Helena Vallo Hult
email: helena.vallo-hult@hv.se

Katriina Byström

Martin Gellerstedt

ICT and Learning Usability at Work Challenges and Opportunities for Physicians in Everyday Practice

Keywords: ICT, Information and Communication Technology, Informal learning, Information seeking, Physicians, Workplace learning

The medical profession demands training and lifelong learning to ensure patient safety and quality of treatment. Main barriers are lack of time and resources. Information and communication technology (ICT) has proven to be useful to support e-learning, but less focus has been placed on the potential role of ICT as support for continuous learning in everyday practice. The aim of this qualitative interview study was to explore physicians' perspective of learning and how ICT in various ways can support learning at work. The findings indicate that continuous learning to a large extent is case driven, and that ICT may play an important role and support reflection and learning for individual physicians and for the collective as well. We argue that such ICT solutions must be adopted to and integrated in the everyday work, save time and include learning usability.

Introduction

The medical profession demands training and lifelong learning to ensure patient safety and quality of treatment. Patients who are more aware of their treatment options, the rapidly growing amount of accessible knowledge and new information and communication technology (ICT) poses challenges but also opportunities in terms of information, communication and learning.

The deficiencies of continued training for medical specialists, mainly due to lack of time and resources, is one challenge that has gained increased attention [START_REF]European Commission: Study concerning the review and mapping of continuous professional development and lifelong learning for health professionals in the EU[END_REF][START_REF]A summary of the state of knowledge about physician training[END_REF]. Recommendation regarding physicians professional development emphasize that it should cover both clinical and non-clinical aspects and that continuous training needs to focus on daily practice [START_REF]European Commission: Study concerning the review and mapping of continuous professional development and lifelong learning for health professionals in the EU[END_REF]. Furthermore informal learning through i.e. collegial communication, learning by doing and peer-learning is considered an important part of lifelong learning [START_REF] Strimel | Integrating and Monitoring Informal Learning in Education and Training[END_REF][START_REF] Cobo | Strategies to promote the development of e-competences in the next generation of professionals: European and International trends[END_REF]. Despite the recognized importance of training and lifelong learning for health professionals, less attention has been paid to how physicians learn in the workplace [START_REF] Dornan | Workplace learning[END_REF][START_REF] Van De Wiel | Exploring deliberate practice in medicine: how do physicians learn in the workplace?[END_REF].

Along with keeping up with the latest medical knowledge, physicians have to face an increasingly digitalized workplace. Tablets and smartphones provide quick and easy access to up-to date information and are used in a variety of ways, including information management, decision support and medical education [START_REF] Boruff | Mobile devices in medicine: a survey of how medical students, residents, and faculty use smartphones and other mobile devices to find information[END_REF][START_REF] Mickan | Evidence of effectiveness of health care professionals using handheld computers: a scoping review of systematic reviews[END_REF][START_REF] Sclafani | Mobile tablet use among academic physicians and trainees[END_REF][START_REF] Ventola | Mobile devices and apps for health care professionals: uses and benefits[END_REF]. Rapid advances in medicine and technology also provide for innovative health services, such as use of mobile technology for patient information and new technologies for selfcare. This has led to an increase of health related ICT (eHealth/mHealth) research [START_REF] Barello | eHealth for Patient Engagement: a systematic review[END_REF][START_REF] Jacobs | A systematic review of eHealth interventions to improve health literacy[END_REF][START_REF] Li | Prioritization of actions needed to develop IT skills among healthcare workforce[END_REF][START_REF] Van Gemert-Pijnen | A holistic framework to improve the uptake and impact of eHealth technologies[END_REF] and practice [START_REF]Strategy for National eHealth[END_REF][START_REF] Kay | mHealth: New horizons for health through mobile technologies[END_REF][START_REF]European Union: eHealth Action Plan 2012-2020-Innovative healthcare for the 21st century[END_REF]. Despite of documented benefits, many eHealth initiatives have failed to realize predicted benefits in practice, and as a result health professionals are often sceptical and less supportive of eHealth technologies [START_REF] Van Gemert-Pijnen | A holistic framework to improve the uptake and impact of eHealth technologies[END_REF].

Research show that use of ICT also has an important role and potential to support continuous training and learning [START_REF]European Commission: The use of ICT to support innovation and lifelong learning for all -A report on progress[END_REF][START_REF] Vaona | E--learning for health professionals[END_REF] especially on informal learning activities [START_REF]European Commission: The use of ICT to support innovation and lifelong learning for all -A report on progress[END_REF]20,[START_REF] Yaşar | The power of social media in informal learning[END_REF]. While social media is well established and used in the external communication, it is only in recent years that focus has been on the use of social technologies for informal communication, collaboration and learning within organizations [START_REF] Brzozowski | Effects of feedback and peer pressure on contributions to enterprise social media[END_REF][START_REF] El Ouirdi | Employees' use of social media technologies: a methodological and thematic review[END_REF][START_REF] Leonardi | Enterprise Social Media: Definition, History, and Prospects for the Study of Social Technologies in Organizations[END_REF][START_REF] Song | Has Web 2.0 revitalized informal learning? The relationship between Web 2.0 and informal learning[END_REF]. Current research highlight that engagement in social media and use of online tools for knowledge sharing and collaboration can be a key way for health professionals to continuously learn and incorporate lifelong learning principles in daily work [START_REF] Kind | Social media for lifelong learning[END_REF][START_REF] Brown | How Doctors View and Use Social Media: A National Survey[END_REF][START_REF] Grajales | Social media: a review and tutorial of applications in medicine and health care[END_REF].

Successful design and implementation of ICT in health care demands an understanding of the context, both on an organizational level but also on an individual level [START_REF] Li | Prioritization of actions needed to develop IT skills among healthcare workforce[END_REF][START_REF] Van Gemert-Pijnen | A holistic framework to improve the uptake and impact of eHealth technologies[END_REF][START_REF] Lupianez-Villanueva | The integration of Information and Communication Technology into medical practice[END_REF]. Practical experiences point out that many IT systems are perceived as time-consuming, non-user friendly, poorly integrated in medical practice and incompatible with each other [START_REF] Song | Has Web 2.0 revitalized informal learning? The relationship between Web 2.0 and informal learning[END_REF][START_REF] Kind | Social media for lifelong learning[END_REF]. As a consequence it is fundamental to examine individual physicians' perception and experience of ICT, its use and potential in practice.

The aim of this study is to gain a better understanding of physicians' perception of learning in the workplace, and to explore how ICT in various ways can support and contribute to information related activities such as collegial communication, collaboration, knowledge sharing and keeping up to date. The research question is: How do resident physicians' experience everyday learning in connection to information related activities and ICT, both as individual specialists and as members of a community?

Theoretical background

Learning in the workplace may occur in different forms and takes place in different settings. It is common to distinguish between formal, non-formal and informal learning. Formal learning usually refers to learning that is organized and structured, leading to certification. Non-formal learning is structured but occurs outside the formal education system, for example courses organized by workplaces. Informal learning refers to learning acquired through every day work, not organized or structured in terms of objectives, time or learning support [START_REF] Strimel | Integrating and Monitoring Informal Learning in Education and Training[END_REF][START_REF] Cedefop | Terminology of European education and training policy : a selection of 100 key terms. Office for Official Publications of the European Communities[END_REF][START_REF] Ala-Mutka | Review of Learning in Online Networks and Communities[END_REF].

A review of the literature on informal learning in the workplace by Le Clus [START_REF] Clus | Informal learning in the workplace: a review of the literature[END_REF] showed that informal learning is often spur-of-the-moment learning and self-directed, highlighting the importance of social context for the learning and concludes that if informal learning emerges during everyday activities in the workplace, there is potential for this type of learning to occur more often than formal learning. According to Eraut [START_REF] Eraut | Informal learning in the workplace[END_REF][START_REF] Eraut | Informal learning in the workplace: evidence on the real value of work-based learning[END_REF] most learning in the workplace is informal and consists of both learning from others and from personal experience, and although informal learning contributes to most of the learning in workplaces (70--90 %) it is often not looked upon as learning but instead occurs as a by-product of engaging in work activities.

The notion that learning is a social process embedded in everyday life and work, as opposed to merely the acquisition of knowledge and skills, is central for theories of situated learning and communities of practice [START_REF] Lave | Situated learning : legitimate peripheral participation[END_REF][START_REF] Wenger | Communities of practice : learning, meaning, and identity[END_REF]. According to this perspective learning and knowing is related to engagement in practice through participation and interaction with others, and the informal learning that comes with it [START_REF] Wenger | Communities of practice: A brief introduction[END_REF]. More recent work by Wenger et al. [START_REF] Wenger | Learning in landscapes of practice : boundaries, identity, and knowledgeability in practice-based learning[END_REF] introduce the concept of knowledgeability as an outcome of learning with respect to a landscape of practice rather than focusing on a single community of practice, referring to social learning capability and professional knowledge as something not only associated with competence in specific practices but a negotiation of identity and claim of competence in and across an increasingly complex landscape of practice.

Research on physicians learning has shown that traditional education focus on formal learning and medical or scientific knowledge, which might not provide the students with other skills necessary needed throughout their working life [START_REF] Embo | Integrating workplace learning, assessment and supervision in health care education[END_REF], such as evidence based practice and lifelong learning [START_REF] Teunissen | The competent novice: lifelong learning at work[END_REF] or ICT skills [START_REF] Li | Prioritization of actions needed to develop IT skills among healthcare workforce[END_REF][START_REF] Bronsburg | The Impact of an Osteopathic Medical Program on Information Technology Skills of Physicians Entering the Workforce[END_REF]. Hansson and Marklund [42] highlights in a Swedish study that resident doctors believe it is important to acquire a scientific and critical way of thinking in order to be able to examine their own practice and to respond adequately to the patients' questions and that the education should relate more to their own everyday practice. Reflection and reflective practice has long been recognized as an important part of continuous professional development in healthcare [START_REF] Jayatilleke | Reflection as part of continuous professional development for public health professionals: a literature review[END_REF][START_REF] Mann | Reflection and reflective practice in health professions education: a systematic review[END_REF]. According to Schön [START_REF] Schön | The reflective practitioner : how professionals think in action[END_REF] there is a difference between reflection in action (during the experience, at point of care when treating patients in clinical practice) and reflection on action (in retrospective, after an experience or particular situation has happened, consulting colleagues or the literature). Although the original focus of this distinction was on individual reflection, as shown by Prilla et al. [START_REF] Prilla | Collaborative reflection at work: supporting informal learning at a healthcare workplace[END_REF] it also applies to collaborative reflection.

Within research on information behaviour, there has been an increasing interest in health professionals' information seeking as a result of rapid growth of medical information [START_REF] Case | Looking for information : a survey of research on information seeking, needs, and behavior[END_REF]. Earlier studies have mainly focused on physicians' information needs and use, with emphasis on formal information sources related to either keeping up to date or clinical treatment and patient care [START_REF] Davies | The information--seeking behaviour of doctors: a review of the evidence[END_REF][START_REF] Gorman | Information needs of physicians[END_REF]. More recent studies have focused on information seeking in context, highlighting information access, usability issues and information overload [START_REF] Clarke | Information needs and information--seeking behaviour analysis of primary care physicians and nurses: a literature review[END_REF][START_REF] Younger | Internet--based information--seeking behaviour amongst doctors and nurses: a short review of the literature[END_REF]. Also access to online health information is challenging the professional identity and redefining roles of physician and patient [START_REF] Higgins | A literature review on health information seeking behaviour on the web: a health consumer and health professional perspective[END_REF].

Many studies on ICT and information seeking in health care focus on how the new technology can help increase efficiency, patient safety and quality of care (from the individual doctor's point of view), and do not have learning as their focus. They do emphasize on the benefits of ICT for education purposes and training, but do not look at learning as such. Although not explicit, the new technology is seen as useful for learning purposes such as: search for information and answers to questions in everyday clinical practice (individual learning); communication, collaboration and peer-topeer learning (collective learning); the introduction of standards, best practices, guidelines and recommendations (organizational learning).

Methodology

This study is based on 15 individual semi-structured interviews with Swedish resident physicians. The research approach is qualitative, which is appropriate since the purpose of the research is explorative, aiming at gaining deeper understanding of the meanings, experiences, and views of the physicians [cf.53]. The interviews were transcribed and analysed first manually and later with the qualitative data analysis software NVivo 10 [e.g.54]

Setting and Participants

Resident physicians are a typical specialized profession, which has long been committed to lifelong learning. They practice as physicians but are also engaged in a minimum of five years continued clinical training towards specialist competence. In Sweden this is the responsibility of the public health authorities, not the higher education [START_REF]Socialstyrelsen: Doctors' specialist medical training -Regulations and general guidelines. Descriptions of objectives" corresponds to[END_REF].

There are a number of different documents and frameworks that directly or indirectly control and imposes on physicians to keep up to date and continuously learn in professional practice. All members of the health care staff are to carry out their work in accordance with science and proven experience, and the patient shall be given competent and attentive health care that meets these requirements [START_REF]Socialstyrelsen: Health care report 2009[END_REF]. Working with Evidence Based Medicine (EBM) means integrating individual clinical expertise with the best available external clinical evidence from systematic research [START_REF] Sackett | Evidence based medicine: what it is and what it isn't[END_REF].

Data Collection and Analysis

Semi-structured interviews were conducted with individual physicians, attending a course on scientific approach during the spring semester 2015, as part of their specialist medical training 1 . The research project was introduced to the physicians at the beginning of the course. Thereafter an invitation to participate was sent by email to all attendees. The invitation email was explaining the purpose and objectives of the study, also emphasizing that although the study was carried out in connection with the course, the intention was not to evaluate the course or knowledge level of participants.

There were totally 24 course attendants, 18 agreed to participate in the study and a total of 15 interviews were completed. Each interview lasted for about 1 hour and was recorded on tape. Prior to the study two pilot interviews were carried out to test the interview guide, resulting in minor adjustments. Informed consent was obtained according to Codex Rules & Guidelines [START_REF]The Swedish Research Council: Codex Rules & Guidelines[END_REF].

The interview guide was developed by the researchers, with expertise in scientific methods and workplace learning, together with a senior physician experienced in qualitative methods in the selected population. It was structured around three key themes, as shown in Table 1, with open, explorative questions, aiming to encourage the respondents to talk freely on the subjects. Initial analysis was conducted manually by the interviewing researcher. All interviews were transcribed and read through multiple times with the purpose to obtain a sense of the whole material. Key words and interesting aspects were highlighted, and reflections, impressions and observations from the interviews were written down as field notes. All interview transcripts and field notes were formatted and imported into NVivo. Interview data were read and coded iteratively, followed by a process including multiple coding to different nodes and recoding nodes into broader/narrower themes during analysis. A basic coding scheme with was developed with descriptions of each node and secondary analysis were conducted by a second researcher.

Findings and Analysis

The results are presented according to the themes, as shown in fig. 1: patient cases as the engine for learning (self-learning, collegial learning and evidence based learn-ing), Patient perspective (googling patients pros and cons, pedagogical task) and the promising potentials beyond the technical hassles. Self-learning. The participating physicians had a strong focus on their own responsibility for learning. Many of them expressed this as a matter of professional identity, being a doctor is about being reflective, analytic and continuously keeping up to date:"…but it is also a part of work, to always trying to learn and keep updated and work from the best knowledge available". Also relating this to patient responsibility, as a doctor you need to make important and well informed decisions about your patients every day: "And you want to sleep well at night, knowing you have treated your patient the best way possible, so you read, you search, you learn". Thus, underpinning this focus, and related to all patient cases were continuous ongoing learning activities, to prepare and study, consulting colleagues and experts, follow up etc. Related to self-learning the physicians also talked about the responsibility of always to be prepared to back up decisions with liable arguments based on evidence, not on personal opinion. On the one hand a critical approach is essential for making decisions based on individual experience and judgement, as well as listening to and learning from colleagues and experts, and on the other hand following procedure and recommendations for treatment and common best practice. Throughout the interviews the physicians expressed this as being a balance in the progression of becoming a specialist: "it used to be that I had to search because I didn't know, but now I have more experience and searching is more for confirmation" But with experience comes also a risk to lose motivation for learning "and you think you know because you learned it a long time ago, but now to take the time to search and keep updated on things you know, you just don't have that time". Several commented on reading medical news in trade press and journal articles at evenings or on the bus to work, but explicit or implicit not defining it as "real" work. Much the same as with patient administration which is a lot about self-learning, but were often not looked upon as learning as such.

Collegial learning. The physicians talked also about how they participate in everyday collegial exchange with supervisors, colleagues and experts or consultants. They described how they learn in supervision, but also function as a source for new and updated knowledge for the supervisor: "there is a desire from the supervisor, and also a stress I think, to learn from me, because I have the new updated knowledge" Learning from and with colleagues were highlighted by many as an important part of day to day learning, also to a great extent driven by patient cases creating a learning situation: "We have weakly staff meetings where we discuss patient cases, but we also have open doors and a lot of discussions during the day, and I think this is really how I learn the most". Informal learning in the workplace was often addressed from the individual physician's point of view, described in relation to solving problems or asking or questions ad hoc, as they occur in the daily work. From an ICT perspective it is interesting to note that the physicians also called for better structure and more systematic and organized forms for collegial exchange of experiences. They saw the need for collegial learning, confirming it as an important way of learning at work, but hard to maintain "when the responsibility is imposed upon individual physicians".

Evidence Based Learning. The physicians expressed high awareness of the EBM approach to summarize and give recommendation for treatment, based on the best available research evidence: "As a physician you are trained in critical thinking […] and pretty used to stand upon summarized regulations and guidelines. Many expressed feelings of concern and anxiety as well as to frequently have bad conscience not doing or being enough when it comes to learning and information seeking: "you don't have time to search for evidence based research, so you just have to go on your own knowledge, and be confident in yourself that you can stand for your decision" Condensed Information Site. All of the respondents described that they use the internet daily for seeking work related information, to check for facts or specific documents, or for confirmation: "So I Google a lot, but it's not like I learn new things, It's more of relearning or refreshing of knowledge that I already have but have forgotten at the time". It was also common to use Google as an alternative to bookmarks in the web browser, i.e. to google things you use often both out of convenience and on purpose not to miss out on new search results. The physicians' information seeking and choice of sources had a lot to do with what type of information that was needed at the time which was mostly short and fast answers to specific questions related to the patients or work task at hand. Besides confirmation and fact-checking, Google was used for image seeking (e.g. dermatological) and for finding clips on YouTube. These were regarded as being useful for instructions on how to perform certain procedures, either as information for the doctor or to show to a patient. Systematic information seeking using scientific databases was less common in clinical practices. It was judged as important but was more for specialisation and something done separate from the day to day work. In the everyday working with patients the physicians in general preferred local information and information written in Swedish: "It's not so advanced the daily work, I don't need PubMed for that, and in case it's more complicated, then there is always national guidelines or recommendation that I can trust".

Sources of Authority.

Altogether the interviews present a similar picture with respect to online information seeking. The Swedish medical information sites internetmedicin.se and praktiskmedicin.se (practical medicine) were mentioned as the most important sources for information, often referred to as "sources of authority", and were commonly used for case related information seeking. Furthermore, trustworthiness and user-friendliness were highlighted by many of the physicians as important aspects, exemplified by Internetmedicin.se as having both reliable content and an information structure organized according to physicians working methods. Another common remark about internetmedicin.se was that the authors were selected as specialists and authorities in their field of expertise: "Internetmedicin you can trust, because it's written by experts and then reviewed by other experts so you feel confident that you can go on those recommendations". Because of that, and since it is such a common information source among doctors, with many professionals reading and using it every day, it ought to be self-correcting (someone would react on incorrect or controversial information). In general the respondents claimed to trust their own judgement and ability to have a critical approach and way of telling if an information needed is trustworthy and correct: "I can also tell my own opinion based on experience and regulations" Although collegial learning was highlighted as important, there was also the opinion that turning to trustworthy internet based sources, representing 'the common professional knowledge', may in fact be a better option than getting a subjective opinion from a colleague or specialist at work.

Patient perspective

The physicians' major focus was on patient care, which is where and how you learn to be a doctor. Even though the subject was on ICT and physicians learning, it was significant how the patient perspective occurred as a cross-cutting theme throughout the interviews.

Googling Patient Pros and Cons. Patients who google their symptoms were pretty much seen as a common part of the daily clinical practice, and not perceived upon as particularly problematic. Several of the physicians commented from a patient perspective that it may cause unnecessary anxiety and worries for patients who misinterpret googled biased or incorrect information. Other than that most of them emphasized on the positive effects: "I think it's better when they have searched, because then I don't have to explain everything and that saves time" and "you may even learn, and sometimes it might even be helpful with ideas for diagnoses". Furthermore, when it comes to more unusual diseases, the patient always knows best and contributes with knowledge: "and in those cases it is obvious that the patient knows more than me so I don't think that is an issue at all". It was less common among the physicians to search together with patients, but yet something they seemed to do on a regular basis, for example searching for drug related side effects, or looking up something the patient referred to in consultation. Very few commented at all on experiences of quantified self, that is patient generated data i.e. activity bracelets or patient apps for self-care.

Pedagogical Task. Several of the physicians reflected on the doctor-patient relationship and commented on an ongoing change in the medical profession leading them to take on a more pedagogical or consultative role: "a challenge is to help the patient to reach an understanding, to explain in a pedagogical way so there is no unnecessary worry, and to obtain compliance". This was described for example by how taking on responsibility and explain for patients is becoming an important part of the clinical practice. Also by comments that referred to patient information leaflets (1177, patientinformation.se) as a great way to inform the patient. They were aware that patients do not take in information during a consultation but now can go home and read and remember and come to a better understanding. Some of the respondents also commented on how patients may feel about the doctor using Google, that it might look unprofessional. But that neither was seen as a problem nowadays: "you just explain that this is how we work now, we are modern doctors and have digital access to all this information, and everything is right here in the computer and as a patient you should worry more if we did not use it".

The Promising Potentials Beyond the Technical Hassles

Lack of time and IT-related problems are well known challenges among health professionals as well as in modern work life in general, and was confirmed by this study. In particular the physicians expressed concern about the future and how to find time for learning and reflection as a completed specialist, considering there is little time to study even when it is scheduled as part of the specialist medical training.

The physicians emphasized heavy on ICT related problems at work and information overload, but were at the same time positive towards the possibilities with modern technology. They shared feelings of frustration due to overall outdated ITsystems and information environment: "I just think that we are so far behind that it's embarrassing, patients take for granted that I know, if they've been in the hospital to where I have sent them, but I don't until I get a letter three weeks later, if I don't ask them to fax, so it's not really the 2000s". Also because there is much potential in the systems but it is not being put into practice. It was noticeable during the interviews a very separate view on private vs work, almost as if they take off their digital clothes, while change into work clothes, and also between "real" work as in patient care and health related ICT, and administration, such as intranet or reading e-mails. Something that also signals that caring and information work is very separate. They seldom mentioned social media or digital tools for collegial collaboration or patient communication spontaneously. But even so it was apparent that many of them did read and seek for information, as well as having work related discussion outside of work. They expressed a similar approach to social media as something private and not work related: "well, a barrier is that it is, that I want it to be private, I don't want anything work related here" several stressed the importance of patient confidentiality especially in digital media: "Facebook? No no, that's only private, no patient discussions" But then there is the fact that the physicians' social networks, although viewed upon as private, are built up by student contacts from medical school and colleagues, which means there are a lot of doctor's talking informally. It was also common to read and follow discussions online, not make any comments in social media but bringing it up with colleagues at work for discussion. When it comes to apps and mobile technology, a few of them mentioned patient apps they knew of but had not really used any work related apps. There were some mentions of initiatives for seminars using skype and webcasting, as well as podcasts on specific subjects. In general the physicians showed little experience or interest in use of mobile technology, mostly explained because there was not something they needed in the workroom where there is always a computer available. When commenting on ICT they related this to technological advances in patient care, such as tablets for visualizing anatomy or sending images for direct expert opinion. Some of the physicians also commented on technology itself as an obstacle: "it's not possible to fully concentrate on the patient and at the same time looking at a computer screen". But on the other hand there were also examples described when the doctor and patient search and talk about what they read and learn together.

Discussion

It was evident that the physicians are well aware of that their occupation is highly specialized and undergoes rapid development. Consequently, lifelong learning and keeping up to date are regarded as a natural part of the profession. Professional development in terms of participation in formal training and acquisition of medical knowledge seems to almost go without saying. However, learning on the job was stressed as the most important form of professional development (i.e. clinical experience, treating the patient and informal collegial communication). This is in line with earlier research on informal workplace learning [cf. 34] and further underline the importance of finding ways to better incorporate work and learning and bring awareness of informal learning as part of physicians continuous training.

Findings from this study illustrate a shift that has taken place in recent years towards a more evidence based practice. An approach which now seems to be well integrated in the clinical work. Before EBM medical decisions were to a large extent left to the individual physician, who had to judge necessity of research evidence, and merge this with previous experience and beliefs, possibly with nearby colleagues as counsellors. It is clear that this process nowadays is done on a higher gear, where evidence is essential and collegial advice is available not only among local peers but also in a global collegial community, due to the Internet.

This study has shown that workplace learning activities prompted by handling patient cases were considered as a major aspect of all learning. The physicians clearly expressed that learning is strongly related to the frequency of patient cases. Patient cases can be regarded as an engine which demands that the physician merge EBM, own and collegial experience into a decision which takes account to the characteristics of the individual patient. This was described both as a blessing and a burden. The physicians seemed to find it difficult to navigate and relate between their own knowledge (practical and theoretical), patient preferences and collegial learning. Thus, the challenges are not caused by time and resources only, but also by a concern and anxiety about corresponding to the diverse aspects in a holistic manner, and that in turn is the engine for activating the learning.

Regarding ICT, there was a duality of views. Although the physicians brought up a lot of IT-related problems in the interviews, ICT was accepted as a central part of the information society, and there was a positive attitude towards the possibilities, especially in relation to access information. The dominant role of ICT for the medical practice is highlighted by the physicians' reflections over the technical development and how they had hard to understand how doctors used to work before, when there were no computers and no internet. There were also many suggestions for improvements, both with regard to the "personal working environment", where better use of ICT could facilitate access to patient related information as well as, and integrated with, easy access to decision support systems, evidence based information and more practical information for learning purposes and documentation of experiences.

Given this, one may wonder how ICT could support physicians in their profession and continuous learning. Obviously patient cases are the main core of the physicians' everyday work, and it is also the engine for a number of learning activities. From a workplace learning perspective it is easy to make a parallel to the use of case methodology in teaching. One final ingredient in working with a case in education is to review and reflect over the learning process [START_REF] Kjellén | Cases as boundary objects: Transfer and authenticity in workintegrated learning[END_REF][START_REF] Kjellén | The case method as seen from different pedagogical perspectives[END_REF]. This also goes hand in hand with the concept of "reflective practice", which implies that the experience alone is no guarantee for learning, it must be complemented with reflection [START_REF] Schön | The reflective practitioner : how professionals think in action[END_REF]. Some of the physicians mentioned the importance of collegial discussions regarding guidelines, regulations and also "ungoogleable" questions, i.e. questions that are more a matter of judgment than searching for facts or confirmation. However, beyond these comments most of the collegial discussions seem to be focused on finding the best decision for a specific patient. Perhaps a more reflective approach and reviewing of how decisions are reached could constitute an important part of the continuous learning for both the individual physician and the collective. Considering that ICT and use of social media have been identified as a way to support workplace learning [START_REF] Kind | Social media for lifelong learning[END_REF] our findings suggest that there is potential for information systems that facilitate i.e. saving anonymised patient cases for learning purposes and integrate functions for sharing and storing experiences and knowledge in everyday work.

Conclusion and implications

"Medical care is often said to be the art of making decisions without adequate information" [START_REF] Sox | Medical decision making[END_REF]. This study has illustrated how evidence based practice, health related ICT and digitalization of working life and learning is changing the healthcare landscape and the role of the physician. Thereby, making modern medical care the art of knowing how to best navigate the vast amount of adequate information available; own experiences with recommendations, regulations and the collected knowledge of collegial expertise and the Internet, and then balance this with the new emerging role of patients as co-creators and partners in care.

Overall this study has contributed to a better understanding of how physicians engage in information activities related to learning at work, and the role and potential of ICT as support for learning in the working life of health professionals. Findings confirm some already known problems regarding lack of time and resources and ITproblems as well, highlighting the need for better integration of continuous learning in physicians' everyday practice and information systems more adopted to physicians working methods. Moreover though, this study have shed some light on the complexity of digitalization and how it's affecting this group of young/newly trained resident physicians, who as it seems are facing day-to-day challenges, a new professional role and a changing healthcare landscape with confidence and careful optimism.

Due to the fact that there is an existing culture of mistrust regarding some of the old systems, it is important that the new era of supporting ICT must be based on the work and learning situation in daily clinical practice. Solving the problems with technical hassles and incompatible systems not adopted to daily work will save time and reduce a lot of stress, frustration and irritation. This has implications both for research and practice: How could we find more user friendly tools for supporting informal learning at work? In which ways can ICT contribute to information seeking, knowledge sharing and keeping up to date in clinical practice?

Even though new technologies and systems require more learning, they might actually be a part of the solution as well. We believe that ICT and social media technologies could play an important role for enabling new ways of learning and supporting continuous learning for physicians. Better integration of both health related and administrative ICT as well as learning in everyday work is an important aspect. Designing personal working environment (PWE) could be helpful for sorting and filtering information. Finally, we believe that ICT support for more reflective practice regarding patient cases, may increase the learning usability of the systems substantially.

  Gain a deeper understanding on information seeking in relation to continuous learning, and to identify formal and informal networks for knowledge sharing and exchange of experiences.Information use and needs in the clinical practiceObtain an understanding of problem solving in the clinical work, including the physicianpatient relation, with regard to communication and information aspects.Information and communication technology (ICT) and views on the futureIdentify what challenges and opportunities resident physicians relate with use of ICT, and explore their views on digitalization and use of mobile technology (for learning and information seeking) in the working life of today and in the future.

Fig. 1 .

 1 Fig. 1. Thematic nodes, sources and references coded

Table 1 .

 1 Semi-structured interview guide

	Question themes	Aim/purpose
	Continuous professional development (CPD)
	and learning in the workplace

The regulations and general guidelines for doctors' specialist medical training by the Swedish National Board of Health and Welfare (2008), stipulate that the trainee should acquire a scientific approach, by attending a course and by carrying out an individual written work.


Anna Sigridur Islind
email: anna-sigridur.islind@hv.se

Tomas Lindroth
email: tomas.lindroth@hv.se

Ulrika Lundh Snis
email: ulrika.snis@hv.se

Carsten Sørensen
email: c.sorensen@lse.ac.uk

Co-Creation and Fine-tuning of Boundary Resources in Small-scale Platformization

Keywords: Platform, Platformization, knowledge communication, fine-tuning, co-creation, boundary resources

Most research on platform innovation studies the phenomena from a distance due to lack of access. This paper reports from within an action research case of platform development in a small-scale context. The case is based on a regional business initiative with the goal to establish an arena for mobile commerce and stimulate local industry growth. It was conducted in collaboration between researchers and third-party developers. The article shows how the initial phases of platformization are characterized by socio-technical arrangements, co-creation of boundary resources and intimate knowledge communication. The paper contributes to platform research by acknowledging a small-scale context for platform research. It further develops distributed tuning of boundary resources into an intimate fine-tuning process that we illustrate is valid for a small-scale context.

Introduction

While research on mobile platforms in general has been the subject of research through the past decade and a half [START_REF] Ciborra | The Platform Organization: Recombining Strategies, Structures, and Surprises[END_REF][START_REF] Gawer | Platform Leadership: How Intel, Microsoft, and Cisco Drive Industry Innovation[END_REF] the recent explosive growth of smartphone apps on Apple and Google's app stores, along with a number of other notable examples, has elevated the issue of software and smartphone app platforms within the academic discourse. The iOS and Android app stores have jointly generated a total of 3 million different apps representing the development of around 150 billion lines of code since 2008 [START_REF] Sørensen | Mobile Platforms and Ecosystems[END_REF]. Apple alone has paid out $25 billion to its developer community the first six and a half years [START_REF] Ranger | iOS versus Android. Apple App Store versus Google Play: Here comes the next battle in the app wars[END_REF].

However, the examples of Apple and Google are far from the only ones, as the success of a range of services partly or entirely based on a generative Internet element [START_REF] Zittrain | The Generative Internet[END_REF] engages in complements from independent third-party developers through exposing Application Programming Interfaces (APIs), by providing Software Development Kits (SDKs), by relying on standard Internet technologies, and through providing quality assurance support.

In previous research, the platformization is viewed as primarily an exercise of innovation at arms length through a variety of boundary resources [START_REF] Ghazawneh | Balancing Platform Control and External Contribution in Third-Party Development: The Boundary Resources Model[END_REF][START_REF] Eaton | Distributed Tuning of Boundary Resources: The Case of Apple's iOS Service System[END_REF]. Tilson et al. [START_REF] Tilson | Change and Control Paradoxes in Mobile Infrastructure Innovation: The Android and iOS Mobile Operating Systems Cases[END_REF] reported from successful examples with significant installed bases of code and coders. The studies of mobile platforms generally do not have access to primary data sources, but tend instead to study the phenomenon indirectly. This paper, however, takes an exclusively inside-out view of the nascent phase of platform establishment with a particular focus on the initial creation of the boundary resources that will constitute a mobile platform. This process of establishing a platform will in this paper be called platformization. This paper reports from platformization in a small-scale context, as a contrast to the previously reported, large scale platformization studies mentioned above. In large-scale platforms the process of developing boundary resources does happen in an unprompted manner from an uncoordinated large group of third-party developers. This is not likely to happen in a small context since there are no uncoordinated large groups of developers. In a small scale context there are at the utmost small development teams or local SME firms that will engage in platform development and co-creation through various types of projects.

This article addresses two research gaps. First, the lack of accounts on how smallscale mobile platforms is established and how boundary resources are developed in such platforms. Second, there has been relatively little attention paid to how the role of knowledge communication in platform innovation influences the creation and use of boundary resources among the different actor groups. These research gaps imply that today's knowledge of mobile platforms cannot be directly applied to a smallscale context. Drawing on this, we describe the initial phases of platformization carried out in a small-scale context.

The paper is based on an action research case where a consortium of academics and practitioners developed a platform for local apps and services aimed at becoming a mobile commerce hub of a local Swedish community. The paper describes the main findings from the development process through a post-hoc analysis based on diary entries, email thread analysis, interviews and project documentation. The empirical analysis explores the effects from choices made during the platformization process, and seeks to understand these effects in terms of the communication and transfer of knowledge between the constituents. Initial findings suggest that communication and knowledge transfer calls for a more intimate knowledge communication process where the embeddedness of knowledge into codes and software modules must be reconsidered. Therefore, this paper asks the question: How can small-scale platformization be understood in terms of the creation of boundary resources and the knowledge communication?

The following section outlines the theoretical constructs for our analysis. Section 3 briefly presents the research approach leading to the empirical results in Section 4. Section 5 discusses the findings and synthesizes our contribution. Section 6 concludes the paper.

Theoretical concepts

Platforms and generativity

Most of the literature on platforms and platformization is grounded within innovation management and explores the shifting interrelationships between internal production arrangements, external partners and independent complementors [START_REF] Gawer | Platform Leadership: How Intel, Microsoft, and Cisco Drive Industry Innovation[END_REF][START_REF]Platforms, Markets and Innovation[END_REF][START_REF] Gawer | Bridging differing perspectives on technological platforms: Toward an integrative framework[END_REF][START_REF] Thomas | Architectural Leverage: Putting Platforms in Context[END_REF]. Within platform research, there is a distinction between technical and sociotechnical platforms [START_REF]Platforms, Markets and Innovation[END_REF].

A growing body of literature concerns research regarding mobile-and softwarebased platforms where the main focus is on platforms as two-sided markets [START_REF] Sørensen | Mobile Platforms and Ecosystems[END_REF][START_REF] Ghazawneh | Balancing Platform Control and External Contribution in Third-Party Development: The Boundary Resources Model[END_REF][START_REF] Eaton | Distributed Tuning of Boundary Resources: The Case of Apple's iOS Service System[END_REF][START_REF] Tiwana | Platform Evolution: Coevolution of Platform Architecture, Governance, and Environmental Dynamics[END_REF][START_REF] Wareham | Technology Ecosystem Governance[END_REF]. Much insight can be gained from studying this body of work, the successful platforms with a significant digital element tends to fall into the category of two-or multi-sided markets where the platform brings parties together in open co-creation arrangements [START_REF] Boudreau | How to Manage Outside Innovation[END_REF]. Such platform arrangements are based on the exposure of APIs, sourcing of SDKs, and relying on standard Internet technologies for the development of new services.

One of the core platform characteristics often discussed is the generativity emerging from the digital characteristics supporting independent developers engaging in producing new and interesting boundary resource recombinations [START_REF] Tilson | Change and Control Paradoxes in Mobile Infrastructure Innovation: The Android and iOS Mobile Operating Systems Cases[END_REF]. Zittrain [START_REF] Zittrain | The Generative Internet[END_REF] claims that: "Generativity denotes a technology's overall capacity to produce unprompted change driven by large, varied, and uncoordinated audiences", and further characterizes the following five dimensions of generativity: 1. Leverage in performing some task; 2. Adaptability and built upon with ease; 3. Ease of mastery for broad audience; 4. Accessibility of tools; and 5. Transferability of results.

This paper focuses primarily on the socio-technical platform, that is, not only the technical components of the platform, the APIs or the SDKs. These are important parts but they need to be understood together with the so-called social dimensions or contexts, i.e. the information requirements and knowledge communication among different actor groups. In regard to Zittrain's [START_REF] Zittrain | The Generative Internet[END_REF] five dimensions, which are primarily of social character, we consider the social aspects as equal important in platform research and thus we draw attention to how boundary resources are co-created and how knowledge communication would have been facilitated.

Boundary resources and distributed tuning

The research on software-and smartphone app platforms tends to explore features relating to the open and flexible models of collaboration facilitated by distributed development based on shared boundary resources, thus providing architectural leverage. To illustrate this, Ghazawneh and Henfridsson [START_REF] Ghazawneh | Balancing Platform Control and External Contribution in Third-Party Development: The Boundary Resources Model[END_REF] introduce the boundary resources model.

Boundary resources are "the software tools and regulations that serve as the interface for the arm's length relationship between the platform owner and the application developer." [6 p.174]. There are two forms of specific platform boundary resources [START_REF] Ghazawneh | Balancing Platform Control and External Contribution in Third-Party Development: The Boundary Resources Model[END_REF]. First there are technical boundary resources typically consisting of software development kits (SDK) and application programming interfaces (APIs). Secondly there are social boundary resources, typically incentives, intellectual property and platform's documentation [START_REF]Platforms, Markets and Innovation[END_REF][START_REF] Ghazawneh | Micro-strategizing in platform ecosystems: a multiple case study[END_REF]. These resources enable access to central modules of the platform [START_REF] Yoo | The Next Wave of Digital Innovation: Opportunities and Challenges, A Report on the Research Workshop of[END_REF]. This opens up for the necessary complementary innovation by third-party developers [START_REF] Gawer | How companies become platform leaders[END_REF].

Generally, the third-party developers are those who develop applications that enrich a platform [START_REF] Ghazawneh | Balancing Platform Control and External Contribution in Third-Party Development: The Boundary Resources Model[END_REF] and involve a heterogeneous group of app-developers (individuals or groups) who are disbursed and not a part of the same community as the platform owners. The platform owners are usually refereed to as the core management of the platform in terms of operating the platform and managing the boundary resources as assets for the third-party developers to a) use in its existing form and b) further develop the boundary resources.

Ghazawneh and Henfridsson's [START_REF] Ghazawneh | Balancing Platform Control and External Contribution in Third-Party Development: The Boundary Resources Model[END_REF] model is primarily designated for large-scale platforms development contexts. The model emphasizes the distributed use of the boundary resources developed. Such processes are guided by principles of objectified and commodifying knowledge as well as the arms-length relationships.

The notion of tuning is originally built on Pickering [START_REF] Pickering | The Mangle of Practice: Agency and Emer-gence in the Sociology of Science[END_REF] whereas Barrett et al. [START_REF] Barrett | Reconfiguring Boundary Relations: Robotic Innovations in Pharmacy Work[END_REF] have extended the concept of tuning. In Eaton et al [START_REF] Eaton | Distributed Tuning of Boundary Resources: The Case of Apple's iOS Service System[END_REF] the concept of tuning is further developed into a platformization approach of distributed tuning. Based an an embedded case study analysis from Apple, their iOS service system and third-party developers they offer a process model that accounts for the power-oriented dynamics of using and designing boundary resources. "Distributed tuning emerges from ongoing tensions among dispersed heterogeneous actors who deal with a set of technology artifacts in a network of dialectic interrelating as shown in all five themes." [7, p.235].

To understanding the creation of sociotechnical platforms, tuning is a robust analytical lens to understand "the dynamic nature of boundary resources in service systems" [7, p.221]. They also note that there is a power dimension in the relationship between the actors participating in a service system where they are not all equal in degree of agency over both material and other actors in the service system [START_REF] Eaton | Distributed Tuning of Boundary Resources: The Case of Apple's iOS Service System[END_REF]. The relationships of tuning and influence function as fundamental characteristics of how boundary resources are resisted and accommodated [START_REF] Eaton | Distributed Tuning of Boundary Resources: The Case of Apple's iOS Service System[END_REF]. They further highlight the distinction between boundary resources, auxiliary boundary resources and technology resources.

We apply Ghazawneh's and Henfridsson's model [START_REF] Ghazawneh | Balancing Platform Control and External Contribution in Third-Party Development: The Boundary Resources Model[END_REF] for a detailed analysis of the nascent phases in the development of our small-scale platform and we specifically examine the platform development in terms of the relationship between platform owners, platform and third-party developers. The ambition is to argue for the communication of knowledge and capability to third-party developers in order to cultivate and contribute to the boundary resources of the platform.

Knowledge communication in innovation

If we then consider the social boundary resources and "management of knowledge at arms length" as a core function of design capability it highlights the importance of knowledge communication and learning for platform innovation. Much knowledge in today's society in general, but in platform innovation in particular, is based on technical knowledge [START_REF] Scarbrough | Blackboxes, Hostages and Prisoners[END_REF]. This knowledge remains in the heads of the experts, or in software developer or innovation teams. The knowledge and skills are more or less built-in and embedded in a particular organization's processes and systems. Hence, the communication of knowledge mainly emphasizes the economic exchange of knowledge objectified in the boundary resources, which implies a knowledge communication through product-based economic transactions [START_REF] Scarbrough | Blackboxes, Hostages and Prisoners[END_REF]. A too great focus on technical knowledge can lead to an expert-driven approach that might not be appropriate for dealing with tacit and distributed knowledge among various actor groups [START_REF] Sørensen | Innovation through knowledge codification[END_REF]. An opposite approach is that of knowledge communication through social processes of professionalization [START_REF] Scarbrough | Blackboxes, Hostages and Prisoners[END_REF]. Herein knowledge is rather co-created and shared among different groups of individuals. It fits well when routines and standards are not yet set and when on-going interaction does not depend of a robust structure of relationships [START_REF] Hislop | Mission impossible? Communicating and sharing knowledge via information technology[END_REF]. In the nascent phases of platform innovation we regard this latter approach as highly relevant.

Research approach

The study is based on data collected over a 2.5 year action research (AR) project building a mobile app platform devoted to developing and harnessing local mobile commerce within a medium-sized Swedish city. The project was a regional business initiative with the goal of establishing an arena for mobile commerce and stimulating local industry growth. To reach the goal the project decided to design and build a socio-technical, mobile service cross-platform that should function as a bridge that should facilitate local entrepreneurship in mobile commerce.

The socio-technical platform was designed to support and manage the entire lifecycle of mobile app design, development and go-to-market strategies. In our case the socio-technical indicates a platform consisting of actors like programmers and managers, design processes, coding frameworks, SDKs and APIs, generic code modules as well as go-to-market and knowledge transfer strategies. App development processes were set up as a co-creative effort involving both platform owners, expert developers and local third-party developers.

To gain deeper insights conceptualized we applied qualitative approaches, conducted in close co-operation with industry. It was conceptually and methodologically framed using a variety of terms such as action research [START_REF] Avison | Action research[END_REF][START_REF] Baskerville | Investigating Information Systems With Action Research[END_REF][START_REF] Baskerville | Special issue on action research in information sys-tems: Making IS research relevant to practice-foreword[END_REF] and action case research [START_REF] Braa | Balancing interpretation and intervention in information system research: the action case approach[END_REF][START_REF] Braa | Interpretation, intervention, and reduction in the organizational laboratory: a framework for in-context information system research[END_REF][START_REF] Braa | From observation to intervention[END_REF].

The action-oriented activities in this research initiative were about the balance between involvement in the change process (the problem solving) and the research process [START_REF] Mckay | The dual imperatives of action research[END_REF]. We developed and conceptualized interventions in terms of introducing an artifact as a result of multiple perspectives on design, improvement, and use. The development process was organized between a group of platform owners including researchers and representatives from the municipality and third-party developers including technical consultants, teachers and local students, as further described in section four. The design process was constructed based on the principled outlined in the extant literature on action research, for example [START_REF] Baskerville | A critical perspective on action research as a method for information systems research[END_REF][START_REF] Hevner | Design Science in Information Systems Research[END_REF][START_REF] Mathiassen | Style Composition in Action Research Publication[END_REF].

The action-oriented process generated a variety of data as the researchers (later on called platform owners) sought to be present in almost all activities concerning the project. Data was to a large extent captured through participatory observations at key points in the project cycles, such as: team meetings, discussion in on-line coordination tools, and education and training workshops. Furthermore, data was continuously collected through project documentation, such as, minutes and email conversations from project meetings and from ad-hoc interaction. At the end of the project, a series of 6 semi-structured interviews were conducted, 3 with expert developers and 3 with local third-party developers -in order to capture participant reflections on their experiences. It can, therefore, be argued that this data represents an inside-out perspective on platformization as opposed to the traditional outside observer perspective based on limited primary data or decontextualized secondary data.

For this paper, the data-set was re-analyzed specifically focusing on architectural choices, boundary resources, and knowledge communication within the project. Three main actor groups were involved, which will be explained more thorough in the result section. Three of the authors of this paper are a part of the group later called platform owners and the fourth, non-participant author of this paper served through this reanalysis the role of critical outsider seeking to challenge the analytical assumptions [START_REF] Lee | A Scientific Basis for Rigor in Information Systems Research[END_REF].

Results

In this section we describe the different roles and their activities in the project. The platformization process is visualized and exemplified with a senior citizen app. Additionally, the technological decisions are described as well as the so called knowledge transfer process from the third-party consultants to the local third-party developers.

The roles

There were several different actors in the project. Here we describe their main roles. The roles of platform owners and third-party developers are both inline with the theoretical underpinning. In Figure 1 the three major roles within the project are visualized.

Platform owners Third--party developers

Representatives from the local municipality and university including researchers.

Expert developers from a national IT--consultancy.

Local third--party developers: Faculty teachers and system developer students.

Figure 1: The different roles

The platform owners: The platform owners were researchers at the university that were involved in a research project (see Figure 2). The researchers contributed with user experience, service design as well as system analysis competence. Part of the platform owners group were also members from the local municipality contributed with access to the local business setting.

Expert developers: In order to ensure the best possible design and execution of the platformization effort, a leading Swedish IT consultancy firm was hired to lead the technical development effort together with the platform owners. Consequently, the expert developers were employed at a large consultancy firm. The firm employed a great number of skilled management consultants and programmers with important platform related competences.

Local third-party developers: Third-party developers used the boundary resources for utilizing the platform's capabilities in developing apps. In this local setting, the third-party developers were primarily local entrepreneurs, businesses and students at the university. The plan was that this group would subsequently use, enrich and develop the platform after the contract with the expert third party developers ended. This linked the general ambition of stimulating entrepreneurship and regional business. Herein, the project is used when referring to all three groups simultaneously.

The platformization process

Phase A) Initiating and exploring platformization: The platform owners evaluated a range of different platform architectures from the researchers and expert developers point of view. A key consideration during this process was to come up with alternatives on what platform architecture and development arrangement to choose and design. The following options were available: (a) Open, web-based architecture with plain vanilla versions of HTML, CSS, JavaScript etc, allowing to build what in effect would be mobile websites partly cached on the handset, (b) Entirely native apps to be published across the two main smartphone platforms, iOS and Android, written using the respective SDKs and APIs (for example Objective C, Swift, etc), (c) using more advanced high-level generator tools to produce a variant of a), for example such as: PhoneGap, Angular.js, Telerik or Backbone.

The first choice to be made was between native apps or apps based on enriched HTML web-services. In this decision the consultants' standpoint was that the project should build hybrid (HTML) apps that would be modular and that the platform should be a self-supporting stand-alone entity. When it was clear that a native solution did not fit the project goals, other alternatives were considered. Different Platform as a Service (PaaS) solutions from Microsoft, Amazon and Google were evaluated and discussed.

Option (c) with a specific arrangement of Javascript environment and cloud provision was chosen. When the decision of (c) was delivered via e-mail written by the expert third party developers, to the platform owners, the reaction was a genuine surprise among the platform owners, who felt they had not been a part of that particular decision-making process as much as they would have liked. The motivation for this choice was that with (c), the project would be able to maximize the number of modules that were built, and the degree to which these modules would be reusable. Both aspects were regarded as central to the generativity of the platform. As one consultant expressed it: "Considering the skills needed and learning thresholds for a student, which is an important issue, we propose a PaaS-solution. That is, the environment and systems are operated and monitored by the cloud owner and not by us." The argumentation from the consultant focuses on the PaaS choice. The chosen javascript framework and associated SDKs were downplayed both in the first e-mail that declared their choice and in the subsequent project presentation. The platform was, after these decisions, to be built in a cloud service called Cloudbees, which is based on Jenkins [START_REF] Loof | Cloud development and deployment with CloudBeesPackt Publ[END_REF]. This particular service platform was set up to handle hybrid apps (HTML) with complex user interfaces and a Javascript library. This particular Javascript library is called Backbone and is fundamentally a Model View Controller (i.e. MVC) that enables the code to be modular and imposes calls to the server to be entirely done through RESTful API. This choice, the choice of Jenkins, Java and Backbone were never discussed, these were just silently implemented in the platform. An overview of the innovation platform is given in figure 1 below.

Figure 1. An overview of the cloud-based innovation platform

Phase B) Creating the apps and general modules: To get the platform working, the expert developers started developing and creating relevant modules. Initially, it was decided to develop a set of apps and services with associated code modules that later could be combined and further developed by the third-party developers. The generic modules were common features regarding secure login, GPS-features and payment options, among others. In addition to these modules the expert developers developed three apps as proof of concepts in order to show the generativity of the general modules: a) senior citizens app b) talent attraction app c) parking app. See Figure 3 for an overview of the development process. The proof of concept apps is marked with orange boarders in Figure 2.

Figure 2: The platformization process: phase A, B and C

Later, in the development process it was time for the local third-party developers to develop their first apps in the established platform (Green in Figure 3). The generic modules were then used in several apps, which was in line with the general strategy to reuse the modules and code which were now ready for them to re-use as lego pieces. The plan was that this pwould be done in Scrum as well, and be a rather fast process. See Figure 4 for an overview of the platform architecture, its content and the end-user groups of the developed apps.

The experiences of developing apps in the platform were mixed. A local third party developer working within the platform felt that: "The advantages of the platform was that many modules and solutions from previous apps were available. It was also very modular, making it easy to reuse functionality." But on the other hand, the third party developers also thought "Cloudbees rarely gives the user feedback control. The feedback was not kind. You receive an error code which was about 700 lines, only of exception failures from Java". The module-based architecture was supposed to speed up the programming process. Instead, when the expert consultants successively handed over the platform and the programing to the local third-party developers, the time to create an app increased, as seen in Figure 2.

Phase C) Transferring of knowledge:

In order for the platform to thrive and reach generativity it was central to have a knowledge transfer strategy from the platform owners and expert developers to the local third party developers. The aim was to lower the entrepreneurial threshold by providing the necessary prerequisites and components to cost-effectively build and manage apps and thereby stimulate industry growth.

The knowledge transfer phase occurred in parallel with the development phases as illustrated in Figure 2. The third-party developers were able to sit at the consultancy and be present while the expert developers developed the boundary resources for the platform. To ensure the knowledge transfer for the local third party developers, there was a knowledge transfer series with lectures in how to develop new generative modules as well as in using the generative modules that were already in the platform. The knowledge transfer series was in a top-down manner where the technology was introduced and pushed onto the local third party developers. During these series, the consultancy wanted to ensure that they had done their part in the knowledge transfer obligation and to do that, they flew in and had lectures.

The students craved more of focused training: "The visits of {the consultancy} made the work with {the project} feel like a real job. The training was quite okay, what I remember was that the focus was on delivery deadlines during the time I was with them. So there was more focus on the project than on the training and learning." A teacher felt that the process became so oriented towards limiting waste, that making mistakes was scaled down to the minimum, which left almost no space for the training to evolve into a real learning experience and competency.

As the local third-party developers consisted of students and teachers as a resource in developing apps for the platform, the chosen architecture implied a too steep learning curve due to the complex architecture of the platform. The students were overwhelmed with the technology framework, the rapid software development and knowledge transfer tempo.

The aspect of time, was therefore an important one, to overcome the barriers of the platform. However, due to the rapid sprints, there was no time available. The students and teachers' thoughts on the matter was the platform was too big, the platform interface was too messy and that other programming frameworks would have been a better fit. As one of the student said: "So I think that the platform had too many templates and settings for what {the project} was doing, which made it messier." Another student has a similar comment: "The worst limitations that I experienced with Cloudbees was the lack of control."

Pushing the expert developer's choice of technology onto the relatively inexperienced local third-party developers was not good, but pushing the compressed and front loaded learning cycles onto them as well with no time for reflection due to the time press and agility of the project, was worse. The lectures came to be in a monolog form where the consultancy (expert developers) fed the third-party developers information during a specific timeslot and there was no time for reflection. The third-party presence at the consultancy and the lecture series both happened before the actual handover of the programming responsibility to the local developers. When they were in the middle developing their first apps, they were on their own. At that time the knowledge transfer process had ended and the consultants had moved on to another project.

Discussion

As we stated in the introduction, platform innovation is a complex arrangement of both technical and social boundary resources that need to be critically considered [START_REF] Ghazawneh | Balancing Platform Control and External Contribution in Third-Party Development: The Boundary Resources Model[END_REF], [START_REF]Platforms, Markets and Innovation[END_REF]. Diverse stakeholders are involved and different technical boundary resources become important such as application platforms, cloud services, code bases, programming knowledge, etc. Zittrain's [START_REF] Zittrain | The Generative Internet[END_REF] principles of generativity, where the capacity of general-purpose technology is utilized as boundary resources at arms length by groups of third-party developers, was backgrounded in this research initiative. Through the nascent phases in this platformization study, architectural leverage was not easy to master as it turned out to have a number of consequences for the communication of knowledge and skills requirements. There were several vital decisions made by the expert developers, which possibly were motivated by their preexisting set of technical knowledge. In general, these were not bad decisions, the technical platform is a modern, state-of-the-art development suit, but it turned out to be a poor match of requirement and skills for the local third party developers and the project in its nascent phase.

The more socially oriented resources, like knowledge about platform innovation remained in the heads of the experts, innovation teams as well as organization's processes and systems [START_REF] Scarbrough | Blackboxes, Hostages and Prisoners[END_REF][START_REF] Sørensen | Innovation through knowledge codification[END_REF]. Furthermore, the social relations were not coordinated towards the overall purpose of the actual project. The platform owners were interested in seeing the local context blossoming from a two-sided market perspective [START_REF] Boudreau | How to Manage Outside Innovation[END_REF], whereas the expert developers interest was to produce as many generative modules as possible [START_REF] Zittrain | The Generative Internet[END_REF].

As [START_REF] Eaton | Distributed Tuning of Boundary Resources: The Case of Apple's iOS Service System[END_REF] imply, at an arm's length relationship, much knowledge is embedded into the APIs and SDKs as commoditized knowledge aimed to be directly used by distant third-party developers. But in the small-scale setting, there were no critical mass of developers that could act as the other side in a two-sided market. The genuine cocreation process of boundary resources did not occur as the communication and sharing of knowledge was hard to engage in for an outsider, i.e. a local third-party developer. There was no ease of mastery for accessibility or "reuse" [START_REF] Zittrain | The Generative Internet[END_REF] for the third party developers.

Hence, the architectural leverage was not yet achieved, as the tension between the communication of knowledge and the commodification of knowledge was not considered carefully [START_REF] Sørensen | Mobile Platforms and Ecosystems[END_REF], [START_REF] Scarbrough | Blackboxes, Hostages and Prisoners[END_REF], [START_REF] Sørensen | Innovation through knowledge codification[END_REF]. How knowledge is produced and how skills are being trained for the purpose of platform building was one such important aspect in the context of this case. This meant, in a small-scale project, aiming for generativity is less essential than getting the right skills and competencies to match the technical choices made and to the boundary resources that needs to be established. In the forefront was the primary challenge of coordinating the social relations and knowledge communication, which in retrospect is key consideration that should have been done more carefully with a gentler fade out compared to the mid project "prompt stop" in fifth week, as visualized in Figure 3, phase C.

Thus, for the nascent stages of platformization, establishing the foundation and negotiating best choices should all activities be governed by social arrangement and knowledge communication in accordance with [START_REF] Scarbrough | Blackboxes, Hostages and Prisoners[END_REF] notions of professionalization and sedimentation.

Towards an intimate fine-tuning approach

This actual platform innovation initiative, with scarce resources and diverse participants, demanded a more advanced type of knowledge communication process that can bridge multiple types of actors in an open and efficient manner. Facilitating a more intimate climate for tuning the knowledge communication was in hindsight the most critical challenge. In retrospect, we can realize that the tuning process in a smallscale platform project cannot be of a distributed character with arms-length relationship [START_REF] Eaton | Distributed Tuning of Boundary Resources: The Case of Apple's iOS Service System[END_REF]. For a small-scale platform, the relationship should instead be characterized by intimacy. With intimacy we mean close collaboration over an extended period of time during the whole development process. We argue for a finetuning process where intimacy and knowledge communication in a co-creation process are key characteristics. In the following we summarize this discussion in more detail.

In a small-scale context, a platform cannot simply be brought in from the outside and placed within the local setting in terms of commodified boundary resources [START_REF] Ghazawneh | Balancing Platform Control and External Contribution in Third-Party Development: The Boundary Resources Model[END_REF] and expected to grow; it takes intimacy and nurturing. Seeing code as value, as well as seeing knowledge as value is vital. There is a need for fine-tuning knowledge communication to accommodate the intimacy of professionalization and sedimentation. Frameworks, code and developed modules do not have an intrinsic value of their own especially if there are not skills and competency on how to enhance them. In a small scale platform context co-creation needs to be a goal, and offshoring or outsourcing may not be a viable alternative. Thus, the platform boundary resources needs to be co-created and locally legitimized in order to achieve architectural leverage and make it be cultivated in the local platform ecology. Without this cocreation and communication of knowledge, the code and modules lacks value [START_REF] Boudreau | How to Manage Outside Innovation[END_REF], [START_REF] De Reuver | Governance Mechanisms for Mobile Service Innovation in Value Networks[END_REF].

The code-base was from the expert developers point of view the main knowledge needed to be progressively transformed into new, commoditized mobile application services. The human craft of socially produced knowledge out of code bases was neglected. This stands in contrast to what Scarbrough [START_REF] Scarbrough | Blackboxes, Hostages and Prisoners[END_REF] points out when stating that technological innovation needs social communicability and that the commodification of hardware and software knowledge has actually "provided a platform for increasing demand for human expertise." [20, p. 1000]. De Reuver and Bouwman [START_REF] De Reuver | Governance Mechanisms for Mobile Service Innovation in Value Networks[END_REF] point out the importance of balancing dependencies and power in the development phase. At the same time, they state the challenges for "too many small parties" without any power-based governance often prevents entering the implementation phase. We experienced the strong dependency to the consultancy firm (the expert developers) as a resource to be used more intimately, as in alignment to [START_REF] Sørensen | Innovation through knowledge codification[END_REF]. The local third party developers involved called for more training and knowledge communication, rather than the delivery of modules. There was a clear need for professionalization aligning the remote expertise and architectural choice to the local expertise and competency. Viewing the students and teachers as boundary resources and boosting their knowledge, might have lead to a less dependency with the expert developers. The arm's length relationship was not valid. Involving the students and teachers more in the selection of architecture and taking into account the students and teachers pre-existing programming skills and the teachers background in selection of architecture, would in retrospect, have delivered a different outcome for the local setting. Lean approaches also played a role in this case. Both focus on short sprints and limiting waste is a central aspect. With longer sprints and with a more forgiving process regarding mistakes both teachers and students could have played a more central role in the development process. Following Zittrain's [5, p.1980] notion of generativity: "Generativity denotes a technology's overall capacity to produce unprompted change driven by large, varied, and uncoordinated audiences" might need a re-consideration. In this case, as a small-scale platform establishment, it is much better characterized in terms of the opposite context, namely, prompted change through a small, possibly homogenous, and coordinated set of socio-technical arrangements [START_REF]Platforms, Markets and Innovation[END_REF][START_REF] Boudreau | How to Manage Outside Innovation[END_REF] to establish the platform and its complements. The communication of knowledge emphasizes a fine-tuning process of intimacy in professionalization, sedimentation of skills and competency but also a different view of time as well as goals. This fine-tuning approach is fitting for a small-scale platformization, rather then the arms-length relationship that fits for a large-scale platformization discussed by Eaton et al [START_REF] Eaton | Distributed Tuning of Boundary Resources: The Case of Apple's iOS Service System[END_REF]. However, we acknowledge that as a platform grows from small to large the importance of social arrangement and knowledge communication decrease in favor for commoditized knowledge into code, SDK's and API's.

Conclusion and further work

The aim of this paper was to shed light on the initial phases of platformization in a small-scale context. We have argued for acknowledging small-scale contexts as a part of the platform research. The models presented in prior research do not fit the purpose of the platformization processes observed in our case. The biggest challenge regarding the models is concerning the arms-length relationship between the platform owners and the third-party developers, which is the key in a large-scale platform. Through our research, we have illustrated that in a small-scale platformization, the relationship needs to be formed differently. The intimacy in the relationship between the platform owners and the third-party developers is the core. From an evolving small-scale platformization perspective, this relationship must be supported by an intimate and co-creative process of knowledge communication, herein called finetuning.

From this, we call for further research regarding fine-tuning of boundary resources for similar small-scale contexts. Research tends to cover platformization efforts once they have become successful and by definition are past their nascent phase. We would, however, argue that the first steps in the life of a platform are just as essential as its later race for global domination, and that perhaps we can learn from those babysteps that result in falls rather than running.