Examining the effects of patient characteristics and prior value needs on the patient-doctor encounter process in healthcare service delivery

Psychosocial factors contributing to value creation in value-based healthcare: a scoping review

Background

Healthcare systems constantly evolve to improve care quality and resource utilization. One way is implementing Value-Based Healthcare (VBHC) an economic approach. This scoping review aims to identify and describe the literature on VBHC, particularly its psychosocial aspects, to uncover research gaps.

Method

The review followed the PRISMA guidelines for Scoping Reviews. We took the following 14 steps: (a) defining the research question; (b) identifying relevant studies; (c) selecting studies; (d) 15 mapping data; (e) collecting, synthesizing and reporting results. A detailed Boolean search was conducted from January 2021 to August 31, 2021, across APA PsycINFO and PubMed databases using keywords such as "Value-Based Healthcare" and "psychosocial perspective." Initially, three reviewers screened 70 e-records independently, assessing titles, abstracts, and full-text against the inclusion criteria. Discrepancies regarding the evaluation of the articles were resolved through consensus sessions between the reviewers.

Results

The final review included 14 relevant e-records in English from peer-reviewed sources, focusing on quantitative and qualitative research. From the analysis, four areas emerged: (1) Value chains in Healthcare; (2) Styles, activities, and practices of value co-creation in Healthcare; (3) Value co-creation in the encounter process; (4) Value co-creation in preventive health services.

Conclusion

The scoping review findings suggest several potential key aspects, including the interdependence between patients and healthcare organizations, organizational culture in healthcare, and the role of patient-centered approaches that focus on relationships, communication, and social support in healthcare. This can be achieved through patient engagement, patient-centered care and communication, health literacy, psychosocial support services, comprehensive psychosocial assessments, care coordination, and continuity of care. Integrating psychosocial elements in VHBC enhances quality and optimizes resource use. Findings highlight the need to develop practical guidance on how to implement a culture of value in care that takes into account the psychosocial aspects that have emerged, but not fully addressed. The pandemic teaches that the workforce poorly receives sudden and unsystematic changes. This review could provide an initial basis for the redesign of value in healthcare and a paradigm shift that has already begun with patient-centered medicine and patient engagement.

Value of Care: An Exploratory Qualitative Study with Doctors and Patients

The concept of value in healthcare is mainly based on economic and financial aspects. However, the literature has emphasised the need to investigate value from other perspectives. The present study aimed to explore the views of physicians and patients on the value of healthcare, and to examine in depth the psychosocial and organisational elements that have emerged but that need to be investigated more. Therefore, two qualitative studies were performed, in which 69 physicians and 111 patients participated. The data were analysed using content analysis and text mining using t-lab software. The results revealed common elements between the two healthcare actors that constitute value in healthcare, including competence, professionalism, and soft skills like communication and empathy. Furthermore, the importance of functioning health services and effective organisational culture in local healthcare and investment emerged. These findings can guide healthcare organisations to consider the potential psychosocial factors related to value in healthcare, which affect organisation in terms of costs and healthcare relationships. In addition, these findings are a first step in filling the gap found in the literature regarding the consideration of value from a non-economic perspective and the difficulty of defining and measuring it.

Value Cocreation in Health Care: Systematic Review

Background

Value cocreation in health care (VCCH), mainly based on service-dominant logic, emphasizes that participants, including both patients and physicians, can effectively enroll in the health care value creation process. Effective VCCH is of great significance for realizing value-based health care and improving doctor-patient relationships. Therefore, a comprehensive understanding of VCCH is critical. However, the current literature on VCCH is fragmented and not well studied.

Objective

The goal of the research is to investigate the antecedents, consequences, and dimensions of VCCH by systematically searching, selecting, summarizing, and evaluating relevant literature.

Methods

English-language articles on VCCH in the Web of Science, PubMed, and Scopus databases published from January 2008 to December 2019 were identified. The articles were screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, and the quality of studies included were appraised using the Mixed Methods Appraisal Tool.

Results

Out of the 181 publications initially identified through the bibliographic searches, 28 publications met the inclusion criteria. This review summarizes antecedents, consequences, and dimensions of VCCH, as well as possible associations among them. An integrative framework is also proposed for mapping the literature of VCCH grounded on social cognitive theory to reveal the whole process of VCCH.

Conclusions

The findings of this systematic review provide implications for continued development of VCCH and contribute to inspire more research in the future.

The COVID-19 emergency as an opportunity to co-produce an innovative approach to health services provision: the women's antenatal classes move on the web

The COVID-19 pandemic has strongly affected healthcare organizations, leading to the need for reorganizing also maternal care services during pregnancy. The Regional Health Authorities in Tuscany (Italy) promoted the creation of online antenatal classes (ACs). This study illustrates the innovative approach to deliver ACs online and discusses how the collaborative approach in co-producing this innovative solution co-creates value in healthcare. The action research design was based, on one hand, on the indirect involvement of users by analyzing qualitative data collected through a continuous survey to pregnant women and, on the other one, on the direct involvement of managers and health professionals in meetings and workshops. The authors encompassed all necessary changes in organizational practices and facilitated the collaborative process implementation and analysis. The main findings are that moving ACs online has been a relevant choice, since the need of pregnant women to share information and receive emotional support increased in times of crisis. Additionally, in the perspective of health professionals, the new online ACs model emerged as a valuable solution not only for the contingent situation, but also in a long-term perspective to reach more women during pregnancy and to early support them throughout the maternal care pathway. This study shows that the collaborative approach to co-innovate healthcare services provision, such as with ACs online, facilitates the creation of, long-lasting, and integrated solutions in healthcare, to be used also after pandemic period. Finally, despite this action-research is context-specific, the findings presented in this paper may help other healthcare organizations innovate their own strategies in ACs’ provision.

Co-creating value with suppliers: a conceptual framework

Purpose

This study aims to put forward a conceptual framework to promote strategies for exploring and exploiting value co-creation with suppliers through dynamic capabilities development.

Design/methodology/approach

The conceptual framework was developed by applying deductive logic to blend the theoretical perspectives of value co-creation and dynamic capabilities concerning interaction and innovation.

Findings

The suggested framework emphasized that to co-create value with suppliers, health-care organizations need to integrate innovation abilities with interactional abilities for assimilating mutual processes and resources. The study also points out the crucial role of middle managers to articulate the diverse value perspectives and act as change catalysts.

Practical implications

This paper provides a roadmap for health-care managers to develop internal bundles of resources and integrate inter-organizational processes in the direction of co-creating value. The approach suggests the use of project pipelines and performance measures as managerial tools for aligning value co-creating initiatives with suppliers.

Originality/value

The study is a pioneering attempt to develop a conceptual framework for co-creating value with suppliers and, consequently, to provide innovative services to patients. The study aligns with previous value co-creation and dynamic capabilities works in terms of interaction and innovation development. However, based on the interrelation of these two dimensions, the study puts forth four interrelated processes (experimenting new possibilities of value creation; articulating value alignment initiatives; implementing mutual benefits; and executing and managing performance improvement) attached by mutual change mechanisms.

Empowering Patients to Co-Create a Sustainable Healthcare Value

Extensive literature suggests that a solution to the current problems of healthcare sustainability is the active involvement of patients in health management through the empowerment of their abilities. Latest marketing frameworks suggest that patients are important resources for co-creating health value together with operators. This research aims to analyze the effects of patient empowerment on patients’ value co-creation behaviors. An empirical survey was conducted on 250 patients with chronic diseases in Italy. The results, analyzed using the structural equation modeling, showed that their empowerment enhanced value co-creation behaviors. Patients apply their health competencies and resources in their co-creation of health service with operators. It is, therefore, important to empower patients in their transformation from passive to active stakeholders, working with providers for the most optimal health outcomes. This research provides practitioners with suggestions for patient involvement which utilizes their knowledge, capabilities and responsibility to improving healthcare services.