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Nowadays, digitalization and technology bring forth new challenges and opportunities for organizational innovativeness. Technological development has led organizations to an ongoing process of change. What has been reached is not enough to keep up in the long run. Innovativeness encourages creating a novel or enhanced activity. Innovativeness and the innovation process have taken on a new form with digital service design. Furthermore, there are changes in definitions of concepts of innovations and their deployment in the current situation. In the healthcare context, innovations can be classified as service innovations (Parris, Bouchet, Peachey, & Arnold, 2016) and more precisely, for the purpose of this systematic literature review, as digitally enabled service innovations (Lusch & Nambisan, 2015). According to current trends, healthcare service innovations have a clear connection to services with different technological innovations. Technology encounters major expectations, and its achievements have been radical in developing treatments and healthcare systems or at least renewed and intensified patient care.
Healthcare organizations function in different clusters: investors, suppliers, consultants, technology firms, and customers with cooperation of an organization’s staff. The complex adaptive systems theory approach can be used to construe the understanding of these actors’ cooperation and achievements. The approach can enlighten healthcare innovative activity in which innovations can evolve on the basis of the interaction and knowledge of stakeholders. Complex adaptive system theory and digital service design have the following elements in common: diverse participants in its operating environment, spontaneity, creativity, innovativeness, and emergence of novelty as the result of activity. Emergence is beforehand an unknown outcome; it may be achieved or not (De Wolf & Holvet, 2005), and as a such, it applies to healthcare technology and its innovative process because no one knows exactly where technological development can lead. The healthcare system is an appropriate context in which to diagnose sicknesses and developing healthcare processes is an ongoing necessity. Therefore, innovativeness, complexity, and new technological solutions are ongoing processes in the development of healthcare services. The aim of the study was to investigate digital service design as an innovative process based on complex adaptive systems theory. The knowledge of the ways that organizations, employees, and users interact and also, the descriptions of the specific tools and methods of users involvement in the development of new services are lacking (Wetter-Edman, 2013). In many studies, the complexity of healthcare is highlighted (e.g., Finchman, Hohli, & Krisman, 2011), but its meaning seems to be ambiguous and especially, how it evolves during the innovative process, how stakeholders of an organization self-organize, and what kind of emergence is accomplished. Most studies report on the results of interventions or the deployment of innovations, but more research is needed concerning the self-organizing that can lead to an emergence of digital service design (e.g., Poutanen, Soliman, & Ståhle, 2016). Furthermore, the combination of emergence and self-organization is suggested to be a more promising approach than investigating them on their own in complex multi-agent systems (De Wolf & Holvet, 2005).
The research question of the systematic literature review was how healthcare organizations’ innovative processes of digital service design regarding stakeholders can be described by self-organization and emergence of complex adaptive system theory. The sub-questions covered the main research question by asking how healthcare professionals, patients, and other stakeholders participate in an innovative process of digital services, and what are the benefits and barriers of the self-organization and/or emergence in a healthcare organizations’ innovative process of digital service design.