A Business Model for Spa Tourism Enterprises: Transformation in a Period of Sustainable Change and Humanitarian Crisis

Abstract

The global events of the third decade of the 21st century prove that the specter of humanitarian problems caused by health and military crises is real, and even very probable. Contemporary tourist entities, however, are not doomed only to a destructive reaction, but can also assume a significant social role for humanitarian aid. The aim of this article is to assess the changes taking place in the business models of spa services companies in the context of crisis situations caused by organizational changes and the COVID-19 pandemic. The research was conducted in 2018 and 2020, based on in-depth interviews as part of the generic contingency principle (GCP) methodology. In the course of the research, it was found that business models are not a frequently used management tool in spa enterprises. Based on the findings, a business model for spa businesses was created, followed by a more sustainable version, that can be shared in the form of open innovation. Due to the outbreak of the COVID-19 pandemic during the project, further research was done on spa enterprises regarding the use of the spa infrastructure for supporting the health system during epidemic threats.

1. Introduction

Health tourism is one of the key forms of the tourism industry. The importance of this form of tourism is especially great in aging societies, for whom there is a high awareness of the relationship between their health condition and the need to take up physical activity. It is also an opportunity taken up in an attempt by tourist facilities or areas to attract tourists in order to provide them with above-standard services [1] aimed at health improvement or prevention. The main form of practicing health tourism is spa tourism, which takes a varied form in many countries of the world. R. N. Okech [2], and G. Georgiev and M. Trifonova Vasileva [3] cite types of spa definition, developed by the International SPA Association [4]. Spa facilities are broken down into club spa, cosmetic spa, cruise ship spa, daily spa, destination spa, medical spa, mineral springs spa, resort or hotel spa. However, it is noted that the same classification does not apply everywhere. For example, in Australia, spa facilities and destinations are classified into categories such as: Day spa (day spa, wellness spa, bathhouse spa, MediSpa, and CosmediSpa), destination spa (resort spa, hotel spa, spa retreat, health spa), natural bathing spa (natural-spring spa, hot-spring spa, natural-mud spa, and sea-water spa), and related spa (salon spa, dental spa, and nail spa). In turn, British scientists have classified these objects as part of the classification of the International SPA Association and the SPA Business Association (SBA). Western Europe divides spa areas into the following: mineral and thermal spas or springs, climatic-health resorts and Kneipp (hydropathi) spas, and health resorts. On the other hand, in Eastern Europe, territorial division dominates, including seaside, lowland, piedmont, and mountain spas, among these being even underground spas. The form of spa product often depends on the natural resources used in spa treatments offered to tourists, sometimes including or not including such treatments in the set of services financed by the health care system. V. Ramos and A. Untong [5] add that health tourism includes all the health-related activities that fulfill the definition of tourism.

The noticeably upward trend in the volume of tourist traffic in the 21st century in national statistics, especially in the tourist activity of pursuing health goals through traditional treatments [6], as well as the increasingly frequent overtourism, with undertourism or even no-tourism caused by the pandemic condition [7], poses many difficult challenges for the tourism market. These challenges are mainly faced by managers of tourism enterprises, who, in order to maintain or achieve a competitive advantage, must increase their managerial competencies [8]. Contemporary managers have access to many management tools, among which business model diagrams are unusually inspiring. However, these are universal tools, which at the same time means that they are not dedicated to specific types of activity, and are even sometimes difficult to adapt to specific conditions and problems. One of the specific markets is the contemporary market of spa tourism enterprises, whose structural and functional complexity requires many implementation operations.

The aim of the article is to assess the changes taking place in the business models of spa services companies in the context of crisis situations caused by organizational changes and the COVID-19 pandemic. The article discusses the results of the scientific research carried out from 2018 to 2022 in Poland within the research project titled, “A business model for spa tourism enterprises”. It should be noted that this work is a part of research, therefore it presents only a summary of the obtained results.

2. Innovative Business Models

Scientific problems of management methods in the face of modern challenges of globalization indicate many possible solutions. Among the many contemporary management methods, dynamic development of innovative business models [9], especially sustainable business models [10], are noticeable.

For the business model, most of the management methods and tools have been defined in the literature many times [11], but for the purpose of this study, it can be characterized as a heuristic logic, which combines technical potential with the realization of economic value [12,13,14]. Most often, this heuristic logic is presented as a conceptual tool containing a set of elements and their relations to the set objectives, allowing for exposing the business logic of the company [15]. A tool-based view of the business model is extremely popular due to its practicality [16]. One of the most popular conceptual visualizations of a business model is the proposal of A. Osterwalder and Y. Piguneur [15], which involves the use of nine components of the CANVAS model, i.e., customer segments, value propositions, distribution channels, customer relationships, revenue streams, key resources, key activities, key partners, and cost structure.

The scheme of the business model presents the structure and interrelationships of the individual components of the enterprise. However, each of the components has an individual meaning in the processes taking place in the organization. Value proposition is a key component of each model as it presents a set of benefits, products, and services, as well as other values that the customer can obtain. However, this value can also be extended to the enterprise itself (captured value), as well as its local social environment (social value). Customer segment is an element that defines for whom the company undertakes business activity. Distribution channel is a component that determines the way of reaching the customer. It uses communication, distribution, and sales channels. Customer relationship is an element of the model that is responsible for the mutual relationships with key recipients of the company’s services or products. Revenue stream and cost structure are two components responsible for financial flows in the organization. It is therefore the part of the model responsible for the pricing mechanisms and methods of financing the activity and determining the main costs of the activity. Key resource is an element presenting the resources at the company’s disposal (financial, material, human resources, intangible assets, etc.). Key activity defines the basic activities undertaken in business processes, the effect of which is to obtain value. Key partner is the last component, which includes a set of all stakeholders (except for customers who are placed in a separate component).

However, S. Prendeville and N. Bocken [17], in addition to noting the importance of the tool describing the activities of the business, identified them as activities that relate to business transactions between customers, partners, and suppliers and the organization and their participation in value creation and capture. The literature also recognizes an abstract approach to this issue, formulating business models as an abstract textual or graphical representation of the interrelated structures of the model architecture developed by the organization, and all the products and services that the organization proposes and that are needed to achieve the goal [18].

However, a business model is not only its structure, but also the relationships between its elements (components) and stakeholders. These often become the criteria for the division of models. One of the classifications using the criterion of income generating factors is that of J. Brzóska [19], who divides business models into four groups. The first group consists of models based on profitability determinants. In this group, he distinguishes three models: the model based on sectoral and specific factors of the enterprise, the model of dynamic marketing strategy, and the model of economic efficiency. The second group singles out models that expose competitive advantage, achieved through innovative activities that create a value chain. There are two types of such models, i.e., models of creating application and maintaining competitive advantage, and models combining competitive advantage with operative efficiency. In the third group, J. Brzóska includes models focused on creating and developing the potential of resources ensuring competitiveness, where the primary objective is the growth of value. This includes the business model as a unique combination of value-creating assets and the model based on competitive potential. The last group consists of models that use radical innovation to create customer value and increase company profit. Their goal is to increase the efficiency and growth of the enterprise by creating a new market space. Listed here are the strategic model underlying the innovative business concept and the model based on value innovation (blue ocean strategy).

M. Kardas [20], grouping the business modes of O. Gassmann et al. [21], M. Johnson [22], and J. Linder and S. Cantrell [23], formulated dozens of their categories, which include groups of models such as pricing, marketing, convenience, experience, product “plus”, chain, intermediaries, trust, innovation, legal instruments, and financial categories. Examples of models include the following:

• Reverse razor and blade, which involves selling low-margin products at a low price to increase sales of high-margin products (Gillette);
• White label—products are sold under the brand name of another company (e.g., a distributor) rather than that of the manufacturer;
• Cool brands, which assume higher prices for competitive products thanks to strong brand management (production outsourcing);
• Free for advertising—offering products to end consumers free of charge in exchange for them watching advertisements;
• Add-on, consisting of a competitively priced basic offer with many additional paid elements, allowing it to be tailored to the customer’s needs;
• Direct selling, in which products are offered directly to customers by the producer (excluding intermediaries);
• Open market-making, where a company creates a market open to all customers and finances it by charging commissions on the transactions concluded there.

A. Osterwalder and Y. Pigneur [15], noting the common parts and similar arrangement of doing business, proposed five categories of models. They listed the following categories:

• Separated corporation: based on distinguishing three complimentary types of business activity, that is, maintaining a relationship with the customer, activity related to the infrastructure and the creation of product innovations (banking sector and mobile phones);
• Long tail is a business concept based on selling fewer products belonging to a rich list of categories; often involves accumulating sales of niche products (eBay, Facebook, and YouTube);
• Multilateral platforms: connecting separate but interrelated groups by creating conditions for interaction (Visa, Google, and Microsoft Windows);
• Free model: offering at least one segment of customers products free of charge; the costs are borne by customers belonging to another customer group (Metro, Skype, and Google);
• Open business models: these models are about cooperation with external partners in the form “from outwards to the center” or “from the center outwards”, in which the company uses external ideas or forwards the unused ideas onwards.

An interesting division of models is presented by R. McGrath [24], who proposed the following six key categories of business models:

• Advertising models, based on the assumption that the company bears the cost of reaching the potential user and the user does not pay for the product, while the total cost of the operations and margin are borne by advertisers;
• Bundling models, which assume that core products are relatively cheap, while the margin is charged on complementary products;
• Promotion models, where customers are offered a reward for purchasing a product in the form of a free gadget;
• Freeminium is the name of models in which the basic offer is free of charge, while margins are charged to customers who buy the extended version of the product;
• Barter models are those in which a product is exchanged at no charge for another equivalent product;
• Gratis models, which involve the provision of free basic products, generally created by volunteers, and value is captured here by offering additional services.

In the literature, one of the fundamental thematic issues concerning business models is innovation, or rather business model innovation (BMI). However, business models should not be viewed through technological, product, or service innovation alone, but also through the innovation of the business model itself [25]. Often, these models also refer to their applications in the area of sustainability [26] and attempt to determine the relationship between productivity and BMI use [27].

V. Figueiredo de Faria et al. [28] stated that BMIs are based on at least one of the foundational elements of value creation, delivery, and capture. This allows the company to activate overlooked sources of value or create systems that are difficult to imitate. R. Amit and Ch. Zott [29] formulated six questions that should underpin the construction of such a BMI. Among them, are questions such as “what perceived needs can be satisfied through the new model design?”, “what novel activities are needed to satisfy these perceived needs?”, and “how could the required activities be linked to each other in novel ways?”. V. Figueiredo de Faria et al. [28] also cited an opinion by M. Yunus et al. [29], that BMI is about generating new sources of profit by finding novel combinations of value propositions and even entire value constellations.

The development of business model innovation is going in many directions. S. Ruggiero et al. [30] proposed a morphological box model that represents the extreme states of firm BMI. The literature also contains numerous examples of applications of BMI [31,32], also by using popular diagrams [33] and ways of mapping models and sources of value [34], e.g., by combining the business model CANVAS alongside Sources of Value in the e-Business (SVCeB) model [11,35,36,37].

Recent research in BMI develops these models in an applied direction. They apply to diverse industries, including, but not limited to, the IT industry [38,39]; the automotive industry [39]; Internet-of-Things businesses [40]; the application of artificial intelligence to industrial ecosystem business models [41]; the internet of value, which will replace the internet of information [42]; and for air navigation service providers [43]. Interesting modifications of models are also seen, such as Aggregator’s business models [44] or in business models considered in the context of climate change [45].

The worsening global environmental problems are the reason for directing the development of business models towards sustainable solutions. A sustainable business model (SBM) is a simplified depiction of the elements, their interconnections, and the interactions with stakeholders that an organizational unit employs to generate, provide, collect, and exchange sustainable value for, and in partnership with, a wide variety of stakeholders [46].

The tourism and therapeutic activities carried out in spas based on natural healing resources also require efforts to protect the resource deposits, local flora and fauna, and local culture from degradation caused by exceeding the critical tourist capacity, particularly evident during the summer season. Therefore, it becomes necessary to include the implementation of sustainable development principles beyond the business model.

The literature of the last decade notes examples of research undertaken in the field of business models in tourism activities [47,48,49]. In general, these are not papers that discuss the entire business model, but rather individual components of the model. Examples include works on customer relations or value proposition [50,51,52].

Notably, the business models proposed in the literature have a structure that is inadequate to meet the needs of the rapidly growing spa market, where the value proposition includes not only material values, but also hard-to-quantify improvements in health and well-being, while also being a unique way to support the healthcare system in humanitarian emergencies [53] or a place of temporary stay for refugees. A.P. Navarrete and G. Shaw [54] emphasized that the virus is not waterborne and is therefore not a threat to spas, but proposed common security protocol against COVID-19. Taking into account the events of recent years, plunging humanity into a pandemic and war, which increases the need to intensify humanitarian aid, the practice of rapid change of the profile of activity should be the subject of open access of applied innovations. An important way to achieve this goal is sharing good practices in the form of open innovation [55,56,57,58,59], and even in the form of culture for open innovation dynamics [60]. Similar solutions successively appear in the literature, thus allowing the concept to be developed in various industries [61]. An example is the extension of the concept of open innovation by H. Chesbrough [62,63] and other researchers [27,38,64].

Researchers [36] emphasize that innovations in business models can occur in many ways. This can be done by adding novel activities or by combining activities in an innovative way. Eventually, innovation can occur by changing parties that perform any of the activities. M. Pichlak [65] states that the external use of an idea refers to the deliberate exploitation of an organization’s knowledge by other independent entities, which allows organizations to allocate some assets or direct resources to markets and clients previously unavailable to innovators. However, it may become an external social innovation, exceeding its commercial significance.

In the context of open innovation, the key processes of creating economic value can take the form of the following:

• Active participation of recipients in the process of generating innovation [66], e.g., through mutual exchange of practices and principles of providing humanitarian aid in the event of health, war, and climate crises;
• Technology transactions [67], in this case having the dimension of the process of changing the profile of a service activity or production line, or even aliases of research and development activity.

The other two forms, i.e., the purchase or sale of intellectual property rights [68] and the creation of innovation markets by intermediation in technology transfer [69], may be less relevant in this case.

An important issue is also the method of generating open innovations, and then their implementation in subsequent tourist establishments. While the issue of adapting innovations supporting the social environment may be based on the general model proposed by H. Chesborough and R.S. Rasenboom [12] and graphically developed by M. Peñarroy-Farell and F. Miralles [70] (Figure 1), it is worthwhile to find out how to generate knowledge that is universal enough to be useful in critical situations.

There are also many interesting thinking experiments in the literature. In 2017, J.J. Yun proposed the business model design compass [71], and in 2020, together with his team, he developed this concept through an experiment based on a rectangular compass concept model [72,73]. Thanks to these experiments involving 17 patents of business models, it is known that open innovation, which is based on a new combination of technology and the market, can stimulate the dynamics of innovation in a sustainable business model.

3. Materials and Methods

In Poland, health spa tourism and medical activity are based on balneology and physical medicine, i.e., both physiotherapy treatments and the use of the therapeutic properties of brine, mineral and thermal waters, and peloid, as well as the therapeutic effects of the climate and tourist activity. This activity may be carried out only in health resorts, i.e., in strictly defined natural areas with confirmed properties of stimulating the impact of the climate. There are only 45 such places in Poland. The tourist and therapeutic activity conducted there is included in the health care system and is financed by state health insurance institutions [74].

The primary objective of our research was to learn about the tourism and medical activities of spa enterprises in terms of models, notably the breadth of the business model’s application in spa businesses and the identification of important social and economic developments influencing current spa businesses. The methodological and application objectives were to develop a business model dedicated to spa enterprises and to provide knowledge to enable individual approaches to modeling tourism and treatment activities.

The primary research was conducted according to the Generic Contingency Principle [75] (GCP), methodology, referring to the assumptions of grounded theory [76,77]. The first stage of the proceedings included theoretical research in the form of a critical analysis of the literature on business models and spa tourism, and then empirical research was carried out, including in-depth interviews with managers of spa enterprises and survey research, conducted among consumers and potential consumers of these facilities. Conducting research as part of the adopted methodology made it possible to successively update the business model dedicated to spa enterprises.

In-depth interviews were conducted among the managers of 17 spa enterprises, which are also spa treatment facilities, operating as both tourism centers and therapeutic facilities in balneology and physical medicine. The companies were chosen based on the potential of their offerings. Thus, these were the companies with the largest share of the domestic market, with a total share of 33% of all services provided in 2018, and accounting for 36% of all facilities of such types in Poland. Quantitative surveys were conducted on a random sample of 753 respondents, of which 63.5% (478 respondents) were visitors to Polish spas (to find out their opinions) and 36.5% (275 respondents) were classified as potential visitors (to determine their expectations).

Follow-up research of spa enterprises was conducted in 2021, targeting additional social functions of spa facilities, initiated by the outbreak of the COVID-19 pandemic and by the need to focus spa activities on sustainability. The investigation was conducted among managers of 18 spa enterprises (the vast majority of which were the same enterprises that participated in the 2018 research). The research was guided by two cognitive objectives. The first objective was to assess the level of alignment of the business of health tourism enterprises with the sustainability criteria developed by the Global Sustainable Tourism Council (GSTC) [78], and then to identify changes in the business models of spa enterprises, transforming them into sustainable business models. In contrast, the second objective of the study was to learn about the effects of the COVID-19 pandemic outbreak in spas (after one year of the pandemic) and to characterize the role of spa businesses in reducing the impact of the epidemic threat.

In line with the objectives of both stages of the empirical research, two interview questionnaires were used, designed to characterize the models of enterprises participating in the research.

The first interview questionnaire (A-2018) mainly covered issues related to business models. Managers were asked about the knowledge of business models, the use of models, and then questions were formulated regarding the nine components of business models (in line with the CANVAS concept). Additionally, there were questions characterizing the main goals of the undertaken activities and the strategy of these enterprises.

In addition, the 2018 study used an online survey (B-2018) conducted among customers of the surveyed enterprises, analyzing their impressions, experiences, and needs. Here, only customers who had used the services of health resorts in the last 10 years could participate in the research. The obtained results were to help confront the results of the interviews through triangulation studies [79].

The second interview questionnaire (C-2020) contained three groups of questions. The first group identified questions about employment, income, and changes implemented during the first year of the COVID-19 pandemic. The second part dealt with the changes in the business models of spa facilities, and the third part dealt with the implementation of the principles of sustainable development by the facility. The interviews were conducted with the presidents of the boards of these companies or their appointed board representatives. Each study lasted about 30–45 min, and its course depended on the ongoing discussions and commitment to answering any questions that would deepen the interviews.

4. Results

4.1. Market, Production, and Ownership Changes

A critical analysis of the literature on the activities of tourism and spa enterprises in the first stage made it possible to identify the determinants characterizing these activities in the last three decades. Three groups of influential factors have been identified in terms of key social and economic changes affecting contemporary spa enterprises. These have market, product, and ownership dimensions.

A significant transformation of the spa services market was observed, which, with the new century changed from a purely therapeutic activity, to a tourism and treatment activity, adopting the structure of a network of tourism enterprises with a tourism and treatment profile (market dimension). These transformations also included changes in the ways of financing and the scope of services for spa guests.

Changes in the structure of the spa product were also recognized, which consisted of complementing traditional spa treatment methods with modern recreation methods, creating a mixed offer (product dimension). The change also concerned the expansion of recipient segments, among which seniors were still the dominant group.

An important development was also the change in ownership of spa companies, which were part of the Polish Mass Privatization Program in 2005–2015. The Program resulted in their transformation from state enterprises into private companies, and thus in the adoption of an economic perspective, focused primarily on economic results and the search for competitive advantage (ownership dimension).

Identification of the three above-mentioned dimensions shaping the contemporary health spa business in Poland enabled both learning about the specificity of this business and the current problems of this element of the tourism market. Consequently, this stage of research was the starting point for empirical studies. First, however, based on the literature research on business models, research tools were developed in the form of research questionnaires and data analysis methods.

4.2. Business Applicability in Spas

The obtained results of the empirical research conducted among managers indicated that fewer than one in three (30%) declared having knowledge of business models. However, further deepening of the research in this regard showed that the actual knowledge of business models was negligible. Most often, managers’ knowledge referred to an abstract understanding of the concept, but at the same time was devoid of textual or graphical representation of the interrelated structures of the model architecture. Every third manager claimed the usage of tools defining different components (domains) of the company, indicating that the application of business models in spa companies was equivalent to the level of managers’ understanding of this management tool. In general, the components that underwent modeling were key activities, market segments, communication channels, and customer relations. No attempt to formalize the integration of all components into a business model or to use business model schemes known in the literature was observed in any company. Summarizing the first part of the empirical research, we should conclude that the applicability of business models in tourism and treatment establishments in spas is incidental and fragmentary.

4.3. Business Model Components in Spa Enterprises

The confrontation of the results of the empirical research carried out among the managers of tourism and health spa enterprises and among the clients of these establishments has made it possible to characterize the individual components of the contemporary business model of these enterprises and their environment. The business model was formulated based on the structure of the CANVAS diagram [14], formulating and comparing at the same time its form (1) before the economic transformation, (2) contemporary (after the economic transformation), and (3) in the future (sustainable). The most significant component of the business model is the value proposition, which nowadays takes into account three perspectives, i.e., customer value, value captured by the enterprise, and social value of spa enterprises.

The following research results were subject to mutual confrontation due to the qualitative research conducted among the managers, as well as the quantitative research conducted among the tourists and potential tourists of the spa enterprises. The result of this confrontation was the original business model, and as a consequence of subsequent (supplementary) research, a sustainable model was created. In the course of further research, further refinements of the sustainable business model of the spa enterprise were created. Its final form is presented in the overall scheme of the sustainable business model of the spa enterprise shown in Figure 2. In the resulting model scheme, you can see all the identified elements of the nine components of the model. Due to the breadth of the issues discussed, their mutual relations and relations with the environment have been presented in other works by the authors.

Learning about the components of spa enterprise business models and their applicability also enabled a follow-up study that coincided with the COVID-19 pandemic. Therefore, the topic of the follow-up research was to develop a sustainable business model for spa enterprises with a focus on crisis management and to identify the role of spa enterprises in countering global humanitarian crises (global pandemics or the effects of wars and armed conflicts).

4.4. Innovative Business Model of a Spa Enterprise

Complementary research made it possible to identify solutions for spa businesses that foster the realization of sustainable development principles, especially by directing the social value proposition to reduce resource consumption, pollution emissions, and to protect and support local cultural heritage. The transformation of the business model into a sustainable business model was preceded by a diagnosis of the current situation in the realization of the principles of sustainable development, and then on the basis of managers’ opinions, guidelines for sustainable business models were developed.

The evaluation of the level of alignment of business activities with GSTC sustainability criteria was carried out based on four groups of criteria, as follows: (1) demonstrate successful long-term management, (2) maximize social and economic advantages to the local community while minimizing negative consequences, (3) maximize cultural heritage benefits while minimizing negative impacts, and (4) maximize environmental benefits while minimizing negative impacts.

A sustainability management system (program) was implemented in every second surveyed spa entity (50%). In most companies where sustainability management was implemented, the involvement of employees and managers in its implementation and development was found. Unfortunately, it was also found that the companies did not communicate the implemented principles of sustainable management to their customers and contractors. Customer satisfaction was not monitored, and no educational efforts were made among external stakeholders with regard to environmental protection, local culture, or desired environmental behaviors.

The surveyed managers simultaneously declared that the functioning of their health resort in no way restricted the local community’s access to food, water, energy, health care, sanitary facilities, and technical infrastructure. The vast majority of managers were taking initiatives to support the local community, especially in offsetting the negative effects of climate change and hazards.

All of the companies surveyed used good practices for promoting cultural heritage among tourists, as well as strengthening local cultural assets and preserving places and customs of historical, archaeological, cultural, and spiritual significance.

The highest awareness of managers was observed in the area of environmental protection. The use of solutions aimed at saving natural resources was declared by almost all managers. This was especially true for reducing unnecessary purchases and saving electricity and water.

The knowledge gained enabled another transformation of the business model into a sustainable model. The next stage of the transformation process involved permanent changes in almost all components of the model. Specific changes concerned the value proposition, which should include concern for environmental protection and local culture, but also key partners who will co-implement sustainability goals (sustainability value), as well as key actions, which should include not only reducing resource consumption and emissions and noise, but also active measures to support the natural environment.

4.5. The Role of Spa Businesses in the COVID-19 Pandemic

The outbreak of the COVID-19 pandemic caused spa businesses to shut down and close their facilities to tourists. However, as they are part of the health care system in Poland, they almost immediately assumed the role of infrastructural reserves for the overburdened inpatient health care system. Follow-up studies allowed for observing the innovative social role of these enterprises, as the tasks assigned to spa enterprises included the following:

• Acting as isolators, i.e., places where people who were asymptomatic carriers of the SARS-CoV-2 virus and who did not require inpatient treatment were quartered;
• Treatment of patients who have been diagnosed with SARS-CoV-2 virus but did not require intensive care;
• Accommodating health care workers working in hospitals treating patients with COVID-19 to avoid exposing loved ones to disease transmission;
• Treating patients who had COVID-19 and had a negative COVID test result but required rehabilitation;
• Organization of vaccination of the local population for COVID-19.

Among the surveyed enterprises, only half (50%) provided post-COVID rehabilitation therapy, and 44% organized COVID-19 vaccination sites. Of the enterprises, 28% operated isolation facilities for those infected with SARS-CoV-2 but who were asymptomatic. The need to adapt spa facilities for the intensive treatment of COVID-19 patients was noted in only 3 of 18 enterprises. These were facilities functioning as spa hospitals.

In connection with the obtained results of the supplementary research, the necessity of including atypical tasks of spa enterprises in business models by creating an additional component—“Crisis Management and Critical Activities”—was also recognized. According to the proposed assumptions, this component should include the following:

• Crisis plans aimed at reducing the local impact of health, environmental, and terrorist disasters;
• Rapid re-deployment scenarios as part of a coordinated emergency response;
• Infrastructure and material reserves maintained within the national security system.

This component should have a direct link to the social value in the value proposition, and at the same time it should be closely linked to the cost and revenue stream and the inclusion of governmental emergency service coordination structures among the key partners.

5. Discussion

M. Sanni and E. Verdolini [80] noted that open innovation runs counter to the individualistic mentality of traditional R&D implementation in enterprises. Usually, philanthropy is practiced in times of economic prosperity, allowing for the sharing of earned income surpluses. Resistance to sharing resources may be greater the more severe the actual or expected effects of the crisis. Meanwhile, the idea of open innovation may paradoxically be an element of the expansion of effective solutions that protect the company, sector, economy, or even the entire society against strategic threats. Therefore, one of the key conclusions resulting from the conducted research concerns the need to develop knowledge on changing the profile of activity in the event of social threats (such as a pandemic, climate catastrophe, or armed conflict). This knowledge should be offered and developed in the form of open innovation.

However, the first step in this matter is to systematize the knowledge base that can help in optimizing the way of adapting new business profiles. It is worth adopting specific preliminary assumptions, as follows:

• The aim of the critical profile of activity is to voluntarily support the society in times of humanitarian threats, which at the same time does not mean the pressure to change the profile of activity, and even less the necessity to implement changes;
• Changing the business profile may not be at the expense of the current commercial activity, if it is possible to conduct, but should be an alternative to inactivity caused by a threatening situation;
• The transfer of knowledge obtained as part of the implementation and use of open innovations in tourism enterprises should be two-way, which at the same time assumes the possibility of increasing the social potential in terms of responding to crisis situations;
• Generating, acquiring, or exchanging innovations cannot be limited only to the periods of threats, but should have the character of a continuous process also in the periods of safety maintenance (between critical situations).

The process of transformation of the business model adopts successive variants A, B, and C, and A is presented in Figure 3. It is also an exemplification of the feedback between enterprises participating in the process of exchanging innovative solutions via the knowledge exchange center (KEC), coordinated by the government administration and the crisis management team. The establishment of the knowledge exchange center enables the transfer of open innovations to other enterprises without the need to conduct tedious search for innovations directly at each enterprise (even more competitive). The constant exchange of knowledge and experience improves the information resources of KEC, and thus also improves the operational efficiency of enterprises in taking coordinated anti-crisis measures.

Figure 4 shows the possibility of mutual translocation of knowledge resources between tourism enterprises and the knowledge exchange center. It is worth noting, however, that the process of exchanging innovations enabling social support during the crisis does not end with the end of the crisis. It is followed by the consolidation of the acquired experience and knowledge in the form of three stages, preparing for the next crisis. First of all, it is a summary of the acquired information resources that may take part in open knowledge transfer in the future. Then, the acquired knowledge is analyzed and further conclusions are drawn. On their basis, adjustment processes are made in the event of subsequent crisis situations.

It is worth noting that the so-called knowledge exchange center (KEC), as a strategic knowledge hub, not only plays the role of a knowledge accumulation center, but also a knowledge transfer center. The point is both to systematize the acquired innovative solutions of an open nature, but also to adapt them to the possibility of application in other enterprises capable of supporting the local community in crisis situations.

Depending on the current activity profile of the health-care enterprise, the translocation of the crisis component of the activity profile from and to the business model may be smooth or sudden. However, it also requires an appropriate connection to the rest of the components in the model. In general, this change may be forced by the suddenness of a crisis situation (e.g., lack of tourists overnight, mass resignation of cooperating entities, or a sharp drop in demand from tour operators or social insurance institutions), which at the same time means a suspension of the revenue stream. The use of knowledge transfer in the field of the critical profile of activity during lockdown periods may be an important factor in maintaining at least the safe economic activity of tourist entities, while using some of the service potential for social purposes. It is obvious, however, that a strict definition of a universal framework for transformation and the use of potential is impossible, therefore the transfer of knowledge in the field of open innovations must be based on a situational approach, while maintaining the main operational objective, which in this case will be to reduce the cost stream, in view of the fundamental reduction of the revenue stream.

6. Conclusions

The issue of business models of spa enterprises, conducting specific tourist and medical activities, shows a wide range of possibilities offered by solutions implemented as part of this activity. Particularly noteworthy is the possibility of using the infrastructure resources of spa enterprises in times of serious social threats. The experiences of the COVID-19 pandemic prove that despite the lockdown, tourist entities can perform extremely important rescue functions. However, it seems important to transfer knowledge in the field of transforming their business models so that they also serve the local community. Then, an unforeseen threat of a global nature may become an opportunity for cooperation with the local community, and in a wider social scope, it may be an important element of the health care system.

The perspective of further research indicates the need to continue research in the following direction: (1) reducing overtourism in spas, taking into account the aging trend of the Polish population; (2) implementing sustainable development practices, especially for the protection of natural medicinal resources in spas; and (3) establishing the role of spa businesses as health prevention centers in situations of permanent and incidental humanitarian threats. The aforementioned research areas will be the subject of further studies by the authors.

Finally, it is worth mentioning that an Android smartphone app was also developed based on the research results. The MBUProject application is a program that generates exemplary business models of spa enterprises. The user can get acquainted with the general concept of business models and the results of the research, as well as independently generate a business model, based on their own specification and selection of specific assumptions. The application generates eight business models depending on the user’s needs. It was made available to managers of health resort enterprises in Poland. It is also the first step to make the acquired knowledge and locally applied innovations available as open innovations.