Critical elements underpinning the emergence of the medical game ecosystem:gamifying traumatic brain injury rehabilitation in Finland

The healthcare sector is currently in the verge of a reform and thus, the medical game research provide an interesting area of research. The aim of this study is to explore the critical elements underpinning the emergence of the medical game ecosystem with three sub-objectives: (1) to seek who are the key actors involved in the medical game ecosystem and identify their needs, (2) to scrutinise what types of resources are required in medical game development and what types of relationships are needed to secure those resources, and (3) to identify the existing institutions (‘the rules of the game’) affecting the emergence of the medical game ecosystem. The theoretical background consists of service ecosystems literature. The empirical study conducted is based on the semi-structured theme interviews of 25 experts in three relevant fields: games and technology, health and funding. The data was analysed through a theoretical framework that was designed based upon service ecosystems literature. The study proposes that the key actors are divided into five groups: medical game companies, customers, funders, regulatory parties and complementors. Their needs are linked to improving patient motivation and enhancing the healthcare processes resulting in lower costs. Several types of resources, especially skills and knowledge, are required to create a medical game. To gain access to those resources, medical game companies need to build complex networks of relationships. Proficiency in managing those value networks is crucial. In addition, the company should take into account the underlying institutions in the healthcare sector affecting the medical game ecosystem. Three crucial institutions were identified: validation, lack of innovation supporting structures in healthcare and the rising consumerisation. Based on the findings, medical games cannot be made in isolation. A developmental trajectory model of the emerging medical game ecosystem was created based on the empirical data. The relevancy of relationships and resources is dependent on the trajectory that the medical game company at that time resides. Furthermore, creating an official and documented database for clinically validated medical games was proposed to establish the medical game market and ensure an adequate status for the effective medical games. Finally, ecosystems approach provides interesting future opportunities for research on medical game ecosystems

Barriers to Service-sector SME Internationalization in the EU Business Environment

The service sector in the global world is constantly growing: in Europe, they account currently approximately for 70 per cent of the total economy. Yet service internationalization is rather a new phenomenon: services have been traditionally seen as local entities, which also explains why research on service internationalization has properly begun only few decades ago. Even though the Single European Market allows free service movement between Member States, services do not move as actively as desired: approximately only one fifth of services are involved in cross-border trade. Therefore, the main purpose of this thesis is to analyze the barriers to service-sector SME internationalization in the EU business environment. To address the research purpose, the internationalization of service-sector SMEs in the EU area is first described and thereafter, the barriers to service-sector SME internationalization in the European context are mapped and analyzed from intra- and extra-firm perspectives. In order to understand the topic area and the phenomenon, a short glance is first taken into Europe as a business environment for service industries: the market characteristics and benefits of the common free trade area for service industries are described. Also earlier literature on service internationalization and barriers to international service trade are discussed. Due to low previous research activity on barriers specifically to international service trade, the discussion is improved by presenting general findings of barriers to SME internationalization. This research is conducted with qualitative methods: there is only a limited amount of previous research and qualitative methods provide a way of gathering in-depth information and reaching understanding from respondents’ perspectives. The evidence presented in the study was collected through six semi-structured interviews with six different small or medium sized international service firm representatives that all had the first-hand knowledge regarding their company’s process of delivering services from home market to other European countries. The results of the study provide a detailed description and analysis of intra- and extra-firm barriers to service-sector SME internationalization in the context of EU and indicate that in general, internal firm-specific barriers have a greater impact in determining firm’s possibilities to be engaged in cross-border service trade – external barriers played a smaller role. What might explain these results is that first of all, the study has full focus on service firms of smaller size and internal barriers tend to be particularly effective to SMEs as their resources, skills and capabilities are often limited, which limits internationalization possibilities. Second, the results may indicate that EU’s internal market and the free trade concept function quite well from service firms’ perspective, and the low service movement rate may be rather caused by firm’s own competences and resource-related difficulties than directly by flaws in the market. The results complete earlier literature and provide new and more detailed knowledge of barriers to cross-border service trade in the context of Europe. They also indicate that service internationalization should be observed separately from internationalization of traditional manufacturing firms due to unique service-specific characteristics. The findings of this study are particularly beneficial for small or medium sized service firm managers as it provides knowledge of delivering services across borders in Europe and of barriers that relate to that process.