(Re-)Designing the Business Model of a Digital Ecosystem: An
Example in the Socio-Care Context
Andrea Pistorio
1
, Luca Gastaldi
1
, Paolo Locatelli
2
and Mariano Corso
1
1
Department of Management, Economics and Industrial Engineering, Politecnico di Milano,
via Lambruschini 4b, Milan, Italy
2
Fondazione Politecnico di Milano, Milan, Italy
Keywords: Ecosystem, Business Model Design, Innovation, Healthcare, Antecedents.
Abstract: The advent of digital innovations is pushing many companies to re-design their Business Models (BMs). Amir
and Zott (2015) described the process concerning the design of a new BM as constituted by elements, themes
and antecedents. This research is based on a European project aimed at improving the independent living for
elderly people affected by Mild Cognitive Impairment (MCI) or Mild Dementia (MD), through the definition
of a new BM based on the adoption of digital innovations. Through a clinical inquiry approach, this research
aims at analysing the interactions among antecedents and providing suggestions regarding the tools that could
support BM re-design processes for an ecosystem of actors. Results highlighted alternation of antecedents
that results in the continuous development of knowledge and increase of collected information. The increasing
complexity should be limited thorough the integration of the collected information that allows the removal of
not consistent information.
1 INTRODUCTION
Nowadays innovations require contributions of
different actors that collaborate and compete in the
development of new products and services
(Brandenburger and Nalebuff 1998; Moore 1993).
The concept of ecosystem is useful to analyse
contexts based on inter-organisational relationships
(Adner 2011; Moore 1993). Following Adner (2017,
p.42), ecosystem comprises “the multilateral set of
partners that need to interact in order for a focal value
proposition to materialize”. Value proposition is
defined as a “selected bundle of products and/or
services that caters to the requirements of a specific
customer segment” (Osterwalder and Pigneur 2010,
p.22). It is one of the main parts in Business Model
(BM) literature (Zott et al. 2011). It considers the
expectations and perspectives of the various actors of
the ecosystem, and it should enable the creation and
distribution of value among them (Adner 2017;
Gomes et al. 2016). The selection of the best value
proposition is a complex process because of the
multitude of available choices regarding existing
innovations and the various actors considered
(Schwartz 2003).
BM is a relevant concept in strategy literature, and
the number of publication about it increased from the
late of the 1990s (Klang et al. 2014; Massa et al.
2016). Most of these publications focus on the
perspective of the BM of a single firm, while others
also consider the network as the unit of analysis but
with the primary attention on the focal firm within the
network (Zott and Amit 2010; Amit and Zott 2015).
Following Wirtz et al. (2016), there are several
research areas concerning BM. These areas span from
the description of constituents of BM to the achieved
performance based on specific BMs. One of these
areas regards BM Design (BMD), and it illustrates
how BMs are created.
Some authors analysed this area (Zott and Amit
2010; Pigneur and Werthner 2009) and identified
several key conceptsi.e., antecedents, elements,
themes. Antecedents are the aspects that should be
taken into account before designing the BM (Amit
and Zott 2015). Elements are related to which
activities should be performed, who should perform
these activities and how these activities are
interrelated, while themes are the effects of these
activities and can be considered as proxies of the
value proposition (Zott and Amit 2010). Following
Amit and Zott (2015), there is still room to study
Pistorio, A., Gastaldi, L., Locatelli, P. and Corso, M.
(Re-)Designing the Business Model of a Digital Ecosystem: An Example in the Socio-Care Context.
DOI: 10.5220/0006712905790586
In Proceedings of the 11th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2018) - Volume 5: HEALTHINF, pages 579-586
ISBN: 978-989-758-281-3
Copyright © 2018 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
579
BMD regarding already established firms that are
modifying their BM (re-design) because of some
market opportunities. Moreover, it is not clear if
antecedents are still valid in the case of re-design of
the BM and which tools are suggested to accomplish
these activities. Finally, the relationships among
antecedents and themes are described, but it is not
clear if there are relationships also among
antecedents. Therefore, this research aims at
answering the following research questions (RQs):
RQ
1
: What are the existing
relationships among the antecedents
concerning the process of business
model re-design for an ecosystem of
actors?
RQ
2
: What are the tool supporting the
activities related to the antecedents for
an ecosystem of actors involved in the
process of business model re-design?
To answer these questions, we exploit an action
research accomplished among the activities of a
European project (Horizon 2020 program) aiming at
improving the quality of life of the people affected
with MD or MCI through the new care processes
supported by Digital Innovations (DIs) (Locatelli et
al. 2017). Therefore, we consider the viewpoints of
all the actors involved in the care process (e.g.
caregivers, healthcare professionals, social care
professionals, IT providers) to re-design the BM of
this ecosystem of actors. Indeed, the notions of BM
related to DIs are also diffusing in the healthcare
context (Steinberg et al. 2015).
2 THEORETICAL FRAMEWORK
Following Massa et al. (2016), BM research is
characterised by several definitions. Given the need
to take into account several actors and to avoid
focusing on a single focal firm, we adopt the
definition provided by Zott and Amit (2010, p.216),
which considers BM “as a system of interdependent
activities that transcends the focal firm and spans its
boundaries”. The research of Zott and Amit (2010)
identified the key design elements of content,
structure and governance. They are related to the set
of activities, called activity system, which the actors
perform to reach the overall objectives of the
ecosystem.
The other aspects analysed by these authors are
related to the themes, i.e., the primary drivers of value
creation. They are distinguished in the following four
categories: Novelty, Lock-in, Complementarities and
Efficiency. Amit and Zott (2015) furtherly developed
their research through the study of the four
antecedents of BMD named goal, template,
stakeholders activities and environmental
constraints, and linked them to the BMD themes. The
scholars focused on the creation of a new BM and did
not consider the case of a firm aiming at modifying
the already existing BM. Goal refers to value
creation. Template is the tendency of entrepreneurs to
copy/recycle from other BMs. Stakeholders activities
is related to the collaboration among the actors of the
ecosystem during the design phase and/or during the
usage/application of the designed BM.
Environmental constraints is related “to the
conditions imposed on the business model designer
by the economic, legal, socio-political, regulatory,
and cultural environment in which the business model
will be embedded” (Amit and Zott 2015, p.343).
The studies of Amit and Zott considered the
antecedents individually and identified the
relationships among antecedents and themes.
Furthermore, it is not clear how to connect
antecedents with the elements. Finally, they
deliberately did not consider internal constraints (i.e.
capabilities and resources required to perform the
required activities) to limit the complexity of the
proposed framework. Nevertheless, this omission
could not be appropriate in the case of an already
established firm that intends to change its BM. As
stated by Amit and Zott, the relationships among
antecedents and themes could require a review. This
paper describes the possible relationships among
antecedents and proposes some tools to support this
complex process, which is preparatory for the actual
BM design (i.e., the definition of the elements).
3 METHODOLOGY
The paper is based on the activities accomplished by
the authors during a European project. The overall
objective of the project is related to the improvement
of independent living for elderly people affected by
MCI or MD. This objective should be pursued
through the definition of a new BM based on the
adoption of DIs. The three years long project (from
mid-2015 to mid-2018) is characterised by the launch
of four pilots, in Israel, Italy, Spain and Sweden,
which are useful to test the designed BM.
The actors involved in this project were different
categories of organisations, i.e. healthcare centres, IT
HEALTHINF 2018 - 11th International Conference on Health Informatics
580
providers, universities/research centres, related to
five different Countries.
The results described in this paper are related to
the first year of the project and concern the process
through which the BM of the ecosystem has been
designed. This article does not consider the
subsequent phases concerning pilots and the actual
implementation of the BM. We adopted an action
research in the form of clinical field work research,
also known as clinical inquiry research (Schein 2008;
Schein 1987).
The primary objective of researchers is to support
practitioners to solve a problem. The opportunity of
learning is caused by a specific demand of the
practitioner requiring support (Schein 2008).
Practitioners are more likely to provide critical
information. Researchers are involved as facilitators
to provide technical knowledge and advice, but the
other actors are responsible for defining the specific
interventions that will take place, i.e. the design of the
BM. The purpose of the clinical field work consists
of theoretical and practical contributions. From the
academic perspective, we aim at extending the
scientific knowledge regarding the antecedents of
BMD. From the viewpoint of practitioners, the
clinical field work aims at supporting them through
the creation of the basis for the creation of a new BM.
The advent of the new one will imply organisational
changes and development (Kotter 1996). The related
process is based on the adoption of several tools that
other organisations could exploit during the re-design
of their BM.
During the first 12 months of the project,
researchers directed and participated in various
activities leading to the development of the new BM
in the four pilot sites and the launch of the related
pilots. Hence, scholars support practitioners release
resources through self-intervention and self-
examination (Stebbins and Shani 2009). The research
allowed actively involving “those who experience or
“own” the real world problem”, e.g. caregivers
associations, healthcare professionals (Elden and
Chisholm 1993, p.129).
This field work was based on collaboration,
incorporation of local knowledge and eclecticism and
diversity (Greenwood et al. 1993). Collaboration
because interactions and cooperation among
researchers and practitioners played a key role in the
BMD process. The field work incorporates local
knowledge because allowed us to interact with the
people of other organisations, especially those
working with patients. It is characterised by
eclecticism and diversity because it adopted several
methods and sources of information.
Data collection to describe the BMD process
followed during the project is based on several
sources: (i) direct observation; (ii) focus groups; (iii)
documents and emails regarding the project; (iv)
reports regarding the meetings among the actors of
the project. All the produced documentation was
digitally stored and collected during the project. The
documentation regarding reports comprises not only
the final version of the developed documents but also
the drafts of these, including the feedback/comments
provided by other actors. Coherently with other
authors adopting action research regarding DIs, data
analysis was interlinked with data collection (Braa et
al. 2004). To perform the analysis, we organised and
categorised all the collected materials in terms of
antecedents, ordered them chronologically, and we
identified the typology of tools adopted/developed.
All the related activities were analysed regarding the
actors involved, the typology of the required inputs
and achieved results (outputs). It allowed identifying
the paths of the various outputs and highlighting the
link among antecedents.
4 RESULTS
This chapter illustrates the four phases that
characterised the preparatory activities required for
BMD. Each section is specific to one of the phases
and describes the related activities. The purpose is to
describe the steps made by the ecosystem of actors
involved in the project to move from the antecedents
to the elements of the BM.
At the end, we provide a graphical representation
of the performed activities regarding antecedents
illustrating the path of the developed outputs and the
tools to perform these activities (Figure 1).
Furthermore, we also consider the collection of the
various templates gathered during template activities
(Figure 2).
Figure 1: Example of the graphical representation of
antecedents and related tool concerning two phases.
Figure 2: Example of the graphical representation of
template antecedents, related tools and collected templates.
AntecedentA
1
st
PhaseTool1
Outputspathfrom
AntecedentAtoAntecedentB
AntecedentB
2
nd
PhaseTool
Templates
Collection
Template
1
st
PhaseTool1
Template
1
st
PhaseTool2
(Re-)Designing the Business Model of a Digital Ecosystem: An Example in the Socio-Care Context
581
The decisions regarding the tools adopted and all
the outputs of the performed activities were subject to
the review/judgment of the other actors involved in the
project. Therefore, all the antecedents always included
a component of stakeholders activities, because they
are also based on collaboration among actors.
4.1 Needs, Current Processes and
State-of-the-art of Practices
The overall goal of the project was the improvement
of the quality of life for MCI or MD patients at home
through the adoption of digital technologies. It was
clear from the beginning that the designed BM should
also support other actors involved in the care process
of patients, i.e. the caregiver but also healthcare and
social care professionals.
The first BMD antecedent considered was goal,
and it concerned the simultaneous achievement of the
objectives of all the actors of the ecosystem. The
achievement of this multitude of objectives required
the identification of the needs of patients, caregivers,
healthcare and social care professionals. It was
performed through two tools that supported goal
definition: a literature analysis and an analysis of the
four pilot sites. The literature analysis concerned MCI
and MD pathologies allowed classifying all the
aspects useful to examine and describe these patients
and the healthcare context in which they are inserted.
They concerned medical, functional and socio-
economic perspective, the various related needs, the
characteristics of the related care network. Given the
will to adopt digital innovations, it was also relevant
to consider the level of ICT acceptance and literacy
of patients.
The study of the four pilot sites allowed obtaining
information about the characteristics of the related
care services (e.g. care activities, processes, roles,
information shared), i.e. the elements of the current
BM. Therefore, this analysis highlighted also the
related organisational needs. Nevertheless, the main
output is the current care process and the related BM,
that is recallable to internal constraints (not
considered in the model of Amit and Zott (2015)).
The existing BM is an aspect that cannot be ignored
not only in terms of the constraints that it introduces
in BMD process but also for the potential synergies
among the two BMs that should be taken into account
(Markides and Charitou 2004).
Together with the analysis of the care systems,
researchers of a healthcare organisation conducted a
literature analysis regarding the state-of-the-art of
clinical and assistance management practices. It
concerned the most accepted, evidence-based
pharmacological and non-pharmacological therapies
for patients with MCI and dementia. These treatments
should allow the improvement of the quality of life,
independent living and physical activity. The study
also included the analysis of several successful
international examples of implementations of integra-
ted care programs. Furthermore, the investigation
incorporated also quality guidelines regarding
integrated care programs for patients with MCI and
dementia. This research is recallable to the antecedent
called template because it suggested solutions that
can be “borrowed” (Amit and Zott 2015) and adopted
to design the new BM.
The first phase of the BMD process required goal
and template antecedents. The literature review and
the analysis of care processes are the tools used to
perform goal activities and allowed developing the
list of needs and describing the current care systems
in the four pilot sites. Therefore, two tools contributed
to support the same antecedent. Another literature
review contributed to template activities and helped
to collect the first possible components that could be
borrowed to design the new BM (Figure 3). During
this stage, the only interaction among antecedents is
related to the feedback provided by stakeholders
activities related to the review of the outputs.
4.2 Validated Needs and Processes,
Borrowing Components
The second phase required the passage from needs to
the potential solutions to address these needs and it
was characterised by two literature reviews. The first
regarded technologies to support patients affected by
MCI or MD and the other actors involved in the care
process. The second literature review concerned the
components of BMs related to digital solutions to
support people with MCI or MD. These tools are
recallable to template, and they were used to integrate
the outputs of this antecedent obtained during the
previous phase.
The framework adopted to categorise the various
aspects of BMs was business model canvas of
Osterwalder and Pigneur (2010) and exploited the
results of the literature review regarding technologies
and the list of needs obtained in the previous phase.
The work done in the previous phase regarding the
needs was useful to understand the characteristics of
the targeted customers better. The knowledge about
the potential patients, caregivers and healthcare
professionals allowed searching for all the solutions
not only specifically designed for MCI/MD but also
other DIs adopted for pathologies with similar
characteristics.
HEALTHINF 2018 - 11th International Conference on Health Informatics
582
Since this moment, Stakeholders activities were
only associated with the meetings of the various
research groups, the emails among people of different
institutions to coordinate and provide feedback about
the developed works. These aspects are examples of
collaboration, one of the typical traits of action
research (Greenwood et al. 1993). Given the necessity
to validate the outputs of the previous phase and to
integrate the preliminary results of the literature
reviews on technologies and BMs, four focus groups
were organised (i.e. in Israel, Italy, Spain and
Sweden). The focus groups lasted on average 4 hours
each and involved several categories of actors, i.e.
nurses, physicians, therapists, social care workers,
ICT professionals, managers cure/care institution,
nutritionists. These focus groups were also useful to
consider perspectives different from the one of the
researchers performing the studies. They encouraged
the incorporation of local knowledge (Greenwood et
al. 1993). The outputs of the four focus groups were:
(i) validation of the current care systems, the list of
(ii) validated needs, (iii) further possible
organisational solutions and (iv) further technological
functionalities.
The validated description of the current care
system (internal constraints) constitutes one of the
inputs required for the re-design of the BM. The
selection of BM elements is also based on the existing
processes, which support the decision maker in the
identification of the required organisational and
technological changes. In this phase, the previous
outputs of goal and template were validated and
extended through stakeholder activities. The
extension of the list of “templates” was also pursued
through further literature analysis regarding
technological aspects and BMs. All the components
(e.g. needs, functionalities/value propositions),
except the current care systems, are still considered
individually (i.e. was not stated which technological
functionalities addressed the various needs) and are
not context-specific (Figure 3).
4.3 Environmental Constraints and
Pairs Need-functionality
The third phase of the BMD process was
characterised by three main activities useful to
consider contextual variables, context-specific
preferences and to link technological functionalities
with needs. The study of the contextual aspects aimed
at listing all the Country-specific characteristics
regarding (i) key trends, (ii) macro-economic forces,
(iii) industry forces and (iv) market forces. These
aspects were analysed regarding the four pilot sites.
This research was performed through a literature
analysis, and the results were complemented through
the suggestions provided by the other actors within
the project. Once the list of various needs was
validated and consolidated in the previous phases, the
required information was then related to the relevance
of these needs in the four contexts where the pilots
would take place. It was assessed through a
questionnaire delivered to the four pilot sites a
questionnaire. It contained the list of the needs and
the request to provide, through a Likert scale,
information about the relevance of the various needs
in the case of care processes for MCI or MD patients.
Another key passage concerned the connection
between the needs and the technological
functionalities useful to address these needs. Through
knowledge from previous literature analysis
regarding technologies and BMs, we were able to
identify coherent pairs functionality-need, i.e.
functionalities that are useful to address the various
needs. The output of this activity is a prerequisite for
the following phase and constitutes a useful
information for firms.
The relevance of needs and the coherent pairs
functionality-need were also discussed and validated
during the second round of focus groups organised in
the four pilot sites. As the previous ones, they were
characterised by the involvement of several
categories of actors (i.e. nurses, physicians,
therapists, social care workers, ICT professionals,
nutritionists, home care professionals, mental care
professionals, caregivers, policymakers). The results
of the questionnaires and the outputs of the second
series of focus groups allowed taking into account the
needs of all the actors. Therefore, it is another
example of the antecedent goal but mixed with
stakeholder activities, given the adoption of focus
groups (Figure 3). Furthermore, the activity conducted
to find the coherence among needs and functionalities
is not recallable to any of the antecedents described
by Amit and Zott (2015). Therefore, we adopted the
word “integration” to identify this further antecedent.
4.4 Environmental Coherence and
Decision Support System
The last phase regarding the antecedents of BMD was
based on the control of the collected templates
regarding consistency with external constraints and
the development of a Decision Support System
(DSS).
(Re-)Designing the Business Model of a Digital Ecosystem: An Example in the Socio-Care Context
583
Figure 3: Overall Antecedents of BMD process (stakeholders activities related to outputs review are not shown).
Coherence between the components of the collected
templates and the gathered environmental constraints
is one of the information required to design a BM. It
allowed the exclusion of the collected templates
which were not coherent with the constraints. It
reduced the number of available alternatives and the
complexity that decision makers should face during
the selection of the elements of the new BM. Given
the fact that the re-design of a BM for an ecosystem
of actors is intrinsically complex (e.g. different needs
of different actors, different DIs from different actors,
different contexts, etc.), the reduction of complexity
is recommended. Therefore, the reduction of
complexity is also pursued through the DSS. The DSS
allows discerning between (a) coherent and
incoherent pairs functionality-need; (b) relevant and
not relevant pairs functionality-need; (c) Country-
specific and common among Country pairs
functionality-need.
The DSS considered and integrated multiple
inputs, i.e. (i) the list of the needs; (ii) the list of
technological functionalities; (iii) the list of pairs
technological functionality-need; (iv) the Country-
specific relevance of the needs for the two categories
of patients (i.e. MCI or MD). The tool allowed
highlighting the relevant pairs technological
functionality-need. It is achieved through the
definition of a threshold related to the relevance of
needs (e.g. coherently with the Likert-scale values,
the user can select a value of 4 to consider all the
needs with a relevance equal or higher than 4) and the
selection of the Country analysed. The DSS was
devised to (i) insert further functionalities, (ii) keep
track of the Country-specific information regarding
the relevance of the needs, (iii) update the Country-
specific information concerning the relevance of the
needs, (iv) highlight the commonalities with other
Countries in terms of relevance of the various needs.
Hence, the DSS was designed to be also adopted for
further changes in BM and different contexts (i.e.
Countries). The fourth aspect enables future
collaborations among actors of different Countries.
Therefore, this tool provided useful information for
various actors (e.g. governmental organisations,
firms, healthcare organisations) and integrated the
results of the activities related to the antecedents’
goal, stakeholders’ activities and template. Then, the
activity associated with the consistency with external
constraints contemplated the efforts related to all the
four antecedents described by Amit and Zott (2015).
The developed tool of DSS is an example of the
integration of outputs regarding antecedents. The tool
considers the various key aspects needed by the
decision makers before the design of the BM. The
tool allows analysing these aspects highlighting the
relationships among them and considering the
relevance of the needs. Therefore, DSS helps also in
terms of prioritisation of the available coherent
Goal
LiteratureReview
MCI/MD
Pathologies
Stakeholders
Activities
IFocusGroups
Template
Literature
Review- BMs
Goal
Questionnaire
Stakeholders
Activities
IIFocusGroups
Template
LiteratureReview- State-of-
the-artclinicalcareand
assistancemanagement
LiteratureReview
TechnologicalFunctionalities
Environmental
Constraints
LiteratureReview
Environmental
Constraints
Content
Structure
Governance
Elem entsAntecedents
Integration
DSS
Environmental
Coherence
Templates
Collection
InternalConstraints
Caresystem
analysis
Templates
Collection
Antecedent
1
st
PhaseTool
Outputspath
Elem ents
2
nd
PhaseTool 3
rd
PhaseTool 4
th
PhaseTool
Integration
Matching
Functionalities-
Needs
HEALTHINF 2018 - 11th International Conference on Health Informatics
584
alternatives. We think that considering the four
antecedents separately limits the overall
understanding of BMD processes. Therefore, we
suggest that Integration should be considered as one
of the antecedents. Environmental coherence and
DSS are the tools supporting the activities concerning
this antecedent. At the end of this phase, the outputs
are the information that will be useful for the design
of the BM, i.e. the definition of the elements (Figure
3). They include the list of relevant pairs
functionality-need, the information that is consistent
with the environmental constraints, and the
description of the existing care process. All this
information is replicated for the four pilot sites.
5 DISCUSSION
The research described the preparatory activities for
the design of the new BM, related to the first year of
a European project.
The adoption of the various antecedents described
by Amit and Zott (2015) was illustrated in the four
phases. It allowed considering the relationships
among these antecedents. We suggest the adoption of
some tools to perform the activities concerning
antecedents and to support decision makers.
The answer to the RQ
1
is based on the analysis of
the paths of the outputs developed during each
activity concerning antecedents, and it is summarised
in Figure 3. The results showed that the various
categories of antecedents continuously alternate with
each other during the process of re-design of the BM.
Furthermore, the amount of information generated
through the different antecedents is constantly
increasing, and it results in the rise of complexity that
should be managed by decision makers during the
selection of the elements of the new BM. These
aspects constitute an academic contribution to the
literature of business models (Amit and Zott 2015).
Therefore, we can suggest the following
propositions:
P
1
: The process of business model re-
design for an ecosystem of actors is
characterised by the alternation of
antecedents that results in the
continuous development of knowledge
and increase of collected information
P
2
: The various categories of
antecedents regarding the process of
business model re-design for an
ecosystem of actors are not
independent among them.
Furthermore, managing the increasing complexity
concerning the re-design of the BM for an ecosystem
of actors is not possible with the adoption of a single
antecedent. The integration of the collected
information to remove the incoherent information is
required to reduce this complexity. This aspect
supports decision-makers in the selection of the
elements of the BM. Therefore, we suggest that
“integration” should be considered as another key
aspect concerning antecedents.
Then we can recommend the third proposition:
P
3
: The complexity, concerning the
process of business model re-design for
an ecosystem of actors, can be reduced
through the integration of the
information collected over time and the
exclusion of inconsistent information
The last aspect concerning the answer to the first
RQ is related to the presence of the antecedent
“internal constraints” in the process of BM re-design.
It is coherent with the concepts of Amit and Zott
(2015). The answer of the RQ
2
is showed in Figure 3
that shows the tools adopted or developed to support
the activities concerning the various antecedents
during the four phases analysed. Template and
environmental constraints are performed through
bibliographic approach; therefore, they do not require
the contribution of several actors. The other
antecedents are instead characterised by the
contribution of the various actors and by different
categories of tools to support the related activities,
e.g. questionnaire, focus groups.
The adoption of focus groups, considering not
only the perspective of the final user but also the
viewpoints of the other actors within the ecosystem,
is probably the aspect that contributes most to the
generation of the knowledge that will be used during
the selection of the elements of the BM. Finally, The
DSS and Environmental Coherence are the tools that
support the activities concerning the suggested new
antecedent integration.
Therefore, the adoption of focus groups and DSSs
constitutes a practical contribution useful for
organisations that intend to work within an ecosystem
of actors aiming at developing a new BM.
Furthermore, this study applied the concepts of
antecedents in a real context where the DIs play a
peculiar role. It constitutes a contribution to the BM
literature regarding digital technologies that lack of
(Re-)Designing the Business Model of a Digital Ecosystem: An Example in the Socio-Care Context
585
studies regarding antecedents (Zott et al. 2011). From
the point of view of the methodology adopted, the
article illustrated the potential of the clinical inquiry
for studies of BMD processes in practice. We applied
this methodology, not in a single organisation, but in
an ecosystem of actors (Greenwood et al. 1993; Braa
et al. 2004).
Finally, this research does not come without
limitations. Given the nature of the project, there is a
lack of iteration. It is not possible to generalise the
results of this study, but it is the starting point for
other scholars investigating the antecedents of
BMD.Furthermore, the focus was only on the
antecedents. and not on the impact of the antecedents
to the themes. Further studies could analyse the
impact on the themes of the various tools and
frameworks adopted to perform the activities
concerning antecedents. Moreover, they could
include all the three components of BMD of Amit and
Zott (2015), assessing the contributions of
antecedents on the elements and then analysing the
impact on themes.
ACKNOWLEDGEMENTS
The authors thank the consortium of the European
project Digital Environment for Cognitive Inclusion
(DECI) (Horizon 2020 Programme EU Call PHC20
- Grant No 643588): Fondazione Politecnico di
Milano, Consoft Sistemi SpA, Fondazione Don Carlo
Gnocchi Onlus (Italy), Maccabi Healthcare Services
(Israel), Hospital Universitario de Getafe - Servicio
de Geriatría (Spain), Centre for Healthcare
Improvement Chalmers University of Technology,
Västra Götalandsregionen (Sweden), Roessingh
Research and Development (The Netherlands).
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