| Internal drivers | Indicators | References |
|---|---|---|
| Organizational culture | Stimulating creative thinking | Shattow (1996)Shattow, M. (1996). Out of the blue. Electric Perspectives, 21(3), 44-54. |
| Freedom and autonomy for human capital |
McLean (2005)McLean, L. D. (2005). Organizational culture’s influence on creativity and innovation: A review of the literature and implications for human resource development. Advances in Developing Human Resources, 7(2), 226-246. doi:10.1177/1523422305274528 https://doi.org/10.1177/1523422305274528... |
|
| Risk acceptance |
Claver, Llopis, Garcia, and Molina (1998)Claver, E., Llopis, J., Garcia, D., & Molina, H. (1998). Organizational culture for innovation and new technological behavior. Journal of High Technology Management Research, 9(1), 55-69. doi:10.1016/1047-8310(88)90005-3 https://doi.org/10.1016/1047-8310(88)900... |
|
| Strategies | Innovation as a strategic part of the firm |
Toivonen and Tuominen (2009)Toivonen, M., & Tuominen, T. (2009). Emergence of innovations in services. The Service Industries Journal , 29(7), 887-902. doi:10.1080/02642060 902749492 https://doi.org/10.1080/02642060 9027494... , Bessant and Tidd (2009)Bessant, J., & Tidd, J. (2009). Inovação e empreendedorismo: Administração. Porto Alegre: Bookman. and Radaelli, Currie, Frattini, and Lettieri (2017)Radaelli, G., Currie, G., Frattini, F., & Lettieri, E. (2017). The role of managers in enacting two step institutional work for radical innovation in professional organizations. Journal of Product Innovation Management , 34(4), 450-470. doi:10.1111/jpim.12385 https://doi.org/10.1111/jpim.12385... . |
| Mechanisms to analyze technological and market developments | Bessant and Tidd (2009)Bessant, J., & Tidd, J. (2009). Inovação e empreendedorismo: Administração. Porto Alegre: Bookman. | |
| Raising awareness among employees about innovation strategies | Bessant and Tidd (2009)Bessant, J., & Tidd, J. (2009). Inovação e empreendedorismo: Administração. Porto Alegre: Bookman. | |
| Employees | Training for innovative activities and for the use of new technology |
Camisón and Monfort-Mir (2012)Camisón, C., & Monfort-Mir, V. M. (2012). Measuring innovation in tourism from the Schumpeterian and the dynamic-capabilities perspectives. Tourism Management, 33(4), 776-789. doi:10.1016/j.tourman.2011.08.012 https://doi.org/10.1016/j.tourman.2011.0... and CIS (2012)Camisón, C., & Monfort-Mir, V. M. (2012). Measuring innovation in tourism from the Schumpeterian and the dynamic-capabilities perspectives. Tourism Management, 33(4), 776-789. doi:10.1016/j.tourman.2011.08.012 https://doi.org/10.1016/j.tourman.2011.0... |
| Rewards for the suggestion of ideas to improve services and processes |
Bessant and Tidd (2009)Bessant, J., & Tidd, J. (2009). Inovação e empreendedorismo: Administração. Porto Alegre: Bookman. and Ostrom et al. (2010)Ostrom, A., Bitner, M., Brown, S., Burkhard, K., Goul, M., Smith-Daniels, V., … & Rabinovich, E . (2010). Moving forward and making a difference: Research priorities for the science of service. Journal of Service Research , 13(1), 4-36. doi:10.1177/1094670509357611 https://doi.org/10.1177/1094670509357611... |
|
| Degree of qualification and how selection and recruiting are conducted |
CIS (2012)Community Innovation Survey (2012). Community innovation survey 2008-2010. Dublin: Stationery Office. and Camisón and Monfort-Mir (2012)Camisón, C., & Monfort-Mir, V. M. (2012). Measuring innovation in tourism from the Schumpeterian and the dynamic-capabilities perspectives. Tourism Management, 33(4), 776-789. doi:10.1016/j.tourman.2011.08.012 https://doi.org/10.1016/j.tourman.2011.0... |
|
| Research and development | Existence of R&D centers and their relationships with research institutions and/or hiring of external R&D |
Yam, Guan, Pun, and Tang (2004)Yam, R. C. M., Guan, J. C., Pun, K. F., & Tang, E. P. Y. (2004). An audit of technological innovation capabilities in Chinese firms: Some empirical findings in Beijing, China. Research Policy , 33(8), 1123-1140. doi:10.1016/j.respol.2004.05.004 https://doi.org/10.1016/j.respol.2004.05... and CIS (2012)Community Innovation Survey (2012). Community innovation survey 2008-2010. Dublin: Stationery Office. |
| Expenses with R&D |
Camisón and Monfort-Mir (2012)Camisón, C., & Monfort-Mir, V. M. (2012). Measuring innovation in tourism from the Schumpeterian and the dynamic-capabilities perspectives. Tourism Management, 33(4), 776-789. doi:10.1016/j.tourman.2011.08.012 https://doi.org/10.1016/j.tourman.2011.0... |
|
| R&D development for creating new knowledge | CIS (2012)Community Innovation Survey (2012). Community innovation survey 2008-2010. Dublin: Stationery Office. | |
| External drivers | Indicators | References |
| Technological trajectory | Employment of technologies over time that are compatible or superior to those used by the competition |
CIS (2012)Community Innovation Survey (2012). Community innovation survey 2008-2010. Dublin: Stationery Office. and Camisón and Monfort-Mir (2012)Camisón, C., & Monfort-Mir, V. M. (2012). Measuring innovation in tourism from the Schumpeterian and the dynamic-capabilities perspectives. Tourism Management, 33(4), 776-789. doi:10.1016/j.tourman.2011.08.012 https://doi.org/10.1016/j.tourman.2011.0... |
| Technology management and technical abilities |
Bharadwaj (2000)Bharadwaj, A. S. (2000). A resource-based perspective on information technology capability and firm performance: An empirical investigation. MIS Quarterly, 24(1), 169-196. doi.org/10.2307/3250983
org/10.2307/3250983... |
|
| Institutional trajectory | Incentives and barriers imposed by the state throughout the years |
Dosi (1982)Dosi, G. (1982). Technological paradigms and technological trajectories: A suggested interpretation of the determinants and directions of technical change. Research Policy , 11(3), 147-162. doi:10.1016/0048-7333(82)90016-6 https://doi.org/10.1016/0048-7333(82)900... and Camisón and Monfort-Mir (2012)Camisón, C., & Monfort-Mir, V. M. (2012). Measuring innovation in tourism from the Schumpeterian and the dynamic-capabilities perspectives. Tourism Management, 33(4), 776-789. doi:10.1016/j.tourman.2011.08.012 https://doi.org/10.1016/j.tourman.2011.0... , and CIS (2012)Community Innovation Survey (2012). Community innovation survey 2008-2010. Dublin: Stationery Office. |
| Social taboos, punishments, customs, traditions, and codes of conduct | Berger and Luckmann (1978)Berger, P. L., & Luckmann, T. (1978). Construção social da realidade. Petrópolis: Vozes. | |
| Competitors | Sharing of experiences | CIS (2012)Community Innovation Survey (2012). Community innovation survey 2008-2010. Dublin: Stationery Office. and Bessant and Tidd (2009)Bessant, J., & Tidd, J. (2009). Inovação e empreendedorismo: Administração. Porto Alegre: Bookman. |
| Systematic comparison of services and processes | Bessant and Tidd (2009)Bessant, J., & Tidd, J. (2009). Inovação e empreendedorismo: Administração. Porto Alegre: Bookman. | |
| Consumers | Comprehending consumer needs |
Bessant and Tidd (2009)Bessant, J., & Tidd, J. (2009). Inovação e empreendedorismo: Administração. Porto Alegre: Bookman. and Pinto, Dell'Era, Verganti and Bellini (2017)Pinto, G. L., Dell’Era, C., Verganti, R., & Bellini, E. (2017). Innovation strategies in retail services: Solutions, experiences and meanings. European Journal of Innovation Management, 20(2), 190-209. doi:10.1108/EJIM-06-2015-0049 https://doi.org/10.1108/EJIM-06-2015-004... |
| Definition of the consumer role and the development of methods to encourage them |
Ostrom et al. (2010)Ostrom, A., Bitner, M., Brown, S., Burkhard, K., Goul, M., Smith-Daniels, V., … & Rabinovich, E . (2010). Moving forward and making a difference: Research priorities for the science of service. Journal of Service Research , 13(1), 4-36. doi:10.1177/1094670509357611 https://doi.org/10.1177/1094670509357611... and Larivière et al. (2017)Larivière, B., Bowen, D., Andreassen, T. W., Kunz, W., Sirianni, N. J., Voss, C., Wünderlich, N. V., & De Keyser, A. (2017). Service encounter 2.0: An investigation into the roles of technology, employees and customers. Journal of Business Research , 79, 238-246. doi:10.1016/j.jbusres.2017.03.008 https://doi.org/10.1016/j.jbusres.2017.0... |
|
| Suppliers | Maintaining a good relationship with suppliers | Bessant and Tidd (2009)Bessant, J., & Tidd, J. (2009). Inovação e empreendedorismo: Administração. Porto Alegre: Bookman. |
| Evaluating the suppliers |
Winter and Lasch (2016)Winter, S., & Lasch, R. (2016). Recommendations for supplier innovation evaluation from literature and practice. International Journal of Operations & Production Management, 36(6), 643-664. doi:10.1108/IJOPM-07-2014-0341 https://doi.org/10.1108/IJOPM-07-2014-03... |
|
| Control variables | Indicators | References |
| Size | Approximate revenue from the last financial year |
Bessant and Tidd (2009)Bessant, J., & Tidd, J. (2009). Inovação e empreendedorismo: Administração. Porto Alegre: Bookman. , CIS (2012)Community Innovation Survey (2012). Community innovation survey 2008-2010. Dublin: Stationery Office. , and Pires et al. (2008)Pires, C. P., Sarkar, S., & Carvalho, L. (2008). Innovation in services - How different from manufacturing? The Service Industries Journal , 28(10), 1339-1356. doi:10.1080/02642060802317812 https://doi.org/10.1080/0264206080231781... |
| Age | Firm age | Bessant and Tidd (2009)Bessant, J., & Tidd, J. (2009). Inovação e empreendedorismo: Administração. Porto Alegre: Bookman. |
| Location | Where it is located | Bessant and Tidd (2009)Bessant, J., & Tidd, J. (2009). Inovação e empreendedorismo: Administração. Porto Alegre: Bookman. and CIS (2012)Community Innovation Survey (2012). Community innovation survey 2008-2010. Dublin: Stationery Office. |
| Performance | Indicators | References |
| Financial performance | Sales variation |
Morgan, Vorhies, and Mason (2009)Morgan, N. A., Vorhies, D. W., & Mason, C. H. (2009). Market orientation, marketing capabilities, and firm performance. Strategic Management Journal , 30(8), 909-920. doi.org/10.1002/smj.764
doi.org/10.1002/smj.764... |
| Profits variation |
Calantone, Cavusgil, and Zhao (2002)Calantone, R. J., Cavusgil, S. T., & Zhao, Y. (2002). Learning orientation, firm innovation capability, and firm performance. Industrial Marketing Management, 31(6), 515-524. doi:10.1016/S0019-8501(01)00203-6 https://doi.org/10.1016/S0019-8501(01)00... |
|
| Non-financial performance | Variation of new customer acquisition | Kaplan and Norton (1996)Kaplan, R. S., & Norton, D. P. (1996). The balanced scorecard: Translating strategy into action. London: Harvard Business Press. |
| Protocol | |
|---|---|
| Objective | Proposing a theoretical model to describe service innovation. |
| Design | Multiple cases. |
| Hospitals were chosen due to the industrial viewpoints to analyze the topic. | |
| Survey of drivers that direct service innovation. | |
| Case selection | Convenience, due to the nature of the study object. |
| Procedures | Approval of Research Ethics Committee and appropriate procedures, according to each hospital. |
| Data collection | Literature review to theoretically reference the proposed model and its indicators. |
| Contact was made to verify the participation. If this was possible, procedures were begun in each hospital. | |
| Semi-structured interviews with strategic managers in the hospitals. | |
| Analysis | Dynamic systemic comprehension, through the synthesis of crossed cases (Yin, 2005Yin, R. K. (2005). Estudo de caso: Planejamento e métodos. Porto Alegre: Bookman .). |
| Variables | Indicators | Case 1 | Case 2 | Case 3 | Case 4 |
|---|---|---|---|---|---|
| Size | Approximate revenue from the last financial year (in Brazilian reais) | 85 million | 30 million | 35 million | 60 million |
| Age | Age (in years) | 47 | 155 | 41 | 3 |
| Location | Where it is located | Central region | Campaign region | South-central region | Metropolitan region |
| Drivers | Indicators | Case 1 | Case 2 | Case 3 | Case 4 |
|---|---|---|---|---|---|
| Organizational culture | Encouraging personnel to think creatively. | Stiff structure with little creativity | Suggestions allowed at any time, which helps creativity. | Management through competences to develop abilities creatively. | Projects to highlight the employees. |
| Environment of freedom and autonomy for the human capital | Open for people to develop freely. | Freedom to discuss the process at any time. | Delegates autonomy responsibly. | Freedom to bring up ideas that generate value. | |
| Personnel used to risk acceptance | Aware of activity-inherent risks. | Risks are comprehended through a specific decision-making apparatus. | Operative plans that define the collaborator's capacities. | Risk acceptance is a characteristic that is a part of the profession. | |
| Strategies | Perception of innovation as a strategic factor | Nonexistent strategic program. | Adoption of new technologies. | Adoption of new technologies. | Innovation as a strategic variable. |
| Mechanisms to analyze market and technological developments | Cost/benefit. | Cost/benefit. | Specific courses. | Benchmarking and syndical participation. |
|
| Raising employee awareness about innovation strategies | Nonexistent innovation strategies. | From the selection process onwards. | Periodic meetings to clarify the strategies. | Periodic meetings to clarify the strategies. | |
| Employees | Training for innovative activities and the use of new technologies | Training for new technology. | Training for new technology. | Training for new technology. | PDCA tool. |
| Employees make suggestions for better services and processes and are rewarded | Periodic meetings. No rewards. |
Organically. No rewards. |
Periodic meetings. No rewards. |
Organically. Rewards. | |
| Degree of qualification and how selection and recruiting are conducted | From high school to Ph.D. Selection through public entrance exam. | From high school and college. Selection conducted through a profile matrix. | From high school and college. Selection conducted by the psychologist and directors. |
From high school to Ph.D. Recruiting and selection through a specific process. | |
| R&D | Existence of R&D centers, relations with research institutions, and/or hiring of external R&D | Yes; partnerships with the private initiative. | Nonexistent. | Nonexistent. | Epidemiology nucleus. They have a relationship with universities. |
| Expenses | 2% of total revenues. | None. | None. | Between 1% and 2% of monthly revenue. | |
| Developing R&D activities to create new knowledge that solves problems | Reduction of energy consumption. | Audits and strategic planning. | Projects for there to be full-time doctors. | Sustainability projects. |
| Drivers | Indicators | Case 1 | Case 2 | Case 3 | Case 4 |
|---|---|---|---|---|---|
| Technological trajectory | Long-term employment of technologies that are compatible and/or superior to those used by competitors. |
Technological evolution after the year 2000, leading to an equalization with competitors. | Evolution after 2010 with acquisition of specific technologies. Perceives superiority in comparison to competitors. | After 2012, with the implantation of the Soul system. Compatible with other hospitals of the same size. | No marked transformations. Technology is superior to that of most competitors. |
| Technical abilities and technology management. | It participates in a hospital network that is oriented towards the development of technology and abilities. | At the point of purchase, there is training regarding the technology that will be implemented. | At the point of purchase, it has training regarding the technology that will be implemented. | It has periodical training linked to technology. | |
| Institutional trajectory | Incentives and barriers imposed by the public sector throughout the years. |
Previous governments supported the hospital's development. | Promulgation of the 1988 Federal Constitution. | After the implantation of the state contracts model in 2007. | Conceived as a model for Brazilian Public Health System hospitals. |
| Societal taboos, punishments, customs, traditions and codes of conduct. | Population unaware of the health system. | The State adapts the services in this aspect. | Regional events are taken into consideration, as well as cases from rural activities. | Activities to inform society about risk classification. | |
| Competitors | The firm has competition in its partner network, which facilitates the sharing of experiences. | It shares experiences through a network of partners. | It shares experience through the Federation of Santa Casa Hospitals, and Beneficent, Religious and Philanthropic Hospitals of Rio Grande do Sul and visits other hospitals. | It conducts and receives visits with the intention of exchanging experiences with other companies. | Participation in forums and partnerships with other hospitals. |
| The company systematically compares products (services) and processes with those of its competitors. | It does not notice competition. However, it exchanges information with other partners through social networks. | It participates in the Regional Development Council of Rio Grande do Sul. Exchanges information at these encounters. | Participates in the Federation of the Santas Casas, where they exchange information with other associates. | Benchmarking at the syndicate and other institutions. | |
| Consumers | The company possesses a thorough knowledge of consumers' needs. | Mostly, it conducts socio-economic surveys. | Satisfaction surveys, periodic patient visits and social service. | Satisfaction surveys. | Satisfaction surveys, forms for criticism, customer service center and forums. |
| The firm defines the consumer role and develops methods to stimulate them to participate in the service provision process. | It attempts to raise patient awareness of their role in the process through security services. | Specific training to seek treatment humanization and patient engagement in processes. | Specific work is intended to integrate patients and potential patients. | It uses consumer satisfaction tools. | |
| Suppliers | The company maintains a good relationship with suppliers (mutual benefit). | It maintains a high level of rotation, focusing on prices when making purchases. | Relations guided by price and quality. | Good relationship with the suppliers, despite some deficiencies. | Relationships guided by the lowest price. |
| The company evaluates its suppliers. | Through the National Supplier Registration System. | Through an electronic platform: Bioexo. | Through the Soul platform. | There is a specific type of evaluation. However, no details were provided. |
| Drivers | Indicators | Case 1 | Case 2 | Case 3 | Case 4 |
|---|---|---|---|---|---|
| Performance | Sales variation | Base year 2014: 30% more | Base year 2014: 9% more | Base year 2012: 100% more | Base year 2017: 5% less |
| Profits variation | Not profitable | Not profitable | Not profitable | Not profitable | |
| Variation in the acquisition of new consumers | From 15 to 18 thousand per year | Not measured | Not measured | Not measured |
Source: Elaborated by the authors.