Goals and objects in value co-creation within healthcare innovation networks Open Access

The growing elderly population, increasing number of chronic illnesses and rapid technological advancements have sparked healthcare innovation efforts based on networking across national, organizational and occupational boundaries (Wagrell et al., 2022). Healthcare challenges have become global issues requiring multi-stakeholder collaborations to define and solve them. The recent pandemic stands as a poignant example, illustrating how healthcare innovation brings together public and private actors worldwide to solve global issues and transform practices and activities on an extensive scale (Sebastiani and Anzivino, 2022). The involved healthcare innovation networks can be seen as goal-oriented systems aimed at collaborative value creation at the network level, often without direct business relationships (Matinheikki et al., 2017; Möller and Halinen, 1999). Healthcare networks are complex settings for collaborative innovation, involving various actors from different societal spheres and pluralistic organizations with strong professional hierarchies (Wagrell et al., 2022). Managing value co-creation toward intricate societal objectives in such innovation settings presents a challenge.

Initially, research in value co-creation focused on company–customer interactions (Grönroos and Voima, 2013; Prahalad and Ramaswamy, 2004), examining how companies engage with customers to co-create value through products, services and experiences in dyadic interactions (Aarikka-Stenroos and Jaakkola, 2012; Baumann and Le Meunier-Fitzhugh, 2015). Research on value co-creation has also examined inter-organizational relationships among multiple stakeholders who contribute to value co-creation at the network level (Jaakkola and Hakanen, 2013; Möller and Rajala, 2007; Reypens et al., 2016) and within the public sector (Torfing et al., 2021). Embeddedness in societal structures is prevalent in healthcare, where achieving sustainability depends on the effective integration of healthcare activities and interactions among actors in the healthcare system (Wagrell et al., 2022). However, limited research exists on how diverse actors in innovation networks align for value co-creation, particularly in addressing society-level challenges (Matinheikki et al., 2017). This study answers the question: how healthcare innovation collaboration embeds multiple organizational goals and societal objects in the value co-creation of a network?

We build on value co-creation approaches that move beyond dyadic relationships to the network level. Our starting point is value nets (Möller and Rajala, 2007), rather than focusing on exchange relationships in service systems (Vargo and Lusch, 2004) or dyadic interactions between service providers and customers (Grönroos, 2008). Moreover, we take value co-creation activities as a core element (Ballantyne and Varey, 2006; Corsaro, 2019) and acknowledge the societal forces and structures shaping the value co-creation process (Edvardsson et al., 2011). We expand on this through the object-oriented view of collaborative activity (Engeström, 2001; Foot, 2002; Toikka et al., 2016) to bring in the system level and its importance in directing network-level activity within complex socio-economic systems, such as healthcare. In the empirical part, we conduct a case study of an international network that brings together healthcare organizations, testing hubs and organizations representing private firms in the Nordic countries to facilitate health technology (health tech) innovation. Through collaborative activity, network members work together to experiment, test and refine solutions, aiming to ensure innovative products, services and technologies.

The analysis of the collaborative activity reveals various organization-level goals and society-level objects which direct the network’s value co-creation activities. The value co-creation of the network parties is influenced by roles and conditions developing within and outside the network. The analysis suggests bridging-in and bridging-out as mechanisms through which goals and objects come together in value co-creation at the network level and make the collaborative activity develop. As its primary contribution, our study enhances the understanding of how value co-creation unfolds within complex healthcare innovation networks. Moreover, the object-orientedness of activities in value co-creation offers new insights into aligning innovation network-level activity with the societal dilemmas the network seeks to address. The object-oriented view embeds the network in the broader societal context by focusing on the society-level “need states” that actors draw on to frame the activity as sustainable.

Value co-creation refers to the joint activities of actors with the purpose of creating value through collaborative and reciprocal interactions (Grönroos, 2012; Grönroos and Voima, 2013). In innovation networks, value co-creation is founded on multi-actor collaborations that share work multilaterally and strive to produce system-level practices despite different value perceptions (Kohtamäki and Rajala, 2016; Reypens et al., 2016). Their members can be any organization that participates in value-creating activities and is perceived to contribute value in the system (Möller and Halinen, 1999). Value in innovation networks is actor-specific, embedded in spatial and temporal contexts (Corsaro and Snehota, 2010; Corsaro, 2014) and an experienced outcome of interaction that is uncertain and tacit (Möller and Halinen, 2017). We view value co-creation as a network-based process where multiple actors interact and contribute over time.

Value co-creation is shaped by actor experiences and depends on their individual goals, perspectives and actions (Möller and Svahn, 2003; Möller and Rajala, 2007). In an innovation network, diverse goals related to different knowledge bases and competences can foster innovation, but may also lead to negative outcomes, such as disputes, lack of coordination (Corsaro et al., 2012) and value-destructing tensions (Tóth et al., 2018). Pursuing common goals is a key driver for value co-creation in buyer–seller dyads (Baumann and Le Meunier-Fitzhugh, 2015), and service interactions (Nätti et al., 2014; Neghina et al., 2015). Planko et al. (2017) attribute innovation network effectiveness to achieving a common goal, which increases motivation and affects the composition (e.g. determining the diversity of involved actors) to build a collective system. Co-creation may involve resolving contradictions between actors’ different institutional logics through which created value is considered legitimate (Massi et al., 2021).

A collective goal is more vital for network-level value creation, the wider the variety of actors and the more radical the innovation pursued (Matinheikki et al., 2017). Wagrell et al. (2022) discuss economic and social sustainability goals as key determinants of activity in healthcare, highlighting the importance of a user system, which increases the variation of goals and perspectives among network actors. Generally, collective goals are the basis for collective value, a subjective measure of collective goal achievement, always assessed from an individual perspective (Kleinaltenkamp et al., 2022). Hence, value co-creation in innovation networks is a relationship-based interactive process that inherently not only involves a variety of organizational goals but also depends on collective direction.

Because of the individual actor differences in organizational goals and to keep the actors motivated and effective in collaborative innovation, value co-creation needs to build on interactive activities. Ballantyne and Varey (2006) distinguished relating, communicating and knowing as three value co-creating activities. These involve building connections for knowledge creation and communicating to initiate and nurture relationships that facilitate the exchange of new knowledge. Later research has identified commitment, common goals, equitable dialogue and sharing of interests as enablers (Baumann and Le Meunier-FitzHugh, 2015) and trust, information seeking and sharing, feedback and communication frequency, direction and content as antecedents (Neghina et al., 2015) of this activity. Neghina et al. (2015) categorized various types of joint actions as contributing to the overarching goal of co-creating value for the network or at least one participant. Corsaro (2019) defined value processes in terms of bridging, advising and adapting activities that generate specific outcomes for network actors. Overall, value co-creation activities exhibit particularities in different interaction settings.

By bringing together value co-creation, value net and innovation network research, we focus on the interactive and dynamic nature of collaborative efforts to achieve mutual value through innovation. We recognize the inevitability of goal variation, which influences value co-creation and the suggestive importance of shared and collective goals at the network level. Contrasting goals may lead to value destruction or harmful tensions within the network. Value co-creation activities in the network involve joint actions for relationship-building, communication and knowledge construction. However, little attention has been given to the systemic contexts in which value co-creating networks are embedded; we will elaborate on this aspect through an object-oriented view.

Systemic views have recently been emphasized in healthcare studies in European countries. Rodríguez et al. (2020) explored the evolution of sustainability initiatives, focusing on the interconnectedness of actors and dynamics within B2B networks in the healthcare industry. Russo Spena and Mele (2020) discussed healthcare as a network, emphasizing the interconnectedness of various actors including patients, healthcare providers and third-party actors involved in ecosystem-level value co-creation. Similarly, Sebastiani and Anzivino (2022) emphasized the ecosystem to account for new ways of interaction and value creation by heterogenous actors, from individual to governmental and transnational levels, combining healthcare and societal needs. Wagrell et al. (2022) emphasizes the integration of healthcare activities to achieve social and economic sustainability goals. Similarly, Mathialagan and Kuthambalayan (2023) highlight economic sustainability in terms of mobilization and efficient use of resources and social sustainability in terms of meeting individuals’ health needs and securing accessibility. For these goals, the decisions made within healthcare should be assessed within their broader societal context, acknowledging both short-term outcomes and long-term implications within and beyond healthcare systems.

To enrich our understanding of contributions from innovation collaborations that go beyond individual organization goals and short-term collective network goals, we will draw inspiration from the activity theory to use an object-oriented system view (Engeström, 2001; Toikka et al., 2016). It defines objects as the driving force of human activity that carries the motives of collective effort (Kaptelinin, 2005). Accordingly, activity is always object-oriented, but an object may take both rather abstract and more concrete manifestations as a contradictory unity of its societal use value (the societal need or problem being addressed) and its exchange value (the market-based product related to that need) (Miettinen, 2005). The object of activity is often seen as the ultimate reason or purpose embedded in collective activity (Foot, 2002; Kaptelinin, 2005), inherently conveying a “need state,” a societal dilemma (Miettinen, 2005) to which the activity contributes. We are drawn to this concept of object and object-oriented activity, as they allow us to relate network-level innovation and value co-creation activity to societal challenges confronted in present-day healthcare.

Engeström (2001, p. 136) characterizes the object of activity as “a moving target, not reducible to short-term goals” and illustrates how it can change and expand through the activity and can have several manifestations simultaneously. Even though objects can be rather unspoken, they carry motives at the system level (Engeström and Blackler, 2005). Goals are also prominent in activity theory as the conscious targets that direct the actions of an individual (Kaptelinin, 2005). Extending our analysis beyond the immediate goals and actions of network members to the object of activity will help us identify how societal-level embeddedness directs the network’s activity, while the network also creates itself in relation to innovation (Toikka et al., 2016). We aim to leverage this concept to elucidate the connection between the value co-creation of an innovation network and the societal needs that direct its collaborative activity.

This study uses a qualitative, case study research approach, which allows for a deeper understanding of the dynamic, embedded nature of networks (Easton, 1995) and the multifaceted, context-specific nature of value co-creation (Corsaro and Snehota, 2010). Our research approach is abductive, involving an iterative process that aligns empirical fieldwork with the theoretical framework, refining our understanding of the phenomena as new insights emerge (Dubois and Gadde, 2002).

Having set the aim to uncover how healthcare innovation collaboration embeds multiple goals and societal objects in value co-creation, we select an innovation network where diverse actors pioneer new technological solutions and products, actively shaping an emerging field, that is, health tech (Möller and Rajala, 2007). The case involves an international network established in 2015, comprising ten partners from renowned healthcare institutions, testing hubs and organizations representing private firms from five Nordic countries. It provides testing in all phases of healthcare innovation development and serves as a gateway for companies looking for testing sites.

We consider the case appropriate for the following reasons. The network’s composition includes a wide range of stakeholders with different roles and contributions, providing a rich setting to study the alignment of diverse goals and societal objectives in value co-creation. The Nordic healthcare system is characterized by high quality and knowledge, and they tend to be early adopters of new treatments and technology (Brennan et al., 2015). It allows for certain similarity in healthcare within the Nordic welfare societies despite country and organization level differences. The network demonstrates active and sustained collaboration, offering rich opportunities to examine how value co-creation unfolds in practice. This makes the network particularly suitable for exploring the dynamics of value co-creation within collaborative innovation activity. The international nature, high level of commitment and interactions among multiple actors provide rich empirical data to understand value co-creation in healthcare innovation networks.

This study uses interviews and secondary data to uncover network activities. To ensure comprehensive representation, all partner organizations were invited to participate, with eight of ten agreeing. Each organization had one to three representatives in the network, and we aimed to interview at least one from each. We conducted 11 interviews between April 2023 and September 2023. The interviews were conducted via videoconference, except for one face-to-face interview, and lasted from 33 to 142 min each, creating altogether 761 min of data (Table 1). The missing two organizations are unlikely to impact the findings, as the interviewees represented the core actors driving the network’s collaborative activity. Moreover, we collected secondary data, such as project reports and notes from biweekly meetings where partners and invitees shared knowledge, know-how and discussed current and future activities. This helped us capture the views of all network partners, including their expectations, motivations and goals.

The interview data offer perspectives from diverse network organizations with varying involvement, expertise and roles, providing a comprehensive view of value generation and negotiation for health tech innovation. The focus was on participants with the longest involvement, including members from the network’s inception. This approach allowed for a detailed reconstruction of events in the network’s development and its co-creation dynamics over time. All respondents held influential roles within the network and innovation-focused positions within their respective organizations, driving collaborative endeavors with the healthcare industry. We conducted five interviews with testbeds, located within hospital premises or as part of a cluster of organizations, that provide testing facilities and expertise for health tech companies. We also interviewed three organizations representing companies, including incubators and consultancies that are supporting startups and other businesses in their local and international healthcare-related endeavors. Additionally, we interviewed a testbed in the process of establishment and the two network coordinators who provided invaluable insights into network-level activities.

The interviews focused on the organization’s aims and motivations for joining the network and their perspective on the network’s formation, evolution and prospects. Discussions centered on the collaboration dynamics within the network and with various stakeholders, focusing on the interactions and activities that define the network’s operations. The researcher maintained an open-ended discussion with broad themes to avoid using theoretical constructs that might lead the interviewees. This yielded insights into value co-creation activities and how they influence the collaboration and shape the network’s trajectory.

Using abductive logic, we iterated between the data and existing theories to build a deeper understanding of the phenomena during the coding process. The data was analyzed through qualitative content analysis, involving coding phases of data reduction, data display and drawing conclusions (Miles et al., 2013). The data was coded using thematic content analysis (Braun and Clarke, 2006) to identify, analyze and report themes and patterns of individual experiences that capture the actor’s aims, needs and interactions within the network. Relying on the theoretical discussion, we had three initial categories to which we coded the data: organizational goals, network’s value co-creation and societal objects. We aimed to generate new concepts rather than confirm existing theory (Dubois and Gadde, 2002), initially taking an inductive stance that allowed the data to speak for itself and themes to emerge naturally within these categories. As the amount of data was manageable and the initial coding categories were limited to three, it was possible to work closely with the data manually, using Microsoft Word and Excel as the primary tools.

By examining transcript segments where interviewees discussed aims, challenges and aspirations, we identified relevant data examples that capture the objectives embedded within the network’s collaborative activity. From the outset, we focused on capturing representative data that highlights the organizational long-term goals driving partners to join the network and shape their operations (goals). We also gathered data that conveys a societal need or dilemma that the network’s collaborative activity seeks to address (objects), thereby clarifying the distinction between objects and goals. We intentionally let themes and concepts emerge from the data to ensure that the analysis remains relevant and authentic to the participants’ experiences. Through further analysis of underlying emphases and patterns, we derived sub-themes that captured more specific patterns within the selected quotes. For organizational goals, these sub-themes were represented by ten categories showcasing their emphasis (e.g. solving local problems). For objects, the sub-themes represented the identified seven dimensions of the societal objects (e.g. Nordic harmonization). By combining sub-themes into broader categories, we identified four themes of organizational goals (e.g. faster innovation), either relating to the organization itself or the entire network, and three themes describing objects aimed at higher-level, society-wide contributions (e.g. new healthcare solutions to market), reflecting the varied focuses within the data.

In a similar manner, we selected and coded text segments in which interviewees discussed the network’s activities, actions and interactions. By examining patterns, inconsistencies and emergent ideas within the selected representative data, we identified eight sub-themes (activities). After these sub-themes and patterns emerged inductively, we revisited the literature to interpret these findings. Some concepts align with prior research (e.g. empowerment), while others are specific to the network (e.g. testing). These were further consolidated into three overarching themes that capture the value co-creating activities (aligning, streamlining and sharing) and reflect different strategic orientations. Extensive documentation of network operations allowed us to use secondary data to contextualize specific activities. We kept account of whether the activities were between partner organizations within the network or between network partners and external actors (e.g. hospitals and inquiring companies). This helped identify the bridging mechanism that embeds goals and value co-creating activities within the evolving object-oriented collaborative activity.

While focusing on common perspectives within the network, we acknowledged individual approaches to goals and activities by partners that contribute to the objects of activity. To enhance trustworthiness, we included representative data examples for goals (Table 2), value co-creation activities (Table 3) and objects (Table 4). To capture change over time, we constructed a timeline for network development, focusing on these core concepts. Interviews, triangulated with secondary data, helped identify critical events and illustrate how these concepts interacted throughout the network’s development.

Aligned with our theorizing, we first present the network’s organizational goals and value co-creation activities. Subsequently, we identify the different manifestations of the object of activity and how they are emphasized throughout the development of the network.

The network annually reviews short-term goals, such as increasing the number of inquiring companies and cross-country testing projects. However, our focus was on long-term goals that motivate partners to join the network and guide their operations. We identified network-level goals with varying weights, depending on the roles of the actors in the network (Table 2).

Faster innovation: Participants mention that while there is an efficient system for facilitating clinical trials for new drug development, the same cannot be said for health tech products and solutions. They acknowledge numerous issues that slow down health tech innovation, including limited access to testing environments, difficulties in obtaining regulatory approvals and funding, lack of standardization, user adoption resistance and insufficient measures to ensure products meet real patient needs. The aim is to accelerate innovation by supporting the health tech industry in developing technology and solutions and facilitating their easier integration into the healthcare sector:

While the goal unites the partners, we note varying emphases among parties based on their roles in the network. For public administrators, faster innovation and health tech implementation offer opportunities to improve public services by leveraging technological advancements. Testbeds emphasize the needs of healthcare providers, ensuring solutions are clinically efficient, safe and meet patient needs. Partners that provide connections to external testbeds work to ensure business growth and commercial success for inquiring companies. There is an emphasis on shortening time-to-market by providing access to networks, investors and industry experts.

Increasing market fairness: The partners agree that the healthcare sector should ideally have a single-entry point and aim to increase market fairness by ensuring equal access to testbeds for companies:

At the company level, many entry pathways to healthcare settings rely on personal connections, and many testbeds are localized, requiring insider connections for product testing. Companies face challenges accessing such facilities, especially when targeting international markets. Typically, large corporations have easier access to testing and development collaborations, while SMEs and startups face impediments such as lack of connections and limited financial resources. These entries often lack documentation, consequently yielding no observable results from innovation testing and development, which hinders efforts to change procedures in departments, hospitals and even across borders. Increasing fairness in the health tech market involves addressing disparities in company access to resources, knowledge and opportunities. Testbeds aim to provide fair access for all companies, regardless of size or resources.

Organizations that guide startups aim to provide appropriate mentorship and opportunities to achieve connections, expertise and investments. This approach helps level the playing field for various innovative actors. While most partners leverage the network to attract international companies, some specifically aim to use the network to help local companies expand abroad.

Transparent support system: Navigating the health tech innovation process can be challenging because of complex regulations, limited access to expertise and funding and lengthy approval processes. The network aims to provide clear, accurate and accessible information related to processes and resources available to support health tech companies:

The network aims to streamline engagement by simplifying contact procedures and reducing hurdles for potential inquiries. For some partners, facilitating market access is a central goal, and a transparent guidance process ensures that such opportunities are provided fairly. They support companies in product development and provide guidance on each Nordic country’s healthcare system. They also help companies understand guidelines, timelines, potential challenges and get timely feedback on regulatory approval requirements.

One initial network goal was to strengthen the Nordic cooperation between testbeds. When the network was formed, testbed activities were new for many. There were few administrative and clinical procedures and long processing times and additional costs for companies, discouraging innovation. The network strives to create a testing hub by establishing infrastructure for coordination among testbeds, matching companies with suitable testbeds. Some partners are more interested in cross-country collaborations, while others incline toward improving services together but conducting testing individually. Through client-oriented testing services, fostering needs-driven innovation and prioritizing a scalable infrastructure, the network aims to prepare testbeds for domestic and international projects.

New collaboration opportunities: Scouting for and creating new collaboration opportunities relates to the need to develop the healthcare innovation ecosystem and is a key goal of the network:

For many partners, joining the network addressed local issues such as lack of scaling opportunities, testing knowledge and providing connections and solutions for local companies. Partners not representing a testbed were particularly interested in the potential connections the network could facilitate. By building relationships and engaging in joint activities, actors seek potential collaborators and opportunities to expand their innovation networks.

Partners identified the need to keep up with accelerating technological advancements and evolving regulatory frameworks. Network interactions inspired the goal to learn about the market. Partners operating a testbed can identify intriguing products and solutions that may not be immediately relevant but are important for anticipating and developing solutions that can address future needs. The partners seek insights into the latest developments from inquiring health tech companies and also benefit from each other’s expertise.

Value co-creation in the network consists of three categories of activities (Table 3). Two focus on the public-private interface, creating value through allowing innovations to start from an initial understanding of needs or by smoothening the innovation process between them. The third category focuses on value co-creation from the connections and interactions among network partners.

Aligning public and private needs: To alleviate discrepancies between the public and private healthcare sectors, the network is assessing the needs on both sides and mediating relationship building. Co-creating activities aim to align the private sector’s focus on innovation, scalability and profitability with the public sector’s emphasis on affordability, public health outcomes and safety:

Through close collaborations with hospitals, partners can assess the real needs of healthcare consumers (patients) and providers (clinicians, administrators and staff). Partners that work directly with hospitals can observe operational difficulties, patient care demands and healthcare delivery processes. Some partners hold monthly meetings with hospitals to identify testing needs and discuss incoming company inquiries. Others have internal systems where hospital employees can submit demands or propose solutions. Assessing public sector needs is more difficult for partners that do not operate a testbed, so they focus more on understanding company needs.

The network also conducts activities to assess the specific needs of inquiring companies. This includes inquiry forms and individual meetings to discern the nature of their solution, product development phases, specific assistance required and whether the network has the resources and capabilities to fulfil those requirements. The regularity of these interactions fosters a continuous feedback loop that helps adapt network activities toward meeting the needs of both sectors.

The network mediates interactions by facilitating understanding, communication and co-creation between the public and private sectors. Through testing, meetings and organized events, the network provides opportunities for sectors to connect and discuss their goals and challenges. While the network works to align the needs of both sectors, we observe the predominance of company needs in the discussions, as the inquiring companies actively seek testing, validation and collaboration with the public sector. Most respondents note the difficulty of encouraging change in hospital settings.

The network helps companies receive feedback in all phases of product development. Depending on individual company needs, partners can provide a variety of services such as expert panel workshops or clinical trials in simulated or actual use conditions. The focus is to ensure proper use, safety and user needs match. While the network provides the connection, the actual testing and documentation is conducted by partner organizations. Some partners only provide connections; others assist during interactions; and testbeds take full responsibility for testing. The more involved they are, the easier it seems to be to mediate the push from companies for testing innovation and resistance from hospitals.

Streamlining public–private interaction: The network focuses on providing easy connections between companies and leading health institutions and testing hubs across the Nordic countries, which helps streamline health tech collaboration and innovation:

Organizing and coordinating solution testing is a key activity for the network’s collaborative operations. Testbeds have developed in parallel throughout the Nordic countries, resulting in diverse operational business models, service offerings and isolated project testing. Despite this, similar case handling requirements have created an impetus to share and standardize test processes, which also allows for large multi-center projects.

Despite knowledge sharing and replication of tools and practices between network partners, more personalized interactions tend to be tailored to individual needs. Partners emphasize flexibility in their approaches, as inquiries come at different product development phases and cover various healthcare challenges. When the network cannot meet a company’s inquiries, partners attempt to introduce them to relevant organizations from their own connections.

The network continuously optimizes the company screening process, service catalogue and partner representation. They emphasize nurturing companies and ideas before they reach testing readiness, as the quality and volume of test cases relate to the network’s sustainable operation model and will affect subsequent co-creation efforts in hospital settings. By refining how companies communicate their specific requirements, the network can effectively match them with the right public institutions or testing environments. Partners also emphasize improving network service descriptions and creating a comprehensive catalogue that communicates the range of offerings on the official website and during promotional events. These activities streamline the process for easier engagement, ensuring companies have direct access to experts who can assist with product development.

Sharing experience and expertise: The network conducts internal activities to facilitate sharing and learning between partners. They organize a best practice program where various topics are shared and discussed based on individual partner experiences. Themes discussed include case handling, clinical trials, case evaluation and challenges with access to healthcare data:

Given the differing roles, capacities and locations of partner organizations, ensuring the network makes the most of its competencies is an ongoing process. It is difficult to create an identity that encompasses the network’s diversity and develop a comprehensible value proposition within the network, which will also streamline external collaboration processes.

The network empowers actors to seek opportunities to add more value to the collective endeavor. Connections between partners are both needs-based and common value-based. The network has a partner-driven concept that facilitates proactive participation through collective decision-making. The chosen mode of coordination through informal communication and less bureaucracy forms stronger interpersonal ties. Through a dedicated schedule of partner visits and biweekly meetings, partners share struggles, developments and common areas of interest, fostering a closer community. Respondents often mention coordination as key to maintaining the current level of commitment, sharing and familiarity between partners.

The learning process aligns with sharing experience and expertise. Partners replicate practices and tools acquired from each other or developed collaboratively within the network. They often implement the same inquiry forms, pricing mechanisms and case handling tools. This standardizes their practices, which in turn makes testbeds more professional and sustainable.

Overall, the network’s collaborative activity is directed at the betterment of healthcare systems, and this object has three primary manifestations (Table 4). The objects are intertwined with other market, political and social processes and, therefore, can be seen as shared motives of many business and public systems.

New healthcare solutions to market: The network’s collaborative activity builds on the view that healthcare systems increasingly rely on technology to address workforce shortages and use new possibilities for diagnosis and treatment. The network is founded on the need to bring new health tech solutions to the market:

While the network is not directly involved in bringing health tech products to the market, it aims to facilitate the creation of new healthcare solutions to meet the healthcare sector’s long-term needs. Through testing facilities and collaborations between healthcare institutions and industry, innovations are designed to meet the needs of hospitals and patients and adhere to healthcare standards.

While an innovative solution might pass testing and regulatory approval, its successful market launch is not guaranteed. Some solutions have obtained all necessary documentation and approvals and garnered the interest of potential buyers but have not progressed further. Although the network does not monitor progress post-testing, they do hear about the launches and acknowledge successes.

Elevated Nordic healthcare: Health and welfare are high on the innovation policy agenda in every Nordic country. They face similar challenges, and to tackle them, the network works to elevate the Nordic ecosystem for health innovation and related technology markets as a unified structure:

The network focuses on a shared need that unites partners: providing health tech companies with access to premium testing facilities through cross-border cooperation and coordinated services. Still, developing and using new patient-centered technological solutions in healthcare requires a complete ecosystem. While strengthening collaborations is at the forefront in Nordic national policies, it is challenging to harmonize practices across such a variety of organizations.

Collaborative healthcare innovation at the Nordic level expands market opportunities, provides in-depth insights on common challenges, offers a greater pool of ideas and expertise and attracts companies and international investments. One belief behind the network’s formation was that sharing experiences and knowledge would prevent wasting resources on solving almost identical problems in each country. The geographical proximity and similarities in healthcare enable them to work toward common goals across the Nordic countries. The countries’ long history of collaboration lays the groundwork for a Nordic brand, benefitting the parties and aiding companies aiming to expand internationally.

Sustainable welfare societies: Further development of test facilities and collaborations between healthcare institutions and industry should generate benefits for the entire healthcare ecosystem and create long-term value for the society by solving key challenges:

Maintaining publicly funded welfare societies is seen as essential for ensuring equitable access to healthcare and other social services. To solve future challenges, the public health sector must become more innovative and adopt new solutions. Health tech innovations such as telemedicine, AI-driven diagnostics and wearables can lower healthcare costs by improving efficiency, reducing hospital stays and enabling remote patient monitoring. The collaborative activity supports the creation of an environment for testing digital solutions. Additionally, efforts are being made to expand offerings, supporting a wider variety of companies and broader innovation.

Data sharing infrastructures are a third dimension of this object, which, however, carries tensions between the need for strict regulation and a neutral ground for healthcare and industry to share data. Companies need a hub with both synthetic and patient data to test solutions, but currently, data is mostly available for research and not for innovation activity.

We identify bridging as the core mechanism that can explain the embeddedness of various goals and objects in value co-creation and develop the collaborative activity of the innovation network. It connects the success of the network’s activity to its interfaces with other actors and activity in the healthcare sector (Corsaro, 2019). We distinguish between bridging-in, which nurtures and strengthens the collaboration among the network’s partner organizations, and bridging-out, which fosters connections and interactions with stakeholders outside the immediate network. The contribution to the healthcare sector and welfare societies is dependent on bridging-out, which helps align internal and external needs. Figure 1 illustrates how value co-creating activities drive the network toward societal-level transformations by contributing to solving societal dilemmas as the object of activity. The changes and adaptations within the network were fueled by societal needs. We identify three phases through which the activity developed and shaped the network itself under different conditions (Toikka et al., 2016).

The initial phase of network formation was marked by the novelty of the network’s activity and healthcare developments. As healthcare became increasingly dependent on technology, developing test facilities and fostering collaborations between healthcare institutions and industry became essential. This drove the network’s formation and directed its activity toward the object of bringing new healthcare solutions to the market. The testbeds were at various stages of maturity, from facilities that were in the process of being built, to well-established ones with years of experience, but the collaborative activity aimed to support all. This made bridging-in prevalent as partners shared expertise to streamline collaborative operations and better align public and private needs. These internal value co-creating activities established a standard of professionalism that every partner upholds when bridging-out to companies and hospitals. The bringing-in efforts illuminated the differences and similarities among organizations and the demands they could or could not meet, leading to a pivotal shift in the collaborative activity to meet a broader range of needs.

The following diversification phase was spurred by an influx of company inquiries that could not be met, coupled with an interest in involving diverse actors in the network. While the network was dominated by testbeds, an ecosystem within health innovation and business creation was needed to develop and use new technological solutions. The network became open to new partners, such as incubators, startups and cluster organizations. Bridging-out became more prominent, and the network made numerous efforts to connect, align and streamline interactions with a wider range of stakeholders. Partners were empowered to scout for new partners, increase collaborating efforts with affiliated partners, as well as conduct webinars and industry meetings where opportunities might appear. Bridging-in drove network promotion, communication and guidance for a fairer and more transparent innovation support system. These activities, along with the broader reach of the diversified network, can lead to a wider range of perspectives and ideas in health tech development, achieving healthcare system-level outcomes. While diversity in collaborative activity contributes to the creation of a complete healthcare ecosystem with broader innovation and collaboration opportunities, it can pose challenges in achieving a harmonized Nordic health tech brand.

The current phase of the collaborative activity focuses on scaling the network’s operations, reach and impact while maintaining the established foundational elements. The activity involves more cross-country collaborations and complex projects spurred by rapid advancements in technology, specifically pertaining to AI and data-driven solutions, targeting clinical treatment, prevention and well-being. Bridging-in includes more frequent sharing of insights and learning from best practices. Bridging-out involves aligning and streamlining private–public co-creation efforts for integrated healthcare solutions. Scaling also brings divergent views regarding the network’s future activity, such as responding to broader healthcare needs or specializing in a specific area. Moreover, the activity starts to be divided into smaller networks centered around common interests and specific value co-creation activities. Overall, scaling is driven by the object of developing sustainable healthcare delivery models and innovations that can adapt to changing societal needs, technological advancements and environmental pressures.

Our study expands the limited research on how diverse actors in an innovation network collaborate for value co-creation, particularly in addressing society-level challenges (Matinheikki et al., 2017; Wagrell et al., 2022). Through the object-oriented view of collaborative activity, we connected network-level value co-creation to the societal challenges faced in today’s healthcare (Engeström, 2001; Foot, 2002; Toikka et al., 2016). We answered the question of how healthcare innovation collaboration embeds multiple organizational goals and societal objects in the value co-creation of a network.

Prior research suggests both the importance of different knowledge bases related to the varying goals of collaborating actors (Corsaro et al., 2012) and common goals (Planko et al., 2017), as well as potential tensions arising from differing goals (Tóth et al., 2018). We identified that objects drive the network’s activity toward societal needs, developing a collective focus, despite diverse individual goals. According to activity theory, while the goals can be diverse and are the conscious targets directing activity implementation (Kaptelinin, 2005), the object offers a motive not explicitly established by organizations but reflects the network’s orientation to fulfill societal needs. The object can evolve and manifest in multiple ways (Engeström, 2001). We identified three manifestations that shape the activity, with their priority shifting as societal needs change. Prior research has also established economic and social sustainability goals as key determinants of activity in healthcare (Wagrell et al., 2022). The object-oriented view embeds the network’s collaborative activity in the broader societal context by focusing on the society-level “need states” that actors use to frame the activity as sustainable.

Moreover, our study describes in detail different types of value co-creation activities in healthcare innovation networks. While some activities align with prior research, such as Neghina’s (2015) empowerment dimension, several are specific to the healthcare innovation context (health tech testing) or acquire unique nuances from the public–private setting. The findings address calls to research the alignment of value co-creating activities with an overarching goal and their relevance in longitudinal studies (Neghina et al., 2015; Corsaro, 2019). While previous research on goal alignment focused on value creation mainly within the network (Matinheikki et al., 2017), we expand on this by emphasizing the types of actor interactions. Aligning and streamlining focuses on the public–private interface, facilitating value creation by fostering understanding between stakeholders. In contrast, sharing contributes to value co-creation through the connections and ongoing interactions among network participants. These elements can work as cues in understanding the categories of joint value co-creation in such complex healthcare innovation networks. The activities foster alignment between partner organizations and external stakeholders, helping them navigate differences and work toward common goals.

Our findings identify bridging as the core mechanism that explains how diverse goals and objects are embedded within value co-creation. While extant research identifies bridging as an important activity that would build on interdependence between actors and their requirements to coordinate their efforts toward mutual success (Corsaro, 2019), we distinguish between bridging-in and bridging-out and differentiate their effects in a cyclical manner, through distinct phases that develop the network activity. We identify how changes and adaptations within the network, fueled by objects built from societal needs, can affect the network’s emphasis in its collaborative activity through time (Figure 1). Within this framework, we define bridging-in as strengthening collaborations between the network’s partner organizations and bridging-out as fostering connections and interactions with stakeholders outside the immediate network. We assert that a healthcare innovation network must balance internal value co-creation with partners and external activities involving companies that seek testing facilities and healthcare organizations needing innovative solutions.

This study aimed to understand value co-creation within an innovation network considering evolving societal structures shaping its activities. By analyzing a Nordic healthcare innovation network, we defined multiple organizational goals, value co-creation activities and societal objects intertwined in the collaborative activity. We examined the impact of network–object interaction on the development of the collaborative activity over time.

This study contributes to research on value co-creation within innovation networks, that has given little attention to the systemic contexts in which value co-creation within networks is embedded (Wagrell et al., 2022). This study adds to organizational analysis the object-orientedness of the collaborative activity. It goes beyond individual organizations’ goals and short-term collective goals to the society-level “need states” that guide the network’s collaborative activity over time. Although often unspoken, these objects serve as carriers of motives at the system level (Engeström and Blackler, 2005). Identifying these objects deepens the understanding of how societal needs shape the network and guide its value co-creation activities. This insight not only sheds light on the broader context in which the network operates but also assists in managing value co-creation efforts effectively.

Moreover, this study enhances understanding of multi-actor value co-creation efforts within complex healthcare innovation networks. While existing research often regards high heterogeneity as negative and disruptive, complicating the formation of a collective goal (Matinheikki et al., 2017; Tóth et al., 2018), our findings suggest a more positive perspective. They align with the notion that diversity in network resources can enhance innovation (Corsaro et al., 2012; Planko et al., 2017). Partners within healthcare innovation networks operate in a common area but often occupy unique positions because of varying conditions and capabilities. This diversity fosters new collaborations and alignment with stakeholder needs, while also inevitably leading to a range of organizational goals. Although prior research mentions negative outcomes as a result of a variety of goals in an innovation network (Corsaro et al., 2012; Tóth et al., 2018), our results show that they can be beneficial if they are interconnected, where advancements in one positively influence others. The network’s diverse goals are unified by underlying societal needs that serve as guiding motives. The bridging mechanisms, through aligning internal organizational priorities with external stakeholder interactions, not only reduce the impact of individual goals but also guide the collective efforts toward broader societal challenges.

Regarding practical implications, our findings suggest managers should move beyond viewing value co-creation as a tool for narrow, short-term goals and instead recognize it as part of a larger, interdependent system (Corsaro, 2019). To apply this, managers should take a proactive role in explicitly defining the objects and understanding the different viewpoints involved, as these often remain unspoken and unwritten. This will enable them to align contributions with longer-term societal and organizational needs, thereby enhancing the sustainability of collaborative efforts.

The practical implications of our findings extend to network coordination among diverse actors, with changing composition and focus. Our findings suggest that having a variety of goals can be beneficial provided they are interconnected in addressing broader system-level challenges. Moreover, managers can create a unified direction for co-creation by integrating societal needs as shared objects, ultimately enhancing the collaborative activity’s transformative capability at the societal level. The identified distinct value co-creating activities (aligning, streamlining and sharing) also provide practical grounds for managing value co-creation. While these activities often focus on partner interactions, our findings suggest that managers should prioritize and establish professional standards for engaging with external stakeholders (bridging-out). Strengthening these interactions is crucial for ensuring alignment between internal and external needs. For instance, managers can establish regular communication channels with external stakeholders to ensure their needs are met, ultimately fostering more effective and sustainable value co-creation.

The single-case method and context-specific focus on health tech innovations requires caution regarding generalizations. This study is based on a case with network members from well-developed countries and an initial basis for collective effort in the long history of cross-country collaborations, and this socio-economic context may influence the observed value co-creation dynamics. Future research could explore how societal needs are embedded in collaborative activity between parties from countries with different economic conditions and also in sectors beyond healthcare. The identified goals, objects and value co-creation activities correspond to the type of collaborative activity, and we do not exclude the existence of others. Moreover, while we aimed to capture different levels of interaction, future research could further nuance such multi-actor interactions for value co-creation.

Although the network is international, we did not account for possible differences or changing perceptions in cross-border value co-creation activities. Future research could focus on how the international aspect influences value co-creation and how societal needs from different countries, coupled with local responses, shape the collaborative activity. Finally, while value co-creation ideally involves equal participation from all stakeholders, companies are currently more active in searching for innovation collaboration than hospitals. This highlights the need for research on enhancing public sector engagement and practical steps to empower hospitals to build expertise and overcome resource constraints, ensuring balanced collaboration for healthcare innovation.