Transformative service research and service design: synergistic effects in healthcare

Healthcare processes for parent participation in neonatal intensive care units: A self-determination theory perspective

This research explores parents' experiences in the NICU to inform design and implementation of processes that motivate and direct parent participation in healthcare processes for their children. Qualitative methods were employed combining elements of grounded theory and phenomenology. Findings reveal that despite known benefits, parent participation does not always occur in NICUs due to difficulties NICUs face while balancing technologically complex care that increases survival rates with parent-participation models that provides holistic wellbeing. Self-determination theory provides a work design perspective that can guide design and implementation of parent participation, as partial employees, as a key component of NICU healthcare processes.

Service design activities in health services: A systematic literature review based on ecosystem perspective and transformative approach

Service Design (SD) represents a breakthrough in searching for solutions to health systems challenges, but the activities that support these solutions remain underexplored. This research investigates how SD has been applied in the healthcare sector based on two conceptual models: multilevel ecosystem perspective and SD transformative approach. First, we conducted a systematic literature review in eight comprehensive databases in March 2021. Eligibility criteria returned 990 articles filtered by a search protocol, resulting in 47 studies. After this, we identified 23 studies (49%) with a transformative approach through a thematic analysis. Also, the analysis of these 23 studies allowed the identification of five key aspects necessary for enabling a transformative character of SD initiatives: (1) identification of all the actors that make up the provision of healthcare services, (2) identification of users by ecosystem level, (3) knowledge about the SD tools arsenal, (4) use of technology, and (5) applying the Experience-Based Design and Co-Design (EBD/EBCD) approach. The study underlines the role of management for the success of SD in the health sector and suggests an instrument (checklist) to help managers implement SD initiatives successfully.

Service design for the transformation of healthcare systems: A systematic review of literature

There is a growing interest in applying the Service Design (SD) approach to innovate and transform healthcare systems. However, comprehensive studies are scarce. This study systematically reviews the literature on SD initiatives towards healthcare system transformation. The research questions are: How has the SD approach been applied to the healthcare sector? To what extent are the SD initiatives contributing to transform the health systems? What are the main challenges faced by SD initiatives to transform the health system? Which are the main stakeholders involved in the process, and how could they change according to the type of initiative? The search was conducted in March 2021 in eight databases and returned 990 articles evaluated through a research protocol, resulting in 47 studies included in this review. These studies were explored through thematic analysis and considering two conceptual models: the SD approach (Patrício et al., 2020) and the ecosystem perspective (Beirão et al., 2017). The findings show that SD initiatives have been implemented at all levels of the ecosystem, but only 49% (47/23 studies) present a transformative character. The SD initiatives challenges were organized into four themes: (1) Planning SD initiatives as a lever in transforming health systems; (2) Using SD tools creatively; (3) Considering the use of new technologies to transform health systems positively, and (4) Facing the challenges of applying the Experience-Based Design and Experience Based in Co-Design approaches in project development. This study is relevant for helping managers and researchers in their efforts to design truly transformative services with a focus on improving health systems and social wellbeing.

Service design in healthcare: a segmentation-based approach

Purpose

The study aims to explore how segmentation as a methodology can be adapted to the healthcare context to provide a more nuanced understanding of the served population and to facilitate the design of patient-centric services.

Design/methodology/approach

The study was based on a collaborative project with a national healthcare organization following the principles of action design research. The study describes the quantitative segmentation performed during the project, followed by a qualitative interview study of how segments correspond with patient behaviors in an actual healthcare setting, and service design workshops facilitated by segments. A number of design principles are outlined based on the learnings of the project.

Findings

The segmentation approach increased understanding of patient variability within the service provider organization and was considered an effective foundation for modular service design. Patient characteristics and life circumstances were related to specific patterns of health behaviors, such as avoidance or passivity, or a persistent proactivity. These patterns influenced the patients' preferred value co-creation role and what type of support patients sought from the care provider.

Practical implications

The proposed segmentation approach is immediately generalizable to further healthcare contexts and similar services: improved understanding of patients, vulnerable patients in particular, improves the fit and inclusivity of services.

Originality/value

The segmentation approach to service design was demonstrated to be effective in a large-scale context. The approach allows service providers to design service options that improve the fit with individual patients' needs for support and autonomy. The results illuminate how patient characteristics influence health and value co-creation behaviors.

Cocreating transformative value propositions with customers experiencing vulnerability during humanitarian crises

To understand the cocreation and impact of transformative value propositions (TVPs), which are designed to address vulnerabilities that customers experience because of humanitarian crises, this study applies a typology of service innovation archetypes as a domain theory to examine different ways to cocreate TVPs. The authors identify different types of customers who experience vulnerability, using a social determinants of health (SDOH) framework. Exemplary TVPs reveal how service organizations can alleviate customer vulnerabilities, in the short and long terms, and highlight a distinction between TVPs that require incremental changes to existing resource deployment versus those that require novel capabilities. This article contributes to transformative service research by establishing a value-centric model that relates the cocreation of TVPs to customers experiencing vulnerability. In turn, researchers and managers can identify the output-based, process-based, experiential, and systemic changes needed to cocreate TVPs.

Mobile-Health based physical activities co-production policies towards cardiovascular diseases prevention: findings from a mixed-method systematic review

BACKGROUND

Cardiovascular disease (CVD) is the first cause of death globally, with huge costs worldwide. Most cases of CVD could be prevented by addressing behavioural risk factors. Among these factors, there is physical and amateur sports activity (PASA), which has a linear negative correlation with the risk of CVD. Nevertheless, attempts to encourage PASA, as exercise prescription programmes, achieved little impact at the community-wide level. A new frontier to promote PASA is represented by mobile health tools, such as exergaming, mobile device apps, health wearables, GPS/GIS and virtual reality. Nevertheless, there has not yet been any evident turnabout in patient active involvement towards CVD prevention, and inactivity rates are even increasing. This study aims at framing the state of the art of the literature about the use of m-health in supporting PASA, as a user-centric innovation strategy, to promote co-production health policies aiming at CVD prevention.

METHODS

A mixed-method systematic literature review was conducted in the fields of health and healthcare management to highlight the intersections between PASA promotion and m-health tools in fostering co-produced services focused on CVD prevention. The literature has been extracted by the PRISMA logic application. The resulting sample has been first statistically described by a bibliometric approach and then further investigated with a conceptual analysis of the most relevant contributions, which have been qualitatively analysed.

RESULTS

We identified 2,295 studies, on which we ran the bibliometric analysis. After narrowing the research around the co-production field, we found 10 papers relevant for the concept analysis of contents. The interest about the theme has increased in the last two decades, with a high prevalence of contributions from higher income countries and those with higher CVD incidence. The field of research is highly multi-disciplinary; most of documents belong to the medical field, with only a few interconnections with the technology and health policy spheres. Although the involvement of patients is recognized as fundamental for CVD prevention through PASA, co-design schemes are still lacking at the public management level.

CONCLUSIONS

While the link between the subjects of motor activity, medicine and technology is clear, the involvement of citizens in the service delivery process is still underinvestigated, especially the issue concerning how "value co-creation" could effectively be applied by public agencies. In synthesis, the analysis of the role of co-production as a system coordination method, which is so important in designing and implementing preventive care, is still lacking.

A methodological framework for crafting situated services

Purpose

This paper discusses how service design can be used to activate a transition of textile artisan communities towards a sustainable future.

Design/methodology/approach

Two participatory case studies were undertaken with textile artisans in the UK and South Africa. These led to the development of an original methodological framework for “crafting situated services” – services designed to be meaningful to the local communities within which they are embedded. An evaluation study assessed the originality of the framework, its relevance for tackling real-world problems, its extensibility and the rigour of the research process.

Findings

The framework brings together a variety of roles, methods and tools that designers can adopt in order to enter communities, make sense of sustainable futures, facilitate the co-design of situated services and activate legacies within communities. Building on emerging anthropological approaches, the framework makes a bridge between service management and service design for social innovation, advancing the field towards design for social entrepreneurship.

Originality/value

Arguing against the idea of the designer “parachuting” into communities to create services regardless of the local context, the concept of “situated services” is proposed in this paper, alongside a process for “crafting” meaningful social innovations. This requires the service designer to adopt a more situated and embedded approach to designing with communities in order to align with their needs and aspirations, interweave places, time, people and practices within the process, and co-design contextually better services.

A transformative service research for healthy transition to adulthood of young people living alone in Korea

This study was conducted to explore phenomena related to the physical, psychological and social health vulnerabilities of young people who lived alone and to establish strategy for service implementation to facilitate their healthy transition to adulthood. In accordance with the double diamond process of service design, five workshops involving 12 participants and 9 experts were held from July to November 2018 in the D-district of Seoul, Korea. As a result, the participants were identified as a difficult group to engage in health management because of their features: unconcern for health, inevitable neglect for health or fixation of lifestyle far from health. They were also a special group that was undergoing a double transition: the transition to adulthood and from living with their parents to living alone. Therefore, the strategy for them was derived that had to be in an indirectly and incidentally effective for health through the settlement of independent life and habit formation by transitional care as part of a nudge effect. The findings of this study can provide a basis for health and social care strategies and policies concerning young people who live alone. A follow-up study is proposed, which will involve the actualisation and application of a program based on the intervention strategy derived from these findings.

Algorithmic pollution: Making the invisible visible

In this article, we focus on the growing evidence of unintended harmful societal effects of automated algorithmic decision-making in transformative services (e.g. social welfare, healthcare, education, policing and criminal justice), for individuals, communities and society at large. Drawing from the long-established research on social pollution, in particular its contemporary ‘pollution-as-harm’ notion, we put forward a claim – and provide evidence – that these harmful effects constitute a new type of digital social pollution, which we name ‘algorithmic pollution’. Words do matter, and by using the term ‘pollution’, not as a metaphor or an analogy, but as a transformative redefinition of the digital harm performed by automated algorithmic decision-making, we seek to make it visible and recognized. By adopting a critical performative perspective, we explain how the execution of automated algorithmic decision-making produces harm and thus performs algorithmic pollution. Recognition of the potential for unintended harmful effects of algorithmic pollution, and their examination as such, leads us to articulate the need for transformative actions to prevent, detect, redress, mitigate and educate about algorithmic harm. These actions, in turn, open up new research challenges for the information systems community.

Examining the relationship between patient experience and readmission rates: A profile deviation analysis

The purpose of this study is to examine the relationship between patient experience and readmissions by exploring whether the deviation from an ideal patient-experience profile is linked to higher readmissions. Using patient experience scores, hospitals were assigned to one of four groups based on their deviation from an ideal profile. The readmission rates for the four groups were analyzed using Profile Deviation, ANOVA, and Least Significant Difference. Patient experience is a central component of hospital performance, specifically, readmission rates. Findings indicate as patient experience scores decrease, profile deviation increases, with a corresponding increase in readmission rate. This study provides empirical support for administrators focusing on patient experience as part of an overall strategy for reducing hospital readmissions. The key feature of this research is the use of a profile deviation methodology to examine the relationship between patient experience and readmission rates.

Transformative Value Co-creation in Healthcare Services in the COVID-19 Era: The Case of Centro Cardiologico Monzino

The outbreak of COVID-19 has presented great challenges for health services targeted at patients with chronic diseases, such as cardiovascular disorders. Hospitals and medical clinics must find new and effective solutions to address the impacts on individual and collective well-being due to the increased diffusion of these types of diseases, especially during a pandemic. This implies the evolution of the service ecosystem through enhanced coordination and resource integration between different actors (patients, doctors, service providers, relatives, caregivers, etc.). The coordination process might be leveraged by technological devices aimed at integrating resources and co-creating transformative value (Anderson et al. 2013; Danaher and Gallan 2016; Anderson et al. 2018). This chapter, in particular, investigates how digital health technologies impact the evolution of the Italian healthcare service ecosystem in a transformative way through the study of the case of Centro Cardiologico Monzino. The study adopted a qualitative approach based on in-depth interviews with patients of Centro Cardiologico Monzino with cardiovascular pathologies who use digital health devices and doctors, caregivers, and other key informants who are experts in the Italian healthcare service ecosystem. Our findings illustrate how digital health contributes to value co-creation and to the enhancement of individual and collective well-being, considering the renewed interaction between different actors in the service ecosystem.

A transformative supply chain response to COVID-19

Purpose

This research employs a transformative service lens to examine the role of the supply chain ecosystem in ensuring the health and safety of employees and customers as a well-being outcome during the coronavirus disease of 2019 (COVID-19) pandemic.

Design/methodology/approach

This is a conceptual paper examining the response of the supply chain to the current food crisis caused by the pandemic.

Findings

Based on the service-dominant logic (SDL) paradigm, the COVID-19 examination of the supply chain ecosystem provides a foundation for further research employing a transformative lens.

Research limitations/implications

The COVID-19 situation is primarily explored from a Western, educated, industrialised, rich and democratic (WEIRD) societies’ context. Future research should explore the applicability of the transformative service lens to other societies.

Practical implications

The conceptual discussion and research agenda provide direction for researchers, practitioners and policymakers towards a transformative supply chain ecosystem.

Originality/value

This research includes the well-being of employees and customers in the service supply chain outcome measures, draws supply chain management into the TSR domain, while also solidifies a service ecosystem perspective of supply chain management.

The transformative service paradox: the dilemma of wellbeing trade-offs

Purpose

A transformative service aims to improve wellbeing; however, current approaches have an implicit assumption that all wellbeing dimensions are equal and more dimensions led to higher wellbeing. The purpose of this paper is to present evidence for a new framework that identifies the paradox of competing wellbeing dimensions for both the individual and others in society – the transformative service paradox (TSP).

Design/methodology/approach

Data is drawn from a mixed-method approach using qualitative (interviews) and quantitative data (lab experiment) in an electricity service context. The first study involves 45 household interviews (n = 118) and deals with the nature of trade-offs at the individual level to establish the concept of the TSP. The second study uses a behavioral economics laboratory experiment (n = 110) to test the self vs. other nature of the trade-off in day-to-day use of electricity.

Findings

The interviews and experiment identified that temporal (now vs. future) and beneficiary-level factors explain why individuals make wellbeing trade-offs for the transformative service of electricity. The laboratory experiment showed that when the future implication of the trade-off is made salient, consumers are more willing to forego physical wellbeing for environmental wellbeing, whereas when the “now” implication is more salient consumers forego financial wellbeing for physical wellbeing.

Originality/value

This research introduces the term “Transformative Service Paradox” and identifies two factors that explain why consumers make wellbeing trade-offs at the individual level and at the societal level; temporal (now vs. future) and wellbeing beneficiary.

Leveraging service design for healthcare transformation: toward people-centered, integrated, and technology-enabled healthcare systems

Purpose

This paper explores how service design can contribute to the evolution of health service systems, moving them toward people-centered, integrated and technology-enabled care; the paper develops a research agenda to leverage service design research for healthcare transformation.

Design/methodology/approach

This conceptual study starts by analyzing healthcare challenges in terms of demographic trends and economic constraints, along with the problems of lack of people-centricity, dispersion of care and slowness in incorporating emerging technologies. Then, it examines the theoretical underpinnings of service design to develop a framework for exploring how a human-centered, transformative and service systems approach can contribute to addressing healthcare challenges, with illustrative cases of service design research in healthcare being given.

Findings

The proposed framework explores how a human-centered service design approach can leverage the potential of technology and advance healthcare systems toward people-centered care; how a transformative service design approach can go beyond explanatory research of healthcare phenomena to develop innovative solutions for healthcare change and wellbeing; and how a service systems perspective can address the complexity of healthcare systems, hence moving toward integrated care.

Originality/value

This paper systematizes and develops a framework for how service design can contribute to healthcare transformation. It identifies key healthcare application areas for future service design research and pathways for advancing service design in healthcare by using new interdisciplinary bridges, methodological developments and theoretical foundations.

Transformative service research, service design, and social entrepreneurship

Purpose

The purpose of this paper is to provide an interdisciplinary framework bridging service design and social entrepreneurship with transformative service research (TSR) to create greater synergetic effects to advance wellbeing and drive social impact.

Design/methodology/approach

This research provides an interdisciplinary review and synthesis of literature to establish a basis for a conceptual framework advancing human wellbeing and driving social impact.

Findings

The overarching framework created incorporates various concepts, methods and tools across the three research domains. At the core of the framework is the ultimate goal of multilevel wellbeing and social impact. The core is subsequently supported by established social entrepreneurship concepts and strategies: prosocial motivation, hybrid identity, social bricolage, entrepreneurial thinking, community engagement, business model design and innovative delivery. The implementation of these concepts could benefit from the methods and tools used in service design, such as: design probes, service blueprints, appreciative inquiry, contextual interviews, actor maps, sustainable business model canvas and service prototyping.

Practical implications

The paper uses the refugee crisis as an illustrative example of how the proposed framework can be put into action by service organizations.

Originality/value

By bridging literature in TSR, service design and social entrepreneurship, this paper provides service managers with a framework to guide scalable systemic solutions for service organizations interested in advancing human wellbeing and driving social impact.

Reshaping mental models – enabling innovation through service design

Purpose

The purpose of this paper is to analyze how service design practices reshape mental models to enable innovation. Mental models are actors’ assumptions and beliefs that guide their behavior and interpretation of their environment.

Design/methodology/approach

This paper offers a conceptual framework for innovation in service ecosystems through service design that connects the macro view of innovation as changing institutional arrangements with the micro view of innovation as reshaping actors’ mental models. Furthermore, through an 18-month ethnographic study of service design practices in the context of healthcare, how service design practices reshape mental models to enable innovation is investigated.

Findings

This research highlights that service design reshapes mental models through the practices of sensing surprise, perceiving multiples and embodying alternatives. This paper delineates the enabling conditions for these practices to occur, such as coaching, diverse participation and supportive physical materials.

Research limitations/implications

This study brings forward the underappreciated role of actors’ mental models in innovation. It highlights that innovation in service ecosystems is not simply about actors making changes to their external context but also actors shifting their own assumptions and beliefs.

Practical implications

This paper offers insights for service managers and service designers interested in supporting innovation on how to catalyze shifts in actors’ mental models by creating the conditions for specific service design practices.

Originality/value

This paper is the first to shed light on the central role of actors’ mental models in innovation and identify the service design practices that reshape mental models.