Expectations and Needs of Estonian Health Sector SMEs from Living Labs in an International Context
Round 1
Reviewer 1 Report
The paper is original in connecting small firms with Living labs.
However, the paper is (somewhat) immature and needs a lot of reflection on what is observed (patterns), how that may hold true for other healthcare SMEs that are not interviewed, in Estonia, but also in other Nordic countries.
The paper would be more interesting if a set of hypotheses is forwarded at the end.
Many methodological issues need to be clarified:
1) Selection of the nine SMEs; if self- selection plays a role, bias may have influenced the results.
2) Who are the respondents of SMEs? Each time the same 'functional' person, like CEO or R&D manager? If not, variability issues may have emerged.
3) To what extent are the respondents familiar with Living labs (one firm seems experienced)? Systematic comparing of users of Living labs with non-users may have been more interesting.
4) A preliminary conceptual framework is missing that connects SMEs characteristics with opinions on needs, expectations, obstacles, etc.
Presentation:
A concise table with SME characteristics and opinions would make reading more attractive and may reveal some patterns (see 4).
Finally, the essential role of Living labs deserves more attention, namely co-creation with customers. If co-creation is not emphasized, a lot of 'Living labs activities' can be derived from other agents/organizations, etc. like on market research (feed back), and consultancy on many issues (e.g. regulation, business model, certification).
Author Response
Point 1: Selection of the nine SMEs; if self- selection plays a role, bias may have influenced the results.
Response 1:
There are a total of 25 companies in the SME category of Tehnopol’s Connected Health Cluster. An additional 5 companies that are not members of the Tehnopol’s Connected Health Cluster can be found in the same category from the Startup Estonia website and 4 additional health care SMEs registered in Estonia can be found on the AngelList website. Hence, the sample covers 26% of the SMEs from health care domain registered in Estonia, which can be found on the public websites of the SME associations. The interview requests were sent to all identified health care SMEs in Estonia, however 9 of them agreed to be interviewed and be part of this research.
Point 2: Who are the respondents of SMEs? Each time the same 'functional' person, like CEO or R&D manager? If not, variability issues may have emerged.
Response 2:
Estonian SMEs are very small (ca 93 % of the SMEs have up to 9 employees). The respondents were either in managerial positions or leading the development processes as they usually operate in multiple roles.
Point 3: To what extent are the respondents familiar with Living labs (one firm seems experienced)? Systematic comparing of users of Living labs with non-users may have been more interesting.
Response 3:
All interviewees had no previous practical experience in using living laboratories, the main reason being the simple fact that such an opportunity had never been offered before "Previously haven't been used in LL, because there hasn't been an option for this." [SME9].
In general, the understanding of a living lab was addressed by making the closest connections, which is characterized primarily by testing or validating the product or service. The respondents tried to explain the concept through their previous experience, which gives some idea of the current practices of entrepreneurs, but still deviates from the main characteristics of live lab format (e.g. co-creation).
In Estonian context the living labs are not known. Hence, in general there might also be cases that they have tested some products using the living lab approach but they just cannot recognize it as a living lab.
Point 4: A preliminary conceptual framework is missing that connects SMEs characteristics with opinions on needs, expectations, obstacles, etc.
Response: In the Estonian case the SMEs addressed here are small and they all focus on B2B in their business model. Hence, there were no significant differences between the characteristics of the SMEs and then between the characteristics and the opinions. We have added a 2 charts to illustrate the needs and obstacles and added the further research about the comparisons with the Nordic countries. This article will address the differencs in characteristics too.
Point 5: A concise table with SME characteristics and opinions would make reading more attractive and may reveal some patterns (see 4).
Response 5: Two charts have been added about the needs and obstacles.
Point 6: Finally, the essential role of Living labs deserves more attention, namely co-creation with customers. If co-creation is not emphasized, a lot of 'Living labs activities' can be derived from other agents/organizations, etc. like on market research (feed back), and consultancy on many issues (e.g. regulation, business model, certification).
Response 6:
The article’s focus is on the needs and obstacles of the SMEs and what they expect from living labs. Unfortunately the SMEs did not focus on co-creation. The reason might be that the Estonian SMEs have experiences with other forms and the Living Lab format is not known to them and they cannot recognize it. We know that in Estonia Living Labs need much more promotion.
Reviewer 2 Report
General comments:
- Formulation of the title
The title is concise, but the suggestion is to take into account the additional comments below.
- The importance and usefulness of the research
This paper is of great interest because it presents a framework on the importance of developing Living Labs as tools for SMEs in the health sector. The role is important for the rapid commercialization and expansion of innovations and products on global markets, but also to receive feedback, respectively to develop products, bringing countless benefits to SMEs.
The usefulness of research for science, education, economics: This study presents the potential of internationalization of Livings Laboratories for SMEs in the Estonian health sector focusing on analyzing the needs and interests of companies in testing and validating products or services, respectively what are the demands of SMEs for entering the foreign market, but also for product development.
- Originality and novelty
The novelty of the paper is reflected by the integrated approach of the needs and expectations of SMEs or testing and validating products and services with health Living Labs in the Baltic Sea States. The originality of the treatment of the issue addressed is clear from the results obtained following the realization of the case study presented in the paper.
- Scientific quality
Regarding the theoretical part, the authors go through the literature and present the concept of Living Labs, identifying the main characteristics and perspectives which define a Living Lab. The results of the theoretical analysis were used appropriately, thus motivating the purpose of the research.
The work has a logical structure and the study is detailed sufficiently for understanding the importance of the topic addressed.
Regarding the coherence of the arguments, respectively the scientific interpretation of the obtained results, it results that the facilitation of the access of SMEs to Living Labs in the Baltic Sea States is clearly presented.
The results of the paper were approached both in terms of theoretical and practical contributions.
- The style of expression
Clarity, accessibility and understanding of assertions, observance of spelling and punctuation.
- Use of References
Good reflecting of the ideas in the text by the references used; there are quotes from internationally recognized journals. Use of relevant, recent references.
Additional comments:
1) Paper title. Considering the purpose of the paper: “The main aim of this article is to study SMEs in Estonia in the field of health care technologies and analyze the companies’ needs and interests in testing and validating its products or services in living labs in Baltic Sea region.“ - the recommendation is to reformulate the title in order to comply as much as possible with the aim and results of the research (e.g. field of health / SMEs / Estonia).
2) Please specifiy the period in which the research (interviews of companies) was carried out.
3) In conclusion, please mention what needs to be provided to SMEs in order to benefit from Living Labss as well (We recommend you visit ACSELL, https://www.interregeurope.eu/acsell/).
In addition to the purpose of the research, please consider drawing conclusions on how to achieve the sustainable development of public – private – people partnerships, (i.e. what is the impact on the three pillars of sustainability: economic, social and environmental).
3) To better justify the results of the research, we recommend that you compare them with other health-related Living Labs (e.g. LiCalab, a living lab from Belgium), see the paper “Urban living labs as a new form of co-production. Insights from the European experience”.
4) Regarding the references, as an addition, we recommend the following bibliographical references:
Kelly Bronson et al., “Moving toward Generalizability? A Scoping Review on Measuring the Impact of Living Labs”, 2019.
Emma Puerari, et al., “Co-Creation Dynamics in Urban Living Labs”, 2018.
5) Regarding the graphic presentation of the paper the recommendation is to make better use of the visuals (pie-charts, graphics and so on).
Author Response
Point 1: The title is concise, but the suggestion is to take into account the additional comments below.
Response 1: The title has been changed into "Expectations and Needs of Estonian health sector SMEs from Living Labs in an International Context".
Point 2: Please specifiy the period in which the research (interviews of companies) was carried out
Response 2: It has been added.
Point 3. In conclusion, please mention what needs to be provided to SMEs in order to benefit from Living Labs as well (We recommend you visit ACSELL, https://www.interregeurope.eu/acsell/).
In addition to the purpose of the research, please consider drawing conclusions on how to achieve the sustainable development of public – private – people partnerships, (i.e. what is the impact on the three pillars of sustainability: economic, social and environmental).
Response 3: Thank you for the suggestion. It has been added.
Achieving the sustainable development in quadruple helix will be the topic of further research and the scale of it would go beyond this article.
Point 4: To better justify the results of the research, we recommend that you compare them with other health-related Living Labs (e.g. LiCalab, a living lab from Belgium), see the paper “Urban living labs as a new form of co-production. Insights from the European experience”.
Response 4: The authors are very familiar with the LiCalab practices and operations and have used the experiences in their practical work. However, the comparisons between the Living Labs are part of our other article in progress.
Point 5: Regarding the references, as an addition, we recommend the following bibliographical references:
Kelly Bronson et al., “Moving toward Generalizability? A Scoping Review on Measuring the Impact of Living Labs”, 2019.
Emma Puerari, et al., “Co-Creation Dynamics in Urban Living Labs”, 2018.
Response 5: Thank you for the suggestion. A reference has been added.
Point 6: Regarding the graphic presentation of the paper the recommendation is to make better use of the visuals (pie-charts, graphics and so on).
Response 6: Thank you for the suggestion. Two charts have been added.
Round 2
Reviewer 1 Report
In this second round I recommend:
- To mention explicitly to what extent the 9 firms that responded, are similar to the ones that failed to respond, in other words whether there is a non-response bias. For example, have important needs/obstacles remained under the radar of the study, because these companies failed to participate?
- To check the text for consistency: is understanding of obstacles also part of the aims of the study?
- Table 2 and 3 are not clear. It needs to be indicated what the numbers on the vertical axis are: number of SMEs, or number of needs/ barriers mentioned?
- Line 454: 108 cases? Another research? Not clear.
- Text in Section 4 needs to be shortened.
- Conclusion needs to mention more explicitly whether the results can be generalized to other Baltic states.
- Language needs to be checked.
Author Response
Dear reviewer,
Please find the article where the changes have been made using "track changes" tool.
Line 11 and 254. Obstacles and expectations added for consistency.
Line 269. Explanation on the sample added.
Line 591 and 679. The charts are corrected with the explanations of the axis.
Line 626-632 moved from the discussion to the findings.
Chapter 4 has been significantly shortened as requested with several paragraphs and sentences deleted and adding new linking and explanatory sentences in lines 696, 707, 729, 878-881.
Line 729 added to explain the cases.
Line 911-913. Explanation on generalization has been added.
The whole text has been proof-read and corrected by a native English speaker.
Best regards,
Katri-Liis Lepik
Author Response File: 
Author Response.pdf
