Since its notion 40 years ago, innovations developed by users rather than producers have become a general phenomenon across various fields. Recently, a stream of research has turned toward user innovation in the health care arena and there is evidence for the capacity of patients and caregivers to innovate medical devices, treatments, and therapies (e.g., Lettl, Herstatt and Gemuenden, 2006; Habicht, Oliveira and Shcherbatiuk, 2013; Oliveira, Zejnilović, Canhão and von Hippel, 2015). Yet, the vast majority of patient innovations does not get diffused and happens “under the radar” (Oliveira et al., 2015). This problem is commonly known as a form of “market failure” and has been shown in the context of off-label drug discoveries (von Hippel, DeMonaco and De Jong, 2014) and consumer goods (De Jong, von Hippel, Kuusisto and Raasch, 2015). Thus, diffusion rates of user innovations tend to be low and almost 80% of user innovations do not become accessible to society (von Hippel et al., 2014).
Users can reveal their innovation free of charge to potential adopters, also referred to as “peer-to-peer diffusion”. Other users may opt to diffuse their innovation through a commercial entity, either through an existing firm or through the foundation of a new venture (De Jong et al., 2015).
User entrepreneurship is distinct from traditional entrepreneurship (Shah and Tripsas, 2007). Users experience a personal need that is not satisfied by existing solutions, and, prior to any formal opportunity evaluation, engage in experimentation, development and sometimes diffusion. Feedback, whether requested or unrequested, sometimes sparks the idea of entrepreneurship. Various studies have highlighted the crucial role of user communities for user entrepreneurship (e.g., Hienerth, Lettl and Keinz., 2014; Hienerth and Lettl, 2011; Shah and Tripsas, 2007): community members can provide relevant support for entrepreneurial lead users in the process of venture creation through providing market feedback, technical knowledge, physical resources and through serving as a target for first sales (Hienerth and Lettl, 2011). Hence, user communities partly compensate for the complementary assets which are required for market entry and which most users do not possess (Agarwahl and Shah, 2014).
Free sharing has been shown to be unrelated to the general value that users assign to their innovation (De Jong et al., 2015). When sharing innovation-related information, users may be driven by the expectation of receiving feedback or improvement by others (Shah and Tripsas, 2007) or expectations of reciprocal behavior (Lakhani and von Hippel, 2003). Particularly in the context of health care, the motivation to help others, might be a strong motivator (e.g., Raymond, 1999; Lakhani and von Hippel, 2003).
However, within the field of patient innovation, it is mostly unexplored how external factors and individual characteristics lead patient innovators to diffuse their ideas. Hence, learning from those patient-innovators who actually do have invested efforts to share their innovation, offers an opportunity to explore diffusion patterns: When do they decide to diffuse their solution? Why do they do so? What role does their social environment play in their decision-making?
To answer these questions of “How” and “Why” and to make theoretical insights about the diffusion of patient innovations, the study applies a multiple-case study research method (Yin, 2009). The unit of analysis is the patient-developed innovation. Case study evidence is gathered in about 15 semi-structured interviews with patients and caregivers who have already diffused their innovation. To investigate the reasons for a specific diffusion pathways chosen, the sample space was developed based on a set of about 600 solutions. It centers around the diffusion outcome and is comprised of patient-innovators who have (1) freely shared their innovation, (2) commercialized it, (3) commercialized it after initial free sharing or (4) shared it freely after commercialization. Within these groups, the objective is to identify characteristic patterns prior to, during, and after the innovation activity that help explain the diffusion pathway chosen and the efforts invested.
Seven interviews have been conducted so far. First results indicate that altruism is a major driver for the three cases of free sharing. Moreover, in one case, access to and utilization of open source designs has motivated free sharing. In two cases of commercialization after free sharing, the scarcity of financing options that would allow for scaling and making the innovation available for a larger audience pushed the innovators towards raising Venture Capital and moving to a commercial business model. Independently of the diffusion pathway chosen, the role of doctors seems crucial: in four cases, interviewees have involved their doctors in the process of development and diffusion and received support for prototyping, testing, acquiring medical approval and even firm foundation. Moreover, innovators seem to search for the involvement of doctors to add credibility to their innovation.
Exploring patterns like these allows for the generation of practical insights and helps policy makers, research entities, medical professionals and producers to leverage the innovative capacity of patients and caregivers in a much more systematic way. Specifically, research on user entrepreneurship is still in its very early stages, with few empirical studies available and no research design norm having evolved yet (Agarwahl and Shah, 2014). There is also little understanding about how, when and why the innovators decide to diffuse their innovation and which factors are contributing the most to the decision to diffuse. An exploration of these topics is essential to address the problem of market failure.
At the time of submission, the study is in the stage of data collection and analysis. We expect to collect all the cases by June 6th and produce the first draft of the paper by July, 2016.
