Institutional types and institutional change in healthcare ecosystems

Purpose The purpose of this paper is to propose a typology of institutions enabling or constraining customer centricity and value co-creation in service ecosystems; illustrate the various types of institutions with examples from healthcare; and provide case study evidence on how pharmaceutical companies react to and induce institutional change. Design/methodology/approach First, a typology of institutions enabling or constraining customer centricity and value co-creation is proposed and illustrated with examples from healthcare. Next, to clarify how companies deal with these institutions by reacting to or inducing institutional change, two case companies from the pharmaceutical industry are described. Findings The research identifies and illustrates nine types of institutions (culture, structure, processes, metrics, language, practices, IP, legislation and general beliefs) grouped by three levels of analysis (micro, meso and macro). Furthermore, the findings of the two case studies indicate that companies react to, but also proactively induce, institutional change. Research limitations/implications The investigation is limited to two case studies. Practical implications Organizations need to understand the micro-, meso- and macro-level institutions of their service ecosystem; react to institutional changes imposed by other actors; and proactively change institutions by breaking, making or maintaining them. Social implications Pharmaceutical companies can improve patient well-being by inducing institutional change. Originality/value This research develops a mid-range theory of service ecosystem institutions by developing a typology. This typology is empirically examined in a healthcare context.