| 1. |
- Kabel, Daan, 1995-
(author)
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Exploring customer needs from a digital healthcare service
- 2023
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Licentiate thesis (other academic/artistic)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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| 2. |
- Martin, Jason, 1969-
(author)
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Quality Management Competencies-in-use : exploring competence and practice perspectives on quality management work
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Quality management is an established, widespread and well-researched management concept. Yet, surprisingly little research can be found on understanding the potential for action that is required in order to perform quality management work. The field of quality management has a strong emphasis not only on a customer and supplier focus (external), but also on a process focus (internal). This creates a constant challenge in the way in which quality management is conceived and realised. Another challenge is reflected in current research that describes the need for conceptual change in quality management due to extensive ongoing changes in society and the business environment. The nature and pace of technological development, coupled with changes in social behaviour, continuously bring out new customer needs and new ways for customers to interact with the producers of goods and services. This requires adaptive and innovative approaches for organisations, in order to stay competitive and relevant.This thesis uses competence-based and practice-based perspectives to better understand the requirements placed on quality management in meeting these challenges. It investigates what quality management work is and what properties must exist, in terms of competence and practice, in order to make quality management work possible. The purpose of this thesis is, therefore, to explore how the theoretical perspectives of competence and practice can contribute to an increased understanding of what is required to perform quality management work. Three research questions are posed and answered. The first research question concerns the nature of quality management work and how its key factors may be characterised; the second research question deals with competencies of quality management and how these are interrelated with quality management work; the third research question concerns how the interplay between quality management competencies can be understood. The research questions are answered by interpreting the findings of five papers included in the thesis, using a conceptual framework.The results of the thesis suggest two main directions of quality management work: expansive and adaptive quality management work. Expansive work is characterised by explorative practice, radical change to existing processes or the development of new processes, a logic of development, an orientation towards development and innovation, a striving to increase external efficiency and a striving to increase process variation. Adaptive work is characterised by exploitative practice, incremental change to existing processes, a logic of performance, an orientation towards goals and productivity, a striving towards internal efficiency and a striving to decrease process variation. Quality management competencies relate to quality management work in combining role dependency and discretion. Role dependency signifies the potential and capability to assume multiple role-responsibilities. Discretion is the ‘freedom of movement’ for quality practitioners to engage in practices and choose quality management work directions according to task and situation. The interplay between quality management competencies is understood as the combined effects of two competence antecedents: individual and/or collective dispositions to change and learning. This thesis extends research on quality management by increasing our knowledge and understanding of the requirements needed, not only to select and perform existing quality management practices, but also to adopt and engage in practices where emergence is accommodated by ambidexterity.
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| 3. |
- Andersson, Ann-Christine
(author)
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Quality Improvement in Healthcare : Experiences from a Swedish County Council Initiative
- 2013
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Doctoral thesis (other academic/artistic)abstract
- Quality improvement (QI) has become an important issue in healthcare settings. A central question for many healthcare systems is how to manage improvement initiatives adequately. All county councils and regions managing healthcare in Sweden have started to work with QI at an organizational system level, to varied extents. The Kalmar county council improvement initiative constitutes the empirical basis of this thesis. The aim of the thesis is to provide knowledge about different aspects of a county-wide improvement initiative, and a broader understanding of factors and strategies that affect participation, management and outcomes. The overall study design is based on a case study.The first two studies illuminate the practice-based (micro level), bottom-up perspective. Inductively five different areas (categories) were identified. Factors influencing participation in improvement initiatives provided the basis for the next study. The result showed that different staff categories were attracted by different initiatives. The next two studies illuminate the top-down (macro/meso) management perspective. Managers’ views of how patients can participate were investigated and a content analysis of the written answers was made. Four main areas (categories) were identified. A survey study investigated all of the county council managers’ experiences of the whole improvement initiative. Overall the managers thought that the improvement work was worth the effort. To evaluate the Breakthrough Collaborative program, a survey was developed and tested. This survey was used to investigate process and outcome of the BC program. The majority of the respondents were satisfied with their work, but wanted more time for teams to meet and work. To find out if an improvement program can affect outcome and contribute to sustainable changes, interviews were made with project applicants (n=202). Almost half (48%) of the projects were funded, and of those 51% were sustained. Of the rejected (not funded) projects, 28% were accomplished and sustained anyway. The results in this thesis cannot show that the “golden mean” exists, or that a single best way to manage changes and improvements in a healthcare organization has been found, but the way QI initiatives are organized does affect participation and outcomes. The intention, from the management topdown system level, encouraging staff and units and letting practice-based ideas develop at all system levels, can stimulate and facilitate improvement work.
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| 4. |
- Engström, Jon
(author)
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Co-creation in Healthcare Service Development : A Diary-based approach
- 2012
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Licentiate thesis (other academic/artistic)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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| 5. |
- Engström, Jon
(author)
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Patient involvement and service innovation in healthcare
- 2014
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Doctoral thesis (other academic/artistic)abstract
- This thesis adds to a stream of research suggesting that healthcare can be more patient centered and efficient by redefining the role of the patient from a passive receiver to a more active and collaborative participant. This may relate to healthcare provision (Anderson and Funnell, 2005; Berry and Bendapudi, 2007; Bitner and Brown, 2008; McColl-Kennedy et al., 2012; Nordgren, 2008) and innovation (Bate and Robert, 2006; Groene et al., 2009; Longtin et al., 2010). Through research initiative containing four healthcare units and 68 patients, the present thesis combines healthcare research (e.g., Anderson and Funnell, 2005; Nelson et al., 2002) with service research (e.g., Grönroos, 2006; Vargo and Lusch, 2008, 2004) to explore three aspects of patient involvement and service innovation.Firstly, the concept of patient involvement itself is investigated through an extensive literature review of empirical research on patient involvement. A model describing the antecedents, forms and consequences of patient involvement is proposed. What value is, and how patients can co-create value is discussed from the perspectives of healthcare research and service management thought.Secondly, the thesis proposes a diary-based methodology for involving patients in service innovation. My colleagues and I developed the methodology in collaboration with the participating care providers and applied it in practice. We used the experiences we gained from the project and the contributions from the patients to examine the opportunities for user involvement in service innovation. The participants contributed with ideas and insights stemming from their experiences in their contact with healthcare and other resources. We suggest the following three ways of learning from the collected data: As ideas for improvements; through summary reports to illustrate other quantitative data; and as narratives to promote change.Thirdly, the thesis explores patients’ motivations to participate in service innovation, a hitherto unexplored field. Through an analysis of patients’ contributions and interviews with participants we found that there are a number of factors that motivate patients to participate and that participation is perceived as a social- and meaningladen event. Patients derive psychological well-being and support from participation, but disease was sometimes a barrier to participation. This thesis elaborates on how the most motivated users can be involved in service innovation, applying thinking from the lead-user methodology to a healthcare setting.Overall, the thesis explores patient involvement from new perspectives and, by doing so, adds to our collective efforts to improve healthcare.
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| 6. |
- Lindskog, Magnus, 1973-
(author)
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On systems thinking in logistics management - A critical perspective
- 2012
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Doctoral thesis (other academic/artistic)abstract
- Systems thinking. Systems theory. The systems approach. All these concepts have in various guises been claimed as central to logistics management, since its dawning in the mid twentieth century. Such claims are the starting point of this dissertation, the purpose of which is to contribute to an increased understanding of systems thinking in logistics management research, both present and for future advances. The primary unit of analysis in this dissertation is thus logistics management research.The purpose is pursued through a strategy of triangulation of research approaches, via two research objectives:To describe the nature of systems thinking in logistics management research.To explore the merits for logistics management research of an interpretive approach to actors’ systems thinking.The term systems thinking in this dissertation denotes any somewhat ‘organised’ bodies of thought with aspirations to be ‘holistic’ in the sense of aiming for comprehensiveness. This part relates mostly to the systems part of the term. With regard to the other part, systems thinking is also regarded as a term that encompasses thinking about, and in terms of, systems; either that of researchers or that of actors in logistics practices.Systems thinking can sometimes be theorised on in such a way that it seems fair to label it as systems theory. Another term that is also frequently employed is systems approach. This denotes any approach to intervene in and/or conduct research on enterprises, with a holistic ambition. Such approaches can or cannot be informed by systems theory. By approach is meant the fundamental assumptions of the effort, such as ontological and epistemological positions, views on human nature, and methodologies.This dissertation employs an approach informed by a strand of systems theory labelled Critical Systems Thinking (CST). This builds on a pluralist strategy, which entails an awareness of the strengths and weaknesses of all types of systems approaches, and thus strives towards putting them to work under such circumstances in which they are best suited.The first objective is pursued by means of a combined inductive-deductive approach presented mainly through two peer-reviewed, published journal articles. The first is an extensive literature review of academic publications in logistics management; the second is a survey of logistics management academics. Results show that the systems thinking within the discipline most often is not informed by systems theory, and is oriented towards a narrow section of the available systems approaches. This is an approach that builds on an objective world-view (realist ontology), and which seeks knowledge in terms of different kinds of law-like regularities. There are variations to the kinds of knowledge that are sought, in the sense that some search for deeper, underlying generative mechanisms (structuralist epistemology), some seek causal relationships among observable phenomena (positivist epistemology). The common view on human nature is determinist, and methodologies are often quantitative. It is concluded that logistics management employs a functionalist systems approach, which implicitly assumes homogeneity in actors’ systems thinking in mutual contexts (i.e. shared logistics practices).The second objective is pursued by adopting an interpretive systems approach, thus embracing a nominalist ontology and interpretivist epistemology, in order to explore what benefits such a perspective can lend to logistics management. Informed by the pluralist commitment of CST, theoretical constructs and methods grounded in cognitive psychology are employed to study logistics management practitioners’ systems thinking through cognitive mapping. If this reveals heterogeneities in systems thinking among actors of a mutual context, in which a high degree of homogeneity can be expected, the rationale is that the dominant homogeneity assumption is insufficient. The study, presented through an unpublished working paper, concludes that actors’ systems thinking can differ in ways that render the assumptions of the functionalist systems approach inadequate. More thought, debate, and research on an interpretive systems approach within logistics management is called for.With constant expansions in the scope of ambition for logistics management in mind – towards larger enterprise systems in the spirit of supply chain management, towards more goals for enterprises than the traditional financial ones, and towards new application areas (e.g. healthcare) – it is recognised that more and more actors become stakeholders in the practices that logistics management research seeks to incorporate within its domain of normative ambitions. This leads to an expanding scope of voices that ought to be heard in order to legitimise efforts to improve logistics management practices. This in turn motivates that we should seek to accommodate not only interpretive systems approaches, but also emancipatory, in order to ensure normative prescriptions that are legitimate from the perspectives of as many stakeholders as possible, not only from the common a priori efficiency perspectives of functionalist logistics management research.
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| 7. |
- Neubeck, Truls
(author)
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Quality improvement within nonprofit social service providers
- 2016
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Doctoral thesis (other academic/artistic)abstract
- As a relatively new phenomenon in 2009, Swedish nonprofit social service providers proposed quality improvement as a way to reduce mistakes, use resources more effectively and meet the needs and expectations of clients in a better way. Although similar experiences have been studied in health care, the transfer of quality improvement to nonprofit social services gives a possibility for more knowledge on what enables, and constrains, systematic quality improvement in this specific context.This thesis is based on five years of supporting quality improvement in the Swedish nonprofit welfare sector. Specifically, it builds knowledge on which active mechanisms and enabling or constraining structures exist for nonprofit social service quality improvement. By studying quality improvement projects that have been conducted in the development program Forum for Values, critical cases and broad overviews are found valuable. These cases have resulted in four papers on quality improvement in nonprofit social services. The papers include: critical cases from a nursing home for elderly and a daycare for disabled children (Paper I); a critical case from a sheltered housing (Paper II); an overview of performance measurements in 127 quality improvement projects (Paper III); and an analytical model of how improvement policy and practice are bridged by intermediaries (Paper IV). In this thesis, enabled or constrained events and activities related to Deming's system of profound knowledge are identified from the papers and elaborated upon. As a basis for transforming practice into continuous improvement, profound knowledge includes the four knowledge domains: appreciation of a system, theory of knowledge, understanding of variation and psychology of change. From a realist perspective, the identified events are seen as enabled or constrained by mechanisms and underlying regularities, or structures, in the context of nonprofit social services.The emerging mechanisms found in this thesis are: describing and reflecting upon project relations; forming and testing a theory of action; collecting and displaying measurable results over time; and engaging and participating in a development program. The structures that enable these mechanisms are: connecting projects to shared values such as client needs; local ownership of what should be measured; and translating quality improvement into a single practice. Constraining structures identified are: a lack of generalizable scientific knowledge and inappropriate or missing infrastructure for measurements.Reflecting upon the emergent structures of nonprofit social services, the role of political macro structures, reflective practice, competence in statistical methods and areas of expertise becomes important. From this discussion and the findings some hypotheses for future work can be formulated. First, the identified mechanisms and structures form a framework that helps explain why intended actions of quality improvement occur or not. This frameworkcan be part of formulating a program theory of quality improvement in nonprofit social services. With this theory, quality improvement can be evaluated, reflected upon and further developed in future interventions. Second,new quality improvement interventions can be reproduced more regularly by active work with known enablers and constraints from this program theory. This means that long-lasting interventions can be performed and studied in a second generation of improvement efforts. Third, if organizations integrate quality improvement as a part of their everyday practice they also develop context-specific knowledge about their services. This context-specific knowledge can be adopted and further developed through dedicated management and understanding of variation.Thus, if enabling structures are invoked and constraining structures handled, systematic quality improvement could be one way to integrate generalizable scientific knowledge as part of an evidence-creating practice.
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| 8. |
- Olsson, Olle, 1986-
(author)
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Managing variation in hospital patient flows
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Performing healthcare services is a complex practice. With the continuous developments in the medical field, healthcare organisations and professionals have become increasingly specialised, and healthcare services increasingly fragmented. When focusing on how to treat and cure diseases, the organisational and managerial aspects of care delivery can be overlooked. This increases the risk of sub-optimisation, when focusing on single activities, patient flows or healthcare units without considering the impact on the organisation as a whole. With every individual patient also having different combinations of diseases, severity levels and responses to medical interventions, much variation is introduced into patient flows. To address these challenges, the purpose of this thesis is: To explore the impact and management of variation in patient flows within hospitals. This thesis reports the results from three different studies, performed at three different hospitals. The first study analyses the impact of changes in patient inflow, available resources, treatment times and duration of activities on bed occupancy and length of stay. It does so by developing a simulation model of an emergency department (ED) and inpatient ward. The results show that the impact of variation in acute patient flows is smaller for the ED than the inpatient ward, which indicates that EDs might be more adaptable than inpatient wards in handling variation in acute patient flows. Bed occupancy on inpatient wards also seems to be strongly influenced by variation in patient flows. The second study is based on a single case study of the management of variation in acute patient flows at a university hospital. In accordance with the results of the first study, this second study shows that many actions are used to handle high bed occupancy, while few are used to handle ED overcrowding. More actions are also used to improve the situation in clinical departments than in the hospital as a whole, increasing the risk of sub-optimisation. The study highlights the need for top management to support department chiefs in managing variation in patient flows, e.g. by establishing a hospital-wide strategy for handling variation in acute patient flows. In the third study, the combined results from a case study and a quantitative before/after study are used to analyse whether the implementation of standardised cancer care pathways leads to crowding out effects, in terms of longer waiting times for other elective patient groups. The study shows that care pathway implementation is likely to lead to crowding out effects, if these effects are not addressed in the implementation process. Hence, a strategy to handle variation in one patient flow influences the options for handling variation in other patient flows and at the healthcare units as a whole. Crowding out effects were evaluated as most likely for patients from the patient group that is overtaken by the care pathway patients, and least likely for patients from the patient group with the lowest priority, due to a redistribution of waiting times between different patient groups. All in all, the research reported in this thesis demonstrates the need to take a systems perspective when managing variation in patient flows in order to avoid sub-optimisation, which otherwise often follows when focusing on just one part of a system.
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| 9. |
- Rejler, Martin
(author)
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Quality improvement in the care of patients with inflammatory bowel disease
- 2012
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Doctoral thesis (other academic/artistic)abstract
- A range of studies have supported the existence of a gap between what medicine could possibly deliver and what it actually does deliver. This is also true for the delivery of care to patients with inflammatory bowel disease (IBD) and several international stakeholders have called for action. The aim of this thesis was to describe, study and evaluate a quality improvement intervention (QII) in the care for patients with IBD in a population-based setting, with special reference to clinical redesign, performance measurement and patient experience.The patient population on which this thesis is based was recruited from the gastroenterological unit at the Department of Internal Medicine, Highland Hospital, in Eksjö, Sweden. The QII was implemented through iterative improvement cycles in the early years of the 21st century. Data from yearly check-ups of patients including identification, gender, disease duration, medication, four questions about quality of life (QoL) and laboratory results were entered into a local register created as part of the QII. In addition, data on admittances to hospital were retrieved. The interactions between staff and patients as well as the elements of the delivered care were analysed by applying the model of clinical microsystems (CMS) and the Chronic Care Model (CCM). The QII was studied using a retrospective, descriptive analysis with quantitative elements. A multidimensional quality tool, the Clinical Value Compass (CVC), was applied to assess the quality of care. Later, the CVC and the quality model by Donabedian (Df) were merged to create a quality framework for IBD, which was tested on already existing data in the local IBD register. In a study of patients’ experiences of living with IBD, a content analysis was applied to interviews with 20 purposefully sampled patients.The main components of the redesign, described as a “patient- and demand-directed care”, were: - A specialist nurse staffed the outpatient clinic full time and could offer patients who contacted the clinic an acute visit at the outpatient clinic within two days. - Yearly checkups to either the nurse or physician were offered, either as telephone calls or as traditional visits to the clinic. A letter preceded the contact and included a QoL questionnaire and instructions for laboratory testing of haemoglobin (Hb). The QII led to decreasing numbers of hospitalizations compared to national data and better access to care. The prevalence of anaemia in the population was 6% and was correlated to a risk of being admitted to hospital during the year. The analysis of the interviews showed several parallels to the experiences of people who live with other chronic diseases than IBD. Consequences of living with IBD were associated with everyday life and the adaptations needed to restore one’s life. It was always shadowed by the person’s worry that he or she might potentially need a toilet.The main contribution of this thesis is the overall example of how a quality improvement intervention including continuous performance measures and frameworks, as well as the study of patients’ experiences, can be applied in a local population-based setting. The understanding of the interactions between patients, staff and the healthcare system was described and analysed through the application of CMS and the CCM. As a whole, this thesis contributes to the international quest for quality improvement efforts to bridge the quality gap in the delivery of IBD care today.
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| 10. |
- Samuelsson, Peter, 1984-
(author)
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Framing service innovation in healthcare
- 2021
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Doctoral thesis (other academic/artistic)abstract
- Healthcare faces multiple challenges. Besides a raging pandemic have the number of people struggling with mental illness and chronic illnesses increased. Service innovation is a possible way of meeting these problems. However, service innovation is a scattered concept, with many different conceptualizations and schools of thought, all providing vital research aspects. Research has unraveled three elements that form different approaches for service innovation research. Healthcare also offers a complex context for conducting change and service innovation, containing prerequisites challenging previous understanding and conceptualizations of service innovation.To study service innovation in healthcare and to clarify research, this thesis aims to develop a framework for service innovation that relates and differentiates three approaches and their key characteristics and to determine how the prerequisites for healthcare relate to this framework, and finally to study, test, and illustrate the framework in the empirical context. The thesis builds upon three studies and four individual papers. The studies consist of one literature review, providing the conceptual groundwork for constructing the framework, and two empirical studies assessing and further developing the framework. The individual papers uses the empirical studies and depart from the different approaches to service innovation and healthcare prerequisites, providing key insights and clarifying the different approaches' strengths and weaknesses. The proposed framework recognizes the need for multiple service innovation research approaches since no single approach is enough to study the multifaceted service innovation phenomena in healthcare. The individual papers also contribute to the growing literature stream addressing service innovation in healthcare by describing social entrepreneurs' motivation during the service innovation process and explaining some of the effects of different service innovation types.
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