 2  We ask ourselves “what is possible with the technique? What features can we  technological possibility

24 deliver?

 Usability is important. How do elderly people feel about using these features?

 The product should be affordable. To lower the barrier, we don’t sell the product as a single item, but we offer the product in combination with the service, for which we make use of subscriptions.

 The product should be of high quality. The casing of the product should not interact with the skin. So the skin should not get irritated, and the other way round the casing should not be affected by body fluids.

 usability

 affordability

 high quality

 comfortability

Start-up 3  We find it important that the product is comfortable to wear. The product should be should be discrete

 The reliability of the measurement is very important. The ‘old standard’ is spirometry. Spirometry gives one reference point in time, which can provide unreliable results. We discovered that we need a more reliable standard

 Our product should give more reliable results than spirometry

 Our product will be medically validated; we want to be acknowledged as such.

 comfortability

 reliability

 quality

home nurse

psychogeriatric team (team leader) / Case manager dementia

 On the job we make little use of medical devices. We are basically the resource that supports the client. As a secondary resource supporting the caregiver in helping the client we use it as a last resort. This for the reason it can scare the client. The client may not understand the use of the product. For instance the purpose of a toilet chair may be unclear and is only perceived as chair.

We are asked to find people who want to test a robot. On one hand, I think it’s good, but I’m also afraid what it can cause.

 Automation solutions can be used fairly well, for instance for tracking/ monitoring purpose

 Devices that have a professional approach are often expensive, while a cheap solution would suffice. For instance of our clients bought a tracker for small children and used this to monitor his father.

 Products differ in quality, price and efficiency

 Not all old people have the strength and motorial abilities to be able to use all product

 Products shouldn’t be complicated; caregivers should be able to teach patients the use of the product. Dementia patients still have the ability to learn but everything

 usability

 quality

 price

 efficiency

 safety

25 has to be taught step by step, and repeated until it’s engrained in their system.

 When caregivers need products for their clients, another care giver assesses whether product is necessary

 Safety is another important criterion. For instance, I don’t feel comfortable using wall mounts (for in the bathroom) that are secured by means of suction cups. I prefer them being bolted onto the wall.

Table 5: Product criteria

26 What criteria relating to the platform are important for the feasibility of the platform?

Based on table 6 there are a number of things that have to be kept in mind for platform Q. There are three main elements that are important, which are the question of segmenting, the provision of information and quality of the platform itself.

Firstly, there is the issue of fragmenting the website in multiple consumer segments. Start-up 1 argued that marketing wise it is difficult to use multiple segments as it may confuse the target audience. From a healthcare perspective, however, it makes sense to create several segments. Without segments customers may get lost in a huge amount of products that may not be best for them. In the case of segmenting it is essential to make comprehensible segments that include all products that are suitable to this type of customer. If the segments are incomplete people may leave the platform, thinking it was not meant for them.

Moreover, the platform could play an important role in providing unequivocal information. The platform could enhance it role when it provides information that is in line with what caregivers, patient organizations or pharmacies in the Netherlands would prescribe.

Lastly, the platform should think about how it wants to present itself and what products it will offer.

Start-ups 3 indicated that it will offer a medically validated product and wants to be recognized as such Accordingly, combining or not distinguishing between validated and not medically validated products could have be negative for the platform. The home nurse psychogeriatric care supports this idea by stating that products should be supported by research, in that not all kinds of products are available through the website. Thus quality of products, but also quality of the platform is essential.

One element mentioned here is usability: people should be able to easily filter products on price

(range) and quality. In the discussion section, the topic of website quality will be discussed in more

detail.

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27 Stakeholder What is important for the platform?

General practitioner  The information should be unequivocal. There are differences in treatment of diseases in the Netherlands and the United States. So if a patient uses google, he becomes confused. There is a risk that too many parties get involved, which blurs lines. Therefore, when you offer something it should fulfil the requirements of quality improvement for clients, time savings for care givers, cheaper (solution).

 products should be offered in a confidential setting under auspices of a general practitioner Health insurer  The relationship between the health insurer on the platform is not clear

 For insurer this is attractive when it decreases the health costs in the healthcare chain, decreases the costs of professional healthcare and decreases premiums

Practitioner nurse  If you’re planning to make segments, you could segment the way we do: CVRM, diabetes, Asthma/COPD, elderly

 If some products fit more categories; just put it on twice, it has to be complete

 When it comes to the reviews: a combination of criteria and open textbox might work, so that people can clearly evaluate elements that are interesting to other people.

 I can imagine that some segments will be easier to attract then others and some products will be more attractive. COPD patients will be more difficult to attract, as I experience that they are not that interested. There are little to no devices available to them. In our practice diabetics and elderly show most interest in their health. For the elderly it will be mostly the family that wants their parent to be safe, elderly not only, but family members.

Organisation for business development and financing

 It is too soon for the platform to connect different ‘peels’ (E.g. distributors)

 You could involve a patient organization

 You could involve a venture lab

Start-up 1  Multiple segments make it more difficult

Start-up 2  Success depends on how well you will be able to attract people

 Distributors are only interested when the platform is up and running

 You need to develop a website that people like to visit, so you need to offer something else than your offering, making use of ordinary things that are interesting for people of all ages. In the past, games were interesting, nowadays news, information and gossip is more interesting.

Start-up 3 Criteria for the platform:

28

 How is it presenting itself?

 The organization should have experience in developing and organizing of web shops

 It could be negative if the platform would sell products that are not medically validated, Our product is medically validated, we want to be recognized as such

If you want to extend the platform, there should be synergy with the core business; I would not directly search a partner for the development of the product.

home nurse

psychogeriatric team (team leader) /

Case manager dementia

 I think it’s important that the platform uses filter options early in the search process. There should be well divided segments, perhaps even for problems with a specific segment.

 It is important to provide information how to get the product and what the costs are.

 Also take a look at quality and price range, so that people can filter about what they are willing to pay. Usability would also important.

 Products should be supported by research. I assume that you will work with parties that are knowledgeable. Not everybody should be able to just put products on the platform.

 To what people do you want to make the site accessible? You could ask care providers to test a product with their clients. The care providers can inform you whether the product is suitable to these clients.

Table 6: Important points of attention for Platform Q