A Disruptive Innovation Approach to Design a Business Model for a Startup DigitalHealthcare Platform.

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A Disruptive Innovation Approach to Design

a Business Model for a Startup Digital

Healthcare Platform

Group 13 :

Bsirini, Hekmat

Hashem, Moe Gamil

Jayasinghe, Hasitha Gayathri

School of Business, Society & Engineering

Course: Bachelor Thesis in Business

Course code : FOA243 [15Cr]

Supervisor: Johnstone, Leanne Co-assessor: Emre Yildiz Date : 27/ 05 / 2021

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ABSTRACT

Date: 27/05/2021

Level: Bachelor thesis in Business Administration, 15 cr

Institution: School of Business, Society and Engineering, Mälardalen University

Authors: Hekmat Bsirini Moe Gamil Hashem Hasitha Gayathri Jayasinghe (93/04/22) ( 90\08\23 ) ( 86/11/04 )

Title: A Disruptive Innovation Approach to Design a Business Model for a Startup Digital Healthcare Platform.

Tutor: Leanne Johnstone

Keywords: disruptive innovation - healthcare - business model - digitalization - business model innovation.

Research question: How should a disruptive innovation be successfully integrated into the business

model of a digital healthcare platform startup, in terms of its value proposition?

Purpose: Understanding the importance of innovative business models for new entrants to the healthcare sector, in terms of the marketing-related elements (namely, customer relationships, segments, and channels) which affect the whole process as the means to implement strategic aims.

Method: This study used an action research approach. Data was generated by three integrative methods; a discussion with five board members of the case company, a secondary data review, and a questionnaire survey with potential customers.

Conclusion: The model developed in this study identifies the implications of the disruptive innovation approach for a startup digital healthcare platform. It points out, identifying a customer segment that has been away from digital healthcare platforms due to certain inefficiencies in current platforms and designing the business model elements to cater to their needs eventually leads to the domination of the startup in the market.

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1. Introduction

The rapid growth of disruptive technology and its progressive integration in almost all significant aspects of life is remarkably outstanding (Christensen et al., 2018). Disruptive technology could be described as a type of technology that changes how businesses operate (Kumaraswamy et al., 2018). The digitalization revolution is changing all businesses everywhere, and the swift change in the healthcare sector is not excluded (Herrmann et al., 2018). Life expectancy continues to increase worldwide due to advances in science and technology and general improvements in social and environmental conditions (Oderanti & Li, 2018). However, the primary healthcare objective to provide adequate and sufficient medical services remains the same. The way of doing procedures is significantly changing due to progressive changes in disruptive technology (Blix & Levay, 2018).

The theory of disruptive innovation, as explained by Christensen (1997), helps explain how complicated, expensive products and services are eventually converted into simpler, affordable ones by disturbing an existing market through new value positions or offerings. One example of disruptive innovation is the retail, medical clinics, which alternatively breaks down the typical image of hospitals’ model and traditional doctors’ appointments.

Initially, Christensen himself worked in the healthcare industry alongside two doctors, and they realized that the incumbents in the healthcare sector (i.e., traditional big hospitals and doctors’ offices) “were like integrated mills”1_{(Macfarquhar, 2012) because they could do everything.}

They had expert doctors and specialists who had received years of training and accumulated years of experience. They could interpret patients' problems and prescribe custom solutions. But because this model was very customized, unique, and unpredictable, it was also very expensive in terms of expertise and administration because it could not be routinized. As Christensen and colleagues explain, it can be called a solution shop business model. As the authors explain, these shops are businesses that are structured to diagnose and solve unstructured problems. He

continues that consulting firms, advertising agencies, research and development organizations, and certain law firms fall into this category. These solution shops deliver value primarily through

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expert employees who draw upon their intuition and analytical and problem-solving skills to diagnose the cause of complicated problems (Christensen et al., 2014).

In contrast, several convenient care clinics have standardized protocols to diagnose and treat a small but increasing number of disorders. (Moore, 2019) The author continues, by lowering the level of expensive expertise and providing relatively easy, cheap, convenient, and accessible services that have been turned into repeatable processes, retail clinics are opening up care to a broader market and disrupting long-standing incumbents in healthcare.

Sensmeier (2012) explained that those diagnostic and therapeutic technologies had enabled nurse practitioners and physician assistants to diagnose and treat disorders that would have previously required a physician. Therefore, patients can refer to these clinics to relieve simple conditions, such as allergies, headaches, fever, sinus infections, routine vaccinations, regular blood tests, and severe conditions such as diabetes. Also, these clinics are usually located in accessible areas with suitable opening hours and drop-in appointments, which are deemed valuable by patients.

Further, the use of intelligent patient care devices and electronically documented care has made patients experience an entirely new healthcare system and feel the care is more individualized (Sensmeier, 2012).

Blix and Levay (2018) explain that new innovative entrants (i.e., nascent firms) establish themselves in mature industries and offer improvements to existing services at a lower cost. Moreover, wholly new services are being provided that would not have been possible. This means that incumbent companies have been pushed or even replaced by startups due to their ignorance of new entrants and their innovation while continuing to improve the performance of their existing products and services. Over time, the new entrant’s disruptive innovation gradually improves and eventually, becomes good enough to serve mainstream customers (Kumaraswamy et al.,2018).

However, in order to achieve the value outcome of this process, it should be commercialized in some way via a business model (Chesbrough, 2010). A company’s business model is a system of interconnected and interdependent activities that determine how the company “does business”

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with its customers, partners, and vendors (Amit & Zott, 2012). According to Osterwalder and Pigneur (2010), it is like a blueprint for implementing a strategy through organizational structures, processes, and systems.

Disruptive innovation can impact business models by enhancing the value of existing products and services or by rendering existing business models obsolete. On the one hand, this encourages providers to rethink who their customers are, and on the other hand, customers to rethink what they value (Kumaraswamy et al.,2018). Also, as Osterwalder and Pigneur (2010) describe, value propositions are an aggregation or bundle of benefits a company offers to customers. Therefore, the authors of this thesis suggest that when considered in terms of marketing, the value

proposition is where innovation begins.

1.1 Research problem

Technology is accelerating business change nearly in every industry. Therefore, in the healthcare sector, according to Blix and Levay (2018), the expectation is that digitalization will not merely open new pathways to strengthen patients, but also improve the accessibility of healthcare. In other words, the concern is to find ways to make medical care more affordable and accessible rather than finding ways to afford expensive medical care.

Some companies have already seen significant opportunities in the emerging market of eHealth (Menvielle et al., 2018). Healthcare corporations are adopting these advanced improvements. For instance, some companies like Google and Apple have already begun operating in the eHealth market. Additionally, other national healthcare guidelines and applications such as 1177, Kry, and Doctor.se in Sweden offer optimal accessibility and flexibility to the healthcare centers. Furthermore, this opens up potential diagnostic, curative, and consulting services with lower costs and more availability for patient-oriented services (Senbekov et al., 2020). Arguably, this has become even more important due to the social distancing measures being currently

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As Peek et al., (2020) explained, the COVID-19 pandemic has created many challenges for health and care services worldwide. It has led to one of the most significant societal crises in the last century, which has also been a test for the maturity of digital health technologies, be it for frontline care, surveillance, or the discovery of new strategies. Developing digital healthcare platforms helps reduce social interactions to maintain the spread of the Covid-19 virus. Thus, fewer patients will have to visit healthcare centers. Many countries have adopted digital-first strategies, remote monitoring, and telehealth platforms to enable healthcare provision without physical interactions (Peek et al., 2020). Therefore, the importance of investigating and developing these platforms arises.

However, despite the availability of so many high-tech medicine and sophisticated medical technologies, various authors argue that the digital transformation of healthcare has not been disrupted to a significant level yet (Hwang & Christensen, 2008; Herrmann et al., 2018).

Different reasons for this are identified by other literature. For example, limiting the technology primarily to help hospitals and doctors solve the most complex problems (Hwang & Christensen, 2008) and the heavily regulated nature of the sector (Herrmann et al., 2018), among others. Apart from the slow transition, Blix and Levay (2018) explain that many inefficiencies have been identified in Sweden’s already existing digital healthcare platforms. Together, the slow transition and inefficiencies call for a need for an innovative business model that suits the healthcare sector.

In recent years, the entrepreneurial success of new entrants in various markets has gained both theoretical and practical importance but has left a key imperative: the business model unexplored (McDonald and Eisenhardt, 2019; Teece, 2010). Out of the nine elements of the business model that explain how logical and efficient connections are created within the internal process and how that is to be done creatively the central element, value proposition creates value

quantitatively or qualitatively, for a customer segment through a distinct mix of elements

catering to that segment’s needs. Expressed differently, the value proposition can be a product or service that helps customers get the job done effectively, conveniently, and affordably

(Osterwalder & Pigneur, 2010); this case helps patients receive the job healthcare services they need in a timely and efficient way. In line with this, the authors of this paper argue that in the analysis of how a new entrant to the healthcare sector can gain such an advantage via a

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disruptive business model innovation, the value proposition must be identified as the starting point central to the business model innovation.

1.2 Research question

The primary purpose of this research is to understand the importance of innovative business models for new entrants to the healthcare sector in terms of the marketing-related elements (namely, customer relationships, segments, and channels) which affect the whole process as the means to implement strategic aims. Hence, the study aims to answer: “How should a disruptive

innovation be successfully integrated into the business model of a digital healthcare platform startup, in terms of its value proposition?” through qualitative action research of a nascent digital

startup in Sweden and its potential customers. This study is novel because it has theoretical contributions to the areas of innovation and entrepreneurship within the marketing field and clear, practical recommendations for a specific start-up. Notably, it aims to provide a guidance framework, through action research, for the startup in question on how its value proposition can be built to ensure strategic success when it begins operations in the Swedish market.

This thesis will be organized as follows. First, previous literature is overviewed on the business model canvas by Osterwalder and Pigneur, (2010), disruptive innovation, and implementation of disruptive innovation in the healthcare sector in terms of the value proposition. Based on the reviewed literature, the authors propose a framework explaining how disruptive innovation should be implemented in the business models. Next, in the method section, the qualitative method and the three cycles of the action research are explained. Thereafter, the findings will be presented and the proposed model will be analyzed using the findings. Finally, in the discussion section, the applicability of the model will be discussed based on the analysis.

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2. Literature Review

2.1 Business model

Osterwalder and Pigneur (2010) define a business model as the rationale for creating, delivering, and capturing value. It can also be identified as a device through which the value outcome of the innovation process is achieved since neither innovation nor technology can create value itself (Chesbrough, 2010). However, in some literature, the business model is defined in terms of customer-centricity. A company’s business model is a system of interconnected and

interdependent activities that determine how the company “does business” with its customers, partners, and vendors (Amit & Zott, 2012). Similarly, Teece (2010) defines the business model as a way the entrepreneur values customers, how it will do so, and how it will capture a portion of the value that it delivers.

McDonald and Eisenhardt (2019) explained that the business model consists of two tightly coupled elements: a value proposition and the activity system. Customers value the value proposition over existing solutions. The activity system is linked to components and resources that help create and deliver this value (Amit and Zott, 2012).

The mapping approach, as explained by Chesbrough (2010), is one promising approach that can be used by managers when they want to experiment with alternative business models, which then allows them to become a source of experiments considering alternative combinations of the process. He names “the business model canvas” introduced by Osterwalder and Pigneur (2010) as an example of this approach.

This model explains nine elements that characterize a business model, as illustrated in Figure 1. The center of all the elements within this business model is the value proposition. The left side of the model explains the activity system that delivers the value proposition through key activities, partner network, key resources, and cost structure while the right side explains how the value proposition is generated by client relationships, client segments, distribution channels, and revenue flows.

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Figure 1: The business model canvas

Source: http://business-model-design.blog-spot.com/2005/11/what-is-business-model.html

Meertens et al., (2012), concerning the IT market, emphasize the importance of business model creation in the design process and propose a mapping from this business modeling canvas. Similarly, Amanullah et al., (2015) identified this model as an excellent tool to analyze business management strategy. They used this business model canvas in their study to compare three consultant companies based on the elements value proposition, customer segments, and key resources. However, in his study, Ladd (2018) found that the firms that heavily used elements of customer segmentation, value proposition, and channel performed two times better than those that barely used those elements. Hence he argues that some elements of this canvas may be unhelpful for nascent firms. For the purpose of this study, we focus on the inner top circle on the right side of the canvas (i.e. the customer aspects) and its potential to create value in addition to Ladd's Recognition of the importance of these elements. Here, Osterwalder and Pigneur terms are used to define each aspect:

Namely, the value proposition is identified as “the bundle of products and services that create

value for a specific customer segment”, customer relationships as “types of relationships a company establishes with specific customer segments”, customer segments as “the different groups of people or organizations an enterprise aims to reach and serve” and distribution

channels as “how a company communicates with and reaches its customer segments to deliver a

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2.2 Disruptive innovation

Disruptive innovation, disruptive technology, and disruptive business strategies are emerging and increasingly prominent business terms used to describe a form of revolutionary change

(Christensen et al., 2018). Technological innovation is fundamentally a different phenomenon from disruptive business model innovation. These innovations arise in different ways and impact the competitive effects as described in the following paragraph (Markeds, 2006). However, it is worth mentioning, as explained by Christensen (1997), that the combination of these different kinds of innovation will possibly lead to remarkable success for the new entrants.

Christensen (1997) described disruptive technologies or technological innovation centered on how new technologies exceed remarkable technologies in a market. Later, Christensen and Raynor (2003) extended the concept by uniting both technological aspects and business model aspects, which is called “disruptive innovation,” that generally aids to provide products and services with substantially higher quality, lower cost, and more convenience for consumers (Christensen et al., 2000). Therefore, as identified by Pete et al., (2003), disruptive innovation is successfully exploited processes, technologies, products, services, or business models that allow organizations to significantly change conventional competitive rules, thus transforming the demands and needs of existing markets. They further explain that new performance dimensions are introduced in direct conflict with traditional approaches in this process, which historically could have only been offered by specialists to enable a larger population of customers to consume products and services in a more convenient setting.

On the other hand, as Christensen et al. (2015) explained, not all technological innovations can be considered disruptive. Indeed it has been distinguished between two sorts of technological innovations: sustaining innovations and disruptive innovations. According to Christensen et al., (2015) the sustaining innovation is clarified as a technological innovation that helps the

incumbent sustain their position within the established market and maintain the flow of customers. On the other hand, disruptive innovations are characterized for weakening and undermining the role of established firms in a market by targeting a smaller group of niche customers through enhancing peculiar traits. Therefore, in this research study, the industry of

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digital healthcare services is considered disruptive due to the potential and substantial impact on other players within traditional healthcare services (Herrmann et al., 2018).

In figure 2, the disruptive innovation model illustrates the critical disparities between sustaining innovation which incumbent companies represent, and disruptive innovation that new entrants depict; both are depicted in red lines that show the process development and improvement of products or services performance over some time. In comparison, the blue lines describe the willingness of customers to pay for specific products or service performance. As the upper red line shows that incumbent companies’ main objective is to produce and constantly develop higher quality products or services that satisfy the needs of the topmost customers that are willing to pay more for superior performance (higher profitability in the market), they ignore the needs of a part of the middle mainstream and least customers. Therefore, this allows the new entrants to target the lower class of less profitable customers.

Figure 2: Evolution of disruptive products/ services (Christensen et al., 2018, p. 1074).

Additionally, over time due to the rapid pace of technological improvement, incumbents’ main objectives are to rapidly enhance and develop products or services. As mentioned earlier, this

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Offers performance that over-serve the market and exceeds customers’ capability for utilizing and absorbing the offering. Thus, it creates a technology performance gap where new entrants fill with a disruptive innovation that may dominate the new entrant. However, this is the case if the incumbents’ have not responded to adopt in disruptive innovation; for instance, as suggested by Christensen et al., (2018), the incumbent can maintain their position as a leader within the market if they expand an independent unit with full possession of autonomy to execute their processes for pursuing the disruptive opportunities (Christensen et al., 2018).

Moreover, the disruptive trajectory of new entrants starts from the inferior segment moving upward over time to reach the highest profitable customers and compete with the incumbents through its improvement process (Christensen et al., 2015).

Another point of view to figure 2 is that the lines can meet at some point or flatten, as can be noticed by following the lines. However, in the technology innovations, some new products take the place of other old products. Therefore, the last (old products) takes either a flatten or receding line form, which can be seen as trajectory sustaining. “ Under normal circumstances, when there is a technological change from an existing technology to a new one with higher performance, such as the change from disk-pack drives to Winchester drives, the market reacts positively to it” (Takahashi et al., 2013, p.3-4). This holds whether the technological change is continuous or discontinuous as Dosi, (1982) referred to this type of discontinuity as (upward compatibility); upward compatibility accepts programs from an older, smaller one to a newer, larger one. However, given that performance of the new technology is higher than the old one; if not, the product would not be marketable. Thus, this type of change should be trajectory sustaining.

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2.3 Disruptive innovation in the healthcare industry

The disruptive innovations had formerly taken place in several industries, specifically by the digital transformation of certain products and services (Kumaraswamy et al., 2018). However, the healthcare sector is expected to be disrupted by digital transformation as the other industries (Herrmann et al., 2018). In line with this, the following paragraphs focus on the value

proposition aspect of the business model as central to healthcare providers from a customer perspective (i.e., in terms of the top right circle of the business model canvas that includes client relationships, segments, and distribution channels).

2.3.1 Value proposition

According to Dickson and Ginter (1987), for any startup company, the concept of differentiation of their product or service should be considered. Therefore, understanding the phenomenon of disruptive innovation in this regard is highly required (Pete et al., 2003). Differentiation (i.e., to gain competitive advantage by standing out) means that the objective of entrepreneurs should be the optimal distinctiveness, where being similar to others and different from others is balanced (McDonald & Eisenhardt, 2019). For instance, a new business model - telemedicine, which provides healthcare similar to that a patient would receive after traveling and visiting a doctor located miles away, but now in a different way vis-a-vis distribution channel, which is more convenient and accessible.

Therefore, as highlighted by Amit and Zott (2012), in the developing technology market space, this competitive advantage is provided not by focusing merely on product innovation but also through the innovation process of the whole business model. The business model innovation is achieved through changing or adjusting any element of the business model (Osterwalder and Pigneur, 2010). Furthermore, the characteristics of a business model, which is more likely to yield profits and can be a pathway to competitive advantage, are sufficiently differentiated and should be hard to replicate for incumbents and new entrants (Teece, 2010).

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The goal of innovative companies is to understand each customer individually to make

customers more comfortable with them than with competitors (Oztekin, 2017). Herrmann et al., (2018) identified the significant challenges healthcare systems face: rising costs, increasing demand for provision of care in aging societies, and outcome problems. Arguably, the push driven by the COVID-19 pandemic has also added another issue for healthcare providers and customers alike due to social distancing measures and fear of physical meetings by some population segments. Therefore, the expectation is to increase the patients’ awareness to reduce the asymmetry that has long existed between patients and healthcare professionals through digitalization (Blix & Levay, 2018). The most promising innovative business model in the healthcare sector in the present time in Sweden is digital healthcare platforms that offer accessibility and flexibility to the healthcare center and open up potential diagnostic, curative, and consulting services with lower cost and more availability for patient-oriented services (Senbekov et al., 2020).

In the field of digital healthcare in Sweden, some platforms are already established in the market.

Nevertheless, there are certain deficiencies. According to Blix and Levay (2018, P.81), some of them are as follows;

● Unnecessary duplication and extra time for health care professionals ● Implementation where there is no synergy or network effect

● Electronic data improved compliance, but costs did not decrease

● Increased demand for health care via telemedicine physicians when the remuneration system is ill-adapted to digital healthcare

Also, Christinsen et al., (2000) explain that the main focus of the National Institutes of Health has been to develop medicines to cure fatal diseases rather than determining how to make

healthcare more effective, accessible, and affordable, which is demanded by most people most of the time.

Thus, the startup platforms can gain a competitive advantage by identifying such inefficiencies of these existing platforms (Pete et al., 2003). For these reasons, small firms with limited funds

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and resources compared to incumbents of the healthcare industry are experimenting with disruptive business models to compete in the market (Blix & Levay, 2018).

However, other than focusing on prevailing inefficiencies, as explained by Koivisto (2017), certain risks are associated with digital healthcare platforms that need to taken into consideration when designing their disruptive value propositions, such as the unnecessary consumption of medicine and demanding tests and procedures associated with unnecessary costs as well.

2.3.2 Customer segmentation

“The disruption is an overall process of evolution of (the disruptive) product or service over time” (Christensen et al., 2015, p. 6). Herrmann et al., (2018) identified that start-up companies are deemed to be more flexible to take advantage of the new technology and business model that tends toward novel disruptive innovations. On the other hand, established corporations were essentially pursuing a long gradual improvement process for the business model. As depicted in figure 2, for a new entrant, the disruption process begins with identification and focusing on the needs of low-end customers of the market.

As Blix and Levay (2018) identified in their study, there are still inequalities in the service received by different customer segments regarding the healthcare industry in Sweden. For example, some people have to travel long distances to get to the nearest primary care facility and even longer distances to reach hospitals or specialist care due to the considerable variation in the country’s population density.

Also, Blix and Levay (2018) identify older people as a customer segment that is remarkably distant from digital healthcare platforms due to a lack of their skills to use digital services. However, the older population is fast-growing, hence requires attention regarding their health and well-being (Coto et al., 2017).

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2.3.3 Customer relationships

In customer relationship management, the direct involvement of customers and creating value by identifying their needs and providing practical solutions is advantageous in any business context (Wilkin et al., 2018). In this sense, social media can produce customer engagement in a digital healthcare platform and improve users’ knowledge and emotional involvement (Presti et al., 2019). Shaughnessy (2016) suggests that gaining “the network effect” through a model that combines a mobile phone system, social network, and messaging app and “the advocacy effect” by building up a network of users who become potent advocates who recommend it and

demonstrate how they benefit from the platform, is an important strategy to maintain customer relationships of a business model.

However, according to Coto et al., (2017), since the elderly population is growing faster worldwide, efforts to improve their quality of life have gained attention. They further explain that even though some literature sees social networks as a noticeable tool to support older people, there are potential dangers, for instance, privacy issues and false diagnosis due to lack of

technology skills. On the other hand, the use of telemedicine (Blix & Levay, 2018) and the use of social media by the older population are shallow. Even though the main reason has been

technology access and skills, many older people with internet access and skills are also not using social media (Coelho & Duarte, 2017). Therefore this can be identified as an issue regarding reaching and building solid relationships with the customer segment of older people.

2.3.4 Distribution channels

Distribution channels are another essential element described by Osterwalder and Pigneur (2010) in their business model canvas through which value propositions are delivered to customers.

As depicted in Figure 3, disruptive innovation has changed how the value proposition is delivered to the customers in the healthcare sector over time. Initially, the problematic and intractable illnesses treated in general teaching hospitals have become more routinized and

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treated in outpatient clinics and focused care centers. That type of care is becoming in the office and eventually, even in the home (Christensen et al., 2000).

Figure 3: Evolution of healthcare industry with the impact of disruptive innovation Source: https://hbr.org/2000/09/will-disruptive-innovations-cure-health-care

Since in-home care, the most recent way of disruption, is based on digital platforms,

communication has become more critical. Any technological improvements such as apps that allow direct communication between patients and doctors, AI (Artificial Intelligence) to improve the use of different languages have gained attention in the research field (Blix & Levay, 2018).

Based on the findings, the authors of this thesis have developed a theoretical model, as depicted in Figure 4. This explains how disruptive technologies can be implemented in the business model of a startup digital healthcare platform in terms of marketing-related aspects. Remarkably, the authors build up the business model canvas framework in terms of the centrality of the value proposition, which bridges supplier and customer sides but focuses on the marketing dimensions outlined above (i.e., distribution channels, customer relationships, and customer segments). This model will be the basis for our study and the operationalization of the method. That being said, the authors want to emphasize again that all aspects of the business model canvas are important for nascent firms when entering a market.

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Figure 4

Proposed model for the integration of disruptive technology in marketing-related business model elements of a startup digital healthcare platform

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3. Methodology

3.1 Research approach

According to Saunders et al., (2019, p. 188), “studies that establish causal relationships between variables may be termed explanatory research.” In line with this, the authors intend to examine and explain the apparent problem demonstrated in the research question of how should disruptive innovation be integrated successfully with the business model of a digital healthcare platform startup, in terms of the value proposition?. The relationship between disruptive innovation and marketing-related elements of the business model, as suggested in figure 4, need to be analyzed to reach this research objective.

According to Saunders et al., (2019), the data collected qualitatively for an explanatory purpose can be substantially efficient for illustrating a customer point of view related to a particular business. In line with this, the authors applied a qualitative research design to answer the research question. In addition, the qualitative approach in this research study is convenient due to the appropriateness of using an interpretive philosophy approach (Denzin and Linkon, 2018, as cited in Saunders, 2019), in order to expand the understanding of a particular problem of digital healthcare services in Sweden, also since the authors clarified earlier that they intend to understand customers and business perceptions on this particular phenomenon in the digital healthcare services (Hanson et al., 2011). Furthermore, since both customer and business

perspectives are essential when it comes to the value proposition, the authors deemed those who took part in the study as participants rather than respondents due to the emphasis of the high sensitivity while collecting data in qualitative research, especially for interpreting words and meanings with participants (Saunders et al., 2019). Additionally, the qualitative approach

allowed the authors to examine the pointed focal issues more profoundly and granted the authors a flexible tendency to redirect interviews that can potentially appear during collecting data. Thus, adjusting and revising the framework is considered more superficial in any unexpected

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A few years ago, a new phenomenon appeared in healthcare, such as the digital healthcare platforms. Based on literature introduced by Christensen (2002), Wong (2008), and many more, they have absorbed various explanations to the phenomenon of disruptive innovation under a few different terms. However, since in this thesis, the theory of disruptive innovation is considered the most relative explanation, which highly supports and consolidates the primary purpose of this paper, the approach needs to ensure that the authors analyze the phenomenon both in practical terms and theoretical terms. Therefore, this thesis will discuss this theory (disruptive innovation) abductively by using the data collection to evaluate proposed models related to an existing theory (deductively). This model can be modified (not necessarily) based on the pre-prepared

interviews, secondary data, and questionnaire to potential customers (inductively). As noticed above, the authors moved back and forth from theory to data (as in deductive) or data to theory (as in inductive); this movement is the main character of the abductive approach (Saunders et al., 2019).

3.2 Company description

For this study, the authors aim to examine how disruptive innovation theory can be successfully integrated into the business model for a digital healthcare platform, in terms of value proposition, particularly for a startup company in the Swedish market, taking the case company, Bashi, as a representative.

One of the authors of this thesis had a friendship connection with the owner of the company Bashi. The author discussed the idea of the thesis with the company’s owner, where indeed the owner showed interest in participating in the study. Likewise, this granted the authors an

advantage for collaborating with a company that corresponded perfectly for their study. Also, the authors believe that having the two impartial authors can generate better consequences in the study and reduce bias.

Bashi is a digital healthcare platform that has already built its website and business model. It is planned and expected to launch its services during summer. However, the company faces a marketing problem in creating and increasing awareness of its business among potential

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customers in Sweden before its launch. Therefore, Bashi is genuinely appropriate for this action research study.

The company’s founder is a doctor who personally derived the idea from self-experience by working in various sectors within the healthcare area. The company developed a website to offer all possible subjective diagnoses or medical solutions through any device (mobile phone, laptop). However, the primary purpose of Bahsi is to provide proper guidance and direction to individuals based on their subjective automated diagnosis system. It can also lead patients directly to the nearest healthcare center from their locations and suggest the nearest available time for booking among all healthcare centers in a particular location. There are plenty of other features that the company has developed. Yet, some of the issues Bashi is trying to solve are to reduce the overflowing number of patients to the ER (emergency room), secondly put a balance among the healthcare centers due to the rising issue of overflowing patients to some particular centers, on the other hand, some are considered vacant.

The authors will focus on the implication of disruptive innovation theory on the business model to explain how it should be integrated to propose the best value for customers. Therefore, it may suggest improvements for their business model, which is an appropriate choice for other start-up companies in the same situation.

3.3 Research process

This study applies an action research approach which is a process that promotes solutions to real organizational problems over a participative and collaborative approach (Saunders et al., 2019). As Heron and Reason (2008) explained, this participative and collaborative approach enables understanding the situation and developing creative solutions as people akin to each other in terms of concerns and interests work together. This action research approach has been used to develop creative solutions in many different sectors. For example, Erbilgin (2019), in his study of improving teaching and learning processes in the educational sector, Casey et al., (2019) developed a new health-related policy analysis tool in the healthcare sector. In Particular, Virtanen et al., (2017) used this approach in developing a marketing strategy for a startup

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company on Instagram. Therefore, in line with the research purpose, by applying this approach, the authors have incorporated a range of experience and expertise (i.e., managers, customers, and authors themselves as business students) to answer their research question.

As depicted in Figure 5 (Saunders et al., 2019), each cycle in the action research cycles involves a process of diagnosing or constructing issues, planning, taking action, and evaluating.

Figure 5: The action research spiral

Source: Saunders et al., 2019, P.203

Based on this action research cycle, as illustrated in Figure 6, the authors have designed their research in three cycles, comprising four elements of diagnosing, planning, taking action, and evaluation within each cycle.

3.3.1 The first cycle

The author who had contact with the owner arranged a Zoom meeting between all three authors and the company owner to introduce and become more familiar with the platform before starting

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the research process. Afterward, the research team of three members diagnosed the importance of a disruptive innovation approach in the marketing-related aspects of the business model. Therefore, the authors designed the interview questions, so the outcome enables them to

understand the practical usability of the model created using the theoretical framework (figure 4). They conducted a group interview with the owner and four other employees of the company. The primary data gathered during the interview were analyzed and compared with the model

proposed using the theoretical framework (Figure 4). In the action stage, a draft of the business model suggested by the authors [Draft 1(Figure 7)] was created. This draft is based on a

literature review and expertise within the team representing the start-up company. However, when applying a disruptive innovation approach to the business model, since it is a

transformation of the demands and needs of existing markets, it is necessary to evaluate how incumbents in the market cater to those demands and needs. Therefore, evaluate the draft’s practical aspects in terms of the disruptive innovation approach. Apart from the case company managers’ viewpoint, the draft was reviewed additionally using secondary data, i.e., a Swedish governmental report by Blix and Levay (2019), in the evaluation stage.

3.3.2 The second cycle

Based on the outcome of the first cycle, after comparing the first draft of the business model and secondary data, the need for a refined version of the first draft was diagnosed. Necessary

adjustments were made to draft 1 to produce the second draft [Draft 2 (figure 8)] in the action stage. Therefore, draft 2 reflects the theoretical aspects and practical aspects from the viewpoint of nascent firms and incumbent firms. This increases the reliability of the model, especially in terms of competition in the market. In the end, a questionnaire was designed based on draft 2 and sent to a sample representing potential customers of the digital healthcare platforms to find out the relevance of the suggestions from the viewpoint of customers. In the evaluation stage, draft 2 was compared with the analysis of the customer perception questionnaire survey.

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3.3.3 The third cycle

After evaluating draft 2 using customer questionnaire survey outcomes during the evaluation stage of the second cycle, the need for further refinement was diagnosed. Therefore necessary modifications were made on draft 2 to create the final model which is the suggested business model for a startup digital healthcare platform. This model reflects the usability of the model from the viewpoint of management of a startup as well as incumbents and of customers. Therefore, this final model may suggest improvements to the case company’s business model and is an appropriate choice for other start-up companies in the same situation. As stated, figure 6 overviews the action research spiral for this study.

Figure 6: Action research spiral for the development of marketing-related business model

innovation for a digital healthcare platform 3.4 Collecting data

As mentioned in the research process, the authors have collected data in three ways, i.e. primary data through interviews, questionnaire survey, and secondary data (the Swedish government report).

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3.4.1 Interview

The authors conducted a group interview with the company’s board members (Bashi) through non-standardized semi-structured interviews, which is the most prevalent method used in

qualitative healthcare research (Bolderston, 2012). The interview took place in a web conference meeting via a video telephony software program called Zoom rather than a face-to-face meeting due to the latest worldwide pandemic Covid-19. That allowed the interviewers to have a facial recognition meeting through a synchronous internet-mediated group interview with the

participants (Saunders et al., 2019). Additionally, the software used for the interview (Zoom) allowed the authors to audio-visual record the entire meeting, emphasizing all the participants' consent. According to Bolderston (2012), such an online virtual interview is considered substantially appropriate for applying a semi-structured interview. Furthermore, this interview mode granted the authors and the participants the flexibility for a direct interaction among participants. It allowed the authors to provide any further elaboration of any focal interest point (Saunders et al., 2019).

However, a list of questions (see appendix 1 and 2) was predetermined based on the themes required in order to attain knowledge from the business aspect (participants) regarding their value proposition to potential customers and their business model (Saunders et al., 2019). Subsequently, the authors sent the questions to the CEO before the interview to be familiar with the theme going to be discussed during the group interview and asked to share it with the other participants due to the absence of direct communication between the interviewers and the other board members. Additionally, the group interview was determined a week before the agreed date for the interview, based on an arrangement between the interviewers and the participants through a phone call between one of the authors and the CEO. Also, all the participants were familiar with the Zoom program. Thus, one of the interviewers created a zoom meeting and shared the link through all the email addresses of the interviewers and the participants.

The sample is selected as a group interview representing the business aspect of the case company, which includes five members of the board of directors, including the CEO. The five members’ positions in the company are participant 1 the CEO and the owner of the highest share

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in the company; participants 2 and 3, owners of equal shares of the company; participant 4 is the web developer; and participant 5 is the programmer. One group interview was conducted rather than five separate interviews with each member. This was determined because the purpose of the interview is to make the group of participants representing the company aspect more encouraged to answer a particular question based on each participant’s major (Saunders et al., 2019). This allows a broader exposure of important data focused upon the center of attention of explaining the specific concepts about this research action paper (Ibid). Moreover, according to Saunders et al., (2019), interpretive researchers apply group interviews to build and regulate meanings through sensemaking about a particular topic. Also, implementing semi-structured group interviews can be considered perfectly compatible with explanatory and diagnostic purposes (Oates & Alevizou, 2018, as cited by Saunders et al., 2019).

Furthermore, the interview took approximately two hours, where all the participants had sufficient equal time to participate in the discussion based on their significant position in the company. However, the participants requested the interviewers to preserve their names anonymously, yet they allowed them to indicate their positions.

3.4.2 Secondary Data

The authors used secondary data to evaluate draft one created in the first cycle, especially in competition in the market. The main focus was the market-related elements of the business models of the incumbent firms. This enabled the authors to analyze their model viewpoint of nascent firms and incumbent firms in the market. Furthermore, as emphasized by Saunders et al.,(2019), the primary data that has been collected (i.e.through interview) can be compared with secondary data, therefore assess the generalizability of findings. For this reason, the authors of this thesis decided to use the report of the Swedish government by Blix and Levay (2018), as secondary data to identify market trends in relation to the four elements, value proposition, customer segmentation, customer relations, and distribution channels, therefore to evaluate the validity of draft 1. Also, since the authors worked in close collaboration with the company, they gave access and permission to use its data such as their website and business model information developed so far.

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3.4.3 Questionnaire

The purpose of the questionnaire in this study is to evaluate draft 2 from the customer perspective regarding their perceived values on a digital healthcare platform. Even though healthcare is a service consumed by every citizen of the country, the main focus of this

questionnaire is potential customers of the platform, who are most likely to use online services. Therefore, the authors decided it is adequate to conduct their questionnaire online. This matched with their limited time and available resources.

Even though the sample must proportionately represent the population, due to the unavailability of relevant quota variables and difficulty identifying individual cases, the authors chose the self-selection sampling technique to be used in this questionnaire (Saunders et al., 2019).

Therefore authors publicize the need for participants by asking them to take part. The link to the questionnaire was posted on Facebook groups that the authors found relevant to healthcare. The posts were followed by an introduction of the purpose of the questionnaire and an assertion of anonymity and confidentiality. Furthermore, the authors invited their colleagues and friends through emails or private messages. The responses were collected from the 3rd of May to the 10th of May, which was decided as a sufficient period to be responded to by those who are interested.

The questionnaire was influenced by draft one, and it was designed to enable the evaluation of draft 2 in terms of customer perception of digital healthcare platforms. Therefore, the

questionnaire included questions to measure to what extent customers prefer each component of the second draft of the model. A Likert scale of a balanced five-point scale was developed for the customer perception (Appendix 2). The scale was anchored by “least preferred” (1) and “most preferred” (5). Also, few open questions were included, where participants could add short comments.

As Safdar et al., (2016) argue, even though questionnaires are easier to undertake and relatively less costly, the descriptive value of results might be low. In this context, considering the

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explanatory purpose of this research, the authors recognized the importance of a qualitative approach to complement the questionnaire results. Even though qualitative surveys or

questionnaires are almost non-existent in textbooks, specific populations have been investigated qualitatively to figure out patterns of particular topics of interest within a population rather than form frequencies, means, or other parameters (Jansen, 2010). Simultaneously, Manton et al., (2014) and Engström and Runeson (2010) have used this approach in their qualitative research. Therefore, the authors of this research have analyzed the customer perception patterns observed in the sample from the questionnaire qualitatively, rather than testing the outcomes of the questionnaire through quantitative software programs. This means that although the results of most of the questions in this questionnaire are quantitative by definition in terms of providing numbers and scales, they are merely used to describe trends/patterns in customer preferences for digital healthcare platforms. This enabled the authors to evaluate the draft of the

marketing-related business model in a way it leads to the final model.

3.5 Data analysis

“Qualitative data is often subjective, rich, and consists of in-depth information normally presented in the form of words. Analyzing qualitative data entails reading a large number of transcripts looking for similarities or differences, and subsequently finding themes and developing categories”2_{(Wong, 2008). Wong continues, “ Qualitative research yields mainly}

unstructured text-based data. These textual data could be interview transcripts, observation notes, diary entries, or medical and nursing records. In some cases, qualitative data can also include a pictorial display, audio or video clips”.

In this paper, a thematic analysis method was used to analyze data, which is a more accessible form of analysis for the relatively unfamiliar researchers with qualitative research methods, since it does not require detailed theoretical and technological knowledge (Nowell et al., 2017).

First, the authors transcribed the interview and through prolonged engagement with the interview transcript, they familiarize themselves with the details. Then the data were separated under four

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main themes: value proposition, distribution channels, customer segmentation, and customer relationships that are explained in the conceptual model (figure 4). Secondly, each author went through the data and noted down different issues discussed under each theme. Then those issues that each author noted were reviewed in group meetings to generate sub-themes, as shown in table 1, and different color codes were assigned to each issue to be used during the whole process of analysis. Using this analysis, draft 1 was created.

In the next stage, secondary data collected under different themes were also analyzed using the same color codes (Table 1). In order to analyze how the firm’s business model has applied disruptive innovative aspects, a comparison between draft one and the secondary data under different subthemes was made. After this analysis, the authors added their suggestions to the business model and created draft 2.

Next, questionnaire results were converted into graphical illustrations (Figure 9) to make them easier to analyze qualitatively. Also, each graph and answers to open questions were marked using the same color codes. Both the patterns of each graph and short answers to open questions with the same color code, as the details on draft 2, were used to evaluate the validity of each sub-theme. Based on this analysis, each subtheme was confirmed, removed, or changed and the final proposal for the business model of Bashi was created.

3.6 Validity and reliability

As mentioned above, to ensure the validity and reliability of the study, the creation of themes and analysis was done independently by each author and compared their findings through group meetings. A conclusive mediation among authors indicates the likelihood that the final outcome of the analysis is valid (Krippendorff, 2004).

In this paper, the validity and reliability are being clarified and justified in the methodology. The authors measured the reliability according to the consistency in the paper and measured the validity through the accuracy used while designing the interview questions and the survey.

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4. Findings

As mentioned in the methodology section, data was collected at three stages, through a group interview with the management of Bashi, secondary data from the report to the Swedish

government’s expert group on public economics (Blix and Levay, 2018), and a questionnaire to potential customers of Bashi as discussed in the following sections.

4.1 Group interview 4.1.1 Value proposition

According to the CEO, Bashi’s primary offering to their customers is to diagnose diseases accurately by allowing them to go through an automated assessment with verbal and visual information and directing them to the most relevant, closest, and vacant healthcare center using that diagnosis. Therefore they are planning to integrate their system into different healthcare centers in Sweden.

According to partner 3, clarifying the primary purpose of Bashi’s platform, “these services are offered by Bashi for customers in order to solve a major problem, particularly directing them to the right department, and this will be completely free for customers.” Further explanation by the CEO about the operationalization strategy of Bashi “therefore our main strategy is to collaborate with private healthcare centers where they pay us fees for our services and then will integrate it for free with government-owned healthcare centers because when it comes to the government owned ones, we need to convince them with showing proof of concept and the best way to do that is offering it for free for maybe couple years.”

The developer explained, “We are going to optimize the problem of how long it should take, so we are creating a system where we grade the symptoms because we often see that the loudest one get the care first instead of the one in need. Therefore, our system categorizes patients and takes care based on symptoms”. So they provide recommendations on whether it is acceptable to wait for a few weeks before an appointment or should they visit a doctor immediately. This means that through their system, they provide medical diagnosis objective rather than subjective to individuals.

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The CEO believes this value proposition differentiates them from other digital healthcare platforms. She further explained, “as far as I know, up to date, I have not found anybody that does it to that extent that we are offering, which is short click.”

On the other hand, from the medical centers’ and medical professionals' viewpoint, this process will make them more comfortable. As explained by partner 2, “Bashsi is going to deliver the value of optimized patient care, for medical professionals, sitting and answering the phone calls and providing patients information on when, where, and what patients should book, we optimize their daily activities, so they can focus on patient care rather than administration.” As the web developer explained, since they will make their process more efficient and sign contracts with Bashi, it is hard to replicate their value proposition for a new entrant. Which he called

“first-mover advantage.”

The CEO added, “by reducing the number of patients that might overcrowd the health centers through this system, the patients who are really in need get the proper care quickly. Hence reduce the waiting time.”

The CEO, who has been working as a doctor for years, explained, “to become a doctor of a digital healthcare platform, you do not need any kind of level of competence, but when you work at a registered healthcare center, you need to have a very strong background.” Therefore, by aiming to collaborate with healthcare centers rather than providing them healthcare virtually, they believe in enhancing the quality of their offerings.

Another feature that makes them unique from other platforms is their direct navigation of transportation. As explained by the programmer, “you get a specification of different

transportation options to the hospital which is unique for what you are presenting with what symptoms.”

4.1.2 Distribution channel

According to the web developer on how Bashi’s communication system is going to

operationalize can differ from direct to indirect, where stated “If you choose an alternative for going to Apotia, that is direct because you get the products directly and you can order them instantly from Bashis' platform, so in that case it is direct” but on the other hand, “ if you choose to communicate with a healthcare center, in my case I would say that direct communication is when you can communicate with chat or through an email or a video conference with a doctor or

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nurse, thus, for now, Bashi is not developed in a direct way to allow direct communication with video or chat alternatives, but we are working on developing such features.”

The way of using Bashis’ platform is simply described as the programmer illustrated “right now the communication is always going through Bashi platform, you log in with your bank ID (online identification), and that is where you choose your healthcare center to communicate with, and the website is developed with simple click options where everyone in different ages can simply use it. Also, you always send your questions in your remarks through the Bashi platform. You receive the answers to the Bashi platform”. Furthermore, the CEO clarified the importance of providing such online services in different languages when she said, “from the beginning, the main idea was to offer the platform in 11 languages, because of the fact that it was something that's lacking in other platforms. So that is our definite short list of what is on the pipeline, basically reinvesting all the money into providing most spoken languages in Sweden” adding on that, partner 2 said “I think it is substantial for a patient to communicate with healthcare centers using his or her native language, which can enhance accuracy and reduce misinterpretation.”

4.1.3 Customer relations and segmentation

Bashi has developed new features in the new platform created by the developers of the company. These features can be recognized in some easy steps, made explicitly for elderly people. The changes take place in regards to making an easy registration and simplified steps to make specializing the symptoms very accurate. The CEO of Bashi explains these changes when she was asked of how Bashi will try to involve more elederaly people in Sweden, she states “ to register in our platform it takes only five minutes in a very easy and simple steps, and according to what their symptoms where specialized, we refer them to the direct healthcare provider.”

Worth mentioning that Bashi does not necessarily segment their customers, rather than giving more attention to people who find difficulties in using technology in general. Adding such features and changes does not exclude any other group of people.

Moreover, it is noticed from conducting an interview with Bashi that the company does not aim to segment the patients in regards to their age, rather than to segment more groups of people who were not taken into consideration in the existing platforms. For example, including a group of

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people in regards to the language aspects, the CEO added, “there will be a huge, huge success, and what I really think will be the biggest success, are the ones who are not fluent in Swedish.”

As mentioned in the methodology section, at the first stage, primary data were collected based on the model developed in the literature review section, and draft 1, illustrated in figure 7, was created.

Figure 7: Draft 1

4.2 Secondary data collection (Report to Swedish government’s expert group on public economics)

As explained by Blix and Levay, (2018), the new trend of digitizing healthcare can improve quality and efficiency of healthcare, through proper guidance and reducing waste of time. They explain that, “The long queue for patients and difficulties to access the healthcare system can induce them to seek emergency care which is more costly for society and can pose real problems

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for those who really need emergency care”. However, they further explain the downside of digitization as well. The patient empowerment or incorrect routine diagnosis may lead to an incorrect diagnosis for medical objectives.

Another important aspect highlighted by Blix and Levay, (2018) is the importance of direct communication between patient and doctor for an accurate diagnosis. Because in a direct meeting, the doctor can do a physical examination, but an indirect diagnosis can have severe limitations that make the practice unsound. Therefore, they emphasize the importance of technological advancements such as digital tools, professional measuring instruments, and cheaper consumer tools that facilitate avoiding such limitations.

Blix and Levay (2018) emphasize the importance of the patient’s spoken language in the

diagnosis process, referring to research done by Corcoran et al. (2018). This research has proved that diagnosis from spoken language gives a 72% chance to assess the initial stage of the disease. They further clarify the possibility of this using voice recognizing and language processing robots in the process of medical diagnosis. An added advantage of this technology is that talking to a robot makes the patient more comfortable than talking to a real doctor. However, they add that “Human contact is often a strength, but not always” (Blix and Levay, 2018, p.58).

In relation to the network effect, Blix and Levay (2018) explain that the Internet and social networks, other than as a marketing tool, also strengthen patients’ knowledge and make it possible to exchange information and experiences, even for those with rare illnesses.

When it comes to customer segments, Blix and Levay (2018), mention that at least 400,000 elderly people were outside the digital society in Sweden, even though elderly people have physical impairments that make travel difficult. However, they explain the bright side as well. Even though, in the short term, many elderly end up in a situation of digital exclusion, it is difficult to say how the situation will look in a future society with higher digital maturity.

As explained in the methodology section, draft one was evaluated using the findings from a report to the Swedish government on digitalization and healthcare by Blix and Levay in 2018. The secondary data and draft 2, illustrated in figure 8, were created.

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Figure 8: Draft 2

As mentioned in the methodology section, secondary data were collected to evaluate the sub-themes discussed during the group interview. Those sub-themes are summarized in table 1 alongside the main findings from a report to the Swedish government on digitalisation and healthcare by Blix and Levay in 2018 as part of the secondary data.

Table 1: Summary of interview and report issues in connection to the business model of the digital healthcare platform

Theme Issues discussed in the interview Issues discussed in the report to the Swedish government’s expert group on public economics

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Subjective to individuals rather than objective.

- Improper guidance for patients, thus Bashi aims to direct individuals to the proper resource.

- Shorten the waiting time - Higher quality by connecting to

healthcare center rather than connecting to any medical professional virtually

- Hard to replicate since the connection to the healthcare center cannot be gained by a second entrant. (since Bashi has the first-mover advantage) - In ER referral for a specific

diagnosis, the patient can get direct navigation on the transportation.

an incorrect diagnosis for medical objective( Blix & Levay, 2018 page 18-19)

- Improper prescription or diffusion of automated routines diagnosis (Blix & Levay, 2018, page 29). - The time and quality can be

improved by digitizing health care (Blix & Levay, 2018, page 32). - The long queue for patients and

difficulties to access the healthcare system can induce them to seek emergency care which is more costly for society and can pose real problems for those who needs emergency (Blix & Levay, 2018, page 32)

Distribution channels - Provide direct communication for individuals through the Bashi platform with Apotea (Sweden’s online full-scale pharmacy with no physical stores), which allows them to order medicines directly.

- Also, provide a direct connection with healthcare centers.

- The platform is in Swedish and English, but the short-term priority goal is to reinvest gains to provide 11 top listed languages in Sweden. - More subjective pictures and video

demonstrations rather than explaining in words

- Simple and easy to use the platform

- Current platforms can mainly solve simple medical problems, however, those problems requiring more care can get a better direction to the appropriate healthcare department (Blix & Levay, 2018, page 35).

- Video calls or chatting through digital healthcare platforms allow individuals from rural areas to have more accessibility to medical help (Blix & Levay, 2018).

Customer segmentation

- Not fluent in Swedish - Digital platform users

- Older people can simply learn using the Bashi platform due to the simplicity.

- According to Blix and Levay (2018), at least 400,000 older adults were outside the digital society in Sweden.

Customer relationships

- Customers can sign up and create their profiles, update information in easy steps that would take only 5 min.

- Influencers of different age groups

- According to Blix and Levay (2018), the digital platforms provide accessible, uncomplicated, and direct navigation to the

department the patients wish to visit according to their symptoms.

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4.3 Questionnaire to potential consumers of Bashi 4.3.1 Value proposition

The potential customer survey shows different levels of perception on different features offered by already existing platforms and Bashi. Most of the participants viewed that the diagnosis through digital healthcare platforms [Figure 9(a)] and guidance to the correct resources [Figure 9(b)] are accurate to some extent, but not completely. On the waiting time for an appointment [Figure 9(c)], most of them view that it takes longer than expected.

In regards to the preferences of contacting a registered healthcare center, the respondents preferred “direct contact to the clinic they are registered in”, while a smaller group of

respondents do not mind contacting a digital healthcare platform. In the same content, a high number of the respondents stated that “they prefer to visit a doctor instead of meeting him/her virtually” [Figure 9(d)]. Moreover, respondents stated that “they would highly appreciate a platform that provides direct navigation to the nearest healthcare/ ER department” [Figure 9(e)].

However, as identified through the open and closed questionnaire, the most apparent features that are considered substantially important when using a digital healthcare platform can be

summarized based on the willingness for potential customers to benefit from quick access to the platform and plainly to use, most importantly as emphasized by the respondents “as being able to have video calls”, “sharing pictures” and “quick access to chatting room with qualified doctor or nurse”, in addition to enabling optimized accuracy diagnosis. Furthermore, most of the

respondents mentioned that the consequences of the Covid-19 pandemic have also made them use more digitized services than before. Additionally, respondents appeared to have several reasons which drive them unlikely to use a digital healthcare platform. The results showed that they do not prefer digital healthcare platforms “because they might be slow in giving

appointments in case of severe and major problems”. The respondents also showed that they would avoid these platforms “if people they know have had bad experiences in using such platforms”, or “if these platforms are not of the same quality as regular healthcare centers”.