The changing role of the health care customer: review, synthesis and research agenda

Antecedents of innovative work behavior among leading physicians: Empirical evidence from German hospitals

Healthcare professionals' innovative work behavior (IWB) plays a key role in the development and implementation of innovative solutions in hospitals. However, relevant antecedents of IWB have not been fully captured to date. This study empirically examines the relationships between proactive personality, collaborative competence, innovation climate, and IWB. Hypotheses were tested using a sample of 442 chief physicians from 380 German hospitals. The results indicate a positive and significant influence of proactive personality, collaborative competence, and innovation climate on IWB, with collaborative competence having a stronger influence on IWB than innovation climate. Managers should note that important resources for IWB are accessible through a variety of actors and relationships. To leverage these resources and thus promote IWB, more emphasis should be placed on an employee's network.

From hospital-centered care to home-centered care of older people: propositions for research and development

PURPOSE

Providing high-quality and cost-efficient care of older people is an important development priority for many health and social care systems in the world. This paper suggests a shift from acute, episodic and reactive hospital-centered care toward longitudinal, person-centered and proactive home-centered care. The purpose of this paper is to contribute to the knowledge of a comprehensive development strategy for designing and providing home-centered care of older people.

DESIGN/METHODOLOGY/APPROACH

The study design is based on qualitative research with an inductive approach. The authors study development initiatives at the national, regional and local levels of the Swedish health and social care system. The data collection methods included interviews (n = 54), meeting observations (n = 25) and document studies (n = 59).

FINDINGS

The authors describe findings related to policy actions and system changes, attempts to achieve collaboration, integration and coordination, new forms of care offerings, characteristics of work settings at home and differences in patients' roles and participation at home and in the hospital.

PRACTICAL IMPLICATIONS

The authors suggest home-centered care as a solution for providing person-centered and integrated care of older people and give examples of how this can be achieved.

ORIGINALITY/VALUE

The authors outline five propositions for research and development related to national policies, service modularity as a solution for customized and coordinated care, developing human resources and infrastructure for home settings, expanding services that enable older people living at home and patient co-creation.

User perspectives of digital manufacturing for lower-limb prosthetic sockets

BACKGROUND

There is growing interest to use digital technology (DT) for manufacturing lower-limb prosthetic sockets to improve efficiency and clinical outcomes. However, little is known about how lower-limb prosthesis users perceive DTs, such as 3D scanning and 3D printing.

OBJECTIVES

This study aimed to provide an understanding of perceptions and experiences with DT for prosthetic socket manufacturing from the perspective of prosthesis users.

STUDY DESIGN

A qualitative descriptive research study.

METHODS

Nine lower-limb prosthesis users (mean age 56; 5 female; 4 male) participated in one-on-one semistructured telephone interviews. Inductive thematic analysis was performed to identify a codebook and emerging themes from the interview transcripts.

RESULTS

Two major themes were identified: (1) expectations and prioritization of 3D printed socket usability and (2) facilitators and barriers to uptake of DT among patients.

CONCLUSION

DT methods were found to be acceptable and feasible from a patient perspective, although technological advancements are still required, and real-time communication about the process may be vital for ensuring patient engagement. Consideration of these findings may improve patient satisfaction to emerging prosthesis treatment plans and ultimately support widespread adoption of DT as an additional tool for fabricating prosthetic sockets.

People and place attachment: Exploring compliance in neighborhood health centers

This article explores the roles of place attachment and social relationships in encouraging clients of a health center to comply with their health providers' directives. We draw on place attachment theory to explore the extent to which emotional bonds between clients and the center promote compliance. Next, we draw on place social bonding to explore whether clients' experiences derived from interactions at the center encourage compliance. Based on data obtained from center clients, we conclude that place attachment and social bonding drive compliance. From a practical perspective, providers and clients must engage in social interaction to promote compliance and engender place attachment.

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.

Goal Setting and Health-Related Outcomes in Chronic Diseases: A Systematic Review and Meta-Analysis of the Literature From 2000 to 2020

Identifying and synthesizing recent empirical research on goal setting among adults with chronic disease is the focus of this article. The article has two phases: Phase 1, a thematic analysis with machine reading of the data and manual thematic analysis, and Phase 2, a quantitative meta-analysis. Qualitative, quantitative, and mixed-method studies are included in Phase 1 (99 papers). Phase 2 includes only quantitative studies (75 papers). Five main themes are identified: (a) the effect of goal characteristics on health-related outcomes, (b) the effect of goal setting on health-related outcomes, (c) the effect of goal achievement on health-related outcomes, (d) goal alignment between patients and health care service providers, and (e) individual and collaborative goal setting of patients and health care service providers. The meta-analysis reveals considerable evidence of an association between goal setting and health-related outcomes.

Co-creation in healthcare: framing the outcomes and their determinants

Purpose

Understanding the outcomes of co-creation (CC) in healthcare is increasingly gaining multidisciplinary scientific interest. Although more and more service management scholars have pointed out the benefits of cross-fertilization between the various research fields, the literature on this topic is still scattered and poorly integrated. This study aims to summarize and integrate multiple strands of extant knowledge CC by identifying the outcomes of health CC and the determinants of these outcomes and their relationships.

Design/methodology/approach

A structured literature review was conducted per PRISMA guidelines. A total of 4,189 records were retrieved from the six databases; 1,983 articles were screened, with 161 included in the qualitative thematic analysis.

Findings

This study advances a comprehensive framework for healthcare CC based on a thorough analysis of the outcomes and their determinants, that is, antecedents, management activities and institutional context. Extant research rarely evaluates outcomes from a multidimensional and systemic perspective. Less attention has been paid to the relationship among the CC process elements.

Research limitations/implications

This study offers an agenda to guide future studies on healthcare CC. Highlighting some areas of integration among different disciplines further advances service literature.

Practical implications

The framework offers an operational guide to better shape managerial endeavors to facilitate CC, provide direction and assess multiple outcomes.

Originality/value

This is the first extensive attempt to synthesize and integrate multidisciplinary knowledge on CC outcomes in healthcare settings by adopting a systematic perspective on the overall process.

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.

How to Monitor the Transition to Sustainable Food Services and Lodging Accommodation Activities: A Bibliometric Approach

The transition to sustainable food systems is one of the main challenges facing national and international action plans. It is estimated that food services and lodging accommodation activities are under pressure in terms of resource consumption and waste generation, and several tools are required to monitor their ecological transition. The present research adopts a semi-systematic and critical review of the current trends in the food service and lodging accommodation industries on a global scale and investigates the real current environmental indicators adopted internationally that can help to assess ecological transition. This research tries to answer the subsequent questions: (i) how has the ecological transition in the food service industry been monitored? and (ii) how has the ecological transition in the lodging accommodation industry been monitored? Our study reviews 66 peer-reviewed articles and conference proceedings included in Web of Science between 2015 and 2021. The results were analyzed according to content analysis and co-word analysis. Additionally, we provide a multidimensional measurement dashboard of empirical and theoretical indicators and distinguish between air, water, energy, waste, health, and economic scopes. In light of the co-word analysis, five research clusters were identified in the literature: “food cluster”, “water cluster”, “consumers cluster”, “corporate cluster”, and “energy cluster”. Overall, it emerges that food, water, and energy are the most impacted natural resources in tourism, and users and managers are the stakeholders who must be involved in active monitoring.

Impact of distance monitoring service in managing healthcare demand: a case study through the lens of cocreation

Background

There is a consensus among healthcare providers, academics, and policy-makers that spiraling demand and diminishing resources are threatening the sustainability of the current healthcare system. Different telemedicine services are seen as potential solutions to the current challenges in healthcare. This paper aims to identify how distance monitoring services rendered for patients with chronic conditions can affect the escalating demand for healthcare. First, we identify how distance monitoring service changes the care delivery process using the lens of service cocreation. Next, we analyze how these changes can impact healthcare demand using the literature on demand and capacity management.

Method

In this qualitative study, we explore a distance monitoring service in a primary healthcare setting in Norway. We collected primary data from nurses and general physicians using the semi-structured interview technique. We used secondary patient data collected from a study conducted to evaluate the distance monitoring project. The deductive content analysis method was used to analyze the data.

Result

This study shows that the application of distance monitoring services changes the care delivery process by creating new activities, new channels for interaction, and new roles for patients, general physicians, and nurses. We define patients’ roles as proactive providers of health information, general physicians’ roles as patient selectors, and nurses’ roles as technical coordinators, data workers, and empathetic listeners. Thus, the co-creation aspect of the service becomes more prominent demonstrating potential for better management of healthcare demand. However, these changes also render the management of demand and resources more complex. To reduce the complexities, we propose three mechanisms: foreseeing and managing new roles, developing capabilities, and adopting a system-wide perspective.

Conclusion

The main contribution of the paper is that it demonstrates that, although distance monitoring services have the potential to have a positive impact on healthcare demand management, in the absence of adequate managerial mechanisms, they can also adversely affect healthcare demand management. This study provides a means for practitioners to reflect upon and refine the decisions that they make regarding telemedicine deployment and resource planning for delivering care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08164-2.

I am. Therefore, I will? Predicting customers' willingness to co-create using five-factor theory

Purpose

Customers' participation in co-creation is a prerequisite for co-creation success. To identify customer co-creators, research has shown a recent interest in the role of personality traits as predictors of customers' engagement in co-creation. However, the empirical results regarding the direction and significance of these relationships have been inconclusive. This study builds on the five-factor theory (FFT) of personality to enhance one's understanding of the nomological network that determines the relationship between personality traits and customers' willingness to co-create (WCC).

Design/methodology/approach

Based on a large-scale empirical study on technology-based services (TBSs) in healthcare (n = 563), the authors empirically investigate the role of the five-factor model (FFM), innate innovativeness (INI) and enduring involvement (EI) in predicting customers' WCC using partial least squares structural equation modeling (PLS-SEM).

Findings

The authors’ empirical findings show that depending on the configurational setting of the personality traits tied to the FFM, INI and EI evolve as mediators in determining customers' WCC.

Originality/value

This study is the first to introduce the FFT of personality into co-creation research. The results of this paper shed light on the relationships between personality traits, characteristic adaptations and customers' WCC.

Where Does Sustainability Stand in Underground Tourism? A Literature Review

Underground sites have become an attractive tourist destination for an increasing number of visitors. This flow of visitors has made sustainability a major issue, that is, the way in which tourism development ensures economic benefits for host communities and respects local identity without compromising the environmental resources. Many studies have explored sustainable tourism in the Underground Built Heritage (UBH), but privilege the analysis of a single perspective, that is, economic sustainability, e.g., potentialities of cultural routes, or environmental sustainability, such as the impact of visitors on the cave climate. However, some attention has been paid to the social implications of tourism in the UBH, that is, the impacts of tourism development on improving the quality of life of the local community and the enhancement of their sense of community while respecting cultural authenticity. Our aim is to reconcile these perspectives and obtain, through a semi-systematic review, a clear picture of the sustainability of tourism in UBH sites. The aggregation of existing knowledge around the three pillars of sustainability has highlighted the importance of community involvement and collaboration among UBH stakeholders to ensure a balance between the protection and valorisation of UBH, which can also be achieved through networking strategies.

Health care professionals' experiences of how an eHealth application can function as a value-creating resource - a qualitative interview study

Background

The number of patients with one or more chronic conditions is increasing globally. One strategy to achieve more sustainable care for these patients is by implementing use of home-based eHealth applications. Such services support patients to take on a more active role as value-creating co-producers of their own care, in collaboration with health care professionals. Health care professionals have a key role in the value creation process, but little is known about value formation within eHealth interactions, especially from their perspective. Therefore, this study aimed to provide a deeper understanding of how an eHealth application can function as a value-creating resource from the perspective of health care professionals.

Methods

Semi-structured interviews were conducted with thirteen health care professionals (nurses, physicians and first-line managers). Qualitative content analysis was used to analyze the interviews.

Results

The findings indicate that value formation processes are strongly influenced by the organizational preconditions and by the usability and functionality of technology. The experiences of the health care professionals indicated that value was conceptualized in dimensions of meaningfulness, building of relationships, building safety and feelings of trust. Although these dimensions were mainly expressed in a positive way, such as perceived improvement of medical care, accessibility and continuity, they also had a negative side that caused value destruction. This was primarily due to patient difficulties in using the application or making measurements. Subsequent efforts at value recovery resulted in value creation, but were often time-consuming for the professionals.

Conclusions

This study contributes by extending conceptualizations of value to the role of health care professionals and by highlighting technology as sometimes facilitating and sometimes hampering value formation processes. The findings indicate that the eHealth application was a value-creating resource, facilitating proactive communication and supporting patients’ engagement and control over their self-care. However, for the application to become a more valuable resource in practice and counteract inequity in care, it needs to be further developed to be adapted to the needs and preconditions of patients.

The Influence Mechanism of Information Interaction on Value Cocreation Based on the Smart Healthcare Context

In recent years, the Chinese government has issued a series of deepening reform policies around smart healthcare, established a diversified technical basis and environmental protection, and deeply excavated the derivative value of healthcare information, aiming to provide high-quality healthcare services for patients. Information interaction in the context of smart healthcare is a kind of health information interaction completed by users with smart healthcare applications as the hub. It is an application form of social behavior and has an impact on value cocreation. Based on the theory of information interaction and value cocreation, this paper systematically reviews the research on information interaction and value cocreation in the smart healthcare context, analyzes the information interaction mode and information interaction mechanism in the smart healthcare context, constructs a theoretical model of the impact of information interaction on value cocreation, and empirically tests the relationship between information interaction and value cocreation in the smart healthcare context. The research of this paper aims to provide high-quality information interaction services for smart healthcare users, promote the dimensional management of information behavior in the context of smart healthcare, and promote the continuous improvement of the operation and management of smart healthcare.

Exploring the perspectives of prosthetic and orthotic users: past and present experiences and insights for the future

PURPOSE

The aim of this work was to qualitatively explore the personal perspectives of prosthetic and orthotic users, in the context of their past and present experiences and understand their insights for the future.

MATERIALS AND METHODS

A narrative exploration study design, employing a phenomenological approach was used. Semi-structured interviews were conducted with three female and two male prosthetic and orthotic users from Australia and the United Kingdom. Interviews were analysed, coded and key themes and sub-themes identified.

RESULTS

Three themes were identified. The Maximising Opportunity theme linked sub-themes of recreation and pushing boundaries. The Health Care Network theme included sub-themes of communication, peer support and building a team. The final theme, Changes over time, included sub-themes of disability perception, advice and advancements over time.

CONCLUSION

Prosthetic and orthotic users identified that there had been vast changes in disability perception, disability rights, and their role in the health care system, along with the variety of technology and materials available. Key findings were that prosthetic and orthotic users want to be listened to, considered central to the health care team, and had a deep understanding of their own health care needs.Implications for rehabilitationProsthesis and orthosis users want to be listened to and considered central within the health care team.Attending medical and allied health teams must recognise that prosthesis and orthosis users have a fundamental understanding of their own health care needs.Themes, whilst potentially generalisable, are derived from specific individuals and may particularly relate to these individuals.

The Evaluation of Determinants and Impacts of Co-Production in Healthcare: A Research Protocol for OPAT in Cystic Fibrosis

Introduction:

Co-production is more and more considered as a promising tool for dealing with the main challenges in the health sector (e.g., growing rates of chronic diseases, budget constraints, higher patients’ expectations of the quality and the value of services, equity to access of care, etc.). However, there is still little evidence on co-production determinants and impacts.

Description:

This research protocol aims to present a framework to assess the determinants and impacts of the co-productive approach in healthcare delivery on patients, professionals, and providers from economic, organisational, and clinical perspectives. To this end, the paper examines the co-produced outpatient parenteral antimicrobial therapy (OPAT), applied to cystic fibrosis patients in an Italian hospital. A mixed methods approach will be adopted and data will be collected through semi-structured interviews and surveys of patients, caregivers, and professionals; biological samples of patients; archival sources. Then, the analyses to be performed are the following: (i) cost evaluation, (ii) content, (iii) descriptive and inferential statistical, (iv) microbiome analysis, and (v) desk analysis.

Conclusion:

The research protocol contributes to both theoretical and practical knowledge. It represents the first attempt to develop a systematic analytical framework for the evaluation of co-production in healthcare. Moreover, the findings gathered within the study will provide evidence to support policy makers and managers in decision-making and managerial processes within the health service.

Co-Production Performance Evaluation in Healthcare. A Systematic Review of Methods, Tools and Metrics

Co-produced practices and publications in the healthcare sector are gaining momentum, since they can be a useful tool in addressing the sustainability and resilience challenges of health systems. However, the investigation of positive and, mainly, negative outcomes is still confused and fragmented, and above all, a comprehensive knowledge of the metrics used to assess these outcomes is lacking. To fill this gap, this study aims to systematically review the extant literature to map the methods, tools and metrics used to empirically evaluate co-production in health services. The search took place in six databases: Scopus, Web of Science, Psych INFO, PubMed, Cochrane and CINAHL. A total of 2311 articles were screened and 203 articles were included in the analysis, according to PRISMA guidelines. Findings show that outcomes are mainly investigated through qualitative methods and from the lay actor or provider perspective. Moreover, the detailed categorisation of the quantitative measures found offers a multidimensional performance measurement system and highlights the impact areas where research is needed to develop and test new measures. Findings should also promote improvements in empirical data collection on the multiple faceted co-produced activities and spur the consciousness of the adoption of sustainable co-productive initiatives.

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.

Information ecology in digitalising welfare services: a multi-level analysis

Purpose

The purpose of this paper is to examine and reinterpret information ecology in the context of the changing environment of services, which has been strongly affected by digitalisation and increasing citizen engagement. Here, information ecology refers to the interaction and co-evolution of technologies, human beings and the social environment.

Design/methodology/approach

The data consist of 25 thematic interviews conducted in a public Finnish organisation responsible for organising welfare services, and in its collaborating organisations. The interviews were analysed qualitatively. The analytical framework is based on Nardi and O'Day's five components of information ecology: system, diversity, co-evolution, keystone species and locality.

Findings

The analysis shows that these basic components still exist in the digitalisation era, but that they should be interpreted and highlighted differently, for example, stressing the openness of the information system instead of closed systems, as well as emphasising the increasing meaning of diversity amongst digitalisation, and the dynamic co-evolution between the elements of the system. New capabilities, such as the ability to combine various kinds of information and knowledge, are needed in this adaptation.

Research limitations/implications

The study illustrates a wider, updated information-ecology concept with the help of empirical research. Technology affects care organisations' information ecologies in numerous – often invisible – ways, which this study brings into light.

Originality/value

So far, information-ecology research has overlooked social and healthcare, but this study provides findings concerning this societally important sector.

Knowledge sharing motives and value co-creation behavior of the consumers in physiotherapy services: a cross-cultural study

Purpose

This study aims to investigate the role of consumers’ (patients) motives in knowledge sharing and value co-creation with the service provider in the context of physiotherapy services.

Design/methodology/approach

The authors used partial least squares structural equation modeling for the analysis of the physiotherapy services users’ data from Germany and Pakistan.

Findings

The results show that in both consumer groups, individualizing, empowering and development motives are common influences on the willingness to share knowledge leading to value co-creation. However, the relating, ethical and concerted motives show varying influences in the data set.

Research limitations/implications

A key research implication relates to specifying the link between consumer knowledge sharing and value creation and the role of cultural factors in this context. It is one of the first studies to undertake a comparative analysis in this specific context by highlighting the changing role of consumers from collective and individualistic societies, in influencing service provision through participation in the service exchange.

Practical implications

For the managerial audience, this paper highlights the importance of being sensitive to cultural elements as they tend to influence personal knowledge sharing by the consumer, especially in the well-being sector, which ultimately influences the value co-creation.

Originality/value

To the best of the authors’ knowledge, the current paper is one of the first studies focusing on the knowledge sharing motives of consumers in the specific context of physiotherapy services leading to value co-creation. Moreover, specific focus on individual consumer’s motives and their role in comparative, cross-cultural settings, adds further value to the contribution of this study.

Employee involvement in innovation activities in hospitals: How perception matters

Employees are a very important source of innovation and essential for the generation, dissemination and implementation of these ideas throughout the organization. This is especially relevant when considering innovation in services during service (co-) creation such as within the healthcare sector. However, perceived employee involvement in innovation (EII) and between stakeholder group interactions in hospitals has not yet been studied in detail. This paper addresses the following research questions: "How do different employee groups perceive their involvement in the innovation process in hospitals and how do their actual involvement levels differ?" and (2) "How do different employee groups perceive their interaction with other employee groups in the innovation process and how do their actual interactions differ?" We analyzed a single typical German research hospital and conducted episodic interviews with employees representing different staff groups. We revealed that while all groups of employees are involved in innovation activities, perception of their involvement in innovation activities differs widely. There is a gap between perception and actual involvement particularly for lower level employees such as nurses. Further, their interaction differs among employee groups and innovation takes place in-group, rather than through group interaction. With our paper, we add to the understanding of perceived EII in hospitals and discuss measures for hospital management to increase EII.

Exploring integrated supply chain performance in healthcare: a service provider perspective

Purpose

The paper identifies the antecedents and consequences of integrated supply chain performance (ISCP) in healthcare systems.

Design/methodology/approach

Based on a review of the literature constructs of supply chain flexibility (SCF), employee relationships (ERs), organizational orientation (OO) and knowledge exchange (KE) were identified as antecedents of ISCP, and patient centricity (PC) emerged as its consequence. This structural relationship was tested using partial least square structural equation modeling (PLS-SEM).

Findings

ERs, SCF, OO and KE positively impacted the performance of an integrated healthcare supply chain. Furthermore, enhanced ISCP in operational processes of the hospital positively influenced patient centeredness and care quality.

Research limitations/implications

Paper contributes by identifying antecedents and consequences of ISCP. Future researchers may explore the inter-relationships among the antecedents of ISCP.

Practical implications

Insights from this study will help practitioners in enhancing hospital operations by integrating processes along the healthcare service supply chain and developing a patient-centric approach.

Social implications

This paper highlights how PC may be achieved by focusing on a facilitative internal environment. This understanding may help in designing processes that deliver health as a social good in an effective manner.

Originality/value

The empirical evidence from this study can help hospitals integrate their functions, thus, enabling them to deliver quality care.

Whose experience is it anyway? Toward a constructive engagement of tensions in patient-centered health care

Purpose

Healthcare delivery faces increasing pressure to move from a provider-centered approach to become more consumer-driven and patient-centered. However, many of the actions taken by clinicians, patients and organizations fail to achieve that aim. This paper aims to take a paradox-based perspective to explore five specific tensions that emerge from this shift and provides implications for patient experience research and practice.

Design/methodology/approach

This paper uses a conceptual approach that synthesizes literature in health services and administration, organizational behavior, services marketing and management and service operations to illuminate five patient experience tensions and explore mitigation strategies.

Findings

The paper makes three key contributions. First, it identifies five tensions that result from the shift to more patient-centered care: patient focus vs employee focus, provider incentives vs provider motivations, care customization vs standardization, patient workload vs organizational workload and service recovery vs organizational risk. Second, it highlights multiple theories that provide insight into the existence of the tensions and how they may be navigated. Third, specific organizational practices that engage the tensions and associated examples of leading organizations are identified. Relevant measures for research and practice are also suggested.

Originality/value

The authors develop a novel analysis of five persistent tensions facing healthcare organizations as a result of a shift to a more consumer-driven, patient-centered approach to care. The authors detail each tension, discuss an existing theory from organizational behavior or services marketing that helps make sense of the tension, suggest potential solutions for managing or resolving the tension and provide representative case illustrations and useful measures.

Dynamics of wellbeing co-creation: a psychological ownership perspective

Purpose

People are responsible for their wellbeing, yet whether they take ownership of their own or even others' wellbeing might vary from actor to actor. Such psychological ownership (PO) influences the dynamics of how wellbeing is co-created, particularly amongst actors, and ultimately determines actors' subjective wellbeing. The paper's research objective pertains to explicating the concept of the co-creation of wellbeing and conceptualizing the dynamics inherent to the co-creation of wellbeing with consideration of the influences of all involved actors from a PO perspective.

Design/methodology/approach

To provide a new conceptualization and framework for the dynamics of wellbeing co-creation, this research synthesizes wellbeing, PO and value co-creation literature. Four healthcare cases serve to illustrate the effects of engaged actors' PO on the co-creation of wellbeing.

Findings

The derived conceptual framework of dynamic co-creation of wellbeing suggests four main propositions: (1) the focal actor's wellbeing state is the intangible target of the focal actor's and other engaged actors' PO, transformed throughout the process of wellbeing co-creation, (2) PO over the focal actor's wellbeing state is subject to the three interrelated routes of exercising control, investing in the target, and intimately knowing the target, which determine the instigation of wellbeing co-creation, (3) the level of PO over the focal actor's wellbeing state can vary, influence and be influenced by the extent of wellbeing co-creation, (4) the co-creation of wellbeing, evoked by PO, is founded on resource integration, which influences the resources–challenges equilibrium of focal actor and of all other engaged actors, affecting individual subjective wellbeing.

Originality/value

This article provides a novel conceptual framework that can shed new light on the co-creation of wellbeing in service research. Through the introduction of PO the transformation of lives and wellbeing can be better understood.

Patient involvement in surgical wound care research: A scoping review

Active involvement of patients in planning, conducting, and disseminating research has been adopted by many organisations internationally, but the extent to which this occurs in surgical wound care is not evident. This scoping review aimed to identify how patients have been involved in surgical wound care research and the quality of its reporting. Full-text studies focused on preoperative and postoperative surgical wound care in the acute care setting, published in English between 2004 and 2019, were included in the review. Screening, data charting, and quality assessment were conducted by two reviewers independently, adjudicated by a third, and then reviewed by five others. Thematic analysis synthesised the findings. Of the eight included studies, seven explained the methods for patient involvement and five described aims related to patient involvement and commented on patient involvement in the discussion. None met all of the quality assessment criteria. Three themes emerged: involvement in modifying and refining research processes, connecting and balancing expert and patient views, and sharing personal insights. Recommendations to improve patient involvement in surgical wounds research include the following: using framework and tools to inform future research; training researcher and patients in their respective research roles; and ongoing monitoring of patient involvement.

Visioning a hospitality-oriented patient experience (HOPE) framework in health care

Purpose

This paper considers the question: what would happen if healthcare providers, like their counterparts in the hospitality industry, adopted the principles of customer experience management (CEM) in order to facilitate a more holistic and personalized patient experience? It proposes an alternative vision of the patient experience by adding to an emerging hospitality–healthcare literature base, this time focusing upon CEM. A hospitality-oriented patient experience (HOPE) framework is introduced, designed to enhance the patient experience across all the touchpoints of the healthcare journey.

Design/methodology/approach

This is a conceptual paper that draws upon three distinct literatures: hospitality literature; healthcare literature; and CEM literature. It utilizes this literature to develop a framework, the HOPE framework, designed to offer an alternative lens to understanding the patient experience. The paper utilizes descriptions of three unique patient experiences, one linked to chronic pain, a second to gastro issues and a third to orthopedic issues, to illustrate how adopting the principles of hospitality management, within a healthcare context, could promote an enhanced patient experience.

Findings

The main theoretical contribution is the development of the HOPE framework that brings together research on CEM with research on cocreative customer practices in health care. By selecting and connecting key ingredients of two separate research streams, this vision and paradigm provide an alternative lens into ways of addressing the key challenges in the implementation of person-centered care in healthcare services. The HOPE framework offers an actionable roadmap for healthcare organizations to realize greater understanding and to operationalize new ways of improving the patient experience.

Originality/value

This paper applies the principles of hospitality and CEM to the domain of health care. In so doing it adds value to a hospitality literature primarily focused upon extensive employee–customer relationships. To a healthcare literature seeking to more fully understand a person-centered care model typically delivered by a care team consisting of professionals and family/friends. And to a CEM literature in hospitality, which seeks to facilitate favorable employee–customer interactions. Connecting these separate literature streams enables an original conceptual framework, a HOPE framework, to be introduced.

An artificial-intelligence-based method for assessing service quality: insights from the prosthodontics sector

Purpose

The prosthodontics sector is facing major challenges because of scientific and technological advances that imply a clearer definition of lines of action and decision making processes. Measuring quality of service in this sector is a complex decision problem since the perceptions of three main players need to be considered: patients, dentists and dental technicians. This study sought to develop an artificial-intelligence-based (AI-based) method for assessing service quality in the dental prosthesis sector.

Design/methodology/approach

Using strategic options development and analysis (SODA), which is grounded on cognitive mapping, and the measuring attractiveness by a categorical based evaluation technique (MACBETH), a constructivist decision support system was designed to facilitate the assessment of service quality in the dental prosthesis sector. The system was tested, and the results were validated both by the members of an expert panel and by the vice-president of the Portuguese association of dental prosthesis technicians.

Findings

The methodological process developed in this study is extremely versatile and its practical application facilitated the development of an empirically robust evaluation model in this study context. Specifically, the profile analyses carried out in actual clinics allowed the cases in which improvements are needed to be identified.

Originality/value

Although already applied in the fields of AI and decision making, no prior work reporting the use of SODA and MACBETH for assessing service quality in the prosthodontics sector has been found.

Customers' contamination concerns: an integrative framework and future prospects for service management

Purpose

Customers might become concerned about getting contaminated and adapt their behavior accordingly, which is of critical concern for service managers. The purpose of this paper is threefold. First, this paper synthesizes the extant body of research within psychology and marketing into an integrative framework that helps understand the current state of knowledge on contamination. Second, this review summarizes evidence-based managerial recommendations on how to deal with customers' contamination concerns. Third, this paper provides guidance for future research by proposing several ways in which those concerns might influence service management.

Design/methodology/approach

This paper conducts an integrative literature review of over 30 years of psychology and marketing research on contamination concerns.

Findings

The paper reviews physical and metaphysical contagion models, the situational cues that may activate customers' contamination concerns, the psychological mechanisms that underlie the relationship between contamination and customer outcomes and the individual characteristics that influence customer sensitivity to contamination cues. Moreover, this review identifies actions that service managers can take to prevent customers' contamination concerns. Finally, still much has to be learned about how organizations should deal with fear of contamination by the time a next pandemic breaks out.

Originality/value

This paper develops an integrative framework that serves as a structured knowledge map onto the contamination phenomenon and paves the way for future service research.

Engaging customers with employees in service encounters

Purpose

Keeping both employees and customers highly engaged has become a critical issue for service firms, especially for high-contact and highly customized services. Therefore, it is essential to engage employees and customers during service interactions for better service outcomes. However, past research on employee and customer engagement has primarily focused on brands and organizations. Little research has concentrated on service interactions as the objects of engagement. To fill this research gap, this study aims to clarify and define service engagement behaviors (SEBs), identify various employee and customer SEBs and develop a model to investigate the relationships between these behaviors.

Design/methodology/approach

A theoretical framework was developed based on social contagion theory and service-dominant (S-D) logic to explore the effects of employee SEBs on customer SEBs through customer perceptions of relational energy and interaction cohesion. Dyadic survey data collected from 293 customer-employee pairs in various high-contact and highly customized service industries were examined through structural equation modeling.

Findings

Results show that employee SEBs (service role involvement, customer orientation behavior and customer empowerment behavior) positively influence relational energy and interaction cohesion, which in turn affect customer SEBs (service exploration behavior and service coordination behavior).

Originality/value

This study represents pioneering research to conceptualize SEBs. Different from the extant literature on engagement, SEBs capture the proactive and collaborative engagement behaviors of employees and customers in service interactions. Various employee and customer SEBs were identified and an empirical model was proposed and tested to investigate the effect of employee SEBs on customer SEBs through relational energy and interaction cohesion.

Fostering older adult care experiences to maximize well-being outcomes

Purpose

Caring for older adults is an increasingly complex and multi-dimensional global concern. This article provides a comprehensive definition of the older adult care experience and discusses its key components to help practitioners deliver older adult-centered care to maximize well-being outcomes for older adults.

Design/methodology/approach

Based on prior research on service operations, service experience, person-centered care and the unique, evolving needs of older adults regarding their care, this paper develops a conceptual framework in which the older adult care experience is the central construct, and key dimensions of well-being are the outcomes.

Findings

The older adult care experience is shaped by older adults' perceptions and evaluations of the care that they receive. Older adult-centered care has autonomy, dignity, unique needs and social environment as its core dimensions and results in those older adults feel empowered, respected, engaged and connected as part of their experience. The article also discusses how such experience can be evaluated by using quality dimensions from service operations, hospitality and healthcare contexts, and challenges that service firms may face in creating older adult care experience.

Research limitations/implications

Given the changing demographics and unique needs of older adults, it is an imperative for academics and practitioners to have an understanding of what determines older adult care experience to better serve them. Such understanding is important as by creating and fostering older adult care experience, service organizations can contribute to individual and societal well-being.

Originality/value

To the authors' best knowledge, this is the first paper to provide a comprehensive conceptualization of the older adult care experience.

How do clients and (In)formal caregivers experience quality of home care? A qualitative approach

AIM

To explore and understand the views of clients and formal and informal caregivers about the experienced quality of home care for older people.

DESIGN

A descriptive qualitative study was conducted using individual interviews.

METHODS

Six home care clients, four formal and six informal caregivers were recruited from two Dutch home care organizations. Individual, semi-structured interviews took place between April - November 2018. The INDividually EXperienced QUAlity of Long-term care framework was used to guide data collection and content analyses.

RESULTS

The analyses revealed several important attributes contributing to experienced quality of home care such as a preferred small number of caregivers, perceived sufficient time for care provision and a caring atmosphere facilitating open communication and humour. Participants indicated that care routines fitting with the care receiver's former way of living were important. A more 'close' personal care relationship related to trust, openness and empathy was preferred over a more 'detached' professional care relationship.

CONCLUSION

This study identified a wide range of attributes related to experienced quality of care from the perspectives of clients and formal and informal caregivers in home care.

IMPACT

Care providers are being challenged to structurally assess individual experienced quality of home care. This study underlines the importance of incorporating care preferences and experiences throughout the care process from a relationship-centred care approach. Relevant care measures and outcomes should be determined to gain insight and further improve individual care provision.

An update on customer value: state of the art, revised typology, and research agenda

Purpose

The context of marketing and service research is rapidly changing as a result of advances in academic research and business practice. This has implications for our understanding of customer value. The purpose of this paper is to provide an update on customer value given today’s context (including recent advances such as technologies, human contact, collaborative consumption, service ecosystems and transformative service research); to revise Holbrook’s value typology; and to propose a research agenda.

Design/methodology/approach

This paper uses a conceptual approach that is rooted in the service and marketing literature.

Findings

The contribution of this paper is threefold. First, this paper presents an evolved view on customer value which accounts for recent advances in academic research and business practice. Second, this paper updates Holbrook’s value typology by revising existing value types as well as identifying additional value types; and offers guidelines for measuring and modeling customer value. Third, this paper proposes a research agenda to guide and stimulate future value research.

Originality/value

This paper provides an update on customer value, which is one of the most fundamental concepts in service and marketing research. This updated perspective has been approved and applauded by Morris B. Holbrook, one of the founding fathers of value research.

Exploring patient empowerment

Purpose

The purpose of this paper is to develop a research framework for exploring and improving patient empowerment through the analysis of the effects produced by a satisfying physician relationship on patient involvement in the healthcare process.

Design/methodology/approach

The authors begin with a literature review of patient empowerment in healthcare, useful to highlight the importance of relational aspects. Then, the authors tested the hypotheses of the research through the analysis of 450 questionnaires. The results are analyzed through covariance-based structural equation modeling.

Findings

This paper highlights how empowerment is a more complex phenomenon, needing many dimensions to be investigated. The hypotheses were tested, and correlations computed, highlighting a medium-strong positive correlation between physician relationship and patient involvement determining satisfying patient empowerment.

Research limitations/implications

The considerations conducted in the paper are restricted to physician relationship and needs further research aimed to analyze and evaluate the changes in the patient behaviors influenced by empowerment.

Practical implications

The research points offer new insight into patient empowerment and allow the healthcare provider to create new opportunities for promoting patient empowerment through the development of quality relationship for effective patient involvement.

Originality/value

The study developed contributes new insight about patient empowerment in the healthcare management literature, proving the key role of satisfying physician relationship useful for future researches.

Design of a Care Pathway for Preventive Blood Pressure Monitoring: Qualitative Study

Background

Electronic health (eHealth) services could provide a solution for monitoring the blood pressure of at-risk patients while also decreasing expensive doctor visits. However, a major barrier to their implementation is the lack of integration into organizations.

Objective

Our aim was to design a Care Pathway for monitoring the blood pressure of at-risk patients, in order to increase eHealth implementation in secondary preventive care.

Methods

A qualitative design study was used in this research. Data were collected by conducting visual mapping sessions including semistructured interviews with hypertension patients and doctors. The data were transcribed and coded and thereafter mapped into a Care Pathway.

Results

Four themes emerged from the results: (1) the current approach to blood pressure measuring has disadvantages, (2) risk and lifestyle factors of blood pressure measuring need to be considered, (3) there are certain influences of the at-home context on measuring blood pressure, and (4) new touchpoints between patients and health professionals need to be designed. These in-depth insights combined with the visualization of the current blood pressure process resulted in our Care Pathway design for monitoring the blood pressure of at-risk patients as secondary preventive care.

Conclusions

The Care Pathway guides the implementation of eHealth devices for blood pressure self-measurement. It showcases the pathway of at-risk patients and increases their involvement in managing their blood pressure. It serves as a basis for a new service using eHealth.

Service dominant logic and primary care services

Purpose

The purpose of this study is to explore perceptions of successful collaboration by a group of professionals in primary health care, using service-dominant logic (SDL) as a theoretical framework.

Design/methodology/approach

This study carries out secondary analysis of the results from a Norwegian national survey on collaboration amongst professionals in primary health care services.

Findings

Findings illustrate that SDL can provide a theoretical framework for understanding health and social care services. The study provides evidence for the relevance of the theory at micro level. Viewing primary care through the lens of SDL enables an understanding of the applicability of market principles to health and social care. The study illustrates the relevance of the following principles: services are the fundamental basis of exchange; indirect exchange can mask the fundamental basis of exchange. Operant resources are the fundamental source of strategic benefit; actors cannot deliver value but can participate in the creation and offering of value propositions.

Social implications

Awareness of the use of SDL in health care services can be positive for service provision and it could be incorporated as a supplementary perspective in educational programs for health care professionals.

Originality/value

Applying principles from SDL as a theoretical framework for primary care services challenges the conventional understanding of marketing in health services. This paper responds to the need for a more in-depth understanding of how SDL can help health care professionals recognize their role as participants in providing seamless health care at micro level.

Breidbach C, Piening EP, Salge TO. The impact of occupational stereotypes in human-centered service systems

Purpose

The purpose of this paper is to explore the impact that occupational stereotypes held by customers have on value co-creation processes in human-centered service systems (HCSSs) like hospitals. Specifically, by exploring if and how customers’ (i.e. patients’) stereotypes toward frontline employees (e.g. nurses) affect their satisfaction as co-creators of value, this study responds to current service research priorities attempting to understand value co-creation in collaborative contexts like healthcare, and addresses calls to investigate the changing role of health care customers therein.

Design/methodology/approach

A field study was conducted in the context of German hospitals, which provides unique empirical evidence into the relationship between patients’ stereotypes toward healthcare professionals and their satisfaction with health services as well as the mediating mechanisms through which such stereotypes affect patient satisfaction.

Findings

Negative (positive) stereotypes patients hold toward healthcare occupations decrease (increase) their satisfaction and are associated with perceptions of reduced (improved) patient orientation and patient participation in co-creation. However, only perceived patient orientation partially mediates the link between occupational stereotypes and patient satisfaction.

Originality/value

This study develops and tests new hypotheses related to occupational stereotyping in complex HCSSs, and extends previous research on stereotypes in service by exploring the previously unknown mediating mechanisms through which these impact value co-creation processes overall. It furthermore provides important guidance for future research about stereotyping in general, and its impact on value co-creation and HCSS, in particular.

Am I seeing things through the eyes of patients? An exercise in bolstering patient attentiveness and empathy

Background

Modern marketing thought heavily emphasizes the need for healthcare providers to possess a customer orientation, placing patients at the focal point of attention within health and medical establishments. This has motivated significant investments in tools and techniques that foster outstanding service, attention, and support. Such investments in isolation, however, offer no guarantees that a true customer orientation will emerge. Proper implementation also is required—and that falls on the shoulders of health and medical personnel.

Discussion

The most innovative and expensive of customer-oriented tools and techniques mean very little unless they are placed in the hands of capable individuals possessing the ability and desire to serve patients well. But the rigors of industry life complicate matters, resulting occasionally in lost focus, compromising the patient experience. One of the simplest and most effective methods for encouraging patient attentiveness rests with a reflective exercise that encourages staff members to see themselves and their actions from the perspective of patients. Asking the operative question, “Am I seeing things through the eyes of patients?” serves as an effective reminder of priorities, building empathy and motivating personnel to continually deliver their very best.

Conclusions

Viewing one’s actions from the perspective of patients can be very revealing, opening eyes wide and permitting opportunities for any necessary improvements, making for a simple but powerful learning experience. The “Am I seeing things through the eyes of patients?” reflective exercise helps well-intentioned staff members avoid tendencies which can lull them into states of complacency, ensuring that they remain focused on those in their care.

DEDICATE: proposal for a conceptual framework to develop dementia-friendly integrated eCare support

Background

Evidence shows that the implementation of information and communication technologies (ICT) enabled services supporting integrated dementia care represents an opportunity that faces multi-pronged challenges. First, the provision of dementia support is fragmented and often inappropriate. Second, available ICT solutions in this field do not address the full spectrum of support needs arising across an individual’s whole dementia journey. Current solutions fail to harness the potential of available validated e-health services, such as telehealth and telecare, for the purposes of dementia care. Third, there is a lack of understanding of how viable business models in this field can operate. The field comprises both professional and non-professional players that interact and have roles to play in ensuring that useful technologies are developed, implemented and used.

Methods

Starting from a literature review, including relevant pilot projects for ICT-based dementia care, we define the major requirements of a system able to overcome the limitations evidenced in the literature, and how this system should be integrated in the socio-technical ecosystem characterizing this disease. From here, we define the DEDICATE architecture of such a system, and the conceptual framework mapping the architecture over the requirements.

Results

We identified three macro-requirements, namely the need to overcome: deficient technology innovation, deficient service process innovation, and deficient business models innovation. The proposed architecture is a three level architecture in which the center (data layer) includes patients’ and informal caregivers’ preferences, memories, and other personal data relevant to sustain the dementia journey, is connected through a middleware (service layer), which guarantees core IT services and integration, to dedicated applications (application layer) to sustain dementia care (formal support services, FSS), and to existing formal care infrastructures, in order to guarantee care coordination (care coordination services, CCS).

Conclusions

The proposed DEDICATE architecture and framework envisages a feasible means to overcome the present barriers by: (1) developing and integrating technologies that can follow the patient and the caregivers throughout the development of the condition, since the early stages in which the patient is able to build up preferences and memories will be used in the later stages to maximise personalization and thereby improve efficacy and usability (technology innovation); (2) guaranteeing the care coordination between formal and informal caregivers, and giving an active yet supported role to the latter (service innovation); and (3) integrating existing infrastructures and care models to decrease the cost of the overall care pathway, by improving system interoperability (business model innovation).

Customer experience challenges: bringing together digital, physical and social realms

Purpose

The purpose of this paper is to explore innovations in customer experience at the intersection of the digital, physical and social realms. It explicitly considers experiences involving new technology-enabled services, such as digital twins and automated social presence (i.e. virtual assistants and service robots).

Design/methodology/approach

Future customer experiences are conceptualized within a three-dimensional space – low to high digital density, low to high physical complexity and low to high social presence – yielding eight octants.

Findings

The conceptual framework identifies eight “dualities,” or specific challenges connected with integrating digital, physical and social realms that challenge organizations to create superior customer experiences in both business-to-business and business-to-consumer markets. The eight dualities are opposing strategic options that organizations must reconcile when co-creating customer experiences under different conditions.

Research limitations/implications

A review of theory demonstrates that little research has been conducted at the intersection of the digital, physical and social realms. Most studies focus on one realm, with occasional reference to another. This paper suggests an agenda for future research and gives examples of fruitful ways to study connections among the three realms rather than in a single realm.

Practical implications

This paper provides guidance for managers in designing and managing customer experiences that the authors believe will need to be addressed by the year 2050.

Social implications

This paper discusses important societal issues, such as individual and societal needs for privacy, security and transparency. It sets out potential avenues for service innovation in these areas.

Originality/value

The conceptual framework integrates knowledge about customer experiences in digital, physical and social realms in a new way, with insights for future service research, managers and public policy makers.

Service operations: what’s next?

Purpose

The purpose of this paper is to present exciting and innovative research questions in service operations that are aligned with eight key themes and related topics determined by the Journal of Service Management (JOSM) Service Operations Expert Research Panel. By offering a good number of such research questions, this paper provides a broad range of ideas to spur conceptual and empirical research related to service operations and encourage the continued creation of deep knowledge within the field, as well as collaborative research across disciplines that develops and incorporates insights from service operations.

Design/methodology/approach

Based on a Delphi study, described in the companion article, “Service Operations: What Have We Learned?,” the panel identified eight key research themes in service operations where leading-edge research is being done or has yet to be done (Victorino et al., 2018). In this paper, three or four topics within each theme are selected and multiple questions for each topic are proposed to guide research efforts. The topics and questions, while wide-ranging, are only representative of the many ongoing research opportunities related to service operations.

Findings

The field of service operations has many interesting research topics and questions that are largely unexplored. Furthermore, these research areas are not only increasingly integrative across multiple themes within operations but often transcend functional disciplines. This creates opportunities for ever more impactful research with a greater reach throughout the service system and suggests that service researchers, regardless of functional affiliation, can contribute to the ongoing conversation on the role of service operations in value creation.

Originality/value

Leveraging the collective knowledge of the JOSM Service Operations Expert Research Panel to expand on the research themes generated from the Delphi study, novel questions for future study are put forward. Recognizing that the number of potential research questions is virtually unlimited, summary questions by theme and topic are also provided. These questions represent a synopsis of the individual questions and can serve as a quick reference guide for researchers interested in pursuing new directions in conceptual and empirical research in service operations. This summary also serves as a framework to facilitate the formulation of additional research topics and questions.

Evolving roles and structures of triadic engagement in healthcare

Purpose

The purpose of this paper is to focus on the changing nature of healthcare service encounters by studying the phenomenon of triadic engagement incorporating interactions between patients, local and virtual networks and healthcare professionals.

Design/methodology/approach

An 18-month longitudinal ethnographic study documents interactions in naturally occurring healthcare consultations. Professionals (n=13) and patients (n=24) within primary and secondary care units were recruited. Analysis of observations, field notes and interviews provides an integrated picture of triadic engagement.

Findings

Triadic engagement is conceptualised against a two-level framework. First, the structure of triadic consultations is identified in terms of the human voice, virtual voice and networked voice. These are related to: companions’ contributions to discussions and the virtual network impact. Second, evolving roles are mapped to three phases of transformation: enhancement; empowerment; emancipation. Triadic engagement varied across conditions.

Research limitations/implications

These changing roles and structures evidence an increasing emphasis on the responsible consumer and patients/companions to utilise information/support in making health-related decisions. The nature and role of third voices requires clear delineation.

Practical implications

Structures of consultations should be rethought around the diversity of patient/companion behaviours and expectations as patients undertake self-service activities. Implications for policy and practice are: the parallel set of local/virtual informational and service activities; a network orientation to healthcare; tailoring of support resources/guides for professionals and third parties to inform support practices.

Originality/value

Contributions are made to understanding triadic engagement and forwarding the agenda on patient-centred care. Longitudinal illumination of consultations is offered through an exceptional level of access to observe consultations.