(Re-)Designing the Business Model of a Digital Ecosystem: An

Example in the Socio-Care Context

Andrea Pistorio

, Luca Gastaldi

, Paolo Locatelli

and Mariano Corso

Department of Management, Economics and Industrial Engineering, Politecnico di Milano,

via Lambruschini 4b, Milan, Italy

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 concepts—i.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

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):

: What are the existing

relationships among the antecedents

concerning the process of business

model re-design for an ecosystem of

actors?

: 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

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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

PhaseTool1

Outputspathfrom

AntecedentAtoAntecedentB

AntecedentB

PhaseTool

Templates

Collection

Template

PhaseTool1

Template

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.

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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

IIFocusGroups

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

PhaseTool

Outputspath

Elem ents

PhaseTool 3

PhaseTool 4

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

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:

: 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

: 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:

: 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

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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