PhD Defense | Anna Baturevich successfully defends her doctoral dissertation

How do regulation and professional standards shape digital healthcare platforms? In her PhD dissertation at the Stockholm School of Economics (SSE), Anna Baturevich examines how constraints affect platform design, clinicians’ work, and innovation. 

Associate Professor Anna Essén, SSE, chaired the defense. Professor Joost Rietveld of the UCL School of Management in the United Kingdom served as faculty opponent. 

Professor Joost Rietveld complimented the dissertation for its coherence and breadth, highlighting how the three studies explore different aspects of platform design while combining theoretical, quantitative, and qualitative research methods.

He also commended the clarity of the writing and noted that the dissertation demonstrates Anna’s versatility and skills as a researcher. 

What the dissertation is about 

Much of the research on digital platform design examines settings with relatively few regulatory constraints. Anna Baturevich’s dissertation asks what happens when that is not the case. 

Using digital healthcare as her main research setting, she examines how constraints at the organizational, worker and wider healthcare ecosystem levels shape which design choices are available to platforms. Clinicians are licensed professionals who can work elsewhere, and healthcare is a heavily regulated sector. Together, these constraints shape which platform features are viable, how they are designed and what consequences they have. 

Design shapes skills 

The first study develops a theoretical framework explaining how the way platforms organize work can affect workers’ skills. Depending on how tasks are divided and coordinated, workers may develop transferable skills, lose existing skills or acquire skills that are useful mainly on a particular platform. Opportunities for communication, feedback and training, as well as task allocation, play an important role in these outcomes. 

Clinicians care about how they work, not just pay 

In the second study, co-authored with Holmer Kok, 398 clinicians were asked to choose between digital healthcare platforms varying in their features. 

The results show that pay and flexibility account for roughly half of what matters to clinicians when choosing a platform. The other half concerns how they can perform their work. Clinicians value opportunities to communicate with colleagues and develop their skills, while text-only consultations with patients are a major drawback compared to video and multimodal formats. They are also generally positive towards automated tools, such as patient triage systems, but not at the expense of what can be observed of the patient.  

Regulation works through the ecosystem 

The third study, co-authored with Anna Essén and Annabelle Gawer, is a longitudinal study of a European digital health software company operating in Sweden, following its automated patient triage tool over 10 years. 

When the new European Union Medical Device Regulation (MDR) came into effect, health software developers faced new challenges in bringing their digital solutions to market. New rules had to be interpreted by multiple ecosystem actors, including the certifying bodies, the customers, the local regulators, and the developers themselves. The company withdrew a machine-learning feature from its tool not because the rules explicitly prohibited it, but because there was no accepted way to demonstrate that it met the new regulatory requirements. The study shows how regulation can reshape innovation through the rules themselves, as well as through how different organizations interpret and apply them. 

Practical implications 

For platform managers, the findings suggest that competitive pay and flexibility alone may not be enough to attract clinicians: features that support professional standards of care, such as video consultations and opportunities for peer learning, also make clinicians more willing to join. The framework developed in the first study suggests that excessive automation and fragmentation of clinical work may also risk eroding the very skills a platform depends on in the long run. 

For regulators, the findings highlight how new rules can have unintended consequences for innovation. They also point to a need for clearer, more practical guidance for certifying bodies and manufacturers. 

Read the dissertation: "Platform Design Under Constraint: The Case of Digital Healthcare."

Assessment committee 

Chair of the defense: Associate Professor Anna Essén, Stockholm School of Economics, Sweden  

Faculty opponent: Professor Joost Rietveld, UCL School of Management, United Kingdom 

Assessment committee: 

• Associate Professor Joey van Angeren, Vrije Universiteit Amsterdam, the Netherlands 

• Associate Professor Kaisa Koskela-Huotari, Stockholm School of Economics, Sweden 

• Professor Valentina Tartari, Stockholm School of Economics, Sweden 

Supervisors: 

• Associate Professor Anna Essén, Stockholm School of Economics 

• Associate Professor Holmer Kok, Stockholm School of Economics 

• Professor Annabelle Gawer, University of Surrey 

Celebratory mingle 

After the defense, the assessment committee excused themselves to deliberate. They soon returned to announce that Anna had successfully defended her dissertation. 

The celebration then took place in the Faculty Lounge at the House of Innovation, where guests and colleagues toasted Anna’s achievement. 

On behalf of everyone at SSE and the House of Innovation, congratulations, Anna!