Rethinking digital transformation of healthcare - The role of technology and institutions in service innovation

Arto J. Wallin

Research output: ThesisDoctoral ThesisCollection of Articles


Due to the mounting prevalence of chronic diseases, increasing demand for expensive treatments and the growing old-age dependency ratio, there is a pressing need to augment the productivity and quality of health and elderly care. Although the potential of digital technologies is widely acknowledged, focusing on technological innovations and incremental improvements originating from the healthcare system does not appear to provide the desired results. Therefore, there is a need for innovation that breaks established rules and practices and enables systemic transformation in healthcare. This article-based doctoral thesis builds on four published studies employing abductive case research strategy: a dialogue between theory and empirical analysis. The first two studies were conducted under the framework of European innovation programmes. They explore how digitally-enhanced services improve service productivity in the elderly care setting, and provide insights into innovation challenges experienced during a three-year collaborative innovation project. The latter two studies focus on start-ups operating under a start-up business accelerator programme. They increase understanding of the institutional constraints experienced by entrepreneurs when developing innovations that diverge from the prevailing rules of healthcare, and of the ways in which they attempt to change the rules hindering the adoption of innovations. The thesis contributes to service research by constructing a more profound understanding of the mechanisms that advance, hinder, enable and constrain service innovation in the field of healthcare. In particular, the thesis contributes to integrating the perspective of institutional entrepreneurship in service innovation, highlighting the importance of actions that contribute to breaking prevailing 'rules of the game' (i.e. institutions) and creating new ones. In addition, the thesis depicts how digitalization reveals the pervasive role of technology in innovation. Jointly, these contributions advance the synthesis view on service innovation – a view that highlights the importance of both technological and service aspects in innovation. The policy and managerial implications of the thesis suggest that, in addition to a complex set of institutions that guide innovation in the field of healthcare, the development context may also have a notable impact on innovation. The institutional structures of collaborative innovation programmes should encourage collaboration outside project boundaries, in order to foster the actors' awareness of the institutional and market environment. Exposing innovation to institutional forces makes it easier to comprehend the necessary institutional change and to develop ways of justifying the change to actors that are vital for its support. The institutional perspective should be more tightly linked to the practice of innovation.
Translated title of the contributionTerveydenhuollon digitalisoituminen ja muutos - Teknologian ja instituutioiden rooli palveluinnovaatiossa
Original languageEnglish
QualificationDoctor's degree
Awarding Institution
  • Aalto University
  • Rajala, Risto, Supervising Professor
  • Toivonen, Marja, Thesis Advisor
Print ISBNs978-952-60-8019-2, 978-951-38-8638-7
Electronic ISBNs978-952-60-8020-8, 978-951-38-8637-0
Publication statusPublished - 2018
MoE publication typeG5 Doctoral dissertation (article)


  • digitalization
  • service innovation
  • innovation challenges
  • institutionalisation
  • healthcare renewal


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