| 1. |
- Engström, Jon
(författare)
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Co-creation in Healthcare Service Development : A Diary-based approach
- 2012
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The patient is the only person who experiences the complete course of a healthcare problem, from first symptom to any contacts with the healthcare system to examination, treatment, follow-up activities and rehabilitation. The aim of this thesis is to explore how caregivers, together with patients, can draw on the knowledge patients acquire from their experiences in healthcare service development. This represents a break with the traditional role of the patient, which has been one of a passive receiver of care, following a supplier-centered view on value creation, which has increasingly been challenged both in the healthcare management discourse and in service research. Instead it is argued that value can only be co-created with customers, or patients in the case of healthcare. This means that the patients’ value-creating processes and contexts need to be emphasized and that patients are seen as a possible resource in their own care but also in the development of services and products. Despite this change in discourse, practical methods and empirical studies concerning patient involvement are scarce. This thesis adds to the field through an empirical exploration of co-creation in the development of healthcare. Through an action research approach, researchers and healthcare personnel have collaborated to develop a model for involving patients in service development, by inviting patients to share ideas and experiences through diaries.A workable, three-phase (preparation, execution and learning) model for patient involvement through diaries has been developed, and applied in three clinics (orthopedic, rehabilitation, gastro). A total of 53 patients from the different care processes have contributed ideas and experiences using paper and pen diaries or blogs, or by calling an answering machine. By doing so for a period of 14 days, the patients have submitted a total of 360 ideas.Three ways are proposed for utilizing the rich data submitted by the patients in service development. First, ideas from diaries can be used as input for service development. Second, a larger sample of diaries can be used to create a report of patient experiences, in which problem areas in the care process can be identified, and combined with other statistics. Third, individual patients’ stories can be highlighted and serve as a basis for discussion in the organization to shift the focus to the patient’s experience, serving as a motivator for change within the caregiving organization.The study shows that patients can share ideas and experiences regarding a range of topics, including clinical, organizational, social, informational, and practical issues and attitudes among healthcare staff. The contexts to which these ideas and experiences applied were caregiver, home, extended caregiver, and work, and often concerned topics and aspects of the patient’s care process that are invisible to the caregiver.Although healthcare organizations should be aware of the limitations to participation an illness may imply among some patients, patient co-creation in service development provides several important benefits. Acquiring knowledge regarding the parts of the patient’s care process that are invisible to the caregiver is key to improving care and supporting patients’ work of healing and managing life. Patients’ insights and creativity are an untapped resource for development of many aspects of the healthcare process.
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| 2. |
- Johansson, Elisabeth, 1983-
(författare)
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Managing Quality in a Service Context
- 2013
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In recent years, service organizations have had to increase the number of offerings they provide. These organizations face difficulties in changing their internal processes to provide high-quality offerings. With the increase in demand for delivered services and competitive organizations from low-cost countries, service organizations currently face several issues. Today’s service organizations combine products and services into a solution to improve their competitiveness. These organizations experience changes in customer expectations depending on what they offer. That is, expectations, demands, and wishes change depending on the offering that a customer uses. Thus, service organizations need to know how expectations for quality change based on offerings and how they can work to change certain emphasized quality aspects. Hence, the aim of this licentiate thesis is to contribute to the knowledge of how to manage quality in a service context.This licentiate thesis is based on three different studies. One study is based on a number of self-assessment studies conducted at 138 Swedish service organizations using a total of more than 5,000 respondents. In the second study, data was collected over a five-year period through a literature review, interviews, a document study, and observations to capture the quality profile and associated interventions. The second study was conducted in a service organization in the public transportation industry. In the third study, a literature review was performed to provide theoretical propositions for developing a conceptual model. The conceptual model was built on theories from product quality, service quality, service logic, and solutions.The findings revealed that a service organization could change the performance level of a quality principle if the correct interventions are used. Furthermore, a service organization immature in quality management emphasizes one or two quality principles and, after the initial phase focuses on other principles as well. Therefore, if a service organization wants to change its quality profile pattern, it must change its emphasis on certain norms and principles. A further finding is the proposed solution’s quality concept and its six quality dimensions: (i) reliability, (ii) flexibility, (iii) consistency, (iv) empathy, (v) approachability, and (vi) tangibility. Furthermore, a model connecting the empirical findings in a quality concepts model is proposed. This model shows that the need exists to change work activities if the service organization changes strategic direction, that is, changes the number of offerings offered.
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| 3. |
- Snyder, Hannah
(författare)
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Patient Involvement : A Service Perspective
- 2014
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- For a long time, patients were seen as weak and passive recipients of care, whose only role was to provide information and comply with doctors’ orders. This is beginning to change, and patients are more seen as autonomous, active, and involved collaborators in care, co-creating value with service providers and others. In parallel, the healthcare sector is changing due to an aging population, advances in technology, medical knowhow, and the prevalence of chronic diseases, which all call for a more involved patient. During the last decade, patient involvement in healthcare has been recognized as important to provide more efficient, integrated, patient-focused healthcare. Despite this recent gain in attention, there is a gap between rhetoric’s and practice, since the meaning and benefits of patient involvement are unclear both in theory and practice. This thesis takes an alternate perspective on patient involvement, departing from service theory on value creation and customer involvement. It aims to understand and explore patient involvement and how patients can be involved in both the use, and development, of healthcare services.This thesis is based on three different studies using both qualitative and quantitative research methods. The first study is a systematic literature review of healthcare research, addressing the topic of patient involvement and related concepts. Based on a total of 125 reviewed empirical articles, this study serves as an introduction and orientation to the diverse field. It aims to contribute to the knowledge base in the growing research field of patient involvement. The second study addresses and explores lead-user theory as a method to identify highly innovative patients who can be suitable for involvement in healthcare development. The third study explores how patients, depending on disease, care process and context, can take different roles in healthcare development.The results indicate that patient involvement is not an isolated activity but influences the whole healthcare system. This extends the view of patient involvement from just decision-making and isolated encounters to patients potentially being substantially involved in all aspects of healthcare. This is also important in involvement in use. The patient’s individual experiences, context, and type of illness play an important role in development initiatives. Patients should be selected carefully, for involvement in healthcare development, depending on the goal of the initiative. The type of illness and the patient’s context are key factors to the kind of contributions patients can make. Depending on the type of illness, and if it shows up mostly at home or at the care provider’s, patients develop different contributions.This thesis contributes to understanding patient involvement by taking a service perspective on co-creation and customer involvement. This approach to patient involvement extends the traditional view by proposing that patients should be involved in all stages of healthcare. Understanding how individuals create value and manage their health is important for individuals, healthcare providers, and government. Much of a patient’s value creation takes place outside the patientprovider sphere, and is therefore unknown to the healthcare provider. By actively involving patients in both use and development, healthcare providers can apply a whole-person perceptive.
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| 4. |
- Wiger, Malin
(författare)
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Logistics Management in a Healthcare Context : Methodological development for describing and evaluating a healthcare organisation as a logistics system
- 2013
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis tests whether logistics knowledge, theories and principles can be used to provide potential patient flow efficiency improvements. By emphasizing an ideal logistics system by means of its main features and then using these to evaluate two different healthcare organisations, it is assumed that knowledge regarding patient flows can be obtained and potentials for improvement highlighted. Hence, this licentiate thesis presents a developed method intended for evaluating a healthcare organisation by means of a logistics system’s main features. The purpose rests on the assumption that effective management and real flow-efficient improvements can only be accomplished by viewing logistics as an integrated system.Demographics, increased costs, strong technical and medical developments, new kinds of customer requirements, stressed staff and preventable adverse events are some of the challenges the Swedish healthcare system is currently facing. In addition, there is a constant demand on healthcare to be more cost-effective while fulfilling demands as regards waiting times, quality and availability. Experience from structural changes in other industries gives reason to be positive about the potential for long-term productivity leaps in the healthcare sector. The challenge is to simultaneously find successful application of efficient production and flexible adaptation to changing patients’ demands and requirements. Taking advantage of the logistics expertise that already exists can be a way to meet these challenges. It can be assumed that logistics knowledge applied in healthcare can lead to lower costs, shorter waiting lists, better patient service, shorter treatment times and increased capacity. Nevertheless, flow-oriented design of healthcare delivery systems is novel and positions much currently isolated research on a conceptual level or within single wards (Wiger and Aronsson, 2012).The research is part of a three-year project, "Lean and agile – logistics driven improvement in health and social care”, funded by Vinnvård, a collaboration between the Department of Management and Engineering at Linköping University, Hässleholm Healthcare Organisation and the Medical Management Center at Karolinska Institutet in Stockholm. This thesis is partly a theoretical development of logistics models. This is done in order to create an ideal logistics system’s main features and description aspects to describe a system to be able to evaluate it using these features. The two cases are used to test the adequacy of the developed method and its associated models and to identify potential for improvement towards a more flow-oriented business. Four series of interview sessions were conducted with a total of 23 respondents and 18 interviews and over 500 Excel files were collected from the business system.It is suggested that a healthcare organisation can be evaluated by the developed logistics main features. These features, listed below, together provide a possibility to complement a healthcare organisation’s ability to meet patient requirements by flow-efficiency and demonstrate logistical operational excellence.A logistics system’s purpose is to meet customer requirements by cost-effective delivery service through flow orientation by prioritising the total performanceA logistics system has a flow-oriented structureA logistics system transforms orders into customer services in a flow-oriented processA logistics system can control the transformation of input (demand) to output (customer service) and thus the cost of resourcesA logistics system measures to capture the whole system’s logistics performance, including total logistics costs, lead times and customer serviceA logistics system has a strategy to meet demandA logistics system uses logistics measurements as feedback to regulate its behaviour to reduce differences between actual and desired performanceThe analysis of the two cases confirms the picture of an organisational design driven by medical specialties. This implies a possibility to change perspective to a more holistic view with the patient flow in focus. The fact that there are very few possibilities to control the transformation has partly to do with ownership of patient flows being less well-defined than clearly defined medical responsibilities within each specialty. It also has to do with the inability to distinguish between the uncertainty regarding unique patients on a low level of aggregation and at the higher level where there should be complete and explicit specifications of the end-product requirements and delivery requirements. The lack of demand strategies that support the total logistics performance ultimately leads to both clinics having to use a sacrificing work effort rather than working systematically to be able to meet the demand. At the case hospital, there is a lack of information aggregated from operational level about patient processes that is made available for strategic decision-making. Neither of the two cases measure on the basis of improving patient flow efficiency, especially not the total patient flow costs or the total logistics costs.The major contribution is the analysis based on the logistics system’s main features, which gives a more purposive understanding of what can be done to improve flow efficiency within a healthcare organisation to make healthcare organisations progress in their ability to be more flow-oriented. A further contribution is a more clearly defined field of healthcare logistics research and the stressed importance of the “new” research field of logistics management.
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| 5. |
- Kabel, Daan, 1995-
(författare)
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Exploring customer needs from a digital healthcare service
- 2023
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cost-effectively capturing and understanding customer needs allows a firm to stay synchronized with the market, to stay ahead of competitors, and to enable service innovation. Traditional qualitative market research methods, such as interviews and focus groups are well-known methods for identifying and capturing customer needs but can be costly, tedious, time-consuming, and can require intensive collaboration with customers. As social media platforms become increasingly central in customers' daily lives, they can become valuable sources for identifying and capturing customer needs. The process of using social media content in market research is called netnography. In this thesis, the instrumental case to study customer needs is from a healthcare context.The healthcare system is an interesting illustrative case because it struggles with satisfying customers' needs – due to the difficulty of delivering high-quality services across multiple channels and devices, to secure customers' data, and to offer customized human-centred care. Against this backdrop, the purpose of this thesis is, by taking on a customer-centric view, to contribute to a better understanding of the quality of digital services. To fulfil this purpose, two research questions are formulated and answered. The first research question concerns the differences and outcomes between netnography and focus groups when capturing customers' needs. Formally, it is formulated as: What are the differences and outcomes between netnography and focus groups when capturing customers' needs? The second research question concerns the customer value cocreation activities and qualities necessary in a digital healthcare service to satisfy customers' needs. Formally, it is formulated as: What customer value cocreation activities and qualities satisfy customers' needs in a digital healthcare service? Taking customer-centric views, findings from three papers and empirical data from a survey, netnography, and a focus group project are used to shed light on the theoretical entity of customer needs – which is the unit of analysis.The contextual differences between netnography and focus groups are related to the embedded rules, norms, and space-time conditions. Such conditions pattern the information about the service and customers' needs. The netnography method captures sociohistorical-patterned information about more critical events, and realistic and negative service encounters. When capturing customers' needs, the netnography method captures more dominant, unmet, and actual (real time) needs. The focus group method captures transcultural-patterned information about more positive, memorable, and ordinary service encounters. When capturing customers' needs, the focus group method captures more evenly distributed, met (satisfied), and memorable needs. Most surprisingly, both methodologies capture, almost, the same needs. However, the proportion of needs discussed across the two samples is significantly different. The netnography method did not capture the needs of "system capacity" and "access". The focus groups method did not capture the need of corporate "responsibility".A conceptual model is illustrating four value creating activities and quality bundles necessary to deliver customer-determined benefits. The conceptual model is a synthesis of the customer journey, perceived electronic service quality and value concept – and provides a new, integrative view of customers' perceptions of digital healthcare service. The model gives a comprehensive understanding of what makes service journeys superior and supportive, and how service providers can optimize the customer experiences – which includes perceptions of personal health and well-being. This thesis offers several important conclusions for quality management. Broadly speaking, the thesis raises an awareness of the importance of the continuous variables – rules, norms, and space-time conditions – which pattern research data or information about the service and customers' needs. The conceptual model can guide managers on how to allocate resources – and that is to design high-quality service encounters.
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| 6. |
- Smeds, Magdalena, 1990-
(författare)
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Managing care pathways for patients with complex care needs
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- One of the central challenges for the healthcare system today is how to manage care for patients with complex needs. This patient group is not well-defined but covers patients with serious diseases and comorbidities, or with a limited ability to perform basic daily functions due to physical, mental or psychosocial challenges. This group has a high service and resource utilisation resulting in high costs for the healthcare system and, typically, poor health outcomes. To improve care for these patients, it is necessary to implement strategies to manage the differentiated care needs, the additional support needs, the uncertainty in care delivery, and the coordination needs of the involved providers and the patient.Care pathways are increasingly used internationally to make care more patient-centred and to structure and design care processes for individual patient groups. Important elements in care pathways include structuring care activities, by defining their content and sequence; coordinating between providers and professionals; and involving patients in their care process. In this thesis, care pathways are proposed as the overall strategy for managing care for patients with complex care needs.The purpose of this thesis is thus to contribute with knowledge on how care pathways can be managed for patients with complex care needs. This is achieved by analysing how the practices coordination, standardisation, customisation and personalisation can support management of care pathways and by discussing how these practices influence quality of care. The quality of care dimensions discussed are accessible, timely, equitable, and patient-centred care.The empirical context in this thesis is the Standardised Cancer Care Pathways (CCPs) which were implemented in Sweden from 2015 to 2018. CCPs is the umbrella term for the national initiative to shorten waiting times, decrease regional differences and reduce fragmentation in care processes. CCPs include elements such as diagnosis-specific pathways and guidelines, introduction of CPP coordinators, and mandatory reporting of waiting times. Focus has been on implementing care pathways for 31 cancer diagnoses in all Swedish healthcare regions.Both qualitative and quantitative research methods have been used. A case study was conducted to examine standardised and customised care pathways, and coordination and multidisciplinary work in care pathways. A document study of regional reports on CCPs was analysed to study effects of care pathways on accessibility, timeliness and equitability. Finally, a national survey was conducted to deepen the understanding of the role of coordination, as performed by coordinators, in care pathways.This thesis argues that standardised and customised care pathways should be combined to manage care for patients with complex care needs. The customised pathway in particular benefits patients with serious unspecific symptoms, unknown primary tumour or more complex care needs, while patients with care needs that can be treated independently of the main diagnosis benefit from following a standardised care pathway.Coordinators are an important means to manage coordination, customisation and personalisation in the care pathway. The coordinators’ role is twofold: the first role is to manage care pathways by customising the care pathway and coordinating involved providers; the second role is to support and guide patients through the care pathway. This can be achieved by adapting interpersonal communication with patients through personalisation.This thesis further argues that care pathways have most potential to positively influence accessibility, timeliness, equitability, and patient-centredness. Accessibility has been positively influenced, especially for patients with ambiguous symptoms where symptoms indicating cancer have improved their chances of accessing cancer diagnostics. A negative aspect of prioritising patients who follow CCPs has been the potentially longer waiting times for other patient groups in equal need of urgent care. Notwithstanding, prioritised access to care is perceived to positively influence timeliness for patients following CCPs. Care pathways are perceived to have positively influenced patient-centredness by shifting the focus from what to deliver to how to deliver it.
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