Health and Audiovisual Sector: A Meso-analysis of How Systemic Coordination of Sectoral Cooperation Leads to Convergence

Abstract

Abstract In times of converging and diversifying audiovisual (AV) industries, digitising health sector and the increasing phenomenon of cross-sectoral innovation, the question arises about the state of affairs between the health and AV sectors. The chapter aims to explore what the main modes of cross-sectoral cooperation between the health and AV sectors are and what supports and hinders the emergence of a related cross-innovation system. The chapter introduces two case studies carried out in Estonia and the wider Aarhus region (Midtjylland) in Denmark. At each site representatives of the main stakeholders of both sectors were interviewed – policy makers, entrepreneurs, educators and professionals. The results demonstrate the crucial role of path-dependencies – in terms of both hindering and enabling cross-sectoral dialogues – and also the importance of effective coordination in supporting cross-innovation. Keywords Cross-sectoral dialogues Path-dependence Health sector Audiovisual media industries Cross-innovation Innovation systems Citation Tafel-Viia, K. (2019), "Health and Audiovisual Sector: A Meso-analysis of How Systemic Coordination of Sectoral Cooperation Leads to Convergence", Ibrus, I. (Ed.) Emergence of Cross-innovation Systems, Emerald Publishing Limited, Bingley, pp. 121-144. https://doi.org/10.1108/978-1-78769-977-920191015 Publisher: Emerald Publishing Limited Copyright © 2019, Külliki Tafel-Viia. Published by Emerald Publishing Limited License This chapter is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this chapter (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode Introduction In this chapter, we introduce developments in the field of cross-sectoral dialogues between the health and audiovisual (AV) media sectors. We use Estonia and the Aarhus region in Denmark (Midtjylland) as case studies. We chose these cases as our observations identified that amongst the six countries we studied at the initial phase of the study, the manifestations of these sectors’ convergence in these two countries was most visible and/or offered the most interesting initiatives to explore. In Aarhus, we observed the emergence of new convergent enterprises, and in Estonia, the overall systemic development of information and communication technology (ICT) infrastructures and e-governance systems offered a promising starting-point for cross-innovations. The empirical study consisted of 36 interviews with sectoral entrepreneurs, professionals and policy makers of both countries. We start the chapter with an overview of the sectors’ development stage where we outline the main changes that influence the sectors’ current and future development and their overall readiness to adapt to these changes. Thereafter, we describe the current institutional landscape that supports the sectors’ cooperation. In the second part, we continue with the sectors’ general openness to cooperation and describe the common modes and peculiarities of cross-sectoral dialogues. The chapter ends with challenges for policy makers by outlining the main shortcomings that policy could address to better support cross-boundary innovation between the health and AV media sectors. The Changing Face of the AV Media and Health Sectors AV Media Sector The interviews revealed the changing nature of the AV sector – this applies to both Estonia and the Aarhus region. In Aarhus, the AV content and services sector has a rather strong position (2nd place in Denmark after Copenhagen) with a large-scale concentration of AV industries, which are divided into four main categories: films and animation, video games, television production and production of commercials. In Estonia, the main hub of the AV sector is the capital Tallinn. Estonian interviewees were troubled in defining the scope and borders of the AV sector, which demonstrates that sectoral identities remain an important issue. Different opinions existed in terms of what to consider as part of the AV sector and what not, including whether video games are part of the larger AV sector and what fractions of the IT sector should be included. These discussions reflect well both the overall mediatisation trend and convergent processes (discussed in Chapter 1) which have given to the increase in the AV modes used in different sectors and to the borders between different media and creative sectors becoming blurred. Estonian and Danish interviewees acknowledged that the AV sector is growing and expanding. Growth is particularly noticeable in certain subfields of the AV sector, for example, animation, games, etc., which have gone through a tremendous change from a marginalised sector to a globally ascendant industry. However, micro and small-sized companies (one man to 20–25 employees) still dominate in this sector. The growth of this sector is also reflected in its internationalisation. In particular, the Danish interviewees stated that the sector has heavily internationalised during the last decade. On the one hand, there are increasing numbers of expatriates working in AV companies and, on the other hand, the majority of local companies have ties with big international corporations. The growth of the sector also means that the amount of AV content is increasing. The interviewees (in particular, the representatives of the AV sector) highlighted the belief that the importance of AV content and tools will continue to grow – thus, the interviewees pointed to the mediatisation trend. The other important key characteristic of the AV sector is, paradoxically, its both converging and diversifying nature – the multi-directionality of convergence, that Ibrus discusses in Chapter 1; the borders between different sub-sectors are blurring and the intra-sectoral convergence of the AV sector can be observed; the amount of different kinds of cross-, trans- etc. type of content is increasing, the channels and formats have changed, the business models have altered (e.g. emergence of VOD providers as crucial players in the industry), technologies are used more mixedly, the audiences are changing and attracting their attention is becoming more challenging. In addition, the AV sector is also converging with other fields. The importance of augmented reality (AR) and virtual reality (VR) is expected to increase. The interviewees emphasised that the technology is still rather immature; there are plenty of unused opportunities and less successful solutions. However, quite unanimously, the interviewees argued that the technology will become cheaper and more user-friendly. VR and AR were also seen as engaging technologies that will blur the borders between different AV subfields. As the head of a Danish AV incubator described: VR and AR call for people from both worlds […] we work with these new technologies in an engaging way. That’s why we work with the term ‘digital experiences’ instead of ‘films’ or ‘games’ or ‘audio’. As flexibility and fast learning ability were seen as main keywords to adapt to the changes in the future, we may argue that social capacities were considered important in coping with (technological) changes. In the light of those changes, the orientation towards constant product and service innovation was also rather obvious. The interviewees highlighted the fact that innovation process is a daily practice. One Estonian AV company CEO discussed that almost everything they do is experimental. He considered this a challenge, because trying out new things is always money- and time-consuming. Although the interviews pointed to innovation examples across the sector (across companies of different development stages), still, in case of Estonia, we can see that innovativeness, especially innovating in new convergent areas, is more common among younger companies. More traditional and long-term AV companies, including production companies, are somewhat more reserved when it comes to innovation in terms of entering new fields. The matured content production companies also did not consider themselves to be innovative. An owner of a company producing films and commercials explained: ‘the answer to that, how we feel, we do not feel that we are innovative […] the [audio-visual] sector is not innovative’. Several Estonian AV sector interviewees argued that innovativeness (in Estonia) is first and foremost associated with the ICT sector and with the start-up world. Quoting the owner of an Estonian AV company: At the moment in Estonia, there is a hype that all IT and start-ups are innovative and awesome […] How are feature films related to innovation? If you don’t come up with a new ID card or Skype, then you are just doing your movies […] despite the fact that, in my opinion, it is innovative to create a world-class film and bring out a new story and thought. These attitudes reflect that AV media companies, especially those working on film production, often find it difficult to think beyond their traditional practices. The novelty they work towards is usually their next film, but not a new type of cooperation or cross-innovation initiative outside the AV sector. Awareness of development opportunities that cooperation with other sectors would offer is low. Estonian public sector and sectoral umbrella organisations’ representatives also stated that the older companies are in something of a comfort zone and do not see the ultimate need for innovation. As the representative from the Estonian Ministry of Culture remarked: ‘the situation [is] not bad enough that something new should be developed’. The situation is somewhat different with broadcasting companies. The focus on cross-media output was obvious in the case of large Danish broadcasters. To quote the programme manager of a Danish TV production company: They’re also looking for unique formats, unique content, produced straight for the big internationals – Facebook, YouTube, stuff like that, but also for their own digital platforms. Two of the major broadcasters in Denmark have their own digital platforms, where they put all the flow TV, but they want unique content there as well. They want new ideas and the stuff that’s produced directly for their own platforms as well. The public media and broadcasting sector has also become more interactive in Estonia; producing content for different platforms has become an everyday practice. The Health Sector The health sector in Estonia and the Aarhus/Midtjylland region is predominantly public. The share of private sector involvement in the health sector is growing, particularly in Denmark. Differently from the AV sector, which was seen as rather progressive, the health sector was often described as old-fashioned and slow to respond to changes. However, the interviewees stressed that a certain shift has already occurred and the health sector is becoming more open, including in terms of its readiness to cooperate with other sectors. The topic that the interviewees very often addressed was the need to change current medicine education. The interviewees emphasised the need to make it more interdisciplinary and facilitate the connections between students of different fields already during the studies that would facilitate their cooperation in the future. As to the trends, both Danish and Estonian interviewees highlighted several changes that significantly influence the sector’s future development, including those that may also facilitate the emergence of cross-innovations between the health and AV sectors. One of them is the overall change towards a user-centred approach in health care: to put the patient at the centre of the health care system and increase the responsibility of the user for his/her health. Several interviewees also talked about the need to refocus the patient–doctor relationship. The doctor needs to ask the patient what she/he needs (not to define patient’s needs by him-/herself). This in turn presumes that the patient should be ready to take active position about her/his health behavior, including to answer about his/her needs, goals in life, etc. Related to that, the interviewees referred to the necessity for new types of personal assistants and new types of ‘help-desks’ that will change the communication between the patient and the doctor. The CEO and founder of Danish AV + health company remarked: the trend is maybe that […] actually resonates with people. So building feelings into the product, building personality, building character into the product […]. We don’t have an avatar that speaks to you, but we do have character. The trend that is already happening in the health sector is the strategic refocusing towards rehabilitation and prevention. As most of the cooperation with the AV sector predominantly happens in this field of the health sector then this can be seen as a good precondition for cross-innovations to emerge. Another trend that is expected to positively influence cooperation between the AV media and health sectors lies in the generational shift. Future patients are also expected to be more prone for gamified solutions. The changing technology was also seen as the main trend influencing the sector’s development. The driver is the sensed feeling that as technologies evolve one needs to keep up to stay relevant in the marketplace. But the new technologies were also seen as offering opportunities for solutions that were not possible before. Especially, health sector representatives emphasised that the sector’s innovativeness lies primarily in the usage of new cutting-edge technology and related infrastructure. Technology-centeredness in innovation (or technological innovation) was explicitly brought out by Estonian interviewees, but it was highlighted also in Aarhus. As part of technological change, the interviewees also discussed more personalised patient information systems and software developments. Cooperation with the technology-intense AV sector would amplify the technological shaping of the health sector. Health sector representatives also expressed the expectation that the world would become more diverse when the sectors’ borders become more blurred and the mixture of different competences, including social and technological competences, are highly valued. Institutional Landscape for Cross-sectoral Dialogues The current supportive institutional attitudes towards cooperation between the health and AV sectors in Aarhus and Estonia reflect several understandings in contemporary innovation theories. On the one hand, we can notice developments expressed in contemporary cluster-development theories that focus on cross-sectoral cooperation and social and interaction processes that support it (Granovetter, 1985; Harrison, 1992). On the other hand, for policy developers also, the stream of innovation studies that focus on space and proximity issues has been relevant as they attempt to understand how innovations emerge and develop in particular places (e.g. Asheim, 2012; Florida, 1995; Hassink & Klaerding, 2012; Healy & Morgan, 2012). As demonstrated below, the institutional landscape supporting the sectors’ cross-innovation in both studied cases is not limited to the narrow models of ‘innovation system’ (Edquist, 1997; Nelson, 1993), but also encompasses actors other than research institutions and firms. However, it is interesting to point out that research institutions may not be part of the landscape when it comes to the Estonian case. We shall now describe the institutional landscape of cooperation in more detail, starting with Aarhus. As to Aarhus, the key players of the supportive institutional landscape are: (a) higher education institutions (HEIs) as regional sectoral hubs, (b) private sector organisations and community-based initiatives specially targeted to foster intersectoral cooperation and (c) public sector measures that facilitate cooperation and partnerships. HEIs have had a special role to play in supporting the clustering of the AV sector and being the central hub that attracts different actors into the region. Quoting the interviewee from one Danish production company: Because we have the school in Viborg, the animation school, and they have this environment around school with the companies […]. People graduating from schools, […] some people coming back to Viborg starting [their own business]. Because it’s very convenient to be very close to truly educated animators and have access to them. The main ways that private sector organisations and community-based initiatives support the sectors’ cooperation are via creation of physical environments that include (a) labs, incubators, etc., and (b) the organisation of events that aim to bring actors physically close and support face-to-face meetings of different actors. One example here is Interactive Denmark, which is a non-profit organisation. Its mission is to accelerate, coordinate and support the development of the Danish game and interactive cluster by focusing (among others) on the interaction between what they call Digital Visual Industry (DVI) and health. 1 The other example relevant to highlight is the Filmby Aarhus Incubator located in Aarhus, which is a new incubator for start-up companies working within DVI and is aimed at matching them with companies from other sectors and public organisations that have specific challenges for which they need digital visual solutions. The importance of these kinds of initiatives and physical environments, in particular, were highly emphasised both by companies and policy and sector representatives. Quoting the CEO and founder of the Danish AV + health company: We are there [in IdeaLab] because we want to be a part of something bigger. There’s several considerations in it. One is like it’s awesome to go to work and there’s more people than us. So it is nice to have a lot of people to talk to, but it’s also a part of our identity that we are at a place with people who build digital experiences. So that works really well, just the story about it. […] And then we use people sometimes – […] [when] we are testing the product. We have a few conversations with some of the game developers about technical stuff or sometimes they look at it and comment on what we’re doing. So, basically, it’s really, really good to have this option of talking to other people about what we do. In Aarhus, the AV sector is the active player in pursuing cross-sectoral cooperation; AV sector organisations build the partnerships and find ways to facilitate cooperation with other sectors, including the health sector. One of the latest examples is the creation of the Vision Denmark alliance, 2 which has been established by seven AV sector organisations and actors, and whose ambition is to support the growth of digital visual industries. Quoting the representative of a Danish AV sector umbrella organisation: Vision Denmark […] the aim of this organization is to focus precisely on how we can develop the relationship between the audio-visual sectors. We call them the Digital Visual Industry. […] both […] developing their entertainment products, but also developing collaboration with other industries – so, for instance […] creating simulation software for training stewardesses or making VR products for physiotherapy in other sectors. Danish interviews highlighted several additional relevant innovation support measures, but also targeted sectoral measures, including AV funds from which the companies can apply for support. One of the central joint health sector initiatives is the MedTech Innovation Consortium, 3 which was founded in 2009 in response to wishes from biotech and medtech companies in the Central Denmark region as part of the business development programme. Also private sector initiatives, for example, the Egmont fund 4 and the Lego fund, have had a special role to play in supporting cooperation between the health and AV sectors, as they support financially different cooperation projects. When it comes to Estonia’s support ecosystem for the health and AV sectors’ cooperation, the general conclusion is that, compared to Aarhus, the support is more modest and the main actor is the public sector. Characteristic of Estonia is the policy focus on generic support measures and lack of private sector initiatives. The main actors in the cooperation ecosystem are: (1) externally (by public sector) supported sectoral cluster organisations and (2) generic public sector measures that facilitate cooperation and partnerships. As to the clustering support, the emphasis is put on strengthening the AV sector. Estonia supports (through creative industries development centres) the development of different incubators and accelerators in the AV sector that contribute to strengthening the sector in general. Examples include Object, an incubator for AV sector start-ups in Narva and Storytek, an accelerator often highlighted as a good example that fosters cooperation between the AV and technology fields. As to the health sector, recently a new measure has been introduced – an innovation fund – to better plan and support innovative solutions in the health sector. In contrast to Denmark, in Estonia the active parties who seeks cooperation with other sectors are health sector organisations, specifically the Connected Health Cluster 5 (also initiated by public authorities). Estonia has also launched a financial support measure, ‘Support for creative industries cooperation projects’, which aims at supporting the growth of value added to other sectors through the development of business models, products, services, sales and marketing by building on the specific skills and knowledge from the creative industries. Interviews suggested that this measure has not fallen on fruitful ground: there has not been enough cross-industry initiatives to make use of the available funds. The fact that educational institutions do not play an important role in the cooperation landscape allows us to argue that this could be one of the reasons why cooperation between the health and AV sectors has remained rather modest in Estonia. According to Chaminade, Lundvall, and Haneef (2018) and as discussed in Chapter 2, educational systems play a crucial role in the evolution of innovation systems and are among the first initiators of intersectoral contacts. Not to mention that, to refer to Johnson (1992), the diversity in the institutional landscape is extremely important from the knowledge diffusion point of view. Thus, we may conclude that the lack of actors involved in the institutional landscape has been the hindering factor of sectors’ cooperation in Estonia so far and will also slow down changes in the future. In addition, when speaking about public sector intervention mechanisms, we may argue that, despite the creative industries’ policy prominence in Estonia for more than 10 years now, the achievement of its core policy objectives has remained modest, including to enhance spillovers to other industries and stir dynamics and growth in them. We may similarly argue that the development of cross-sectoral policies that are associated with creative industries policy by numerous authors (O’Connor, 2009; Potts & Cunningham, 2008; Throsby, 2008) have not become common practice. Openness, Modes and Peculiarities of Cross-sectoral Dialogues This section explores the different modes of dialogues and cooperation between the health and AV media sectors. We start with the sectors’ general openness towards cooperation and describe the main challenges that hinder cross-sectoral cooperation, which also outlines the peculiarities of sectoral innovation practices. Sectors’ Openness for Mutual Cooperation: Club-mentality and Sectoral Path-dependencies In contemporary innovation studies, innovation is understood as an interactive process and interactive learning (Edquist, 1997; Lundvall, 1988) is considered an important prerequisite for (cross-) innovation. Our study, however, highlighted certain differences of sectors’ dialogic capacities and readiness to cooperate. At first sight, the results of the study reveal that, in general, both sectors are open to cooperation with other sectors. The ‘traffic’ of cooperation activity goes both ways. In particular, Danish AV and health sector companies reported that, as a rule, others are turning to them to seek cooperation. One Danish production company representative remarked: ‘it’s actually like 90% of the time it’s the people come to us’. However, in the case of Estonia, proposing the question about cooperation with other sectors to AV companies or related sector organisations and public sector representatives usually led to an answer about cooperation with other creative industries sectors. The typical answer was for instance that films and games need music and actors. Only after further guiding question(s) did a discussion about cooperation with other sectors (outside creative industries) follow. That is, to consider these kinds of cooperation was somewhat unnatural, with only secondary potentiality. The motivations for cooperation are very pragmatic both in Estonia and in the Aarhus region: mostly it is a lack of certain type of competences. While some cross-sectoral cooperation, for instance with technology providers, is long term the work on innovative solutions, however, requires seeking out new ‘knowledge’ partners from other sectors. The study also demonstrated that the activeness of seeking cooperation is conditioned by the stage of development of the companies. Start-ups are more active in looking for cooperation and trying it out in convergent and thus uncharted waters than more matured companies. As described by an interviewee representing a start-up working on a VR solution in life-saving: ‘So we have to make some phone calls, knock on the doors, just spread the word, to see if they have some interest in it.’ This argument especially applies to companies that are active in emerging convergent fields and that still have to justify their existence and find their place in the market. The emerging businesses in convergent areas (digital health communications, telemedicine, gamified rehabilitation, etc.) also create the need for new type of interdisciplinary dialogues, knowledge transfer and new type of cooperation needs. Quoting the CEO of a Danish VR company that develops apps for the health care sector: I don’t really have a background in any healthcare related area. But in each project that we do, there’s a very big emphasis on having a collaborative partner. […] once it was an occupational therapist, [and] in the case of a physiotherapy project it was a physiotherapist […] and in the case of these multi-handicapped children it was some people that took care of the children at the facility […] pedagogues. As to the health sector, the interviewees complained about its ‘club-mentality’ – the establishment of very strong ‘us-ness’ of the sector as described in Chapter 2. The results of the interviews indicate that the health sector seems to have created its own rules (Dopfer & Potts, 2008) that do not cross sectoral boundaries and that cannot be (so easily) adopted by agents from other sectors. The interviewees expressed rather explicitly that it is hard to cooperate, even harder to do business, if you do not have connections within the health sector. The problem is amplified by the fact that different parties do not understand each other (enough). As illustratively described by a Danish health sector organisation representative: You have to be very precise in how you try to get close to especially the doctors. Because if you don’t speak their language, if you don’t know what they’re saying, understand what they’re saying, you get nowhere. Estonian interviewees claimed similarly that ‘outsiders’ – those who do not have any background or competence in the health sector – have difficulties to convince the health sector to buy new solutions. The crucial factor that facilitates the sectors’ cooperation is having a person with a health sector background involved in the development process. Quoting an Estonian health sector umbrella organisation innovation manager: if a technology person develops an application, then [they have] terrible [problems with] persuasion and sales in the direction of [the] healthcare sector. But if an application is developed in cooperation with [the] health sector, then you don’t need the whole sales works […] it is said that one of the success criteria for health sector start-ups is whether a health sector person is involved or not in your team. He/she doesn’t have to be a team member; they may also be a consultant or shareholder. Even in [the field of] prevention […] as unbelievable it is […] a person does not trust advice from non-medical practitioners. Although, we may conclude that the health and AV sectors have begun to become increasingly important to each other, they still have little tendency to cooperate, as historically the two sectors have not worked together. The study results also demonstrate that dialogues across sectoral boundaries are hindered as the sectors are still learning to know each other: their language, needs and practices. Despite that, we may argue, the potential for cross-innovations is high. This proceeds from Lotman’s argument, elaborated by Ibrus in Chapter 2, that the more culturally distant the domains – as the health sector and AV are – the bigger the probable innovation may be when these domains end up in a dialogue. Four Modes of Cross-sectoral Dialogues The study results demonstrate that co-innovations between the AV and health sectors do not concern the whole spectrum of activ