New developments such as 'Precision Medicine' and 'Digital Health' are emerging areas in healthcare technology, underpinned by 'convergent technology' or 'cross-industry' innovation. However, convergence results in greater uncertainty and influence from new knowledge and actors, including previously disparate technologies and capabilities, bringing specific challenges in the development of innovations. Although the literature addresses the context of technology convergence, there has been limited research reported on the how such innovation is effected in nascent ecosystems.

This qualitative research addresses identified literature gaps, initially by using a combination of ecosystem actor interviews (n=39) to understand the context, followed by five longitudinal in-depth case studies at innovator organisations. Case evidence was obtained from a combination of interviews (n=62), supplemented by field observations, primary documents and evidence from publicly available sources. The data was subjected to multiple coding methods, with plausible causal mechanisms identified through case and cross-case analyses.

The research findings identify a set of five interconnected micro-processes (early organisational routines) which together form a non-deterministic activity system that enables an innovator to navigate (the ecosystem), negotiate (a position within it) and nurture (the innovation and ecosystem). The research further identifies the importance of careful balancing between relationally focussed credibility-seeking and advantage-seeking actions as the main driver 'guiding' managers when developing the innovation, the associated business model(s) and value network in the evolving ecosystem.

A conceptual model and framework are developed to show the interrelationships between organisational routines, the activity systems and the ecosystem. In developing organisational capabilities, it is argued that convergent innovation requires mostly incremental changes (low depth of change) across many organisational routines (high breadth of change), which reduce the uncertainty of organizational change and thus increase internal acceptance.

These findings support the argument that innovators require a more 'systemic' view of innovation and governance approaches contributing to the innovation and capabilities literature. From a practice perspective, the research provides mechanisms for building relational capabilities critical to innovation delivery.