Journal of Business Research 124 (2021) 458–468

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Journal of Business Research

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Emerging technology as a platform for market shaping and innovation☆

Valtteri Kaartemo a, Anna-Greta Nyström b, *
a
University of Turku, Turku School of Economics, 20014 Turun yliopisto, Finland
b
Åbo Akademi University, School of Business & Economics, Vänrikinkatu 3B, 20100 Turku, Finland

A R T I C L E I N F O A B S T R A C T

Keywords: Market shaping literature portrays markets as outcomes of deliberate and designed actions. While technological
Market shaping development might accelerate changes in the market, market-shapers do not often develop technology them­
Technology selves. As they rely on complementary technologies, enabling new ways to integrate resources and co-create
Healthcare
value, the field has not paid particular attention to the role of technology in market shaping and innovation.
Market innovation
5G
To advance the literature, we conceptually differentiate between technology “as a market offering” and “as a
platform for market shaping and innovation”. Through incorporating a structured Delphi study on the impact of
5G technology on the healthcare market, we identify nine important and probable market changes induced by
5G. We contribute to research on market change by highlighting a broad inclusion of market actors for a more
holistic view of market changes introduced by emerging technology.

1. Background and purpose randomly emerge but result from purposeful efforts by a focal actor that
perform and transform markets (Nenonen, Storbacka, & Frethey-
Mainstream marketing has conventionally been built on the Bentham, 2019, p. 251). The result of a market-shaping process is
assumption that markets pre-exist, and firms enter a predetermined, considered a market innovation if there are significant changes in the
existing context, in which they discover opportunities (cf. Coviello & market structure (new market devices and agents) or new market
Joseph, 2012). In this view, the market is beyond the control of the firm, practices (Kjellberg et al., 2015). Correspondingly, according to the
and the firm reacts to the requirements of its business environment. Service-Dominant (S-D) logic view, markets emerge through an inter­
Recently, marketing scholars have started questioning this neoclassical play between technological innovations and institutional arrangements
view of markets and have shifted from treating markets as pre-existing (Vargo et al., 2015). Markets are deliberately shaped by actors with
and given contexts toward viewing markets as entities performed and agency (Mele et al., 2018), and these changes may relate to more specific
represented by various market actors. The change in the conceptuali­ levels, as identified by Nenonen et al. (2019), namely products and
zation of markets has underlined the importance of companies actively price, channels, customers and use, supply-side network, representa­
scripting markets with market propositions (Geiger, Kjellberg, & tions, and norms.
Spencer, 2012; Kjellberg & Helgesson, 2006; Storbacka & Nenonen, Markets are thus institutionalized solutions (cf. Vargo & Lusch,
2011). 2016) in which certain types of (market) actors typically partake in
This development has resulted in the emergence of a stream of exchange. In addition, Baker et al. (2019) note that market change may
literature, which is known as market shaping (Baker, Storbacka, & also be partly driven by ‘peripheral’ or ‘nontraditional’ market actors. As
Brodie, 2019; Nenonen & Storbacka, 2018). It portrays markets as follows, it is important to zoom out from traditional market actors and
outcomes of deliberate and designed actions, which invites companies activity (institutionalized solution) to nontraditional actors and activity
and other actors to engage in shaping markets (Kindström, Ottosson, & that may shape or create market practices.
Carlborg, 2018) and generating market innovations (Kjellberg, Azimont, Technological development is an example activity that can accel­
& Reid, 2015). Vargo, Wieland, and Akaka (2015, p. 64) define market erate market change (Vargo et al., 2017). As noted by Nenonen, Stor­
innovations as institutionalized new solutions. They do not just backa, and Windahl (2019), market-shapers do not often develop

This work was supported by the Foundation for Economic Education; the Academy of Finland [grant number 315604]; and Business Finland [Wireless for
☆

Verticals, WIVE project].

* Corresponding author.
E-mail addresses: valtteri.kaartemo@utu.fi (V. Kaartemo), anna-greta.nystrom@abo.fi (A.-G. Nyström).

https://doi.org/10.1016/j.jbusres.2020.10.062
Received 3 October 2019; Received in revised form 22 October 2020; Accepted 24 October 2020
Available online 14 November 2020
0148-2963/© 2021 Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
V. Kaartemo and A.-G. Nyström Journal of Business Research 124 (2021) 458–468

technology themselves. Instead, they typically rely on complementary institutionalized market but is still somewhat predictable if technology
technologies that enable new ways to integrate resources and co-create development of peripheral actors is carefully analyzed. This encourages
value. Fehrer, Woratschek, and Brodie (2018) describe the setting, in the combination of effectual and causal logic in market shaping (Read,
which focal firms do not control the entire service system, using the Dew, Sarasvathy, Song, & Wiltbank, 2009; Sarasvathy & Dew, 2005).
concept of platform business model. Consequently, the technological Second, the key contribution of our research relates to the advancement
infrastructure influences how actors collaborate in the market (Akaka & of a framework to study market change. We illuminate how Nenonen
Vargo, 2014). Yet, the role of technology as a platform for market et al. (2019) framework can be used as a part of a Delphi study that
shaping and innovation has remained understudied. In other words, focuses on the anticipated market changes, and it presents a critique that
while the extant research raises awareness of the linkage between encourages the broad inclusion of actors for a more holistic view of
technological and market innovations on a high level of abstraction, market changes. Third, we contribute to the technology and market
there is a need for so-called midrange theory development (Brodie, innovation literature (Vargo et al., 2015) by increasing the under­
Löbler, & Fehrer, 2019; Vargo & Lusch, 2017) that brings the abstract standing of the wider changes that new technologies bring to the market
level closer to pragmatic approaches in explaining the relationship be­ as well as how technology as a platform enables the introduction of
tween constructs. Midrange theories target a subset of phenomena market innovations.
relevant to a specific context or subject, and contribute with de­ This paper is structured as follows: First, we present research on
scriptions, explanations, or predictions. Midrange theories thus bridge market shaping and discuss the concept in light of emerging technolo­
the gap between general theory and empirical research, keeping the gies and how technology may act as a platform for market shaping
process manageable during theory construction (Weick, 1989) and processes. Second, we present the empirical setting and method for
eventually refining and expanding the scope of general theories (Brodie, collecting expert views on the impact of emerging technology (5G).
Saren, & Pels, 2011). Third, we present the results from the study. Fourth, we discuss the
The purpose of this paper is to explore how an emerging technology implications for market shaping research and the limitations of the study
may act as a platform for market shaping and innovation. This is and suggest future research avenues.
accomplished by conducting a Delphi study on the impact of the next
generation of wireless technology, 5G, on the healthcare market spe­ 2. Market shaping and innovation
cifically, applying Nenonen et al. (2019) framework on market change.
The study reveals various expert perceptions of what may change in the Market shaping literature (cf. Kjellberg et al., 2015; Storbacka &
healthcare market in the near future, after the introduction of 5G Nenonen, 2011) takes an interest in how market actors can influence
technology. As a result, we are able to show both the usefulness of the markets in ways that are to their own advantage, instead of simply
model in an empirical setting, present a critique that helps to further taking the constraints of the market as a given and struggling with
develop the framework, and contribute with midrange theories on existing competitors for the best possible position within these limits.
market shaping. Markets are social constructions, “co-created by market actors as they
The context of the study, namely the emergence of 5G and its engage in market practices” (Storbacka & Nenonen, 2011, p. 255) rather
anticipated impact on the healthcare market, provides an interesting than pre-determined structures in which actors compete for fixed posi­
empirical context for studying market changes. First, 5G is developed by tions (Araujo, Kjellberg, & Spencer, 2008). Market actors change the
actors, who are not traditionally considered as major players in the way markets are configured through their intentional and unintentional
institutionalized healthcare market. This follows from the interest of the actions. This recent attention towards market shaping and innovation
technology developers to seek opportunities and use cases in various has focused on the issue of the active production of markets, suggesting
markets. Second, 5G technology is developed in collaboration by that markets are ongoing processes of “becoming” rather than stable
different actors globally, and it is not provided by a single market actor. entities (Kjellberg et al., 2015). Subsequently, markets are continuously
Third, the technology enables new solutions to the healthcare market. shaped and reshaped. Kindström et al. (2018) propose that this
For example, 5G is designed for very low-latency applications, a high malleability can be interpreted by examining technological, exchange-
level of accuracy in performing activities remotely, higher data rates, related, and institutional activities in markets. Furthermore, the au­
and lower energy consumption. For instance, 5G enables ultra-reliable, thors identify the role of technology as a functional base for the shaping
low-latency communications (URLLC), which use the mobile network of single and combined activities as well as the creation of useful market
for mission-critical applications that require continuous and robust data offers, thus bringing technology to the forefront of market-shaping
exchange (e.g., remote surgery using robots). 5G will boost the devel­ research. However, research that focuses specifically on market
opment of the Internet of Things (IoT), as the network will be used to shaping and innovation linked to emerging technology is scarce.
connect a large number of devices (e.g., drones providing real-time data
for emergency responders). Fourth, 5G is in the near future, which 2.1. Market innovation and incremental shaping
makes it easier for the industry experts to anticipate the potential impact
of the technology on the market. Finally, safety requirements associated Kjellberg et al. (2015) bring forth market innovation as a process
with heavy regulations make the healthcare market rather traditional facilitated by actors in an attempt at shaping markets, and more spe­
and slow to change. Healthcare has tremendous societal impact, taking cifically shaping the existing market structure and new market devices,
the bulk of public and private spending (which loads any market change altering market behavior, and reconstructing market agents. According
with an economic interest) and is thus interesting to study further from to Kindström et al. (2018), market innovation is one approach to
the perspective of market shaping. conceptualizing market shaping alongside driving markets (Jaworski,
Along with having practical relevance, our research makes three Kohli, & Sahay, 2000), market scripting (Storbacka & Nenonen, 2011),
specific theoretical contributions in the process of bringing the S-D logic and market plasticity (Nenonen et al., 2014).
narrative closer to empirical investigation (Brodie et al., 2019; Vargo & Market shaping does not necessarily entail the creation of entirely
Lusch, 2017) and thus enriching midrange theories on market shaping new markets (Jaworski et al., 2000), but is rather about incremental
and innovation. First, our research extends the base for understanding shaping (Kjellberg et al., 2015) with the goal of actively changing the
market shaping and innovation from an entrepreneurial perspective to a behavior of the existing market. This implies a broader definition of
human-technology-induced change process. Nenonen et al. (2019) market innovation than the opening up of new markets. Market inno­
suggest that markets evolve through activities carried out by various vation means altering the way in which business is traditionally done
actors and is partly based on unpredictable emergence. We show that (cf. Kjellberg et al., 2015), through means and activities varying from
some emergence is not necessarily driven by traditional actors of an sales to changing the rules of the market (Kjellberg & Helgesson, 2006;

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V. Kaartemo and A.-G. Nyström Journal of Business Research 124 (2021) 458–468

Mele, Pels, & Storbacka, 2015). Table 1

The formative indicators of market change (Nenonen et al., 2019, p. 255).
2.2. Market shaping through market change Element of change Indicators

Products & price The products and/or services offered in our industry have
Nenonen et al. (2019) set out to study market change. They define a radically changed (i.e., ours and/or our competitors’).
market as “[…] not only a set of customers, […] value chain or […] The way products/services are combined into offerings has
industry, but a much larger system (cf., Mele et al., 2015; Vargo et al., changed (i.e., the way offerings are bundled or configured).
The pricing structure of products or services in our industry has
2017); a socio-political-technological-material context, governed by
changed (e.g., from pricing on an hourly basis to flat-rate
institutional arrangements, making the market malleable (Nenonen pricing, from selling ownership to renting or leasing, etc.).
et al., 2014) and to some extent designable” (Nenonen et al., 2019, p. The price levels of the products and/or services in our industry
258). Their framework consists of formative indicators, grouped into have changed considerably (e.g., from higher to lower–or vice
elements: i) products and price, ii) customers and use, iii) channels, iv) versa, more variation in prices).
Customers & use Customers have started to use existing products and/or
supply-side network, v) representations, and vi) norms. There are a total
services in different ways or for different purposes (than our
of 22 facets to the elements that guide the use of the framework (see industry originally intended).
Table 1). Markets can be changed through adjustments to these ele­ The kinds of customers who buy our industry’s products and/
ments; however, the authors point out that market change does not or services have changed (i.e., the traditional customers have
exited the market and/or new kinds of customers have entered
necessitate a change in all elements, and a modification to any of the
the market).
elements does not necessarily result in changes to all its facets and their Within our industry, what customers are looking for in
indicators. Of note, their framework focuses on market change from the products and/or services has changed.
subjective perspective of the focal actor (the organization or individual Within our industry, the options customers have regarding full-
interested in mapping a market), which means that there are no objec­ service versus self-service have changed (e.g., gone from more
full-service to more self-service–or vice versa).
tive market boundaries.
Physical or technological infrastructures that enable customers
For this chapter, we briefly reviewed the literature on market to use our industry’s products and/or services have changed (i.
shaping and innovation with a particular focus on Nenonen et al. (2019) e., things our industry does not directly produce but that
framework of market change. Altogether, the extant literature focuses enable usage–such as roads for cars, internet for online shops,
on what changes in the market as well as how market actors can shape etc.).
Channels There are new or different channels that our industry uses to
various market elements. Yet, the literature in general is characterized find and/or service customers.
by the absence of technology as an enabler of, or platform for, market Customers are using new or different channels to find and/or
shaping and innovation. In the following, we tackle this issue by paying contact potential service providers in our industry.
specific attention to market shaping in the context of emerging Supply-side The number of competitors operating in our industry has
network changed (i.e., there are fewer or more than 5 years ago).
technologies.
The ways in which competitors in our industry interact and
cooperate have changed.
3. Market shaping through technology and technology-induced There has been significant changes in the number of suppliers
market change and/or partners that we and/or our competitors work with
(there are fewer or more than 5 years ago).
We and/or our competitors have started to work with new
Market innovation is driven by the combinatorial evolution of value kinds of suppliers and/or partners.
propositions and the emergence and institutionalization of new solu­ There have been changes in how we and/or our competitors
tions. We argue that if scholars intend to study markets in a “socio-po­ outsource work to suppliers and/or partners (i.e., outsourcing
litical-technological-material context” (Nenonen et al., 2019, p. 258), occurs to a greater or lesser extent than 5 years ago).
Representations The terminology commonly used in our industry has changed.
there is a need to incorporate the role of technology in market changes.
The language and/or descriptions that media use to report on
This argument follows S-D logic’s (Akaka & Vargo, 2014) view that our industry has changed.
technology is a critical resource for value co-creation, service innova­ The categories used by official statistics and/or research
tion, and systems (re)formation. In S-D logic, technology is conceptu­ agencies to report on our industry and/or its products/services
alized as an operant resource—one that is capable of acting on other have changed (e.g., new categories have been created, old
categories have been renamed, etc.).
resources to create value. Importantly, technology can be portrayed not The key events and/or awards (e.g., trade fairs, exhibitions,
only as a market offering (or value proposition) but as a medium of value competitions, prizes, etc.) related to our industry have changed
co-creation and innovation (Vargo et al., 2015). their focus.
Market-shaping and innovation literature implicitly assumes that The industry associations (sometimes known as trade
associations) we are connected to have changed their focus (e.
market-shaping technology is developed by actors who deliberately
g., the types of businesses they represent, the themes they
want to change the market. Consequently, the development of tech­ promote, etc.).
nology has to a large extent been treated as a vehicle or medium for Norms There have been changes in our industry’s standards (e.g.,
market shapers (e.g., Biggemann, Kowalkowski, Maley, & Brege, 2013; technical standards, specifications, voluntary codes of conduct,
Kindström et al., 2018). For instance, this would mean that in health­ etc.).
There have been changes to the government regulations
care, the focus would merely be on the development and commerciali­ (regional, national, or international) relevant to our industry.
zation of new health technology (which can be regarded as central In our industry, the types of products, services or activities
technology to the industry). However, the history of technology, from perceived as generally acceptable have changed (e.g.,
the invention of the steam engine to the Internet, has revealed that, environmental values have become more important).
occasionally, disrupting technologies are developed by nontraditional
market actors, which can be regarded as peripheral technology.
on the role of technology in market shaping and innovation, we
Subsequently, we conceptually distinguish between central and pe­
conceptually differentiate between emerging technologies that act as
ripheral technology. We define central technology as technology that is
new offerings in a market and emerging technologies that are platforms for
developed and offered by traditional market actors. Peripheral technol­
market shaping and innovation. Next, we will elaborate further on the
ogy, however, is developed and offered by nontraditional market actors
latter.
and introduces changes in the market offerings that would not take place
in the absence of this technology. We refer to this as technology-induced
market change. To understand the contrast between the two perspectives

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3.1. Emerging technology as a platform for market shaping and The Delphi method enables a pool of experts to contribute ideas,
innovation provide feedback, and assess the emerging judgment of the group
(Dalkey & Helmer, 1963; Okoli & Pawlowski, 2004). By keeping the
The extant technological environment affects how organizations identities of experts confidential, the method avoids direct confrontation
perceive their competencies and the availability of market resources of opposing views. The speculative aspects of the Delphi method enable
(Fehrer, Benoit, et al., 2018), as well as the roles of actors, resources, and a community to both question current paradigms and norms and discuss
practices in markets (Breidbach & Maglio, 2016). Recent work on future issues. In addition, multiple rounds of data collection and feed­
market shaping (Baker et al., 2019) acknowledges the role of “emerging back enable the experts to revise their initial assumptions and opinions
alternatives”—work of nontraditional, peripheral actors—that shape the and to contribute to group consensus in an interactive way (Dalkey &
belief systems, and thus the behavior, of market actors. This introduces Helmer, 1963). The insight developed throughout the study gives the
the idea that unconventional market actors can provide new platforms individuals an opportunity to modify their judgments against the col­
for resource integration and value co-creation. For instance, Amazon’s lective views of the panel (Mitroff & Turoff, 1975). Therefore, it is
Marketplace or the Open Handheld Alliance’s Android are not simply important to keep the same informants throughout the study. The pro­
new offerings that are available to customers but are also platforms for cess starts with expert selection.
novel market practices. In fact, platforms can also be interpreted as
technology ecosystems that enable a large number of actors to engage in 4.1. Expert selection
new service exchange practices (Fehrer, Woratschek, et al., 2018). Thus,
emerging technology can be regarded as an intermediary to orchestrate While industry stakeholders provide interesting insight on market
and facilitate the exchange of resources, rather than as an object of ex­ dynamics (Winkler et al., 2015), various market actors often have
change in itself (Breidbach & Brodie, 2017). A platform may thus be differing views on technological changes and how value is created in the
referred to as “a set of shared core technologies and technology stan­ future market (Sommarberg & Mäkinen, 2018). Therefore, it was
dards [that] supports value co-creation through specialization and important to enable plurality when selecting experts in both the
complementary offerings” (Thomas, Autio, & Gann, 2014, p. 201), healthcare market and 5G technology. Based on our earlier work, we
mediating interactions among users and providers of products and ser­ were able to identify the most active developers of 5G in Finland and the
vices. The notion of technology as platforms for market change is in line key contact persons in these organizations. In terms of the healthcare
with previous research by Baker et al. (2019), Breidbach and Brodie market, we first reviewed a list of the largest health service providers in
(2017), Storbacka, Brodie, Böhmann, Maglio, and Nenonen (2016) as Finland. We decided to invite people in managerial positions as well as
well as Breidbach, Brodie, and Hollebeek (2014). These streams of those in specialist roles that could be linked with either technology or
literature typically stipulate that the platforms are intentionally brought market change (ideally both). To ensure the plurality of views, we did
to the market by lead actors (Frow, McColl-Kennedy, & Payne, 2016). not limit our study to only the largest established healthcare companies
An exception is Pütz, Murphy, Mullins, and O’Malley’s (2019) discus­ operating in Finland; we also invited experts from public healthcare
sion of the effect of an emerging peripheral technology, namely the organizations as well as healthcare market consultants to join the panel.
impact of connected automated vehicles on the motor insurance market. Being actively involved in the Finnish startup scene, we were able to
Altogether, technologically-oriented research is scarce in market collect a list of the most promising health technology startups and
shaping and innovation literature. The extant studies grasp a limited identified potential experts.
view of market change. While market changes can be initiated by The experts from both subpanels (5G network and healthcare mar­
evolving technologies as market offerings, the direct and indirect impact ket) were formally invited to participate in the study by e-mail in June
of technology on representations, norms, and other characteristics of a 2018. For some experts, we had agreed on their participation prior to the
market are rarely discussed. While studies might have considered this formal email invitation. Because we asked for their involvement in
phenomenon, it is often kept implicit. There is less empirical insight on several interactive rounds over a lengthy period of time, we assumed
how peripheral technology influences market shaping and innovation. that numerous invitees would decline or choose not to answer. On
To fill these gaps on technology-induced market change, we particularly average, researchers need to invite 4.4 times more experts than who will
reflect how Nenonen et al. (2019) framework can be used to study the actually participate in the first round of a Delphi study (Nowack,
anticipated market changes in a context in which there is no single Endrikat, & Guenther, 2011). Yet, because Delphi does not seek to
market shaper; rather, the market is shaped by several market actors establish explanatory power from statistical variance, the number of
reacting to the emergence of a new technology. respondents is usually small, with approximately 10–18 experts in a
group (Okoli & Pawlowski, 2004). In heterogeneous groups the pool of
4. Research method experts may grow to 15–30, while in closely-selected expert groups,
5–10 experts may be enough (Loo, 2002). As a result, we aimed at
For empirical research, we utilize a structured Delphi study (Dalkey receiving commitment from 5 to 10 experts in both subpanels. Accord­
& Helmer, 1963), which is a futures research method that enables the ingly, we invited 21 5G network experts and 25 healthcare market
generation of community consensus from expert opinion. Over the experts.
years, the Delphi method has been successfully employed in studying Our final panel comprised 20 experts (response rate 43.5%): 10 5G
market dynamics, from the future of automotive industries in India and network experts and 10 healthcare market experts (Table 2). This panel
China (Winkler, Kuklinski, & Moser, 2015) to the role of online social size elicited sufficiently broad responses, while keeping the complexity
networks in Spanish cultural firms (Gonzalez, Llopis, & Gasco, 2015). of categorizing and consolidating responses manageable. The re­
Emerging technologies, such as 5G, cause uncertainty, which makes the spondents represented a variety of organizations, with only two experts
Delphi method superior to the methods that are based on quantitative working for the same organization. All panelists held managerial or
factual information (Winkler et al., 2015). The method is particularly senior specialist roles in their organizations (e.g., CEO, CTO, head of
suitable for studying a context, in which the future depends less on the research, country manager). The panels included both male and female
past and more on the agency of the actors, such as the context of rapid experts, while we acknowledge the overrepresentation of men in the 5G
environmental changes (Hayes, 2007). Typically, the benefits of the network expert panel. Throughout the entire process all experts
Delphi method are that it can tease out subjective judgments on a col­ remained active, which is an achievement given that the average
lective basis, allowing for a diverse background of experts and enabling dropout rate after the first round is 18% (Nowack et al., 2011).
anonymous and more efficient group communication than face-to-face
meetings (Mitroff & Turoff, 1975).

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Table 2 long-term developmental trajectories following the introduction of 5G.

Respondent information. Round 1 answers were summarized and coded based on their resem­
Expert Position of Number of Type of Male Female blance to Nenonen et al. (2019) framework on market change. We used
group the expert different organization NVivo to code each suggestion as products & price, channels, customers &
organizations use, supply-side network, representations, or norms. While coding the an­
Healthcare CEO (4) 10 Private 6 4 swers, we also used the code other to indicate market changes that
market Head of IT/ company (5) described the changes in the technology itself or outcomes of the pro­
technology Non-profit jected market changes, such as “safer and less expensive mobile network
(3) organization/
Head of foundation
architecture,” and “more cost-effective healthcare.” While analyzing the
development (3) results, we identified fairly few answers referring to representations and
(2) Public norms. Therefore, we decided to run Round 2 to specifically focus on
Change agent organization teasing out insights on the potential shifts in these market-change
(1) (2)
categories.
5G network Head of 9 Private 9 1
research/ company (9) In Round 2, the experts were given another brainstorming task: “[As
CTO (4) a result of 5G] norms, language and rules need to be rethought. What
Innovation could this mean in practice in the healthcare market?” The question was
manager (2) framed around a related comment by one of our expert panelists to avoid
Branch
manager (2)
being too theoretical. We added new ideas to the original list of sug­
Country gested changes. To make the list comprehensible to the panelists, we
manager (1) eliminated full- and near-duplications and consolidated similar themes
System (e.g., remote operations and remote monitoring) under wider topic
designer (1)
areas. To increase the trustworthiness of the coding scheme and the
Total 19 15 5
whole research process, one of the authors met in-person with Professor
Suvi Nenonen, the lead author of Nenonen et al. (2019). As a result of
4.2. Data collection and analysis that discussion, we discarded the changes that were coded as belonging
to other, as these referred to changes in the technology and the outcome
We collected and analyzed the data in four rounds (see Fig. 1) from of projected market changes and did not directly refer to the envisioned
September 2018–April 2019, in a timely manner to avoid crucial market changes. We also modified some of the codes. To ensure that
changes in experts’ circumstances, knowledge, and situational context nothing was missing and that all insights were covered in the list, we ran
(Day & Bobeva, 2005). Of note, we are not aware of any major news or Round 3.
events related to 5G or the healthcare market during these eight months In Round 3, we asked the panelists to view and comment on the
that would have influenced the empirical findings. consolidated list of market changes: “In case you have something to add/
In Round 1, the experts were presented with the following task with amend or comment, please make changes to the attached Word docu­
the intent of having them brainstorm about changes in the market, and ment or send comments by replying to this email. If you do not have any
they were encouraged to take an expansive view of potential changes: comments, simply reply to this email by sending us ‘OK’.” This kind of
“Please, mention 5–10 things that 5G changes in the healthcare market.” iteration and controlled feedback mechanism is characteristic of a Del­
We used an open-ended question as a source of input for the idea- phi study (Nowack et al., 2011). The iteration enables the panelists to
generation function (Nowack et al., 2011). We did not give any time consider each other’s comments and inspires them to envision further
scale, enabling the experts to discuss both immediate changes as well as changes. There were only some minor comments that first helped us to

Round 1 A question on potential Coding of 96 answers on

9/2018 changes in health market anticipated changes

Round 2 A clarifying question on Coding of 20 answers Consolidation of 116 answers

10/2018 norms and representations on norms and representations to 34 anticipated changes

Reorganization of codes and Discussion with Prof. Suvi

consolidation to 32 Nenonen (Nenonen et al.,
anticipated changes 2019) on the coding of 34
anticipated changes

Round 3 A request for feedback Drafting of the final list of

1/2019 on initial results 32 changes

An assessment of 32 changes
Round 4
regarding significance, Analysis of results
2/2019
likelihood and 5G dependence

Fig. 1. The Delphi process.

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draft the final list of anticipated changes and, second, indicated that Table 3
there was a consensus of envisioned market changes. Industry experts’ views on the most important and likely 5G-dependent changes
In Round 4, we asked the experts to assess the importance, likeli­ in the healthcare market.
hood, and 5G dependence of the market change. Importance refers to the Market change Category Importance Likelihood 5G
estimated impact of each suggested change on the healthcare market. of market dependence
Likelihood, in turn, refers to the estimated probability of each suggested change

change. The question on 5G dependence aimed to identify whether or Clients are increasingly Channels 4.35 4.55 3.40
not it was believed the changes could happen even without the emer­ served remotely
through digital
gence of 5G. Of note, while many Delphi studies also ask for the desir­
services
ability of suggested futures, we decided not to include that question in Health-monitoring Norms 4.16 4.10 3.40
our final survey to keep the number of questions at a minimum. devices become the
Assessing 32 suggested changes in terms of importance, likelihood, and new normal
5G dependence resulted in experts facing 96 questions. The most More remote services Products & 4.16 4.00 4.05
are offered: remote price
important and likely 5G-dependent changes were those that scored more operations (e.g.,
than the mean for importance, likelihood, and 5G dependence, which robotic surgeries),
was calculated for all suggested market changes. In other words, we remote monitoring,
were able to eliminate not only less-important changes but also those and remote
consultations and
changes that were potentially important but less likely to occur or less
diagnostics
dependent on 5G than other market changes on average. More sensor-based Products & 4.15 4.35 3.80
services are offered price
5. Findings with alerts and
predictive analytics
More mobile sensors, Supply- 4.05 4.30 3.89
5.1. Expert views within healthcare
sensor data, and IoT side
are offered to enable network
The first three rounds of the Delphi study resulted in 32 suggested health monitoring,
market changes. On a scale of 1–5, the means were 3.84 for importance, remote diagnostics,
and AI
3.71 for likelihood, and 3.24 for 5G dependence. As a result, the sug­
Experts are more Supply- 4.05 4.10 3.55
gested changes were generally perceived as important, likely, and 5G- flexible and available side
dependent. for remote network
Further analysis of the results revealed that there were nine market consultations
changes that scored above average on all three questions (importance, Improvements are Supply- 4.00 4.05 4.10
made in the flow of side
likelihood, and 5G dependence). As a result, we argue that these market
real-time network
changes are among the most important when identifying the impact of information
5G technology on the healthcare market. These changes were as follows New innovation Supply- 3.90 4.25 3.70
(see Table 3): opportunities for side
medical device network
companies
• Clients are increasingly served remotely through digital services. Better access to and Supply- 3.85 3.90 3.45
maintenance of side
“The remote hospital/healthcare (AR/VR/diagnostics) […] may really equipment through network
become possible due to better data traffic.” (Innovation manager, IoT is available
technology vendor A)
“Experts and knowledge are conveyed to the patient without physical
transfer, [like a] local service in your pocket.” (Head of research/CTO, • More remote services are offered: remote operations (e.g., robotic
public healthcare provider) surgeries), remote monitoring, and remote consultations and
“[5G enables] remote diagnostics [and] remote healthcare (video and diagnostics.
artificial intelligence [AI] may be utilized, too).” (Head of research/ “Remote monitoring of the patient/customer, other active data and
CTO, mobile operator B) location: new innovations or monitoring and control data are achieved
due to 5G [as there is] no latency. 5G [and] IoT enable the collection of
data in an increasingly broad use area ([of for instance] smart clothes).”
• Health-monitoring devices become the new normal. (Head of research/CTO, public healthcare provider)
“Patients can be more effectively linked to various remote monitoring or
“We will get more devices for everyday health monitoring. They will surveillance [services] through [5G] mobile networks, using new IoT
become ordinary.” (Head of research/CTO, mobile operator A) technology (NB-IoT and LTE-M). This enables increased cost efficiency in
“Devices become such an integral part of the activity chain that work treatment of illness and predictive care.” (Head of research/CTO, mo­
conventions are significantly adjusted accordingly.” (Head of develop­ bile operator C)
ment, health technology vendor) “[5G] could enable new remote consulting possibilities, for instance,
“The 5G era brings technology that increasingly enables collection of data during situations of demanding surgery.” (CEO, healthcare tech startup)
related to health status, observations and analysis of different signals,
voice, and picture. This surely requires new rules and changes familiar
norms. In practice, within healthcare, voice recognition and analysis:
Alexa/Siri: ‘The person now talking is having a heart attack’.” (Branch • More sensor-based services are offered with alerts and predictive
manager, mobile operator B) analytics.

“Sensors are already used for tracking exercise habits (step counters,
jogging distances, whether your pulse is optimal etc.). In the future,
[sensors are used] more broadly for predictive alarms [and] suggesting

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V. Kaartemo and A.-G. Nyström Journal of Business Research 124 (2021) 458–468

visiting your doctor if something alarming [is detected] (bad sleeping

habits, for example).” (System designer, network operator)
“[5G brings] smart living using different sensors with predictive ana­ • Better access to and maintenance of equipment through IoT is
lytics.” (Head of IT/technology, private healthcare provider A) available.
“5G means that there can be robots and sensors that follow elderly people
“[5G will enable] mobile measurement and testing equipment.” (CEO,
in their every-day life on top of security bracelets, providing help or
private healthcare provider D)
alarming [the care giver or hospital] if help is needed.” (CEO, private
“Within home care, some tests can be conducted at home, for instance,
healthcare provider B)
diabetics care.” (CEO, private healthcare provider B)
“It becomes easier to manage hospital equipment. The accessibility, us­
ability, and maintenance of hospital equipment improve when the
• More mobile sensors, sensor data, and IoT are offered to enable equipment can be complemented with 5G-connections, and thus measured
health monitoring, remote diagnostics, and AI. through them.” (Head of development, health technology vendor)

“People can have several personal sensors, which data is used for decision The results reveal that experts anticipate important and likely
making; calls for further examination, for example.” (System designer, changes driven by 5G technology in four different categories of market
network operator) change. In fact, the top nine changes in the Finnish healthcare market
“[5G] enables better use of technology: drones, smart living [with] refer to three of the six categories, namely supply-side network, channels,
different kinds of sensors and with predictive analytics, robot services for and products & price (Table 3). Interestingly, none of the market changes
senior living or habitants within home care services.” Head of IT/tech­ related to representations, norms, or customers & use were ranked above
nology, private healthcare provider A) average in any of the three questions about importance, likelihood, and
“5G networks will in the future provide wider opportunities to link 5G dependence. The changes in supply-side network had the highest
healthcare processes into Internet of Things through various sensors and number (five) of mentions in the list of anticipated market changes.
devices. Consequently, they bring big data and artificial intelligence as
tools to optimize these processes.” (Head of research/CTO, mobile
operator C) 5.2. The differing views of the subpanels

The views of experts both on the healthcare industry and 5G net­

works differed slightly from each other. The suggested changes were in
• Experts are more flexible and available for remote consultations. general perceived as more important (3.93 vs. 3.76) and more 5G
dependent (3.35 vs. 3.14) by healthcare industry experts than by 5G
“Expert help/remote operations can be conducted flexibly at hospitals/
network experts. However, the changes were considered slightly less
healthcare centers.” (Innovation manager, network vendor)
likely (3.62 vs. 3.80) on average by healthcare experts compared to 5G
“A top surgeon may, for instance, consult local healthcare personnel via
network experts.
video connection, or even conduct a critical surgery without being in the
Healthcare industry experts ranked the following market changes
direct proximity of the patient. [This is enabled by] data speed, slicing and
among the most important: “More sensor-based services are offered with
MEC [mobile edge computing].” (Head of research/CTO, mobile
alerts and predictive analytics”; “More remote services are offered:
operator B)
remote operations (e.g., robotic surgeries), remote monitoring, and
“A world class specialist doctor may monitor a surgery or another
remote consultations and diagnostics”; “Clients are increasingly served
demanding procedure in real-time from a different location.” (System
remotely through digital services”; “Improvements are made in the flow
designer, network operator)
of real-time information”; “More mobile sensors, sensor data, and IoT
are offered to enable health monitoring, remote diagnostics, and AI”;
“More versatile use of video surveillance for patient and general safety”;
• Improvements are made in the flow of real-time information. “Experts are more flexible and available for remote consultations”; “New
innovation opportunities for medical device companies”; “Health-
“Real-time monitoring in the ambulance is conveyed to the emergency monitoring devices become the new normal”; “The use of AI and ro­
room [through 5G].” (Head of research/CTO, technology vendor B) botics becomes accepted in healthcare” (Table 4). These market changes
“Multiprofessional teams can share knowledge and thoughts more easily.” represented seven of the same market changes as in the overall results.
(CEO, private healthcare provider C) In contrast, “The use of AI and robotics becomes accepted in healthcare”
“5G and the development of information systems offer patient data to the and “More versatile use of video surveillance for patient and general
healthcare staff at the location, where it is needed.” (Innovation man­ safety” were included in the healthcare experts’ list but not in the gen­
ager, technology vendor A) eral list. This indicates some differences in viewpoints between health­
care and 5G network experts.

“The use of artificial intelligence and robotics becomes accepted.” (Head

• New innovation opportunities for medical device companies. of research/CTO, mobile operator B)
“The possibilities of medical device manufacturers to do new kinds of “Through the use of robotics, procedures could be done by a person who
product design and development is enabled in a new way, as [mobile] does not fulfil the requirements of healthcare standards. This includes
networks offer remarkably lower latencies compared to earlier and a risks.” (System designer, network operator)
larger transfer capacity in wireless data transfer throughout hospital “The use of video monitoring becomes more versatile and common,
spaces and the near environment of the patients.” (Head of develop­ enabling the surveillance of both patient and general safety in different
ment, health technology vendor) spaces.” (Head of development, health technology vendor)
“New innovations [regarding] monitoring and control data will be “Low latency also enables the fast transfer of alarm information to pro­
enabled through 5G. […] [and] VR, AR and MR as well as other modeling fessionals and the reaction accordingly, including video connection to the
tools within healthcare, and new application areas for mobile cloud ser­ surveillance target.” (Head of research/CTO, public healthcare
vices.” (Head of research/CTO, public healthcare provider) provider)

5G network experts ranked the following market changes among the

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V. Kaartemo and A.-G. Nyström Journal of Business Research 124 (2021) 458–468

Table 4 Table 5
Healthcare industry experts’ views on the most important and likely 5G-depen­ 5G network experts’ views on the most important and likely 5G-dependent
dent changes in the healthcare market. changes in the healthcare market.
Market change Category Importance Likelihood 5G Market change Category of Importance Likelihood 5G
of market dependence market dependence
change change

Clients are increasingly Channels 4.50 4.40 3.60 More remote services Products & 4.11 4.22 4.00
served remotely are offered: remote price
through digital operations (e.g.,
services robotic surgeries),
Experts are more Supply- 4.30 4.00 3.70 remote monitoring,
flexible and available side and remote
for remote network consultations and
consultations diagnostics
Health-monitoring Norms 4.22 3.80 3.70 More sensor-based Products & 4.10 4.60 3.40
devices become the services are offered price
new normal with alerts and
The use of AI and Norms 4.22 3.80 3.70 predictive analytics
robotics becomes New questions arise Norms 4.00 4.50 3.40
accepted in concerning privacy
healthcare and the use of
New innovation Supply- 4.20 4.30 3.90 personal sensor
opportunities for side data
medical device network Increased use of Customers 4.00 4.00 3.56
companies robots and smart & use
More sensor-based Products & 4.20 4.10 4.20 systems
services are offered price More mobile sensors, Supply-side 3.90 4.70 3.67
with alerts and sensor data, and IoT network
predictive analytics are offered to
Improvements are Supply- 4.20 4.00 4.40 enable health
made in the flow of side monitoring, remote
real-time network diagnostics, and AI
information
More mobile sensors, Supply- 4.20 3.90 4.10
sensor data, and IoT side “Robot services for senior living or residents utilizing homecare. Systems
are offered to enable network
that close devices, for instance, when you leave your home. If no one is at
health monitoring,
remote diagnostics,
home, the stove turns off, etc.” (Head of IT/technology, private
and AI healthcare provider A)
More remote services Products & 4.20 3.80 4.10
are offered: remote price Interestingly, there were only three market changes that both sub­
operations (e.g., panels deemed simultaneously important, likely, and 5G-dependent.
robotic surgeries), These were “More remote services are offered: remote operations (e.
remote monitoring,
g., robotic surgeries), remote monitoring, and remote consultations and
and remote
consultations and diagnostics”; “More sensor-based services are offered with alerts and
diagnostics predictive analytics,” and “More mobile sensors, sensor data, and IoT are
More versatile use of Supply- 4.10 4.30 4.00 offered to enable health monitoring, remote diagnostics, and AI”.
video surveillance side
for patient and network
6. Discussion and implications
general safety

6.1. Implications for research

most important: “More remote services are offered: remote operations
(e.g., robotic surgeries), remote monitoring, and remote consultations We make an important contribution to the midrange theories of
and diagnostics”; “More sensor-based services are offered with alerts market shaping and innovation, aiming to facilitate the understanding of
and predictive analytics”; “New questions arise concerning privacy and the abstract S-D logic narrative through empirical investigations (Brodie
the use of personal sensor data”; “Increased use of robots and smart et al., 2019; Vargo & Lusch, 2017). To be concise, our study underlines
systems”; and “More mobile sensors, sensor data, and IoT are offered to how different views of technology influence our empirical findings as
enable health monitoring, remote diagnostics, and AI” (Table 5). “New regards the role of technology in market shaping and innovation. We
questions arise concerning privacy and the use of personal sensor data” advance the collective theoretical understanding of duality of technol­
and “Increased use of robots and smart systems” were included in the 5G ogy by revealing how technologies may be perceived as peripheral or
network experts’ list but not in the general list. central, and as offerings or platforms. Acknowledging this helps scholars
to run empirical studies on the impact of technology on market shaping.
“People may have several personal sensors, and decisions are made on
This also helps managers and entrepreneurs to identify how techno­
their data, [for instance] whether to call for additional examinations. Can
logical development can shape the markets that they are interested in.
this be done without the consent of people, or can we force them? In many
By addressing issues related to ’non-intentional-design’ aspects of
phone applications the use of sensors is accepted for many other pur­
markets, we challenge the current thinking in market shaping and
poses.” (System designer, network operator)
market innovation literature. We elaborate our insight and its implica­
“Privacy concerns: the collection of bio and other personal data, their
tions further below.
combination and storage possibilities create a need to define roles, rights,
Market shapers are not necessarily considered technology developers
and responsibilities better than currently.” (Innovation manager, tech­
but tend to rely on complementary technologies that enable new ave­
nology vendor A)
nues for resource integration (Nenonen et al., 2019). This has partly
discouraged scholars of market shaping and innovation from studying

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V. Kaartemo and A.-G. Nyström Journal of Business Research 124 (2021) 458–468

technology-induced changes in the market. We contribute to the these characteristics, and the impact can be very different in the
research by conceptually demarcating between technology as a new of­ healthcare market, in which highly-customized products are valued
fering in the market and as a platform for market shaping and innovation. more than in the space industry, where 3D printers enable onsite
The former is a focal, market-specific concept that focuses on new value printing. Thus, our research findings should be understood with the
propositions introduced to the actors of that particular market. The given limitation to one technology and one market. However, the dis­
latter encompasses a more generic view of technology that enables the cussion has wider implications for the role of technology in market
introduction of new services and processes in a market. As a result, shaping and innovation.
technology as platforms are not necessarily intentionally brought to the While the shift from market-shaping companies to technology-
market by a lead actor (cf. Frow et al., 2016) but by nontraditional induced market change may be perceived as a critique against the
market actors. Therefore, we consider it important to conceptually active role of managers, we do not claim that markets are not influenced
distinguish between central and peripheral technology. Until today, by market-shaping companies. Rather, we question the hegemonic role
market-shaping literature has to a large extent focused on central of focal actors by showing how peripheral technologies may also initiate
technology as a market shaper’s vehicle for introducing changes. There market changes. Market-shaping entrepreneurs and companies can
are few empirical examples or conceptual works that would consider build on these technologies to develop, for instance, business models
that market shapers can similarly build on peripheral technologies that that eventually impact markets.
act as platforms for market shaping. We contribute to the literature by illuminating how Nenonen et al.
Whether a technology is seen as a new offering or as a platform for (2019) framework can be used as a part of a Delphi study that focuses on
market shaping and innovation depends partly on the viewpoint. For the anticipated market changes and by presenting a critique that
instance, AI technology might be perceived, in general, as a platform for partially stems from the framework’s original purpose and research
market shaping in the healthcare market, while there can also be new AI- context. Our results indicate that 5G is anticipated to affect supply-side
based offerings in the market. Some companies and organizations may networks in the healthcare market more than other elements of market
bring a new solution to the market, such as Microsoft’s Windows oper­ change. In fact, a majority of the important, likely, and 5G-dependent
ating system or Open Handset Alliance’s Android, which can be viewed market changes concern the supply-side network category. This result
as offerings in the PC and mobile device markets, respectively, as well as contradicts the empirical results of Nenonen et al. (2019), which did not
platforms that mediate interactions among users and providers of find any important relationship between supply-side network and
products and services in these same markets. While the new offering is market change. The opposing results may be explained by our focus on
by definition always at the core of the market (central technology), the market level rather than on focal firms, as well as our decision to
platforms for market shaping and innovation may be, and often are, include organizational changes in this category. There is room for debate
developed by nontraditional actors (peripheral technology). on whether organizational change should be included as a market-level
Consequently, we contribute more widely to the recently emerged change, or if organizational change should form its own category.
theme of S-D logic, namely the linkage between technological in­ The deployment of Nenonen et al. (2019) framework illuminates the
novations and markets (Vargo et al., 2015). Particularly, we add to the focal actor–centric design of the original model and research setting. The
discussion on how the technological infrastructure influences value co- framework was initially built on interviews with market-shaping firms,
creation in the market (Akaka & Vargo, 2014). By conceptualizing strengthened with organization-centric market shaping literature, and
technology as a platform, we provide insight to this discussion on the tested with questionnaires directed at organizations who aimed to
link between technology and value propositions as well as technology reflect the market changes from the viewpoint of their own companies.
and market practices. In line with Wieland, Hartmann, and Vargo This setting partly hindered the opportunity to portray market changes
(2017), we show that a technology can play an important role in trig­ more objectively and did not invite comments on organizational changes
gering changes in market practices by fostering new products and or, more particularly, beyond the focal firm.
channels, without being actively exchanged by market actors. As a We revealed that oscillating the foci between focal market-shaping
result, we argue that market practices can be built around a combination firms and other market actors challenges whether a market change be­
of both technology as a new offering in a market (e.g., sensor-, robot-, and longs to a customer or to a supply-side network category. For instance, a
AI-based health solutions) and technology as a platform for market shaping public hospital can be simultaneously a focal organization, a customer,
and innovation (here: 5G technology). We specifically provide empirical and a supplier, depending on who answers the question. Thus, some new
insight on platform business models, introduced by Fehrer, Woratschek, services enabled by an emerging technology can be employed by com­
et al. (2018) to challenge the idea that focal firms manage, influence, panies that are customers to one company but suppliers to another.
and control entire service systems. Our example of 5G as a platform is Similarly, robots can be increasingly used and owned by patients,
categorically different from the examples of ‘platform ecosystems as healthcare providers, or insurance companies, making it challenging to
technology ecosystems’ provided by Fehrer, Woratschek, et al. (2018) determine which category the changes in robotics resources fall into.
and does not feature the physical or virtual touch points as per Breid­ Although we present these concerns about the applicability of the
bach et al. (2014) or Breidbach and Brodie (2016), but complements original framework, they did not have a major influence on our study;
their discussion on how technology ecosystems may organize actors and we can still confidently interpret that industry experts expect that 5G
influence their business logic. will increase the use of sensors in the healthcare market. In other words,
In our empirical findings, we discuss the interplay of technology as a while this may be more of an issue of labeling, rather than distorting the
platform (5G) with new market offerings. As a result, we show that results, it is important to acknowledge that the detailed descriptions of
experts are able to envision new offerings that emerge as new platforms market change are not easily categorized when the focal actor
enable their commercial usage. For instance, various remote services perspective is not clearly defined ex ante.
require a reliable wireless connection. For many life critical services, Finally, we diverge from Nenonen et al. (2019) by teasing out more
mobile networks have traditionally showcased too high a latency and detailed descriptions of market change. Our research encouraged ex­
too low an accuracy in performing activities remotely. For other mar­ perts to envision how the healthcare market is changing after the launch
kets, 5G’s other qualities (e.g., higher data rates and lower energy of 5G. Instead of asking whether there will be a change (yes/no), the
consumption) may be more important and open some bottlenecks that experts were allowed to describe the changes in their own words. While
have postponed the introduction of new offerings. Different technologies Nenonen, Storbacka, and Frethey-Bentham’s study (2019) is limited to
carry their own characteristics. For instance, 3D printing enables the revealing whether changes have taken place, the original framework
creation of low-cost, malleable objects from materials available on-site. does not allow a detailed understanding of how market practices
As a result, the impact of 3D printing technology can be assessed through change. The modified framing in this study provides a more holistic view

466
V. Kaartemo and A.-G. Nyström Journal of Business Research 124 (2021) 458–468

of market change by eliciting more descriptive answers and thus delivers organizations. While we might consider that as a good practice in Delphi
more practical insights rather than merely suggesting that there will be studies, the methodology does not provide clear instructions on how to
changes in how customers use the product/service. define and measure plurality among and between industries. Conse­
quently, marketing scholars are invited to develop the methodology.
6.2. Implications for managerial practice Various experts could be identified by using network pictures (Mouzas,
Henneberg, & Naudé, 2008) or network mobilization tools by Bock­
The anticipated changes suggested by technology developers haven and Matthyssens (2017).
require, in some cases, imaginary-use cases to justify the need (and We acknowledge that 5G may be considered a special case following
often, to guarantee funding) for the development of technology and to a vertical collaboration of market actors. Our study is thus limited by our
make value/market propositions to get other market actors committed focus on a peripheral technology that acts as a platform for market
to technology (Storbacka & Nenonen, 2011). By highlighting the dif­ shaping and innovation. However, we also encourage studies that
ferences in viewpoints between 5G network and healthcare market portray technology as a market offering, to complete the discussion on
experts—as facilitated by the Delphi method—we underline the how conceptually-different technologies induce market changes. It is
importance for technology developers to understand how other market equally important for scholars to focus on technology developed by a
actors perceive the market and the potential of the emerging technology. leading market actor when striving at a more holistic view on the impact
We emphasize collaboration beyond direct customers and suppliers of technology on market shaping and innovation.
to realize new opportunities in the market. However, the growing op­ Finally, while this study highlights the growing importance of
portunities in healthcare are largely dependent on the institutional remote health services (Go Jefferies, Bishop, & Hibbert, 2019), more
environment of the local market. Healthcare is heavily regulated, which research is needed on the technological and institutional forces enabling
may limit the availability of remote services. Similarly, regulation may and hindering the development of remote services in healthcare. In
hinder internationalization efforts of healthcare technology startups. It other words, more research is needed for understanding what kind of
is important that regulators recognize the findings and ensure that pa­ institutional work, other than the introduction of new market offerings,
tient safety as well as competitiveness and the national economy are not is needed for taking full advantage of an emerging technology as a
at stake when 5G induces changes in the local healthcare market. platform for market shaping and innovation.
Our findings elucidate the threat of competition to conventional
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Valtteri Kaartemo (D.Sc.) is Post-Doctoral Researcher at Turku School of Economics,
Triggering and facilitating increased value creation. Journal of the Academy of
University of Turku, Finland. His research interests include market shaping, service
Marketing Science, 47(4), 617–639.
research, technology, innovation management, network dynamics, international entre­
Nowack, M., Endrikat, J., & Guenther, E. (2011). Review of Delphi-based scenario
preneurship, business models, and value co-creation. His research has been published in, e.
studies: Quality and design considerations. In Technological Forecasting and Social
g., Industrial Marketing Management and Journal of Service Management.
Change (Vol. 78 No. 9, pp. 1603–1615). Elsevier Inc.
Okoli, C., & Pawlowski, S. (2004). The Delphi method as a research tool: An example,
design considerations and applications. Information & Management, 42, 15–29. Anna-Greta Nyström is Senior Lecturer at Åbo Akademi University School of Business and
Pütz, F., Murphy, F., Mullins, M., & O’Malley, L. (2019). Connected automated vehicles Economics, Finland, from which she holds a doctoral degree in International Marketing.
and insurance: Analysing future market-structure from a business ecosystem Her current research interests include business networks and innovation, business op­
perspective. Technology in Society, 59, Article 101182. portunities, and market shaping She has published her research in, e.g., Industrial Mar­
Read, S., Dew, N., Sarasvathy, S. D., Song, M., & Wiltbank, R. (2009). Marketing under keting Management, Journal of Business Research, AMS Review and Journal of
uncertainty: The logic of an effectual approach. Journal of Marketing, 73(3), 1–18. Engineering and Technology Management.
Sarasvathy, S. D., & Dew, N. (2005). New market creation through transformation.
Journal of Evolutionary Economics, 15(5), 533–565.

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