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Evolving roles and structures of triadic engagement in healthcare

Debbie Isobel Keeling (School of Business, Management and Economics, University of Sussex, Brighton, UK)
Angus Laing (Lancaster University Management School, Lancaster University, Lancaster, UK)
Ko De Ruyter (Cass Business School, City, University of London, London, UK)

Journal of Service Management

ISSN: 1757-5818

Article publication date: 27 November 2017

Issue publication date: 19 June 2018




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.


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.


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.


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.



This project from which the data within this paper is derived was funded by the National Institute for Health Research Service Delivery and Organisation programme (Project Number 08/1602/130). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR SDO programme or the Department of Health. The authors are very grateful to, and wish to recognise the contribution of, the research team who were involved in the coordination and collection of this data and also for their contributions to the initial analysis of the data for the funder’s report.


Keeling, D.I., Laing, A. and De Ruyter, K. (2018), "Evolving roles and structures of triadic engagement in healthcare", Journal of Service Management, Vol. 29 No. 3, pp. 352-377.



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Copyright © 2018, Emerald Publishing Limited

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