By Marta Rey-Garcia, Vanessa Mato-Santiso, & Ana Felgueiras
Cross-sector collaborations have taken over the stage of new business models in response to long-range, global sustainability challenges. In 2015, the United Nations’ 2030 Agenda placed collaborations involving all types of societal actors –state, market, and civil society– in a central position. Sustainable Development Goal 17, “Partnerships for the Goals”, came to the fore not only as a facilitator and convener of the 16 area-specific goals, but also an end on its own right due to its capacity to propel social change through new social relationships, co-creation, and co-production (Von Schnurbein, G. 2020). Along similar lines, the new framework program of the European Union to harness science and technology also gives cross-sector collaboration a prominent role in solving global challenges like climate change, digitization, and health and social care.
Whereas some of these problems evince social prominence and a sense of urgency, others remain under the radar of societal concerns. This is the case of sustainably securing the independent living of citizens in situations (or at risk) of vulnerability – the elderly, the disabled, the chronically ill, the lonely- in a context of rapidly aging populations and limited health and social care budgets. In response to this economic and social sustainability challenge, new Information and Communication Technology (ICT)-enabled health and social care –telecare, telehealth, telemedicine– has long emerged as a promising innovation. The most extended service is basic home telecare, deployed through pendants or call buttons connected to a domestic terminal that allows for hand-free voice communications with a 24/365 alarm center providing professional attention to emergency situations (illness, domestic accidents, distress, etc.).
Our study examines the pre-pandemic path of “blood, toil, tears and sweat” that it took to develop telecare in Spain through collaborative cross-sector business models that included government, businesses, nonprofits, and informal actors under the leadership of the Spanish Red Cross (1990-2019). Specifically, we explore in which ways tension management contributed to the development of telecare as a sustainability innovation. Tensions in the social services field compounded from exogenous shocks (e.g., the 2008 economic crisis), episodes of contention between incumbents and challengers (with nonprofits fiercely competing with businesses as telecare service providers), and changes in the expected roles of social care beneficiaries (from passive recipients of aid to ICT-empowered citizens). At the interorganizational level, cross-sector collaborative business models were inherently rich in tensions originating from partners’ heterogeneity, conflicting stakeholder interests, and value creation, delivery, and capture aspects.
The Spanish Red Cross managed the tension between cross-sector collaboration vs. competition by enhancing its operational efficiency to better compete with businesses for public telecare contracts while, at the same time, by adding socially enhanced service features (e.g., more comprehensive and personalized attention). These features, coherent with the nonprofit mission, differentiated its telecare services from purely commercial alternatives in the eyes of end users and their carers. As regards the tension between users’ identities as needy beneficiaries vs. resourceful citizens, telecare extended the autonomy of users, but did not empower them. Top-down diffusion dynamics of publicly funded, basic home telecare reinforced the identity of users, first as passive recipients of public aid, and then as mere commercial clients when co-payment and private provision increased. Direct and indirect users and grassroots groups speaking for people at risk or in situation of dependency did not actively participate in the initiation, formalization, and consolidation phases of the innovation. However, nonprofessional caregivers and support groups —family, friends, and neighbors—proactively prescribed the socially enhanced (and more expensive) telecare services of the Spanish Red Cross.
Overall, intensely entrepreneurial tension management by the Spanish Red Cross contributed to making collaborative cross-sector business models for telecare more valuable for partners and for society. Effective engagement with tensions allowed for reconfiguring stakeholder relationships and resources and resulted in learning and further collaborative innovations, such as bottom-up redesigning of programs for the elderly or pilots for advanced telecare adding broadband videoconferencing, multi-media, mobile and internet access, and creation of user communities.
In sum, tension management emerges as a key ability to reconfigure resources and competences to adapt to a dynamic environment. Such a capability may be crucial to help evolve collaborative cross-sector business models for sustainability innovation in social and health care towards more valuable forms in the post-COVID-19 recovery, enhancing the capacity of people at risk, or in situations of dependency, to live as equal citizens. Not by chance, a proposal is on the table for the establishment of a European Partnership on Health and Care Systems Transformation towards more sustainable, resilient, innovative, and high-quality people-centered health and care systems.
References
Rey-Garcia, M., Mato-Santiso, V., & Felgueiras, A. 2021. Transitioning Collaborative Cross-Sector Business Models for Sustainability Innovation: Multilevel Tension Management as a Dynamic Capability. Business & Society, 60(5), 1132–1173. https://doi.org/10.1177/0007650320949822
Von Schnurbein, G. 2020. One for All—SDG 17 as a Driver to Achieve the Sustainable Development Goals (p. 1-10). In Von Schnurbein, G. (Ed.). Transitioning to Strong Partnerships for the Sustainable Development Goals. Transitioning to Sustainability Series 17. Basel, MDPI.