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Sander Faber and Marina van Geenhuizen

This chapter investigates adoption of medical technology in the form of eHealth solutions in hospitals. A model of organizational eHealth adoption is developed and empirically explored using a survey among hospitals in cities in the Netherlands and structural equation modelling (SEM). Technology adoption is seen as a process in different stages, revealing a high level of interest (about 60 per cent of hospitals) but very limited actual adoption (ranging from 6 per cent to 23 per cent). Furthermore, adoption levels tend to be higher in larger cities, and this is confirmed by significant direct influence of urban size on eHealth adoption. Other important factors tend to be organizational readiness and top management of hospitals, but these are not affected by urban size. The results leave the question open as to what makes hospitals in large cities more often adopt new technology if this is not mediated by hospital size and other organizational characteristics.

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Hans Jeekel

This chapter investigates innovation in urban passenger transport and clarifies how cities play a leading role. By focusing on liveability, intelligent systems management and new mobility, single innovations are discussed and the results summarized in a matrix. The most important ‘initiators’ are city governments, citizen groups, public transport authorities and universities, with the enterprise world somewhat lagging until recently. On the physical side, larger cities create more inventions and high density plays a role in feasibility of public transport. Universities are important, as is a historical city centre. On the social side, a well-educated population wishing to continue living in the city enhances innovation, but in some developing countries the electorate which does not own cars appears to be important. Also helpful are city governments acting on openness and trust and active political leaders. Furthermore, the early adopting cities often faced a crisis in mobility or failure of projects.

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Pieter E. Stek

This chapter presents a bibliometric study identifying clusters (cities) that are ‘champions’ in acceleration of invention in solar photovoltaics (PV), using patent analysis. The number of inventions has increased rapidly in the past decades, particularly since 2003. In this process, leading clusters change, in part, over time. Some have held their position since 2000 – Tokyo, Osaka, Seoul and Taipei in East Asia, and San Jose in the US – whereas most high-performing clusters in the US have somewhat lost their position, for example Los Angeles. Over time, there is an increased spread of inventive performance in PV technology across the world. To improve understanding of these patterns, a regression model has been estimated. Using data from 110 clusters, it appears that agglomeration factors and relational factors are equally influential, and they also tend to reinforce each other. Leadership tends to follow from a delicate balance between the size of the cluster and size/diversity of its networks.

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Cities and Sustainable Technology Transitions

Leadership, Innovation and Adoption

Edited by Marina van Geenhuizen, J. Adam Holbrook and Mozhdeh Taheri

This enlightening book elucidates the leadership challenges of various cities in emerging transitions towards higher levels of sustainability. It examines elements of three socio-technical systems, energy, transport and healthcare, while addressing technology invention, commercialization, mass-production and adoption. The book breaks new ground in the analysis of topical issues such as local ‘cradle’ conditions, incentive schemes, niche-development, living labs, impact bonds, grass-roots intermediation and adaptive policy making. It offers a broad coverage of global systems of cities, with a particular focus on Scandinavia, Germany, the Netherlands, China, Korea, Japan, the US and Canada.
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Freek Kuipéri, Marina van Geenhuizen and Jan Anne Annema

This chapter explores important uncertainties faced by cities in designing a charging infrastructure for electric vehicles (EVs), and it provides important ingredients for adaptive policy making. Uncertainty stems from future EV demand, new/improved technology concerning batteries, charging equipment and alternative fuel, and integration of EV batteries as a storage medium in smart energy systems. The chapter illustrates these uncertainties using scenario-analysis of demand for charging infrastructure, including the level of city quarters. Furthermore, large cities in the Netherlands tend to be slightly more ambitious with regard to EV policy than smaller cities, but there may be differences between large cities in different countries, for example Stockholm and Amsterdam. The chapter closes by presenting an adaptive policy making framework, given the uncertainty in national policies impacting on demand for EV cars, in integrating EVs in larger systems of renewable energy, and in arrangements concerning exploitation of charging stations.

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Suvi Konsti-Laakso, Satu Pekkarinen and Helinä Melkas

In this chapter, living labs are perceived as open networks through which new innovations can be developed. The study deals with innovation in the public sector and examines renewal of well-being services for citizens in a regional context, such as establishment of a social enterprise for mental and addiction rehabilitees; use of a service robot in public elderly care; new ways for dentists to increase participation of teenagers in dental care. Using a multiple case study design, a cross-section of 14 living lab initiatives in Lahti (Finland) is analysed and the outcomes presented. Four different outcome categories are identified and analysed: access, windows, new solutions and new capabilities. Specific attention is given to outcomes for utilisers. Furthermore, the results contribute to an improved understanding of regional living lab activities and key conditions for their success, as well as the success of public sector health services, often as an institutional innovation.

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Stephan Diek, Marina van Geenhuizen and Bart van Hulst

The chapter introduces a novel financial arrangement in healthcare services: Health Impact Bonds (HIBs). Transition aims at making healthcare services not only more affordable but also more efficient, the reason why HIBs focus on the performance (output) side of services (pay-for-success contract). The chapter describes the urgency and challenges in moving towards illness prevention, on the system (healthcare) and project levels. Next, it is explored how HIBs can improve situations of care investment that does not (fully) precipitate at the investor while preventing the rise of new problematic situations. Accordingly, a preliminary list of conditions is designed for the alignment of HIBs. Overall, it seems that HIBs provide substantial solutions by combining new contracts on paying-for-success in performance and a shared savings contract, although some questions remain regarding the involvement of investors. The concluding section includes a reflection on city involvement in HIBs.

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Marina van Geenhuizen and Nick Guldemond

This chapter studies living labs as a methodology of user-centric innovation. The focus is on sustainability in healthcare and increasing efficiency, affordability and inclusiveness. The real-life environments are residential homes for elderly people, hospitals and a shopping mall, the latter as an example of increasing accessibility for wheelchairs. The chapter aims to identify critical factors in the performance of living labs, drawing on literature and in-depth case studies in Eindhoven and Maastricht (Netherlands), Copenhagen (Denmark) and Montreal (Canada). Important critical factors are: early involvement of users, including feedback from them, and sufficient involvement of a wider network of stakeholders with the required expertise/input. An appropriate selection of promising inventions is also important. A preliminary analysis of network building through living labs found a trend for both local and global networking, with an emphasis on the latter. These findings touch on a leadership challenge for local governments, namely as a ‘connector’ between different local/ regional organizations.

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Mozhdeh Taheri and Marina van Geenhuizen

This chapter investigates the extent to which university spin-off firms in new medical technology reach the market and create job growth, for example, in support in care-providing, minimally invasive surgery, tissue engineering (organs), and information and communications technology (ICT)-supported diagnosis. The study draws on a small selective sample and employs rough-set analysis to identify preliminary causal patterns. One of the strongest influences seems the subsector indicating diversity in technical complexity (risk) and regulation (testing and approval), while management experience and access to venture capital also have a role. Furthermore, drawing on in-depth case study analysis, the preliminary conclusion is drawn that spin-offs in complex and risk-taking fields are able to survive in close research collaboration with the ‘mother’ university and/or academic hospital, and through this link, with universities and hospitals in global networks. Others that lack such relationship tend to be much more vulnerable, particularly due to healthcare budget constraints and firm-specific lack of management experience.

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Marina van Geenhuizen and J. Adam Holbrook

This chapter summarizes the important findings of the previous chapters and identifies the different challenges in leadership roles of cities with regard to enhancing sustainability transitions. Accordingly, the discussion focuses on challenges in responding to favourable localized assets that are inherited, from nature or from past developments, and challenges in active city policies that connect and enhance seedbed functions, cluster formation/strengthening and bottom-up initiatives. Specific attention is given to the key condition of attracting and retaining talent, in other words a highly skilled and diverse workforce. The chapter closes with a discussion of factors that will enhance city leadership (in the future) and indicates a few important directions of future research.