HealthManagement, Volume 22 - Issue 2, 2022

A Services Readiness Levels Stage Model: A Roadmap

Help with digitisation of healthcare needs a focus on service innovation – using a roadmap can help make implementation more successful.

Key Points

  • Service innovation is a key element for the future of Europe’s health and care.
  • Cities, regions, and sites working on health and care can benefit from using a service innovation roadmap.
  • Successful implementation of new services needs these practical kinds of tools.
  • Much wider use could be made of such a roadmap in many more fields.


Service innovation in healthcare has become an increasingly widespread area of investigation. The European Health Telematics Association (EHTEL) focused part of its innovation-related work on developing an 8-stage service readiness levels model. As a result of its investigation, the EHTEL Innovation Initiative (the EHTEL initiative or initiative) produced an early service innovation roadmap.

Europe Focuses on Service Innovation

Service innovation has become an area of major concern in Europe.

Horizon 2020 was a European Union programme of activities that aimed at improving innovation in Europe in a large number of disciplinary areas. Among the societal challenges faced in the programme were health, demographic change, and wellbeing. One area of importance was the technological support to be given in the service-related fields of health, care, and active and healthy ageing.

In the context of Horizon 2020, the EHTEL initiative concentrated on fields like the tackling of social and societal challenges, and a combination of health care and social care (integrated care) (Kodner and Spreeuwenberg 2002), innovative technologies in the provision of care (Guldemond and Hercheui 2012), and general services including service innovation (Witell et al. 2016). These orientations led EHTEL’s initiative to focus on the notion of service readiness and service innovation in integrated care.

Today, EHTEL continues to update this work under ongoing European endeavours related to Horizon Europe and Digital Europe. Working with European regions and countries, it explores what could be done throughout European countries under the Resilience and Recovery Facility. Chief among progress to be made towards resilience and recovery will be services reform and innovation. As Europe heads towards new sets of major milestones in 2030, one could imagine the potential growth of use of service readiness innovation as a domain for practical application in the integrated care fields of health and care.

Background to Technological Readiness Innovation

Technology readiness is a notion that has increasingly pervaded technological research over a 40-year time-period. Originating from work undertaken in the USA and taken up by international organisations including the space industry and standardisation bodies, it was transformed into the International Organization for Standardization (ISO) standard 16290. A similar, yet simplified, list of technology readiness levels was adopted by the European Commission (European Commission 2014). As part of its own work on service innovation, EHTEL’s initiative decided to critique the model of technological readiness and see to what extent it needed to be complemented by a service readiness levels model.

A Service Innovation Model

The model developed by the EHTEL initiative brings together in a single instrument innovation management and service readiness (Table 1). It was originally called a Service Readiness Levels Stage Model, and produced in the 2015-2017 timeline.

This service readiness levels model is a stage-based model. It was designed to provide a complementary mechanism to the notion of technology readiness levels (TRLs). The main purpose of the model, and its associated template for gathering information, was to focus on the processes involved in scaling-up service innovation. The fields to which it has been applied are in both healthcare and social care, i.e., integrated care. The model was refined by undergoing several iterations.

Ultimately, the model forms a roadmap. It has now been called Roadmapping for Service Innovation. This roadmap covers a set of stages. The stages range from the origins of an innovation proposal through its entire process of scaling-up. Eventually, actual integration of a service innovation is achieved in a healthcare system or service(s).

Three Sites Apply the Use of the Service Innovation Model

A range of sites and examples offered to test both the usability and workability of the service innovation model. These three sites used the model and the template to describe their own good practice(s) as an innovation incubator.

Each service innovation took place in a different region of Europe (both inside and outside the European Union). The three sites reported on their service readiness. They were located in Galicia, Scotland, and Humberside in England.

Each site dealt with a different form of innovation. Each concentrated on particular aspects of its health and care work. The innovations covered work in the secondary care sector (hospitals), the primary care sector (general practices), and a wider domain of activity that encompassed health care, social care, and voluntary care. They included a hospital; a primary care institution with a focus on both cardiac and lung disease; and an organisation offering community social and health care support.

Overview of a Service Readiness Levels Stage Model

The EHTEL initiative’s study of innovation showed that a Service Readiness Levels Stage Model, and the template accompanying it, is easy to use. Use can be made of it by sites that are preparing, or are involved in, the process of scaling-up service innovation.

Other Types of Service Innovation Models

EHTEL’s initiative members designed the 8 levels of the model to be displayed in a way that permits the model to be compared to the international, and especially the European, technical readiness levels model (European Commission, 2014). It can also be examined in a similar way to the approach used in the Electronic Medical Record Adoption Model (EMRAM). EMRAM was developed by the Healthcare Information and Management Systems Society (HIMSS) in the USA.

These two instruments are both stage-based models. The greatest similarity is with their look-and-feel. Ultimately, the instruments might form part of a group of tools which could be grouped together as a toolkit. This toolkit of tools could be used to support the scaling-up of service innovation in a wide range of fields.

Other Types of Supportive Service Innovation Activities

The scaling-up of service innovation and service development could also be undertaken through at least three types of activities. These activities would include twinning, coaching, and self-assessment.

In the first two of these activities, the service innovation model/tool could function as a type of teaching aid or learning aid. Each of these types of activities to support scaling-up is becoming increasingly popular. These types of activities have been supported by a variety of European Commission co-financed activities, through studies such as ScaleAHA and projects like Scirocco and Scirocco Exchange.

The third activity – self-assessment – deserves more attention. When used as self-assessment, the service innovation form (or template) could be displayed online by using a more interactive, attractive visual format. It could then be filled in electronically through a user-based platform.

Future Developments of the Model and Application of the Roadmap

EHTEL members and people involved in the EHTEL initiative concluded that further elaboration of the Service Readiness Levels Model could enable the creation of several instruments: a roadmap; a tool; and a compendium/resource directory.

  • A Roadmap: When used as a roadmap, the mechanism could help a site move towards making more advanced and applied innovative actions. It could enable the people on the site to understand how to make progress, stage-by-stage, on a service innovation journey.

  • A tool: Used as a simple tool, the mechanism could help people to evaluate service innovation initiatives in both health and care. For example, it could constitute just a single component embedded in a user-friendly online course. The overall course could include a teaching set – modules of easily accessible documents – that would be used to introduce and teach the basic foundations of service innovation scaling-up.

  • A compendium or resource directory: Such a compendium or directory could constitute the collection of a set of descriptions of service innovation good practices and experiences. When gathered together, these examples could provide accessible, easy-to-use case studies to be used as examples by other sites. The collection could be used as a reference point for ongoing innovation management and service innovation in health and care.

In this brief article the focus of further work is on the use of the model as a tool. It is evident, however, that investigation could also be undertaken on its use in a much wider set of areas of innovation management and service development in health and care (Joiner and Lusch 2016; Mori et al. 2015; Wise et al. 2011). Other fields, such as food/agriculture, are also ripe for the application of readiness models (Jostein et al. 2021). Within the last year too, suggestions have been made for how to better evaluate and assess public health service innovation (Hughes et al. 2021).

Today, there is rapid growth in fields like hospitalisation@home, the greater need for the use of digital technologies, and for hybrid (physical and virtual) forms of care. All three might offer appropriate fields for further exploration and implementation of the model/tool and, specifically, the roadmap.


This 8-stage model shows that there is an opportunity to focus on concrete approaches to exploring and applying service readiness in real-life applications. With EHTEL’s guidance, three example sites/regions in Europe were able to use the model/template to explore the service readiness and innovation of their digital health developments.

EHTEL remains keen to validate further the use of the model, the template, and especially the roadmap. The association would aim to do so by involving a wider range of organisations and stakeholders. Examples could include innovation incubators, users of services or health and care systems, and representatives or members of regional associations motivated by improved service innovation. Any ensuing gaps in knowledge will be highlighted by further active application and transferred practical learning.

There is considerable potential complementarity between this specific tool and the several others identified. The roadmap especially can be seen as one tool among several that could form a basic toolkit to be used by sites wishing, in the future, to make innovative shifts in their service provision.

As a member organisation, with some 50+ institutional members, EHTEL serves primarily its own members. EHTEL is eager to work with other sites/regions that might wish to apply its service readiness-oriented roadmap. It is especially keen that its application would help in building Europe’s resilience and recovery before 2030 in the field of digitisation of healthcare.


In addition to the three regional sites mentioned in this article, some 30 individuals from EHTEL member organisations provided input and materials for the work undertaken.

Conflict of interest



European Commission (2014) Commission Implementing Decision of 22.7.2014 amending Implementing Decision C(2013)8631 adopting the 2014-2015 work programme in the framework of the Specific Programme Implementing Horizon 2020 – The Framework Programme for Research and Innovation (2014- 2020).

Guldemond N, Hercheui MD (2012) The Role of Technology in the Provision of Care for Patients with Chronic Conditions: the Chronic Care Model as a Framework for the Integration of ICT. In MD. Hercheui, D. Whitehouse, WJ. McIver Jnr. & J. Phahlamohlaka (editors).ICT Critical Infrastructures and Society. International Federation for Information Processing. Springer- Verlag: Heidelberg and Berlin, pp124-134.

Hughes J, Lennon M, Rogerson RJ, Crooks G (2021) Scaling Digital Health Innovation: Developing a New Service Readiness Level Framework of Evidence. Int. J. Environ. Res. Public Health. 18:12575.

Joiner KA, Lusch, RF (2016) Evolving to a new service-dominant logic for health care. Innovation and Entrepreneurship in Health. 3:25-33.

Jostein V, Melås MV, Stræte EP, Soraa RA (2021) Balanced readiness level assessment (BRLa): A tool for exploring new and emerging technologies. Technological Forecasting and Social Change. 129:120854.

Kodner DL, Spreeuwenberg C (2002) Integrated care: meaning, logic, applications, and implications – a discussion paper. International Journal of Integrated Care. 2(4).

Mori AR, Contenti M, Albano V (2015) Completeness Layers towards Integrated Care enabled by Technology (CLICT). Global Telemedicine and eHealth Updates: Knowledge Resources. 8:13-16.

Wise CG, Alexander JA, Green LA et al. (2011) Journey toward a Patient-Centered Medical Home: Readiness for Change in Primary Care Practices. The Milbank Quarterly. 89(3):399–424.

Witell L, Snyder H, Gustafsson A et al. (2016) Defining service innovation: A review and synthesis. Journal of Business Research. 69(8):2863-2872.

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digitisation of healthcare A Services Readiness Levels Stage Model: A Roadmap

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